A nurse is assisting with the care of a client who last used heroin 8 hr ago. Which of the following findings should the nurse identify as a manifestation of opioid withdrawal?

Tachycardia

Miosis

Hypotension

Sedation

Answer and Explanation

The Correct Answer is A

A. Tachycardia: Tachycardia, or an increased heart rate, is a common manifestation of opioid withdrawal. Withdrawal stimulates the sympathetic nervous system, leading to symptoms like tachycardia, sweating, anxiety, and restlessness.

B. Miosis: Miosis, or pinpoint pupils, is associated with opioid intoxication, not withdrawal. During withdrawal, pupils are often dilated (mydriasis) rather than constricted.

C. Hypotension: Hypertension, not hypotension, is more commonly seen during opioid withdrawal due to increased sympathetic nervous system activity. Blood pressure tends to rise rather than fall during withdrawal episodes.

D. Sedation: Sedation is a sign of opioid intoxication rather than withdrawal. Clients experiencing withdrawal are more likely to display agitation, irritability, and insomnia rather than drowsiness or sedation.

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Correct Answer is A

Explanation

A. Drink high-protein nutritional supplements between meals: Clients with COPD often experience anorexia due to fatigue, difficulty breathing while eating, and early satiety. High-protein, high-calorie supplements between meals help meet nutritional needs without overwhelming them during main meals, supporting energy levels and respiratory muscle strength.

B. Eat more hot foods than cold foods at mealtime: Hot foods can produce stronger odors that may worsen appetite loss. Cold foods tend to have milder smells and may be better tolerated by clients with anorexia, making cold foods preferable rather than focusing on hot foods.

C. Eat low-calorie foods first at mealtime: Clients with anorexia and COPD should prioritize high-calorie, nutrient-dense foods first to maximize intake before feeling full. Eating low-calorie foods first could reduce overall calorie intake, worsening weight loss and malnutrition risks.

D. Increase liquids during meals: Consuming large amounts of liquid during meals can cause early satiety, making it harder for clients to consume enough food. It is better to encourage drinking fluids between meals to optimize food intake during eating times.

A. Inject 15 units of air into the regular insulin vial B. Withdraw 10 units of NPH insulin C. Verify the dosage with another nurse D. Place the cap over the needle.

Correct Answer is A

Explanation

A. Inject 15 units of air into the regular insulin vial: After injecting air into the NPH vial without drawing up the medication, the next step is to inject air into the regular insulin vial. This maintains the correct order and prevents contamination of the regular insulin with the cloudy NPH insulin.

B. Withdraw 10 units of NPH insulin: NPH insulin should not be withdrawn first because it is cloudy and could contaminate the regular insulin if mixed incorrectly. Regular insulin, which is clear, should always be drawn up before NPH when mixing in the same syringe.

C. Verify the dosage with another nurse: Verifying insulin doses with another nurse is necessary but is typically done after the insulin is prepared and drawn up. At this stage, the immediate step is to complete proper air injection into both vials before drawing any insulin.

D. Place the cap over the needle: Recapping needles increases the risk of accidental needlestick injuries and should be avoided unless absolutely necessary. There is no need to recap at this stage in the insulin preparation process.

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A nurse is assisting with the care of a client who last used heroin 8 hr ago. Which of the following findings should the nurse identify as a manifestation of opioid withdrawal?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching about anorexia with a client who has COPD. Which of the following instructions should the nurse include in the teaching?

Correct Answer is A

Explanation

A nurse is caring for a client who has a prescription for NPH insulin 10 units and regular insulin 15 units subcutaneously. After injecting 10 units of air into the NPH insulin vial, which of the following actions should the nurse take next?

Correct Answer is A

Explanation

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