A nurse is assisting with the care of a postoperative client who has developed malignant hyperthermia. Which of the following actions should the nurse take?
Administer meperidine IM.
Instill a warm enema solution.
Apply a cooling blanket.
Ventilate client with 50% oxygen.
The Correct Answer is C
Choice A Reason:
Administer meperidine IM is incorrect. Reason why it's not the answer: Meperidine (Demerol) is not recommended in cases of malignant hyperthermia. It can potentially exacerbate the situation by further increasing muscle rigidity and potentially contributing to the hypermetabolic state. Meperidine can trigger additional release of calcium from the sarcoplasmic reticulum in muscles, worsening the symptoms.
Choice B Reason:
Instill a warm enema solution is incorrect. Reason why it's not the answer: Introducing warm solutions can exacerbate the client's condition by further increasing body temperature. Malignant hyperthermia is characterized by a dangerous increase in body temperature, and adding heat through an enema would only make the situation worse.
Choice C Reason:
Applying a cooling blanket is recommendable. Reason why it's the answer: A cooling blanket is a recommended intervention for managing malignant hyperthermia. Lowering the body temperature is crucial in preventing further complications associated with the high fever. Cooling blankets help dissipate heat from the body, aiding in rapidly reducing the dangerously elevated temperature associated with malignant hyperthermia.
Choice D Reason:
Ventilate client with 50% oxygen is incorrect. Reason why it's not the answer: While providing oxygen support might be necessary as part of managing the overall condition, ventilating with 50% oxygen specifically may not directly address the core issue of rapidly cooling the body during a malignant hyperthermia crisis. Ventilation may be required, but the immediate concern is to cool the body to prevent complications arising from the elevated body temperature.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Requesting a dosage increase if the apical heart rate is less than 60/min is not necessary. Propranolol is used to lower heart rate in conditions like atrial fibrillation, so a heart rate below 60/min might be the desired effect of the medication.
Choice B Reason:
Withholding the medication if the systolic blood pressure is less than 90 mm Hg is necessary. Propranolol is a beta-blocker that can lower blood pressure. If the systolic blood pressure drops below 90 mm Hg, withholding the medication is necessary to prevent further lowering of blood pressure, which could lead to adverse effects like dizziness, fainting, or inadequate blood perfusion to vital organs.
Choice C Reason:
Administering the medication with an antacid might interfere with the absorption of propranolol, so they shouldn't be taken together unless instructed by the healthcare provider.
Choice D Reason:
Expecting increased hair growth is not an anticipated effect of propranolol. Hair growth is not a usual side effect associated with this medication.
Correct Answer is D
Explanation
Choice A Reason:
Placing white tape on the edges of stairs is not appropriate. While highlighting the edges of stairs can help improve visibility, white tape might not provide sufficient contrast or durability. Instead, using non-slip strips or adding handrails to stairs would be more effective for preventing falls.
Choice B Reason:
Placing area rugs on wooden floors is not appropriate. Area rugs on wooden floors can pose a tripping hazard, especially for older adults who might have mobility issues. They can easily slip or trip on loose rugs. Securing rugs with non-slip backing or removing them entirely is a better safety measure.
Choice C Reason:
Running wires and cords under carpeting is not appropriate. Running wires and cords under carpeting can create tripping hazards and increase the risk of electrical issues, including potential overheating and fire hazards. It's safer to secure cords along walls or use cord covers to prevent tripping and reduce potential electrical hazards
Choice D Reason:
Having the furnace inspected every 2 years is appropriate. Regular maintenance and inspection of heating systems, such as furnaces, are essential for ensuring their safe and efficient operation. This action reduces the risk of malfunctions or potential hazards like carbon monoxide leaks, which is particularly crucial for older adults who might be more susceptible to the effects of such issues.
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