A nurse is caring for a client.
Exhibits
The nurse reviews the medication administration record following the 0815 assessment findings. Which of the following administered medications would require an incident report?
Propranolol
Pantoprazole
Lovastatin
Morphine
The Correct Answer is A
A. Propranolol is a beta-blocker used to control blood pressure and heart rate. However, the nurse has a hold order for propranolol if the apical pulse (heart rate) is less than 50 beats per minute. The nurse documented a heart rate of 42 bpm at 0815, which falls below the hold parameter for propranolol. Administering propranolol in this case could worsen the client's bradycardia (slow heart rate) and therefore requires an incident report.
B. Pantoprazole is a proton pump inhibitor and doesn't have a direct impact on heart rate within the usual therapeutic range.
C. Lovastatin is a cholesterol medication and wouldn't cause a significant drop in heart rate at this dosage.
D. While morphine can slow the heart rate, it's typically used for pain management and may be necessary for the client's comfort. However, the nurse should monitor the respiratory rate closely due to potential respiratory depression.
E. Cefuroxime is an antibiotic and wouldn't significantly affect heart rate.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Gentamicin administered over 1 hour is an appropriate method for this medication.
B. Injecting Demerol IM into the vastus lateralis is an acceptable site for adults.
C. Crushing bupropion XL (extended-release) tablets is contraindicated as it alters the drug's release mechanism, which can lead to a risk of overdose or ineffective treatment, requiring an incident report.
D. Using a 25-gauge ⅝ inch needle for heparin injection is an appropriate technique.
Correct Answer is B
Explanation
A. The T wave in the inverted position can indicate ischemia or electrolyte imbalances but does not define normal sinus rhythm.
B. The P wave falling before the QRS complex is characteristic of normal sinus rhythm.
C. A QRS duration of 0.20 seconds is within the normal range and does not specifically define normal sinus rhythm.
D. The P-R interval typically ranges from 0.12 to 0.20 seconds, and a slightly prolonged interval here wouldn't necessarily exclude normal sinus rhythm.
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