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 D
Explanation
A. Returning the excess medication to the secure cabinet is not appropriate as it can lead to contamination and safety issues.
B. Saving the excess medication for the next administration is not safe practice due to potential contamination.
C. Placing the excess medication in the sharps container is not the correct procedure for disposing of controlled substances.
D. Having a second nurse witness the disposal of the excess medication ensures proper documentation and accountability for controlled substances.
Correct Answer is ["C","D","E"]
Explanation
A. Increasing the intake of high-fiber foods, not low-fiber ones, as fiber helps to soften stools and promote bowel movements.
B. Drinking warm or hot liquids can stimulate bowel movements, so they should not be avoided.
C. Including probiotic foods in the diet can help maintain a healthy gut flora, which is beneficial for digestion and preventing constipation.
D. It is crucial to increase fluid intake, aiming for at least 1500 mL daily, to help soften the stool and support regular bowel movements.
E. Increasing daily exercise, especially walking, can stimulate the muscles involved in the digestive process and help prevent constipation.
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