A nurse is caring for a client who has respiratory depression from an opioid administration.
After administering naloxone to the client, which of the following findings should the nurse expect?
Increased pain.
Somnolence.
Hyperglycemia.
Hypoventilation.
The Correct Answer is A
The correct answer is A. Increased pain.
Choice A reason: Naloxone is an opioid antagonist that, when administered, reverses the effects of opioids. Since opioids provide analgesia, their reversal will lead to the return of pain sensation. The normal pain response varies widely among individuals and depends on the type and amount of opioid the patient received, as well as their pain threshold and tolerance.
Choice B reason: Somnolence, or drowsiness, is a common effect of opioid administration. Naloxone works by displacing opioids from their receptors, which should counteract the sedative effects of opioids and reduce somnolence. Therefore, after naloxone administration, the nurse should not expect somnolence as a finding.
Choice C reason: Hyperglycemia, or high blood sugar, is not a direct effect of naloxone administration. While some studies suggest that naloxone may affect blood glucose levels under certain conditions, such as in the case of tramadol overdose, it does not typically cause hyperglycemia. Normal blood glucose levels range from 70 to 99 mg/dL fasting, and up to 140 mg/dL two hours after eating.
Choice D reason: Hypoventilation, or reduced breathing rate and depth, is caused by opioid administration. Naloxone’s role is to reverse this effect, restoring normal breathing rates. The normal respiratory rate for a healthy adult at rest is 12 to 20 breaths per minute.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Baked potato chips are a healthier alternative to regular potato chips because they contain less fat due to the baking process. However, they are still a processed snack and might not be the healthiest option, especially for a school-age group. The high sodium content in many baked chips is also a concern for cardiovascular health.
Choice B rationale:
A milkshake made with whole milk might provide essential nutrients like calcium and protein, but it is also high in calories and can be loaded with sugar, especially if additional sugars or syrups are added. Consuming sugary beverages in excess can contribute to weight gain and dental issues.
Choice C rationale:
"Air-popped popcorn." This is the correct answer. Air-popped popcorn is a healthy whole-grain snack option. It is low in calories, high in fiber, and can be a good source of antioxidants. It is important to note that while air-popped popcorn is healthy, adding excessive butter, salt, or sugar can diminish its nutritional value.
Choice D rationale:
Cheesecake is a rich, high-calorie dessert that is not considered a healthy snack option. It is high in saturated fats, sugars, and calories, making it an occasional treat rather than a suitable healthy snack choice for school-age children.
Correct Answer is A
Explanation
Choice A rationale:
This action requires intervention by the nurse. Antiembolic stockings should be smooth and free of creases to ensure even pressure distribution along the legs. Creases, especially if on the front of the legs, can lead to areas of increased pressure, which might compromise circulation and increase the risk of skin breakdown or clot formation.
Choice B rationale:
Applying the stockings before the client gets out of bed is appropriate, as it ensures proper application and minimizes the risk of injury due to the client's leg swelling
Choice C rationale:
Asking the client to point their toes before applying the stockings is appropriate, as it helps with correct placement and reduces the risk of skin damage or discomfort
Choice D rationale:
Turning the stockings inside out (at least down to the heel) before applying them is a common technique to make it easier to position the stocking on the foot and leg properly. This method helps avoid excessive stretching of the stocking and ensures a better fit.
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