A nurse is caring for a client who is 12 hr postoperative following abdominal surgery and has received hydromorphone for pain. The nurse notes that the client's respiratory rate is 10/min. Which of the following prescribed medications should the nurse anticipate administering to the client?

Prednisone

Naloxone

Epinephrine

Flumazenil

Answer and Explanation

The Correct Answer is B

Hydromorphone is a potent opioid analgesic that provides relief through the stimulation of mu-opioid receptors in the central nervous system. A dangerous side effect is respiratory depression, where the drug decreases the responsiveness of brainstem respiratory centers to carbon dioxide levels.

Rationale:

A. Prednisone is a corticosteroid used for its anti-inflammatory and immunosuppressive properties. It has no pharmacological ability to reverse the central nervous system depression caused by opioid agonists like hydromorphone. Administering prednisone to a client with a depressed respiratory rate would provide no benefit in managing the immediate risk of respiratory failure or apnea.

B. Naloxone is an opioid antagonist that competitively binds to mu-opioid receptors, rapidly displacing opioid molecules like hydromorphone. It is the gold standard for reversing opioid-induced respiratory depression, restoring a normal breathing rate and level of consciousness within minutes. The nurse must monitor the client closely after administration, as the half-life of naloxone is shorter than hydromorphone.

C. Epinephrine is a catecholamine used in the treatment of anaphylaxis, cardiac arrest, and severe hypotension. While it can stimulate the cardiovascular system, it is not a reversal agent for opioid toxicity. Using epinephrine for a depressed respiratory rate would not address the underlying receptor-level blockade causing the decreased ventilation and could cause unnecessary cardiac strain.

D. Flumazenil is a benzodiazepine antagonist used specifically to reverse the effects of drugs like diazepam or midazolam. It does not bind to opioid receptors and therefore cannot reverse the respiratory depression caused by hydromorphone. The nurse must correctly identify the offending drug class to ensure the proper antagonist is selected for emergency intervention.

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Correct Answer is ["0.75"]

Explanation

Step 1 is to identify the ordered dose and the available dosage strength

Ordered Dose: 60 mg

Available Strength: 80 mg / 1 mL

Step 2 is to calculate the number of milliliters to administer

Volume to administer = (Ordered Dose ÷ Available Dose) × Available Volume

Volume to administer = (60 ÷ 80) × 1

60 ÷ 80 = 0.75

0.75 × 1 = 0.75

Volume to administer = 0.75 mL

Step 3 is to round to the nearest hundredth

0.75 = 0.75

Answer: 0.75 mL

A. Date, time, digoxin 0.25 PO QD, VO, provider, nurse B. Date, time, digoxin 0.25 mg by mouth daily, VO, provider, nurse C. Date, time, digoxin .25 mg by mouth daily, provider, nurse D. Date, time, digoxin .25 mg PO daily, VO, provider, nurse

Correct Answer is B

Explanation

Safe medical documentation requires the use of standardized terminologyand the avoidance of dangerous abbreviations to prevent medication errors. The Joint Commission maintains a "Do Not Use" list, which prohibits notations that are easily misinterpreted, such as trailing zeros or missing leading zeros.

Rationale:

A.This entry is incorrect because it uses the abbreviation "QD" for daily, which is on the prohibited list as it can be mistaken for "QID" (four times daily). Additionally, it fails to include the unit of measurement "mg" after the dosage, which is a critical safety component. Standardized documentation requires writing out the word "daily" and including full units to ensure there is no ambiguity in the medical record.

B.This is the correct entry because it follows all safety protocols, including the use of a leading zero (0.25 mg) and writing out "daily" and "by mouth." It also correctly documents that it was a verbal order (VO) and identifies both the prescribing provider and the receiving nurse. This level of detail ensures the order is legally sound and minimizes the risk of a ten-fold dosing error or route confusion.

C.This entry is unsafe because it lacks a leading zero (.25 mg), which could result in the patient receiving 25 mg instead of 0.25 mg if the decimal point is missed. Such a massive overdose of digoxin would likely be fatal due to its narrow therapeutic index and cardiac toxicity. Furthermore, it fails to document that the order was a verbal order, which is necessary for legal and clinical accountability.

D.Similar to choice C, this entry is incorrect due to the omission of the leading zero before the decimal point (.25 mg). While it correctly uses "VO" and "daily," the lack of a leading zero is a high-risk charting error that directly violates patient safety standards. Proper notation must always place a zero before a decimal to highlight the fractional nature of the dose to all clinical staff.

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A nurse is caring for a client who is 12 hr postoperative following abdominal surgery and has received hydromorphone for pain. The nurse notes that the client's respiratory rate is 10/min. Which of the following prescribed medications should the nurse anticipate administering to the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer methylprednisolone 60 mg IM to a client. Available is methylprednisolone 80 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest hundredth. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["0.75"]

Explanation

A nurse receives a verbal order for a client for digoxin. Which of the following entries should the nurse document in the client's medical record?

Correct Answer is B

Explanation

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