A nurse is preparing to administer a large dose of prescribed opioid analgesic and light sedation for a dressing change for a client with significant burn injuries. The nurse is aware that which of the following is part of preparing for the opioid analgesic and sedative administration?
Evaluating the patient's level of pain after medication administration
Ensuring a bag valve mask (BVM) is at the bedside.
Verification of allergies to medications.
Documenting the level of pain before medication administration
The Correct Answer is B
A. Evaluating the patient's level of pain after medication administration: This is important but comes after the medication is given.
B. Ensuring a bag valve mask (BVM) is at the bedside: Opioids and sedatives depress respiratory drive. Emergency resuscitation equipment (like a BVM) must be ready in case of respiratory compromise.
C. Verification of allergies to medications: Important, but verifying allergies should already be done before administering any meds; not the priority here.
D. Documenting the level of pain before medication administration: Also important, but secondary to safety preparation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Sodium level: Serum sodium levels can vary and are not a direct measure of fluid retention.
B. Tissue edema: Edema is subjective and can be influenced by other conditions.
C. Urinary output: Many CKD patients have limited or no urine output despite fluid retention.
D. Daily weight: Daily weights are the most reliable non-invasive measure for fluid status.
Correct Answer is B
Explanation
A. pH 7.49, HCO₃ 24, PaCO₂ 30: Indicates respiratory alkalosis. Not consistent with AKI, which typically causes metabolic acidosis.
B. pH 7.26, HCO₃ 14, PaCO₂ 30: Reflects metabolic acidosis, expected in AKI due to accumulation of acidic waste (low pH, low bicarb), and partial respiratory compensation (low PaCO₂).
C. pH 7.49, HCO₃ 30, PaCO₂ 40: Reflects metabolic alkalosis; not expected in AKI.
D. pH 7.26, HCO₃ 24, PaCO₂ 46: Reflects respiratory acidosis (low pH, elevated CO₂), but bicarb is normal, which does not align with AKI-induced acidosis.
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