A nurse is preparing to administer medications to a client who states. "I don't want to take those drugs.’ Which of the following actions should the nurse take?

Explain the purpose for the medications.

Tell the client the physician wants him to take the medications.

Ask the client why he is refusing to take the medication.

Document that the client refuses the medication.

Answer and Explanation

The Correct Answer is C

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Correct Answer is A

Explanation

Neuromuscular-blocking agents paralyze the muscles, including the respiratory muscles. Therefore, it is crucial to ensure that the patient maintains a patent airway and is able to breathe eﬀectively. The nurse should monitor the patient's respiratory rate, depth, and eﬀort, as well as assess for signs of airway obstruction, such as stridor or wheezing.

Skin assessment for rash (option b), blood pressure assessment for orthostatic hypotension (option c), and assessment for ﬂuid volume overload (option d) may also be important assessments for the nurse to obtain, but they are not the most critical assessments when a patient is being treated with a neuromuscular-blocking agent.

A. A recent history of diarrhea for 3 days. B. Serum creatinine 0.8 mg/dL. C. Severe allergy to amoxicillin. D. A history of phlebitis following an IV infusion of 0.9% sodium chloride with 10 mEq potassium chloride.

Correct Answer is C

Explanation

Cefoxitin is a cephalosporin antibiotic and can cause allergic reactions in people who are allergic to penicillin or other beta-lactam antibiotics like amoxicillin. Therefore, a severe allergy to amoxicillin is a contraindication for the client to receive cefoxitin, and the nurse should report this finding to the provider immediately.

A recent history of diarrhea for three days is not a contraindication for cefoxitin administration. However, the nurse should monitor the client for signs of diarrhea and report any worsening symptoms to the provider.

A serum creatinine level of 0.8 mg/dL is within the normal range and is not a contraindication for cefoxitin administration.

A history of phlebitis following an IV infusion of 0.9% sodium chloride with 10 mEq potassium chloride is not a contraindication for cefoxitin administration. However, the nurse should assess the client's veins carefully before administering the medication and choose a diﬀerent site or route for administration if necessary.

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A nurse is preparing to administer medications to a client who states. "I don't want to take those drugs.’ Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which assessment Is most important for the nurse to obtain when a patient is being treated with a neuromuscular-blocking agent?

Correct Answer is A

Explanation

A nurse is reviewing the medical record of a client who is to receive the first dose of cefoxitin, a cephalosporin via intermitent IV bolus Which of the following findings should the nurse Identify as a contraindication for the client to receive cefoxitin and report to the provider?

Correct Answer is C

Explanation

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