A nurse is teaching a client's partner how to administer an optic medication to the client. Which of the following statements by the client's partner indicates an understanding of the teaching?
"I will have my partner tilt their head back while I am instilling the drops."
"I will make sure the solution is cool prior to instilling the drops."
"I will pull the pinna upward and outward prior to instilling the drops."
"I will have my partner lie down on their back while I am instilling the drops."
The Correct Answer is C
Choice A Reason:
"I will have my partner tilt their head back while I am instilling the drops." Is incorrect. Tilting the head back is not typically recommended for administering optic medication as it might cause the medication to flow out instead of remaining in the ear canal.
Choice B Reason:
"I will make sure the solution is cool prior to instilling the drops." Is incorrect. The temperature of the solution usually doesn't need to be adjusted before instilling optic drops unless directed otherwise by specific medication instructions or healthcare provider guidance.
Choice C Reason:
"I will pull the pinna upward and outward prior to instilling the drops." Is correct statement. Pulling the pinna (outer ear) upward and outward helps straighten the ear canal in adults, facilitating the proper administration of optic (ear) drops. This action helps ensure that the medication reaches the ear canal effectively.
Choice D Reason:
"I will have my partner lie down on their back while I am instilling the drops." Is incorrect statement.
Having the partner lie down on their back might not be necessary for administering optic medication and might not be the optimal position for effective instillation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
Ondansetron is incorrect. Ondansetron is an anti-nausea medication commonly used in cancer patients to manage nausea and vomiting, often caused by chemotherapy. It's not typically contraindicated or known to interact significantly with morphine administered via a PCA pump. This combination is often used to manage both pain and associated symptoms in cancer patients.
Choice B Reason:
Acetaminophen is incorrect. Acetaminophen is a pain reliever and fever reducer that doesn't typically interact significantly with morphine administered via a PCA pump. It's often used concurrently with other pain medications to manage discomfort in cancer patients. There isn't a known significant interaction between acetaminophen and morphine when used appropriately.
Choice C Reason:
Nalbuphine is correct. Nalbuphine is an opioid analgesic, similar to morphine, and administering it concurrently with morphine could potentially lead to opioid overdose or increased risk of opioid-related side effects such as respiratory depression. Thus, it's crucial to clarify with the provider whether there might be a potential interaction or if both medications are indeed necessary in this specific clinical scenario.
Choice D Reason:
Insulin glargine is incorrect. Insulin glargine is a long-acting insulin used to manage blood sugar levels in individuals with diabetes. While its interaction with morphine isn't typically a concern, it's essential to monitor blood sugar levels closely in individuals receiving opioids like morphine, as opioids can affect glucose metabolism and may necessitate adjustments in insulin dosage.
Correct Answer is B
Explanation
Choice A Reason:
Extravasation is incorrect. This occurs when the intravenous fluid leaks into the surrounding tissue rather than remaining within the vein. It may cause swelling, pain, and potential tissue damage due to the infused solution's irritant effects.
Choice B Reason:
Phlebitis is correct. Phlebitis refers to the inflammation of a vein often characterized by redness, warmth, swelling, and tenderness along the course of the vein. It can occur due to various reasons, including irritation from the IV catheter, chemical irritation from the infused solution, or infection.
Choice C Reason:
Infiltration is incorrect. Infiltration refers to the inadvertent leakage of the infused fluid into the surrounding tissues. It may cause swelling and discomfort but doesn't typically present with redness and inflammation along the vein.
Choice D Reason:
Venous spasm is incorrect. Venous spasm involves the involuntary contraction of the vein, which can occur in response to irritation or trauma. It may cause temporary difficulty in IV access but does not usually present with redness and inflammation along the vein as the primary signs.
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