A patient is receiving an opiate-based medication to help mange pain. Which assessment has the highest priority when monitoring his condition?
temperature
pulse
blood pressure
respirations
The Correct Answer is D
A. Temperature monitoring is important but not a top priority when a patient is receiving opiates unless there is suspicion of infection.
B. Pulse monitoring is also important but does not immediately indicate issues with opiate use.
C. Blood pressure is influenced by opiate use, but the primary concern is respiratory function due to the risk of respiratory depression.
D. Respirations should be closely monitored because opiates can significantly depress the respiratory system, leading to hypoventilation or respiratory arrest, which is the most critical risk.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The newborn’s head is a major source of heat loss due to the large surface area and insufficient
insulation. Covering the head helps maintain body temperature.
B. While the head can be reshaped, the primary reason for covering it is to prevent heat loss, not reshaping.
C. The head is not necessarily wet and doesn't require drying in all cases, making this less relevant.
D. Although the head has large fontanels, this is not the reason it is covered with a cap; preventing heat loss is the priority.
Correct Answer is C
Explanation
A. While pupil response can be an indicator of consciousness, the primary concern when assessing pupils is to check for signs of increased intracranial pressure, such as unequal pupil size.
B. The shape of the pupil is important to assess, but the concern here is typically more about the size and response to light, which can indicate a neurological issue.
C. Unequal pupil sizes (anisocoria) can indicate neurological problems, such as increased intracranial pressure or brain injury, and requires further evaluation.
D. Pupil size changes could indicate a variety of issues, but the focus should be on detecting unequal pupils, which can be a critical sign in head injury patients.
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