An order is written for phenytoin 500 mg IM q3-4h prn for pain. The nurse recognizes that treatment of pain is not a standard therapeutic indication for this drug. The nurse believes that the health care provider meant to write hydromorphone. What should the nurse do?
Administer the medication and monitor the patient frequently.
Refuse to give the medication and notify the nurse supervisor.
Give the patient hydromorphone, as it was meant to be written.
Call the health care provider to clarify the order.
The Correct Answer is D
A: Administering the medication and monitoring the patient frequently is not appropriate because phenytoin is not indicated for pain management.
B: Refusing to give the medication and notifying the nurse supervisor is a step in the right direction, but the nurse should also seek clarification from the health care provider.
C: Giving the patient hydromorphone without clarification is not appropriate. The nurse must verify the order with the health care provider.
D: Calling the health care provider to clarify the order is the correct action. This ensures that the correct medication is administered as intended.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A: Checking the display on the PCA pump is the first action the nurse should take. This ensures that the pump is functioning correctly and delivering the prescribed dose of medication. It helps identify any technical issues that may be affecting pain control.
B: Obtaining an order for another pain medication for breakthrough pain is important if the current regimen is insufficient. However, this should follow the initial assessment of the PCA pump’s functionality.
C: Administering a bolus of medication may be necessary if the client is experiencing severe pain, but it should be done after confirming that the PCA pump is working correctly.
D: Encouraging the client to administer a demand dose is appropriate if the PCA pump is functioning correctly. However, the nurse should first verify that the pump is delivering the medication as prescribed.
Correct Answer is D
Explanation
A: Wearing earphones is not part of the Rinne test. Earphones are used in other types of hearing tests, such as audiometry.
B: A small probe is not used in the Rinne test. Probes are used in other diagnostic procedures, such as tympanometry.
C: Small electrodes are not used in the Rinne test. Electrodes are used in tests like electroencephalography (EEG).
D: A tuning fork is placed on the mastoid bone behind the ear and then near the ear canal during the Rinne test. This test compares air conduction to bone conduction of sound.
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