Patient Data

Exhibits

Review H and P, and nurse’s note. Identify from the choices below which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s progress.

Choice A reason: This statement indicates understanding of naloxone. Naloxone is an opioid antagonist that can reverse the effects of opioid overdose, such as respiratory depression, sedation, and hypotension. Naloxone can be administered by different routes, depending on the availability and urgency of the situation. Intravenous, intramuscular, and subcutaneous routes are all acceptable ways to give naloxone.

Choice B reason: This statement also indicates understanding of naloxone. Naloxone works best on pure agonist opioids, such as morphine, heroin, and fentanyl. These opioids bind to the same receptors as naloxone, but naloxone has a higher affinity and can displace them. Naloxone is less effective on partial agonist or mixed agonist-antagonist opioids, such as buprenorphine and pentazocine. These opioids have lower intrinsic activity or antagonize some receptors, making them less susceptible to naloxone.

Choice C reason: This statement indicates no understanding of naloxone. Naloxone is not a harmless drug that can be given repeatedly without consequences. Naloxone has a short half-life of about 30 to 90 minutes, which means it can wear off before the opioid does. This can cause the patient to relapse into respiratory depression and require repeated doses of naloxone. However, giving too many doses of naloxone can also cause adverse effects, such as agitation, hypertension, tachycardia, pulmonary edema, and seizures. Therefore, naloxone should be given cautiously and titrated to the minimum effective dose to reverse respiratory depression.

Choice D reason: This statement indicates no understanding of naloxone. Naloxone will affect the client's level of pain by blocking the analgesic effects of opioids. This can cause the patient to experience acute pain and distress, especially if they have a chronic pain condition or a surgical wound. Naloxone should not be used to treat opioid-induced sedation or pruritus without respiratory depression, as this will unnecessarily expose the patient to pain and suffering.

Choice E reason: This statement indicates no understanding of naloxone. When given IV, naloxone starts working immediately, but it does not last several hours. As mentioned earlier, naloxone has a short half-life and can be eliminated from the body quickly. The duration of action of naloxone depends on the dose, route, and frequency of administration, as well as the type, dose, and route of the opioid involved. Generally, naloxone lasts for about 30 to 90 minutes when given IV, which may not be enough to counteract the longer-lasting effects of some opioids. Therefore, continuous monitoring and repeated doses of naloxone may be needed until the opioid is cleared from the system.

Choice A reason: Eliminating use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, is an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that stabilizes mood and prevents manic episodes. NSAIDs can increase the blood levels of lithium and cause toxicity, which can manifest as nausea, vomiting, tremors, confusion, or seizures.

Choice B reason: Monitoring blood glucose levels daily is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not affect the blood sugar levels or the risk of diabetes. Blood glucose levels may be important for the general health of the client, but they are not related to lithium therapy.

Choice C reason: Notifying healthcare provider prior to dental procedures is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not interact with local anesthetics or antibiotics that may be used during dental procedures. However, the client should inform the dentist about their medical history and medications, as a precaution.

Choice D reason: Avoiding consuming all foods that contain iodine is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not interfere with the thyroid function or the metabolism of iodine. Iodine is an essential nutrient that is found in many foods, such as seafood, dairy products, eggs, and iodized salt. Avoiding iodine can cause deficiency and lead to goiter or hypothyroidism.