The client is a 49-year-old who reports flu-like symptoms including fever and chest congestion for 4 days. He came to the emergency department (ED last night when he was having more difficulty breathing. He has a history of one-half pack a day cigarette smoking for 20 years. He has no significant medical or surgical history

The client has an oxygen saturation of 96% on 8 L simple face mask. The nurse assesses the client, and he is feeling less restless and anxious. His heart rate is now 79 bpm, blood pressure 119/73 mmHg, and respiratory rate 24.

What are the 3 most important goals that would help the nurse evaluate the treatment of this client at discharge?

The client will report pain less than 3/10

The client will have quit smoking

The client will remain free of skin breakdown

The client will maintain oxygen saturation of 96% without supplemental oxygen

The client will be afebrile for 24 hours

Answer and Explanation

Correct Answer : B,D,E

A. While managing pain is important, the client did not report significant pain, making it a lower priority in this scenario.
B. Quitting smoking is crucial for the client's respiratory health, especially given the history of smoking and current respiratory symptoms.
C. There is no indication that the client is at risk of skin breakdown; thus, it is not a priority in the immediate discharge plan.
D. Maintaining an oxygen saturation of 96% without supplemental oxygen is a direct indicator of improved respiratory function and a key goal for discharge.
E. Being afebrile for 24 hours would indicate that the infection is under control, which is a primary concern for discharge after presenting with flu-like symptoms.

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Correct Answer is ["B","C"]

Explanation

A. Ibuprofen: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID commonly used for
pain relief and inflammation. However, it may not be suitable for this patient due to the potential risk of bleeding and interference with wound healing after surgery.
B. Docusate sodium: Docusate sodium is a stool softener commonly prescribed with opioids to prevent constipation, a common side effect of opioid use. It helps to prevent or alleviate opioid- induced constipation.
C. Naloxone: Naloxone is an opioid antagonist used to reverse the effects of opioid overdose. It is typically prescribed alongside opioids as a precautionary measure to counteract the respiratory
depression and sedation that can occur with opioid use. Administering naloxone can rapidly reverse these effects and restore normal breathing if opioid overdose is suspected.

D. Propofol: Propofol is a sedative-hypnotic medication used for anesthesia induction and
maintenance during surgical procedures. It is not typically prescribed for pain management after surgery.
E. Methadone: Methadone is an opioid agonist often used for managing chronic pain and opioid dependence. While it is an option for pain management, it may not be the first choice for acute post-operative pain relief.
F. SennA Senna is a stimulant laxative used to treat constipation. While constipation is a concern with opioid use, docusate sodium is more commonly prescribed initially for its stool softening effects

A. Instruct the client to increase his intake of oral fluids until the skin flushing is relieved. B. Advise the client to place one nitroglycerin tablet under his tongue as a precaution. C. Tell the client to have someone bring him to an emergency department immediately. D. D Reassure the client that skin flushing is a common side effect of the medication.

Correct Answer is D

Explanation

A. Increasing oral fluid intake is not a recommended treatment for skin flushing caused by tadalafil. Skin flushing is a common side effect and usually resolves on its own without the need for increased fluid intake.

B. Advising the client to take nitroglycerin is inappropriate and potentially dangerous. Tadalafil and nitroglycerin both lower blood pressure, and their combined use can lead to a significant drop in blood pressure, which can be life-threatening.

C. Telling the client to go to the emergency department is unnecessary in this case. Skin flushing is a known side effect of tadalafil and does not typically require emergency medical attention unless accompanied by other severe symptoms.

D. Reassuring the client that skin flushing is a common side effect of tadalafil is appropriate. This side effect is generally mild and temporary, and the client should be informed that it is not a cause for concern.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits What other medications would the nurse expect the surgeon to prescribe along with Morphine? Select all that apply.

Correct Answer is ["B","C"]

Explanation

A male client reports to the on-call clinic nurse that he took tadalafil 10 mg by mouth two hours ago and his skin now feels flushed. He reports a history of stable angina but denies experiencing any current or recent chest pain. Which action should the nurse take?

Correct Answer is D

Explanation

A client receives a prescription for norepinephrine 3 mcg/min intravenously (IV). The IV bag is contains norepinephrine 4 mg in dextrose 5% in water (D,W) 1,000 mL. How many mL/hour should the nurse program the infusion pump? (Enter numerical value only.)

A preschool-aged child who is being treated for Streptococcal pharyngitis returns to the clinic for signs of scarlet fever. Which assessment finding provides the earliest indication to the nurse that the child is experiencing a reaction to the toxins that are created by the Streptococcus bacteria?

A client is being urgently transported to radiology for a Computerized Tomography (CT scan) after a sudden decrease in level of consciousness. The client is orally intubated and has a left lateral chest tube to 20 cm suction. Which action is most important for the nurse to take?

The psychiatric nurse is caring for clients on an adolescent unit. Which client requires the nurse's immediate attention?

The nurse is caring for a client who arrives to the emergency department with reports of experiencing dizziness and difficulty walking to the bathroom. The nurse observes right-sided weakness and sluggish enunciation of speech. The nurse should immediately take which action?

The client with influenza needs help in transferring to the bedside commode. The nurse observes the unlicensed assistive personnel (UAP) don gloves and a gown to assist the client. Which action should the nurse take?

The nurse is providing lifestyle change education for a client to slow the progression of coronary artery disease. Which statements by the client should the nurse recognize as needing additional education? (Select at that apply)

The nurse is assigning care of a client with prostatitis to a practical nurse (PN). Which instruction should the nurse provide the PN regarding the care of this client?