The nurse accidentally administers 15 mg of morphine IM to a client who had been given another dose of morphine 15 mg IM about 30 minutes earlier. What action should the nurse be prepared to take?

Assistance with endotracheal intubation

Administration of protamine sulfate

Administration of naloxone (Narcan)

Administration of oxygen

Answer and Explanation

The Correct Answer is C

A. Endotracheal intubation might be necessary in severe cases of respiratory depression, but it is not the first step in addressing opioid overdose.
B. Protamine sulfate is the antidote for heparin, not morphine.
C. Naloxone (Narcan) is an opioid antagonist that can rapidly reverse the effects of opioid overdose, including respiratory depression.
D. Administration of oxygen is supportive care but does not address the root cause of opioid overdose.

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Correct Answer is A

Explanation

A. This response emphasizes the importance of the patient controlling their own pain management. PCA pumps are designed to allow the patient to self-administer pain medication as needed, ensuring they receive the appropriate dose based on their pain levels.
B. This response is inappropriate because it undermines the purpose of a PCA pump, which is to allow the patient to control their own pain relief.
C. While the partner's intention is to help, this response does not address the potential risk of over-sedation and respiratory depression when someone other than the patient administers the medication.
D. This response questions the partner's actions but does not provide clear guidance on the proper use of the PCA pump.

A. Stiffness in the lower extremities B. Difficulty moving the upper extremities C. A reddened area over the sacrum D. Difficulty hearing some types of sounds

Correct Answer is C

Explanation

A. Stiffness in the lower extremities can occur but is not a primary complication of immobility.
B. Difficulty moving the upper extremities is a result of the stroke, not immobility.
C. A reddened area over the sacrum indicates a pressure ulcer, a common complication of immobility.
D. Difficulty hearing some types of sounds is unrelated to immobility.

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The nurse accidentally administers 15 mg of morphine IM to a client who had been given another dose of morphine 15 mg IM about 30 minutes earlier. What action should the nurse be prepared to take?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is using a patient-controlled analgesia (PCA) pump for postoperative pain management. The nurse enters the room to find the client asleep and his partner pressing the button to dispense another dose. Which of the following responses should the nurse make?

Correct Answer is A

Explanation

A nurse in a long-term care facility is caring for an older adult client who had a stroke 4 weeks ago and who is unable to move independently. The nurse should monitor for which of the following complications of immobility?

Correct Answer is C

Explanation

A nurse is preparing to administer a unit of packed red blood cells to a client. Which of the following actions should the nurse plan to take?

A nurse is teaching a class about routes of medication administration. The nurse should include that which of the following routes has the fastest rate of absorption?

A nurse is caring for a postoperative client who has an IV PCA delivering opioids. The client rates their pain as 2 on a scale of 0 to 10 and has not pressed the button to deliver a bolus dose in over 2 hr. Which of the following actions should the nurse take?

A nurse is preparing to teach a group of newly licensed nurses about the first phase of wound healing. Which of the following processes should the nurse plan to discuss?

The nurse accidentally administers 15 mg of morphine IM to a client who had been given another dose of morphine 15 mg IM about 30 minutes earlier. What action should the nurse be prepared to take?

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A nurse is caring for a client who has a large lower leg ulcer. Which of the following foods should the nurse suggest to the client to provide the most protein for wound healing?

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