The nurse is caring for a patient with shallow respirations and diminished breath sounds following abdominal surgery yesterday.


Which are the appropriate actions of the nurse? (Select all that apply.)

Choice A rationale:

Employee Assistance Programs (EAPs): These programs focus on providing confidential counseling and support services to employees for personal and work-related issues, such as mental health, substance abuse, stress management, and family concerns. They do not play a role in determining nursing training requirements for intravenous line initiation.

Choice C rationale:

The MedWatch program: This is a voluntary reporting system for healthcare professionals and consumers to report adverse events and medication errors to the FDA. It's crucial for monitoring drug safety but does not establish training standards for nurses.

Choice D rationale:

The US Food and Drug Administration (FDA): This federal agency regulates food, drugs, medical devices, and cosmetics to ensure their safety and efficacy. While it sets standards for drug approval and labeling, it does not directly determine specific nursing training requirements.

Choice B rationale:

State Nurse Practice Acts: These laws, enacted by each state's legislature, define the scope of nursing practice, including the skills and tasks that nurses are legally authorized to perform. Intravenous line initiation is a skill that falls within the scope of nursing practice, and the specific training requirements for this skill are typically outlined in each state's Nurse Practice Act.

Key points:

State Nurse Practice Acts are the primary legal authority governing nursing practice within each state, including the necessary training for nurses to perform specific skills.

EAPs, MedWatch, and the FDA play important roles in healthcare but do not determine nursing training requirements

Nurses must be aware of the Nurse Practice Act in their state to ensure they are practicing within the legal scope of their profession and have received the required training for the skills they perform.

Choice A rationale:

Incorrect. Patients who develop tolerance to a medication do not typically maintain a stable dose over time. Instead, they often require increasing doses to achieve the same effect.

Physiological adaptation: The body adapts to the presence of the medication, leading to a decreased response over time. This adaptation can occur at various levels, including receptor downregulation, changes in enzyme activity, or alterations in neurotransmitter release.

Individual variability: The rate and extent of tolerance development vary significantly among individuals, influenced by factors such as genetics, age, overall health, and medication type.

Choice B rationale:

Incorrect. Impaired liver or kidney function can affect drug metabolism and elimination, but this is not the primary mechanism of tolerance.

Metabolic impairment: Liver or kidney dysfunction can lead to drug accumulation in the body, potentially increasing the risk of side effects or toxicity. However, this does not necessarily cause tolerance, which is a specific phenomenon of decreased responsiveness to the medication's effects.

Choice C rationale:

Correct. This statement accurately describes the hallmark characteristic of tolerance.

Dose escalation: As tolerance develops, patients often require higher doses of the medication to achieve the same therapeutic effect. This can lead to a cycle of increasing doses and potential risks of adverse effects.

Clinical implications: Tolerance is a significant consideration in medication management, as it can affect treatment efficacy, adherence, and the risk of side effects.

Choice D rationale:

Incorrect. Tolerance can develop even when patients adhere strictly to their prescribed medication regimen. It is a physiological phenomenon that is not solely dependent on patient behavior.

Adherence vs. tolerance: While non-adherence can contribute to treatment failure, it is not the underlying cause of tolerance.