Which medication is recognized by the Registered Nurse (RN) as a dilator for both arteries and veins?

Choice A rationale:

Uncontrolled diabetes mellitus: Corticosteroids can have a hyperglycemic effect, meaning they can raise blood sugar levels. This makes them generally unsuitable for use in patients with uncontrolled diabetes mellitus. In fact, corticosteroids might even worsen glycemic control in these patients. While corticosteroids might be used in some cases of diabetes mellitus, such as to treat diabetic retinopathy or nephropathy, they would be used cautiously and with close monitoring of blood sugar levels.

Choice B rationale:

A recent diagnosis of lung cancer: Corticosteroids are not a primary treatment for lung cancer. They might be used in some cases to help manage symptoms or side effects of other treatments, such as chemotherapy or radiation therapy. However, they would not typically be used as a first-line treatment for lung cancer itself.

Choice C rationale:

Acute exacerbation of COPD: Corticosteroids are a mainstay of treatment for acute exacerbations of COPD. They work by reducing inflammation in the airways, which helps to improve airflow and relieve symptoms such as wheezing, shortness of breath, and chest tightness. Corticosteroids can be given orally, intravenously, or by inhalation. The dose and duration of treatment will depend on the severity of the exacerbation.

Choice D rationale:

Chronic asthma: Corticosteroids are often used as a long-term control medication for chronic asthma. However, they are typically used at lower doses than those used for acute exacerbations of COPD. Inhaled corticosteroids are the preferred form of treatment for chronic asthma, as they deliver the medication directly to the airways and have fewer systemic side effects.

Choice A rationale:

Seizure precautions are necessary because:

The patient has ingested multiple drugs, some of which can lower the seizure threshold, such as benzodiazepines. Naloxone, while reversing opioid overdose, can also precipitate seizures in some individuals.

Flumazenil, used to reverse benzodiazepine overdose, can also induce seizures, especially in patients with a history of epilepsy or benzodiazepine dependence.

The potential for drug interactions and unpredictable effects of multiple drug ingestion further increases the risk of seizures. Specific seizure precautions include:

Placing the patient in a bed with padded side rails. Having oxygen and suction equipment readily available.

Keeping intravenous access open for potential administration of anticonvulsant medications. Closely monitoring the patient's neurological status for any signs of seizure activity.

Choice B rationale:

Aspiration precautions are crucial due to:

The patient's unconscious state, which impairs their ability to protect their airway.

The possibility of vomiting, which can occur as a side effect of naloxone or flumazenil administration.

The potential for aspiration of gastric contents, which can lead to serious respiratory complications, such as pneumonia. Specific aspiration precautions include:

Positioning the patient on their side in the recovery position. Continuously monitoring the patient's respiratory status.

Having suction equipment ready to clear the airway if necessary.

Considering intubation and mechanical ventilation if the patient's airway is compromised.

Choice D rationale:

Fall precautions are essential because:

The patient is unconscious and may be disoriented or uncoordinated upon regaining consciousness.

The effects of the ingested drugs, as well as the medications administered, can impair balance and coordination. Falls can result in serious injuries, such as head trauma or fractures.

Specific fall precautions include:

Keeping the bed in a low position with side rails up.

Assisting the patient with ambulation when they are able to move. Ensuring the patient's environment is free of tripping hazards.

Providing close supervision and assistance as needed.

Choice C rationale:

Suicide precautions are not routinely implemented in this scenario because:

The patient's primary presentation is drug overdose, not active suicidal ideation or attempts.

The focus of care is on addressing the immediate medical complications of the overdose and stabilization.

However, a thorough suicide risk assessment should be conducted once the patient is medically stable to determine if ongoing suicide precautions are necessary.