A charge nurse is observing a newly licensed nurse administer medications to a client. Which of the following actions by the newly licensed nurse should prompt the charge nurse to intervene?

Documents medication administration prior to administering it.

Verifies the medication against the prescription and medication label.

Checks the provider's orders and confirmed dosage in a medication reference guide.

Scans the bar code on the medication administration record and the client's arm band

Answer and Explanation

The Correct Answer is A

A. Documents medication administration prior to administering it: Documenting medication administration before actually administering it is incorrect and can lead to errors in documentation. The nurse should document medication administration after ensuring the medication is given to the client.

B. Verifies the medication against the prescription and medication label: This is a correct action. The nurse should verify the medication against the prescription and medication label to ensure accuracy before administering it.

C. Checks the provider's orders and confirmed dosage in a medication reference guide: This is a correct action. The nurse should check the provider's orders and confirm the dosage in a reliable medication reference guide to ensure accuracy before administering the medication.

D. Scans the barcode on the medication administration record and the client's armband: This is a correct action. Scanning the barcode on the medication administration record and the client's armband helps ensure the "Five Rights" of medication administration: right patient, right medication, right dose, right route, and right time.

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Correct Answer is D

Explanation

A. Protamine: Protamine is used as an antidote for heparin, not for benzodiazepines.

B. Naloxone: Naloxone is an opioid antagonist used to reverse the effects of opioids, such as morphine or heroin. It does not antagonize the effects of benzodiazepines.

C. Diphenhydramine: Diphenhydramine is an antihistamine medication commonly used for allergy relief and as a sleep aid. It does not antagonize the effects of benzodiazepines.

D. Flumazenil: Flumazenil is a benzodiazepine receptor antagonist. It is used to reverse the effects of benzodiazepine overdose or to rapidly reverse the sedative effects of benzodiazepines in cases such as anesthesia recovery. Therefore, it is the correct option for antagonizing benzodiazepines.

A. Involuntary pelvic rocking and hip thrusting movements B. Urinary retention and constipation C. Fine hand tremors and pill rolling D. Tongue thrusting and lip smacking E. Facial grimacing and eye blinking

Correct Answer is ["A","D","E"]

Explanation

Tardive dyskinesia (TD) is a potential adverse effect associated with long-term use of antipsychotic medications like haloperidol. It manifests as involuntary, repetitive movements, primarily involving the face, mouth, and tongue. The nurse should suspect tardive dyskinesia when observing the following manifestations:

A. Involuntary pelvic rocking and hip thrusting movements: These movements are characteristic of tardive dyskinesia and indicate abnormal involuntary motor activity.

B. Urinary retention and constipation: These are not typical manifestations of tardive dyskinesia. Urinary retention and constipation can be side effects of anticholinergic medications but are not associated with tardive dyskinesia.

C. Fine hand tremors and pill rolling: These manifestations are more characteristic of parkinsonism, which can be a side effect of antipsychotic medications but is distinct from tardive dyskinesia.

D. Tongue thrusting and lip smacking: These are classic manifestations of tardive dyskinesia and indicate abnormal involuntary movements of the tongue and lips.

E. Facial grimacing and eye blinking: These are also common manifestations of tardive dyskinesia, involving involuntary movements of the face, including grimacing and blinking of the eyes.

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A charge nurse is observing a newly licensed nurse administer medications to a client. Which of the following actions by the newly licensed nurse should prompt the charge nurse to intervene?

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Naxlex Comprehensive Predictor Exams

A charge nurse is teaching a group of nurses about the antagonist action of medications. The nurse should include in the teaching that which of the following antagonist medications is used for benzodiazepines?

Correct Answer is D

Explanation

A nurse is caring for a client who was admitted with acute psychosis and is being treated with haloperidol. The nurse should suspect that the client may be experiencing tardive dyskinesia when the client exhibits which of the following? (Select all that apply.)

Correct Answer is ["A","D","E"]

Explanation

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