A client in the intensive care unit has a presentation of pinpoint pupils, respiratory depression, and coma after overdosing on morphine sulfate (Astramorph). Which of the following is the appropriate complication based on the client's presentation?
Opioid toxicity triad.
Orthostatic hypotension.
Hypertension.
Abstinence syndrome.
The Correct Answer is A
Choice A rationale
Opioid toxicity triad includes symptoms of pinpoint pupils, respiratory depression, and coma. These symptoms are indicative of a morphine sulfate overdose.
Choice B rationale
Orthostatic hypotension is a form of low blood pressure that happens when standing up from sitting or lying down. It is not related to opioid toxicity.
Choice C rationale
Hypertension is high blood pressure. It is not related to opioid toxicity.
Choice D rationale
Abstinence syndrome is a group of symptoms that occur upon the abrupt discontinuation or decrease in intake of medications or recreational drugs. It is not the appropriate complication for the client's presentation. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Metastasis is when cancerous cells spread into or invade nearby tissues and can travel to distant places in the body to form new tumors. This process involves the detachment of cancer cells from the primary tumor, their movement through the bloodstream or lymphatic system, and the establishment of new tumors in other parts of the body.
Choice B rationale
Metastasis specifically involves cancerous cells, not normal cells. Normal cells do not spread and invade other tissues in a way that causes new tumor formation.
Choice C rationale
Metastasis refers to the spread of cancerous cells, not normal cells. Normal cells do not exhibit the same invasive and migratory behaviors as cancerous cells.
Choice D rationale
Metastasis involves the spread of cancerous cells, which can lead to the formation of malignant tumors in distant parts of the body. It does not treat tumors but rather contributes to the progression of cancer.
Correct Answer is D
Explanation
Choice A rationale
Aspiration is not recommended for subcutaneous injections because it can increase tissue damage and pain. Enoxaparin should be administered without aspiration.
Choice B rationale
Prefilled syringes of enoxaparin contain an air bubble to ensure the entire dose is administered. Expelling the air bubble before injection is not recommended.
Choice C rationale
Enoxaparin should be administered in the abdomen, at least 2 inches away from the umbilicus, to ensure proper absorption and effectiveness.
Choice D rationale
Enoxaparin should be administered subcutaneously, and the needle should be inserted completely to ensure the medication is delivered into the subcutaneous tissue.
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