A client is prescribed alprazolam for acute anxiety. What client history should cause a nurse to question this order?

A personality disorder.

Hypertension.

Alcohol use disorder.

Schizophrenia.

Answer and Explanation

The Correct Answer is C

Choice A Reason
While a personality disorder can present challenges in managing medications due to the complexity of the psychiatric condition, it is not typically a contraindication for the use of alprazolam. However, caution is advised as the dynamics of personality disorders can affect medication adherence and response.

Choice B Reason
Hypertension is not a direct contraindication for alprazolam. However, since alprazolam can sometimes cause changes in blood pressure, it is important for the nurse to monitor the client's blood pressure and consult with the physician if there are concerns.

Choice C Reason
Alcohol use disorder is a significant concern when prescribing alprazolam. Alprazolam is a benzodiazepine, and concurrent use with substances like alcohol can increase the risk of respiratory depression, sedation, and misuse or addiction. Therefore, a history of alcohol use disorder should prompt the nurse to question the order and discuss alternative treatments with the physician.

Choice D Reason
Schizophrenia itself is not a contraindication for the use of alprazolam, but it is essential to consider the overall treatment plan for the client. Alprazolam is not a primary treatment for schizophrenia and is used for anxiety management. The nurse should ensure that the use of alprazolam does not interfere with the treatment of schizophrenia.

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Correct Answer is B

Explanation

Choice A reason:
A respiratory rate of 24/min is slightly elevated, which can be expected in a client with pneumonia due to the body's attempt to increase oxygen intake and carbon dioxide elimination. However, this rate does not directly indicate ineffective airway clearance.

Choice B reason:
A weak, nonproductive cough is a key indicator of ineffective airway clearance. In pneumonia, the presence of secretions in the airways is common, and an effective cough is necessary to clear these secretions. A weak cough that does not produce sputum suggests that the client is unable to clear their airways effectively, which can lead to impaired gas exchange and worsening of symptoms.

Choice C reason:
Pulse oximetry (SpO2) of 90% indicates that the client's oxygen saturation is below the normal range, which is typically between 95-100% for healthy individuals. While this finding is concerning and warrants intervention, it is a result of ineffective airway clearance rather than a direct indicator of it.

Choice D reason:
Shortness of breath with activity is common in clients with pneumonia and can result from various factors, including impaired gas exchange, decreased lung compliance, and increased work of breathing. While it may be associated with ineffective airway clearance, it is not as specific as a weak, nonproductive cough for indicating this particular problem.

A. Place the client on 2L via nasal cannula. B. Obtain a blood glucose. C. Call the physician for an order for a stat arterial blood gas to be drawn. D. Request an order for lorazepam.

Correct Answer is C

Explanation

Choice a reason:
Placing the client on 2L via nasal cannula is a common intervention for hypoxemia, but with the client's pulse oximetry at 88%, which is below the normal range of 95-100%, and the presence of tachypnea, a more immediate assessment of the client's respiratory status is warranted. Oxygen therapy should be guided by the results of arterial blood gas (ABG) analysis to tailor the treatment to the client's specific needs.

Choice b reason:
Obtaining a blood glucose level is not the most immediate concern in the context of altered mental status and respiratory distress. While it is important to rule out hypoglycemia as a cause of altered mental status, the primary concern indicated by the vital signs is the client's respiratory condition.

Choice c reason:
Calling the physician for an order for a stat arterial blood gas is the most appropriate action. The ABG will provide detailed information about the client's oxygenation, carbon dioxide levels, and acid-base balance. This is crucial for a client with a new onset change in mental status and tachypnea, as it can indicate respiratory failure or other serious complications of pneumonia.

Choice d reason:
Requesting an order for lorazepam is not appropriate given the client's current respiratory status. Lorazepam, a benzodiazepine, can depress the central nervous system and respiratory drive, potentially worsening the client's hypoxemia and respiratory effort.

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A client is prescribed alprazolam for acute anxiety. What client history should cause a nurse to question this order?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse formulates the problem of ineffective airway clearance for a client who has pneumonia. Which assessment data best supports this problem?

Correct Answer is B

Explanation

During an assessment of an anxious client diagnosed with right lower lobe pneumonia, the nurse notes a new onset change in mental status and tachypnea. The latest vital signs for the client are T: 98.4 F; HR: 108; RR: 28; BP: 144/90; Pulse ox: 88%. What is the priority nursing action?

Correct Answer is C

Explanation

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