A nurse identifies that a medication is ordered for the client as twice the regular dosage. What action should the nurse take?
Administer the medication as ordered.
Administer the standard dose and notify the prescriber.
Check to see if previous nurse gave the medication as ordered.
Collaborate with the prescriber regarding the ordered dose.
The Correct Answer is D
Collaborate with the prescriber about the order. This is because the nurse has a responsibility to ensure the safety and effectiveness of the medication administration and to question any orders that seem inappropriate or unclear. The nurse should not administer the medication as ordered without verifying it first, as this could cause harm to the client or result in a medication error. The nurse should not check to see if previous shift nurses gave the medication, as this does not address the issue of the current order and could lead to missed or duplicated doses. The nurse should not administer only the standard dose of the medication, as this could be against the prescriber’s intention and could compromise the client’s treatment or outcome.
Choice A is wrong because it does not follow the principle of safe medication administration and could put the client at risk of adverse effects or overdose.
Choice B is wrong because it does not respect the prescriber’s authority and could result in underdosing or ineffective therapy for the client.
Choice C is wrong because it does not solve the problem of the current order and could cause confusion or inconsistency in the medication administration.
Choice D is correct because it demonstrates critical thinking and professional accountability, and ensures that the order is appropriate and accurate for the client’s condition and needs.
The normal ranges for medication dosages depend on various factors, such as the type of medication, the route of administration, the client’s age, weight, renal function, liver function, and other comorbidities.
The nurse should always consult reliable sources of information, such as drug guides, pharmacists, or prescribers, to determine the safe and effective dosages for each client
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Notify the health care provider to report and anticipate new orders.
This is because an oral temperature of 100.8° F (38.2° C) indicates a fever, which could be a sign of infection or inflammation in an elderly client.
A fever of this magnitude could also cause dehydration, confusion, or seizures in older adults.
Therefore, the nurse should notify the health care provider as soon as possible to determine the cause and treatment of the fever.
Choice B is wrong because covering the client with an additional blanket could increase the body temperature and worsen the fever.
The UAP should not recheck the temperature in two hours, but rather monitor it more frequently and report any changes to the nurse.
Choice C is wrong because charting the temperature on the vital signs sheet and reporting to the new shift coming on is not enough to address the urgency of the situation.
The nurse has a responsibility to act on abnormal findings and communicate them to the health care provider.
Choice D is wrong because assessing the client’s temperature rectally and comparing the results is not necessary and could cause discomfort or injury to the client.
Rectal temperatures are usually higher than oral temperatures by about 0.5° F (0.3° C), so this would not change the interpretation of the fever.
The normal range for oral temperature in adults is 97.6° F to 99.6° F (36.4° C to 37.6° C).
Correct Answer is A
Explanation
A toileting routine is the priority intervention for a client diagnosed with total urinary incontinence because it helps to prevent skin breakdown, infection, and odor. It also promotes dignity and comfort for the client.
Choice B. Kegel exercises are wrong because they are not effective for total urinary incontinence, which is the complete loss of bladder control. Kegel exercises are more useful for stress or urge urinary incontinence, which are caused by weak pelvic floor muscles.
Choice C. Surgery is wrong because it is not a priority intervention for total urinary incontinence.
Surgery may be considered a last resort option if other conservative measures fail to improve the condition. Surgery may also have risks and complications that need to be weighed against the benefits.
Choice D. Anticholinergic drug therapy is wrong because it is not a priority intervention for total urinary incontinence.
Anticholinergic drugs are used to treat overactive bladder or urge urinary incontinence, which are caused by involuntary bladder contractions. Anticholinergic drugs may have side effects such as dry mouth, constipation, blurred vision, and confusion.
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