A nurse is assisting in the care of a client who is receiving morphine via a continuous epidural infusion.
Which of the following findings should the nurse report to the provider immediately?

Respiratory rate 10/min.

Facial flushing.

Constipation.

Blood pressure 88/56 mm Hg.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

A respiratory rate of 10/min is lower than the normal range (12-20 breaths per minute for adults), indicating respiratory depression, which is a serious side effect of morphine and should be reported immediately.

Choice B rationale:

Facial flushing is a common side effect of morphine due to histamine release but it’s not life-threatening.

Choice C rationale:

Constipation is a common side effect of morphine and can be managed with laxatives and diet.

Choice D rationale:

Blood pressure 88/56 mm Hg is lower than the normal range (90/60mmHg to 120/80mmHg), indicating hypotension, which can be a side effect of morphine but it’s not as immediately life-threatening as respiratory depression.

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Correct Answer is B

Explanation

Choice A rationale:

Fever is not a common side effect of acetaminophen. In fact, acetaminophen is often used to reduce fever.

Choice B rationale:

Jaundice, which is a yellowing of the skin or eyes, can be a sign of liver damage, a rare but serious side effect of acetaminophen.

Choice C rationale:

Diarrhea is not a common side effect of acetaminophen.

Choice D rationale:

Tinnitus, or ringing in the ears, is not a common side effect of acetaminophen.

A. Blurred vision. B. Tinnitus. C. Headache. D. Dry mouth.

Correct Answer is C

Explanation

Choice A rationale:

Blurred vision is not a common side effect of the meningococcal conjugate vaccine.

Choice B rationale:

Tinnitus, or ringing in the ears, is also not a common side effect of this vaccine.

Choice C rationale:

Headache is a common side effect of the meningococcal conjugate vaccine.

Choice D rationale:

Dry mouth is not typically associated with this vaccine.

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A nurse is assisting in the care of a client who is receiving morphine via a continuous epidural infusion.Which of the following findings should the nurse report to the provider immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is receiving acetaminophen for mild pain.The nurse should monitor the client for which of the following adverse effects of this medication?

Correct Answer is B

Explanation

A nurse in an acute care facility is collecting data from a client who has received the meningococcal conjugate vaccine.The nurse should monitor the client for which of the following findings as an adverse effect of the vaccine?

Correct Answer is C

Explanation

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A nurse is assisting in the care of a client who is receiving morphine via a continuous epidural infusion.
Which of the following findings should the nurse report to the provider immediately?