A nurse is assisting with the care of a client.
The client likely suffered from
The Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"C"}
The client likely suffered from intoxication as evidenced by hypokinesia.
Intoxication from substances such as opioids can lead to a range of symptoms including sedation and altered mental status. In this case, the presence of a needle in the antecubital space and the administration of naloxone suggest opioid use.
Hypokinesia, characterized by reduced movement, aligns with the symptoms observed in opioid intoxication, such as decreased responsiveness and drowsiness. The historical pattern of sedation, miosis (constricted pupils), and mood alteration further supports the diagnosis of intoxication as the underlying condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","E"]
Explanation
A. Vertigo is common after inner ear surgery like stapedectomy and can be related to changes in the inner ear. It should be monitored, but it's not an immediate concern unless severe.
B. Correct. A change in facial symmetry (left facial droop) is indicative of potential facial nerve dysfunction, which requires immediate attention.
C. Pupils are reactive to light, and their size is within the expected range, indicating normal pupillary function.
D. A pain rating of 5 on a scale of 0 to 10 indicates moderate pain. While it requires attention, it's not a critical concern.
E. Correct. Diminished hearing following ear surgery is an expected finding, but the nurse should assess the degree and type of hearing loss and communicate this to the healthcare provider.
F. Lung assessment is important but does not require immediate action based on the given information.
Correct Answer is C
Explanation
A. One fingerbreadth of space between the cast and the skin is important to prevent constriction, but diminished pulses suggest compromised blood circulation, which is a higher priority.
B. Muscle spasms are common and can cause discomfort, but diminished pulses indicate a more serious circulation issue.
C. Correct. Diminished pulses suggest reduced blood flow, which is a serious concern and requires immediate attention.
D. Ecchymosis might be related to the cast application, but it's less urgent than compromised circulation.
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