A nurse is caring for a client who has respiratory depression from an opioid administration.
After administering naloxone to the client, which of the following findings should the nurse expect?
Increased pain.
Somnolence.
Hyperglycemia.
Hypoventilation.
The Correct Answer is A
The correct answer is A. Increased pain.
Choice A reason: Naloxone is an opioid antagonist that, when administered, reverses the effects of opioids. Since opioids provide analgesia, their reversal will lead to the return of pain sensation. The normal pain response varies widely among individuals and depends on the type and amount of opioid the patient received, as well as their pain threshold and tolerance.
Choice B reason: Somnolence, or drowsiness, is a common effect of opioid administration. Naloxone works by displacing opioids from their receptors, which should counteract the sedative effects of opioids and reduce somnolence. Therefore, after naloxone administration, the nurse should not expect somnolence as a finding.
Choice C reason: Hyperglycemia, or high blood sugar, is not a direct effect of naloxone administration. While some studies suggest that naloxone may affect blood glucose levels under certain conditions, such as in the case of tramadol overdose, it does not typically cause hyperglycemia. Normal blood glucose levels range from 70 to 99 mg/dL fasting, and up to 140 mg/dL two hours after eating.
Choice D reason: Hypoventilation, or reduced breathing rate and depth, is caused by opioid administration. Naloxone’s role is to reverse this effect, restoring normal breathing rates. The normal respiratory rate for a healthy adult at rest is 12 to 20 breaths per minute.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is choice d.
Choice A rationale:
Washing the penis from scrotum to tip using a spiral motion can trap bacteria under the foreskin and increase risk of infection.
Choice B rationale:
Soap helps remove dirt and bacteria, reducing infection risk. Soapy water is preferred over plain water for perineal care.
Choice C rationale:
While hand hygiene is crucial, sterile gloves are not typically required for routine perineal care in an SCI patient unless there's a break in the skin or a high risk of infection.
Choice D rationale:
Discarding the washcloth after cleansing the urethral meatus is essential to prevent transferring bacteria to other areas.
Correct Answer is B
Explanation
Choice A rationale:
Acknowledging the difficulty of caring for a terminally ill person is empathetic, but it doesn't offer a solution to the son's problem. The nurse should provide practical assistance or information to help alleviate the son's stress and fatigue.
Choice B rationale:
(Correct Choice) Offering information about respite care is appropriate in this situation. Respite care provides temporary relief to caregivers, allowing them to take a break from their caregiving responsibilities. Providing information about available resources can empower the son to make decisions that support his well-being and the well-being of his mother.
Choice C rationale:
Suggesting a sleeping pill before bed might not be appropriate without a healthcare provider's assessment. Additionally, relying on medication alone might not address the underlying stress and fatigue the son is experiencing.
Choice D rationale:
Praising the son for his caregiving efforts is supportive, but it doesn't offer a solution to his lack of sleep. While encouragement and recognition are important, addressing the son's immediate need for rest and support should be the priority.
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