A nurse is caring for a client who is receiving meperidine.
Which of the following is the nurse's priority assessment before administering the medication?
Urinary retention.
Vomiting.
Respiratory rate.
Level of consciousness.
The Correct Answer is C
Choice A rationale
Urinary retention is a potential adverse effect of opioid analgesics like meperidine due to their anticholinergic effects, which can relax the detrusor muscle and increase bladder sphincter tone. While important to monitor, it is not the most immediate life-threatening concern compared to respiratory depression.
Choice B rationale
Vomiting is a common gastrointestinal adverse effect of opioid analgesics, often due to stimulation of the chemoreceptor trigger zone in the brainstem. While distressing for the client and requiring intervention, it does not pose the immediate life-threatening risk that respiratory depression does.
Choice C rationale
Meperidine is an opioid agonist that acts on mu-opioid receptors in the central nervous system, including the brainstem respiratory centers. This can lead to dose-dependent respiratory depression by decreasing the sensitivity of these centers to carbon dioxide, making a depressed respiratory rate (normal range 12-20 breaths/min) the priority assessment for client safety.
Choice D rationale
Altered level of consciousness, such as drowsiness or sedation, is a common central nervous system effect of meperidine. While a significant finding indicating opioid effect, it is secondary in priority to respiratory depression, which directly impacts vital gas exchange and can quickly become life-threatening.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Administering half the dose now and the other half in 30 minutes is an inappropriate action for a beta-blocker like atenolol when the heart rate is already low. This approach would still lead to a further reduction in heart rate, potentially causing symptomatic bradycardia or other adverse cardiovascular events, and is not a standard medication administration protocol.
Choice B rationale
Atenolol is a beta-blocker that reduces heart rate and blood pressure. A normal apical heart rate typically ranges from 60 to 100 beats/min. A heart rate of 61/min, although within the normal range, is on the lower end, especially for a client receiving a beta-blocker. Administering atenolol could further decrease the heart rate, leading to symptomatic bradycardia or other adverse effects. Therefore, withholding the medication and contacting the provider is the safest action to assess the client's tolerance and determine if a dose adjustment is necessary.
Choice C rationale
Administering the prescribed dose when the client's apical heart rate is 61/min is generally contraindicated for a beta-blocker like atenolol. Beta-blockers work by decreasing heart rate. Giving the medication could cause the heart rate to fall below acceptable limits (e.g., less than 60 beats/min), potentially leading to dizziness, syncope, or cardiac arrest, necessitating careful clinical judgment.
Choice D rationale
Atropine is an anticholinergic medication used to treat bradycardia (heart rate less than 60 beats/min) by blocking the action of acetylcholine on muscarinic receptors, thereby increasing heart rate. While atropine can be used to treat symptomatic bradycardia, preparing to administer it *before* giving atenolol, especially when the heart rate is 61/min and the client is not yet bradycardic, is premature and not indicated.
Correct Answer is ["B","E"]
Explanation
Choice A rationale
Blood glucose levels are not directly impacted by epoetin alfa. Epoetin alfa stimulates erythropoiesis, the production of red blood cells, and its effectiveness is assessed by parameters related to red blood cell mass and oxygen-carrying capacity, not glucose metabolism.
Choice B rationale
Iron levels are crucial to monitor when a client is receiving epoetin alfa. Epoetin alfa stimulates red blood cell production, which requires adequate iron stores for hemoglobin synthesis. Insufficient iron can limit the therapeutic response to epoetin alfa.
Choice C rationale
Alanine aminotransferase (ALT) levels are indicators of liver function. Epoetin alfa does not have a direct hepatotoxic effect, and therefore, monitoring ALT is not a primary method to assess its effectiveness. Liver enzyme levels are not directly related to erythropoiesis.
Choice D rationale
Thyroid-stimulating hormone (TSH) levels are indicators of thyroid function. Epoetin alfa does not directly influence thyroid hormone production or regulation, and monitoring TSH would not provide information about the medication's effectiveness in stimulating red blood cell production.
Choice E rationale
Hemoglobin levels are the primary laboratory test to monitor the effectiveness of epoetin alfa. The medication's purpose is to stimulate erythropoiesis, leading to an increase in red blood cell mass and subsequently, a rise in hemoglobin concentration (normal range for adult males: 13.5–17.5 grams/dL; for adult females: 12.0–15.5 grams/dL).
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