A nurse is caring for a client who is receiving morphine.
Which of the following assessments should the nurse perform first?

Apical heart rate.

Blood pressure.

Respiratory rate.

Level of consciousness.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Assessing the apical heart rate is important but not the first priority when administering morphine. Respiratory rate takes precedence due to the risk of respiratory depression, a common adverse effect of opioids.

Choice B rationale

Monitoring blood pressure is essential, but the first priority is to assess respiratory rate to promptly identify and address any respiratory depression, which is a critical side effect of morphine administration.

Choice C rationale

Respiratory rate must be assessed first because morphine can cause respiratory depression. Early detection of decreased respiratory rate ensures timely intervention and prevention of severe complications related to opioid use.

Choice D rationale

Level of consciousness should be monitored, as morphine can cause sedation. However, the initial priority is to assess respiratory rate to detect any immediate life-threatening respiratory depression caused by the opioid. .

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Correct Answer is B

Explanation

Choice A rationale

Diazepam is a benzodiazepine used to manage anxiety, seizures, and muscle spasms. It is not effective in treating malignant hyperthermia, a condition characterized by rapid onset of hypermetabolism and muscle rigidity triggered by certain anesthetics.

Choice B rationale

Dantrolene is the drug of choice for malignant hyperthermia. It acts by inhibiting calcium release from the sarcoplasmic reticulum in skeletal muscle, thereby reducing muscle rigidity and metabolic activity. Administer 2.5 mg/kg IV bolus initially.

Choice C rationale

Cyclobenzaprine is a muscle relaxant used to relieve muscle spasms associated with acute musculoskeletal conditions. It does not have the specific mechanism required to counteract the effects of malignant hyperthermia.

Choice D rationale

Metaxalone is a muscle relaxant used to treat discomfort associated with acute skeletal muscle conditions. It is not indicated for the treatment of malignant hyperthermia and does not address the underlying pathophysiology of the condition.

A. Alanine aminotransferase. B. Thyroid-stimulating hormone. C. Potassium. D. Magnesium.

Correct Answer is C

Explanation

Choice A rationale

Alanine aminotransferase (ALT) monitors liver function. While captopril is metabolized by the liver, it is not the most critical value to monitor. Elevated ALT may indicate liver damage, but it is not a primary concern with captopril.

Choice B rationale

Thyroid-stimulating hormone (TSH) is related to thyroid function. Captopril does not typically affect thyroid function, so monitoring TSH levels is not a priority. The focus is on electrolytes and kidney function with captopril.

Choice C rationale

Potassium monitoring is essential due to the risk of hyperkalemia with captopril. Captopril, an ACE inhibitor, can increase potassium levels by reducing aldosterone secretion. Normal potassium range is 3.5 to 5 mEq/L.

Choice D rationale

Magnesium levels are important for various bodily functions, but captopril does not significantly affect magnesium. Monitoring potassium and renal function is more critical due to the potential for hyperkalemia with captopril. .

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A nurse is caring for a client who is receiving morphine.Which of the following assessments should the nurse perform first?

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Naxlex Comprehensive Predictor Exams

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A nurse is caring for a client who is receiving morphine.
Which of the following assessments should the nurse perform first?