A nurse is caring for a client who is receiving Vecuronium during mechanical ventilation.
Which of the following medications should the nurse anticipate administering with this medication?
Dexamethasone.
Fentanyl.
Midazolam.
Furosemide.
Famotidine.
Correct Answer : B,C
Choice A rationale
Dexamethasone is a corticosteroid, primarily used for its anti-inflammatory and immunosuppressive effects. While it may be used in certain respiratory conditions, it is not routinely co-administered with vecuronium to mitigate direct effects of neuromuscular blockade. Its use would be based on the underlying disease process rather than as an adjunct to neuromuscular blockade.
Choice B rationale
Fentanyl is a potent opioid analgesic. It is essential to administer an opioid like fentanyl concurrently with vecuronium because neuromuscular blocking agents induce paralysis without affecting consciousness or pain perception. Paralyzing a patient without providing adequate analgesia would be profoundly distressing and unethical, leading to severe anxiety and suffering.
Choice C rationale
Midazolam is a benzodiazepine, primarily used for sedation and anxiolysis. It is crucial to administer a sedative like midazolam concurrently with vecuronium because patients who are paralyzed by neuromuscular blockers are still fully conscious and aware of their surroundings. Sedation prevents psychological distress and ensures patient comfort during mechanical ventilation.
Choice D rationale
Furosemide is a loop diuretic, used to promote diuresis and reduce fluid overload. While fluid management is often critical in critically ill patients, especially those with ARDS, furosemide is not a medication that is routinely administered *with* vecuronium as a direct adjunct to its action. Its use would depend on the patient's fluid status and renal function.
Choice E rationale
Famotidine is a histamine H2 receptor antagonist, primarily used to reduce gastric acid production and prevent stress ulcers. While stress ulcer prophylaxis is common in critically ill patients, famotidine is not administered concurrently with vecuronium to mitigate direct effects of neuromuscular blockade. Its use is prophylactic and unrelated to the paralytic's action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Positioning the patient sitting on the edge of the bed, leaning on a pillow on the bedside table, is the optimal position for a thoracentesis. This position maximizes the intercostal spaces, allowing for easier access to the pleural cavity while keeping the diaphragm in a lowered position. This widens the spaces between the ribs, facilitating needle insertion and minimizing the risk of injury to surrounding structures like the lungs or diaphragm.
Choice B rationale
Placing the patient in a prone position is contraindicated for a thoracentesis. This position would make accessing the posterior pleural space extremely difficult and unsafe, increasing the risk of accidental organ puncture. It offers no anatomical advantage for the procedure and significantly impedes proper visualization and access to the typical insertion site.
Choice C rationale
Lying supine with arms folded across the chest is not an appropriate position for a thoracentesis. This position would flatten the intercostal spaces, making needle insertion more challenging and increasing the risk of lung puncture. It does not provide optimal access to the pleural cavity for fluid drainage and limits respiratory excursion.
Choice D rationale
Stating no particular positioning is required for a thoracentesis is incorrect and potentially dangerous. Proper positioning is critical for patient safety and procedural success, as it optimizes access to the pleural space, minimizes risks, and enhances patient comfort during the procedure. Incorrect positioning can lead to complications.
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale
Suctioning should be performed only when clinically indicated, such as in the presence of visible secretions, adventitious breath sounds, or a decline in oxygen saturation. Routine, unnecessary suctioning can cause mucosal trauma, hypoxemia, and increased risk of infection. This "as needed" approach minimizes potential complications and preserves airway integrity.
Choice B rationale
Hyperoxygenating the patient with 100% oxygen for 30-60 seconds prior to suctioning helps to create an oxygen reserve in the lungs and minimize the risk of hypoxemia during the procedure. Suctioning can transiently reduce lung volumes and gas exchange, and pre-oxygenation mitigates this by saturating hemoglobin and dissolved plasma oxygen.
Choice C rationale
Suctioning for longer than 10-15 seconds on each pass significantly increases the risk of hypoxemia, atelectasis, and vagal stimulation leading to bradycardia. Prolonged suctioning depletes oxygen from the airways and can cause physiological distress. Brief passes allow for reoxygenation between attempts and minimize adverse events.
Choice D rationale
Performing hand hygiene prior to suctioning is a critical infection control measure. This practice reduces the transmission of microorganisms from the healthcare provider's hands to the patient's airway, thereby preventing healthcare-associated infections like ventilator-associated pneumonia. Adherence to strict aseptic technique is paramount in airway management.
Choice E rationale
Suctioning should never be performed while inserting the catheter into the artificial airway. Applying negative pressure during insertion can cause significant mucosal trauma, bleeding, and increased risk of infection by pulling tissue into the catheter lumen. Suction should only be applied intermittently and during withdrawal of the catheter, to remove secretions effectively and safely.
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