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 B
Explanation
Choice A rationale
An epidural hematoma typically results from arterial bleeding, often after head trauma, leading to rapid accumulation of blood between the dura mater and the skull. This compression can cause acute neurological deterioration, but the chronic presentation and presence of multiple bruises in various healing stages are less consistent with an acute epidural bleed.
Choice B rationale
A chronic subdural hematoma involves venous bleeding into the subdural space, often occurring after minor trauma, especially in elderly individuals or those with brain atrophy, like chronic alcoholics. Blood accumulates slowly, causing gradual neurological symptoms such as weakness and facial droop over weeks to months, aligning with the patient's presentation and history of falls.
Choice C rationale
A cerebral contusion is a bruise on the brain tissue, typically caused by direct impact. While it can cause localized neurological deficits, it's an acute injury. The chronic nature of the patient's symptoms and the presence of multiple scrapes in various healing stages suggest a more insidious and recurring process rather than a single contusion.
Choice D rationale
A concussion is a mild traumatic brain injury resulting in transient brain dysfunction, often without structural damage. Symptoms are typically temporary and include headache, dizziness, and confusion. It does not typically cause focal neurological deficits like arm weakness and facial droop that are progressive or chronic in nature.
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.
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