A nurse is preparing to administer 0800 medications to a client. The medication administration record (MAR) states "phenobarbital" and the medication the pharmacy supplied is pentobarbital. Which of the following actions should the nurse take?
Check the prescription in the client's medical record.
Ask the client if she has any allergies.
Ask the client what medication she took yesterday
Check the client's MAR to see what the client received the day before.
The Correct Answer is A
A. Checking the prescription in the client's medical record can help confirm the correct medication and dosage prescribed by the healthcare provider. It allows the nurse to verify the intended medication and compare it with what was supplied by the pharmacy.
B. While asking the client about allergies is important for medication safety, it may not directly address the discrepancy between the listed medication (phenobarbital) and the supplied medication (pentobarbital). Allergies are relevant to ensuring the safety of the medication administration, but they may not provide immediate clarification of the discrepancy.
C. This action may provide some context about the client's medication history, but it does not directly address the discrepancy between the listed medication and the supplied medication. The focus should be on confirming the correct medication for administration according to the client's current prescription.
D. This action may provide information about the client's previous medication administration history, but it does not directly address the discrepancy between the listed medication and the supplied medication. The nurse's primary concern should be to verify the correct medication to be administered at the current time.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Opioid overdose typically results in central nervous system depression, which can lead to bradycardia (slow heart rate) rather than tachycardia. Bradycardia occurs due to decreased sympathetic nervous system activity.
B. Bradyppnea is a common finding in opioid overdose due to the depressive effect of opioids on the respiratory center in the brainstem. Opioids can suppress the drive to breathe, leading to shallow and rapid breathing, or even respiratory arrest in severe cases.
C. Sedation or drowsiness is a hallmark feature of opioid overdose. Oxycodone, like other opioids, acts on the central nervous system to produce analgesia and sedation. In cases of overdose, sedation may progress to unconsciousness and respiratory depression, which can be life-threatening.
D. Opioid overdose typically causes pinpoint (constricted) pupils rather than dilated pupils. The constriction of pupils, known as miosis, is a classic sign of opioid toxicity due to the suppression of the sympathetic nervous system.
Correct Answer is A
Explanation
A. When administering a TST, the nurse should select an injection site that is free of scar tissue and areas with excessive hair, veins, or visible lesions. The preferred site for TST administration is the volar aspect of the forearm, approximately 2-4 inches below the elbow.
B. After administering the TST, the nurse should not massage or manipulate the injection site. Massaging the site can cause irritation or spread the solution, leading to inaccurate results.
C. he TST is administered intradermally, typically with a 27-gauge needle. The needle should be inserted with the bevel facing upward at a 5-15-degree angle.
D. The standard dose of tuberculin solution (e.g., purified protein derivative, PPD) for a TST is 0.1 mL containing 5 tuberculin units (TU).
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