A nurse is preparing to administer medication to a post-operative client.
Which of the following prescriptions should the nurse verify with the provider?
Morphine 4 mg IV every 4 hr PRN pain.
Hydromorphone 2 mg IV every 2 hr PRN severe pain.
Ondansetron 4 mg PO every 8 hr PRN nausea.
Docusate sodium 240 mg PO daily PRN constipation.
The Correct Answer is B
Choice A rationale
Morphine is a potent opioid analgesic commonly prescribed for moderate to severe pain. A dosage of 4 mg intravenously every four hours as needed for pain is within the typical therapeutic range for post-operative pain management, and the frequency allows for sufficient time between doses to assess the analgesic effect and minimize accumulation.
Choice B rationale
Hydromorphone is a very potent opioid, significantly stronger than morphine. A dosage of 2 mg intravenously every two hours for severe pain is a high dose and a relatively short interval. This combination increases the risk of opioid toxicity, including respiratory depression and profound sedation, necessitating verification with the prescribing provider.
Choice C rationale
Ondansetron is a serotonin receptor antagonist used to prevent and treat nausea and vomiting. A dosage of 4 mg orally every eight hours as needed for nausea is a standard and safe therapeutic dose, commonly employed in the post-operative setting to manage emesis with minimal adverse effects.
Choice D rationale
Docusate sodium is a stool softener that works by increasing water and fat penetration into the stool, making it easier to pass. A dosage of 240 mg orally daily as needed for constipation is a common and appropriate dose for preventing and managing post-operative constipation, which is a frequent side effect of opioid analgesics.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D"]
Explanation
Choice A rationale
An elevated troponin level indicates myocardial injury or infarction. While severe acetaminophen toxicity can rarely lead to cardiac dysfunction, it is not a primary or common finding. The main organ affected is the liver due to the formation of toxic metabolites.
Choice B rationale
Hyperglycemia is not a typical finding in acetaminophen toxicity. Liver damage can impair glucose regulation, but the immediate and common metabolic derangements are usually related to liver enzyme elevation and acid-base imbalances, not primary glucose elevation.
Choice C rationale
Increased alanine aminotransferase (ALT) level is a critical indicator of hepatotoxicity, the primary concern in acetaminophen overdose. N-acetyl-p-benzoquinone imine (NAPQI), a toxic metabolite, depletes glutathione, leading to hepatocellular necrosis and leakage of intracellular enzymes like ALT (normal range 7–55 U/L).
Choice D rationale
Abdominal discomfort is a common finding in acetaminophen toxicity, particularly as liver damage progresses. This discomfort, often described as right upper quadrant pain, results from hepatocellular injury and inflammation, potentially accompanied by hepatic swelling.
Choice E rationale
Diaphoresis, or excessive sweating, is an early and non-specific symptom of acute acetaminophen overdose. It often accompanies other initial gastrointestinal symptoms like nausea and vomiting, occurring as the body attempts to excrete the drug and in response to initial metabolic stress.
Correct Answer is B
Explanation
Choice A rationale
Disulfiram is an aldehyde dehydrogenase inhibitor used in the treatment of chronic alcoholism. It works by blocking the metabolism of ethanol, leading to the accumulation of acetaldehyde, which produces unpleasant physical reactions when alcohol is consumed. It has no pharmacological effect on benzodiazepine overdose.
Choice B rationale
Flumazenil is a competitive benzodiazepine receptor antagonist that rapidly reverses the sedative and other central nervous system effects of benzodiazepine overdose. It acts by binding to the gamma-aminobutyric acid (GABA) receptor complex, thereby displacing benzodiazepines and restoring normal neurological function.
Choice C rationale
Naloxone is an opioid receptor antagonist primarily used to reverse opioid overdose. It competitively binds to opioid receptors, particularly mu receptors, thereby blocking the effects of opioid agonists and reversing respiratory depression and other opioid-induced central nervous system depression. It does not affect benzodiazepines.
Choice D rationale
Dantrolene is a direct-acting skeletal muscle relaxant primarily used in the treatment of malignant hyperthermia and spasticity. It works by interfering with calcium release from the sarcoplasmic reticulum in muscle cells, reducing muscle contraction. It has no role in reversing benzodiazepine overdose.
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