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
Explanation
Choice A rationale
Urinary retention is a potential adverse effect of opioid analgesics like meperidine due to their anticholinergic effects, which can relax the detrusor muscle and increase bladder sphincter tone. While important to monitor, it is not the most immediate life-threatening concern compared to respiratory depression.
Choice B rationale
Vomiting is a common gastrointestinal adverse effect of opioid analgesics, often due to stimulation of the chemoreceptor trigger zone in the brainstem. While distressing for the client and requiring intervention, it does not pose the immediate life-threatening risk that respiratory depression does.
Choice C rationale
Meperidine is an opioid agonist that acts on mu-opioid receptors in the central nervous system, including the brainstem respiratory centers. This can lead to dose-dependent respiratory depression by decreasing the sensitivity of these centers to carbon dioxide, making a depressed respiratory rate (normal range 12-20 breaths/min) the priority assessment for client safety.
Choice D rationale
Altered level of consciousness, such as drowsiness or sedation, is a common central nervous system effect of meperidine. While a significant finding indicating opioid effect, it is secondary in priority to respiratory depression, which directly impacts vital gas exchange and can quickly become life-threatening.
Correct Answer is A
Explanation
Choice A rationale
Cromolyn is a mast cell stabilizer that works by inhibiting the release of inflammatory mediators like histamine from mast cells. This prophylactic action requires consistent, daily use to build up therapeutic levels and prevent the initiation of the asthmatic response, rather than acting as a rescue medication during an acute attack.
Choice B rationale
Using cromolyn as soon as one feels like wheezing is incorrect because cromolyn is not a bronchodilator and does not provide immediate relief for acute bronchospasm. Its mechanism of action involves stabilizing mast cells, which prevents the degranulation and release of inflammatory mediators, thus preventing symptoms from occurring.
Choice C rationale
Expecting to feel better in a week is an inappropriate timeframe for assessing cromolyn's efficacy. The full prophylactic benefits of cromolyn may take several weeks of consistent use to become apparent. Patients should be educated on the preventative nature and delayed onset of action.
Choice D rationale
While cromolyn can be used prophylactically before exercise, using it 2 hours before playing softball is not the recommended timing. For exercise-induced bronchospasm, cromolyn is typically administered 15 to 30 minutes prior to the activity to allow for adequate absorption and mast cell stabilization before exertion.
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