A nurse is reviewing the medication administration record for a client who has cancer and is receiving morphine via a PCA pump. Which of the following prescriptions should the nurse clarify with the provider?

Ondansetron

Nalbuphine

Insulin glargine

Acetaminophen

Answer and Explanation

The Correct Answer is B

B) Nalbuphine: Nalbuphine is an opioid analgesic that acts on the central nervous system to relieve pain. When administered concurrently with morphine, there is a risk of additive respiratory depression and other opioid-related side effects, such as sedation and hypotension. Therefore, the nurse should clarify the prescription for nalbuphine with the provider to ensure that the combination of opioid medications is appropriate for the client's pain management. Additionally, nalbuphine has mixed agonist-antagonist properties and can precipitate withdrawal symptoms in clients who are physically dependent on full opioid agonists like morphine. Due to these potential interactions and safety concerns, it is essential for the nurse to obtain clarification from the provider before administering nalbuphine to the client receiving morphine via a PCA pump.

A) Ondansetron: Ondansetron is an antiemetic medication commonly prescribed to manage nausea and vomiting, which can be side effects of opioid analgesics like morphine. There are no significant contraindications or interactions between ondansetron and morphine, making it a suitable choice for adjunctive therapy in clients receiving PCA morphine for cancer pain.

C) Insulin glargine: Insulin glargine is a long-acting insulin analog used to control blood glucose levels in clients with diabetes mellitus. While clients with cancer may have comorbidities such as diabetes, the prescription for insulin glargine is unlikely to require clarification in the context of concurrent morphine use. However, the nurse should verify the client's current blood glucose levels and adjust the insulin dosage as needed based on the client's glycemic control.

D) Acetaminophen: Acetaminophen is a non-opioid analgesic commonly used to manage mild to moderate pain. When used in combination with opioids like morphine, acetaminophen can provide additive pain relief and may reduce the total opioid dosage required. There are no significant contraindications or interactions between acetaminophen and morphine, making it a suitable choice for adjunctive pain management in clients receiving PCA morphine for cancer pain.

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Correct Answer is C

Explanation

Answer: C. Keep the solution refrigerated until 1 hr before infusion.

Rationale:

A. Change the solution every 36 hr:
Total parenteral nutrition (TPN) solutions should be changed every 24 hours to prevent contamination and bacterial growth. Therefore, changing the solution every 36 hours would not adhere to best practice guidelines.

B. Obtain the client's weight three times a week:
While monitoring the client’s weight is important, especially for those on TPN, it should be done daily to accurately assess fluid balance and nutritional status. This frequency allows for timely adjustments to the TPN regimen.

C. Keep the solution refrigerated until 1 hr before infusion:
This action is correct. TPN solutions must be refrigerated to maintain stability and prevent bacterial growth. Allowing the solution to come to room temperature for at least 1 hour before infusion helps ensure that the solution is at a safe and comfortable temperature for the client.

D. Check the client's WBC count daily:
While monitoring the WBC count can be important for detecting infection, it is not a standard daily requirement specifically related to TPN administration. The priority is to focus on monitoring the client's nutritional status and fluid balance more closely during TPN therapy

A. The client has an increased creatinine level. B. The client is experiencing hypotension. C. The client's IV site is red and edematous. D. The c’ient reports ringing in their ears.

Correct Answer is B

Explanation

A) The client has an increased creatinine level: While an increased creatinine level may indicate renal impairment, it is not specific to a vancomycin infusion reaction. Elevated creatinine levels may occur due to various factors, including underlying kidney disease or dehydration.

B) The client is experiencing hypotension: This is the correct answer. Hypotension, or low blood pressure, can be a manifestation of a vancomycin infusion reaction. Vancomycin infusion reactions may include anaphylaxis or anaphylactoid reactions, which can lead to systemic vasodilation and subsequent hypotension.

C) The client's IV site is red and edematous: Redness ’nd edema at the IV site may indicate phlebitis or infiltration, which are local complications rather than systemic reactions to vancomycin infusion.

D) The client reports ringing in their ears: Ringing in the ears, also known as tinnitus, is a potential side effect of vancomycin, particularly with high doses or prolonged use. However, it is not specific to a vancomycin infusion reaction and may occur independently of the infusion process.

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A nurse is reviewing the medication administration record for a client who has cancer and is receiving morphine via a PCA pump. Which of the following prescriptions should the nurse clarify with the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer total parenteral nutrition to a client. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

Rationale:

A nurse is caring for a client who is receiving vancomycin by IV infusion over 30 min. Which of the following findings indicate the clien experiencing a vancomycin infusion reaction?

Correct Answer is B

Explanation

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