A patient is postoperative after a cholecystectomy and is actively vomiting. The PACU nurse reviews the patient's current orders.
Which of the following medications is appropriate for the patient to receive?
IV Phenergan (Promethazine).
PO Zofran (Ondansetron).
Rectal Tylenol.
PO Ibuprofen.
The Correct Answer is A
Choice A rationale
Promethazine is an antihistamine with potent antiemetic properties often used in the postoperative setting to manage nausea and vomiting. The intravenous route is appropriate for a patient who is actively vomiting and unable to tolerate oral intake. By blocking dopamine receptors in the chemoreceptor trigger zone, it effectively reduces the vomiting reflex. Since the patient is in the PACU and actively emetic, parenteral administration ensures rapid onset of action and reliable systemic absorption.
Choice B rationale
Ondansetron is a highly effective 5-HT3 receptor antagonist used for postoperative nausea. however, the oral route is contraindicated for a patient who is actively vomiting. If a patient cannot keep fluids down, a pill or disintegrating tablet will likely be expelled before it can be absorbed in the gastrointestinal tract. In the immediate postoperative phase with active emesis, the nurse must prioritize non-oral routes, such as intravenous or intramuscular, to achieve therapeutic effects.
Choice C rationale
Acetaminophen administered rectally is an analgesic and antipyretic medication. While it bypasses the oral route, it does nothing to address the patient's primary distress, which is active vomiting. The question asks for an appropriate medication for a patient who is vomiting, and Tylenol lacks antiemetic properties. Using a rectal suppository for pain might be a secondary consideration, but it does not treat the underlying gastric distress or the risk of aspiration and dehydration.
Choice D rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug used for pain and inflammation. Like other oral medications, it is inappropriate for a patient experiencing active emesis. Furthermore, NSAIDs can cause gastric irritation, which might worsen the patient's nausea. In the postoperative period, especially following a cholecystectomy, maintaining a patent airway and stopping vomiting is the priority. Giving an oral medication during active vomiting is ineffective and increases the risk of the patient choking or inhaling vomitus.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E"]
Explanation
Choice A rationale
Spironolactone is a potassium-sparing diuretic that functions by antagonizing aldosterone receptors in the distal renal tubules. This action promotes the excretion of sodium and water while retaining potassium, which effectively reduces total body fluid volume. Therefore, a client taking this medication is at a significantly lower risk for fluid volume excess. In fact, they are more likely to experience fluid volume deficit or hyperkalemia, where normal potassium levels are 3.5 to 5.0 mEq/L.
Choice B rationale
Nasogastric suctioning involves the continuous or intermittent removal of gastric contents, including water, hydrochloric acid, and electrolytes like sodium and potassium. This process results in the loss of isotonic fluid from the extracellular compartment, putting the client at a high risk for fluid volume deficit rather than excess. Additionally, this loss can lead to metabolic alkalosis. Clients with nasogastric tubes require careful monitoring of intake and output to prevent dehydration and significant electrolyte imbalances.
Choice C rationale
Syndrome of inappropriate antidiuretic hormone involves the excessive release of ADH, which causes the kidneys to reabsorb high amounts of water regardless of serum osmolality. This leads to dilutional hyponatremia and a significant increase in total body water, resulting in fluid volume excess. Serum sodium levels in these clients often fall below the normal range of 135 to 145 mEq/L. The water retention expands the intravascular space, potentially leading to hypertension, edema, and weight gain.
Choice D rationale
Renal impairment significantly reduces the glomerular filtration rate, which is the ability of the kidneys to filter waste and excess fluid from the blood. When the kidneys cannot effectively excrete water and sodium, these substances accumulate in the systemic circulation, leading to hypervolemia. Normal creatinine levels are roughly 0.6 to 1.2 mg/dL; elevations indicate reduced function. This fluid retention can manifest as peripheral edema, pulmonary congestion, and increased blood pressure, making fluid management critical.
Choice E rationale
Heart failure occurs when the cardiac muscle cannot pump blood efficiently, leading to decreased cardiac output and subsequent activation of the renin-angiotensin-aldosterone system. This hormonal activation causes the kidneys to retain sodium and water to increase circulating volume, which the failing heart cannot handle. This cycle results in systemic and pulmonary venous congestion. Clients often present with jugular venous distention and crackles in the lungs, necessitating strict fluid restrictions and the use of diuretic therapy.
Correct Answer is A
Explanation
Choice A rationale
Hypoglycemia occurs when blood glucose levels fall below 70 mg/dL, and a level of 42 mg/dL is critically low. This client exhibits classic neuroglycopenic symptoms, including confusion, drowsiness, and irritability, alongside adrenergic signs like diaphoresis. Glipizide, a sulfonylurea, stimulates insulin secretion regardless of glucose levels, which often leads to prolonged hypoglycemia in patients with poor oral intake. Her age and reduced intake over two days significantly increased her risk for this specific metabolic crisis.
Choice B rationale
Diabetic ketoacidosis is characterized by extreme hyperglycemia, typically over 250 mg/dL, along with metabolic acidosis and ketone production. Patients usually present with Kussmaul respirations, a fruity breath odor, and dehydration. This patient’s blood glucose is 42 mg/dL, which is the opposite of the high levels seen in DKA. While confusion can occur in DKA due to acidosis, the low glucose reading and history of glipizide use point directly toward hypoglycemia rather than a state of insulin deficiency.
Choice C rationale
While confusion and irritability can be signs of a stroke, the rapid onset of symptoms in the presence of a known diabetic taking glipizide makes a metabolic cause more likely. Stroke symptoms are usually focal, such as one-sided weakness or facial drooping, which are not described here. Furthermore, the blood glucose reading of 42 mg/dL is an objective finding that explains her neurological status perfectly. It is standard practice to rule out hypoglycemia before diagnosing a stroke.
Choice D rationale
Hyperosmolar Hyperglycemic State is a complication of type 2 diabetes marked by severe hyperglycemia, often exceeding 600 mg/dL, and profound dehydration without significant ketosis. This client’s blood glucose of 42 mg/dL is far below the threshold for HHS. While HHS can cause altered mental status and confusion due to high serum osmolality, this patient’s presentation is dominated by the physiological effects of a sugar deficit, not the osmotic diuresis and high sugar levels characteristic of HHS.
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