A patient is ready for discharge home from a lengthy hospital stay after a motor vehicle accident. The patient suffered multiple fractures and required large doses of morphine for several weeks. The nurse preparing the patient for discharge notes that the patient requests the maximum dose of the oral opioid analgesic at the exact intervals it is prescribed. The nurse is correct to suspect what has occurred?

Drug tolerance

Compulsive drug seeking

Cross-tolerance

Physical dependence

Answer and Explanation

The Correct Answer is A

A. Drug tolerance: Tolerance occurs when the body adapts to a drug, requiring higher or maximum doses to achieve the same therapeutic effect. The patient’s consistent request for the maximum prescribed dose at regular intervals reflects the body’s reduced response after prolonged opioid use.

B. Compulsive drug seeking: Compulsive drug-seeking behavior is characteristic of addiction, in which a patient prioritizes drug use despite harm. In this case, the patient is using opioids as prescribed without out-of-control behavior.

C. Cross-tolerance: Cross-tolerance occurs when tolerance to one drug confers tolerance to another drug in the same or related class. While opioids can cause cross-tolerance, the scenario only highlights reduced effectiveness of the prescribed opioid, not cross-reaction.

D. Physical dependence: While possible after prolonged opioid use, the key finding here is the need for higher dosing at exact intervals, which points more specifically to tolerance rather than dependence.

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Free Nursing Study Resources

Correct Answer is B

Explanation

A. BUN: Blood urea nitrogen reflects kidney function and hydration status, not infection. Elevated BUN levels are usually associated with dehydration or renal impairment rather than a pressure ulcer infection.

B. WBC count: An elevated white blood cell count indicates the body’s immune response to infection. In the context of a pressure ulcer, an increase suggests the presence of local or systemic infection that requires intervention.

C. RBC count: Red blood cell levels reflect oxygen-carrying capacity and are related to anemia or blood loss. An elevated or decreased RBC count does not directly indicate infection.

D. Potassium: Potassium levels are associated with electrolyte balance and cardiac or neuromuscular function. Changes in potassium do not provide direct evidence of infection in a client with a pressure ulcer.

A. "Tilt your head toward your chest." B. "Keep your knees straight." C. "Keep your back straight." D. "Loosen your abdominal muscles."

Correct Answer is C

Explanation

A. "Tilt your head toward your chest.": Tilting the head down places strain on the neck and upper spine, increasing the risk of musculoskeletal injury. Proper body mechanics require keeping the head aligned with the spine and facing forward.

B. "Keep your knees straight.": Keeping the knees locked creates excessive pressure on the back during lifting or transferring clients. Proper posture involves bending the knees slightly to use the leg muscles for support rather than straining the lower back.

C. "Keep your back straight.": Maintaining a straight back ensures correct spinal alignment, reduces the risk of back injuries, and promotes safe body mechanics during client transfers. It allows the larger leg muscles to do the lifting instead of the spine.

D. "Loosen your abdominal muscles.": Abdominal muscles should be engaged, not loosened, when lifting or transferring. Tightening the core provides stability and helps protect the spine from injury by distributing the workload more evenly.

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing the laboratory results of a client who has a pressure ulcer. The nurse should identify an elevation in which of the following laboratory values as an indication that the client has developed an infection?

Correct Answer is B

Explanation

A nurse is teaching a newly licensed nurse about maintaining correct posture when transferring clients. Which of the following statements should the nurse make?

Correct Answer is C

Explanation

A nurse is teaching a client who is at 23 weeks of gestation about immunizations. Which of the following statements should the nurse include in the teaching?

A nurse on a medical unit is assessing four clients for urinary retention. Which of the following clients have manifestations of urinary retention?

A nurse in a pediatric clinic is caring for a child who has iron deficiency anemia and a new prescription for ferrous sulfate tablets. Which of the following instructions should the nurse provide the parents regarding administration of this medication?

The nurse is assessing a patient who is malnourished and has a history of poor nutrition. The patient reports difficulty seeing at night. This patient is likely to be deficient in which fat-soluble vitamin?

A nurse is assessing a client's wound dressing, and observes a watery red drainage. The nurse should document this drainage as which of the following?

Which B vitamin deficiency is associated with cheilosis, glossitis, vascularization of the cornea, and itchy dermatitis of the scrotum and vulva?

A nurse is teaching a client who has diabetic neuropathy about foot care. Which of the following instructions should the nurse include?

A nurse is caring for a client who reports insomnia. The nurse should monitor the client for which of the following adverse effects of sleep deprivation? (Select all that apply.)