After being treated in the emergency department for an opioid overdose two weeks ago, a client arrives to an outpatient treatment clinic. During the admission interview with the nurse, the client denies having a problem with opioid addiction, but admits to gradually increasing the dosage. Which approach is best for the nurse to make?

Recommend substituting opioids with other pain medication.

Explore other coping stategies aside from using medications.

Provide a list of local Narcotics Anonymous meetings.

Explain that opioid abuse poses a great risk to life.

Answer and Explanation

The Correct Answer is B

A. Recommend substituting opioids with other pain medication: Simply switching to another pain medication without addressing underlying misuse behaviors may reinforce dependency. This overlooks the denial and psychological aspects of addiction.

B. Explore other coping strategies aside from using medications: This client-centered approach gently addresses the issue without direct confrontation. It encourages self-reflection, promotes healthy alternatives, and meets the client where they are in terms of readiness for change, which is essential in early recovery.

C. Provide a list of local Narcotics Anonymous meetings: Although this is useful, offering it during the first interaction with a client in denial may lead to resistance. Engagement and trust-building through conversation about alternatives are more effective initially.

D. Explain that opioid abuse poses a great risk to life: Providing factual information about risk can be helpful, but directly labeling it as abuse when the client is in denial may trigger defensiveness. It is more therapeutic to explore behaviors and build insight before confrontation.

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Correct Answer is []

Explanation

Rationale for Correct Choices:

Myocardial infarct (MI): The client presents with chest pain described as pressure and tightness, which worsens over time. The ECG shows ST depression, a common sign of ischemia. This combined with the risk factors and vital signs support myocardial infarction.
Prepare client for possible percutaneous coronary intervention: If a myocardial infarction is suspected, preparing the client for PCI is critical. PCI is used to treat blockages in the coronary arteries, which is essential for restoring blood flow and minimizing myocardial damage.
Educate on nitroglycerin administration: Nitroglycerin helps alleviate chest pain by relaxing coronary arteries, reducing heart workload, and improving blood flow. It is used in MI management to relieve symptoms and reduce ischemia.
Electrocardiogram (ECG): Continuous ECG monitoring is essential to assess the progression of any arrhythmias or ischemic changes, which are common during an MI. It allows real-time identification of worsening conditions.
Chest pain: Monitoring chest pain closely helps evaluate the effectiveness of treatment and determine whether ischemia persists or resolves. Pain relief indicates that interventions are successful.

Rationale for Incorrect Choices:

Atrial fibrillation: While atrial fibrillation can cause chest discomfort, the patient’s clinical presentation, including ECG findings and risk factors, is more consistent with an MI. Atrial fibrillation usually presents with irregular heartbeats rather than persistent chest pressure.
Congestive heart failure: The current presentation, including chest pain, ECG changes, and pain unrelieved by rest, points to a myocardial infarction rather than congestive heart failure. There are no signs of fluid overload or symptoms associated with heart failure in this scenario.
New onset angina: While the client may experience angina, the unrelieved chest pain lasting for over 30 minutes and the severity of the symptoms suggest a myocardial infarction rather than just new onset angina, which typically resolves with rest.
Begin chest compressions: Chest compressions are necessary only in cases of cardiac arrest. While this client is experiencing chest pain and signs of an MI, there is no indication of cardiac arrest, so chest compressions are not appropriate at this point.
Consult physical therapy: Physical therapy is not immediately needed for the acute management of myocardial infarction. The priority is stabilizing the patient's cardiac status and addressing the ischemia, not physical rehabilitation.
Conduct a nutritional history: While a nutritional history is important for long-term heart disease management, it is not an immediate concern during an acute MI episode. The focus should be on stabilizing the patient and addressing the immediate cardiovascular issues.

Lung sounds: Lung sounds are not directly relevant to this patient's current condition. While they may be important for detecting complications like pulmonary edema, they are not a priority when assessing for an acute MI.
Pedal pulses: Pedal pulses can be useful in assessing peripheral circulation but are not a priority in the management of MI unless signs of shock or poor circulation are noted.
Intake and output: While monitoring intake and output is important for fluid balance, it is not the immediate focus for managing this patient’s acute MI. The focus should be on cardiac parameters and symptom relief, such as monitoring chest pain and ECG changes.

Correct Answer is ["1350"]

Explanation

Rationale:

Fluid resuscitation rate using the Parkland formula:

Calculate the total fluid volume needed for the first 24 hours.

The Parkland formula: 4 mL × client weight (kg) × % TBSA burned.

Client weight = 90 kg

TBSA burned = 45%

Total fluid volume = 4 mL × 90 kg × 45 = 16,200 mL

Determine the amount of fluid to be given in the first 8 hours.

According to the Parkland formula, half of the total fluid volume is administered in the first 8 hours from the time of the burn injury.

Fluid for first 8 hours = 16,200 mL / 2

= 8,100 mL

Calculate the infusion rate for the first 8 hours.

The burn occurred at 1000. The nurse arrives at 1200. This means 2 hours have already passed since the burn occurred within the initial 8-hour period.

Remaining time in the first 8 hours = 8 hours - 2 hours

= 6 hours.

Infusion rate (mL/hour) = Fluid for remaining first 8 hours / Remaining time in first 8 hours

= 8,100 mL / 6 hours

= 1350 mL/hour.

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Naxlex Comprehensive Predictor Exams

Correct Answer is []

Explanation

Correct Answer is ["1350"]

Explanation

A parent brings their child, who has a history of asthma, to the emergency room. The child is wheezing and speaking one word between each breath. The child is anxious, tachycardic, and has labored respirations. Which assessment is most important for the nurse to obtain?

Exhibits Choose the most likely options for the information missing from the statements by selecting from the lists of options provided. The nurse monitors the client's dropdownafter administering the morphine. The nurse should include dropdownto reduce complications of the client's injury.

An older adult male client arrives at the clinic reporting that his bladder always feels full. The client also reports a weak urine flow, frequent dribbling after voiding, and increasing nocturia with difficulty initiating the urine stream. Which action should the nurse implement?

The wife of a newly diagnosed client with Parkinson's disease asks the nurse if alternative or complimentary medical therapies might cure the disease. Which response should the nurse provide?

A pre-school age child with a congenital heart defect is brought to the clinic by the parent because of a fever and an earache. During the assessment, the parent asks the nurse why the child is at the 5th percentile for weight and height for age. Which response is best for the nurse to provide?

The nurse is speaking with the spouse of a client who has passed away unexpectedly. The spouse is very calm and says, "No, there must be a mistake." Which action should the nurse take?

The nurse is caring for a client with chronic kidney disease (CKD). Which meal selection should the nurse recommend to the client?