An unconscious patient was admitted to the emergency department.
The patient was found to have consumed multiple drugs including acetaminophen, opiates, benzodiazepines, and others that are unknown.
The patient was given naloxone (Narcan), flumazenil (Romazicon), and activated charcoal. What precautions should be taken for the patient? (Select all that apply)

Seizure precautions

Aspiration precautions

Suicide precautions

Fall precautions

Answer and Explanation

Correct Answer : A,B,D

Choice A rationale:

Seizure precautions are necessary because:

The patient has ingested multiple drugs, some of which can lower the seizure threshold, such as benzodiazepines. Naloxone, while reversing opioid overdose, can also precipitate seizures in some individuals.

Flumazenil, used to reverse benzodiazepine overdose, can also induce seizures, especially in patients with a history of epilepsy or benzodiazepine dependence.

The potential for drug interactions and unpredictable effects of multiple drug ingestion further increases the risk of seizures. Specific seizure precautions include:

Placing the patient in a bed with padded side rails. Having oxygen and suction equipment readily available.

Keeping intravenous access open for potential administration of anticonvulsant medications. Closely monitoring the patient's neurological status for any signs of seizure activity.

Choice B rationale:

Aspiration precautions are crucial due to:

The patient's unconscious state, which impairs their ability to protect their airway.

The possibility of vomiting, which can occur as a side effect of naloxone or flumazenil administration.

The potential for aspiration of gastric contents, which can lead to serious respiratory complications, such as pneumonia. Specific aspiration precautions include:

Positioning the patient on their side in the recovery position. Continuously monitoring the patient's respiratory status.

Having suction equipment ready to clear the airway if necessary.

Considering intubation and mechanical ventilation if the patient's airway is compromised.

Choice D rationale:

Fall precautions are essential because:

The patient is unconscious and may be disoriented or uncoordinated upon regaining consciousness.

The effects of the ingested drugs, as well as the medications administered, can impair balance and coordination. Falls can result in serious injuries, such as head trauma or fractures.

Specific fall precautions include:

Keeping the bed in a low position with side rails up.

Assisting the patient with ambulation when they are able to move. Ensuring the patient's environment is free of tripping hazards.

Providing close supervision and assistance as needed.

Choice C rationale:

Suicide precautions are not routinely implemented in this scenario because:

The patient's primary presentation is drug overdose, not active suicidal ideation or attempts.

The focus of care is on addressing the immediate medical complications of the overdose and stabilization.

However, a thorough suicide risk assessment should be conducted once the patient is medically stable to determine if ongoing suicide precautions are necessary.

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Correct Answer is A

Explanation

Choice A rationale:

Propylthiouracil (PTU) is a thionamide medication that inhibits the synthesis of thyroid hormones. It is the preferred drug for presurgical treatment of Graves' disease because it effectively lowers thyroid hormone levels and reduces the risk of thyroid storm, a life-threatening complication that can occur during or after surgery.

PTU acts by blocking the enzyme thyroid peroxidase, which is essential for the production of thyroid hormones. It also inhibits the conversion of thyroxine (T4) to triiodothyronine (T3), the more active form of thyroid hormone. This results in a decrease in circulating levels of both T4 and T3, leading to a reduction in the symptoms of hyperthyroidism.

PTU is typically started at a dose of 100-300 mg daily, divided into two or three doses. The dose is then adjusted based on the patient's response and thyroid hormone levels. The goal of treatment is to achieve a euthyroid state, which means that the thyroid hormone levels are within the normal range.

PTU is generally well-tolerated, but it can cause some side effects, including skin rash, itching, nausea, vomiting, abdominal pain, joint pain, and hair loss. In rare cases, it can also cause serious side effects, such as liver damage and agranulocytosis (a decrease in white blood cells).

Choice B rationale:

Liotrix (Thyrolar) is a combination of synthetic T4 and T3 hormones. It is not used for presurgical treatment of Graves' disease because it can worsen the symptoms of hyperthyroidism.

Choice C rationale:

Propranolol (Inderal) is a beta-blocker medication that can be used to control the symptoms of hyperthyroidism, such as tachycardia, tremor, and anxiety. However, it does not lower thyroid hormone levels and is not used for presurgical treatment of Graves' disease.

Choice D rationale:

Levothyroxine sodium (Synthroid) is a synthetic T4 hormone. It is used to treat hypothyroidism, but it is not used for presurgical treatment of Graves' disease.

A. Breakfast B. Supper C. Lunch D. Snack

Correct Answer is A

Explanation

Choice A rationale:

Regular insulin peaks within 2-4 hours after administration. Therefore, to prevent hypoglycemia due to the insulin administered at 0700, the client should eat breakfast within 1-2 hours of insulin administration. This will ensure that there is glucose available in the bloodstream to match the insulin's action and prevent blood sugar levels from dropping too low.

Breakfast is the most important meal of the day, especially for individuals with diabetes. It helps to regulate blood sugar levels throughout the morning and can even help with weight management and overall health.

Skipping breakfast can lead to fluctuations in blood sugar levels and increase the risk of hypoglycemia, especially after insulin administration.

Choice B rationale:

Supper, typically consumed in the evening, would not be timely enough to prevent hypoglycemia due to the 0700 insulin administration. The insulin's peak action would have already subsided by that time, and the client would be at risk for hyperglycemia (high blood sugar) instead.

Choice C rationale:

Lunch, typically consumed around noon, would also be too late to prevent hypoglycemia from the 0700 insulin administration. The insulin's peak action would have already passed, and the client would be more likely to experience hyperglycemia.

Choice D rationale:

A snack, while it can provide some glucose, is not a substitute for a balanced meal like breakfast. Snacks often contain less protein and fiber, which are essential for slowing down glucose absorption and maintaining blood sugar stability. Relying solely on snacks to prevent hypoglycemia is not a reliable strategy for long-term blood sugar management.

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Naxlex Comprehensive Predictor Exams

A patient with Graves’ disease exhibits symptoms of tachycardia, heat intolerance, and exophthalmos. Which drug is used to alter thyroid hormone levels prior to surgery?

Correct Answer is A

Explanation

The nurse has administered 12 units of regular insulin to a client with type 1 diabetes at 0700. Which meal would prevent the client from experiencing hypoglycemia due to this administration?

Correct Answer is A

Explanation

A patient has been prescribed levothyroxine (Synthroid) for hypothyroidism. The patient inquires if the medication should be taken with food.What would be the most appropriate response from the nurse?

Which patient’s condition would raise concerns regarding the administration of labetalol (Normodyne)?

For which of the following patients would the RN anticipate an order for sodium bicarbonate IVP?

Which medication is recognized by the Registered Nurse (RN) as a dilator for both arteries and veins?

A patient who is experiencing chest pain and shortness of breath is brought to the emergency department.The nurse assesses a heart rate of 98 beats per minute, bilateral lung crackles, and an oxygen saturation of 90%. What will the nurse expect to administer initially to this patient?

A patient was admitted to the intensive care unit with cardiogenic shock and a blood pressure of 78/38. Which vasopressor medication does the nurse identify as the first-line treatment for cardiogenic shock?