Complete the following using the list of options.

The nurse is admitting a new client to the hall.

While looking at the orders, she notes a medication order for Lasix 40 mg PO daily.
The nurse knows that this is an example of?

Choice A rationale

Tolerance is a physiological adaptation to a drug, characterized by a decreased response to the same dose, or a need for increased doses to achieve the same effect. In this case, the increased dosage of morphine over several weeks indicates that the client's body has adapted to the drug's effects, requiring more to manage pain.

Choice B rationale

An adverse reaction is an undesirable and unintended effect of a drug, occurring at normal doses. While an increased dosage might lead to adverse effects, the described scenario specifically highlights the need for a higher dose to maintain efficacy, which is characteristic of tolerance, not simply an adverse reaction.

Choice C rationale

Idiosyncrasy refers to an unpredictable, uncharacteristic, or exaggerated response to a drug that is not an allergic reaction. It is typically a genetically determined abnormal response that occurs with initial exposure or after a few doses, unlike tolerance which develops over time with repeated exposure.

Choice D rationale

Polypharmacy refers to the concurrent use of multiple medications by a patient, often more than medically necessary. While the client is receiving medication, the scenario specifically describes a change in dosage of a single medication due to a diminished response, which is characteristic of tolerance, not polypharmacy.

Choice A rationale

The bell of the stethoscope is designed to auscultate low-frequency sounds, such as certain heart murmurs or bowel sounds, due to its larger surface area and lower diaphragm tension. Breath sounds, however, are generally higher frequency and require the diaphragm for optimal clarity and discrimination of adventitious sounds, which are often subtle and require careful attention to pitch and quality.

Choice B rationale

Limiting auscultation to only the posterior chest misses significant lung fields, especially the anterior and lateral segments of the upper and middle lobes. Comprehensive respiratory assessment necessitates evaluating all accessible lung surfaces to detect localized abnormalities, ensuring no consolidation, atelectasis, or pleural effusions are overlooked, providing a complete diagnostic picture.

Choice C rationale

Instructing the patient to breathe in and hold their breath would prevent the continuous airflow necessary to generate breath sounds. Auscultation relies on the movement of air through the tracheobronchial tree. Holding the breath eliminates this vital acoustic phenomenon, rendering the assessment ineffective for evaluating air entry, presence of adventitious sounds, or symmetry.

Choice D rationale

Comparing sounds on the left and right sides allows for the identification of unilateral abnormalities, which are crucial for diagnosing localized pathologies. This systematic approach helps detect differences in breath intensity, the presence of unilateral adventitious sounds like wheezes or crackles, or diminished air entry, guiding further diagnostic investigation and treatment.