Four hours after administering promethazine to a male patient, the practical nurse (PN) takes his temperature.
When the patient asks the PN about the reason for taking his temperature, how should the PN respond?
Encourage the patient to share his concerns about the care plan.
Explain the need to assess for medication side effects.
Assure that vital signs are routinely taken every four hours.
Describe how the medication works to lower body temperature.
None
None
The Correct Answer is B
Choice A rationale
Encouraging the patient to share his concerns about the care plan is important, but it does not directly address the patient’s question about why his temperature is being taken.
Choice B rationale
Promethazine is a medication that can cause a variety of side effects, including changes in body temperature. Therefore, monitoring the patient’s temperature can help assess for potential side effects of the medication. This is the most direct and relevant response to the patient’s question.
Choice C rationale
While it’s true that vital signs are often taken routinely, this does not specifically address why the patient’s temperature is being taken in this particular instance, four hours after
administering promethazine.
Choice D rationale
While promethazine can affect body temperature, it is not primarily used to lower body
temperature. Therefore, explaining that the medication works to lower body temperature may not be entirely accurate or relevant in this context.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Mouth dryness is not a typical therapeutic result of minoxidil. It’s not listed as a common side effect either.
Choice B rationale
Dizziness is a known side effect of minoxidil. It can occur when the medication causes a drop in blood pressure, leading to lightheadedness or dizziness.
Choice C rationale
An elevated blood glucose level is not related to the administration of minoxidil. It could be an unrelated finding, possibly indicating another condition like diabetes.
Choice D rationale
Pain rated at 1/10 is not directly related to the therapeutic effect or side effects of minoxidil. It could be an unrelated finding.
Correct Answer is A
Explanation
Choice A rationale
If a child undergoing a blood transfusion complains of itchy skin and appears flushed, these
could be signs of a transfusion reaction. The PN should stop the transfusion immediately.
Choice B rationale
While inspecting the infusion site is a part of regular monitoring during a transfusion, it would
not typically be the first action in response to symptoms of a possible transfusion reaction.
Choice C rationale
Applying lotion to the skin would not address the underlying issue if the child is experiencing a
transfusion reaction.
Choice D rationale
Checking the vital signs is important, but the first action should be to stop the transfusion if a
reaction is suspected.
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