The client is a 42-year-old female who had a right above-the- knee amputation for osteomyelitis. The client has a drain in place and a surgical dressing that will need to be changed by the surgeon on post-op day 1. What actions should the nurse take to assure safety morphine administration? Select all that apply.

Suction the client to clear the airway

Restrain the client with soft restraints

Perform a 12-lead electrocardiogram

Have a manual resuscitation bag at the bedside

Ask the client about other medications she takes

Take an initial respiratory rate

Answer and Explanation

Correct Answer : E,F

A. Suctioning the client to clear the airway is not directly related to the administration of morphine and is typically not a routine precaution unless the patient has a specific need.
B. Using soft restraints is not a standard safety measure for morphine administration and could be considered if the patient has a history of confusion or agitation, but there is no such indication in this scenario.
C. Performing a 12-lead electrocardiogram is not a standard procedure for ensuring the safe administration of morphine and is usually done for cardiac assessment.
D. Having a manual resuscitation bag at the bedside is a good practice in case of an emergency but is not specific to morphine administration safety.
E. Asking the client about other medications she takes is crucial to prevent drug interactions, as morphine can interact with many medications, potentially leading to adverse effects.
F. Taking an initial respiratory rate is important because morphine can cause respiratory depression, and it is essential to have a baseline to monitor for any changes after administration.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

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Correct Answer is C

Explanation

A. Center attention on positive upbeat music . While positive music can be helpful for some individuals in managing anxiety, it may not be effective for everyone, especially those experiencing moderate anxiety.

B. Find outlets for more social interaction: Increasing social interaction may be beneficial for managing anxiety for some individuals, but it may not address the underlying issues contributing to recurrent moderate anxiety.

C. Practice using muscle relaxation techniques: Muscle relaxation techniques, such as progressive muscle relaxation or deep breathing exercises, can help reduce physical tension and promote relaxation, which can be effective in managing anxiety symptoms.

D. Think about reasons the episodes occur: While understanding triggers for anxiety episodes is important, simply thinking about the reasons may not provide immediate relief or effective coping strategies for managing anxiety symptoms.

A. Reposition the infant every 2 hours: B. Cover with a receiving blanket. C. Perform diaper changes under the light. D. feed the infant every 4hours

Correct Answer is A

Explanation

A. Reposition the infant every 2 hours: This ensures that all areas of the infant's skin receive equal exposure to the phototherapy light, which is important for the effective treatment of jaundice.

B. Cover with a receiving blanket: This is incorrect because the phototherapy light needs to reach the infant's skin directly. Covering the infant with a blanket would block the light and reduce the effectiveness of the treatment.

C. Perform diaper changes under the light: While it is important to minimize the time the infant is away from the phototherapy light, diaper changes should be done quickly and efficiently, not necessarily under the light, to ensure cleanliness and to prevent any potential discomfort or safety issues.

D. Feed the infant every 4 hours: Feeding the infant is important, but the frequency of feeding should be based on the infant's needs and not specifically tied to the phototherapy schedule. Additionally, frequent feeding can help promote bowel movements, which can aid in the excretion of bilirubin.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing education to a client who experiences recurrent levels of moderate anxiety to situations and perceived stress. In addition to information about prescribed medication and administration, which instruction should the nurse include in the teaching?

Correct Answer is C

Explanation

Correct Answer is A

Explanation

A client with obstructive sleep apnea (OSA ambulates in the hallway with the nurse prior to bedtime and then returns to bed. Which intervention is most important for the nurse to implement before leaving the client?

Three hours after birth, a newborn becomes jittery and tachypneic. What should the nurse do first?

Patient data Exhibits The nurse is reviewing the orders for the infant of a diabetic mother to determine priorities Which 6 orders take priority?

The nurse is preparing a 50 mL dose of 50% Dextrose IV for a client with insulin shock. How should the nurse administer the medication?

At the end of a preoperative teaching session on pain management techniques, a client starts to cry and states. "I just know I can't handle all the pain." Which is the priority nursing problem for this client?

Days after surgical fixation of a fractured femur, a client suddenly reports chest pain and difficulty in breathing. The nurse suspects that the client had a pulmonary embolus. Which action should the nurse take first?

To auscultate for a carotid bruit, the nurse places the stethoscope at what location (Select the correct location on the image. To change, click on a new location.)