The nurse notes that a client has been receiving hydromorphone every six hours for four days. Which assessment is most important for the nurse to complete?

Auscultate the client's bowel sounds. B. Observe for edema around the ankles.

Count the apical and radial pulses simultaneously.

Measure the client's capillary glucose level.

Answer and Explanation

The Correct Answer is A

Hydromorphone is an opioid analgesic that can cause constipation as a side effect by slowing down gastrointestinal motility. Prolonged use of opioids, such as hydromorphone, increases the risk of developing opioid-induced constipation (OIC), which can lead to discomfort, bowel obstruction, and other complications if left untreated.

B. Edema is not typically associated with hydromorphone use, especially when administered for a short duration.

C. Hydromorphone administration is not typically associated with significant alterations in heart rate or rhythm, especially when administered at appropriate doses.

D. hydromorphone administration is not typically associated with alterations in blood glucose levels. Therefore, assessing capillary glucose levels may not be the most relevant assessment in this scenario.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is C

Explanation

C. In the case of oral candidiasis, using a toothbrush with soft bristles is essential to prevent further irritation and damage to the already compromised oral mucosa.

A. Offering the client mouthwash for thorough cleansing after brushing teeth might not be appropriate. Many commercial mouthwashes contain alcohol, which can further irritate the oral mucosa and exacerbate the symptoms of oral candidiasis.

B. Assisting with personal care but leaving oral care for the nurse to complete is not the best option. Oral care is an essential aspect of hygiene, especially for someone with oral candidiasis.

D. Oral candidiasis is a fungal infection that is not typically transmitted through contact,

A. pH 7.30, PCO, 20 mm Hg, HCO, 22 mEq/L (22 mmol/L), PO, 85 mm Hg. B. pH 7.46, PCO, 55 mm Hg, HCO, 36 mEq/L (36 mmol/L), PO, 95 mm Hg. C. pH 7.49, PCO, 45 mm Hg, HCO, 32 mEq/L (32 mmol), PO, 90 mm Hg. D. pH 7.29, PCO, 35 mm Hg, HCO, 25 mEq/L (25 mmol/L), PO, 99 mm Hg.

Correct Answer is B

Explanation

B. pH 7.46, PCO2 55 mm Hg, HCO3 36 mEq/L, PO2 95 mm Hg

The pH is high (alkalotic).

The HCO3 level is elevated, indicating metabolic alkalosis.

The PCO2 is high (respiratory acidotic picture due to secondary response). This option matches the criteria for metabolic alkalosis.

A. pH 7.30, PCO2 20 mm Hg, HCO3 22 mEq/L, PO2 85 mm Hg

The pH is low (acidic), not alkalotic.

The HCO3 level is within the normal range.

The PCO2 is low, which could indicate respiratory alkalosis. This option does not match the criteria for metabolic alkalosis.

C. pH 7.49, PCO2 45 mm Hg, HCO3 32 mEq/L, PO2 90 mm Hg The pH is high (alkalotic).

The HCO3 level is elevated, indicating metabolic alkalosis. The PCO2 is within the normal range.

This option does not meet the criteria for metabolic alkalosis D pH 7.29, PCO2 35 mm Hg, HCO3 25 mEq/L, PO2 99 mm Hg

The pH is low (acidic), not alkalotic. The HCO3 level is low, not elevated. The PCO2 is within the normal range.

This option does not match the criteria for metabolic alkalosis.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse notes that a client has been receiving hydromorphone every six hours for four days. Which assessment is most important for the nurse to complete?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An adult client is admitted with AIDS and oral Candide albicans manifested by several painful mouth ulcers. The nurse delegates oral care to the unlicensed assistive personnel (UAP) and discusses how to assist the client. Which instruction should the nurse provide to the UAP?

Correct Answer is C

Explanation

Correct Answer is B

Explanation

A client who has had a laryngectomy and tracheostomy frequently expectorates copious amounts of purulent secretions. When changing the lies of the tracheostomy tube, which action is most important for the nurse to take?

Which instruction should the nurse include in the discharge teaching plan for an adult client with hypernatremia?

Which approach is best for the nurse to use when directing a client with Huntington's disease to the hospital cafeteria?

A client with open-angle glaucoma asks the nurse how long the prescribed eye drops will need to be used. Which response made by the nurse is accurate?

Patient Data Exhibits What order(s) would the nurse question? (Select all that apply.)

An older adult client is hospitalized with a fractured femur. During a routine nursing assessment, the client repeatedly asks the nurse to "speak up" so that the client can hear the questions. Which action is best for the nurse to take?

To assess the quality of an adult client's pain, which approach should the nurse use?