The practical nurse (PN) is caring for a client with fractured metatarsals after slamming a hand in the car door. After administering the prescribed hydrocodone/acetaminophen for pain, which intervention should the PN include in the client's care?
Implement ongoing assessments for signs of shallow or slow breathing.
Assess the skin daily for areas of ecchymosis or other signs of bleeding.
Encourage the client to resume normal activities after medication administration.
Observe the client for involuntary movements of the lips and tongue.
The Correct Answer is A
Choice A rationale:
After administering hydrocodone/acetaminophen for pain, the PN should closely monitor the client for signs of respiratory depression, which may manifest as shallow or slow breathing.
Ongoing assessments are crucial because respiratory depression is a potential adverse effect of opioid medications like hydrocodone. If this complication is detected early, appropriate interventions can be implemented to ensure the client's safety.
Choice B rationale:
Assessing the skin daily for areas of ecchymosis or other signs of bleeding is not directly related to the administration of hydrocodone/acetaminophen. While bruising and bleeding are possible side effects of some medications, this assessment is not the priority in this scenario.
Choice C rationale:
Encouraging the client to resume normal activities after medication administration is not appropriate in this situation. Hydrocodone/acetaminophen can cause drowsiness and impairment, so the client should be advised to avoid activities that require alertness or coordination until the effects of the medication are known.
Choice D rationale:
Observing the client for involuntary movements of the lips and tongue is relevant when administering antipsychotic medications, as these movements may be signs of tardive dyskinesia. However, it is not directly related to the use of hydrocodone/acetaminophen. The priority after administering this pain medication is to monitor for respiratory depression, as opioids can affect the respiratory system
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
PVCs are abnormal heartbeats that occur when a ventricle contracts earlier than expected. They can indicate electrolyte imbalance, such as hypokalemia, which can result from NG suctioning. The PN should report this finding to the healthcare provider, as it may require treatment or adjustment of the suctioning.
The other options are not correct because:
A. Hyperactive bowel sounds on assessment may indicate increased peristalsis or bowel obstruction, but they are not related to the client's symptoms or NG suctioning.
C. Hypoactive bowel sounds on assessment may indicate decreased peristalsis or ileus, which are expected after bowel surgery and do not require immediate intervention.
D. Regular heart rate of 100 beats per minute on telemetry may indicate tachycardia, which can have various causes, but it is not as concerning as PVCs in this context.
Correct Answer is ["A","C","D"]
Explanation
The correct answers are:
A. Oatmeal is a good choice for breakfast.
C. Add lentils and black beans to soups.
D. Increase green leafy vegetables in the diet. Choice A rationale:
Oatmeal is a good choice for breakfast because it is a vegetarian option that is rich in iron. It contains non-heme iron, which is the type of iron found in plant-based foods. Non-heme iron may not be as easily absorbed as heme iron (found in animal products), but it can still contribute to increasing iron levels in the body, especially when combined with other sources of iron.
Choice B rationale:
Eat red meat just until the anemia is resolved is not a suitable instruction for a vegetarian client. Red meat is a source of heme iron, which is not part of a vegetarian diet. While heme iron is more easily absorbed by the body, there are other plant-based sources of iron that can be recommended to the client without compromising their dietary preferences.
Choice C rationale:
Lentils and black beans are excellent choices for a vegetarian client to increase iron intake. Both foods are rich in iron, and they also contain other nutrients that aid in iron absorption, such as vitamin C. Including lentils and black beans in soups can be a tasty and nutritious way to enhance iron intake.
Choice D rationale:
Increasing green leafy vegetables in the diet is another appropriate recommendation for a vegetarian client. Green leafy vegetables, such as spinach and kale, contain non-heme iron, as well as other essential vitamins and minerals that contribute to overall health. Combining them with vitamin C-rich foods can enhance iron absorption.
Choice E rationale:
Take two prenatal vitamins with iron daily is not necessary since the healthcare provider already prescribed one prenatal vitamin with iron daily. Taking additional supplements without medical advice can lead to an excessive intake of certain nutrients, which may have adverse effects on health.
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