Which nursing action has the highest priority when administering a dose of codeine with acetaminophen to a client?
Tell the client to notify the nurse if the pain is not relieved.
Advise the client that the medication should start to work in about 30 minutes.
Administer a stool softener/laxative at the same time as the analgesic.
Instruct the client to request assistance when ambulating to the bathroom.
The Correct Answer is D
Choice A reason: Telling the client to notify the nurse if the pain is not relieved is an important nursing action, but it is not the highest priority. The nurse should assess the client's pain level before and after administering the medication, and evaluate its effectiveness. If the pain is not relieved, the nurse should report it to the prescriber and consider other interventions.
Choice B reason: Advising the client that the medication should start to work in about 30 minutes is an informative nursing action, but it is not the highest priority. The nurse should educate the client about the expected onset, peak, and duration of action of the medication, and how to take it safely and effectively. However, this does not address any immediate risks or needs of the client.
Choice C reason: Administering a stool softener/laxative at the same time as the analgesic is a preventive nursing action, but it is not the highest priority. The nurse should anticipate and prevent potential side effects of the medication, such as constipation, which can be caused by codeine. However, this does not address any urgent or emergent issues of the client.
Choice D reason: Instructing the client to request assistance when ambulating to the bathroom is the highest priority nursing action, as it addresses a serious safety concern of the client. The nurse should protect the client from falls and injuries, which can be caused by codeine's sedative and drowsy effects. The nurse should also monitor the client's respiratory rate and level of consciousness, as codeine can cause respiratory depression and altered mental status.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.1"]
Explanation
To find out how many mL of dalteparin are needed for 2500 units, we need to use a proportion formula:
- (units of dalteparin)/(mL of dalteparin) = (units of dalteparin prescribed)/(mL of dalteparin needed)
- We can plug in the values that we know into the formula:
- (5000 units)/(0.2 mL) = (2500 units)/(x mL)
- We can cross-multiply and solve for x:
- 5000x = 2500 x 0.2
- x = (2500 x 0.2)/5000
- x = 0.1
- Therefore, the nurse should administer 0.1 mL of dalteparin to deliver 2500 units of the medication.
Correct Answer is D
Explanation
Choice D reason: Probenecid is a uricosuric drug that increases the excretion of uric acid in the urine by inhibiting its reabsorption in the kidneys. Uric acid is a waste product that results from the breakdown of purines, which are found in certain foods and drinks, such as meat, seafood, beer, and wine. Probenecid is used to treat gout, a type of arthritis that occurs when uric acid crystals accumulate in the joints and cause inflammation, pain, swelling, and stiffness. By lowering uric acid levels in the blood, probenecid can prevent gout attacks and reduce joint damage.
Choice A reason: Increasing the strength of the urine stream is not a purpose of probenecid, but rather a possible effect of some medications that relax or dilate the urinary tract muscles, such as alpha-blockers or anticholinergics. These medications can help to improve urinary flow and reduce symptoms of benign prostatic hyperplasia (BPH), or enlarged prostate gland, which can cause difficulty urinating or weak urine stream.
Choice B reason: Preventing the formation of kidney stones is not a purpose of probenecid, but rather a potential benefit of some medications that lower calcium or oxalate levels in the urine, such as thiazide diuretics or potassium citrate. These medications can help to prevent calcium oxalate stones, which are one of the most common types of kidney stones. Kidney stones are hard deposits of minerals and salts that form in the kidneys and can cause severe pain, nausea, vomiting, and blood in the urine.
Choice C reason: Decreasing pain and burning during urination is not a purpose of probenecid, but rather a desired outcome of some medications that treat urinary tract infections (UTIs), such as antibiotics or phenazopyridine. These medications can help to eliminate the bacteria that cause UTIs and relieve the discomfort and inflammation that they cause. UTIs are infections that affect the bladder, urethra, or kidneys and can cause frequent or urgent urination, pain or burning during urination, cloudy or foul-smelling urine, and fever.

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