You are taking care of 4 clients who are receiving opioid analgesics for pain management. Which patient is MOST likely to be experiencing a life-threatening opioid side effect?

Patient with respiratory rate of 10 breaths/min who is breathing deeply.

Patient with a respiratory rate of 8 breaths/min who is snoring.

Patient with blood pressure of 150/75 mm Hg and heart rate of 102 beats/min.

Patient with a temperature of 100.5°F who is asleep but easily roused.

Answer and Explanation

The Correct Answer is B

Choice A reason: A respiratory rate of 10 breaths/min with deep breathing is low but less concerning than 8 breaths/min with snoring, indicating potential airway obstruction. Respiratory depression is the primary opioid risk, making this incorrect compared to the more severe respiratory compromise.

Choice B reason: A respiratory rate of 8 breaths/min with snoring suggests severe opioid-induced respiratory depression, a life-threatening side effect requiring immediate intervention. This aligns with opioid safety monitoring, making it the correct patient most likely experiencing a critical opioid adverse effect.

Choice C reason: Elevated blood pressure and heart rate suggest pain or stress, not respiratory depression, the primary opioid danger. A low respiratory rate with snoring is more critical, making this incorrect, as it doesn’t indicate a life-threatening opioid side effect.

Choice D reason: A temperature of 100.5°F and being easily roused suggest mild fever, not respiratory depression. Snoring with a rate of 8 breaths/min is more dangerous, making this incorrect, as it doesn’t reflect a life-threatening opioid effect in the patient.

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Correct Answer is D

Explanation

Choice A reason: Cough suppressants may reduce discomfort but don’t address hypoxia risk during thoracentesis in COPD exacerbation. Oxygen application ensures safety, making this incorrect, as it doesn’t prioritize respiratory support needed for the client undergoing a procedure affecting lung function.

Choice B reason: A prone position is unsafe for thoracentesis, which requires an upright or side-lying position to access pleural fluid. Oxygen supports breathing, making this incorrect, as it risks procedural complications compared to ensuring oxygenation for the COPD client’s safety.

Choice C reason: Arterial blood gases post-procedure assess respiratory status but aren’t the primary safety intervention during thoracentesis. Oxygen prevents hypoxia, making this secondary and incorrect compared to the immediate need for respiratory support in the COPD client undergoing the procedure.

Choice D reason: Applying oxygen via nasal cannula ensures adequate oxygenation during thoracentesis, critical for a COPD client with exacerbation prone to hypoxia. This aligns with procedural safety protocols, making it the correct intervention to maintain client safety during the pleural fluid removal.

A. Coffee. B. Chocolate. C. Peppermint. D. Nonfat milk. E. Fried chicken. F. Scrambled eggs.

Correct Answer is ["A","B","C","E"]

Explanation

Choice A reason: Coffee, caffeinated or decaf, relaxes the esophageal sphincter and irritates the mucosa, worsening GERD. This aligns with dietary restrictions, making it a correct substance the nurse would teach the client to avoid to prevent GERD symptom exacerbation.

Choice B reason: Chocolate contains methylxanthines and fat, relaxing the esophageal sphincter and triggering GERD symptoms. This aligns with GERD dietary guidelines, making it a correct item the nurse would include for the client to avoid to reduce reflux.

Choice C reason: Peppermint relaxes the lower esophageal sphincter, increasing acid reflux in GERD. This aligns with dietary teaching, making it a correct substance the nurse would advise the client to avoid to minimize GERD symptom flare-ups effectively.

Choice D reason: Nonfat milk is less likely to trigger GERD, as high-fat dairy worsens reflux. Coffee is a stronger trigger, making this incorrect, as it’s not a primary substance the nurse would include on the GERD avoidance list.

Choice E reason: Fried chicken, high in fat, delays gastric emptying and exacerbates GERD symptoms. This aligns with dietary restrictions, making it a correct item the nurse would teach the client to avoid to prevent GERD symptom exacerbation.

Choice F reason: Scrambled eggs are low-fat and unlikely to trigger GERD compared to chocolate or coffee. This is incorrect, as it’s not a primary substance the nurse would include on the list of items to avoid for GERD management.

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You are taking care of 4 clients who are receiving opioid analgesics for pain management. Which patient is MOST likely to be experiencing a life-threatening opioid side effect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with exacerbation of chronic obstructive pulmonary disease (COPD) is scheduled for a thoracentesis. Which nursing intervention would be appropriate for client safety?

Correct Answer is D

Explanation

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items would the nurse include on this list? (Select all that apply)

Correct Answer is ["A","B","C","E"]

Explanation

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