How it Works
Try Naxlex NCLEX-RN (Free-Trial)

You are the PACU nurse that is caring for a client who has been receiving frequent doses of IV Morphine Sulfate, and opioid pain medication, for post-operative pain. Upon reassessment of the patient you find them unarousable with a decreased level of consciousness, snoring respirations at 10 breaths per minute, and an oxygen saturation of 89%. What should be your first intervention?

A.

Administer oxygen at 4 liters per minute via nasal cannula

B.

Administer Naloxone via IV push

C.

Open the patient's airway with a head tilt.

D.

Place them in the shock position with legs elevated

Answer and Explanation

The Correct Answer is B

A. Administering oxygen is important, but the priority is reversing the opioid-induced respiratory depression with naloxone. Oxygen alone will not address the underlying cause of the decreased level of consciousness.  
B. Administering naloxone (Narcan) is the priority intervention because it is an opioid antagonist that will reverse the effects of morphine and other opioids, improving respiratory function and consciousness.  
C. Opening the airway is important, but the primary issue here is opioid overdose, which requires naloxone administration for reversal of respiratory depression.  
D. Placing the patient in the shock position is not indicated in this scenario. The focus should be on reversing opioid toxicity, not on positioning for shock.


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

Naxlex Comprehensive Predictor Exams

Free Nursing Study Resources

Related Questions

Correct Answer is D

Explanation

A. Encouraging the client to void every 5-6 hours is not appropriate for preventing complications in chronic pyelonephritis. Regular voiding every 2-3 hours is recommended to prevent urinary stasis and bacterial growth.
B. Limiting fluid intake to 1.5L/day is counterproductive in chronic pyelonephritis, as it increases the risk of concentrated urine and urinary tract infections.
C. While decreasing sodium intake may be beneficial in other conditions, it is not directly relevant to managing chronic pyelonephritis. The focus is on maintaining adequate hydration.
D. Increasing fluid intake to at least 3 L/day helps dilute the urine, reduce bacterial concentration, and flush out the urinary system, which is essential for managing and preventing further episodes of pyelonephritis.

Correct Answer is ["125"]

Explanation

  • Determine the infusion time: The total dose is 40 mEq, and it's being infused at a rate of 10 mEq/hr.
  • Therefore, the total infusion time is 40 mEq / 10 mEq/hr = 4 hours.
  • Calculate the infusion rate in mL/hr: The total volume is 500 mL, and the infusion time is 4 hours.
  • So, the infusion rate is 500 mL / 4 hours = 125 mL/hr.

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

Register