a nurse is preparing to administer a dose of hydrocodone which of the following should the nurse assess first
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Nursing Elites

ATI LPN

PN ATI Capstone Proctored Comprehensive Assessment 2020 B with NGN

1. A healthcare professional is preparing to administer a dose of hydrocodone. Which of the following should the healthcare professional assess first?

Correct answer: A

Rationale: When administering hydrocodone, a healthcare professional should assess the respiratory rate first because hydrocodone is an opioid that can lead to respiratory depression. Monitoring the respiratory rate helps to detect any signs of respiratory distress or depression early on. Assessing blood pressure, pain level, or heart rate is also important but not the priority when administering hydrocodone, as the risk of respiratory depression is a more critical concern.

2. A nurse is caring for a client who has a new prescription for an antidepressant. The client reports experiencing dry mouth. Which of the following instructions should the nurse give the client?

Correct answer: B

Rationale: The correct answer is to instruct the client to chew sugarless gum. Chewing sugarless gum can help alleviate dry mouth by stimulating saliva production, which is a common side effect of many antidepressants. Decreasing fluid intake (choice A) is not recommended as it can worsen dry mouth. Avoiding mouthwash (choice C) is not as effective as chewing gum in stimulating saliva. Increasing intake of dairy products (choice D) is not directly related to managing dry mouth caused by antidepressants.

3. A nurse is caring for a client who has acute pancreatitis. Which of the following laboratory findings should the nurse expect?

Correct answer: C

Rationale: In acute pancreatitis, the nurse should expect elevated blood glucose levels. This is due to impaired insulin production by the inflamed pancreas. While serum amylase and lipase levels are typically elevated in acute pancreatitis, blood glucose levels are also affected due to the pancreatic dysfunction. Therefore, choices A and B are incorrect. Elevated calcium levels are not typically associated with acute pancreatitis, making choice D incorrect.

4. A client is being educated by a nurse on how to use a PCA pump postoperatively. Which statement by the client indicates understanding?

Correct answer: C

Rationale: The correct answer is C. This statement indicates understanding because the client recognizes that they should use the PCA pump when they start to feel pain. Waiting for the pain to become severe is not recommended as it may lead to inadequate pain control. Option B is incorrect because only the client should control the PCA pump to ensure safety and appropriate dosing. Option D is also incorrect as there is no set limit on how often the button can be pressed, as it should be used as needed when pain is felt.

5. A client with chronic renal failure needs dietary instructions. Which of the following should the nurse provide?

Correct answer: C

Rationale: The correct answer is to instruct the client to restrict protein intake. In chronic renal failure, the kidneys are unable to effectively filter waste products, so limiting protein helps reduce the buildup of waste in the body. Increasing calcium intake (Choice A) is not typically necessary unless there is a specific deficiency. Providing a diet high in potassium (Choice B) is contraindicated as potassium levels need to be monitored and controlled in renal failure. Increasing fluid intake (Choice D) may be necessary depending on the individual's condition, but restricting protein intake is a more critical dietary instruction for clients with chronic renal failure.

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