Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is providing discharge teaching to a client who has a prescription for acetaminophen and hydrocodone (Vicodin).Which of the following instructions should the nurse include in the teaching?
A. Avoid driving while taking this medication
The nurse should instruct the client to avoid driving or operating heavy machinery while taking acetaminophen and hydrocodone (Vicodin) because these medications can cause drowsiness, dizziness, and impaired mental function.The nurse should also warn the client about the risk of addiction, overdose, and death from misuse of this medication.
B. Take this medication on an empty stomach
This is wrong because taking this medication on an empty stomach can increase the risk of nausea and vomiting.The nurse should advise the client to take this medication with food or milk to prevent stomach upset.
C. Increase intake of foods rich in vitamin K
This is wrong because increasing the intake of foods rich in vitamin K is not relevant to taking acetaminophen and hydrocodone (Vicodin).Vitamin K is involved in blood clotting and may interact with some anticoagulant medications, but not with this medication.
D. Limit fluid intake to prevent fluid retention.
This is wrong because limiting fluid intake to prevent fluid retention is not necessary for a client taking acetaminophen and hydrocodone (Vicodin).This medication does not cause fluid retention or edema.The nurse should encourage the client to drink plenty of fluids to prevent constipation, which is a common side effect of opioid medications.
This question is an excerpt from Nurse Dive's nursing test bank - More questions on this topics. Take the full exam now
Full Explanation
The correct answer is choice A. Avoid driving while taking this medication. The nurse should instruct the client to avoid driving or operating heavy machinery while taking acetaminophen and hydrocodone (Vicodin) because these medications can cause drowsiness, dizziness, and impaired mental function. The nurse should also warn the client about the risk of addiction, overdose, and death from misuse of this medication.
Choice B is wrong because taking this medication on an empty stomach can increase the risk of nausea and vomiting. The nurse should advise the client to take this medication with food or milk to prevent stomach upset.
Choice C is wrong because increasing the intake of foods rich in vitamin K is not relevant to taking acetaminophen and hydrocodone (Vicodin). Vitamin K is involved in blood clotting and may interact with some anticoagulant medications, but not with this medication.
Choice D is wrong because limiting fluid intake to prevent fluid retention is not necessary for a client taking acetaminophen and hydrocodone (Vicodin). This medication does not cause fluid retention or edema. The nurse should encourage the client to drink plenty of fluids to prevent constipation, which is a common side effect of opioid medications.
Similar Questions
A nurse is reviewing laboratory results for a client who takes acetaminophen for osteoarthritis pain management.Which of the following findings should alert the nurse to possible hepatotoxicity? (Select all that apply.).
A. Elevated aspartate aminotransferase (AST)
This is aliver enzyme that can indicate hepatotoxicity (liver damage) from acetaminophen overdose. The normal ranges for these enzymes are: • AST: 10 to 40 U/L • ALT: 7 to 56 U/L • ALP: 45 to 115 U/L
B. Elevated alanine aminotransferase (ALT)
This is aliver enzyme that can indicate hepatotoxicity (liver damage) from acetaminophen overdose. The normal ranges for these enzymes are: • AST: 10 to 40 U/L • ALT: 7 to 56 U/L • ALP: 45 to 115 U/L
C. Elevated alkaline phosphatase (ALP)
This is aliver enzyme that can indicate hepatotoxicity (liver damage) from acetaminophen overdose. The normal ranges for these enzymes are: • AST: 10 to 40 U/L • ALT: 7 to 56 U/L • ALP: 45 to 115 U/L
D. Elevated blood urea nitrogen (BUN)
This is wrong because it is an indicatorof renal function, not liver function. The normal ranges for these values are: • BUN: 7 to 20 mg/dL • Creatinine: 0.6 to 1.2 mg/dL
E. Elevated creatinine.
This is wrong because it is an indicatorof renal function, not liver function. The normal ranges for these values are: • BUN: 7 to 20 mg/dL • Creatinine: 0.6 to 1.2 mg/dL
Full Explanation
The correct answer is choice A, B, and C. These are all liver enzymes that can indicate hepatotoxicity (liver damage) from acetaminophen overdose.
The normal ranges for these enzymes are:
• AST: 10 to 40 U/L
• ALT: 7 to 56 U/L
• ALP: 45 to 115 U/L
Choice D and E are wrong because they are indicators of renal function, not liver function.
The normal ranges for these values are:
• BUN: 7 to 20 mg/dL
• Creatinine: 0.6 to 1.2 mg/dL
A nurse is caring for a client who has a sickle cell crisis and is receiving morphine via patient-controlled analgesia (PCA) pump.
Which assessment finding indicates that the PCA pump is effective?
A. The client reports a pain level of 4 on a scale of 0 to 10.
This indicates that the PCA pump is effective in reducing the client’s pain, which is the primary symptom of a sickle cell crisis.
B. The client has a respiratory rate of 12 breaths per minute.
This is wrong because a respiratory rate of 12 breaths per minute is normal and does not indicate the effectiveness of the PCA pump.
C. The client has a blood pressure of 140/90 mm Hg.
This is wrong because a blood pressure of 140/90 mm Hg is high and may indicate hypertension, which is a complication of sickle cell disease.
D. The client has a pulse oximetry reading of 95%.
This is wrong because a pulse oximetry reading of 95% is normal and does not indicate the effectiveness of the PCA pump. Normal ranges for vital signs are: • Respiratory rate: 12-20 breaths per minute • Blood pressure: <120/80 mm Hg • Pulse oximetry: >95%
Full Explanation
The correct answer is choice A. The client reports a pain level of 4 on a scale of 0 to 10. This indicates that the PCA pump is effective in reducing the client’s pain, which is the primary symptom of sickle cell crisis.
Choice B is wrong because a respiratory rate of 12 breaths per minute is normal and does not indicate the effectiveness of the PCA pump.
Choice C is wrong because a blood pressure of 140/90 mm Hg is high and may indicate hypertension, which is a complication of sickle cell disease.
Choice D is wrong because a pulse oximetry reading of 95% is normal and does not indicate the effectiveness of the PCA pump.
Normal ranges for vital signs are:
• Respiratory rate: 12-20 breaths per minute
• Blood pressure: <120/80 mm Hg
• Pulse oximetry: >95%
A nurse is teaching a client who has cancer pain about the use of oral oxycodone with acetaminophen (Percocet).
Which statement by the client indicates a need for further teaching?
A. “I should drink plenty of fluids and eat high-fiber foods to prevent constipation.”
This is wrong because drinking plenty of fluids and eating high-fiber foods can help prevent constipation, which is a common adverse effect of opioids.
B. “I should avoid driving or operating heavy machinery while taking this medication.”
This is wrong because avoiding driving or operating heavy machinery is a safety precaution for clients taking opioids, as they can cause drowsiness and impaired judgment.
C. “I should take this medication only when I have severe pain that does not respond to other drugs.”
The client should take this medicationregularlyas prescribed to maintain a steady level of analgesia and prevent breakthrough pain. Taking the medication only when the pain is severe can lead to inadequate pain relief and increased side effects.
D. “I should report any signs of an allergic reaction, such as rash, itching, or difficulty breathing.”.
This is wrong because reporting any signs of allergic reaction is an important instruction for clients taking any medication, especially opioids, which can cause severe hypersensitivity reactions.
Full Explanation
The correct answer is choice C. The client should take this medication regularly as prescribed to maintain a steady level of analgesia and prevent breakthrough pain.
Taking the medication only when the pain is severe can lead to inadequate pain relief and increased side effects.
Choice A is wrong because drinking plenty of fluids and eating high-fiber foods can help prevent constipation, which is a common adverse effect of opioids.
Choice B is wrong because avoiding driving or operating heavy machinery is a safety precaution for clients taking opioids, as they can cause drowsiness and impaired judgment.
Choice D is wrong because reporting any signs of allergic reaction is an important instruction for clients taking any medication, especially opioids, which can cause severe hypersensitivity reactions.