54. A client with chronic back pain is admitted to a local health care facility for
respiratory depression secondary to an inadvertent overdose of his opioid analgesic.
The client is to receive naloxone. Which of the following would the nurse include
before administering naloxone?
A) Monitor the client's blood pressure every 5 minutes.
B) Review the client's allergy history and treatment modalities.
C) Monitor vital signs every 5 to 15 minutes if the client is responsive.
D) Monitor respiratory rate and rhythm of the client. Answer: B
Response:
Before administering the antagonist, the nurse should review the client's initial health
history, allergy history, and treatment modalities. The nurse should also obtain the
client's blood pressure, pulse, and respiratory rate and review the record for the drug
suspected of causing the symptoms of respiratory depression. All these interventions are
part of the preadministration assessment, which is conducted before the administration
of the drug. Monitoring the client's blood pressure every 5 minutes until the client
responds, monitoring vital signs every 5 to 15 minutes if the client is responsive, and
monitoring the client's respiratory rate and rhythm are all interventions involved in the
ongoing assessment of the client that the nurse performs while the client is undergoing
the drug therapy.
55. A client is given a postoperative opioid drug for pain relief. The nurse observes that
the drug has slowed the client's breathing pattern. Which of the following reasons
would the nurse most likely identify as the cause of the lowered breathing pattern?
a. Anxiety
b. Somnolence
c. Nausea
d. Anorexia Answer: B
Response:
The nurse should identify somnolence as a cause of slowing of the client's breathing
pattern. Sometimes the somnolence and pain relief produced by the opioid drug can
slow the client's breathing pattern. Anxiety, nausea, and anorexia are not known to be
responsible for slowing down a client's breathing pattern when the client is administered
an opioid drug.
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, 56. A client is admitted to a local health care facility for alcohol dependence. The nurse
knows that the physician is most likely to prescribe which of the following drugs for
the client?
a. Cisapride
b. Naproxen
c. Lincosamide
d. Naltrexone Answer: D Response:
The nurse should administer naltrexone to the client who has alcohol dependence. It is
also used to block the effects of suspected opioids if they are being used by the person
undergoing treatment for alcohol dependence. Cisapride, naproxen, and lincosamide are
not used to treat alcohol dependence.
57. After administering naloxone to a client with respiratory depression, the nurse
would expect to see the effects of the drug within which time frame?
a. 1 to 2 minutes
b. 3 to 4 minutes
c. 5 to 6 minutes D) 7 to 8 minutes Answer: A Response:
Naloxone is capable of restoring respiratory function within 1 to 2 minutes after
administration.
58. A nurse suspects that a client receiving naloxone is experiencing an adverse reaction
when the assessment reveals which of the following?
a. Bradycardia
b. Dry, flushed skin
c. Tremors D) Diarrhea Answer: C
Response:
Generalized reactions to naloxone include nausea and vomiting, sweating, tachycardia,
increased blood pressure, and tremors.
59. A client who has been receiving naloxone suddenly starts grimacing and moaning,
moving his arms back and forth across his body, and drawing his legs up to his
abdomen. Prior to administration the client was sleepy and calm. Assessment
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respiratory depression secondary to an inadvertent overdose of his opioid analgesic.
The client is to receive naloxone. Which of the following would the nurse include
before administering naloxone?
A) Monitor the client's blood pressure every 5 minutes.
B) Review the client's allergy history and treatment modalities.
C) Monitor vital signs every 5 to 15 minutes if the client is responsive.
D) Monitor respiratory rate and rhythm of the client. Answer: B
Response:
Before administering the antagonist, the nurse should review the client's initial health
history, allergy history, and treatment modalities. The nurse should also obtain the
client's blood pressure, pulse, and respiratory rate and review the record for the drug
suspected of causing the symptoms of respiratory depression. All these interventions are
part of the preadministration assessment, which is conducted before the administration
of the drug. Monitoring the client's blood pressure every 5 minutes until the client
responds, monitoring vital signs every 5 to 15 minutes if the client is responsive, and
monitoring the client's respiratory rate and rhythm are all interventions involved in the
ongoing assessment of the client that the nurse performs while the client is undergoing
the drug therapy.
55. A client is given a postoperative opioid drug for pain relief. The nurse observes that
the drug has slowed the client's breathing pattern. Which of the following reasons
would the nurse most likely identify as the cause of the lowered breathing pattern?
a. Anxiety
b. Somnolence
c. Nausea
d. Anorexia Answer: B
Response:
The nurse should identify somnolence as a cause of slowing of the client's breathing
pattern. Sometimes the somnolence and pain relief produced by the opioid drug can
slow the client's breathing pattern. Anxiety, nausea, and anorexia are not known to be
responsible for slowing down a client's breathing pattern when the client is administered
an opioid drug.
Page 9
, 56. A client is admitted to a local health care facility for alcohol dependence. The nurse
knows that the physician is most likely to prescribe which of the following drugs for
the client?
a. Cisapride
b. Naproxen
c. Lincosamide
d. Naltrexone Answer: D Response:
The nurse should administer naltrexone to the client who has alcohol dependence. It is
also used to block the effects of suspected opioids if they are being used by the person
undergoing treatment for alcohol dependence. Cisapride, naproxen, and lincosamide are
not used to treat alcohol dependence.
57. After administering naloxone to a client with respiratory depression, the nurse
would expect to see the effects of the drug within which time frame?
a. 1 to 2 minutes
b. 3 to 4 minutes
c. 5 to 6 minutes D) 7 to 8 minutes Answer: A Response:
Naloxone is capable of restoring respiratory function within 1 to 2 minutes after
administration.
58. A nurse suspects that a client receiving naloxone is experiencing an adverse reaction
when the assessment reveals which of the following?
a. Bradycardia
b. Dry, flushed skin
c. Tremors D) Diarrhea Answer: C
Response:
Generalized reactions to naloxone include nausea and vomiting, sweating, tachycardia,
increased blood pressure, and tremors.
59. A client who has been receiving naloxone suddenly starts grimacing and moaning,
moving his arms back and forth across his body, and drawing his legs up to his
abdomen. Prior to administration the client was sleepy and calm. Assessment
Page 10
