The correct answer is Increased respiratory rate.
Rationale
• Naloxone (Narcan) is an opioid antagonist. It works by competing for opioid receptors in the brain, effectively
displacing the opioid (in this case, morphine) and reversing its effects.
• Respiratory depression is the most life-threatening adverse reaction to morphine. Therefore, the primary
therapeutic goal of naloxone is to return the client's breathing to a normal rate and depth.
• Increased pain relief would not occur; in fact, naloxone typically causes a sudden return of pain because it blocks
the analgesic effects of the morphine.
• Decreased blood pressure and decreased nausea are not the primary therapeutic targets of naloxone; conversely,
the rapid reversal of opioids often causes a surge in the sympathetic nervous system, which can lead to increased
blood pressure and increased nausea/vomiting.
,The correct answer is Hyponatremia.
Rationale
• Lithium and Sodium Balance: Lithium is a salt, and the kidneys process it in a very similar way to sodium.
There is an inverse relationship between the two: when sodium levels in the body drop, the kidneys attempt
to conserve sodium but mistakenly retain lithium instead.
• Exercise Risk: A new exercise program often leads to sweating. Sweat contains both water and sodium. If a
client loses significant sodium through diaphoresis (sweating) and does not replace it, they develop
hyponatremia.
• Lithium Toxicity: Hyponatremia is a major risk factor for lithium toxicity. Because the kidneys retain
lithium to compensate for the low sodium, lithium levels in the blood can quickly rise to dangerous, toxic
levels.
• Patient Education: Nurses must instruct clients on lithium to maintain a consistent salt and fluid intake,
especially during periods of heavy exercise or hot weather, to prevent this imbalance.
,Correct Answer
"I will need to have blood levels drawn."
Rationale
Theophylline is a methylxanthine used for long-term control of chronic asthma or COPD. It has a narrow therapeutic
index, meaning the margin between a therapeutic dose and a toxic dose is very small.
• Routine Monitoring: Because of this narrow range, patients must have their serum theophylline levels
monitored regularly to ensure the drug remains at a therapeutic level (typically 5 to 15 mcg/mL) and to avoid
toxicity (which can cause seizures and dysrhythmias).
, Correct Answer
Check the client's glucose level.
Rationale
This question addresses a medication error involving "look-alike, sound-alike" drugs. The nurse administered
metformin instead of metoprolol.
• Metformin is an antidiabetic biguanide used to lower blood glucose levels.
• Metoprolol is a beta-blocker used primarily for hypertension and heart rate control.
When a medication error occurs, the nurse’s priority is the safety and assessment of the client. Since metformin’s
primary pharmacological effect is lowering blood glucose (and potentially causing hypoglycemia, though less
common than with other antidiabetics), the nurse must immediately check the client's blood sugar to monitor for
adverse effects.
Rationale
• Naloxone (Narcan) is an opioid antagonist. It works by competing for opioid receptors in the brain, effectively
displacing the opioid (in this case, morphine) and reversing its effects.
• Respiratory depression is the most life-threatening adverse reaction to morphine. Therefore, the primary
therapeutic goal of naloxone is to return the client's breathing to a normal rate and depth.
• Increased pain relief would not occur; in fact, naloxone typically causes a sudden return of pain because it blocks
the analgesic effects of the morphine.
• Decreased blood pressure and decreased nausea are not the primary therapeutic targets of naloxone; conversely,
the rapid reversal of opioids often causes a surge in the sympathetic nervous system, which can lead to increased
blood pressure and increased nausea/vomiting.
,The correct answer is Hyponatremia.
Rationale
• Lithium and Sodium Balance: Lithium is a salt, and the kidneys process it in a very similar way to sodium.
There is an inverse relationship between the two: when sodium levels in the body drop, the kidneys attempt
to conserve sodium but mistakenly retain lithium instead.
• Exercise Risk: A new exercise program often leads to sweating. Sweat contains both water and sodium. If a
client loses significant sodium through diaphoresis (sweating) and does not replace it, they develop
hyponatremia.
• Lithium Toxicity: Hyponatremia is a major risk factor for lithium toxicity. Because the kidneys retain
lithium to compensate for the low sodium, lithium levels in the blood can quickly rise to dangerous, toxic
levels.
• Patient Education: Nurses must instruct clients on lithium to maintain a consistent salt and fluid intake,
especially during periods of heavy exercise or hot weather, to prevent this imbalance.
,Correct Answer
"I will need to have blood levels drawn."
Rationale
Theophylline is a methylxanthine used for long-term control of chronic asthma or COPD. It has a narrow therapeutic
index, meaning the margin between a therapeutic dose and a toxic dose is very small.
• Routine Monitoring: Because of this narrow range, patients must have their serum theophylline levels
monitored regularly to ensure the drug remains at a therapeutic level (typically 5 to 15 mcg/mL) and to avoid
toxicity (which can cause seizures and dysrhythmias).
, Correct Answer
Check the client's glucose level.
Rationale
This question addresses a medication error involving "look-alike, sound-alike" drugs. The nurse administered
metformin instead of metoprolol.
• Metformin is an antidiabetic biguanide used to lower blood glucose levels.
• Metoprolol is a beta-blocker used primarily for hypertension and heart rate control.
When a medication error occurs, the nurse’s priority is the safety and assessment of the client. Since metformin’s
primary pharmacological effect is lowering blood glucose (and potentially causing hypoglycemia, though less
common than with other antidiabetics), the nurse must immediately check the client's blood sugar to monitor for
adverse effects.
