Question

A nurse is preparing to administer fentanyl to a client. What is the priority assessment?

Answer 1

Correct Answers:

Respiratory rate

Rationale :

💎 Respiratory rate is the priority assessment before administering fentanyl because fentanyl is a strong opioid analgesic.

💎 Opioids can depress the respiratory center in the brain, leading to slow respirations, hypoventilation, hypoxia, or respiratory arrest.

💎 The nurse should assess the client’s respiratory rate, depth, oxygen saturation, and level of sedation before giving the medication.

💎 If the client has a low respiratory rate or excessive sedation, the nurse should hold the medication and notify the provider.

💎 Although pain assessment is important before giving analgesics, airway and breathing are always the priority.

Ability to ambulate

💎Ambulation may be affected after fentanyl because the client can become dizzy, weak, or sedated.

💎However, it is not the priority assessment before administration.

Last bowel movement

💎Opioids commonly cause constipation, so bowel history is relevant during ongoing opioid therapy.

💎However, constipation is not the immediate life-threatening concern before giving fentanyl.

Pain level

💎Pain level should be assessed to evaluate the need for fentanyl and later determine effectiveness.

💎However, respiratory status must be checked first because fentanyl can suppress breathing.

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Answer 2

Correct Answers

Blank 1 Correct Option: an elevated heart rate
Blank 2 Correct Option: Levothyroxine toxicity or Hyperthyroidism

Rationale :

🔷 An elevated heart rate is concerning in a client taking levothyroxine because it can indicate excessive thyroid hormone replacement.

🔷 Too much levothyroxine can produce symptoms of hyperthyroidism, including tachycardia, palpitations, tremors, nervousness, sweating, heat intolerance, and weight loss.

🔷 Levothyroxine increases metabolic activity, and an excessive dose can overstimulate the cardiovascular system.

🔷 Tachycardia is especially important because it can increase cardiac workload and place the client at risk for dysrhythmias.

🔷 The nurse should report this finding and anticipate evaluation of TSH and free T4 levels.

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Answer 3

Correct Answers:

The nurse gently rotates the NPH insulin vial.

Rationale :

🟢 NPH insulin is cloudy insulin and must be gently rotated before withdrawal to evenly mix the suspension.

🟢 The vial should not be shaken because shaking can create bubbles and interfere with accurate dosing.

🟢 When mixing NPH with regular insulin, the nurse prepares the cloudy insulin but draws up the regular insulin first.

🟢 The correct mixing rule is clear before cloudy, meaning regular insulin is withdrawn before NPH insulin.

🟢 Gentle rotation ensures an accurate concentration of NPH insulin in the dose.

The nurse withdraws the NPH insulin first.

🟢NPH should not be withdrawn first because it can contaminate the regular insulin.

🟢Regular insulin is clear and should be drawn up before cloudy NPH.

The nurse selects a 3 mL syringe to mix insulins.

🟢Insulin must be measured using an insulin syringe, not a regular 3 mL syringe.

🟢Using the wrong syringe can cause a serious medication dosing error.

The nurse injects air into the regular insulin vial first.

🟢When mixing insulin, air is injected into the NPH vial first, then into the regular insulin vial.

🟢The nurse then withdraws regular insulin first, followed by NPH.

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Answer 4

Correct Answers

Blank 1 Correct Option: therapeutic index
Blank 2 Correct Option: therapeutic drug monitoring

Rationale :

🟣 A low therapeutic index means there is a narrow range between the effective dose and the toxic dose.

🟣 Even small changes in dose, metabolism, kidney function, or drug interactions can cause toxicity.

🟣 These medications require therapeutic drug monitoring to ensure serum levels remain safe and effective.

🟣 Examples include digoxin, lithium, phenytoin, warfarin, and aminoglycosides.

🟣 Monitoring helps prevent medication toxicity while maintaining the intended therapeutic effect.

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Answer 5

Correct Answers:

The client takes levothyroxine with breakfast.

Rationale :

🟠 Levothyroxine should be taken on an empty stomach to promote consistent absorption.

🟠 It is usually taken in the morning with water, 30 to 60 minutes before breakfast.

🟠 Food, calcium, iron, antacids, and some supplements can reduce absorption of levothyroxine.

🟠 Taking the medication with breakfast can make the dose less effective and lead to continued hypothyroid symptoms.

🟠 The nurse should reinforce taking levothyroxine at the same time each day before food or interacting medications.

The client has lost 6 pounds in 7 weeks.

🟠Some weight loss can occur when hypothyroidism improves with appropriate treatment.

🟠It becomes more concerning if accompanied by tachycardia, tremors, sweating, or heat intolerance.

The client just found out they are pregnant.

🟠Pregnancy is not a reason to stop levothyroxine because thyroid hormone is important for fetal development.

🟠The provider may need to adjust the dose because levothyroxine requirements often increase during pregnancy.

The client sleeps through the night.

🟠Sleeping through the night is not concerning and may suggest symptom improvement.

🟠Insomnia would be more concerning for excessive thyroid hormone effect.

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Answer 6

Correct Answers:

Steady state

Rationale :

🔵 Steady state occurs when the amount of drug absorbed equals the amount eliminated.

🔵 At steady state, the medication level in the body remains relatively consistent with repeated dosing.

🔵 This usually occurs after about 4 to 5 half-lives for many medications.

🔵 Steady state is important because it helps determine when the full therapeutic effect and possible toxicity can be evaluated.

🔵 Nurses monitor the client’s response closely when medications reach steady state.

Duration of action

🔵Duration of action refers to how long a drug produces its therapeutic effect.

🔵It does not describe the balance between drug absorption and elimination.

Peak effect

🔵Peak effect is the time when a drug reaches its maximum therapeutic effect.

🔵It does not mean the rate of drug absorption equals the rate of elimination.

Half-life

🔵Half-life is the time required for half of the drug amount to be eliminated.

🔵It helps predict steady state but is not the same as steady state.

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Answer 7

Correct Answers

Slowed gastric emptying [ Absorption ]
Decrease in total body water [ Distribution ]
Decreased albumin level [ Distribution ]
Decreased hepatic blood flow [ Metabolism ]
Decreased intact nephrons [ Excretion ]

Rationale :

Slowed gastric emptying — Absorption

🟡 Slowed gastric emptying changes absorption because medications remain in the stomach longer before reaching the small intestine.

🟡 Since many drugs are absorbed mainly in the small intestine, delayed gastric emptying can delay medication onset.

🟡 Older adults may experience slower or less predictable responses to oral medications.

🟡 This does not mainly affect metabolism or renal clearance.

🟡 The nurse should monitor for delayed therapeutic effects.

Decrease in total body water — Distribution

🟡 Decreased total body water affects distribution of water-soluble medications.

🟡 Water-soluble drugs may become more concentrated in the bloodstream when body water decreases.

🟡 This can increase the risk of adverse effects or toxicity.

🟡 Older adults are especially vulnerable because body composition changes with aging.

🟡 Careful dose monitoring may be needed.

Decreased albumin level — Distribution

🟡 Decreased albumin affects distribution because many medications bind to plasma proteins.

🟡 Low albumin increases the amount of free, active drug in circulation.

🟡 More free drug can increase medication effects and toxicity risk.

🟡 This is important for highly protein-bound drugs such as warfarin, phenytoin, and some NSAIDs.

🟡 The nurse should monitor for exaggerated drug responses.

Decreased hepatic blood flow — Metabolism

🟡 Decreased hepatic blood flow affects metabolism because less drug is delivered to the liver for breakdown.

🟡 Older adults may metabolize medications more slowly.

🟡 Slower metabolism can prolong drug action and increase drug accumulation.

🟡 Drugs with significant first-pass metabolism may be especially affected.

🟡 The nurse should monitor for toxicity and delayed drug clearance.

Decreased intact nephrons — Excretion

🟡 Decreased intact nephrons affect excretion because the kidneys eliminate many drugs and metabolites.

🟡 Reduced renal function can cause drug accumulation in the body.

🟡 Accumulation increases the risk of adverse effects and toxicity.

🟡 Serum creatinine may appear normal in older adults despite reduced kidney function due to decreased muscle mass.

🟡 The nurse should monitor renal function and medication response carefully.

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Answer 8

Correct Answers:

History of constipation

Rationale :

🟤 Codeine is an opioid, and constipation is one of its most common side effects.

🟤 Opioids slow intestinal peristalsis, which causes stool to remain in the bowel longer.

🟤 A client with a history of constipation is at higher risk for worsening constipation while taking codeine.

🟤 The nurse should assess bowel patterns and encourage fluids, fiber, mobility, and prescribed stool softeners or laxatives when appropriate.

🟤 Preventing opioid-induced constipation is important because it can become severe and uncomfortable.

Elevated blood glucose

🟤Elevated blood glucose is not a common risk factor for codeine-induced constipation.

🟤It may require diabetes management but does not increase the typical opioid bowel effect.

Respiratory rate of 18

🟤A respiratory rate of 18/min is within the expected adult range.

🟤A low respiratory rate would be more concerning for opioid-related respiratory depression.

Decreased gastric pH

🟤Decreased gastric pH is not the main risk factor for constipation from codeine.

🟤Codeine causes constipation primarily by slowing gastrointestinal motility.

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Answer 9

Correct Answers:

Skip your dose of repaglinide if you skip your meal.

Rationale :

🟩 Repaglinide is a meglitinide that stimulates the pancreas to release insulin.

🟩 It is taken before meals to control postprandial blood glucose.

🟩 If the client takes repaglinide without eating, insulin release can occur without carbohydrate intake.

🟩 This places the client at risk for hypoglycemia, which can cause sweating, shakiness, confusion, weakness, or loss of consciousness.

🟩 The key teaching is: skip the dose if skipping the meal.

Hyperglycemia can occur if taken with a sulfonylurea.

🟩Repaglinide and sulfonylureas both increase insulin release.

🟩Taking them together increases the risk for hypoglycemia, not hyperglycemia.

Repaglinide should be taken once daily in the morning.

🟩Repaglinide is not simply taken once every morning.

🟩It is meal-related and should be taken before meals as prescribed.

Weight loss is a common side effect of repaglinide.

🟩Repaglinide is not commonly associated with weight loss.

🟩It can cause hypoglycemia and may contribute to weight gain because it increases insulin secretion.

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Answer 10

Correct Answers:

The client took their morning dose of metformin

Rationale :

🔴 Taking metformin before a CT scan with iodine-based contrast is concerning because contrast can affect kidney function.

🔴 If renal function decreases after contrast exposure, metformin can accumulate in the bloodstream.

🔴 Metformin accumulation increases the risk of lactic acidosis, a rare but life-threatening complication.

🔴 The nurse should notify the provider or radiology team and follow facility policy for holding metformin and checking renal function.

🔴 This finding is the priority because it creates a potential medication-contrast safety risk.

The client reports occasional abdominal bloating

🔴Occasional abdominal bloating is not the priority concern before iodinated contrast.

🔴It does not directly increase the risk for contrast-related kidney injury or lactic acidosis.

The client’s last oral intake was before midnight

🔴Being NPO before a scheduled procedure may be expected depending on facility policy.

🔴This finding does not create a medication safety concern.

The client’s blood glucose level was 92 on arrival

🔴A blood glucose of 92 mg/dL is within the expected range.

🔴It does not indicate an immediate reason to delay the contrast study.

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Age-Related Change	Absorption	Distribution	Metabolism	Excretion
Slowed gastric emptying
Decrease in total body water
Decreased albumin level
Decreased hepatic blood flow
Decreased intact nephrons

QLexNursing

1 :
A nurse is preparing to administer fentanyl to a client. What is the priority assessment?

2 :
Complete the following sentence by choosing from the list of options. A nurse is caring for a client who takes levothyroxine daily.

Correct Answers

3 :
The nurse is caring for a client with an order for regular insulin and neutral protamine Hagedorn (NPH) insulin. When mixing the insulins in a single syringe, which action by the nurse is correct?

4 :
Drugs with a low Select Answer Choice require Select Answer Choice.

Correct Answers

5 :
The nurse is caring for a client who started taking levothyroxine seven weeks ago. Which finding should concern the nurse?

6 :
What is the time when the amount of the drug eliminated and the amount of the drug absorbed are equal?

7 :
For each age-related change, click to specify if the change will alter absorption, distribution, metabolism, or excretion.

Correct Answers

8 :
The nurse is caring for a client prescribed codeine. Which finding puts the client at a higher risk for a common side effect of codeine?

9 :
The nurse is planning education for a client newly prescribed repaglinide. What information should the nurse plan to include?

10 :
A client arrives at the hospital for a scheduled CT scan with iodine-based contrast at 1000. Which finding should concern the nurse?

QLexNursing

1 : A nurse is preparing to administer fentanyl to a client. What is the priority assessment?

2 : Complete the following sentence by choosing from the list of options. A nurse is caring for a client who takes levothyroxine daily.

Correct Answers

3 : The nurse is caring for a client with an order for regular insulin and neutral protamine Hagedorn (NPH) insulin. When mixing the insulins in a single syringe, which action by the nurse is correct?

4 : Drugs with a low Select Answer Choice require Select Answer Choice.

Correct Answers

5 : The nurse is caring for a client who started taking levothyroxine seven weeks ago. Which finding should concern the nurse?

6 : What is the time when the amount of the drug eliminated and the amount of the drug absorbed are equal?

7 : For each age-related change, click to specify if the change will alter absorption, distribution, metabolism, or excretion.

Correct Answers

8 : The nurse is caring for a client prescribed codeine. Which finding puts the client at a higher risk for a common side effect of codeine?

9 : The nurse is planning education for a client newly prescribed repaglinide. What information should the nurse plan to include?

10 : A client arrives at the hospital for a scheduled CT scan with iodine-based contrast at 1000. Which finding should concern the nurse?

1 :
A nurse is preparing to administer fentanyl to a client. What is the priority assessment?

2 :
Complete the following sentence by choosing from the list of options. A nurse is caring for a client who takes levothyroxine daily.

3 :
The nurse is caring for a client with an order for regular insulin and neutral protamine Hagedorn (NPH) insulin. When mixing the insulins in a single syringe, which action by the nurse is correct?

4 :
Drugs with a low Select Answer Choice require Select Answer Choice.

5 :
The nurse is caring for a client who started taking levothyroxine seven weeks ago. Which finding should concern the nurse?

6 :
What is the time when the amount of the drug eliminated and the amount of the drug absorbed are equal?

7 :
For each age-related change, click to specify if the change will alter absorption, distribution, metabolism, or excretion.

8 :
The nurse is caring for a client prescribed codeine. Which finding puts the client at a higher risk for a common side effect of codeine?

9 :
The nurse is planning education for a client newly prescribed repaglinide. What information should the nurse plan to include?

10 :
A client arrives at the hospital for a scheduled CT scan with iodine-based contrast at 1000. Which finding should concern the nurse?