a nurse is caring for a client receiving patient controlled analgesia pca which of the following interventions should the nurse take while caring for
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Nursing Elites

ATI RN

ATI Capstone Pharmacology Assessment 1

1. A nurse is caring for a client receiving patient-controlled analgesia (PCA). Which of the following interventions should the nurse take while caring for this client?

Correct answer: B

Rationale: The correct answer is B because encouraging the client to use the PCA before dressing changes helps in managing pain proactively. Choice A is incorrect as PCA is a safe method of pain control when used appropriately, and the nurse should not suggest using it sparingly. Choice C is incorrect as only the client should operate the PCA to ensure they are in control of their pain management. Choice D is incorrect as changing the PCA limit without proper assessment and orders from the healthcare provider can lead to adverse effects.

2. A nurse is administering metformin to a client with type 2 diabetes. Which of the following adverse effects should the nurse monitor for in this client?

Correct answer: D

Rationale: The correct answer is D, Lactic acidosis. Lactic acidosis is a rare but serious adverse effect of metformin use. Metformin is not known to cause hyperglycemia or hypoglycemia. Diarrhea is a common gastrointestinal side effect of metformin but is not as serious as lactic acidosis, which requires immediate medical attention.

3. A nurse has provided education to a client regarding prescribed levothyroxine sodium. Which of the following client statements demonstrates understanding of medication administration?

Correct answer: C

Rationale: Levothyroxine should be taken once in the morning to prevent insomnia and maintain therapeutic levels.

4. Before administering blood products, which action should be taken?

Correct answer: A

Rationale: Correct answer: Before administering blood products, the client's temperature must be assessed to establish a baseline and monitor for transfusion reactions. Choice B is incorrect because documenting client response should occur after administering the blood products. Choice C is incorrect as priming IV tubing with 0.45% sodium chloride is not directly related to assessing the client before administering blood products. Choice D is incorrect because administering epinephrine is not a routine action before administering blood products.

5. A client is receiving magnesium sulfate for the management of preeclampsia. Which of the following client assessments should the nurse monitor to prevent complications of therapy?

Correct answer: B

Rationale: The correct answer is deep tendon reflexes. Monitoring deep tendon reflexes is crucial to assess for magnesium toxicity during therapy for preeclampsia. Magnesium sulfate can lead to neuromuscular blockade, reflected by decreased or absent deep tendon reflexes. Assessing bowel sounds (choice A) is important for gastrointestinal function but is not directly related to magnesium sulfate therapy. Oxygen saturation (choice C) is vital for respiratory status but is not specifically linked to magnesium sulfate administration. Fluid balance (choice D) is essential but does not directly correlate with monitoring for complications of magnesium sulfate therapy in the context of preeclampsia.

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