In the immediate postoperative period, a client is prescribed morphine via a patient-controlled analgesia (PCA) pump. Which finding should the PN consider the highest priority in this client?

Correct Answer: B

Rationale: The highest priority for the PN is to assess the rate and depth of the client's respirations when a client is receiving morphine via a PCA pump. Respiratory depression is a life-threatening side effect of intravenous morphine administration. If the client's respiratory rate falls below 10 breaths/min, the PCA pump should be stopped, and the healthcare provider must be notified immediately to prevent further complications.

Correct Answer: B

Rationale: In pharmacology, understanding the expected therapeutic responses to medications is crucial for safe and effective nursing practice. In the case of carbidopa-levodopa administered to a client with Parkinson's disease, the correct answer is B) Lessening of tremors. This is because carbidopa-levodopa is a medication commonly used to manage the symptoms of Parkinson's disease, particularly tremors, muscle stiffness, and difficulty with movement. A therapeutic response would be a reduction in the client's tremors, indicating that the medication is effectively addressing the symptoms of the disease. Option A) Decreased blood pressure is not a typical therapeutic response to carbidopa-levodopa and would not indicate an appropriate reaction to the medication in this context. Option C) Increased salivation is not a desired outcome and could potentially indicate adverse effects rather than a therapeutic response. Option D) Increased attention span is not directly related to the expected therapeutic effects of carbidopa-levodopa in managing Parkinson's disease symptoms. Educationally, this question highlights the importance of understanding pharmacological actions and expected outcomes of medications used in specific disease processes. By recognizing the therapeutic responses to medications, nurses can assess the effectiveness of treatment and ensure optimal patient care.

Correct Answer: D

Rationale: The correct answer is D) Brush and floss teeth daily. Phenytoin is known to cause gingival hyperplasia, a condition where the gums become overgrown and inflamed. Therefore, it is crucial for the client to maintain good oral hygiene practices to prevent this side effect. By reinforcing the importance of brushing and flossing daily, the practical nurse can help the client minimize the risk of developing gingival hyperplasia. Option A) Maintain consistent sodium intake is incorrect because phenytoin does not interact with sodium intake. Option B) Use sunscreen when outdoors is incorrect as it is not directly related to the medication phenytoin. Option C) Return for monthly urinalysis is incorrect as phenytoin does not typically require monitoring through urinalysis. In an educational context, it is important for practical nurses to understand the side effects and implications of medications to provide appropriate patient education. By reinforcing specific instructions related to medication use, practical nurses can help clients manage their conditions effectively and prevent potential complications.

Correct Answer: A

Rationale: Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride in the kidneys, leading to increased potassium excretion and potentially causing hypokalemia. Hypokalemia can lead to cardiac irregularities, making it crucial for the practical nurse to monitor the client for this electrolyte imbalance.

Correct Answer: B

Rationale: The correct action for the nurse to take when a client reports orange urine after taking rifampin is to inform the client that this change is not harmful. Rifampin is known to cause orange discoloration of urine, which is a harmless side effect. There is no need to notify the health care provider as this is an expected outcome. Monitoring creatinine levels or assessing for nephrotoxicity is unnecessary in this situation, as rifampin does not typically cause kidney damage.