You have a patient with severe multiple sclerosis that is advanced and progressive who now develops renal failure secondary to diabetes. The patient is alert and has elected to put the DNR (Do-Not-Resuscitate) order in place at her own discretion. The patient's potassium level is now markedly elevated at $8 \mathrm{meq} / \mathrm{L}$. Which of the following is the most appropriate management of this patient?

Correct Answer: C

Rationale: A 'Do-Not-Resuscitate' (DNR) order is very specifically defined as refraining from cardiopulmonary resuscitative efforts such as chest compressions, antiarrhythmic medications such as amiodarone or lidocaine, and electrical cardioversion in the event of the patient's cardiopulmonary arrest. A DNR order has nothing to do with any of the other forms of care that the patient is receiving. A DNR order has no impact on the use of dialysis. You should pretend that the DNR order does not exist when evaluating for dialysis. Hyperkalemia is life threatening. It is illogical to use an inferior therapy such as kayexalate for the long-term management of the hyperkalemia of renal failure if dialysis is indicated. This patient is awake, alert, and able to understand his or her own medical problems. The patient's family is not relevant in terms of the decision-making pathway if the patient has the capacity to understand his or her own medical problems.

Correct Answer: D

Rationale: The correct answer is D) any of the above. Monitoring an individual's vital signs such as pulse, blood pressure, and respiratory rate before administering certain medications is crucial for ensuring patient safety. Pulse rate is important as some medications can affect heart rate, causing it to increase or decrease significantly. Blood pressure monitoring is essential because certain medications can cause fluctuations in blood pressure, which can be dangerous if not monitored closely. Respiratory rate is another vital sign that needs to be checked before administering medications, especially those that can affect respiratory function. Options A, B, and C are incorrect because monitoring only one vital sign may not provide a comprehensive picture of the individual's physiological status before administering medications. It is essential to assess multiple vital signs to ensure that the patient is stable and able to tolerate the medication without adverse effects. In an educational context, understanding the importance of monitoring vital signs before medication administration is fundamental for nursing practice. It ensures that healthcare providers can identify any potential risks or contraindications before giving medications, ultimately promoting patient safety and positive health outcomes. Nurses and other healthcare professionals must be vigilant in assessing vital signs to prevent medication errors and adverse reactions.

Correct Answer: B

Rationale: In this situation, option B is the correct response because it emphasizes the importance of proper communication and collaboration with the healthcare team. Asking the individual to describe the headache allows for a better understanding of the situation, and paging the nurse ensures that the appropriate action is taken based on the individual's symptoms and the healthcare provider's directions. Option A is incorrect because administering aspirin for a headache when it is only ordered for fever goes against the principles of safe medication administration. Medications should only be given for their intended purposes as per the healthcare provider's orders to prevent adverse effects. Option C is also incorrect as administering Motrin from another individual's supply without an order is a violation of medication administration protocols. Each individual's medication supply is specific to their own needs and conditions, and using someone else's medication can lead to serious consequences. Option D is incorrect as it dismisses the individual's complaint and fails to address their needs. Disregarding a person's discomfort or symptoms can result in overlooking a serious health issue or failing to provide appropriate care. Educationally, this question emphasizes the importance of following proper protocols in medication administration, including consulting healthcare professionals for guidance and ensuring medications are administered based on the prescribed indications. It highlights the need for clear communication, critical thinking, and adherence to healthcare policies to deliver safe and effective care to individuals.

Correct Answer: C

Rationale: In the context of medication administration, understanding the appropriate route of administration is crucial to ensure optimal patient outcomes. In the case of nitroglycerin for chest pain, the correct route is sublingual (option C) due to its rapid onset of action. Nitroglycerin is a vasodilator used to relieve angina by dilating blood vessels and improving blood flow to the heart. When administered sublingually, the medication is absorbed directly into the bloodstream through the mucous membranes under the tongue, allowing for quick systemic distribution and rapid relief of symptoms. This route bypasses the first-pass metabolism in the liver, leading to a faster onset of action compared to oral administration. Option A (oral administration) is not appropriate for nitroglycerin in the acute management of chest pain because the medication would be subject to degradation in the gastrointestinal tract and hepatic metabolism, delaying its therapeutic effects. Option B (buccal administration) involves placing the medication between the cheek and gum, which is not the recommended route for nitroglycerin and may not provide the same rapid absorption as sublingual administration. Option D (rectal administration) is not indicated for nitroglycerin for chest pain as it does not offer the same rapid absorption and reliable onset of action as sublingual administration. Educationally, understanding the rationale behind the correct route of medication administration is essential for nursing and medical students preparing for exams like the NCLEX. It not only ensures safe and effective patient care but also demonstrates knowledge of pharmacological principles and the rationale behind specific drug administration practices. By grasping the nuances of drug delivery routes, healthcare professionals can optimize treatment outcomes and provide quality care to patients.

Correct Answer: A

Rationale: In the context of medication administration, understanding the purpose and indications of psychotropic medications like Clozapine (Clozaril) and Risperidone (Risperdal) is crucial for safe and effective nursing practice. The correct answer is A) mental illness because these medications are primarily used in the treatment of psychiatric disorders such as schizophrenia, bipolar disorder, and other mental health conditions. Choosing option A is correct because both Clozapine and Risperidone are classified as antipsychotic medications. Clozapine is often used for treatment-resistant schizophrenia, while Risperidone is used for various psychotic disorders and behavioral disturbances. These medications work by affecting neurotransmitter levels in the brain to help regulate and improve symptoms associated with mental illnesses. Options B, C, and D are incorrect. Option B) seizures is incorrect because these medications are not indicated for seizures; they are specifically designed to target symptoms of mental illnesses. Option C) heart disease is incorrect as these medications do not primarily treat cardiovascular conditions. Option D) diarrhea is incorrect as this is not a known indication for either Clozapine or Risperidone. From an educational perspective, understanding the correct use of psychotropic medications is essential for nurses and healthcare professionals to provide safe and effective care to patients with mental health conditions. Knowing the specific indications, mechanisms of action, potential side effects, and nursing considerations associated with these medications is crucial for medication safety and patient outcomes. Nurses should always verify the appropriateness of the medication, the correct dosage, and monitor patients closely for any adverse effects when administering psychotropic medications.