Correct Answer: A

Rationale: The correct answer is A: Dysrhythmias. Straining while defecating can lead to increased intra-abdominal pressure, which can stimulate the vagus nerve and result in dysrhythmias such as bradycardia or even atrial fibrillation. This occurs due to the vagal response triggered by the increased pressure.

Choices B, C, and D are incorrect because straining while defecating does not directly cause dilated pupils, gastric ulcers, or diarrhea. By understanding the physiological implications of increased intra-abdominal pressure on the vagus nerve, we can conclude that dysrhythmias are the most likely consequence of straining during defecation in an older adult client.

Correct Answer: B

Rationale: The correct answer is B: Respirations are unlabored. This indicates a therapeutic response to epinephrine for angioedema. Epinephrine acts as a bronchodilator, improving airway patency and reducing respiratory distress. Unlabored respirations suggest improved air exchange and a positive response to the medication.

A: Peripheral edema is not a direct indicator of epinephrine effectiveness for angioedema.
C: Groin pain reduction may not be related to the expected response of epinephrine for angioedema.
D: Blood pressure levels do not directly reflect the effectiveness of epinephrine in treating angioedema.

In summary, the key to identifying the therapeutic response to epinephrine for angioedema is the improvement in respiratory status, making option B the correct choice.

Correct Answer: D

Rationale: The correct response is D: Your husband should decide when more medication is needed. This empowers the patient to control their pain management and ensures safety. The partner should not be administering medication without consulting the patient or healthcare provider. Option A enables potential overmedication, option B doesn't address the issue of patient autonomy, and option C is inappropriate as the nurse should be the one managing the PCA pump. Option D promotes patient autonomy and safety.

Correct Answer: D

Rationale: The correct answer is D: Level of sedation. Monitoring sedation is crucial when a client receives an opioid narcotic due to the risk of respiratory depression. Assessing the level of sedation helps to ensure the client is not overly sedated, which could lead to respiratory compromise. This assessment guides the nurse in determining the need for interventions such as stimulating the client or administering a reversal agent.

A: Pain level is important but not the priority in this scenario as respiratory status takes precedence.
B: Pulse oximetry is important for assessing oxygenation but may not directly indicate respiratory depression from sedation.
C: Blood pressure is relevant but not as critical as monitoring sedation for respiratory depression.
Summary: Monitoring the client's level of sedation is the priority to detect and prevent respiratory depression when opioid narcotics are administered.

Correct Answer: D

Rationale: The primary focus of interventions for a client who sleepwalks should be to maintain patient safety during episodes of somnambulism (walking during sleep). This is the correct answer because safety is paramount during sleepwalking episodes to prevent injury or harm. Administering medications to suppress stage III sleep (choice
A) is not recommended as it can have side effects and may not address the underlying cause. Encouraging the child to verbalize feelings (choice
B) is important but not the primary focus for addressing sleepwalking. Providing a quiet environment for nighttime sleep (choice
C) is beneficial for improving overall sleep quality but does not directly address sleepwalking safety. Maintaining patient safety (choice
D) is crucial in managing sleepwalking episodes effectively.