Test Bank Pharmacology and the Nursing Process

Correct Answer: B

Rationale: The correct answer is B: sitting at the side of the bed with both arms resting on a locked overbed table. This position allows for better lung expansion and easier access to the thoracic cavity during the procedure. Sitting position helps in maximizing lung volume and facilitates drainage of pleural effusion. Arms resting on a locked overbed table helps the patient maintain a stable position and reduces the risk of movement during the procedure. Other choices are incorrect because supine position (A) may not allow for optimal lung expansion, high fowler's position (C) may not provide easy access to the thoracic cavity, and semi-fowlers position (D) may not facilitate efficient drainage of pleural effusion.

Correct Answer: C

Rationale: The correct answer is C: An intravenous set-up. Checking for an intravenous set-up is crucial to ensure that Mrs. Zeno is receiving necessary medications or fluids. It allows the nurse to monitor the infusion rate, prevent potential complications like infiltration, and ensure proper medication administration. A tracheostomy set (A) may be important for respiratory support but not essential for immediate safety. A hypothermia blanket (B) is used for temperature management and not directly related to Mrs. Zeno's immediate safety. A syringe and edrophonium HCl (D) are specific to a diagnostic test for myasthenia gravis and not necessary for general bedside safety assessment.

Correct Answer: D

Rationale: The correct answer is D: Exhale deeply as the nurse re-inflates the cuff. Rationale: 1. When the cuff of the tracheostomy tube is deflated, the client should be instructed to exhale deeply to prevent aspiration of secretions. 2. Exhaling helps to clear the airway by pushing secretions out of the trachea, reducing the risk of aspiration. 3. Inhaling or holding the breath while the cuff is being re-inflated can increase the risk of inhaling secretions. 4. Coughing as the cuff is being deflated (choice A) may not be as effective in clearing secretions as exhaling deeply. 5. Taking a deep breath as the nurse deflates the cuff (choice C) may not be as effective as exhaling deeply in preventing aspiration. In summary, choice D is the correct answer because exhaling deeply helps clear secretions and reduce the risk of aspiration, while the other choices may

Correct Answer: A

Rationale: The correct answer is A. Before administering a narcotic analgesic like Morphine, assessing the client's level of alertness and respiratory rate is crucial to ensure they can tolerate the medication without compromising their breathing. Alertness indicates their ability to handle potential side effects, while respiratory rate is vital to monitor for any signs of respiratory depression. Choice B (last meal) is not directly related to giving a narcotic analgesic, although it may impact the absorption rate. Choice C (bowel habits) and last bowel movement are not immediately relevant to assessing the client's readiness for a narcotic analgesic. Choice D (history of addictions) is important but not the priority when assessing for immediate safety and efficacy of the medication.

Correct Answer: A

Rationale: Step-by-step rationale: 1. Allowing the client to grasp the nurse's hand firmly assesses grip strength and motor coordination. 2. This step helps evaluate the client's ability to follow instructions and perform a coordinated motor task accurately. 3. Assessing grip strength is essential in determining any muscle weakness or neurological deficits. 4. It also provides insight into the client's motor function and coordination abilities. Summary: - Choice B is incorrect because it focuses on sensory functions rather than motor functions. - Choice C assesses fine motor skills, not grip strength and coordination. - Choice D evaluates cognition and logic, which are not directly related to motor function assessment.