The nurse is caring for a client who experienced a severe headache. When the prescribed dose of analgesics did not cause relief, the client took double the dosage 1 hour later. The nurse should assess the client for what adverse effect?
An allergic reaction
Anaphylactic reaction
Poisoning
Sedative effects
The Correct Answer is C
A. An allergic reaction is a possible response to medication, but it is not directly related to doubling the dosage.
B. Anaphylactic reaction is a severe and rapid allergic response; while possible, it is not the most likely consequence of an overdose in this context.
C. Poisoning is a likely concern when a client takes double the prescribed dosage of analgesics, especially if the medication has a narrow therapeutic index or is known to cause toxicity at high doses.
D. Sedative effects could occur depending on the analgesic used, but poisoning is a more pressing concern following an overdose.
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Correct Answer is B
Explanation
A. Performing a blood sugar analysis is important, but in the case of sudden symptoms such as weakness, shakiness, and dizziness, it is crucial to act quickly to address the potential hypoglycemia without delay.
B. Having the client drink a 4-ounce glass of orange juice is the most appropriate initial response as it provides a quick source of glucose to alleviate symptoms of hypoglycemia, which is a common concern in clients with type 1 diabetes experiencing these symptoms.
C. Administering 1 ampule of 50% dextrose intravenously is an effective treatment for hypoglycemia but is typically reserved for severe cases where the patient is unable to consume oral glucose or is unconscious.
D. Administering 10 units of regular insulin subcutaneously would exacerbate the problem by lowering blood sugar further and is contraindicated in a patient experiencing hypoglycemic symptoms.
Correct Answer is ["A","B","D","E"]
Explanation
A. Maintain good oral hygiene to minimize dry mouth is correct; good oral hygiene practices can help alleviate dry mouth, which is a common anticholinergic effect.
B. Void before taking the medication so urinary hesitation is less problematic is correct; this strategy can help manage urinary retention, another potential side effect of tricyclic antidepressants.
C. Avoid situations where bruising or lacerations are a possibility is incorrect; while caution is always advisable, this statement does not directly relate to anticholinergic effects.
D. Eat several small meals daily rather than three larger meals is correct; smaller meals can help mitigate gastrointestinal side effects and maintain steady blood sugar levels.
E. Use caution in situations where it may be possible to become overheated is correct; anticholinergic medications can impair thermoregulation, increasing the risk of heat-related illnesses.