Use the case study information provided to answer this question. >The nurse should recognize that `____` and `____` are the *most* important nursing interventions to take next after reviewing the vital signs from 0930.

administering Narcan® (naloxone) IV; calling the physician for further orders

placing the client’s bed in reverse Trendelenburg position; notifying the RN

initiating a normal saline IV bolus; calling the physician

administering oxygen per nasal cannula; administering 1 L normal saline bolus

Question 40 of the Pharmacological Therapies Practice Test for the NCLEX-PN Exam

Intro to case:

You are assigned to float to the orthopedic surgical floor as an LPN. One of your clients is a 48-year-old female who was admitted to the floor yesterday after a motor vehicle accident (MVA) in which she fractured her pelvis and right femur. She had emergency surgery last night and her anesthesia has worn off.

Nurse’s Notes

0730: Client is in bed fidgeting and constantly trying to change positions stating, “no matter what position I’m in, everything hurts.” Client is restless and diaphoretic. She states her pain level is “10” on the 1-10 numerical pain scale. Client’s last IV Dilaudid was given at 0630.

0800: Consulted with the RN regarding the client’s pain and vital signs. RN called the doctor to request additional pain medicine. The doctor wrote a new order for a patient-controlled analgesia (PCA) pump containing Morphine for client. Will set up intravenous PCA pump with RN present in room and educate client on use.

History and Physical

Body System	Findings
Cardiovascular	Hx of mild hypertension, varicose veins, and Raynaud’s phenomenon. Capillary refill > 3 sec, hypertensive, mottling noted to right foot.
Integumentary	Hx of squamous cell carcinoma. Right leg incision clean, dry, intact, and approximated. No signs of infection noted.
Neurological	AAOX4, PERRLA, but notes tingling in right foot since her accident.
Respiratory	Hx of 1/2 PPD smoker. Quit smoking 1 month ago. Lungs clear. Client is tachypneic.
Musculoskeletal	Hx of osteoarthritis, tendinitis of both ankles. Right pelvic fracture and right femur fracture from MVA- surgically repaired by external fixation yesterday.

Vital Signs

	0800	0930
BP	178/96	86/54
T	99.2\(^\circ\)F	98.9\(^\circ\)F
HR	121	70
RR	22	6
SpO2	96%	88%

Question 40 - Pharmacological Therapies Practice Test for the NCLEX-PN Exam