Question 47:

Four hours after administering promethazine to a client, the practical nurse (PN) measures the client's temperature. When the client questions the PN about taking the temperature, how should the PN respond?

A. Describe how the medication works to lower body temperature.
B. Encourage the client to share concerns about the plan of care.
C. Offer assurance that vital signs are routinely taken every 4 hours.
D. Explain the need to assess for side effects of the medication.

The practical nurse should reassure the client about the routine vital sign checks and explain the importance of assessing for medication side effects.

Explanation:

The practical nurse (PN) should respond by:

Offering assurance that vital signs are routinely taken every 4 hours. This response reassures the patient about the monitoring of their vital signs, maintaining transparency, and addressing the client's query.
Explaining the need to assess for side effects of the medication. This educates the patient about the purpose of monitoring for potential side effects, promoting understanding and awareness.

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