Pain Management - ATI 3.0
A nurse is caring for a client who has a fractured humerus and received an opioid medication intravenously 1 hr ago for pain. Which of the following questions should the nurse ask to determine the intensity of the client's pain at this time? "On a scale from 0 to 10, how do you rate your pain?" "How often do you feel the pain?" "How often do you feel the pain?" "Can you point to where you have pain?" "What does your pain feel like?"
"On a scale from 0 to 10, how do you rate your pain?" ~ CORRECT-The nurse should ask the client to rate their pain using a pain scale to assess the intensity of the pain. "How often do you feel the pain?"-INCORRECT: The nurse should determine the time, frequency, and onset of the pain, but this does not address the intensity of the client's pain. "Can you point to where you have pain?"-INCORRECT: The nurse should identify the region of the pain, but this does not address the intensity of the client's pain. "What does your pain feel like?"-INCORRECT: The nurse should assess the quality of the client's pain, but this does not address the intensity of the client's pain.
A nurse is preparing to administer acetaminophen 1,000 mg PO every 12 hr for a client who has arthritic pain. The nurse should monitor the client for which of the following adverse effects? Hepatotoxicity Salicylism Respiratory depression Gastrointestinal bleeding
Correct: _Hepatotoxicity The nurse should monitor the client for hepatotoxicity. The client should not receive more than 4 g/day of acetaminophen to prevent damage to the liver. Salicylism -INCORRECT: The nurse should monitor the client who is taking salicylates, such as aspirin, for salicylism, which can manifest tinnitus or vertigo. Respiratory depression- INCORRECT: The nurse should monitor the client who is taking opioids for sedation, which can lead to respiratory depression. Gastrointestinal bleeding- INCORRECT: The nurse should monitor the client who is taking NSAIDs for gastrointestinal bleeding. NSAIDs can irritate the lining of the stomach, which can dad to bleeding.
A nurse is caring for a client who has a left hip fracture and is prescribed a morphine IV bolus as needed for pain. The nurse should monitor the client for which of the following adverse effects? Diarrhea Tachypnea Sedation Polyuria
Diarrhea- INCORRECT: Constipation is an adverse effect of morphine. Tachypnea- INCORRECT: Respiratory depression is an adverse effect of morphine. Sedation- CORRECT: The nurse should monitor the client for sedation, which is an adverse effect of morphine and can lead to respiratory depression.. Polyuria-INCORRECT: Urinary retention is an adverse effect of morphine.
A nurse is preparing to administer hydrocodone to a client who reports throbbing pain following a back injury. The nurse should document that the client is experiencing which of the following types of pain? idiopathic neuropathic visceral somatic
Idiopathic-INCORRECT: Idiopathic pain is a chronic pain that has no identifiable location or psychological cause. Neuropathic- INCORRECT: Neuropathic pain affects the nerves in the body, such as a neuropathy. Visceral-INCORRECT: Visceral pain affects the organs and intestines of the body, such as gastrointestinal pain. Somatic-~ CORRECT: The nurse should identify that the client who has a back injury is experiencing somatic pain, which affects the bones, joints, and muscles of the body.
A nurse is collecting data about a client's pain. Which of the following questions should the nurse ask the client to assess the quality of the pain? When did the pain begin? How would you rate your pain on a scale from 0 to 10? What does your pain feel like? Can you show me where you have pain?
When did the pain begin?"-INCORRECT The nurse should determine the time, frequency, and onset of the pain, but this does not address the quality of the client's pain. "How would you rate your pain on a scale from 0 to 10?" INCORRECT- The nurse should use pain scales to measure the intensity of the pain, but this does not address the quality of the client's pain. "What does your pain feel like?"-CORRECT. The nurse should assess the quality of the client's pain by asking them to describe how it feels. "Can you show me where you have pain?"- INCORRECT The nurse should identify the region of pain, but this does not address the quality of the client's pain.
