lacharity pain

what is the best way to schedule medication for a client with constant pain 1. PRN at the client's request 2. before painful procedures 3. IV bolus after pain assessment 4. around the clock

4

which nonpharm. pain measure to help Ms. R (RA) relieve her early morning stiffness should be delegated to the UAP? 1. assisting ms r to get in a bathtub full of warm water 2. sharing some relaxation techniques with mrs r 3. assisting ms r to take a warm shower 4. evaluating the effectiveness of paraffin therapy

3

mr o (tibia-fibula fx) is at risk for compartment syndrome becuase of the cast. which pain assessment finding most strongly suggests compartment syndrome? 1. pain on passive motion 2. sudden increase in pain 3. intense discomfort r/t an itching sensation 4. absence of pain despite no recent medication

1

ms j is receiving opiates to control her pain caused by end-stage multiple myeloma. which side effect is the major concern for this patient 1. constipation 2. respiratory depression 3. n/v 4. sedation

1

In the care of clients with pain and discomfort, which task is most appropriate to delegate to the UAP? 1. assisting the client with preparation of a sitz bath 2. monitoring the client for signs of discomfort while ambulating 3. coaching the client to deep breathe during painful procedures 4. evaluating relief after applying a cold compress

1

a client is crying and grimacing but denies pain and refuses pain medication because my brother isa drug addict and has ruined our lives. what is the priority intervention for this client 1. encourage expression of fears and past experiences 2. provide accurate information about the use of pain medication 3. explain that addiction is unlikely among acute care clients 4. seek family assistance in revolving this problem

1

after reviewing ms j's end stage multiple myeloma medicaiton list, the RN is most likely to question scheduled doses of which medication 1. naltrexone 2. fentanyl 3. moprhone 4. acetaminophen

1

for mrs r (RA) which discharge topic is the most important to emphasize to prevent a major postsurgical complication 1. activity and movement limitations for the affected shoulder 2. continuation of pain medication as prescribed 3. possibility or repeat surgery for ongoing disease changes 4. expected postsurgical symptoms, such as localized pain

1

the client is prescribed a fentanyl patch for persistent severe pain. which client behavior most urgently requires correction 1. frequently likes to sit in the hot tub to reduce joint stiffness 2. prefers to place the patch only on the upper anterior chest wall 3. saves and refuses the old patches when he can't afford new ones 4. changes the patch every 4 days rather than the prescribed 72 hours

1

the nurse is caring for a postop client who reports pain. based on recent evidence-based guidelines which approach would be best 1. multimodal strategies 2. standing orders by protocol 3. IV PCA 4. opioid dosage based on valid numerical scale

1

the nurse is considering seeking clarification for several prescriptions of apin medication. which client circumstance is the priority concern 1. a 35yo opioid naive adult will receive a basal dose of morphine via IV PCA 2. a 65 yo adult will be discharged with a prescription for NSAIDs 3. a 25yo adult is prescribed as needed IM analgesic for pain 4. a 45 yo adult is taking oral fluids fand goods has orders for IV morphine

1

the nurse is working with a HCP who prescribes opioid doses based on a specific pain intensity rating. which client circumstances is cause for greatest concern 1. a 73yo frail female client with a hx of COPD is prescribed 4mg IV morphine for pain fo 1-3 on a scale of 0-10 2. a 25yo postop male client with a hx of opioid addiction is prescribed one tablet of oxycodone and acetaminophen for pain of 4-5 on a scale of 0-10 3. a 33 yo opioid naive female client who has a severe migraine headache is prescribed 5mg IV morphine for a pain of 7-8 on a scale of 0-10. 4. a 60yo male with a history of rheumatoid arthritis is prescribed one tablet of hydromorphone for pain 5-6 on a scale of 0-10.

1

the nurse recognizes that there are ethical considerations in helping clients to achieve relief from pain. which nursing action is the best example of the principle of nonmaleficence? 1. client seems excessively sedated but continues to ask for morphine, so the nurse conducts further assessment and seeks alternatives to opioid medication 2. client has no known disease disorders and no objective signs of poor health or injury, but reports severe pain, so nurse advocates for pain medicine 3. client is older, but he is mentally alert and demonstrates good judgement, so the nurse encourages the client to verbalize personal goals for pain management 4. client reportedly refuses pain medication but shows grimacing and reluctance to move, so the nurse explains the benefits of taking pain medication

1

when an analgesic is titrated to manage pain, what is the priority goal 1. titrate to the smallest dose that provides relief with the fewest side effects 2. titrate upward until the client is pain free or acceptable level is reached 3. titrate downward to prevent toxicity, overdose, and adverse effects 4. titrate to a dosage that is adequate to meet the clients subjective needs

1

which nonpharmacologic intervention for pain management is the most appropriate for mr L kidney stone 1. avoid overhydration and underhydration 2. gently massage the lower back 3. darken the room to encourage rest and sleep 4. apply an ice pack to the kidney area

1

according to recent guidelines form the american pain society in collaboration with the american society of anesthesiologists, what are the priority pain management strategies that the nurse would expect to see int eh pain management for postsurgical clients? Select all that apply. 1. acetaminophen and/or NSAIDs for management of postop pain in adults and children without contraindications 2. surgical site-specific peripheral regional anesthetic techniques in adults and children for procedures 3. neuraxial epidural analgesia for major thoracic and abdominal procedures if the client has risk for cardiac complications or prolonged ileus 4. multimodal therapy that could include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies 5. long acting oral opioids, especially int he immediate postoperative period, for continuous around the clock relief 6. neuraxial administration of magnesium, benzodiazepines, neostigmine, tramadol, or ketamine is recommended for postoperative pain

1 2 3 4

which morning tasks can be delegated to the UAP. select all that apply 1. assisting Mrs R who has RA with morning care 2. reinforcing to Mr L who has a kidney stone the need to save urine for straining 3. preparing mr h's room for his return from the OR for hernia repair 4. reporting ont he condition of Mr O's skin resulting from his MVA 5. getting coffee for Ms. j's family 6. checking on the pulse oximeter reading for mr. a who has bacterial penumonia

1 2 3 5

which of the 6 patients can be assigned to the new RN. select all that apply 1. rheumatoid arthritis 2. kidney stones 3. motorcycle accident 4. inguinal hernia repair 5. end-stage multiple myeloma 6. bacterial pneumonia and HIV positive

1 2 4

which end-of-shift tasks can be deleated to the UAP? SATA 1. emptying trash can and placing personal items within reach 2. checking mr a's linens for moisture or soiling before shift change 3. asking mr l if he needs a dose of pain med before shift change 4. assisting to change position in bed to relieve pressure on joints 5. ensuring leg is elevated and evlauting comfort 6. emptying urinal and recording the output

1 2 4 6

which tasks r/t pain management can be delegated to the UAP. SATA 1. reporting on grimacing seen in an unresponsive patient 2. asking about the location, quality, and radiation of pain 3. reminding pt's to report pain as necessary 4. observing for relief after med is given 5. asking patients directly, are you having any pain 6. determining if position change relieves pain

1 3 5

which client must be assigned to an experienced RN? select all that apply 1. client who was in an automobile crash and sustained multiple injuries 2. client with chronic back pain r/t a workplace injury 3. client who has returned from surgery and has a chest tube in place 4. client with abdominal cramps r/t food poisoning 5. client with severe H/A of unknown origin 6. client with chest pain who has a history of arteriosclerosis

1 3 5 6

which client has the most immediate need for IV access to deliver immediate analgesia with rapid titration 1. client who has sharp chest pain that increases with cough and SOB 2. client who reports excruciating lower back pain with hematuria 3. client who is having an acute MI with severe chest pain 4. client who is having severe migraine with an elevated BP

3

which client is most likely to receive opioids for extended periods of time 1. a client with fibromyalgia 2. a client with phantom limb pain in the leg 3. a client with progressive pancreatic cancer 4. a client with trigeminal neuralgia

3

for a cognitively impaired client who cannot accurately report pain, what is the first action that the nurse should take 1. closely assess for nonverbal signs such as grimacing or rocking 2. obtain baseline behavioral indicators from family members 3. note the time of and client's response tot he last dose of analgesic 4. give the maximum PRN dose within the minimum time frame for relief

2

a client with diabetic neuropathy reports a burning electrical=type pain in the lower extremities that is worse at night and not responding to NSAIDs. which medication will the nurse advocate for first. 1. gabapentin 2. corticosteroids 3. hyrdomorphone 4. lorazepam

1.

Mrs R tells the nurse that she is really dreading doing the postop exercises. she seems fearful and grimaces when the nurse suggests that pain medication can be given before the exercises begin. which member of the health care team would the nurse consult first? 1. psychiatric clinical nurse specialist to evaluate fears 2. OT to review the exercise therapy 3. pharmacist to verify efficacy of the prescribed pain meds 4. surgeon to review the expected progress of healing

2

a client received pRN morphine, lorazepam, and cyclobenzapine. the UAP reports tha tthe client has a respiratory of 10 breaths/min. what is the priority action. 1. call the HCP to obtain an order for naloxone 2. assess the client's responsiveness and respiratory status 3. obtain a bag valve mask and deliver breaths at 20 breaths/min 4. double check the prescription to see which drugs were ordered

2

based on the information that the nurse received during hand-off report for Mr. L (kidney stone) what is the priority concept to consider in planning interventions for this patient? 1. elimination 2. pain 3. fluid 4. infection

2

based on the information that the nurse received during handoff for Mr A who has bacterial pneumonia and is HIV positive, what is the priority concept to consider in planning care for this patient 1. pain 2. gas exchange 3. immunity 4. cellular regulation

2

mr a (bacterial pneumonia) has a single lumen PICC and he has the following medications scheduled for now: vanco, levofloxacin, D5 with K, and an IV bolus of morphine. what is the priority action? 1. call the HCP and ask if the medication times can be staggered 2. call the pharmacy and inquire about the compatibility of the medications and solutions 3. give the bolus dose of morphine becuase it will take the least amount of time 4. obtain an order to establish an additional peripheral IV site

2

mr h (hernia repair) is asking for pain medication and the HCP has orderd 10mg of immediate-release oxycodone PRN. the pharmacy has stocked 5mg tablets of controlled-release oxy in the med cabinet. what is the priority action 1. call the HCP for clarification of the original prescription 2. call the pharmacy and obtain the immediate release form of the drug 3. ask the patient if the immediate or controlled release action is preferred 4. give two fo the 5m tablets to achieve the correct dose

2

mr h returns from the OR after a hernia repair. he says that he is afraid to walk becuase it will make the pain feel really bad. what does the nures explain as the best option 1. pain medication every 4 hours if he needs or wants it 2. medication 30-40 mintues before ambulation or dressing changes 3. around-the-clock pain meds even if he has no report of pain 4. talking to the hcp for reassurance about the tx plan

2

mr h says i have several friends who became addicted to drugs and it totally ruined their lives. i'm afraid to take any kind of addictive drugs. what is the nurse's best response 1. your HCP prescribes types of opioids that do not cause addiciotn 2. you will be given opioids for a very short time and addiction is unlikely 3. your friends probably had addictive personalities and you don't need to worry 4. if you become addicted, the HCP will refer you to a drug rehab porgram

2

ms j's son tells the RN my mom is having trouble breathing and she is havign a lot of pain. on assessment, ms j demonstrates shallow rapid breathing and reports pain over the right lateral ribs that increases with movement and breathing. what is the priority action? 1. take VS with pulse ox reading and inform the HCP 2. apply o2 and raise the HOB if the pt is not hypotensive 3. obtain an order to start an IV and to give a bolus dose of moprhine 4. be calm, stay with the patient, and encourage pursed lip breathing

2

pain disorder and depression have been diagnosed for a client. he reports chronic low back pain and states, none of these doctors has done anything to help. which client statement is cause for greatest concern. 1. i twisted my back last night, and now the pain is a lot worse 2. i'm so sick of this pain. i think i'm going to find a way to end it 3. occasionally, i buy pain killers from a guy in my neighborhood 4. i'm going to sue you and the doctor, you aren't doing anything for me

2

the UAP reports tha tthe new RN is undermedicating the patients. what is the best way for the team leader to handle this situation 1. ignore her, the UAP is not qualified to judge an RN 2. ask the UAP to give specific examples 3. go to the new RN and question her 4. do an assessment on all of the nurse's patients

2

the client is diagnosed by the ED HCP with an acute migraine. for which situation is it most important to have a discussion with the HCP before medications is prescribed? 1. the HCP is considering dexamethasone to prevent reoccurrence, that the client has type 2 DM 2. the HCP is considering subq sumatriptan and the client took ergotamine 3 hours ago 3. the HCP is considering metoclopramide and this is a first time migraine for the client 4. the HCP is considering prochlorperazine and the client drove himself to the hospital

2

the new nurse tells the team leader that she cannot find any documentation that shows the time of mr l's kidney stone last does of pain medication. what action should occur first 1. help the new RN look at the chart and MAR 2. tell the new RN to ask the night RN before she leaves 3. speak to the night shift RN about the documentation 4. have the new RN ask Mr L when he last had his med

2

the nurse is assessing a client who has been receiving opioid medication via PCA. what is an early sign that alerts the nurses to a possible adverse opioid reaction. 1. client reports SOB 2. client is more difficult to arouse. 3. client is more anxious and nervous 4. client reports pain is worsening

2

the nurse is caring for a young client with type 1 diabetes who has sustained injuries when she tried to commit suicide by crashing her car. her BG level is 550, but she refuses insulin; however, she wants the pain medication. what is the best action. 1. notify the charge nurse and make arrangements to transfer to the intensive care 2. explain significance of BG and insulin and then call the HCP 3. withhold the pain medication until she agrees to accept insulin 4. give her the pain medication and document the refusal of the insulin

2

which postoperative client is manifesting the MOST serious negative effect of inadequate pain management? 1. demonstrates continuous use of call bell related to unsatisfied needs and discomfort 2. develops venous thromboembolism r/t immobility caused by pain and discomfort 3. refuses to participate in PT becuase of fear and pain caused by exercises 4. feels depressed about loss of function and hopeless about getting relief from pain

2

during the shift, the following events occur at the same time. prioritize the order for addressing these problems 1. mr l is calling out loudly about right sided flank pain caused by his kidney stone 2 mr o who was in a MVA is calling "the pump tipped over and it's broken" 3. another nurse needs opioid wastage witnessed 4. mr a with bacterial pneumonia is urinating in the corner of his room

2 1 4 3

which clients can be appropriately assigned to an LPN/LVN who will function under the supervision or an RN or a team leader? select all that apply 1. client who needs preop. teaching about the PCA pump 2. client with a leg cast who needs neuro-circ checks and PRN hydrocodone 3. client who underwent a toe amputation and has neuropathic pain 4. client with terminal cancer and severe pain who is refusing medication 5. client who reports abdominal pain after being kicked, punched, and beaten 6. client with arthritis who needs scheduled pain medications and heat applications

2 3 6

which tasks related to mr a's bacterial pneumonia pain management can be delegated to the UAP? SATA 1. clean the TENS unit 2. notify the nurse about the pt's request for pain meds 3. reinforce the use of a pillow splint when coughing 4. observe for actions that increase fatigue/anxiety 5. suggest that relatives bring personal comfort items 6. assist the patient o change position every 2 hours.

2 3 6

at the end of the shift, the opioid count shows that two tablets of oxy are unaccounted for. the team leaders has spoken to all of the nurses and pharmacists who had access to the medication cabinet during the shift, but no one will admit to removing htose two tablets. what should the team leader do? SATA 1. inform the staff that no one can leave until the matter is resolved 2. fill out an incident report and include facts about findings and actions 3. interview all of the patients 4. discuss the matter with the unit manager and review potential problems of the current system 5. review available records and med retrieval for the past 24 hours 6. ask the staff if they saw any other people who may have accessed the cabinet during the shift

2 4 5 6

which clients can be appropriately assigned to a newly graduated RN who has recently completed orientation? select all that apply 1. anxious client with chronic pain who frequently uses the call button 2. client on the second postoperative day who needs pain medication before dressing changes 3. client with AIDS who reports headache and abdominal and pleuritic chest pain 4. client with chronic pain who is to be discharged witha new surgically implanted catheter 5. client who is reporting pain at the site of a peripheral IV line 6. client with a kidney stone who needs frequent PRN pain medication

2 5 6

a client's family member comes to the nurse's station and says he needs more pain medicine. he is still having a lot of pain. what is the nurse's best response. 1. the HCP ordered the medicine to be given every 4 hours 2. if medications given too frequently, there are ill effects 3. please tell him that i will be right there to check on him 4. let's wait about 40 minutes. if then he still hurts, i'll call th eHCP

3

a client's opioid therapy is being tapered off, and the nurse is watchful for signs of withdrawal. what is one of the first signs of withdrawal 1. fever 2. nausea 3. diaphoresis 4. abdominal cramps

3

family members are encouraging the client to tough out the pain rather than risk drug addiction to opioids. the client is stoically abiding. the nurse recognizes that the sociocultural dimension of pain is the current priority for the client. which question will the nurse ask? 1. where is the pain located and does it radiate to other parts of your body 2how would you describe the pain and how is it affecting you 3. what do you believe about pain medication and drug addiction 4. how is the pain affecting your activity level and your ability to function

3

for a postop patient, the heath care provider prescribed multimodal therapy, which includes acetaminophen, NSAIDs, PRN opioids, and nonpharmaceutical interventions. the client continuously asks for the PRN opioid, and the nurse suspects that the client may have a drug abuse problem. which action by the nurse is best 1. administer acetaminophen and spend extra time with the client. 2. explain that opioid medication is reserved for moderate to severe pain. 3. give the opioid because client deserves relief and drug abuse is unconfirmed. 4. ask the hcp to validate suspicions of drug abuse and alter the opioid prescription

3

for mr o in addition to pain medication, which action will help the most to relieve pain associated with the tibia-fibula fracture caused by his MVA 1. instruct him to periodically move his toes 2. use diversional activities 3. elevate the injured leg above the heart 4. place the patient in a high fowler position

3

for which of these clients is IV morphine the first-line choice for pain management 1. a 33 yo intrapartum client needs pain relief for labor contractions 2. a 24 yo client reports severe headache r/t being hit in the head 3. a 56 yo client reports breakthrough bone pain r/t multiple myeloma 4. a 73 yo client reports chronic pain associated with hip replacement surgery

3

in application of the principles of pain tx, what is the first consideration 1. tx i based on client goals 2. a multidisciplinary approach is needed 3. client's perception of pain must be accepted 4. drug side effects must be prevented and managed

3

it is the ned of the shift, and the new nurse is trying to give pain medication to one patinet, provide comfort measures for another patinet, and redo pain assessments on all her patients. her documetnation is incomplete. what should the team leader do 1. offer to help by performing the comfort measures 2. let her struggle through so she can find her own way 3. help her to prioritize and delegate the tasks 4. ask someone from the oncoming shift to help her

3

later in the shift mr a (bact. pneumo) reports that the chestt pain is gone but his back really hurts. he says he needs more morphine. based on the ethical principles of nonmaleficence, what is the prioirity action. 1. believe mr a's subjective report of pain and give the pain medication as ordered 2. contact the HCP for an increase in dosage because mr a appears to need higher dosages 3. consider hx of addiction and chronic pain, respiratory status, and time of last dose 4. offer nonpharm measures such as position changes or distraction

3

mr he is given a dose of pain medication. one hour later he is anxious and appears uncomfortable, and he asks "what is the matter? is something wrong? i'm still hurting." what action should be taken first 1. call the HCP for a change in medication or dose 2. initiate NPO in case surgery is needed 3. check for bladder distention and last voiding 4. reassure the patient that the hernia is not recurring

3

mr l (kindey stone) calls for pain medication. he describes the pain caused by his kidney stone as excruciating. he is crying, diaphoretic, and pacing around the room. what is the priority action? 1. instruct mr l to do deep breathing exercises 2. remind mr l to use the PCA pump when he has pain 3. give mr L a PRN IV bolus dose as ordered 4. call the HCP immediately to report pain and other symptoms

3

mr l kidney stone reports that th epain has decreased compared with earlier but now he is having other symptoms. which symptom is of greatest concern? 1. painless hematuria with small clots 2. dull pain that radiates into the genitalia 3. absence of pain but scant urine output 4. sensation of urinary urgency

3

mr o reports an increasing pain in the right abdomen. on physical examination, there are hyperactive bowel sounds, a tense abdomen with guarding, and exquisite tenderness with gentle palpation. what is the priority action. 1. give a PRN pain medication 2. notify the HCP of findings 3. take a complete set of vital signs 4. assist him to change positions

3

ms j is having severe pain and admits to it; however, she becomes very anxious when certain family members come and go and refuses to take the pain medication. which adjunct medication would be most useful to ms j to help her manage these episodes 1. naproxen 2. doxepin 3. lorazepam 4. dicyclomine

3

the charge nurse of a long-term care facility is reviewing the methods and assessment tools that the staff nurses are using to assess pain. which nurse is using the best method to assess pain? 1. nurse a uses a behavioral assessment tool when the client is engaged in activities 2. nurse b asks a client who doesn't speak english to point to the location of pain 3. nurse c uses the same numerical rating scale every day for the same client 4. nurse d asks the daughter of a confused client to describe the client's pain

3

the health care provider prescribes 7mg morphine IV PRN. the nursing student prepares the medication and shows the syringe to the nursing instructor. what should the nursing instructor do first. 1. tell the student to review the providers's prescription before administering medication 2. waste the medication and tell the student that remediation is required for a serious error 3. ask the student to demonstrate the calculations and steps required to prepare the dose 4. accompany the student to the client's room and observe as the medication si administered

3

the home health nurse discovers that an older adult client has been sharing his pain medication with his daughter. despite the nurse's warnings about the dangers of sharing - he states my daughter cannot afford to see a doctor or to buy medicine, so i must give her a few of my pain pills. which member of the health care team is the nurse most likely to consult first. 1. HCP to renew the prescription so that the client has enough medicine 2. pharmacist to monitor the frequency of the prescription refills 3. social worker to help the family locate resources for helath care 4. home health aide to watch for inappropriate medication usage by family

3

the nurse is caring for a young man with a history of substance abuse who had exploratory abdominal surgery 4 days ago for a knife wound. there is a prescription to discontinue the morphine via PCA and to start oral pain medication. the client begs, please don't stop the morphine. my pain is really a lot worse today than it was yesterday.what is the best response. 1. let me stop the pump, and we can try oral pain medication to see if it relieves the pain 2. i realize that you are scared of the pain, but we must try to wean you off the pump 3. show me where your pain is and describe how it feels compared with yesterday 4. let's take your vital sings; then i will discuss your concerns with the HCP

3

the team leader is giving hte end of shift report about the RA patient to the oncoming nurse. place the followin info in correct order 1. she had shoulder pain 4/10 and was reluctant to move around 2. do you have any questions for me 3. mrs r is a 55yo woman 4. she had a shoulder arthroplasty 3 days ago 5. she received a PRN dose of acetaminophen with codeine and her pain is now a 1/10 6. the PT must speak to Ms r 's duaghter so page him when she arrives

3 4 1 5 6 2

a client has severe pain and bladder distention related to urinary retention and possible obstruction. an experienced UAP states that she received training in indwelling catheter insertion at a precious job. what task can be delegated to this UAP? 1. assessing the bladder distention and the pain associated with urinary retention 2. inserting the indwelling catheter after verifying her knowledge of sterile technique 3. evaluating the relief of pain and bladder distention after the catheter is inserted 4. measuring the urine output after the catheter is inserted and obtaining a specimen

4

a client with chronic pain reports to the charge nurse that the other nurses have not been responding to requests for pain medications. what is the charge nurse's initial reaction? 1. check the MAR for the past several days 2. ask the nurse educator to provide in-service training about pain management 3. perform a complete pain assessment on the client and take a pain history 4. have a conference with the staff nurses to asses their care of this client

4

an inexperienced graduate nurse is reviewing the MAR for a client who has a PCA pump for pain management. the new nurse compares the MAR and the HCP prescription, and both indicate that larger doses are prescribed at night compared with doses throughout the day. which member of the health care team should the new nurse consult first. 1. ask the client if he typically needs extra medication in the evening 2. ask the HCP to verify that the larger amount is the correct dose 3. ask the pharmacist to confirm the dosage on the original prescription 4. ask the charge nurse if this is a typical dosage for nighttime PA

4

mr a (bacterial pneumonia) reports left-sided anterior chest pain. what is the priority action 1. obtain an order for an ECG and continuis tele 2. auscultate the lung fields and compare to baseline assessments 3. give PRN pain med and reevaluate after 30 min 4. ask him to describe the pain and measure vital sins

4

ms j's son repeatedly insists that ms j is not getting enough pain medictaion. he threatens to sue. the team leader has used therapeutic medication skills iwth the son and advocated for the patient with the HCP. the HCP says "i'll be in tomorrow. just tell the son to chill out" what is the best action 1. call another HCP 2. continue to use the current orders 3. advise the son to call the HCP 4. notify the unit manager

4

on the first day after surgery, a client receiving an nalagesic via PCA pump reports that the pain control is inadequate. what is the first action that the nurse should take 1. deliver the bolus per standing order 2 contact the HCP to increase the dose 3. try nonpharmacologic comfort measures 4. assess the pain for location, quality, and intensity

4

one of the staff members is talking about mr a who has bacterial pneumonia saying he complains all the time about pain everywhere. well he is going to have pain. he's a drug addict, so what does he expect? - what is the best response to this comment. 1. all patietns have a right to care regardless of race or creed 2. i'll take mr. a. i don't mind taking care of him 3. you should think about how he really feels 4. what can we do to help mr a cope with his pain

4

the HCP has ordered a placebo fora client with chronic pain. the newly hired nurse feels very uncomfortable administering the medication. what is the first action that the new nurse should take 1. prepare the medication and hand it to the HCP 2. check the hospital policy regarding the use of a placebo 3. follow a personal code of ethics and refuse to participate 4. contact the charge nurse for advice and suggestions

4

the charge nurse is reviewing the records of clients who were assigned to a newly graduated RN. the RN has correctly documented dose and time of medication, but there is no documentation regarding nonpharmaceutical measures. what action should the charge nurse take first. 1. make a note in the nurse's file and continue to observe clinical performance 2. refer the new nurse to the in-service education department 3. quiz the nurse about knowledge of pain management and pharmacology 4. give praise for documenting dose and time and discuss documentation deficits

4

the home health nurse is interviewing an older client with a history of midl heart failure and rheumatoid arthritis.. the client reports feeling pretty good except for the pain and stiffness in her joints when she first gets out of bed. which member of the health care team would be the most appropriate to aid in the client's report of pain 1. HCP to review the dosage and frequency of her pain meds 2. PT for evaluation of function and possible exercise therapy 3. social worker to locate community resources for complementary therapy 4. UAP to help client with a warm shower in the morning

4

the nurse reinforces teaching about the purpose and correct use of the PCA with Mr O (tibia-fibula fx) and his mother. both express an understanding and willingness to comply. when is the best time for mr o to activate the pca to receive a dose of pain med? 1. whenever pain is a 5 out of 10 2. 30 minutes after waking up in the morning and 30 minutes before going to bed 3. as soon as the lockout time expires; if pain is still present, even if it is still mild 4. 10 minutes before a painful procedure such as a dressing change or PT

4

the oncoming team leader asks the night shift nurse if anyone spoke to the mother about pushing the PCA button for Mr O. the night nurse states that the mother is just concerned about her son and wants him to have pain relief. besides the prescribed dose is controlled by the pump. what is the team leader's best action 1. report the night nurse to the unit manager for failure to safeguard the patient 2. explain the purpose and function of the PCA delivery system to the mother 3. give the night nurse written information about the dangers of possible overdose 4. first talk to the night nurse about the PCA procedure, then talk to the mother

4

the team is providing emergency care to a client who received an excessive dose of opioid pain medication. which task is best to assign to the LPN/LVN. 1. calling the HCP to report SBAR 2. giving nalaxone and evaluating response to therapy 3. monitoring the respiratory status for the first 30 minutes 4. applying oxygen per nasal cannula as orderd

4

the team leader is preparing to give mr L (kidney stone) pain medication, but the IV site is infiltrated, so the nurse informs him that the IV catheter will have to be reinserted. he yells "what's wrong with you people. can't you do anything right" what is the best response 1. let me call the HCP, and i can get an order for an oral medication 2. this is not my fault, but if you will just give me a couple of minutes I can fix it 3. let me call the nursing supervisor and you can talk to her about the situation 4. i know you are having. let me restart your IV line right now

4

the team leaders is talking to mrs r about discharge plans and follow up appointments. she begins to cry and says i was so active and athletic when i was younger. wha tis the most therapeutic response? 1. your shoulder will get progressively better with time and patience. don't cry 2. i can see that you are really upset. is your shoulder hurting a lot right now 3. i know what you mean. i used to be able to do a lot more when i was younger too 4. it is difficult to deal with changes. what types of activities did you used to to

4

which client is at greatest risk for respiratory depression while receiving opioids for analgesia 1. older client with chronic pain r/t joint immobility 2. client with a heroin addiction and bak pain 3. young female client with advanced multiple myeloma 4. opioid naive adolescent with an arm fracture and CF

4

the nurse is caring for a client who had abdominal surgery yesterday. the client is restless and anxious and tells the nurse that the pain is getting worse despite the pain medication. physical assessment findings include the following: temp 100.3, pulse 110bpm, RR 24, and BP 140/90. the abdomen is rigid and tender to the touch. the nurse decides to notify the client's provider. place the following report information in the correct order according to the SBAR format. 1. he is restless and anxious: vital signs, abd is rigid and tender to touch with hypoactive bowel sounds 2. he had abdominal surgery yesterday. he is on morphine via PCA, but he said the pain is getting progressively worse 3. i have tried to make him comfortable and he is willing to wait until the next scheduled dose of pain medication but i think his pain is getting progressively worse. 4. would you like to give me an order for any laboratory tests or additional therapies at this time 5. dr s this is the nurse from unit x. I am calling about Mr. D who is reporting severe abdominal pain

5 2 1 3 4

the oncoming day shift nurse has received the shift report from the night nurse. the day shift nurse has done a quick check on all the clients and has determined that all are stable and not in acute distress. prioritize the order in which the oncoming nurse will care for the following clients, 2 being the first and 5 being the last 1. adolescent who is alert and oriented. he was admitted 2 days ago for treatment of meningitis. he reports a continuous headache that is partially relieved by medication 2. older man who underwent total knee replacement surgery 2 days ago. he is using the PCA pump frequently with good relief and occasionally asks for bolus doses. 3. middle-aged woman who is demanding and frequently calls for assistance. she was admitted for investigation of functional abdominal pain and is scheduled for diagnostic testing this morning 4. older woman with advanced alzheimer disease who requires total care for all activities of daily living. she struggles during any type of nursing care, and it is difficult to assess her subjective symptoms. she is awaiting transfer to a long term care facility. 5. young man who was admitted with chest pain secondary to spontaneous pneumothorax. today, the chest tube will be removed and the PCA pump will be discontinued

5 3 1 2 4

the team leader decides to do a brief round of all the patients after shift report to ensure safety and to help determine acuity and assignments. list the order in which the team leader should briefly check in on these patients 1. rheumatoid arthritis 2. kidney stones 3. motorcycle accident 4. inguinal hernia repair 5. end-stage multiple myeloma 6. bacterial pneumonia and hiv positive

6 3 2 1 5 4