309 Quiz 4
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? a) Fever b) Nausea c) Diaphoresis d) Abdominal cramps
c
12. Which explanation by the nurse best describes how the TENS unit soothes paint? a) continuous high-pressure stimulation of the pain nerve fibers are blocked b) it sends stimulating pulses through the skin, to block pain signals from reaching the brain c) electrodes are placed at pressure points to measure biofeedback and reduce stress d) needles are inserted to stimulate specific points in the body
b
17. since Natalie is fairly thin, which site is the best choice for the injection? a) back of the arm b) ventrogluteal c) dorsogluteal d) abdomen, 2 inches from the umbilicus
b
189. a client reports severe pain 2 days after surgery. Which INITIAL action should the nurse take after assessing the character of pain? a) encourage rest b) obtain the vital signs c) administer the prn analgesic d) document the client's pain response
b
4. to determine the etiology of Natalie's anxiety, what is the priority nursing intervention? a) refer the client to the clinic social worker b) continue the interview with the client c) review the healthcare provider's notes d) recognize that pain causes anxiety
b
55. based on the client's reported pain level, the nurse administers 8mg of the prescribed morphine. The medication is available in a 10mg syringe. Wasting of the remaining 2mg of morphine should be done by the nurse and a witness. Who should be the witness? a) nursing supervisor b) LPN c) client's health care provider d) designated nursing assisstant
b
732. in the PACU it is reported that the client recieved intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as pert of the client's INITIAL 24-hour postoperative care? a) assessing the client for tachycardia b) monitoring of respiratory rate hourly c) administering naloxone every 3 to 4 hours d) observing the client for signs of CNS excitement
b
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 concerns you the most? a) "I twisted my back last night, and now the pain is a lot worse." b) "I'm so sick of this pain. I think I'm going to find a way to end it." c) "Occasionally I buy pain killers from a guy in my neighborhood." d) "I'm going to sue you and the doctor; you aren't doing anything for me."
b
Which clients can be appropriately assigned to an LPN/LVN who will function under the supervision of an RN or team leader? (Select all that apply.) a) Client who needs preoperative teaching for the use of a PCA pump b) Client with a leg cast who needs neurologic and circulatory checks and PRN hydrocodone c) Client who underwent a toe amputation and has diabetic neuropathic pain d) Client with terminal cancer and severe pain who is refusing medication e) Client who reports abdominal pain after being kicked, punched, and beaten f) Client with arthritis who needs scheduled pain medications and heat applications
b,c,f
20. to ensure that the(guided imagery) exercise is most effective, what action should the nurse implement? a) help the client cross her legs in a semi-yoga position b) encourage the client to lie down rather than sit in a chair c) include as many sensory images as possible in the experience d) suggest that an image involving water may be more restful
c
23. what is the total dosage of morphine that Natalie has received in the last 4 hours? (0.5mg/hour, and demand doses of 1mg/6min <hourly limit of 10mg>)(Natalie had 4 demand doses each hour for the last 4 hours) a) 6mg b) 10mg c) 18mg d) 40mg
c
Family members are encouraging your client to "tough out the pain" rather than risk drug addiction to narcotics. The client is stoically abiding. You recognize that the sociocultural dimension of pain is the current priority for the client. Which question will you ask? a) "Where is the pain located, and does it radiate to other parts of your body?" b) "How would you describe the pain, and how is it affecting you?" c) "What do you believe about pain medication and drug addiction?" d) "How is the pain affecting your activity level and your ability to function?" e) "What information do you need about pain, healing, and addiction?"
c
the nurse overhears two other nurses discussing Natalie's pain management in the hallway. One nurse states that Natalie is exhibiting drug-seeking behavior and is probably already addicted to her pain medications. 27. what is the priority nursing intervention? a) assess the client for signs of drug-seeking behavior b) ask the other nurses what behaviors they want observed c) arrange to continue the conversation in a more private location d) inform the other nurses that the client is not a drug addict
c
16. when Natalie is in the ED, the HCP prescribes an intramuscular injection of 30mg of ketorolac, a nonsteroidal antiinflammatory agent. The medication comes in a preloaded syringe labeled "20mg/mL." How many mL should the nurse expect to administer? ( round to the tenth)
1.5
765. a nurse is caring for a client after a total knee replacement who is requesting Vicodin in addition to the patient-controlled analgesia (PCA). The client reports having taken 2 Vicodin tablets every 4 hours for several weeks before surgery. If each tablet contains 500mg of acetaminophen, how much acetaminophen had the client been ingesting per day? (round to the nearest whole number)
12 tablets (6,000mg)
1. which information obtained by the nurse is most likely to influence Natalie's perception of her pain? a) Natalie's younger child is an infant who feeds every three hours b) Natalie's 4-year-old enjoys being the "big brother" to his baby sister c) Natalie was a first grade teacher before having children but now stays home d) Natalie's parents live in the same neighborhood and often help with the children
a
32. what is a nurse's responsibility when administering prescribed opioid analgesics? (select all that apply) a) count the client's respirations b) document the intensity of the client's pain c) withhold the medication if the client reports pruritus d) verify the number of doses in the locked cabinet before administering the prescribed dose e) discard the medication in the client's toilet before leaving the room if the medication is refused
a,b,d
6. the nurse considers interventions to include in the plan of care. Before implementing any interventions, what action is most important for the nurse to take? a) place a copy of the plan of care in the client's chart b) evaluate the client's response to the interventions c) review interventions in a care plan manual d) discuss the plan of care with the client
d
22. when is the best time to teach Natalie about the use of the PCA? a)the day before the surgery is scheduled b) while she is in the post-anesthesia care unit c) when she is in pain and wants to learn how to obtain relief d) after receiving a dose of medication from the PCA pump
a
5. which is the best goal for the nurse to include in the plan of care related to the problem statement of "acute pain related to strain on muscles with movement?" a) client reports pain of less than 1 on a 0-10 scale b) client will verbalize pain control methods c) client will learn alternative methods for pain control d) client will learn to live with long-term pain
a
59. what are the desired outcomes that the nurse expects when administering a nonsteroidal antiinflammatory drug (NSAID)? (select all that apply) a) diuresis b) pain relief c) antipyresis d) bronchodilation e) anticoagulation f) reduced inflammation
b,c,f
Which client has the most immediate need for IV access to deliver immediate analgesia with rapid titration? a) Client who has sharp chest pain that increases with cough and shortness of breath b) Client who reports excruciating lower back pain with hematuria c) Client who is having an acute myocardial infarction with severe chest pain d) Client who is having a severe migraine with an elevated blood pressure
c
Which client is most likely to receive opioids for extended periods of time? a) A client with fibromyalgia b) A client with phantom limb pain in the leg c) A client with progressive pancreatic cancer d) A client with trigeminal neuralgia
c
19. once the needle is inserted in the skin, what intervention should the nurse perform? (select all that apply) a) observe for a small bleb around the tip of the needle b) place a small sterile gauze pad close to the insertion site c) slowly inject the medication into the muscle mass d) follow the facility policy regarding aspiration of IM injection
c,d
7. Which medication should the nurse suggest as a common NSAID? a) Diphenhydramine (Benadryl) b) Alprazolam (Xanax) c) Calcium Carbonate (Tums) d) Ibuprofen (Motrin)
d
Natalie states that she has also been applying a cold pack an hour at a time to help heal her back as quickly as possible. 10. Which instruction is most important for the nurse to provide? a) the cold pack provides pain relief but doesn't heal the injury b) the cold applications should be alternated with the heating pad c) cold reduces inflammation and prevents tissue swelling d) the cold pack should only be applied for approximately 20 minutes at a time
d
A client received "as needed" (PRN) morphine, lorazepam (Ativan), and cyclobenzaprine (Flexeril). The UAP reports that the client has a respiratory rate of 10/min. What is the priority action? a) Call the physician to obtain an order for naloxone (Narcan). b) Assess the client's responsiveness and respiratory status. c) Obtain a bag-valve mask and deliver breaths at 20/min. d) Double-check the drug order to see what the client should have received.
b
For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take? a) Closely assess for nonverbal signs such as grimacing or rocking. b) Obtain baseline behavioral indicators from family members. c) Look at the MAR and chart to note the time of the last dose of analgesic and the client's response. d) Give the maximum PRN dose within the minimum time frame for relief.
b
11. how should the nurse explain the mechanism that causes the skin to become reddened from prolonged exposure to cold? a) reflex vasodilation occurs following the initial vasoconstricting effects of the cold b) cold causes a numbing sensation, which interferes with circulation at the site c) debris from necrotic tissue collects at the site of vasoconstriction, causing inflammation d) intradermal tissue blisters occur as the result of the damage caused by exposure to cold
a
A client is crying and grimacing but denies pain and refuses pain medication, because "my sibling is a drug addict and has ruined our lives." What is the priority intervention for this client? a) Encourage expression of fears and past experiences. b) Provide accurate information about the use of pain medication. c) Explain that addiction is unlikely among acute care clients. d) Seek family assistance in resolving this problem.
a
A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal anti-inflammatory drugs. Which medication will you advocate for first? a) Gabapentin (Neurontin) b) Corticosteroids c) Hydromorphone (Dilaudid) d) Lorazepam (Ativan)
a
You are the charge nurse. A client with chronic pain reports to you that the nurses have not been responding to requests for pain medication. What is your initial action? a) Check the medication administration records (MARs) for the past several days. b) Ask the nurse educator to provide in-service training about pain management. c) Perform a complete pain assessment on the client and take a pain history. d) Have a conference with the nurses responsible for the care of this client.
d
587. a client who had a total hip replacement asks the nurse about the continuous regional analgesia being used. What information should the nurse include when explaining the benefits of the treatment over conventional methods to control pain? a) adjusting the dose is easily done b) neuropathic pain can be relieved c) systemic side effects are minimal d) the need for parenteral medication is avoided
c
In the care of clients with pain and discomfort, which task is most appropriate to delegate to the UAP? a) Assisting the client with preparation of a sitz bath b) Monitoring the client for signs of discomfort while ambulating c) Coaching the client to deep breathe during painful procedures d) Evaluating relief after applying a cold compress
a
Natalie's nurse believes that the other nurses are incorrect in their understanding of Natalie's pain management. The nurse explains this to the other nurses, providing the nurses with accurate information about the pain management and addiction. 28. the nurse's response demonstrates what ethical principle? a) veracity b) fidelity c) teleology d) confidentiality
a
When an analgesic is titrated to manage pain, what is the priority goal? a) Titrate to the smallest dose that provides relief with the fewest side effects. b) Titrate upward until the client is pain free. c) Titrate downward to prevent toxicity. d) Titrate to a dosage that is adequate to meet the client's subjective needs.
a
on the second postop day, the nurse observes that Natalie is no longer self-administering demand doses of the morphine. 24. what is the most likely reason for this change? a) she is receiving adequate pain control without the additional doses b) she has developed tolerance to the effects of the medication c) she is addicted to the dose of morphine that is still infusing d) the IV line is infiltrated and she no longer obtains any pain relief
a
172. a client with arthritis increases the dose of ibuprofen (motrin, advil) to abate joint discomfort. After several weeks the client becomes increasingly weak. The health care provider determines that the client is severely anemic and admits the client to the hospital. What clinical indicators does the nurse expect to identify when performing an admission assessment? (select all that apply) a) melena b) tachycardia c) constipation d) clay-colored stools e) painful bowel movements
a,b
Which clients must be assigned to an experienced RN? (Select all that apply.) a) Client who was in an automobile crash and sustained multiple injuries b) Client with chronic back pain related to a workplace injury c) Client who has returned from surgery and has a chest tube in place d) Client with abdominal cramps related to food poisoning e) Client with a severe headache of unknown origin f) Client with chest pain who has a history of arteriosclerosis
a,c,d,e
192. a client who had abdominal surgery is receiving patient-controlled analgesia (PCA) intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is still experiencing pain. What should the nurse do FIRST? a) monitor the client's pain level for another hour b) determine the integrity of the intravenous delivery system c) reprogram the pump to deliver a bolus dose every 8 minutes d) arrange for the client to be evaluated by the health care provider
b
2. to assess the quality of Natalie's pain, the nurse asks which question? a) "on a scale of 0-10, how would you rate your pain?" b) "what word best describes the pain you are experiencing?" c) "What actions do you take to relieve the pain?" d) "what do you fear most about your pain?"
b
25. the nurse assesses Natalie's pain and determines that the evaluation of her use of the PCA pump is correct. Natalie's pain has lessened, and she no longer needs any demand doses of morphine. The nurse consults with the surgeon, and the morphine is discontinued. Natalie's new prescription is for hydrocodone/acetaminophen. What is the rationale for combing these two ingredients? a) the antagonistic effect of the two medications reduces the risk for adverse effects b) the synergistic effect of the two medications improves pain control c) the combination effect decreases the risk for significant allergic reactions d) the equianalgesic effect allows each medication to work more efficiently
b
For client education about nonpharmaceutical alternatives, which topic could you delegate to an experienced LPN/LVN, who will function with your continued support and supervision? a) Therapeutic touch b) Application of heat and cold c) Meditation d) Transcutaneous electrical nerve stimulation (TENS)
b
You are caring for a young client with diabetes who has sustained injuries when she tried to commit suicide by crashing her car. Her blood glucose level is 650 mg/dL, but she refuses insulin; however, she wants the pain medication. What is the best action? a) Notify the charge nurse and obtain an order for a transfer to intensive care. b) Explain that insulin is a priority and inform the health care provider. c) Withhold the pain medication until she agrees to accept the insulin. d) Give her the pain medication and document the refusal of the insulin.
b
13. after the nurse explains how the TENS unit soothes pain, Natalie wants to know the best way to apply and use the unit. Which instructions should the nurse include? (select all that apply) a) after applying the electrodes, set the unit to provide continuous stimulation b) be sure to use conducting gel or conductor pads when applying the electrodes to the skin c) remove the electrodes and change sites each time the skin is stimulated d) turn on the unit only when your pain medication does not provide relief e) clean the skin where electrodes will be placed and dry thoroughly
b,e
Which clients can be appropriately assigned to a newly graduated RN who has recently completed orientation? (Select all that apply.) a) Anxious client with chronic pain who frequently uses the call button b) Client on the second postoperative day who needs pain medication before dressing changes c) Client with human immunodeficiency virus (HIV) infection who reports headache and abdominal and pleuritic chest pain d) Client with chronic pain who is to be discharged with a new surgically-implanted catheter e) Client who is reporting pain at the site of a peripheral IV line f) Client with a kidney stone who needs frequent PRN pain medication
b,e,f
14. what characteristic of scheduled drugs results in the need for these specific protocols? a) large doses can be fatal b) respiratory depression can occur c) there is a high potential for abuse d) tolerance develops with repeated use
c
18. the nurse will first place the palm of the hand on what anatomical spot to locate the injection site? a) the upper outer quadrant of the buttock b) the anterosuperior iliac spine c) the greater trochanter d) the iliac crest
c
193. a client with an inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit, which nursing action is appropriate? a) maintain the settings programmed by the health care provider b) turn the machine on several times a day for ten to twenty minutes c) adjust the dial on the unit until the client states the pain is releived d) apply the color-coded electrodes on the client where they are most comfortable
c
775. a client receiving morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate? a) nasotracheal suction b) mechanical ventilation c) Naloxone administration d) cardiopulmonary resuscitation
c
789. a terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do? a) add a placebo to the morphine to appease the spouse b) discuss with the spouse the risk for morphine addiction c) assess the client's pain before increasing the dose of the morphine d) check the client's heart rate before increasing the morphine tto the next level
c
8. what information should the nurse include in responding to Natalie? a) Aspirin comes in children's doses, which can be given safely to 4-year-olds b) buffered aspirin contains an ingredient that can be damaging to small children c) all aspirin products should be avoided unless specifically prescribed d) ibuprofen products should be used for children with a virus
c
A client's family member says to you, "He needs more pain medicine. He is still having a lot of pain." What is your best response? a) "The physician ordered the medicine to be given every 4 hours." b) "If the medication is given too frequently, he could experience ill effects." c) "Please tell him that I will be right there to check on him." d) "Let's wait about 30 to 40 minutes. If there is no relief, I'll call the physician."
c
In application of the principles of pain treatment, what is the first consideration? a) Treatment is based on client goals. b) A multidisciplinary approach is needed. c) The client's perception of pain must be accepted. d) Drug side effects must be prevented and managed.
c
You are 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 an order to discontinue the PCA-delivered morphine 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? a) "Let me stop the pump and we can try oral pain medication to see if it relieves the pain." b) "I realize that you are scared of the pain, but we must try to wean you off the pump." c) "Show me where your pain is and describe how it feels compared to yesterday." d) "Let me take your vital signs, and then I will call the physician and explain your concerns."
c
the clinic stocks a small number of scheduled medications, so the nurse obtains a dose of the prescribed medication for Natalie. At the end of the shift, the nurse counts the remaining medications with the oncoming nurse and notes that the count is not accurate. 15. what action should the nurse implement? a) request that the oncoming nurse investigate the inaccurate count, and leave a written report for the first nurse b) complete a variance report, documenting that the count was inaccurate, and submit the report to the pharmacist c) review prescriptions for any scheduled drugs with all nurses with access to the medications to determine why the count is inaccurate d) schedule a meeting with the medical director of the clinic to discuss methods to reduce drug errors by the nursing staff
c
3. Which behavior does Natalie exhibit , that the nurse documents as objective signs of acute pain? a) states pain level of 5 out of 10 b) complains of shortness of breath c) difficulty concentrating d) frequent grimacing
d
741. a nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen (advil) for discomfort associated with osteoarthritis and notifies the health care provider. Which drug does the nurse expect with MOST likely be prescribed instead of the Advil? a) naproxen (aleve) b) ibuprofen (motrin) c) ketorolac (toradol) d) acetaminophen (tylenol)
d
A client has severe pain and bladder distention related to urinary retention and possible obstruction. An experienced UAP states that she received training in Foley catheter insertion at a previous job. What task can be delegated to this UAP? a) Assessing the bladder distention and the pain associated with urinary retention b) Inserting the Foley catheter, once you ascertain that she knows sterile technique c) Evaluating the relief of pain and bladder distention after the catheter is inserted d) Measuring the urine output after the catheter is inserted and obtaining a urine specimen
d
As the charge nurse, you are reviewing the charts of clients who were assigned to the care of a newly graduated RN. The RN has correctly charted dose and time of medication, but there is no documentation regarding nonpharmaceutical measures. What action should you take first? a) Make a note in the nurse's file and continue to observe clinical performance. b) Refer the new nurse to the in-service education department. c) Quiz the nurse about knowledge of pain management and pharmacology. d) Give praise for correctly charting the dose and time and discuss the deficits in charting.
d
Natalie has also been receiving docusate sodium, a stool softener. She asks the nurse if this needs to be continued. 26. how should the nurse respond? a) "you were receiving the docusate sodium because morphine is very constipating. You will no longer need to take it." b) "schedule III medications such as hydrocodone/acetaminophen tend to be more constipating than schedule II medications such as morphine" c) "the stool softener should have been discontinued as soon as your bowel sounds returned after surgery" d) "you may need to continue the docusate sodium because most opioid analgesics, including hydrocodone/acetaminophen, cause constipation"
d
Natalie states that the guided imagery exercise was helpful, and she is interested in learning additional exercises. The nurse guides Natalie in a progressive relaxation activity. After first establishing a regular breathing pattern, the nurse tells Natalie to locate an area where she can feel muscle tension. 21. What instruction should the nurse provide next? a) apply gentle pressure over the opposing muscle b) apply firm pressure over the muscle c) relax the muscle completely d) tense the muscle fully
d
Natalie tells the nurse that she has an electric heating pad at home that she used when she sprained her ankle. 9. Which response by the nurse is accurate? a) "warm moist compresses are a better choice because there is less chance of injury to your skin" b) "a heating pad is more effective than moist compresses because it will penetrate more deeply into the muscles." c) "heating pads provide dry heat, which promotes vasoconstriction, reducing any muscle swelling that has occurred." d) "the dry heat provided by your heating pad will help relieve your pain by promoting muscle relaxation"
d
On the first day after surgery, a client receiving an analgesic via PCA pump reports that the pain control is inadequate. What is the first action you should take? a) Deliver the bolus dose per standing order. b) Contact the physician to increase the dose. c) Try nonpharmacologic comfort measures. d) Assess the pain for location, quality, and intensity.
d
The physician has ordered a placebo for a client with chronic pain. You are a newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take? a) Prepare the medication and hand it to the physician. b) Check the hospital policy regarding the use of a placebo. c) Follow a personal code of ethics and refuse to participate. d) Contact the charge nurse for advice.
d
The team is providing emergency care to a client who received an excessive dose of narcotic pain medication. Which task is best to delegate to the LPN/LVN? a) Calling the physician and reporting the situation using the SBAR (situation, background, assessment, recommendation) format b) Giving the ordered dose of Narcan and evaluating the response to therapy c) Monitoring the respiratory status for the first 30 minutes d) Applying oxygen per nasal cannula as ordered
d
What is the best way to schedule medication for a client with constant pain? a) PRN at the client's request b) Before painful procedures c) IV bolus after pain assessment d) Around the clock
d
Which client is at greatest risk for respiratory depression while receiving opioids for analgesia? a) Elderly client with chronic pain who has a hip fracture b) Client with a heroin addiction and back pain c) Young female client with advanced multiple myeloma d) Child with an arm fracture and cystic fibrosis
d
You are caring for a client who had abdominal surgery yesterday. The client is restless and anxious and tells you that the pain is getting worse despite the pain medication. Physical assessment findings include the following: temperature, 100.3° F (38° C); pulse rate, 110 beats/min; respiratory rate, 24 breaths/min; and blood pressure, 140/90 mm Hg. The abdomen is rigid and tender to the touch. You decide to notify the client's provider. Place the following report information in the correct order according to the SBAR format. a) "He is restless and anxious: temperature is 100.3° F (38° C); pulse is 110 beats/min; respiratory rate is 24 breaths/min; blood pressure is 140/90 mm Hg. Abdomen is rigid and tender to touch with hypoactive bowel sounds." b) "He had abdominal surgery yesterday. He is on PCA morphine, but he says the pain is getting progressively worse." c) "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 warrants evaluation." d) "Would you like to give me an order for any laboratory tests or additional therapies at this time?" e) "Dr. S, this is Nurse J. I'm calling about Mr. D, who is reporting severe abdominal pain."
e,b,a,c,d
You have received the shift report from the night nurse. Prioritize the order in which you will check on the following clients. a) 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. b) Elderly man who underwent total knee replacement surgery 2 days ago. He is using the patient-controlled analgesia (PCA) pump frequently with good relief and occasionally asks for bolus doses. c) Middle-aged woman who is demanding and needy. She was admitted for investigation of functional abdominal pain and is scheduled for diagnostic testing this morning. d) Elderly woman with advanced Alzheimer disease who requires total care for all activities of daily living (ADLs). 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. e) Young man who was admitted with chest pain secondary to a spontaneous pneumothorax. His chest tube will be removed and his PCA pump discontinued today.
e,c,a,b,d
