Fundamentals Exam 2

The nurse is caring for a client who takes ibuprofen for pain. The nurse is gathering information on the client's medication history and determines it is necessary to consult with the registered nurse if the client is also taking which medications? Select all that apply. 1.Warfarin 2.Glimepiride 3.Amlodipine 4.Simvastatin 5.Hydrochlorothiazide

1.Warfarin 2.Glimepiride 3.Amlodipine

A licensed practical nurse is caring for a postoperative client who is receiving demand-dose hydromorphone via a patient-controlled analgesia (PCA) pump for pain control. The nurse enters the client's room and finds the client drowsy and records the following vital signs: temperature 36.2° C (97.2° F) orally, pulse 52 beats per minute, blood pressure 101/58 mm Hg, respiratory rate 11 breaths per minute, and SpO2 of 93% on 3 liters of oxygen via nasal cannula. Which action should the nurse take first? 1.Document the findings. 2.Attempt to arouse the client. 3.Contact the registered nurse immediately. 4.Check the medication administration history on the PCA pump.

2.Attempt to arouse the client

The nurse is assisting in the care of a client receiving codeine sulfate for pain. The nurse should make note of which finding to detect an adverse effect of this medication? 1.Fluid volume excess 2.Onset of hypertension 3.Strength of peripheral pulses 4.Frequency of bowel movements

4.Frequency of bowel movements

The nurse is assessing a client's postoperative pain using the PQRSTU method. Using this method, which questions should the nurse ask the client? Select all that apply. 1."What does the pain feel like?" 2."Where is the pain located?" 3."Does pain medication help?" 4."How does the pain affect you?" 5."Do you have the pain when you sleep?" 6."What makes your pain better or worse?"

1."What does the pain feel like?" 2."Where is the pain located?" 4."How does the pain affect you?" 6."What makes your pain better or worse?"

A postoperative client has been receiving morphine sulfate every 3 to 4 hours for pain. The nurse should be sure to implement which measures to reduce the risk of adverse effects from this medication? Select all that apply. 1.Encourage fluids when not NPO. 2.Monitor the client's temperature. 3.Monitor the intake and output closely. 4.Maintain the client in a supine position. 5.Encourage coughing and deep breathing. 6.Monitor the number of bowel movements

1.Encourage fluids when not NPO. 5.Encourage coughing and deep breathing. 6.Monitor the number of bowel movements

The nurse has just received report on a newly admitted client who is cognitively impaired and experiencing pain. Which data collection techniques should be included in this client's plan? Select all that apply. 1.Observe for grimacing. 2.Listen for vocalizations. 3.Observe facial expressions. 4.Use a numerical pain scale. 5.Monitor for changes in behavior. 6.Use Wong-Baker Faces® pain rating scale.

1.Observe for grimacing. 2.Listen for vocalizations. 3.Observe facial expressions. 5.Monitor for changes in behavior.

The nurse is reinforcing instructions to an oriented client and the client's family regarding how to use the patient-controlled analgesia (PCA) pump. The nurse should include which instructions? Select all that apply. 1.Report an inability to void or bladder discomfort. 2.Explain that the nurse will assess the pain level at frequent intervals. 3.Notify the nurse if the client begins to feel nauseated or is likely to vomit. 4.Instruct the client to push the button when the pain level begins to increase. 5.Explain that there is a lockout on the machine so the client cannot overdose. 6.Instruct a family member how to push the button every 6 minutes if the client is napping or asleep

1.Report an inability to void or bladder discomfort. 2.Explain that the nurse will assess the pain level at frequent intervals. 3.Notify the nurse if the client begins to feel nauseated or is likely to vomit. 4.Instruct the client to push the button when the pain level begins to increase. 5.Explain that there is a lockout on the machine so the client cannot overdose

A client with new onset migraine headaches is being seen in the clinic. The client has a history of hypotension and diabetes mellitus. The nurse understands the client is at risk for cardiac side effects if the primary health care provider prescribes which medications? Select all that apply. 1.Verapamil 2.Propranolol 3.Sumatriptan 4.Topiramate 5.Divalproex

1.Verapamil 2.Propranolol 3.Sumatriptan

A licensed practical nurse is precepting a student assigned to care for a client with chronic pain. Which statement, if made by the student, indicates the need for further teaching regarding pain management? 1. "I will be sure to ask my client what their pain level is on a scale of 0 to 10." 2."I know that I should follow-up after giving medication to make sure it is effective." 3."I know that pain in the older client might manifest as sleep disturbance or depression." 4."I will be sure to cue in to any indicators that the client may be exaggerating their pain."

4. "I will be sure to cue in to any indicators that the client may be exaggerating their pain."

The nurse is assisting in monitoring a pregnant client receiving nalbuphine for pain management. Which statement is true with regard to the use of nalbuphine? 1.Sleepiness is not likely to occur during the labor process. 2.An amnesic effect is not associated with the use of nalbuphine. 3.Nalbuphine can be used for a client with an opioid dependency. 4.Nalbuphine is not likely to cause significant respiratory depression.

4.Nalbuphine is not likely to cause significant respiratory depression.

A client arrives at the clinic complaining of a severe headache. The client states "It's a 10/10 headache. I took 600 mg of ibuprofen over the past few hours, and it has not decreased the pain." The nurse suspects that the client is experiencing a migraine but wants to validate the suspicion by asking which questions associated with a migraine? Select all that apply. 1."Can you describe the pain?" 2."What other symptoms are you experiencing?" 3."Have you had any recent injuries to your head?" 4."What did you experience right before the headache began?" 5."Do you or a family member have a history of severe headaches?"

1."Can you describe the pain?" 2."What other symptoms are you experiencing?" 4."What did you experience right before the headache began?" 5."Do you or a family member have a history of severe headaches?"

A transcutaneous electrical nerve stimulation (TENS) is prescribed for a client with pain, and the nurse provides information to the client about the TENS unit. Which client statements indicate the need for further teaching? Select all that apply. 1."The unit relieves pain." 2."Electrodes are attached to the skin." 3."The unit will reduce the need for analgesics." 4."The unit should be turned off if I begin to feel pins and needles." 5."Needles are inserted in the subcutaneous tissue to stimulate the nerve."

4."The unit should be turned off if I begin to feel pins and needles." 5."Needles are inserted in the subcutaneous tissue to stimulate the nerve.