LP 3-4: Pain & Hematology

What is the maximum Ibuprofen dose per day?

2400mg/day

A 10-year-old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription? 1. Injection of Factor X 2. IV infusion of Iron 3. IV infusion of Factor VIII 4. IM injection of Iron using the Z-track method

3. IV infusion of Factor VIII Primary tx is replacement of the missing clotting factor; additional medications such as agents to relieve pain, may be prescribed depending on the source of bleeding from the disorder. A child with hemophilia A is at risk for joint bleeding after a fall. Factor VII would be prescribed IV to replace the missing clotting factor and minimize the bleeding. Factor X and iron are not used to tx children with hemophilia A.

The nurse is monitoring a client for s/s related to superior vena cava syndrome. Which is an early sign of this oncological emergency? 1. Cyanosis 2. Arm edema 3. Periorbital edema 4. Mental status changes

3. Periorbital edema Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early s/s generally occur in the morning and include edema of the face, especially around the eyes, and client c/o tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms Cyanosis and mental status changes are late signs

The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for the child? 1. Soccer 2. Basketball 3. Swimming 4. Field hockey

3. Swimming Children with hemophilia need to avoid contact sports and to take precautions such as wearing elbow or knee pads and helmets with other sports. The safe activity for them is swimming.

The nurse should plan to implement which intervention in the care of a client experiencing neutropenia as a result of chemotherapy? 1. Restrict all visitors 2. Restrict fluid intake 3. Teach the client and family about the need for hand hygiene 4. Insert an indwelling urinary catheter to prevent skin breakdown

3. Teach the client and family about the need for hand hygiene In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors and staff. Not all visitors are restricted, but the client is protected from persons with known infections. -Fluids should be encouraged -Invasive measures such as indwelling urinary catheter should be avoided to prevent infections

A chidl with Thalassemia is receiving a long-term blood transfusion therapy for the tx of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate to be prescribed? 1. Fragmin 2. Meropenem 3. Metoprolol 4. Deferoxamine

4. Deferoxamine The major complication of long-term transfusion therapy is hemosiderosis. To prevent organ damage from too much iron, chelation therapy with either Exjade or deferoxamine may be prescribed. Deferoxamine is classified antidote for acute iron toxicity. Fragmin is an anticoagulant used as prophylaxis for postoperative DVT. Meropenem is an antibiotic. Metoprolol is a beta blocker used to tx HTN.

What is the onset, duration, severity, cause, corse of chronic pain?

Onset: gradual Duration: > 3 mos Severity: mild to severe Cause: may not be known Course: wax + wane --> doesn't go away

What is the onset, duration, severity, cause, course of acute pain?

Onset: sudden Duration: < 3 mos Severity: mild to severe Cause: identifyable Course: Decrease over time

The nurse manager is teaching the nursing staff about s/s related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptoms of this oncological emergency? 1. Headache 2. Dysphagia 3. Constipation 4. ECG changes

4. ECG changes Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. ECG include shortened ST segment and a widened T wave

Why is Narcan dangerous with heart disease?

Because after reversal pt's usually are in A LOT of pain and that will increase their BP and HR significantly

The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents? 1. Admin the iron at meal times 2. Admin the iron through a straw 3. Mix the iron with cereal to admin 4. Add the iron to formula for easy administration

2. Admin the iron through a straw An oral supplement should be administered through a straw or medicine dropper placed at the back of the mouth because the iron stains the teeth. The parents should be instructed to brush or wipe the child's teeth or have the child brush teeth after admin. Iron is administered between meals bc absorption is decreased if there is food in the stomach. Iron requires an acid environment to facilitate its absorption in the duodenum. Iron is not added to formula or mixed with cereal or other food items.

How can Narcan be admin?

-IV -IM -SQ -Intranasal

What are examples of medications in the opioid classification?

-Morphine -Hydromorphone -Fentanyl -Oxycodone -Tramadol -Codeine

What are side effects of opioids?

-RR depression -GI (constipation, upset) -Sedation -Pruritus -Hypotension -Bradycardia -Dyspnea

What are examples of NSAID medications?

-Celebrex (celexocib) -Aspirin -Ibuprofen -Naproxen -Toradol

What are the types of pain scales?

1. Numerical 2. Descriptive 3. Visual analog 4. Wong-Baker FACES

A client is admitted to the hospital with a suspected dx of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? 1. Fatigue 2. Weakness 3. Weight gain 4. Enlarged lymph nodes

4. Enlarged lymph nodes Hodkin's disease is a chronic progressive neoplastic disorder of the lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? 1. Stress 2. Trauma 3. Infection 4. Fluid overload

4. Fluid overload The mother of a child with sickle cell disease should encourage fluid intake of 1.5-2 times the daily requirement to prevent dehydration.

The nurse analyzes the lab results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child? 1. PLT count 2. Hct level 3. Hgb level 4. Partial Thromboplastin Time

4. Partial Thromboplastin Time Results of tests that measure platelet function are normal --> results of tests that measure clotting factor function may be abnormal. Abnormal lab results in hemophilia indicate a prolonged PTT. The plt count, hgb and hct are normal in hemophilia

Lab studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the lab results, knowing that which result indicates this type of anemia? 1. Elevated hgb levels 2. Decreased reticulocyte count 3. Elevated RBC count 4. RBCs that are microcytic and hypochromic

4. RBCs that are microcytic and hypochromic The results of a CBC in children with iron deficiency anemia show: Decreased Hgb levels and microcytic and hypochromic RBCs. The RBC count is decreased. The reticulocyte count is usually normal or slightly elevated.

What is the antidote to tylenol?

Acetylcysteine (Mucomyst)

How does Narcan work?

Competes with opioid receptors and knocks the opioid medication off the receptor which decreases/stops the effect of it

What is the patho of Cobalamine Deficiency?

Decreased vitamin B12 NOT intrinsic factor

What is normal Hgb value?

Female: 11.7 - 16 Male: 13.2 - 17.3

What is normal RBC value?

Female: 3.8 - 5.1 Male: 4.3 - 5.7

What is normal Hct value?

Female: 35 - 47 Male: 39 - 50

Why are women lower in hematologic lab values than men?

Menstruation

Do opioids have an analgesic ceiling?

NO

Do non-opioid analgesics have an analgesic ceiling?

YES

A patient you're caring for has a dx of Aplastic Anemia. The pt states their pain is a 9/10. Which of the following medications would you give your patient? a. Tylenol b. Ibuprofen c. Naproxen d. Aspirin

a. Tylenol NSAIDs will increase pt's risk for bleeding

Why might we not want to give a pt with FVO or CHF NSAIDs for pain relief?

because NSAIDs retain fluids!!!!!!!!!!!!!!!!

A 16 year old client from a Mediterranean country is being discharged following hospitalization fro thalassemia, jaundice, splenomegaly and hepatomegaly. The nurse knows that the patient understands the instructions when the patient states: a. "I will brush and floss my teeth after every meal and at bedtime" b. "I will prevent constipation by taking stool softeners twice daily" c. "I will avoid large crowds of people and practice good hand hygiene" d. "I will not participate in soccer or baseball in gym class"

d. "I will not participate in soccer or baseball in gym class" Patients with thalassemia develop splenomegaly due to sequestration of damaged cells, leading to engorgement. These patients should avoid contact sports to decrease risk of splenic rupture

What are examples of Neuropathic pain?

-Damage to peripheral nerves/structures in CNS Numbness/Tingling Ex) Neuropathy Phantom pain -responds positively to adjuvant meds, not opioids

What are side effects of NSAIDs?

-GI upset -GI bleed -Bleeding in general -Hypoglycemia (if diabetic) -Toxicity if taking with calcium-channel blocker

What are examples of Visceral pain?

-Internal organs inflammation, ischemia Ex) Pancreatitis Colitis

What are nursing considerations when admin opioids?

-Start low, go slow -Encourage fluids -Caution in geriatric pt's -Be aware of CNS depression s/s

What are examples of Somatic pain?

-Superficial (tissues) Sharp, stabbing -Deep (bones/joints) throbbing, aching

How long before a procedure should a pt taking daily aspirin stop taking it?

1 week prior

What are the classifications of pain?

1. Acute 2. Chronic 3. Nociceptive a. somatic b. visceral 4. Nueropathic

What are adjuvant medication classifications for pain management?

1. Corticosteroids 2. Antidepressants -TCA's -SSRI's -SNRI's 3. GABA receptor agonists -Baclofen 4. Anti-Epileptics -Gabapentin 5. A2 Adrenergic Agonists -Clonidine 6. Local anesthetics 7. Cannabinoids

The nurse is conducting a staff in-service training on von Willebrand's Disease. Which should the nurse include as characteristics of von Willebrand's disease? select all that apply 1. Easy bruising occurs 2. Gum bleeding occurs 3. It is a hereditary bleeding disorder 4. Tx and care are similar to that for hemophilia 5. It is characterized by extremely high creatinine levels 6. The disorder causes plt's to adhere to damaged endothelium

1. Easy bruising occurs 2. Gum bleeding occurs 3. It is a hereditary bleeding disorder 4. Tx and care are similar to that for hemophilia 6. The disorder causes plt's to adhere to damaged endothelium The disorder causes plts to adhere to damanged endothelium. It is characterized by increased tendency to bleed from mucous membranes. Assessment findings include epistaxis, fum bleeding, easy bruising, and excessive menstrual bleeding. An elevated creatinine level is not associated with this disorder.

The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the RBC count

1. Encouraging fluids Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a UO of 1.5-2 L/day; this requires about 3L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating the renal tubules. Options 2, 3, 4 may be components of the plan of care but are not the priority in this client

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased WBCs 3. Decreased BUN levels 4. Decreased number of plasma cells in the bone marrow

1. Increased calcium level Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated BUN level. An increased WBC count may or may not be present and is not r/t multiple myeloma

What are examples of pain management drug classifications?

1. Non-Opioids: mild-mod pain ex) tylenol, NSAIDs, aspirin 2. Opioids: mod-severe pain ex) morphine, hydro, oxy, codeine 3. Adjuvant: alone or in conjunction ex) corticosteroids, anti-epileptics 4. Non-Pharm: ex) heat, ice, massage, guided imagery, meditation, relaxation, supportive devices

What should be included in a thorough pain assessment?

1. Onset/Duration 2. Location 3. Intensity 4. Quality 5. Associated Symptoms 6. Management strategies 7. Impact of pain 8. Patient goal

What routes can we give pain meds?

1. Oral 2. Transmucosal/Buccal 3. Intranasal 4. Rectal 5. Transdermal 6. Parenteral 7. Intraspinal

The nurse is conducting a history and monitoring lab values on a client with multiple myeloma. What assessment findings should the nurse expect to note? select all that apply 1. Pathological fracture 2. UA positive for nitrites 3. Hgb level of 15.5 4. Ca++ level of 8.6 5. Serum Creatinine level of 2.0

1. Pathological fracture 2. UA positive for nitrites 5. Serum Creatinine level of 2.0 Multiple myeloma is a B-Cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and teh accumulation of mature plasma cells in the bone marrow. The client with malignant melanoma may experience pathologic fractures, hypercalcemia, anemia, recurrent infections, and renal failure. A serum ca++ of 8.6 and a Hgb of 15.5 are normal values Therefore, the correct answers are pathological fractures, and positive UA for nitrites and a serum creatinine level of 2.0

The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the tx of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? select all that apply 1. Restrict fluid intake 2. Position for comfort 3. Avoid strain on painful joints 4. Apply nasal oxygen at 2L/min 5. Provide a high-cal, high-protein diet 6. Give Meperidine, 25mg IV, q4h for pain

1. Restrict fluid intake 6. Give Meperidine, 25mg IV, q4h for pain Oral and IV fluids are an important part of tx. Meperidine is not recommended for a child with sickle cell disease because of the risk for non-meperidine-induced seizures. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would question the prescription for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-cal, high-protein diet are also important parts of the tx plan

What kind of Oncology Emergencies are there? (7)

1. Superior Venca Cava Syndrome 2. Spinal Cord Compression 3. Third Spacing Syndrome 4. SIADH 5. Hypercalcemia 6. Tumor Lysis Syndrome 7. Cardiac Tomponade

The home health care nurse is caring for a client with cancer who is complaining of acute pain. The most appropriate determination of the client's pain should include which assessment? 1. The client's pain rating 2. Nonverbal cues from the client 3. The nurses' impression of the client's pain 4. Pain relief after appropriate nursing intervention

1. The client's pain rating The client's self-report is a critical component of pain assessment. The nurse should ask the client to describe the pain and listen carefully to the words the client uses to describe the pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. The nurse's impression of the client's pain is not appropriate in determining the client's level of pain. Assessing pain relief is an important measure, but this option is not related to the subject of the question.

What are interventional pain management options?

1. Therapeutic Nerve Blocks 2. Neuroablative Techniques 3. Neuroaugmentation

What are challenges in pain management?

1. Tolerance -Need for increased opioid dose to maintain degree of analgesia 2. Physical dependence -Ongoing exposure creates withdrawal symptoms when decreased 3. Pseudo-Addiction -Attempt to compensate for tolerance or worsening pain 4. Addiction -Drive to take substances for reasons other than they are prescribed. Compulsive use.

The nursing student is presenting a clinical conference and discusses the cause of Thalassemia. The nursing student informs the group that a child at greatest risk of developing this disorder is which of these? 1. A child of Mexican descent 2. A child of Mediterranean descent 3. A child whose intake of iron is extremely poor 4. A breast-fed child of a mother with chronic anemia

2. A child of Mediterranean descent This disorder is found primarily in individuals of Mediterranean descent. Options 1, 3, 4 are incorrect.

When a client with thrombocytopenia complains of a severe headache, the nurse interprets that this may indicate which of the following? a. Cerebral bleeding b. Stress of the disease c. Migraine headache d. Sinus congestion

a. Cerebral bleeding When the platelet count is very low, RBC can leak out of the vessels and into the tissue. When the blood pressure is elevated and the platelet count falls to less than 15,000/ul, internal bleeding can occur

A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. The nurse knows the reason for this vitamin deficiency is: a. an inability to absorb the vitamin because the stomach does not produce sufficient acid b. an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor c. an excessive excretion of the vitamin because of kidney dysfunction d. an increased requirement for the vitamin because of the rapid red blood cell production

b. an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows it to be absorbed by the small intestine

Which of the following does the nurse suggest as the most appropriate intervention to manage mucositis for the client with acute leukemia? a. "After each meal, use lemon-glycerin swabs" b. "After each meal, use a commercial mouthwash" c. "After each meal, use saline and baking soda solution." d. "After each meal, use your toothpaste and toothbrush."

c. "After each meal, use saline and baking soda solution." Simple rinses are most effective to moisten the oral mucosa. The other options often contain alcohol, which are drying and should be avoided.

A nurse assesses that a patient receiving epidural morphine has not voided for over 10 hours. What action should the nurse take initially? a. Monitor for withdrawal symptoms b. Place an indwelling urinary catheter c. Ask if the patient feels the need to void d. Document in the patient's chart

c. Ask if the patient feels the need to void

A nurse is caring for a client who reports daily use of acetaminophen (Tylenol) to manage mild knee pain. Which of the following statements by the client should be of the most concern to the nurse? a. "I have a glass of wine before bedtime each evening." b. "I have my blood checked weekly due to the warfarin I am taking." c. "I take two regular strength tablets in the morning and two in the evening." d. "I take three or four Vicodin ES tablets a day for severe shoulder pain as well."

d. "I take three or four Vicodin ES tablets a day for severe shoulder pain as well." Vicodin ES is a combination of hydrocodone and acetaminophen. Withthese current dosages, the patient would exceed their 4,000mg maximum of Tylenol. If the client regularly drinks 3+ alcoholic drinks should limit their Tylenol dose. Clients taking warfarin should not take medications that affect platelet function, such as aspirin

Which of the following terms describes the condition of a client who requires an increase in dosage to maintain adequate analgesia? a. Pseudoaddiction b. Physical dependence c. Addiction d. Drug Tolerance

d. Drug Tolerance Tolerance is a reduced responsiveness to the effect of any drug, which necessitates large doses to achieve an equivalent effect of the initial dose.

In providing care to the client with leukemia who has developed thrombocytopenia, the nurse assesses the most common sites for bleeding. Which of the following is NOT a common site? a. Biliary system b. Gastrointestinal system c. Brain and meninges d. Pulmonary system

a. Biliary system The biliary system is not especially prone to hemorrhage. Thrombocytopenia leaves the client at risk for spontaneous hemorrhage in the GI, respiratory or intracranial cavities.

When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiologic functions? a. Bleeding tendencies b. Intake and output c. Peripheral sensation d. Bowel function

a. Bleeding tendencies Aplastic anemia decreases the bone marrow production of RBC, WBC and platelets

Assessment of a client taking a non-steroidal anti-inflammatory drug (NSAID) for pain management should include specific questions regarding which of the following systems? a. Gastrointestinal b. Renal c. Pulmonary d. Cardiac

a. Gastrointestinal The most common toxicities from NSAIDS are GI disorders (nausea, epigastric pain, ulcers, bleeding).

A nurse is assessing a client with bone cancer pain. Which of the following components of a thorough pain assessment is most significant in regards to pain management? a. Intensity b. Cause c. Aggravating factors d. Location

a. Intensity Intensity is indicative of the severity of pain and is the most important in evaluating the efficacy of pain management. Cause and location cannot be managed buttheintensityofthepaincanbecontrolled. Reducingaggravatingfactorscanhelp, but will ultimately not reduce the intensity of the pain

The client with acute lymphocytic leukemia (ALL) is at risk for infection. What is the priority nursing intervention? a. Place the client in a private room b. Have the client wear a mask at all times c. Have staff wear gown and gloves d. Restrict visitors

a. Place the client in a private room To prevent infection, the client should be in a private room and strict hand washing should be implemented. It is not necessary to wear a mask and it is not contagious so no need for gown and gloves. The client can have visitors but they should be screened for infection and follow hand washing guidelines.

A client with metastatic breast cancer is taking long-acting morphine 120mg every 12 hours for pain. She can have 20mg of immediate-release morphine every 3 to 4 hours as needed for breakthrough pain. The physician should be notified if the client uses more than how many doses of immediate release morphine in 24 hours? a. Seven b. Four c. Two d. One

a. Seven The immediate dose for breakthrough pain is administered over and above the regularly scheduled medication. If more than six doses of immediate release morphine are needed, the dosage for the long-acting morphine should be increased in order to maintain the immediate release dosage and prevent tolerance

Which early symptom does the nurse observe in a client with thrombocytopenia who has developed a hemorrhage? a. Tachycardia b. Bradycardia c. Decreased PaCO2 d. Narrowed pulse pressure

a. Tachycardia The nurse would observe tachycardia in the hemorrhaging client because the heart beats faster to compensate for the decreased circulating volume and decreased number of RBC

When developing a teaching plan for a client who is prescribed acetaminophen (Tylenol) for muscle pain, which information should the nurse expect to include? (SELECT ALL THAT APPLY) a. The drug can be used if the person is allergic to aspirin b. Acetaminophen does not affect platelet aggregation c. This drug causes little or no gastric distress d. Acetaminophen exerts a strong anti-inflammatory effect e. The client should have the International Normalized Ration (INR) checked regularly

a. The drug can be used if the person is allergic to aspirin b. Acetaminophen does not affect platelet aggregation c. This drug causes little or no gastric distress Acetaminophen is an alternative for patient's allergic to aspirin. It does not affect platelet aggregation and the client does not need to have any coagulation studies (such as INR). Acetaminophen causes little or no gastric distress. Acetaminophen exerts no anti-inflammatory effects

The nurse is evaluating the client's understanding of combination chemotherapy. Which of the following statement by the client about the reason for using combination chemotherapy indicates a need for further explanation? a. "It is used to interrupt the cell growth cycle at different points." b. "It is used to destroy the cancer cells and treat side effect simultaneously" c. "It is used to decrease resistance" d. "It is used to minimize the toxicity from using high doses of a single agent."

b. "It is used to destroy the cancer cells and treat side effect simultaneously" Combination therapy does not include medications to treat side effects from the chemotherapy.

The nurse devises a teaching plan for the client with aplastic anemia. Which of the following is the most important concept to teach for health promotion and maintenance? a. Eat animal protein and dark green, leafy vegetables every day b. Avoid exposure to others with acute infection c. Practice yoga or meditate daily to decrease stress and anxiety d. Get 8 hours of sleep at night and take naps during the day

b. Avoid exposure to others with acute infection Clients with aplastic anemia are severely immunocompromised and at risk for infection and possible death related to bone marrow suppression and pancytopenia

A postoperative patient is receiving hydromorphone (Dilaudid) via PCA pump and reports continuous pain. Which of the following should be the nurse's initial action? a. Administer a bolus of medication b. Check the display on the PCA pump c. Obtain an order for a continuous infusion d. Instruct the client to administer a demand dose

b. Check the display on the PCA pump

Which of the following best describes a client's response to chronic pain? a. Elevated vital signs, physical inactivity, facial grimacing and periods of anxiety b. Normal vital signs, physical inactivity and normal facial expression c. Normal vital signs, normal facial expressions and moaning d. Elevated vital signs, grimacing, depression

b. Normal vital signs, physical inactivity and normal facial expression In a client with chronic pain, physiologic adaptation results in minimal changes in behavior and vital signs. Elevated vital signs, changes in facial expression and moaning are characteristic responses to acute pain.

Which of the following clinical manifestations does the nurse most likely observe in a client with Hodgkin's disease? a. Difficulty swallowing b. Painless, enlarged cervical lymph nodes c. Difficulty breathing d. Feeling of fullness over the liver

b. Painless, enlarged cervical lymph nodes Painless, enlarged cervical lymph nodes are signs of Hodgkin's disease.

The nurse teaches the client with chronic cancer pain about optimal pain control. Which of the following recommendations is most effective for pain control? a. Get used to some pain and use a little less medication that needed to keep from becoming addicted. b. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain c. Take analgesics only when pain returns d. Take enough analgesics around the clock so that you can sleep 12 to 16 hours a day to clock the pain

b. Take prescribed analgesics on an around-the-clock schedule to prevent recurrent pain The regular administration of analgesic provides a consistent level in the blood, which can help prevent breakthrough pain. There is little risk for a client with cancer-related pain to become addicted. Sleeping would not allow the patient to participate in daily activities

Which nursing action could the nurse delegate to an unlicensed assistive personnel when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain? a. Check the skin under the heating pad b. Take the respiratory rate every 2 hours c. Monitor sedation using the sedation assessment scale d. Ask the patient whether pain control is effective

b. Take the respiratory rate every 2 hours

When comparing lab values of a post-operative client, the nurse notes that the hematocrit value decreased from 36% to 34% on the third post-operative day even though the hemoglobin value remained stable at 11.9g/dl. Which nursing intervention is appropriate? a. Check the dressing and drain for frank bleeding b. Call the physician c. Continue to monitor vital signs d. Start oxygen at 2L/min via nasal cannula

c. Continue to monitor vital signs The nurse should continue to monitor because the hematocrit value reflects a normal physiological response. In the first one to two post operative days, there is typically retention of fluids due to secretion of ADH. By the third post operative day, this response decreases and the client's hematocrit level is more reflective of the number of RBC in the plasma

A client who had an exploratory laparotomy three days ago has a white blood cell count with a shift to the left. The nurse instructs the unlicensed personnel to report which clinical manifestation? a. Swelling around the incision b. Redness around the incision c. Elevated temperature d. Purulent wound drainage

c. Elevated temperature A shift to the left means that there are more immature than mature WBC. Immature WBC are less effective at phagocytosis and do not produce classic signs of infection. Low grade fever may be the only sign of significant infection

The client with acute leukemia and the health care team establish a goal to improve tidal volume and activity tolerance. Which measure would be least likely to promote this outcome achievement? a. Ambulating in the hallway b. Sitting up in a chair c. Lying in bed and taking deep breaths d. Using a stationary bike in the room

c. Lying in bed and taking deep breaths The client with leukemia must get out of bed to increase activity tolerance due to deconditioning.

The nurse should instruct the client to eat which of the following foods to obtain the best supply of vitamin B12? a. Whole grains b. Green leafy vegetables c. Meats and dairy products d. Broccoli and brussel sprouts

c. Meats and dairy products Good sources of Vitamin B12 include meats and dairy products. Whole grains are a good source of thiamine. Green, leafy veggies are a good source of folate. Broccoli and brussel sprouts are a good source of Vitamin C

The physician ordered IV naloxone (Narcan) to reverse the respiratory depression from morphine administration. Which of the following interventions would be most appropriate after administration of the naloxone? a. Check respirations in 5 minutes because naloxone is immediately effective in relieving respiratory depression b. Check respirations in 30 minutes because the effects of morphine will have worn off by then. c. Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone. d. Monitor respirations each time the client receives morphine sulfate

c. Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone. Naloxone has a short duration of action, usually shorter than the duration of the opioid. The client may need repeated doses of naloxone to prevent or treat recurrence of the respiratory depression. Naloxone is effective in a few minutes but lasts approx. 1-2 hours

The client with Hodgkin's disease undergoes an excisional cervical lymph node biopsy under local anesthesia. After the procedure, what does the nurse assess first? a. Vital signs b. The incision c. The airway d. Neurologic signs

c. The airway As this procedure involves the neck, assessing an open airway is priority. The anesthesia may affect the swallowing reflex or inflammation can close the airway

The nurse notes that the daily white blood cell count (WBC) for a client with aplastic anemia has decreased from 3,900 to 2,900/ul overnight. Which is the appropriate nursing intervention? a. Continue to monitor the client b. Call the laboratory and verify the report c. Document the finding d. Call the physician and place the client in reverse isolation

d. Call the physician and place the client in reverse isolation Protection for the client must be implemented immediately. The faster the decrease in WBC, the greater the bone marrow suppression and the more susceptible the patient is to infection

The goal of nursing care for a client with acute myeloid leukemia (AML) is to prevent: a. Cardiac arrhythmias b. Liver failure c. Renal failure d. Hemorrhage

d. Hemorrhage Bleeding and infection are the major compilations and causes of death for clients with AML.

Which patient with pain should the nurse assess first? a. Patient with postoperative pain who received morphine sulfate IV 15 minutes ago b. Patient with neuropathic pain who has a dose of hydrocodone (Lortab) scheduled now c. Patient who received hydromorphone (Dilaudid) 1 hour ago and currently has a RASS score of -1 d. Patient who returned from the PACU two hours ago and has a respiratory rate of 10

d. Patient who returned from the PACU two hours ago and has a respiratory rate of 10

The client with idiopathic thrombocytopenic purpura (ITP) asks the nurse why she has to take steroids. Which is the nurse's best response? a. Steroids destroy the antibodies and prolong the life of platelets b. Steroids neutralize the antigens and prolong the life of platelets c. Steroids increase phagocytosis and increase the life of platelets d. Steroids alter the spleen's recognition of platelets and increase the life of platelets

d. Steroids alter the spleen's recognition of platelets and increase the life of platelets Steroids suppress the splenic macrophages from phagocytizing the antibody-coated platelets which are recognized as foreign bodies

A client is eligible for patient-controlled analgesia (PCA) when: a. A family member is able to assist with self-dosing b. There is a court-appointed advocate to assist with self-dosing c. The client has the ability to self-dose d. There is a nurse to assist with self-dosing

d. There is a nurse to assist with self-dosing The ability to self-dose is a requirement for the patient to use PCA

What is the patho of Pernicious Anemia?

decreased Intrinsic Factor