final

The medication order for a geriatric patient with chronic pain reads: Tramadol 25 mg every 6 hours as needed. The maximum daily dose is 300 mg for the geriatric patient. The pharmacy label reads: Tramadol 50 mg. Each tablet contains: tramadol 50 mg. How many tablets per dose will the RN administer?

0.5 tab

A pediatric patient with scoliosis has a medication order that reads: acetaminophen (Tylenol) elixir 320mg administered orally every four to six hours as needed for pain. The pharmacy label reads: Tylenol 160mg per 5 mL. How many mL per dose will the RN administer?

10 mL

A-delta fibers

Large-diameter, myelinated fibers with rapid conduction that cause sharp, acute pain

Most common areas of referred pain

Liver - right upper side Appendix - right lower side Colon - umbilical area Heart - clavicle and shoulder area Esophagus - heart area Stomach - left middle area Kidneys - lower stomach area Ureters - pubic area

C fibers

Smaller, unmyelinated fibers with slow conduction that cause a diffuse, dull, and longer-lasting pain

What are appropriate functions of the RN in community-based health care? Select all that apply.

a. Education about wellness b. Order diagnostic testing c. Refer patients for resources d. Coordinate care given by others e. Provide skilled care treatments

The orienting RN is communicating with a person who has a high frequency hearing loss. Which of the following actions by the orienting RN would cause the mentor RN to intervene with the new RN?

a. Speaking in the less impaired ear b. Wearing an opaque face mask c. speaking in moderate voice d. using facial expressions and gestures

The RN has been assigned to conduct a secondary intervention program. Which program would meet this need?

a. Support group for patients with chronic disease b. Education classes on exercise and nutrition for senior citizens c. Vision screening for elementary school students. d. Nutrition education for patients with a new diagnosis of diabetes

Which reflects the RN role providing a tertiary intervention in a community-oriented setting?

a. Teaching antenatal classes for a group of pregnant women expecting a first baby b. Referring a student to a public health clinic following an abnormal Pap smear c. Conducting tuberculosis screening for a family at risk in the geographic region d. Providing classes on dangers of lead-based products, especially for children

Which of the following statements by a patient would reflect the experience of chronic pain?

a. The ai started a few weeks ago and it is improving b. I wake up angry and frustrated in pain every day c. I have been having a sinus headache for the past month d. I am still walking with knee pain since my recent surgery

What information should the nurse provide to a patient with being paroxysmal positional vertigo?

a. The condition resolves quickly spontaneously for most patients b. It is usually treated with several weeks of meclizine for dizziness c. The Epley repositioning maneuver can terminate the symptoms d. The disorder is associated with hearing loss and impairment

Psychogenic pain

arise from the mind. No physical cause can be identified

Cutaneous or superficial pain

arises in the skin or or the subcutaneous tissue

Nociceptive pain

as of result of trauma, surgery, or inflammation Visceral and somatic

Neuroupathic pain

chronic pain, burning, numbness, itching, and pins and needles prickling pain. causes: lower back or hip injury, poorly controlled diabetes, a stroke, a tumor, alcoholism, amputation, or a viral infection.

Pain threshold

is the point at which the brain recognizes and defines a stimulus as pain.

The vertigo is usually accompanied by

nausea and vomiting, but hearing impairment does not generally occur

The endogenous analgesia system

neurons in the brain stem activate descending nerve fibers that conduct impulses back to the spinal cord

Transduction

nociceptors become activated by the perception of mechanical, thermal, and chemical stimuli

Deep somatic pain

originates in the ligaments, tendons, nerves, blood vessels, and bones

reffered pain

pain felt in a part of the body other than its actual source

Phantom pain

pain or discomfort felt in an amputated limb

Visceral pain

pain originating in the internal organs in the thorax, cranium, or abdomen

acute pain

pain that is felt suddenly from injury, disease, trauma, or surgery

Thermal stimuli

result from exposure to extreme heat or cold

Pain tolerance

the duration or intensity of pain that a person can endure

The gate-control theory

the spinal cord contains a neurological "gate" that blocks pain signals or allows them to pass on to the brain

Pain perception

the recognition and interpretation of pain in the frontal cortex

endogenous opioids

endorphins, enkephalins, dynorphins

chronic pain

episode of pain that lasts for 3 to 6 months or longer; may be intermittent or continuous

Mechanical stimuli

external forces that result in pressure or friction against the body

The medication order for the pediatric patient with rheumatoid arthritis reads 200 mg of ibuprofen (Motrin) elixir to be administered orally every four to six hours as needed for pain. The pharmacy label reads: ibuprofen (Motrin) 50 mg per 0.5 mL. How many mL per dose will the RN administer?

2 mL

A pediatric patient has a medication order that reads: Diphenhydramine elixir 6.25 mg administered orally every six hours as needed for pain. The pharmacy label reads: Dephenhydramine elixir 12.5 mg per 5 mL. How many mL per dose will the RN administer?

2.5 mL

The medication order reads: meclizine HCL (Antivert) 50 mg orally. Given: 12.5 mg tablet How many tablets will the RN administer?

4 tablets

The medication order for a pediatric patient with Retinoblastoma reads: ondansetron (Zofran) 4 mg by mouth one hour prior to chemotherapy administration. The pharmacy label reads: Ondansetron Oral Solution 4mg/5mL. Each 5 mL contains: 5mg of ondansetron HCI dihydrate equivalent to 4 mg of ondansetron.

5 mL

The medication order reads: acetaminophen (Ofirmev) 1000 mg intravenous minibag to be administered over 15 minutes every 6 hours for acute pain. Translation OFIRMEV injection, 1000 mg/100 mL (10mg/mL). At what rate, in drops per minute, will the RN regulate the intravenous solution?

7

Underlying disorders that contribute to tinnitus

Cardiovascular disease, thyroid disease, hyperlipidemia, vitamin B12 deficiency, psychological disorders, fibromyalgia, otologic disorder, and neurologic disorder

Chemical stimuli

External - chemical on the skin or internal - heart attack (chemical changes that result from tissue ischemia

Physiology of pain

Four physiological processes of normal (nociceptive) pain: 1. Transduction 2. Transmission 3. Perception 4. Modulation

Infants and children pain

Newborn have the same sensitivity yo pain as older infants and children. Even if they have low score on based on behavioral assessment tool, it does not mean they are pain free.

Developmental stage

The behavior people exhibit when they have pain is strongly influenced by their stage of development.

Pain Modulation

This process changes the perception of pain by either facilitating or inhibiting pain signals through the endogenous analgesia system and the gate-control mechanism

The RN teaching the older adult to check their Amsler grid test for age-related macular degeneration changes. What frequency would the RN teach the client to do the checks?

a. 1 time per year b. 1 time per week c. 1 time per day d. 1 time per month

The RN is collaborating with a health care provider to determine if a patient is eligible for skilled nursing care in the home. Which statement by the health care provider requires correction?

a. "Assessment for response to medications can qualify a patient for skilled care" b. "A 45-year-old with end stage renal disease can qualify for skilled care" c. "Anyone over age 65 years of age will qualify a patient for skilled nursing care" d. "Education for diabetes management can qualify a patient for skilled care"

The patient states "I am having changes in my vision" Which is the RN's best response?

a. "Have you considered adaptive devices to help with poor vision?" b. "Adults age 65 and older should have routine screening examination every six month" c. "Call a healthcare provider for an examination" d. "Visual changes are normal when you age"

Which statement by the parents of a toddler with recurrent otitis media indicates to the RN the need for additional teaching?

a. "If I quit smoking, my child may have a decreased chance of getting ear infections." b. "I will call the office as soon as symptoms appear so an antibiotic can be prescribed" c. "My child has an increased chance of ear infections in the winter and spring months". d. "My child may find it more comfortable eating soft foods and drinking liquids."

The RN is collaborating with the healthcare provider to develop a care plan for a patient with chronic cancer pain. Which is the most effective intervention to support pain management?

a. Administer around the clock (ATC) analgesics in addition to as needed (PRN) medications b. Offer non-steroidal anti-inflammatory drugs (NSAIDs) in conjunction with a proton pump inhibitor c. Substitute intramuscular (IM) route narcotics when patient rates pain as very severe. d. Administer as needed (PRN) analgesics as frequently as allowed by the medical orders

The RN is caring for a patient with glaucoma who has coronary artery disease and asthma. The RN will evaluate this patient for which side effect after administering timodol maleate (Timoptic) eye drops?

a. Amplified eye pain b. Episodes of tachycardia c. Increased wheezing d. Acute hypertension

The new RN is caring for an adult patient with a temperature of 104.2 F who requires a cooling bath. Which statement by the new RN indicates additional teaching is required regarding the procedure for a cooling bath?

a. An ice pack can be placed on the patient's forehead and axilla b. I will assess the patient for shivering c. The goal of the bath is to cool the patient very rapidly d.

Information about ototoxicity must be included with which medications? Select all that apply

a. Aspirin (Acetylsalicylic acid) b. Gentamycin (Garamycin) c. Furosemide (Lasix) d. Digoxin (Lanoxin) e. Lorazepam (Ativan)

The RN is assessing a client with reported pain. The RN notes pallor and increased heart rate. Which type of response is this client showing?

a. Behavior response b. Parasympathetic response c. Sympathetic response d. Psychological response

An alert patient is receiving hospice care in the home setting. The patient is choosing not to eat. The family contacts the health care providers and asks that a feeding tube be inserted. The RN collaborates with the health care provider and does not recommended a feeding tube. What role is the RN exhibiting?

a. Care provider b. Coordinator c. Educator d. Advocate

In report the RN hears the following evidence-based scale data on 4 assigned patients. Which patient will the RN plan to assess last?

a. Comfort Daisies score of 1 b. FACES score of 2 c. d.

The patient has undergone mastoid surgery. Which postoperative assessment finding would be of most concern to the RN?

a. Constant throbbing pain and fever b. Sense of room spinning c. Decrease in hearing d. Hearing popping and crackling noises

An incoming RN receives a report that a patient has been crying and reporting various unresolved discomforts throughout the shift. In developing a care plan for this patient, which nursing intervention would be most appropriae?

a. Consult with the assigned social worker b. Contact the physician for an anti-anxiety medications c. Administer a placebo to the patient and let then think it is an analgesic d. Spend time conversing with the patient

Which action by the RN demonstrates adherence to personal safety considerations when making a home visit?

a. Consulting the map and directions during travel to the home b. Scheduling the visit in the evening when the family is home c. Carrying a charged phone always while visiting d. Keep agency identification badge with name on it out of sight

An 18-year-old with several fractures reports sharp stabbing pain in both legs at intensity of 8 on 0-10 Numeric Rating Scale. The RN notes dilated pupils and an anxious facial expression. The patient is experiencing nausea and is avoiding interaction with visitors. Which is considered a physiologic response to the pain?

a. Dilated pupils b. Anxious facial expression c. Avoiding interaction d. Pain level of 8

Which of the following questions should the RN ask a patient with a chronic illness and pain to determine their comfort-function goal?

a. Do you use complementary therapies for relief and comfort? b. What analgesic medication work best for you? c. What pain rating can you tolerate and carry out desired ADL? d. Is being 100% pain free essential for you?

Which of the following are appropriate steps for the RN to carry out when administering ear drops to an adult? Select all that apply

a. Document the administration b. Position the patient c. Pull the pinna up and back d. Assist patient to upright position e. Warm the solution to body temperature f. Gently tug on external ear

When the RN visits a client for the first time, which is the most important task during the visit?

a. Document the assessment b. Assess the environment c. Provide physical care d. Develop trust with patient

Which action does the RN educate the patient and caregiver to take to dispose of unneeded drugs?

a. Drug take-back program b. Use the garbage disposal c. d.

Which intervention performed by a novice nurse on a 15-month-old child receiving antibiotic ointment for conjunctivitis requires the experienced RN to intervene?

a. Screen the patient for previous allergic reactions b. Applies ointment from outer to inner canthus c. Applies gloves prior to applying ointment d. Educates parent on importance of follow up visit

The RN is working with a patient to manage reports of pain and discomfort. Which nursing interventions would be included to decrease pain and increase comfort? Select all that apply.

a. Evaluate pain relief 60 minutes after the drug or treatment is given b. Consistently administer the lowest dose of analgesic ordered c. Assist patient to feel a sense of control over the pain d. Modify the physical environment such as temperature and lighting e. Demonstrate a supportive caring attitude toward the patient

The patient has been medicated for acute pain 30 min ego. The pain rating was 8 on 0-10 numeric scale. Which patient observation by the RN would indicate the medication was most effective?

a. Eyes closed and patient smiling b. Lying still and quite in bed c. Using deep breathing relaxation exercise d. Rating pain as 2 on 0-10 numeric rating scale

A patient is seen in the eye clinic for glaucoma and is ordered treatment with a beta-adrenergic blocking agent. Which of the patient's pre-existing medical conditions must be reported to the physician before the new eye drop is started?

a. Hypertension b. Hepatic disease c. Heart block d. Dehydration

Which client statement regarding initial troubleshooting of a malfunctioning hearing aid indicates to the RN that the client needs further education?

a. I will check the batteries position b. I will make sure the aid is turned on c. I will clean any wax from the ear mold d. I will ask my audiologist to check it

Which is the priority nursing assessment for a client coming to the emergency department with ocular trauma from chemical burns?

a. Identify the chemical agent b. Assess vision loss as slow or fast c. Assess for presence of Drusen spots d. Perform a fundoscopic examination

The RN briefly observes a cognitively impaired patient who is expected to have significant pain. The patient does not show overt signs of pain or distress. What additional assessment data would the RN expect to confirm the presence of pain?

a. Increased appetite b. Decreased confusion c. d.

Which of the following is a harmful effect of unrelieved pain that the RN will assess for?

a. Increased immune response (no) b. Increased urinary output (no) c. d.

Which behavior by the RN is a violation of HIPPA confidentiality?

a. Keep computer locked until using in the home on visit b. Discussing patient's refusal of medication with caregiving family c. Discussing patient progress with a visiting neighbor couple d. Leaving medical records in a locked car between home visits

Which action by the RN demonstrates adherence to infection control principles when making a home visit? Select all that apply

a. Keep hand gel in the nursing bag to use for hand hygiene b. Bring only the needed items into visit if home unclear c. Use bar soap available at patient's home to wash hands

Which nursing interventions are important to include in the post-operative teaching for a patient who had a cataract removed? Select all that apply.

a. Lift items up to thirty pounds b. Exercise at a moderate pace. c. Lie on the operative eye side. d. wear glasses or an eye shield. e. Avoid bending to pick up objects Correct answers: D, E

Which reflects the RN role providing a primary intervention in a community-based setting?

a. Lobbying elected officials for safe outdoor exercise areas for children b. Conducting tuberculosis screening for a family at risk in the geographic region c. Referring a student to a public health clinic following an abnormal Pap smear d. Providing scoliosis evaluations for children in the school system

The RN preparing a patient for an eye exam with tonometry teaches the patient to avoid which of the following during the procedure?

a. Mouth breathing b. Deep breathing c. Nasal breathing d. Holding their breath

Which statement by the new RN indicates that additional teaching about pain is necessary?

a. Narcotics can be used for children if dosing is correct b. A sleeping child is always comfortable c. Children can report pain using a scale d. Newborns can feel pain

Which nursing intervention is most appropriate for the RN to use when assisting a patient with low vision?

a. Offer their hand to the patient to guide them b. Keep all necessary objects close to patient c. Engage the service dog to establish a relationship d. Inform the patient of general location of items

Which pain assessment tools would be appropriate for the RN to use when assessing an adult with advanced dementia who cannot speak? Select all that apply

a. PAINAD Scale b. CRIES Pain Scale c. FLACC Scale d. 0-10 Numeric Rating Scale e. Checklist of Non-vernal indicators

The RN is collaborating with a patient to meet comfort needs. The patient states, "Having a nurse with me when I talk to the physician makes me feel less stressed" Using Kolcaba's theory, which context of comfort is the nurse addressing?

a. Sociocultural b. Psychospiritual c. Physical d. Environmental

Which of the following interventions would the RN implement when working with a patient with presbycusis?

a. Speak in a high-pitch voice b. Speak into the less impaired ear c. Provide large print materials for teaching d. Encourage hearing evaluation every four years

Which observation by the home care nurse would indicate the plan of care is being followed?

a. Patient asking RN to reorder medication, which ran ou b. Family members participating in the care inconsistently c. Patient has not been home for the last three scheduled visits d. Patient is asking questions about the planned nursing care

Which outcome is most appropriate for the RN to plan for a patient with vertigo and Risk for injury when mobil?

a. Patient will keep eyes positioned straight ahead, after being taught this technique b. Patient will have no episodes of falls during the hospital stay c. Patient will identify successful coping behaviors by the end of hospital stay d. Patient will report no further episodes of nausea or vomiting

The RN has selected Acute confusion as a nursing diagnosis label for a newly admitted 80-year-old patient who is disoriented. What would be an appropriate outcome for this patient with this nursing diagnosis?

a. Patient's vital signs will be within normal range, in one day b. Patient will be independent in self-care activities, in three days c. Patient will demonstrate return to baseline orientation status, in two days d. Patient will report feeling more comfortable in new situation, in four days

What type of pain does the RN expect when a client has a fracture?

a. Phantom b. Visceral c. Somatic d. Referred

A RN observe the LPN performing an ear irrigation. Which of the following actions by the LPN would require the RN to intervene?

a. Positioning the patient b. instilling solution with force c. Instilling ceruminolytic agent d. Irrigating with warm water

Which of the following interventions would be the responsibility of the RN in home health care? Select all that apply

a. Pressure injury treatment b. Telehealth assessment c. Providing daily hygiene d. Patient education e. Urinary catheter insertion

A patient with sickle cell crisis is reporting pain at rating 7 on 0-10 numeric rating scale and requests pain medication. When the RN returns to medicate the patient, the patient is laughing and talking with visitors. Which action by the RN is most appropriate?

a. Provide a distraction activity rather than analgesics b. Hold medication until visitors leave c. Administer the prescribed analgesic medication d. Discuss drug seeking behavior with MD

A novice RN is describing Interventions that provide visual stimulation for a patient. Which intervention indicates the novice RN requires farther teaching by the RN mentor?

a. Provide daily calendar for orientation b. Place family photograph c. assess the patient using the Snellen chart d. position the patient near the window

Which information is most important for the RN to include when teaching a patient about using a patient-controlled analgesia (PCA) pump to control pain?

a. Push the button to administer a dose of the analgesic when pain becomes noticeable b. Naloxone (Narcan) is readily available to treat respiratory depression c. d.

The RN is caring for a patient receiving Fentanyl (Sublimaze) infusion via an epidural catheter. Which assessment would require immediate follow-up with the health care provider?

a. Redness at insertion site b. Respiratory rate of 8 per minute c. Blood pressure of 90/60 mmHg d. Inability to void

A six-year-old is being discharged following eye surgery. Which intervention should the RN assign to the nursing assistive personnel (NAP)?

a. Remove the patient's intravenous catheter b. Escort the patient and parents to the car? c. Provide discharge instructions to the parents d. Apply a new eye patch for the patient

The RN is managing the care of an elderly man living with a caregiver. The patient reports having "nothing to eat or drink all day", "not having medications to take", and "no help to get to bathroom". Which nursing intervention is appropriate?

a. Report suspected neglect to the adult protective services b. Contact health care provider with report of concerns c. Confront the caregiver about lack of meeting patient's needs d. Request a social work referral for further evaluation

Which action used by the RN helps to maintain infection control in a home visit?

a. Use of antimicrobial hand-rub when hands are visibly soiled b. Place saturated wound dressings in a plastic lined waste can c. Schedule home visit first for patient with multidrug-resistant infection

The RN is caring for 3-month-old patient experiencing pain and discomfort following a procedure. Which is the most appropriate nursing intervention to treat this patient's pain?

a. Utilize non-nutritive sucking (NNS) b. Assess intensity of crying c. d.

A patient had a right total knee replacement one day ago and reports pain ranging from 3 to 8 on the 0-10 Numeric Rating Scale. The RN recognizes this patient's pain is caused by which of the following sources?

a. Vascular b. Somatic

Which of the following situations should the RN consider as a patient needing pain addressed? Select all that apply.

a. Verbal rating of 10 on the Comfort Verbal Rating Scale b. Absence of elevated BP and or pulse rate with restlessness c. Verbal rating of 0 on the Numeric Rating Scale d. Close surrogate verbalizing pain noted in patient e. Having a painful procedure, when unconscious

The RN id planning care for a client with intermittent crampy abdomen pain. Which origin of pain will the RN identify for this client

a. Visceral pain b. Somatic pain c. Cutaneous pain d. Referred pain

Which of the following are appropriate steps for the RN to carry out when applying an external heating pad? Select all that apply

a. Wash hands b. Cover the heating pad with towel or fitted sleeve c. Document the treatment d. Place pad over the area e. Check skin frequently for redness or blistering f. Caution clients not to change temperature if they become accustomed to the sensation g. Do not apply heat therapy to non-intact skin

Trasmission

peripheral nerves carry the pain message to the dorsal horn of the spinal cord A-delta fibers C fibers

Radiating pain

starts at the origin but extends to other locations

intractable pain

that which chronic and cannot be relieved; continuous, relentless, as in intractable pain.