sleep, pain, legal

As a staff member in a local hospice, a nurse deals with death and dying on a frequent basis. Where would be the safe venue for the nurse to express her feelings of frustration and grief about a patient who has recently died? A) In the cafeteria B) At a staff meeting C) At a social gathering D) At a memorial service

B) At a staff meeting In hospice settings, where death, grief, and loss are expected outcomes of patient care, interdisciplinary colleagues rely on each other for support, using meeting time to express frustration, sadness, anger, and other emotions; to learn coping skills from each other; and to speak about how they were affected by the lives of those patients who have died since the last meeting. Public settings are inappropriate places to express frustration about the death of a patient.

A nurse on an oncology unit has arranged for an individual to lead meditation exercises for patients who are interested in this nonpharmacological method of pain control. The nurse should recognize the use of what category of nonpharmacological intervention?A)A body-based modality B)A mind-body method C)A biologically based therapy D)An energy therapy

Ans: A mind-body method Feedback:Meditation is one of the recognized mind-body methods of nonpharmacological pain control. The other answers are incorrect.

Your patient is receiving postoperative morphine through a patient-controlled analgesic (PCA) pump and the patient's orders specify an initial bolus dose. What is your priority assessment? A)Assessment for decreased level of consciousness (LOC) B)Assessment for respiratory depression C)Assessment for fluid overload D)Assessment for paradoxical increase in pain

Ans: Assessment for respiratory depression Feedback:A patient who receives opioids by any route must be assessed frequently for changes in respiratory status. Sedation is an expected effect of a narcotic analgesic, though severely decreased LOC is problematic. Fluid overload and paradoxical increase in pain are unlikely, though opioid-induced hyperalgesia (OIH) occurs in rare instances.

Applying the gate control theory of pain, what would be an effective nursing intervention for a patient with lower back pain? a. Encouraging regular use of analgesics b. Applying a moist heating pad to the area at prescribed intervals c. Reviewing the pain experience with the patient d. Ambulating the patient after administering medication

b. Nursing measures such as applying warmth to the lower back stimulate the large nerve fibers to close the gate and block the pain. The other choices do not involve attempts to stimulate large nerve fibers that interfere with pain transmission as explained by the gate control theory.

A patient complains of abdominal pain that is difficult to localize. The nurse documents this as which type of pain? a. Cutaneous b. Visceral c. Superficial d. Somatic

b. The patient's pain would be categorized as visceral pain, which is poorly localized and can originate in body organs in the abdomen. Cutaneous pain (superficial pain) usually involves the skin or subcutaneous tissue. A paper cut that produces sharp pain with a burning sensation is an example of cutaneous pain. Deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep somatic pain.

When developing the plan of care for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain is most effectively relieved when analgesics are administered in what matter? a. On a PRN (as needed) basis b. Conservatively c. Around the clock (ATC) d. Intramuscularly

c. The PRN protocol is totally inadequate for patients experiencing chronic pain. ATC doses of analgesics are more effective, whereas conservative pain management for whatever reason may also prove ineffective. Intramuscular administration is not practical on a long-range basis for a patient with chronic pain.

A female patient who is having a myocardial infarction complains of pain that is situated in her jaw. The nurse documents this as what type of pain? a. Transient pain b. Superficial pain c. Phantom pain d. Referred pain

d. Referred pain is perceived in an area distant from its point of origin, whereas transient pain is brief and passes quickly. Superficial pain originates in the skin or subcutaneous tissue. Phantom pain may occur in a person who has had a body part amputated, either surgically or traumatically.

The nurse is assessing a 73-year-old patient who was diagnosed with metastatic prostate cancer. The nurse notes that the patient is exhibiting signs of loss, grief, and intense sadness. Based on this assessment data, the nurse will document that the patient is most likely in what stage of death and dying? A) Depression B) Denial C) Anger D) Resignation

A) Depression Loss, grief, and intense sadness indicate depression. Denial is indicated by the refusal to admit the truth or reality. Anger is indicated by rage and resentment. Acceptance is indicated by a gradual, peaceful withdrawal from life.

A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate? 1. Allow the client to decline the medication and document the decision. 2. Tell the client that if the medication is refused, hospitalization will occur. 3. Arrange with a relative to add the medication to the client's morning orange juice. 4. Call for help to hold the client down while the injection is administered.

1. Allow the client to decline the medication and document the decision. Rationale: It is ethically appropriate for the nurse to allow the client to decline the medication and provide accurate documentation. The client's right to refuse treatment should be upheld, unless the refusal puts the client or others in harm's way.

Group therapy is strongly encouraged, but not mandatory, in an inpatient psychiatric unit. The unit manager's policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager's policy preserve? 1. Justice 2. Autonomy 3. Veracity 4. Beneficence

2. Autonomy Rationale: The unit manager's policy regarding voluntary client participation in group therapy preserves the ethical principle of autonomy. The principle of autonomy presumes that individuals are capable of making independent decisions for themselves and that health-care workers must respect these decisions.

As the American population ages, nurses expect see more patients admitted to long-term care facilities in need of palliative care. Regulations now in place that govern how the care in these facilities is both organized and reimbursed emphasize what aspect of care? A) Ongoing acute care B) Restorative measures C) Mobility and socialization D) Incentives to palliative care

B) Restorative measures Regulations that govern how care in these facilities is organized and reimbursed tend to emphasize restorative measures and serve as a disincentive to palliative care. Long-term care facilities do not normally provide acute care for their patients. Regulations for long-term care facilities do not primarily emphasize mobility and socialization.

Patients who are enrolled in hospice care through Medicare are often felt to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon? A) Unwillingness to overmedicate the dying patient B) Rules concerning completion of all cure-focused medical treatment C) Unwillingness of patients and families to acknowledge the patient is terminal D) Lack of knowledge of patients and families regarding availability of care

B) Rules concerning completion of all cure-focused medical treatment Because of Medicare rules concerning completion of all cure-focused medical treatment before the Medicare hospice benefit may be accessed, many patients delay enrollment in hospice programs until very close to the end of life. Hospice care does not include an unwillingness to medicate the patient to keep him or her from suffering. Patients must accept that they are terminal before being admitted to hospice care. Lack of knowledge is common; however, this is not why some Medicare patients do not receive adequate attention for the symptoms of their underlying illness.

A pediatric nurse is emotionally distraught by the death of a 9-year-old girl who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurse's own grief? A) Take time off from work to mourn the death. B) Post mementos of the patient on the unit. C) Solicit emotional support from the patient's family. D) Attend the patient's memorial service.

D) Attend the patient's memorial service. In many settings, staff members organize or attend memorial services to support families and other caregivers who find comfort in joining each other to remember and celebrate the lives of patients. Taking time off should not be necessary and posting mementos would be inappropriate. It would be highly inappropriate to solicit emotional support from the patient's family during their time of loss.

In the past three to four decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying? A)Increased incidence of infections and acute illnesses B) Increased focus of health care providers on disease prevention C) Larger numbers of people dying in hospital settings D) Demographic changes in the population

D) Demographic changes in the population The focus on care of the dying has been motivated by the aging of the population, the prevalence of, and publicity surrounding, life-threatening illnesses (e.g., cancer and AIDS), and the increasing likelihood of a prolonged period of chronic illness prior to death. The salience of acute infections, prevention measures, and death in hospital settings are not noted to have had a major influence on this phenomenon.

A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

1. Autonomy Rationale: The nurse should provide the information to support the client's autonomy. A client who is capable of making independent choices should be permitted to do so. In instances when clients are incapable of making informed decisions, a legal guardian or representative would be asked to give consent.

A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes? 1. A client makes inappropriate sexual innuendos to a staff member. 2. A client constantly demands attention from the nurse by begging, "Help me get better." 3. A client physically attacks another client after being confronted in group therapy. 4. A client refuses to bathe or perform hygienic activities.

3. A client physically attacks another client after being confronted in group therapy. Rationale: The nurse would have the right to medicate a client against his or her wishes if the client physically attacks another client. This client poses a significant risk to safety and is incapable of making informed choices. The client's refusal to accept treatment can be challenged, because the client is endangering the safety of others.

A client who will be receiving electroconvulsive therapy (ECT) must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent? 1. The client is paranoid. 2. The client is 87 years old. 3. The client incorrectly reports his or her spouse's name, date, and time of day. 4. The client relies on his or her spouse to interpret the information.

3. The client incorrectly reports his or her spouse's name, date, and time of day. Rationale: The nurse should question the validity of informed consent when the client incorrectly reports the spouse's name, date, and time of day. This indicates that this client is disoriented and may not be competent to make informed choices.

A medical nurse is providing end-of-life care for a patient with metastatic bone cancer. The nurse notes that the patient has been receiving oral analgesics for her pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do? A) Request the physician to order analgesics by an alternative route. B) Crush the medication in order to aid swallowing and absorption. C) Administer the patient's medication with the meal tray. D) Administer the medication rectally.

A) Request the physician to order analgesics by an alternative route. A change in medication route is indicated and must be made by a physician's order. Many pain medications cannot be crushed and given to a patient. Giving the medication with a meal is not going to make it any easier to swallow. Rectal administration may or may not be an option.

An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which ethical principle should a nurse determine has been violated based on these actions? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

4. Justice Rationale: The nurse should determine that the ethical principle of justice has been violated by the physician's actions. The principle of justice requires that individuals should be treated equally, regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief.

Your patient is 12-hours post ORIF right ankle. The patient is asking for a breakthrough dose of analgesia. The pain-medication orders are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner? A)To prevent respiratory depression from the opioid B)To eliminate the need for additional medication during the night C)To achieve better pain control than with one medication alone D)To eliminate the potentially adverse effects of the opioid

Ans: To achieve better pain control than with one medication alone Feedback:A multimodal regimen combines drugs with different underlying mechanisms, which allows lower doses of each of the drugs in the treatment plan, reducing the potential for each to produce adverse effects. This method also reduces, but does not eliminate, adverse effects of the opioid. This regimen is not motivated by the need to prevent respiratory depression or to eliminate nighttime dosing.

A patient is experiencing severe pain after suffering an electrical burn in a workplace accident. The nurse is applying knowledge of the pathophysiology of pain when planning this patient's nursing care. What is the physiologic process by which noxious stimuli, such as burns, activate nociceptors?A)Transduction B)Transmission C)Perception D)Modulation

Ans: Transduction Feedback:Transduction refers to the processes by which noxious stimuli, such as a surgical incision or burn, activate primary afferent neurons called nociceptors. Transmission, perception, and modulation are subsequent to this process.

A nurse who works in the specialty of palliative care frequently encounters issues and situations that constitute ethical dilemmas. What issue has most often presented challenging ethical issues, especially in the context of palliative care?A) The increase in cultural diversity in the United States B) Staffing shortages in health care and questions concerning quality of care C) Increased costs of health care coupled with inequalities in access D) Ability of technology to prolong life beyond meaningful quality of life

D) Ability of technology to prolong life beyond meaningful quality of life The application of technology to prolong life has raised several ethical issues. The major question is, "Because we can prolong life through increasingly sophisticated technology, does it necessarily follow that we must do so?" The increase in cultural diversity has not raised ethical issues in health care. Similarly, costs and staffing issues are relevant, but not central to the most common ethical issues surrounding palliative care.

A 66-year-old patient is in a hospice receiving palliative care for lung cancer which has metastasized to the patient's liver and bones. For the past several hours, the patient has been experiencing dyspnea. What nursing action is most appropriate to help to relive the dyspnea the patient is experiencing? A) Administer a bolus of normal saline, as ordered. B) Initiate high-flow oxygen therapy. C) Administer high doses of opioids. D) Administer bronchodilators and corticosteroids, as ordered.

D) Administer bronchodilators and corticosteroids, as ordered. Bronchodilators and corticosteroids help to improve lung function as well as low doses of opioids. Low-flow oxygen often provides psychological comfort to the patient and family. A fluid bolus is unlikely to be of benefit.

One aspect of the nurse's comprehensive assessment when caring for the terminally ill is the assessment of hope. The nurse is assessing a patient with liver failure for the presence of hope. What would the nurse identify as a hope-fostering category? A) Uplifting memories B) Ignoring negative outcomes C) Envisioning one specific outcome D) Avoiding an actual or potential threat

A) Uplifting memories Hope is a multidimensional construct that provides comfort as a person endures life threats and personal challenges. Uplifting memories are noted as a hope-fostering category, whereas the other listed options are not identified as such.

The nurse is caring for a 51-year-old female patient whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem? A)Anxiety B)Skin breakdown C)Depression D)Hallucinations

Ans: Depression Feedback:Depression is associated with chronic pain and can be exacerbated by the effects of chronic fatigue. Anxiety is also plausible, but depression is a paramount risk. Skin breakdown and hallucinations are much less likely.

You are caring for a patient who has just been told that his illness is progressing and nothing more can be done for him. After the physician leaves, the patient asks you to stay with him for a while. The patient becomes tearful and tries several times to say something, but cannot get the words out. What would be an appropriate response for you to make at this time? A) "Can I give you some advice?" B) "Do you need more time to think about this?" C) "Is there anything you want to say?" D) "I have cared for lots of patients in your position. It will get easier."

B) "Do you need more time to think about this?" Prompt gently: "Do you need more time to think about this?" Giving advice is inappropriate and it is obvious from the scenario that the patient has something to say. Referring to other patients negates the patient's feelings at this time.

A patient's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this patient's care, the nurse should identify what primary aim? A) To prioritize emotional needs B) To prevent and relieve suffering C) To bridge between curative care and hospice care D) To provide care while there is still hope

B) To prevent and relieve suffering Palliative care, which is conceptually broader than hospice care, is both an approach to care and a structured system for care delivery that aims to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care goes beyond simple prioritization of emotional needs; these are always considered and addressed. Palliative care is considered a "bridge," but it is not limited to just hospice care. Hope is something patients and families have even while the patient is actively dying.

A nurse is providing discharge teaching for patients regarding their medications. For which patients would the nurse recommend actions to promote sleep? Select all that apply. A. A patient who is taking iron supplements for anemia. B. A patient with Parkinson's disease who is taking dopamine. C. An older adult taking diuretics for congestive heart failure. D. A patient who is taking antibiotics for an ear infection. E. A patient who is prescribed antidepressants. F. A patient who is taking low-dose aspirin prophylactically.

B. A patient with Parkinson's disease who is taking dopamine. C. An older adult taking diuretics for congestive heart failure. E. A patient who is prescribed antidepressants. Drugs that decrease REM sleep include barbiturates, amphetamines, and antidepressants. Diuretics, antiparkinsonian drugs, some antidepressants and antihypertensives, steroids, decongestants, caffeine, and asthma medications are seen as additional common causes of sleep problems.

A patient has just been told that her illness is terminal. The patient tearfully states, "I can't believe I am going to die. Why me?" What is your best response? A) "I know how you are feeling." B) "You have lived a long life." C) "This must be very difficult for you." D) "Life can be so unfair."

C) "This must be very difficult for you." The most important intervention the nurse can provide is listening empathetically. To communicate effectively, the nurse should ask open-ended questions and acknowledge the patient's fears. Deflecting the statement or providing false sympathy must be avoided.

A hospice nurse is caring for a 22-year-old with a terminal diagnosis of leukemia. When updating this patient's plan of nursing care, what should the nurse prioritize? A) Interventions aimed at maximizing quantity of life B) Providing financial advice to pay for care C) Providing realistic emotional preparation for death D) Making suggestions to maximize family social interactions after the patient's death

C) Providing realistic emotional preparation for death Hospice care focuses on quality of life, but, by necessity, it usually includes realistic emotional, social, spiritual, and financial preparation for death. Financial advice and actions aimed at post-death interaction would not be appropriate priorities.

A nurse is discussing with an older adult patient measures to take to induce sleep. What teaching point might the nurse include? A. Drinking a cup of regular tea at night induces sleep. B. Using alcohol moderately promotes a deep sleep. C. Having a small bedtime snack high in tryptophan and carbohydrates improves sleep. D. Exercising right before bedtime can hinder sleep.

C. Having a small bedtime snack high in tryptophan and carbohydrates improves sleep. The nurse would teach the patient that having a small bedtime snack high in tryptophan and carbohydrates improves sleep. Regular tea contains caffeine and increases alertness. Large quantities of alcohol limit REM and delta sleep. Physical activity within a 3-hour interval before normal bedtime can hinder sleep.

A nurse is caring for an older adult who is having trouble getting to sleep at night and formulates the nursing diagnosis Disturbed sleep pattern: Initiation of sleep. Which nursing interventions would the nurse perform related to this diagnosis? Select all that apply. A. Arrange for assessment for depression and treatment. B. Discourage napping during the day. C. Decrease fluids during the evening. D. Administer diuretics in the morning. E. Encourage patient to engage in some type of physical activity. F. Assess medication for side effects of sleep pattern disturbances.

A. Arrange for assessment for depression and treatment. B. Discourage napping during the day. E. Encourage patient to engage in some type of physical activity. F. Assess medication for side effects of sleep pattern disturbances. For patients who are having trouble initiating sleep, the nurse should arrange for assessment for depression and treatment, discourage napping, promote activity, and assess medications for sleep disturbance side effects. Limiting fluids and administering diuretics in the morning are appropriate interventions for Disturbed Sleep Pattern: Maintaining Sleep.

The nurse is assessing the pain of a neonate who is admitted to the NICU with a heart defect. Which pain assessment scale would be the best tool to use with this patient? a. CRIES scale b. COMFORT scale c. FLACC scale d. FACES scale

a. The CRIES Pain Scale is a tool intended for use with neonates and infants from 0 to 6 months. The COMFORT Scale, used to assess pain and distress in critically ill pediatric patients, relies on six behavioral and two physiologic factors that determine the level of analgesia needed to adequately relieve pain in these children. The FLACC scale (F—Faces, L—Legs, A—Activity, C—Cry, C—Consolability) was designed for infants and children from age 2 months to 7 years who are unable to validate the presence or severity of pain. The FACES scale is used for children who can compare their pain to the faces depicted on the scale.

A nurse instructor is teaching a class of student nurses about the nature of pain. Which statements accurately describe this phenomenon? Select all that apply. a. Pain is whatever the physician treating the pain says it is. b. Pain exists whenever the person experiencing it says it exists. c. Pain is an emotional and sensory reaction to tissue damage. d. Pain is a simple, universal, and easy-to-describe phenomenon. e. Pain that occurs without a known cause is psychological in nature. f. Pain is classified by duration, location, source, transmission, and etiology.

b, c, f. Margo McCaffery (1979, p. 11) offers the classic definition of pain that is probably of greatest benefit to nurses and their patients: "Pain is whatever the experiencing person says it is, existing whenever he (or she) says it does." The International Association for the Study of Pain (IASP) further defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (IASP, 1994). Pain is an elusive and complex phenomenon, and despite its universality, its exact nature remains a mystery. Pain is present whenever a person says it is, even when no specific cause of the pain can be found. Pain may be classified according to its duration, its location or source, its mode of transmission, or its etiology.

A nurse who sits on the hospital's ethics committee is reviewing a complex case that has many of the hallmarks of assisted suicide. Which of the following would be an example of assisted suicide? A) Administering a lethal dose of medication to a patient whose death is imminent B) Administering a morphine infusion without assessing for respiratory depression C) Granting a patient's request not to initiate enteral feeding when the patient is unable to eat D) Neglecting to resuscitate a patient with a "do not resuscitate" order

A) Administering a lethal dose of medication to a patient whose death is imminent Assisted suicide refers to providing another person the means to end his or her own life. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual. The other listed options do not fit this accepted definition of assisted suicide.

The nurse in a pediatric ICU is caring for a child who is dying of sickle cell anemia. The child's mother has been unable to eat or sleep and can talk only about her impending loss and the guilt she feels about the child's pain and suffering. What intervention has the highest priority? A) Allowing the patient to express her feelings without judging her B) Helping the patient to understand the phases of the grieving process C) Reassuring the patient that the child's death is not her fault D) Arranging for genetic counseling to inform the patient of her chances of having another child with the disease

A) Allowing the patient to express her feelings without judging her Listening to the patient express her feelings openly without judging her is the highest priority. The nurse should not impose his or her own values on the patient. The nurse should also help the patient to understand the grieving process and use all the support systems that are available to assist her in coping with this situation. Genetic counseling may be appropriate at a later time.

You are caring for a 50-year-old man diagnosed with multiple myeloma; he has just been told by the care team that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should you do first? A) Ask if he would like you to sit with him while he collects his thoughts. B) Tell him that you will leave for now but will be back shortly. C) Offer to call pastoral care or a member of his chosen clergy. D) Reassure him that you can understand how he is feeling.

A) Ask if he would like you to sit with him while he collects his thoughts. The most important intervention the nurse can provide is listening empathetically. Seriously ill patients and their families need time and support to cope with the changes brought about by serious illness and the prospect of impending death. The nurse who is able to listen without judging and without trying to solve the patient's and family's problems provides an invaluable intervention. The patient needs to feel that people are concerned with his situation. Leaving him does not show acceptance of his feelings. Offering to call pastoral care may be helpful for some patients, but should be done after you have spent time with the patient. Telling the patient that you understand how he is feeling is inappropriate because it does not help him express his feelings.

After contributing to the care of several patients who died in the hospital, the nurse has identified some lapses in the care that many of these patients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings? A) Families' needs for information and support often go unmet. B) Patients are too sedated to achieve adequate pain control. C) Patients are not given opportunities to communicate with caregivers. D) Patients are ignored by the care team toward the end of life.

A) Families' needs for information and support often go unmet. Studies have demonstrated that the health care system continues to be challenged when meeting seriously ill patients' needs for pain and symptom management and their families' needs for information and support. Oversedation, lack of communication, and lack of care are not noted to be deficiencies to the same degree.

A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer patients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply. A) Financial pressures on health care providers B) Patient reluctance to accept this type of care C) Strong association of hospice care with prolonging death D) Advances in "curative" treatment in late-stage illness E) Ease of making a terminal diagnosis

A) Financial pressures on health care providers B) Patient reluctance to accept this type of care D) Advances in "curative" treatment in late-stage illness Physicians are reluctant to refer patients to hospice, and patients are reluctant to accept this form of care. Reasons include the difficulties in making a terminal prognosis (especially for those patients with noncancer diagnoses), the strong association of hospice with death, advances in "curative" treatment options in late-stage illness, and financial pressures on health care providers that may cause them to retain rather than refer hospice-eligible patients.

The nurse is caring for a patient who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the patient's death is imminent? A) Mottling of the lower limbs B) Slow, steady pulse C) Bowel incontinence D) Increased swallowing

A) Mottling of the lower limbs The time of death is generally preceded by a period of gradual diminishment of bodily functions in which increasing intervals between respirations, weakened and irregular pulse, and skin color changes or mottling may be observed. The patient will not be able to swallow secretions, so suctioning, frequent and gentle mouth care, and, possibly, the administration of a transdermal anticholinergic drug. Bowel incontinence may or may not occur.

A patient on the medical unit is dying and the nurse has determined that the family's psychosocial needs during the dying process need to be addressed. What is a cause of many patient care dilemmas at the end of life? A) Poor communication between the family and the care team B) Denial of imminent death on the part of the family or the patient C) Limited visitation opportunities for friends and family D) Conflict between family members

A) Poor communication between the family and the care team Many dilemmas in patient care at the end of life are related to poor communication between team members and the patient and family, as well as to failure of team members to communicate with each other effectively. Regardless of the care setting, the nurse can ensure a proactive approach to the psychosocial care of the patient and family. Denial of death may be a response to the situation, but it is not classified as a need. Visitation should accommodate wishes of the family member as long as patient care is not compromised.

An adult oncology patient has a diagnosis of bladder cancer with metastasis and the patient has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting? A) The patient and family should be viewed as a single unit of care. B) Persistent symptoms of terminal illness should not be treated. C) Each member of the interdisciplinary team should develop an individual plan of care. D) Terminally ill patients should die in the hospital whenever possible.

A) The patient and family should be viewed as a single unit of care. Hospice care requires that the patient and family be viewed as a single unit of care. The other listed principles are wholly inconsistent with the principles of hospice care.

The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial purpose of this patient's strategy? A) The patient may be trying to protect loved ones from the emotional effects of the illness. B) The patient is being noncompliant in order to assert power over caregivers. C) The patient may be skeptical of the benefits of the Western biomedical model of health. D) The patient thinks that treatment does not provide him comfort.

A) The patient may be trying to protect loved ones from the emotional effects of the illness. Patients who are characterized as being in denial may be using this strategy to preserve important interpersonal relationships, to protect others from the emotional effects of their illness, and to protect themselves because of fears of abandonment. Each of the other listed options is plausible, but less likely.

A patient who is receiving care for osteosarcoma has been experiencing severe pain since being diagnosed. As a result, the patient has been receiving analgesics on both a scheduled and PRN basis. For the past several hours, however, the patient's level of consciousness has declined and she is now unresponsive. How should the patient's pain control regimen be affected? A) The patient's pain control regimen should be continued. B) The pain control regimen should be placed on hold until the patient's level of consciousness improves. C) IV analgesics should be withheld and replaced with transdermal analgesics. D) The patient's analgesic dosages should be reduced by approximately one half.

A) The patient's pain control regimen should be continued. Pain should be aggressively treated, even if dying patients become unable to verbally report their pain. There is no need to forego the IV route. There is no specific need to discontinue the pain control regiment or to reduce it.

The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient? A) These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies. B) These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer. C) Try not to be concerned about these symptoms. Every patient feels this way after having radiation therapy. D) Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying.

A) These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies. Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the patient and should not be belittled. Radiation destroys both cancerous and normal cells.

A medical nurse is providing palliative care to a patient with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's care? A) To improve the patient's and family's quality of life B) To support aggressive and innovative treatments for cure C) To provide physical support for the patient D) To help the patient develop a separate plan with each discipline of the health care team

A) To improve the patient's and family's quality of life The goal of palliative care is to improve the patient's and the family's quality of life. The support should include the patient's physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the patient and family. The goal of palliative care is not aggressive support for curing the patient. Providing physical support for the patient is also not the goal of palliative care. Palliative care does not strive to achieve separate plans of care developed by the patient with each discipline of the health care team.

A nurse is assessing patients in a skilled nursing facility for sleep deficits. Which patients would be considered at a higher risk for having sleep disturbances? Select all that apply. A. A patient who has uncontrolled hypothyroidism. B. A patient with coronary artery disease. C. A patient who has GERD. D. A patient who is HIV positive. E. A patient who is taking corticosteroids for arthritis. F. A patient with a urinary tract infection.

A. A patient who has uncontrolled hypothyroidism. B. A patient with coronary artery disease. C. A patient who has GERD. A patient who has uncontrolled hypothyroidism tends to have a decreased amount of NREM sleep, especially stages II and IV. The pain associated with coronary artery disease and myocardial infarction is more likely with REM sleep, and a patient who has GERD may awaken at night with heartburn pain. Being HIV positive, taking corticosteroids, and having a urinary tract infection does not usually change sleep patterns.

The wife of a patient you are caring for asks to speak with you. She tells you that she is concerned because her husband is requiring increasingly high doses of analgesia. She states, "He was in pain long before he got cancer because he broke his back about 20 years ago. For that problem, though, his pain medicine wasn't just raised and raised." What would be the nurses' best response? A)"I didn't know that. I will speak to the doctor about your husband's pain control." B)"Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the patient relief." C)"Cancer is a chronic kind of pain so the more it hurts the patient, the more medicine we give the patient until it no longer hurts." D)"Does the increasing medication dosage concern you?"

Ans: "Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the patient relief." Feedback:Much pain associated with cancer is a direct result of tumor involvement. Conveying patient/family concerns to the physician is something a nurse does, but is not the best response by the nurse. Cancer pain can be either acute or chronic, and you do not tell a family member that you are going to keep increasing the dosage of the medication until "it doesn't hurt anymore." The family member is obviously concerned.

The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse why he has had to keep getting larger doses of his pain medication, although they do not seem to affect him. What is the nurse's best response? A)"Over time you become more tolerant of the drug." B)"You may have become immune to the effects of the drug." C)"You may be developing a mild addiction to the drug." D)"Your body absorbs less of the drug due to the cancer."

Ans: "Over time you become more tolerant of the drug." Feedback:Over time, the patient is likely to become more tolerant of the dosage. Little evidence indicates that patients with cancer become addicted to the opioid medications. Patients do not become immune to the effects of the drug, and the body does not absorb less of the drug because of the cancer.

An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the patient is exaggerating and does not need pain medication. What is the nurse's best response? A)"Pain often comes and goes with postsurgical patients. Please ask her about pain again in about 30 minutes." B)"We need to provide pain medications because it is the law, and we must always follow the law." C)"Unless there is strong evidence to the contrary, we should take the patient's report at face value.'" D)"It's not unusual for patients to misreport pain to get our attention when we are busy."

Ans: "Unless there is strong evidence to the contrary, we should take the patient's report at face value.'" Feedback:A broad definition of pain is "whatever the person says it is, existing whenever the experiencing person says it does." Action should be taken unless there are demonstrable extenuating circumstances. The other answers are incorrect.

You are the emergency department (ED) nurse caring for an adult patient who was in a motor vehicle accident. Radiography reveals an ulnar fracture. What type of pain are you addressing when you provide care for this patient?A)Chronic B)Acute C)Intermittent D)Osteopenic

Ans: Acute Feedback:Acute pain is usually of recent onset and commonly associated with a specific injury. Acute pain indicates that damage or injury has occurred. Chronic pain is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributed to a specific cause or injury. Phantom pain occurs when the body experiences a loss, such as an amputation, and still feels pain in the missing part. "Osteopenic" pain is not a recognized category of pain.

You are assessing an 86-year-old postoperative patient who has an unexpressive, stoic demeanor. When you enter the room, the patient is curled into the fetal position and your assessment reveals that his vital signs are elevated and he is diaphoretic. You ask the patient what his pain level is on a 0-to-10 scale that you explained to the patient prior to surgery. The patient indicates a pain level of "three or so." You review your pain-management orders and find that all medications are ordered PRN. How would you treat this patient's pain? A)Treat the patient on the basis of objective signs of pain and reassess him frequently. B)Call the physician for new orders because it is apparent that the pain medicine is not working. C)Believe what the patient says, reinforce education, and reassess often. D)Ask the family what they think and treat the patient accordingly.

Ans: Believe what the patient says, reinforce education, and reassess often. Feedback:As always, the best guide to pain management and administration of analgesic agents in all patients, regardless of age, is what the individual patient says. However, further education and assessment are appropriate. You cannot usually treat pain the patient denies having if the orders are PRN only. The scenario does not indicate the present pain-management orders are not working for this patient. The family's insights do not override the patient's self-report.

A 52-year-old female patient is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the patient's pain in her plan of nursing care, the nurse should consider what characteristic of cancer pain? A)Cancer pain is often related to the stress of the patient knowing she has cancer and requires relatively low doses of pain medications along with a high dose of anti-anxiety medications. B)Cancer pain is always chronic and challenging to treat, so distraction is often the best intervention. C)Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications. D)Cancer pain is often misreported by patients because of confusion related to their disease process.

Ans: Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications. Feedback:Pain associated with cancer may be acute or chronic. Pain resulting from cancer is so ubiquitous that when cancer patients are asked about possible outcomes, pain is reported to be the most feared outcome. Higher doses of pain medication are usually needed with cancer patients, especially with metastasis. Cancer pain is not treated with anti-anxiety medications. Cancer pain can be chronic and difficult to treat so distraction may help, but higher doses of pain medications are usually the best intervention. No research indicates cancer patients misreport pain because of confusion related to their disease process.

You have just received report on a 27-year-old woman who is coming to your unit from the emergency department with a torn meniscus. You review her PRN medications and see that she has an NSAID (ibuprofen) ordered every 6 hours. If you wanted to implement preventive pain measures when the patient arrives to your unit, what would you do? A)Use a pain scale to assess the patient's pain, and let the patient know ibuprofen is available every 6 hours if she needs it. B)Do a complete assessment, and give pain medication based on the patient's report of pain. C)Check for allergies, use a pain scale to assess the patient's pain, and offer the ibuprofen every 6 hours until the patient is discharged. D)Provide medication as per patient request and offer relaxation techniques to promote comfort.

Ans: Check for allergies, use a pain scale to assess the patient's pain, and offer the ibuprofen every 6 hours until the patient is discharged. Feedback:One way preventive pain measures can be implemented is by using PRN medications on a more regular or scheduled basis to allow for more uniform pain control. Smaller drug doses of medication are needed with the preventive pain method when PRN medications are given around the clock. Offering the medication is more beneficial than letting the patient know ibuprofen is available.

You are the nurse coming on shift in a rehabilitation unit. You receive information in report about a new patient who has fibromyalgia and has difficulty with her ADLs. The off-going nurse also reports that the patient is withdrawn, refusing visitors, and has been vacillating between tears and anger all afternoon. What do you know about chronic pain syndromes that could account for your new patient's behavior? A)Fibromyalgia is not a chronic pain syndrome, so further assessment is necessary. B)The patient is likely frustrated because she has to be in the hospital. C)The patient likely has an underlying psychiatric disorder. D)Chronic pain can cause intense emotional responses.

Ans: Chronic pain can cause intense emotional responses. Feedback:Regardless of how patients cope with chronic pain, pain that lasts for an extended period can result in depression, anger, or emotional withdrawal. Nowhere in the scenario does it indicate the patient is upset about the hospitalization or that she has a psychiatric disorder. Fibromyalgia is closely associated with chronic pain.

You are the case manager for a 35-year-old man being seen at a primary care clinic for chronic low back pain. When you meet with the patient, he says that he is having problems at work; in the past year he has been absent from work about once every 2 weeks, is short-tempered with other workers, feels tired all the time, and is worried about losing his job. You are developing this patient's plan of care. On what should the goals for the plan of care focus? A)Increase the patient's pain tolerance in order to achieve psychosocial benefits. B)Decrease the patient's need to work and increase his sleep to 8 hours per night. C)Evaluate other work options to decrease the risk of depression and ineffective coping. D)Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety.

Ans: Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety. Feedback:Chronic pain may affect the patient's quality of life by interfering with work, interpersonal relationships, or sleep. Thus, the best set of goals would be to "decrease time lost from work to increase the quality of interpersonal relationships, and decrease anxiety." Increasing pain tolerance is an unrealistic and inappropriate goal; exercise could help, but would not be the focus of the plan of care. Decreasing the need to work does not address his pain. Evaluating other work options to decrease the risk of depression is a misdirected diagnosis.

Two patients on your unit have recently returned to the postsurgical unit after knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most plausible rationale for understanding the patients' different perceptions of pain?A)Endorphin levels may vary between patients, affecting the perception of pain. B)One of the patients is exaggerating his or her sense of pain. C)The patients are likely experiencing a variance in vasoconstriction. D)One of the patients may be experiencing opioid tolerance.

Ans: Endorphin levels may vary between patients, affecting the perception of pain. Feedback:Different people feel different degrees of pain from similar stimuli. Opioid tolerance is associated with chronic pain treatment and would not likely apply to these patients. The nurse should not assume the patient is exaggerating the pain because the patient is the best authority of his or her existence of pain, and definitions for pain state that pain is "whatever the person says it is, existing whenever the experiencing person says it does."

You are caring for a patient admitted to the medical-surgical unit after falling from a horse. The patient states "I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse." When planning the patient's care, what variables should you consider? Select all that apply. A)How the presence of pain affects patients and families B)Resources that can assist the patient with pain management C)The influence of the patient's cognition on her pain D)The advantages and disadvantages of available pain-relief strategies E)The difference between acute and intermittent pain

Ans: How the presence of pain affects patients and families, Resources that can assist the patient with pain management, The advantages and disadvantages of available pain-relief strategies Feedback:Nurses should understand the effects of chronic pain on patients and families and should be knowledgeable about pain-relief strategies and appropriate resources to assist effectively with pain management. There is no evidence of cognitive deficits in this patient and the difference between acute and intermittent pain has no immediate bearing on this patient's care.

A 74-year-old woman was diagnosed with rheumatoid arthritis 1 year ago, but has achieved adequate symptom control through the regular use of celecoxib (Celebrex), a COX-2 selective NSAID. The nurse should recognize that this drug, like other NSAIDs, influences what aspect of the pathophysiology of nociceptive pain? A)Distorting the action potential that is transmitted along the A-delta (δ) and C fibers B)Diverting noxious information from passing through the dorsal root ganglia and synapses in the dorsal horn of the spinal cord C)Blocking modulation by limiting the reuptake of serotonin and norepinephrine D)Inhibiting transduction by blocking the formation of prostaglandins in the periphery

Ans: Inhibiting transduction by blocking the formation of prostaglandins in the periphery Feedback:NSAIDs produce pain relief primarily by blocking the formation of prostaglandins in the periphery; this is a central component of the pathophysiology of transduction. NSAIDs do not act directly on the aspects of transmission, perception, or modulation of pain that are listed.

You are part of the health care team caring for an 87-year-old woman who has been admitted to your rehabilitation facility after falling and fracturing her left hip. The patient appears to be failing to regain functional ability and may have to be readmitted to an acute-care facility. When planning this patient's care, what do you know about the negative effects of the stress associated with pain? A)Stress is less pronounced in older adults because they generally have more sophisticated coping skills than younger adults B)It is particularly harmful in the elderly who have been injured or who are ill. C)It affects only those patients who are already debilitated prior to experiencing pain. D)It has no inherent negative effects; it just alerts the person/health care team of an underlying disease process.

Ans: It is particularly harmful in the elderly who have been injured or who are ill. Feedback:The widespread endocrine, immunologic, and inflammatory changes that occur with the stress of pain can have significant negative effects. This is particularly harmful in patients whose health is already compromised by age, illness, or injury. Older adults are not immune to the negative effects of stress. Prior debilitation does not have to be present in order for stress to cause potential harm.

You are admitting a patient to your rehabilitation unit who has a diagnosis of persistent, severe pain. According to the patient's history, the patient's pain has not responded to conventional approaches to pain management. What treatment would you expect might be tried with this patient? A)Intravenous analgesia B)Long-term intrathecal or epidural catheter C)Oral analgesia D)Intramuscular analgesia

Ans: Long-term intrathecal or epidural catheter Feedback:For patients who have persistent, severe pain that fails to respond to other treatments or who obtain pain relief only with the risk of serious side effects, medication administered by a long-term intrathecal or epidural catheter may be effective. The other listed means of pain control would already have been tried in a patient with persistent severe pain that has not responded to previous treatment.

The nurse who is a member of the palliative care team is assessing a patient. The patient indicates that he has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate. What teaching should the nurse do with this patient? A)Medication should be taken when pain levels are low so the pain is easier to reduce. B)Pain medication can be increased when the pain becomes intense. C)It is difficult to control chronic pain, so this is an inevitable part of the disease process. D)The patient will likely benefit more from distraction than pharmacologic interventions.

Ans: Medication should be taken when pain levels are low so the pain is easier to reduce. Feedback:Better pain control can be achieved with a preventive approach, reducing the amount of time patients are in pain. Low levels of pain are easier to reduce or control than intense levels of pain. Pain medication is used to prevent pain so pain medication is not increased when pain becomes intense. Chronic pain is treatable. Giving the patient alternative methods to control pain is good, but it will not work if the patient is in so much pain that he cannot institute reliable alternative methods.

You are frequently assessing an 84-year-old woman's pain after she suffered a humeral fracture in a fall. When applying the nursing process in pain management for a patient of this age, what principle should you best apply? A)Monitor for signs of drug toxicity due to a decrease in metabolism. B)Monitor for an increase in absorption of the drug due to age-related changes. C)Monitor for a paradoxical increase in pain with opioid administration. D)Administer analgesics every 4 to 6 hours as ordered to control pain.

Ans: Monitor for signs of drug toxicity due to a decrease in metabolism. Feedback:Older people may respond differently to pain than younger people. Because elderly people have a slower metabolism and a greater ratio of body fat to muscle mass compared with younger people, small doses of analgesic agents may be sufficient to relieve pain, and these doses may be effective longer. This fact also corresponds to an increased risk of adverse effects. Paradoxical effects are not a common phenomenon. Frequency of administration will vary widely according to numerous variables.

The nurse is accepting care of an adult patient who has been experiencing severe and intractable pain. When reviewing the patient's medication administration record, the nurse notes the presence of gabapentin (Neurontin). The nurse is justified in suspecting what phenomenon in the etiology of the patient's pain? A)Neuroplasticity B)Misperception C)Psychosomatic processes D)Neuropathy

Ans: Neuropathy Feedback:The anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) are first-line analgesic agents for neuropathic pain. Neuroplasticity is the ability of the peripheral and central nervous systems to change both structure and function as a result of noxious stimuli; this does not likely contribute to the patient's pain. Similarly, psychosomatic factors and misperception of pain are highly unlikely.

You are caring for a 20-year-old patient with a diagnosis of cerebral palsy who has been admitted for the relief of painful contractures in his lower extremities. When creating a nursing care plan for this patient, what variables should the nurse consider? Select all that apply. A)Patient's gender B)Patient's comorbid conditions C)Type of procedure be performed D)Changes in neurologic function due to the procedure E)Prior effectiveness in relieving the pain

Ans: Patient's comorbid conditions, Type of procedure be performed, Changes in neurologic function due to the procedure, Prior effectiveness in relieving the pain Feedback:The nursing care of patients who undergo procedures for the relief of chronic pain depends on the type of procedure performed, its effectiveness in relieving the pain, and the changes in neurologic function that accompany the procedure. The patient's comorbid conditions will also affect care, but his gender is not a key consideration.

A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical patients' pain. What principle should guide the nurse's use of placebos in pain management? A)Placebos require a higher level of informed consent than conventional care. B)Placebos are an acceptable, but unconventional, form of nonpharmacological pain management. C)Placebos are never recommended in the treatment of pain. D)Placebos require the active participation of the patient's family.

Ans: Placebos are never recommended in the treatment of pain. Feedback:Broad agreement is that there are no individuals for whom and no condition for which placebos are the recommended treatment. This principle supersedes the other listed statements.

You are the home health nurse caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will be taking care of the patient. What would your priority nursing interventions be for this visit? A)Teach the family the theory of pain management and the use of alternative therapies. B)Provide psychosocial family support during this emotional experience. C)Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication. D)Provide family teaching regarding use of morphine, recognizing morphine overdose, and offering spiritual guidance.

Ans: Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication. Feedback:If PCA is to be used in the patient's home, the patient and family are taught about the operation of the pump as well as the side effects of the medication and strategies to manage them. The family would also need to monitor the IV site and notify the nurse of any changes, such as infiltration, that could endanger the patient. Teaching the family the theory of pain management or the use of alternative therapies and the nurse providing emotional support are important, but the family must be able to operate the pump as well as know the side effects of the medication and strategies to manage them. Offering spiritual guidance would not be a priority at this point and morphine is not the only medication administered by PCA.

The nurse is caring for a male patient whose diagnosis of bone cancer is causing severe and increasing pain. Before introducing nonpharmacological pain control interventions into the patient's plan of care, the nurse should teach the patient which of the following?A)Nonpharmacological interventions must be provided by individuals other than members of the healthcare team. B)These interventions will not directly reduce pain, but will refocus him on positive stimuli. C)These interventions carry similar risks of adverse effects as analgesics. D)Reducing his use of analgesics is not the purpose of these interventions.

Ans: Reducing his use of analgesics is not the purpose of these interventions. Feedback:Patients who have been taking analgesic agents may mistakenly assume that clinicians suggest a nonpharmacolgical method to reduce the use or dose of analgesic agents. Nonpharmacological interventions indeed reduce pain and their use is not limited to practitioners outside the healthcare team. In general, adverse effects are minimal.

The nurse is assessing a patient's pain while the patient awaits a cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at this time using a 0-to-10 pain scale. How should the nurse best respond to this assessment finding? A)Remind the patient that he is indeed experiencing pain. B)Reinforce teaching about the pain scale number system. C)Reassess the patient's pain in 30 minutes. D)Administer an analgesic and then reassess.

Ans: Reinforce teaching about the pain scale number system Feedback:The patient is physically exhibiting signs and symptoms of pain. Further teaching may need to be done so the patient can correctly rate the pain. The nurse may also verify that the same scale is being used by the patient and caregiver to promote continuity. Although all answers are correct, the most accurate conclusion would be to reinforce teaching about the pain scale.

The home health nurse is developing a plan of care for a patient who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the patient teaching? A)Self-care and safety B)Autonomy and need C)Health promotion and exercise D)Dependence and health

Ans: Self-care and safety Feedback:The patient will be at home monitoring his own pain management, administering his own medication, and monitoring and reporting side effects. This requires the ability to perform self-care activities in a safe manner. Creating autonomy is important, but need is a poorly defined concept. Health promotion is an important global concept for maintaining health, and exercise is an appropriate activity; however, self-care and safety are the priorities. Dependence is not a concept used to develop a nursing plan of care, and health is too broad a concept to use as a basis for a nursing plan of care.

A 60-year-old patient who has diabetes had a below-knee amputation 1 week ago. The patient asks "why does it still feel like my leg is attached, and why does it still hurt?" The nurse explains neuropathic pain in terms that are accessible to the patient. The nurse should describe what pathophysiologic process? A)The proliferation of nociceptors during times of stress B)Age-related deterioration of the central nervous system C)Psychosocial dependence on pain medications D)The abnormal reorganization of the nervous system

Ans: The abnormal reorganization of the nervous system Feedback:At any point from the periphery to the CNS, the potential exists for the development of neuropathic pain. Hyperexcitable nerve endings in the periphery can become damaged, leading to abnormal reorganization of the nervous system called neuroplasticity, an underlying mechanism of some neuropathic pain states. Neuropathic pain is not a result of age-related changes, nociceptor proliferation, or dependence on medications.

The nurse caring for a 79-year-old man who has just returned to the medical-surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurse's management of the patient's pain? A)The elderly may require lower doses of medication and are easily confused with new medications. B)The elderly may have altered absorption and metabolism, which prohibits the use of opioids. C)The elderly may be confused following surgery, which is an age-related phenomenon unrelated to the medication. D)The elderly may require a higher initial dose of pain medication followed by a tapered dose.

Ans: The elderly may require lower doses of medication and are easily confused with new medications. Feedback:The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and, therefore, the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion. Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors like environment. Opioids are not absolutely contraindicated and confusion following surgery is never normal. Medication should begin at a low dose and slowly increase until the pain is managed.

You are the nurse in a pain clinic caring for an 88-year-old man who is suffering from long-term, intractable pain. At this point, the pain team feels that first-line pharmacological and nonpharmacological methods of pain relief have been ineffective. What recommendation should guide this patient's subsequent care? A)The patient may want to investigate new alternative pain management options that are outside the United States. B)The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options. C)The patient may want to increase his exercise and activities significantly to create distractions. D)The patient may want to relocate to long-term care in order to have his ADL needs met.

Ans: The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options. Feedback:In some situations, especially with long-term severe intractable pain, usual pharmacologic and nonpharmacologic methods of pain relief are ineffective. In those situations, neurologic and neurosurgical approaches to pain management may be considered. Investigating new alternative pain-management options that are outside the United States is unrealistic and may even be dangerous advice. Increasing his exercise and activities to create distractions is unrealistic when a patient is in intractable pain and this recommendation conveys the attitude that the pain is not real. Moving into a nursing home so others may care for him is an intervention that does not address the issue of pain.

Your patient has just returned from the postanesthetic care unit (PACU) following left tibia open reduction internal fixation (ORIF). The patient is complaining of pain, and you are preparing to administer the patient's first scheduled dose of hydromorphone (Dilaudid). Prior to administering the drug, you would prioritize which of the following assessments? A)The patient's electrolyte levels B)The patient's blood pressure C)The patient's allergy status D)The patient's hydration status

Ans: The patient's allergy status Feedback:Before administering medications such as narcotics for the first time, the nurse should assess for any previous allergic reactions. Electrolyte values, blood pressure, and hydration status are not what you need to assess prior to giving a first dose of narcotics.

You are the nurse caring for the 25-year-old victim of a motor vehicle accident with a fractured pelvis and a ruptured bladder. The nurse's aide (NA) tells you that she is concerned because the patient's resting heart rate is 110 beats per minute, her respirations are 24 breaths per minute, temperature is 99.1°F axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as you assess this patient's physiologic status? A)The patient's understanding of pain physiology B)The patient's serum glucose level C)The patient's white blood cell count D)The patient's rating of her pain

Ans: The patient's rating of her pain Feedback:The nurse's assessment of the patient's pain is a priority. There is no suggestion of diabetes and leukocytosis would not occur at this early stage of recovery. The patient does not need to fully understand pain physiology in order to communicate the presence, absence, or severity of pain.

The mother of a cancer patient comes to the nurse concerned with her daughter's safety. She states that her daughter's morphine dose that she needs to control her pain is getting "higher and higher." As a result, the mother is afraid that her daughter will overdose. The nurse educates the mother about what aspect of her pain management? A)The dose range is higher with cancer patients, and the medical team will be very careful to prevent addiction. B)Frequently, female patients and younger patients need higher doses of opioids to be comfortable. C)The increased risk of overdose is an inevitable risk of maintaining adequate pain control during cancer treatment. D)There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.

Ans: There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug. Feedback:Patients requiring opioids for chronic pain, especially cancer patients, need increasing doses to relieve pain. The requirement for higher drug doses results in a greater drug tolerance, which is a physical dependency as opposed to addiction, which is a psychological dependency. The dose range is usually higher with cancer patients. Although tolerance to the drug will increase, addiction is not dose related, but is a separate psychological dependency issue. No research indicates that women and/or younger people need higher doses of morphine to be comfortable. Overdose is not an "inevitable" risk.

You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of patients who live with chronic pain should inform your care planning?A)They are typically more comfortable with underlying pain than patients without chronic pain. B)They often have a lower pain threshold than patients without chronic pain. C)They often have an increased tolerance of pain. D)They can experience acute pain in addition to chronic pain.

Ans: They can experience acute pain in addition to chronic pain. Feedback:It is tempting to expect that people who have had multiple or prolonged experiences with pain will be less anxious and more tolerant of pain than those who have had little experience with pain. However, this is not true for many people. The more experience a person has had with pain, the more frightened he or she may be about subsequent painful events. Chronic pain and acute pain are not mutually exclusive.

You are the nurse caring for a postsurgical patient who is Asian-American who speaks very little English. How should you most accurately assess this patient's pain?A)Use a chart with English on one side of the page and the patient's native language on the other so he can rate his pain. B)Ask the patient to write down a number according to the 0-to-10 point pain scale. C)Use the Visual Analog Scale (VAS). D)Use the services of a translator each time you assess the patient so you can document the patient's pain rating.

Ans: Use a chart with English on one side of the page and the patient's native language on the other so he can rate his pain. Feedback:Of the listed options, a language comparison chart is most plausible. The VAS requires English language skills, even though it is visual. Asking the patient to write similarly requires the use of English. It is impractical to obtain translator services for every pain assessment, since this is among the most frequently performed nursing assessments.

You are caring for a patient with sickle cell disease in her home. Over the years, there has been joint damage, and the patient is in chronic pain. The patient has developed a tolerance to her usual pain medication. When does the tolerance to pain medication become the most significant problem? A)When it results in inadequate relief from pain B)When dealing with withdrawal symptoms resulting from the tolerance C)When having to report the patient's addiction to her physician D)When the family becomes concerned about increasing dosage

Ans: When it results in inadequate relief from pain Feedback:Tolerance to opioids is common and becomes a problem primarily in terms of maintaining adequate pain control. Symptoms of physical dependence may occur when opiates are discontinued, but there is no indication that the patient's medication will be discontinued. This patient does not have an addiction and the family's concerns are secondary to those of the patient.

You are caring for a patient, a 42-year-old mother of two children, with a diagnosis of ovarian cancer. She has just been told that her ovarian cancer is terminal. When you admitted this patient, you did a spiritual assessment. What question would it have been most important for you to evaluate during this assessment? A) Is she able to tell her family of negative test results? B) Does she have a sense of peace of mind and a purpose to her life? C) Can she let go of her husband so he can make a new life? D) Does she need time and space to bargain with God for a cure?

B) Does she have a sense of peace of mind and a purpose to her life? In addition to assessment of the role of religious faith and practices, important religious rituals, and connection to a religious community, you should further explore the presence or absence of a sense of peace of mind and purpose in life; other sources of meaning, hope, and comfort; and spiritual or religious beliefs about illness, medical treatment, and care of the sick. Telling her family and letting her husband go are not parts of a spiritual assessment. Bargaining is a stage of death and dying, not part of a spiritual assessment.

A patient's daughter has asked the nurse about "helping him end his terrible suffering." The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. What does the Position Statement further stress? A) Educating families about the moral implications of assisted suicide B) Identifying patient and family concerns and fears C) Identifying resources that meet the patient's desire to die D) Supporting effective means to honor the patient's desire to die

B) Identifying patient and family concerns and fears The ANA Position Statement further stresses the important role of the nurse in supporting effective symptom management, contributing to the creation of environments for care that honor the patient's and family's wishes, as well as identifying their concerns and fears. Discussion of moral implications would normally be beyond the purview of the nurse.

Which of the following would be most appropriate for the nurse to do when assisting parents who have experienced the loss of their preterm newborn? A) Avoid using the terms "death" or "dying." B) Provide opportunities for them to hold the newborn. C) Refrain from initiating conversations with the parents. D) Quickly refocus the parents to a more pleasant topic.

B) Provide opportunities for them to hold the newborn.

A 67-year-old woman experienced the death of her husband from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? Select all that apply. A) Reiterating her anger at her husband's care team B) Reinvesting in new relationships at the appropriate time C) Reminiscing about the relationship she had with her husband D) Relinquishing old attachments to her husband at the appropriate time E) Renewing her lifelong commitment to her husband

B) Reinvesting in new relationships at the appropriate time C) Reminiscing about the relationship she had with her husband D) Relinquishing old attachments to her husband at the appropriate time Six key processes of mourning allow people to accommodate to the loss in a healthy way: 1) Recognition of the loss 2.) Reaction to the separation, and experiencing and expressing the pain of the loss 3.) Recollection and re-experiencing the deceased, the relationship, and the associated feelings 4.) Relinquishing old attachments to the deceased 5.) Readjustment to adapt to the new world without forgetting the old 6.)ReinvestmentReiterating her anger and renewing her lifelong commitment may be counterproductive to the mourning process.

The nurse is part of the health care team at an oncology center. A patient has been diagnosed with leukemia and the prognosis is poor, but the patient is not yet aware of the prognosis. How can the bad news best be conveyed to the patient? A) Family should be given the prognosis first. B) The prognosis should be delivered with the patient at eye level. C) The physician should deliver the news to the patient alone. D) The appointment should be scheduled at the end of the day.

B) The prognosis should be delivered with the patient at eye level. Communicating about a life-threatening diagnosis should be done in a team setting at eye level with the patient. The family cannot be notified first because that would breech patient confidentiality. The family may be present at the patient's request. The appointment should be scheduled when principles can all be in attendance and unrushed.

A patient has just died following urosepsis that progressed to septic shock. The patient's spouse says, "I knew this was coming, but I feel so numb and hollow inside." The nurse should know that these statements are characteristic of what? A) Complicated grief and mourning B) Uncomplicated grief and mourning C) Depression stage of dying D) Acceptance stage of dying

B) Uncomplicated grief and mourning Uncomplicated grief and mourning are characterized by emotional feelings of sadness, anger, guilt, and numbness; physical sensations, such as hollowness in the stomach and tightness in the chest, weakness, and lack of energy; cognitions that include preoccupation with the loss and a sense of the deceased as still present; and behaviors such as crying, visiting places that are reminders of the deceased, social withdrawal, and restless overactivity. Complicated grief and mourning occur at a prolonged time after the death. The spouse's statement does not clearly suggest depression or acceptance.

A nurse is caring for an 87-year-old Mexican-American female patient who is in end-stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far. The physician offers to discharge the patient home to hospice care, but the patient and family refuse. After the physician leaves, the patient's daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as? A) Lack of an American education of the patient and her family B) A language barrier to hospice care for this patient C) A barrier to hospice care for this patient D) Inability to grasp American concepts of health care

C) A barrier to hospice care for this patient Historical mistrust of the health care system and unequal access to even basic medical care may underlie the beliefs and attitudes among ethnically diverse populations. In addition, lack of education or knowledge about end-of-life care treatment options and language barriers influence decisions among many socioeconomically disadvantaged groups. The scenario does not indicate whether the patient's family has an American education, whether they are unable to grasp American concepts of health care, or whether they can speak or understand English.

A hospice nurse is well aware of how difficult it is to deal with others' pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome? A) Inefficiency in the provision of care B) Excessive weight gain C) Emotional exhaustion D) Social withdrawal

C) Emotional exhaustion Well before the nurse exhibits symptoms of stress or burnout, he or she should acknowledge the difficulty of coping with others' pain on a daily basis and put healthy practices in place that guard against emotional exhaustion. Emotional exhaustion is more likely to have deleterious effects than inefficiency, social withdrawal, or weight gain, though these may signal emotional exhaustion.

The parents of a preterm newborn being cared for in the neonatal intensive care unit (NICU. are coming to visit for the first time. The newborn is receiving mechanical ventilation and intravenous fluids and medications and is being monitored electronically by various devices. Which action by the nurse would be most appropriate? A) Suggest that the parents stay for just a few minutes to reduce their anxiety. B) Reassure them that their newborn is progressing well. C) Encourage the parents to touch their preterm newborn. D) Discuss the care they will be giving the newborn upon discharge.

C) Encourage the parents to touch their preterm newborn.

The organization of a patient's care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice? A) It is based on the participation of clinicians without a team leader. B) It is based on clinicians of varied backgrounds integrating their separate plans of care. C) It is based on communication and cooperation between disciplines. D) It is based on medical expertise and patient preference with the support of nursing.

C) It is based on communication and cooperation between disciplines. Interdisciplinary collaboration, which is different from multidisciplinary practice, is based on communication and cooperation among the various disciplines, each member of the team contributing to a single integrated care plan that addresses the needs of the patient and family. Multidisciplinary care refers to participation of clinicians with varied backgrounds and skill sets, but without coordination and integration. Interdisciplinary collaboration is not based on patient preference and should not prioritize medical expertise over other disciplines.

A patient with end-stage heart failure has participated in a family meeting with the interdisciplinary team and opted for hospice care. On what belief should the patient's care in this setting be based? A) Meaningful living during terminal illness requires technologic interventions. B) Meaningful living during terminal illness is best supported in designated facilities. C) Meaningful living during terminal illness is best supported in the home. D) Meaningful living during terminal illness is best achieved by prolonging physiologic dying.

C) Meaningful living during terminal illness is best supported in the home. The hospice movement in the United States is based on the belief that meaningful living is achievable during terminal illness and that it is best supported in the home, free from technologic interventions to prolong physiologic dying.

One of the functions of nursing care of the terminally ill is to support the patient and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support patients and their families during this process? Select all that apply. A) Describe their personal experiences in dealing with end-of-life issues. B) Encourage the patient and family to "keep fighting" as a cure may come. C) Try to appreciate and understand the illness from the patient's perspective. D) Assist patients with performing a life review. E) Provide interventions that facilitate end-of-life closure.

C) Try to appreciate and understand the illness from the patient's perspective. D) Assist patients with performing a life review. E) Provide interventions that facilitate end-of-life closure. Nurses are responsible for educating patients about their illness and for supporting them as they adapt to life with the illness. Nurses can assist patients and families with life review, values clarification, treatment decision making, and end-of-life closure. The only way to do this effectively is to try to appreciate and understand the illness from the patient's perspective. The nurse's personal experiences should not normally be included and a cure is often not a realistic hope.

The nurse has observed that an older adult patient with a diagnosis of end-stage renal failure seems to prefer to have his eldest son make all of his health care decisions. While the family is visiting, the patient explains to you that this is a cultural practice and very important to him. How should you respond? A) Privately ask the son to allow the patient to make his own health care decisions. B) Explain to the patient that he is responsible for his own decisions. C) Work with the team to negotiate informed consent. D) Avoid divulging information to the eldest son.

C) Work with the team to negotiate informed consent. In this case of a patient who wishes to defer decisions to his son, the nurse can work with the team to negotiate informed consent, respecting the patient's right not to participate in decision making and honoring his family's cultural practices.

A home health nurse is caring for a patient with multiple myeloma. Which of the following interventions should the nurse prioritize when addressing the patient's severe bone pain? A) Implementing distraction techniques B) Educating the patient about the effective use of hot and cold packs C) Teaching the patient to use NSAIDs effectively D) Helping the patient manage the opioid analgesic regimen

D) Helping the patient manage the opioid analgesic regimen For severe pain resulting from multiple myeloma, opioids are likely necessary. NSAIDs would likely be ineffective and are associated with significant adverse effects. Hot and cold packs as well as distraction would be insufficient for severe pain.

A patient has completed the full course of treatment for acute lymphocytic leukemia and has failed to respond appreciably. When preparing for the patient's subsequent care, the nurse should perform what action? A) Arrange a meeting between the patient's family and the hospital chaplain. B) Assess the factors underlying the patient's failure to adhere to the treatment regimen. C) Encourage the patient to vigorously pursue complementary and alternative medicine (CAM). D) Identify the patient's specific wishes around end-of-life care.

D) Identify the patient's specific wishes around end-of-life care. Should the patient not respond to therapy, it is important to identify and respect the patient's choices about treatment, including measures to prolong life and other end-of-life measures. The patient may or may not be open to pursuing CAM. Unsuccessful treatment is not necessarily the result of failure to adhere to the treatment plan. Assessment should precede meetings with a chaplain, which may or may not be beneficial to the patient and congruent with the family's belief system.

A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important accomplishment available by attending a grief support group? A) Providing a framework for incorporating the old life into the new life B) Normalizing adaptation to a continuation of the old life C) Aiding in adjusting to using old, familiar social skills D) Normalization of feelings and experiences

D) Normalization of feelings and experiences Although many people complete the work of mourning with the informal support of families and friends, many find that talking with others who have had a similar experience, such as in formal support groups, normalizes the feelings and experiences and provides a framework for learning new skills to cope with the loss and create a new life. The other listed options are incorrect because they indicate the need to hold onto the old life and not move on.

The nurse is admitting a 52-year-old father of four into hospice care. The patient has a diagnosis of Parkinson's disease, which is progressing rapidly. The patient has made clear his preference to receive care at home. What interventions should the nurse prioritize in the plan of care? A) Aggressively continuing to fight the disease process B) Moving the patient to a long-term care facility when it becomes necessary C) Including the children in planning their father's care D) Supporting the patient's and family's values and choices

D) Supporting the patient's and family's values and choices Nurses need to develop skill and comfort in assessing patients' and families' responses to serious illness and planning interventions that support their values and choices throughout the continuum of care. To be admitted to hospice care, the patient must have come to terms with the fact that he is dying. The scenario states that the patient wants to be cared for at home, not in a long-term setting. The children may be able to participate in their father's care, but they should not be assigned responsibility for planning it.

The hospice nurse is caring for a 45-year-old mother of three young children in the patient's home. During the most recent visit, the nurse has observed that the patient has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. What goal of nursing interventions should the nurse identify? A) Helping the family to understand why the patient needs to be sedated B) Making arrangements to promptly move the patient to an acute-care facility C) Explaining to the family that death is near and the patient needs around-the-clock nursing care D) Teaching family members how to interact with, and ensure safety for, the patient with impaired cognition

D) Teaching family members how to interact with, and ensure safety for, the patient with impaired cognition Nursing interventions should be aimed at accommodating the change in the patient's status and maintaining her safety. The scenario does not indicate the need either to sedate the patient or to move her to an acute-care facility. If the family has the resources, there is no need to bring in nurses to be with the patient around-the-clock, and the scenario does not indicate that death is imminent.

A clinic nurse is providing patient education prior to a patient's scheduled palliative radiotherapy to her spine. At the completion of the patient teaching, the patient continues to ask the same questions that the nurse has already addressed. What is the plausible conclusion that the nurse should draw from this? A) The patient is not listening effectively. B) The patient is noncompliant with the plan of care. C) The patient may have a low intelligence quotient or a cognitive deficit. D) The patient has not achieved the desired learning outcomes.

D) The patient has not achieved the desired learning outcomes. The nurse should be sensitive to patients' ongoing needs and may need to repeat previously provided information or simply be present while the patient and family react emotionally. Telling a patient something is not teaching. If a patient continues to ask the same questions, teaching needs to be reinforced. The patient's response is not necessarily suggestive of "noncompliance," cognitive deficits, or not listening.

A nurse working in a sleep lab observes the developmental factors that may affect sleep. Which statements accurately describe these variations? Select all that apply. A. REM sleep constitutes much of the sleep cycle of a preschool child. B. By the age of 8 years, most children no longer take naps. C. Sleep needs usually decrease when physical growth peaks. D. Many adolescents do not get enough sleep. E. Total sleep decreases in adults with a decrease in stage IV sleep. F. Sleep is less sound in older adults and stage IV sleep may be absent.

D. Many adolescents do not get enough sleep. E. Total sleep decreases in adults with a decrease in stage IV sleep. F. Sleep is less sound in older adults and stage IV sleep may be absent. Many adolescents do not get enough sleep due to the stresses of school, activities, and part-time employment causing restless sleep. Total sleep time decreases during adult years, with a decrease in stage IV sleep. Sleep is less sound in older adults, and stage IV sleep is absent or considerably decreased. REM sleep constitutes much of the sleep cycle of a young infant, and by the age of 5 years, most children no longer nap. Sleep needs usually increase when physical growth peaks.

The three types of responses to pain are physiologic, behavioral, and affective. Which are examples of behavioral responses to pain? Select all that apply. a. A patient cradles a wrist that was injured in a car accident. b. A child is moaning and crying due to a stomachache. c. A patient's pulse is increased following a myocardial infarction. d. A patient in pain strikes out at a nurse who attempts to bathe him. e. A patient who has chronic cancer pain is depressed and withdrawn. f. A child pulls away from a nurse trying to give him an injection.

a, b, f. Protecting or guarding a painful area, moaning and crying, and moving away from painful stimuli are behavioral responses. Examples of a physiologic or involuntary response would be increased blood pressure or dilation of the pupils. Affective responses, such as anger, withdrawal, and depression, are psychological in nature.

One of the most common distinctions of pain is whether it is acute or chronic. Which examples describe chronic pain? Select all that apply. a. A patient is receiving chemotherapy for bladder cancer. b. An adolescent is admitted to the hospital for an appendectomy. c. A patient is experiencing a ruptured aneurysm. d. A patient who has fibromyalgia requests pain medication. e. A patient has back pain related to an accident that occurred last year. f. A patient is experiencing pain from second-degree burns.

a, d, e. Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Examples are cancer pain, fibromyalgia pain, and back pain. Acute pain is generally rapid in onset and varies in intensity from mild to severe, as occurs with an emergency appendectomy, a ruptured aneurysm, and pain from burns.

Mr. Wright is recovering from abdominal surgery. When the nurse assists him to walk, she observes that he grimaces, moves stiffly, and becomes pale. She is aware that he has consistently refused his pain medication. What would be a priority nursing diagnosis for this patient? a. Acute Pain related to fear of taking prescribed postoperative medications b. Impaired Physical Mobility related to surgical procedure c. Anxiety related to outcome of surgery d. Risk for Infection related to surgical incision

a. Mr. Wright's immediate problem is his pain that is unrelieved because he refuses to take his pain medication for an unknown reason. The other nursing diagnoses are plausible, but not a priority in this situation.