Medical Surgery I Quiz 2

In the role of patient advocate, what does the nurse do first for a patient who reports pain? · Assesses the level of pain · Administers pain medication · Believes the patient's report of pain · Calls the provider for a medication order

· Believes the patient's report of pain Rationale The nurse's primary role in pain management is to advocate for the patient by believing reports of pain. Administering pain medication, assessing the pain level, and calling the provider are not the first step to take. p. 48

Which is a nonpharmacological cognitive-behavioral technique that may relieve anxiety in a patient experiencing chronic pain? · Distraction · Acupuncture · Therapeutic touch · Diaphragm breathing

Distraction Rationale Distraction is an example of a nonpharmacological cognitive-behavioral technique that can relieve anxiety in a patient experiencing chronic pain. Acupuncture, diaphragmatic breathing, and therapeutic touch are nonpharmacological techniques that may help relieve anxiety, but they are physical, not cognitive-behavioral. p. 66

When does the nurse recognize that death has occurred in a patient? · Eyes close · Breathing stops · Jaw closes tightly · Pupils become constricted

· Breathing stops Rationale When breathing stops, the heart stops beating and it is evident that death has occurred in the patient. Other physical manifestations of death include fixed and dilated pupils. The eye may close or remain open without blinking. The jaw may fall open.

Which term also refers to endogenous opioids? · Histamine · Endorphins · Bradykinin · Prostaglandins

Endorphins Rationale Endorphins, which are also known as endogenous opioids, modulate pain and inhibit neuronal activity by binding to opioid receptors. Bradykinin, prostaglandins, and histamine are excitatory compounds, not endogenous opioids. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. IN you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 48

Pain duration may be described using which term? · Hot · Brief · Beating · Penetrating

· Brief Rationale 'Brief' is a descriptor that is used to describe pain duration. Descriptors such as 'beating,' 'penetrating,' and 'hot' are used to describe pain quality. p. 52

Which component of a comprehensive pain assessment is most helpful for differentiating between nociceptive and neuropathic pain? · Intensity · Quality · Onset · Duration

· Quality Rationale Quality refers to the patient's sensory perception of the pain. Descriptions of the quality of pain (such as 'sharp,' 'shooting,' or 'burning') may help identify the presence of neuropathic pain. Intensity (severity of pain), onset (when the pain started) and duration (whether the pain is constant or intermittent) may be similar for nociceptive and neuropathic pain. p. 52

Which term describes pain that occurs along a specific nerve or nerves? · Localized · Projected · Radiating · Referred

· Radiating Rationale Pain along a specific nerve or nerves is known as radiating pain. For example, pain arising in the throat may be felt as pain in the ear as they are supplied by the same nerve. Localized pain refers to pain that is confined to the site of its origin. Projected pain is a diffuse pain around the site of origin; it is not a well-localized pain. Referred pain is known as the pain perceived in an area distant from the site of painful stimuli. p. 50

What is the other term used for subarachnoid analgesia? · Epidural · Extradural · Intrathecal · Extrathecal

Intrathecal Rationale Subarachnoid analgesia is also called intrathecal analgesia because the subarachnoid space is also called the intrathecal space. Epidural analgesia refers to the instillation of a pain-blocking agent into the epidural space. Extradural analgesia and extrathecal analgesia also refer to epidural analgesia. p. 61

Which condition is most commonly associated with acute pain? · Ischemia · Osteoarthritis · Crohn's disease · Interstitial cystitis

Ischemia Rationale The pain associated with ischemia is acute in duration. Crohn's disease, interstitial cystitis, and osteoarthritis produce pain that is chronic in duration. p. 46

The nurse administers acetaminophen to a patient for treatment of a headache. Which process of nociception is affected by the medication's inhibition of peripheral pain mechanisms? · Modulation · Transmission · Perception · Transduction

Modulation Rationale Nociception means 'normal' pain transmission and is generally discussed in terms of four processes: transduction, transmission, perception, and modulation. The inhibition of pain by central and peripheral mechanisms occurs during the modulation process. The initial stimulation of nociceptors occurs during transduction. Perception involves the conscious awareness of pain. During transmission, action potentials are transmitted from the periphery toward the CNS. pp. 47-48

Which component of pain assessment is addressed by the patient describing his pain as 'searing'? · Onset · Quality · Intensity · Duration

Quality Rationale Descriptors such as 'searing' are used to describe pain quality, which refers to the patient's sensory perception of the pain. Intensity refers to severity of pain. Onset refers to when the pain started. Duration addresses whether the pain is constant or intermittent. p. 52

Which pain is felt along a specific nerve or nerves? · Referred pain · Localized pain · Radiating pain · Projected pain

· Radiating pain Rationale Radiating pain is felt along a specific nerve or nerves. Referred pain is usually felt in an area which is away from the site of painful stimuli. Localized pain is limited to the site of origin of pain. Projected pain is not well localized and is diffused around the site of origin. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. IN you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

Which term describes back pain caused by pancreatitis? · Radiating · Localized · Referred · Projected

· Referred Rationale Back pain that is caused by pancreatitis is an example of referred pain, which is felt in an area distant from the site of painful stimuli. Localized pain is confined to the site of origin. Projected pain is diffuse around the site of origin and is not well localized. Radiating pain is felt along a specific nerve or nerves. p. 50

Which term describes right shoulder pain caused by gallstones? · Projected · Referred · Localized · Radiating

· Referred Rationale Right shoulder pain related to gallstones is an example of referred pain, which is felt in an area distant from the site of painful stimuli. Localized pain is confined to the site of origin. Projected pain is diffuse around the site of origin and is not well localized. Radiating pain is felt along a specific nerve or nerves.

What is the process of randomly reflecting on memories of events in one's life? · Religion · Spirituality · Life review · Reminiscence

· Reminiscence Rationale Reminiscence is the process of randomly reflecting on memories of events in one's life. Religions are formal belief systems that provide frameworks for making sense of life, death, and suffering and responding to universal spiritual questions. Spirituality is whatever or whoever gives ultimate meaning and purpose in one's life that invites particular ways of being in the world in relation to others, oneself, and the universe. Life review is a structured process of reflecting on one's life, which is often facilitated by an interviewer. p.112

The nurse is teaching the family members about end-of-life care for a terminally ill patient. Which caregiver statement indicates a need for further teaching? · 'I can sit quietly beside the patient.' · 'I should spend as much time as possible with the patient.' · 'I should wake up the patient if he or she sleeps continuously.' · 'I should talk to the patient normally even if there is no response.'

· 'I should wake up the patient if he or she sleeps continuously.' Rationale A family caring for a terminally ill patient should let him or her sleep without waking him or her up. The other statements indicate understanding. They should spend as much time as possible with the patient by sitting quietly beside them. They should talk to the patient normally even when there is no response. p. 107

The nurse preceptor asks the nursing student to explain principles of postoperative pain management. Which statement by the nursing student is correct? · 'Surgical pain is one of the most common examples of chronic pain.' · 'Failure to report pain is the most common cause of poor pain management.' · 'Postoperative patients experience intense pain that causes an increase in blood pressure.' · 'Poorly managed pain in the postoperative period is a risk factor for long-term postsurgical pain.'

· 'Poorly managed pain in the postoperative period is a risk factor for long-term postsurgical pain.' Rationale Patients who experience unrelieved, severe postoperative pain are at high risk for the development of chronic (long-term) persistent postsurgical pain. Pain that accompanies surgery is one of the most common examples of acute pain, not chronic pain. The response to pain after surgery is highly individual and variable; pain intensity and sympathetic nervous system response (including changes in blood pressure} will vary among patients. Failure to report pain is not a primary cause of inadequate pain management; instead, poorly managed postoperative pain is most often a result of inadequate drug (analgesic) therapy. p. 47

The nurse is teaching the family members about providing care to a patient with a terminal illness whose sleep is increased. Which teaching by the nurse is appropriate? · 'Eliminate having people in the room.' · 'Spend time sitting quietly with the patient.' · 'Play loud music while the patient is sleeping.' · 'Prompt the patient to talk to keep him or her awake.'

· 'Spend time sitting quietly with the patient.' Rationale The older patient who has increased sleep at the end of life should be provided proper care. Family members should spend time with the patient sitting quietly. Family members can talk to the patient in a normal way, even if the patient does not respond. It is not required to reduce the number of people in the room; this would help if the patient was restless. Family members should not play loud music; however, soft music may be soothing to the patient. The patient should not be forced to talk to stay awake. p. 107

A patient being discharged after hip replacement says, 'I am going to use hypnosis instead of medication to manage my pain. I believe in mind over body.' How does the nurse respond? · 'I will cancel your medication order.' · 'That sounds like a great plan; can you tell me more about it?' · 'That sounds like a wonderful idea, and I think it will definitely work!' · 'Your plan will not work; people with your type of pain need narcotics.'

· 'That sounds like a great plan; can you tell me more about it?' Rationale Complementary and alternative therapies should supplement, not replace, medication management. The nurse needs to obtain more data about the patient's plan. Telling the patient that his or her plan will not work is dismissive of the patient. The patient may not need to be prescribed narcotics for the pain. p. 66

Which nursing student statement regarding the Patient Self- Determination Act (PSDA) indicates a need for further teaching? · 'The U.S. Congress passed the PSDA in 1900.' · 'PSDA documentation consists of an advance directive.' · 'The PSDA requires representatives in health care agencies to ask patients whether they have written an advance directive.' · 'The PSDA codifies the right of patients to determine the medical care they want provided, or not provided, when incapacitated.'

· 'The U.S. Congress passed the PSDA in 1900.' Rationale In 1991, the U.S. Congress passed the PSDA. An advance directive (AD) is documentation of a patient's self-determination. The PSDA requires a representative in every health care agency to ask patients whether they have written ADs upon admission. The PSDA guarantees the right of patients to specify the medical care they want provided (or not provided) if they become incapacitated and unable to speak for themselves. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify an incorrect answer.

The nurse is planning a dressing change on a postoperative mastectomy patient. The patient is receiving acetaminophen and oxycodone orally for pain every 4 hours and is due to receive them at 4 PM. When will the nurse change the dressing? · 3:30 PM · 4:00 PM · 4:30 PM · 7:00 PM

· 4:30 PM Rationale About 30 minutes after administration of an analgesic is an optimal time to perform a procedure on a patient. At 4:30 PM, the opioid has had time to take effect and provide relief for the patient. It would be inappropriate to perform a painful procedure, such as a dressing change, just before a scheduled analgesic is received (i.e., 3:30 PM), because the pain medication will be at its lowest concentrations in the patient's system. At 4:00 PM, the analgesic has not had time to enter the patient's system, so it is too soon to perform the dressing change. lithe patient received the analgesic at 4:00 PM, it is not at the highest or best concentration at 7:00 PM to facilitate a dressing change with minimal discomfort. p. 58

The nurse is caring for a patient who has a POLST (physician orders for life-sustaining treatment). What is a POLST? · A special bracelet worn by the patient · A special necklace worn by the patient · A portable 'do-not-resuscitate' (DNR) order · A document where additional treatments in case of cardiac or pulmonary arrest are ordered

· A document where additional treatments in case of cardiac or pulmonary arrest are ordered Rationale A POLST is an advanced directive in which documentation for additional treatments in case of cardiac or pulmonary arrest are ordered by the patient's physician. A POLST follows the patient across all health care settings. A portable DN R order is a state- designated, signed wallet card that is completed before the patient is admitted to the hospital. Like the POLST, a portable DNR follows the patient across health care settings. The patient may also wear a special DNR bracelet or necklace. p. 106

The nurse is caring for a patient who has a history of osteoarthritis and peptic ulcer disease. Which analgesic medication will the nurse anticipate administering to the patient? · Aspirin · Ibuprofen · Naproxen · Acetaminophen

· Acetaminophen Rationale Acetaminophen does not increase bleeding time and has a low incidence of GI adverse effects, making it the analgesic of choice in patients with comorbidities such as peptic ulcer disease. NSAIDs, which include ibuprofen, naproxen, and aspirin, are contraindicated in individuals with peptic ulcer disease. NSAIDs have more adverse effects than acetaminophen, with gastric toxicity and ulceration being the most common of the adverse effects. pp. 55-56

Which is a characteristic of nociceptive deep somatic pain ? · Aching · Shooting · Stabbing · Throbbing

· Aching Rationale A characteristic of nociceptive deep somatic pain is aching. Throbbing occurs in cutaneous, superficial, or subcutaneous tissues. Shooting pain is associated with neuropathic pain. Stabbing pain occurs with nociceptive visceral pain. p. 48

A patient with chronic pain feels no relief with high-dose opioids and says, 'I just can't manage living right now.' What intervention does the nurse anticipate the health care provider will order for this patient? · Adding acetaminophen · Adding duloxetine as adjuvant therapy · Increasing the opioid dose to control the pain · Replacing the opioid with duloxetine for depression

· Adding duloxetine as adjuvant therapy Rationale Both tricyclic and other antidepressants such as duloxetine help treat the depression that can accompany chronic pain. They also stimulate the activity of endogenous opiates (endorphins and enkephalins) by increasing levels of the neurotransmitter serotonin. Adding acetaminophen would not address the patient's depression. Increasing the opioid dose can cause respiratory depression. Discontinuing the opioid can cause relapse pain. pp. 47, 64

The nurse is caring for a patient who is receiving intravenous hydromorphone. Prior to administration of the medication, the patient's respiratory rate was 18 breaths per minute. Ten minutes after receiving a dose of hydromorphone, the patient is unarousable and her respiratory rate is 8 breaths per minute. Which action will the nurse implement immediately? · Administer naloxone · Assess blood pressure · Notify the primary health care provider · Decrease the next medication dose by half

· Administer naloxone Rationale Naloxone, which is an opioid antagonist, is indicated for reversal of opioid-induced respiratory depression and excess sedation. Notification of the primary health care provider may be appropriate, but this is not the priority intervention for treatment of opioid-induced respiratory depression and excess sedation. Blood pressure assessment is not an immediate priority; treatment of respiratory depression is the priority. Administration of any additional opioid medication, including a reduced dose, is contraindicated. p. 57

The patient is receiving opioid analgesic medication via patient controlled analgesia (PCA). On occasion, the patient's spouse activates the PCA button. Which nursing action will the nurse implement immediately? · Discontinue the patient's use of the PCA · Notify the patient's primary health care provider · Ensure that the patient's spouse is familiar with the medication side effects · Advise the patient and his spouse that only the patient may activate the PCA

· Advise the patient and his spouse that only the patient may activate the PCA Rationale Unauthorized activation of the PCA button by anyone other than the patient (called 'PCA by proxy') can be very dangerous. Safety promotion requires the nurse to immediately advise the patient and his spouse that only the patient may activate the PCA. Discontinuation of the PCA is outside the scope of practice of the staff nurse. Notification of the patient's primary health care provider does not allow for an immediate solution to the problem; instead, the nurse should promptly address the issue in a professional manner by advising the patient and his spouse that PCA by proxy is not permitted. Ensuring that the patient's spouse is familiar with the medication side effects does not address the problem of PCA by proxy. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. p. 55

After administering a dose of opioids, the nurse evaluates the patient using the Pasero Opioid Sedation Scale (POSS) and documents a 1. What patient behavior does this indicate? · Somnolence · Slightly drowsy · Awake and alert · Asleep but easy to arouse

· Awake and alert Rationale A Pasero Opioid Sedation Scale (POSS) score of 1 indicates the patient is awake and alert. If the patient is somnolent, the nurse will record a 4. If the patient is asleep but easy to arouse, the nurse will record an S. If the patient is slightly drowsy, the nurse will record a 2. p. 64

Withdrawing or withholding life-sustaining therapy, formerly called passive euthanasia, involves what? · Ending the patient's life without the patient's permission · Administering the causative agent of death by another patient · Obtaining medication from the provider with the intention to commit suicide · Discontinuing therapies that might prolong the life of a person who cannot be cured by the therapy

· Discontinuing therapies that might prolong the life of a person who cannot be cured by the therapy Rationale Withdrawing or withholding life-sustaining therapy involves discontinuing one or more therapies that might prolong the life of a person who cannot be cured by the therapy. Withdrawal of treatment does not directly cause the patient's death. Voluntary active euthanasia is an act by which the causative agent or treatment in the death of a patient is administered directly by another. Ending the patient's life without the patient's consent is involuntary active euthanasia. Physician-assisted suicide is a practice whereby the health care provider provides a medication to the patient knowing that the patient will use it to commit suicide.

Which initiative did the American Chronic Pain Association establish? · The Life Safety Code · Safe Return Program · National Patient Safety Goals (NPSGs) · I0-Step Program from Patient to Person

· I0-Step Program from Patient to Person Rationale The American Chronic Pain Association established the 10-Step Program from Patient to Person. The National Fire Protection Association published The Life Safety Code for building construction, design, maintenance, and evacuation. The Safe Return Program is provided by Alzheimer's Association for the dementia patients and their families. The joint Commission (TSC) published N PSGs to focus on specific priority safety practices. p. 53

Which cognitive behavioral distractions can be useful in reducing a patient's focus on pain? Select all that apply. · Massage · Meditation · Aquatherapy · Biofeedback · Guided imagery

· Meditation · Biofeedback · Guided imagery Rationale Cognitive behavioral distractions that can be useful in reducing the patient's focus on pain include meditation, biofeedback, and guided imagery. Massage and aquatherapy are physical modalities of nonpharmacological management of pain. Test-Taking Tip: Read the question carefully before looking at the answers: (I) determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect. p. 66

Which term is used to describe pain duration? · Splitting · Crushing · Gnawing · Momentary

· Momentary Rationale 'Momentary' is a descriptor that is used to describe pain duration. Descriptors such as 'splitting,' 'crushing,' and 'gnawing' are used to describe pain quality. p. 52

The family of a dying patient is provided with a symptom relief kit for the patient who has chosen a home death. Prochlorperazine 25 mg suppository, which is included in the kit, is used for which sign/symptom? · Unrelieved pain · Unrelieved dyspnea · Loud, wet respirations · Nausea and vomiting

· Nausea and vomiting Rationale Patients who choose home hospice are often provided with a symptom relief kit that provides commonly used drugs to treat symptoms near death. Prochlorperazine is used to help control nausea and vomiting. Unrelieved pain or unrelieved dyspnea is managed with morphine solution. Transdermal scopolamine is used to relieve loud, wet respirations.

Which factor contributes to the development of chronic cancer pain ? · Chemotherapy · Radiation therapy · Nerve compression · Repetitive blood draws

· Nerve compression Rationale Most chronic cancer pain is the result of tumor growth, including nerve compression. Sources of acute pain include cancer treatments, for example, repetitive blood draws, surgery, and toxicities from chemotherapy and radiation therapy. p. 47

Which class of medications includes naloxone? · Opioid antagonists · Opioid analgesics · Adjuvant analgesics · Nonopioid analgesics

· Opioid antagonists Rationale Naloxone, which is an opioid antagonist, is indicated for reversal of opioid-induced respiratory depression and excess sedation. Opioid analgesics include fentanyl and morphine. Nonopioid analgesics include acetaminophen and the NSAIDs. Adjuvant analgesics include a variety of agents with unique and widely differing mechanisms of action, such as local anesthetics and some anticonvulsants and antidepressants. p. 57

Which activity must the nurse attending to a terminally ill patient avoid? · Providing support at end of life · Participating in active euthanasia · Advocating for the patient's wishes · Ensuring quality symptom management

· Participating in active euthanasia Rationale The nurse caring for the terminally ill patient must not participate in active euthanasia or primary health care provider-assisted euthanasia. Active euthanasia is not supported by the American Nurses Association. Nurses, however, play a major role in advocating for the patient's wishes such as advance directives. Nurses are also expected to ensure quality symptom management by administering prescribed medications. Nurses provide moral support to the family and patient at the end of life.

Which process of pain transmission is associated with an emotional response to pain? · Transmission · Modulation · Perception · Transduction

· Perception Rationale Nociception means 'normal' pain transmission and is generally discussed in terms of four processes: transduction, transmission, perception, and modulation. Perception, which may be viewed as the end result of the neural activity associated with transmission of information about noxious events, includes the conscious awareness of pain. It requires the activation of higher brain structures, including the cortex, and involves both awareness and the occurrence of emotions and drives associated with pain. The initial stimulation of nociceptors occurs during transduction. During transmission, action potentials are transmitted from the periphery toward the CNS. The inhibition of pain by central and peripheral mechanisms occurs during the modulation process. p. 48

What psychosocial intervention should the nurse provide while caring for a dying patient? · Promote spirituality · Avoid cultural practices · Discourage reminiscence · Give explanations of the loss

· Promote spirituality Rationale While caring for a dying patient, the nurse should promote spirituality, which can help the patient cope. Also, the nurse should encourage reminiscence and respect cultural practices, not discourage or avoid them. Explanations of loss should be avoided. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

Which should the nurse consider when preparing to meet a patient's spiritual needs during hospitalization? · Spiritual needs cannot be met without religion. · Spiritual needs are whatever gives purpose to a patient's life. · Spiritual needs should focus on the patient's relationship with God. · Spiritual needs should focus only on the patient's designated religion.

· Spiritual needs are whatever gives purpose to a patient's life. Rationale Spirituality comprises whatever or whoever I give meaning and purpose to one's life, including ways of being in the world in relation to others, oneself, and the universe. A patient's spiritual needs may be met with or without religion, depending on preference. A patient might have spiritual needs but no designated religion. A patient might have spiritual needs without belief in God. p. 112

Which pain rating scale requires the patient to select the phrase that best corresponds with the pain intensity? · The Verbal Descriptor Scale (VDS) · The Wong-Baker FACESO Pain Rating Scale · The Numeric Rating Scale (NRS) · The Faces Pain Scale- Revised (FPS-R)

· The Verbal Descriptor Scale (VDS) Rationale The Verbal Descriptor Scale (VDS) uses different words or phrases to describe the intensity of pain, such as 'no pain, mild pain, moderate pain, severe pain very severe pain, and worst possible pain.' The patient is asked to select the phrase that best describes the pain intensity. The Wong- Baker FACESO Pain Rating Scale consists of6 cartoon faces with word descriptors, ranging from a smiling face on the left for 'no pain (or hurt)' to a frowning, tearful face on the right for 'worst pain (or hurt).' The faces are most commonly numbered 0 to 10. Patients are asked to choose the face that best describes their pain. It is important to appreciate that faces scales are self-report tools; clinicians should not attempt to match a face shown on a scale to the patient's facial expression to determine pain intensity. The Faces Pain Scale- Revised (FPS-R) has 7 faces to make it consistent with other scales using the 0 to 10 metric. The faces range from a neutral facial expression to one of intense pain. As with the Wong- Baker FACES O scale, patients are asked to choose the face that best reflects their pain. The Numeric Rating Scale (NRS) is usually presented as a horizontal 0- to 10-point scale, with word anchors of 'no pain' at one end of the scale, 'moderate pain' in the middle of the scale, and 'worst possible pain' at the end of the scale. pp. 51-52

What religious belief of the patient who is Jewish does the nurse consider when providing postmortem care? · The body must not be embalmed. · The body is displayed before cremation. · The family observes a 14-day mourning period. · The soul leaves this world as soon as death occurs.

· The body must not be embalmed. Rationale As per the Jewish religion, the body of a deceased patient is not embalmed. The body is also not displayed or cremated. The Jewish faith believes that the soul does not leave this world until after burial. The body is not left unattended until the funeral, which takes place preferably within 24 hours. The family of the deceased patient observes a 7-day mourning period called Shiva. p. 112

A patient rates their pain at a 2 or 3 on a pain rating scale on a calibrated 0-to-10. How does the nurse interpret this finding? · The patient has no pain. · The patient has mild pain. · The patient has severe pain. · The patient has moderate pain.

· The patient has mild pain. Rationale On a pain rating scale, 2 or 3 would indicate mild pain. A pain rating of 0 means no pain. At 7 or higher, severe pain is implied; and moderate pain is at the middle of the scale, denoted by 5. p. 50

What is the purpose of a durable power of attorney for health care (DPOAHC)? · To appoint a health care proxy · To prevent intubation of the patient · To appoint a primary health care provider · To prevent resuscitation of the patient if the need arises

· To appoint a health care proxy Rationale A DPOAHC is a legal document in which the patient appoints a health care proxy who will make health care decisions for the patient if the patient loses this ability. It does not appoint a primary health care provider. A partial do-not-resuscitate (DNR) order is an order that prohibits intubating a patient, whereas a full DN R order prohibits the resuscitation of the patient if the need arises. p. 104

A dying patient with dyspnea is prescribed atropine ophthalmic solution 1% every 4 hours. What is the purpose of this drug? · To treat bronchospasms · To decrease fluid overload · To treat respiratory infection · To dry up secretions in the respiratory tract

· To dry up secretions in the respiratory tract Rationale Secretions in the respiratory tract and oral cavity may contribute to dyspnea near death. Atropine ophthalmic solution 1% may be administered orally every 4 hours to dry up these secretions. Antibiotics are administered to treat respiratory infections. Diuretics such as furosemide are administered to decrease fluid overload. Bronchodilators such as albuterol are administered for bronchospasms via a metered dose inhaler or nebulizer.

Which term best describes the condition where continuous exposure to a drug leads to a decrease in the drug's effects over time? · Addiction · Tolerance · Pseudoaddiction · Physical dependence

· Tolerance Rationale tolerance is a normal response that occurs with regular administration of an opioid and consists of a decrease in one or more effects of the opioid. Addiction is a primary, chronic neurological disease that is characterized by behaviors that can include impaired control over drug use, compulsive use, continued use despite harm, and craving. Pseudoaddiction is an iatrogenic syndrome created by the undertreatment of pain. It is characterized by patient behaviors such as anger and escalating demands for more or different medications, and results in suspicion and avoidance by staff Physical dependence is an adaptation manifested by a drug-class — it is a specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. p. 58

During which process of pain transmission does the initial stimulation of nociceptors occur? · Modulation · Transmission · Perception · Transduction

· Transduction Rationale Nociception means 'normal' pain transmission and is generally discussed in terms of four processes: transduction, transmission, perception, and modulation. The initial stimulation of nociceptors occurs during transduction. During transmission, action potentials are transmitted from the periphery toward the CNS. Perception involves the conscious awareness of pain. Modulation refers to inhibition of pain by central and peripheral mechanisms. p. 47

Which term is used to describe pain duration? · Pulling · Tugging · Transient · Pressing

· Transient Rationale 'Transient' is a descriptor that is used to describe pain duration. Descriptors such as 'pulling,' 'tugging,' and 'pressing' are used to describe pain quality. p. 52

What activity may the patient's family perform when participating in postmortem care? · Wash the patient. · Clean the patient's room. · Insert the patient's dentures. · Remove or cut all tubes lines.

· Wash the patient. Rationale The nurse may permit the family or significant other of a patient to assist with postmortem care by washing the patient and helping to comb and arrange the hair. This provides the family an opportunity to say their goodbyes. Family members often find it therapeutic, and it assists in coping with the situation. The nurse removes or cuts all the tubes and lines per agency policy and inserts the patient's dentures. Unlicensed assistive personnel (UAP) may help with cleaning the patient's room.

The nurse is attending to an Asian-American patient who cannot communicate in English. What tool does the nurse use when assessing the pain of the patient? · Percent Relief Scale · 0-10 Numeric Pain Distress Scale · Wong-Baker FACES Pain Rating Scale · Simple Descriptive Pain Distress Scale

· Wong-Baker FACES Pain Rating Scale Rationale When assessing the pain of a patient who does not understand English, the nurse should use the Wong- Baker Faces Pain Rating Scale. This scale is also useful for children, older adults, and developmentally disabled patients. The Percent Relief Scale, Simple Descriptive Pain Distress Scale, and 0-10 Numeric Pain Distress Scale are used most commonly in clinical practices for adults who are able to communicate well in English.

Which pain rating scale makes use of six cartoon faces with word descriptors to depict pain levels in a patient? · Verbal descriptor scale · Numeric rating scale (NRS) · Faces pain scale-revised (FPS-R) · Wong-Baker FACES pain rating scale

· Wong-Baker FACES pain rating scale Rationale The Wong- Baker FACES pain scale makes use of six cartoon faces with words describing the intensity of pain. A verbal descriptor scale uses a set of words or phrases to describe the intensity of pain. A numeric rating scale (N RS) is a horizontal 0-to-10 point scale with word anchors such as 'no pain" at one end and 'worst possible pain" at the end of the scale. The faces pain scale-revised (FPS-R) is similar to the Wong- Baker FACES pain rating scale, with seven kinds of facial expressions to adjudge the assessment of pain. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 50