Multiple Patients with Pain
Mr. O is at risk for compartment syndrome because of the cast. Which pain assessment finding would alert you to compartment syndrome? 1. Pain on passive motion 2. Sudden increase in pain 3. Intense discomfort related to an itching sensation 4. Absence of pain despite no recent medication LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Ms. J is receiving opiates to control her pain caused by end-stage multiple myeloma. Which side effect is major concern for this patient? 1. Constipation 2. Respiratory depression 3. Nausea and vomiting 4. Sedation LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Which morning tasks can be delegated to the UAP? (select all that apply) 1. Assisting Mr. R, who has a rheumatoid arthritis, with morning care 2. Reinforcing to Mr. L, who has a kidney stone, the need to save urine for straining 3. Preparing Mr. H's room for his return from the OR for hernia repair 4. Reporting the condition of Mr. O's skin resulting from his motorcycle accident. 5. Getting coffee fro Ms. J's (end-stage multiple myeloma) family 6. Checking on the pulse oximeter reading for Mr. A, who has bacterial pneumonia LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Which of the six patients can be assigned to the new RN? (select all that apply) 1. Ms. R 2. Mr. L 3. Mr. O 4. Mr. H 5. Ms. J 6. Mr. A LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Which end-of-shift tasks can be delegated to the UAP? (select all the apply) 1. Emptying Ms. J's (end-stage multiple myeloma) trash can and placing personal items within reach 2. Checking Mr. A's (bacterial pneumonia) linens for moisture and soiling and changing as needed 3. Asking Mr. L (kidney stone) if he needs a dose of pain medication prior to shift change 4. Assisting Ms. R (rheumatoid arthritis) to change position in bed to relieve pressure on joints 5. Ensuring Mr. O's leg is elevated and evaluating comfort 6. Emptying Mr. A's (bacterial pneumonia) urinal and recording the output LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Which tasks related to pain management can you delegate to the UAP? (select all that apply) 1. Reporting on grimacing seen in unresponsive patients 2. Asking about the location, quality, and radiation of pain 3. Reminding patients to report pain as necessary 4. Observing for relief after medication is given 5. Asking patients directly, "Are you having pain?" 6. Determining if position change relieves pain LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Which team members (RN, UAP, physical therapist) should perform the following tasks related to Mr. A's pain management? 1. Instruct in and supervise use of a transcutaneous electrical nerve stimulation (TENS) unit 2. Administer nonopioid pain medications 3.Answer questions about medication side effects 4.Identify contributing factors such as fatigue or anxiety 5.Suggest that relatives bring personal comfort items 6.Assist the patient to change position every 2 hours 7. Reinforce the use of a pillow to splint when coughing LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
1. Physical therapist 2. RN 3. RN 4. RN 5. RN 6. UAP 7. UAP LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
Mr. A has a single-lumen peripherally inserted central catheter, and he has the following scheduled medications and IV solutions that need to be given now: vancomycin (vancocin) 1.5g in 250 mL of dextrose 5% over 90 minutes; levofloxacin (levaquin) 750 mg in 150 mL of normal saline over 90 minutes; dextrose 5% and 0.45% saline 1000mL with 20 mEq of potassium at 125 mL/hr; and an IV bolus dose of morphine 3 mg. What is your priority action? 1. Call the physician and ask if the medication times can be staggered. 2. Call the pharmacy and enquire about the compatibility of the medications and solutions 3. Give the bolus dose of morphine, because it will take the least amount of time. 4. Establish an additional peripheral IV site. LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Mr. H ia asking for pain medication, and the health care provider has ordered 10 mg of oxycodone controlled-release (OxyContin) as needed. The pharmacy has stocked 5-mg tablets of oxycodone immediate-release in the medication cabinet. What is your first action? 1. Call the health care provider for clarification of the order. 2. Call the pharmacy and obtain the controlled-release form of the drug. 3. Ask the patient if the immediate- or controlled-release action is preferred 4. Give two of the 5-mg tablets to achieve the correct dose LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Mr. H returns from the OR following a hernia repair. He says that he is "afraid to walk because it will make the pain really bad." What will you explain as being the best option? 1. Pain medication every 4 hours before ambulation or dressing changes 2. Medication 45 minutes before ambulation or dressing changes 3. Around-the-clock pain medication even if he as no report of pain 4. Talking to the physician for reassurance about the treatment plan LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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The UAP reports that the new nurse is undermedicating the patients. What is the best way to handle this situation? 1. Ignore her; the UAP is not qualified to judge an RN 2. Ask the UAP to give specific examples 3. Go to the new nurse and question her 4. Do an assessment on all of the nurse's patients LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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The new nurse tells you that she cannot find any documentation that shows the time of Mr. L's (kidney stone) last dose of pain medication. What action should occur first? 1.Help the new nurse look at the chart and medication administration record 2. Tell the new nurse to ask the night nurse before she leaves 3. Speak to the night shift nurse about the documentation 4. Have the new nurse ask Mr. L when he had the last medication. LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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During the shift, the following events occur at the same time. Prioritize the order for addressing these problems. 1. Mr. L is calling out loudly about right-sided flank pain caused by his kidney stone 2. Mr. O, who was in a motorcycle accident, is calling "The pump tipped over and it's broken" 3. Another nurse needs opioids wastage witnessed 4. Mr. A, with bacterial pneumonia, is urinating in the corner of his room. __, __, __, __, LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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At the end of the shift, the opioid count shows that two tablets of oxycodone (OxyContin) are unaccounted for. You have spoken to all of the nurses and pharmacists who had access to the medication cabinet during the shift, but no one will admit to removing those two tables. What should you do? (Select all that apply) 1. Inform the staff that no one cane leave until the matter is resolved 2. FIll out an incident report and include facts about what you found and what you did 3. Interview all of the patients who have orders for oxycodone (oxycontin) 4. Discuss the matter with the unit manager and review potential problems of the current system 5. Review available records of access and medication retrieval for the past 24 hours ASk the staff if they saw any other people (e.g. students, physicians, instructors) who may have accessed the cabinet during the shift LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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For Mr. O, in addition to pain medication, which action will help the most to relieve pain associated with the tibia-fibula fracture caused by his motorcycle accident? 1. Instruct him to periodically move his toes 2. Use diversional therapy 3. Elevate the injured leg above the heart 4. Place the patient in High Fowler position LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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It is the end if the shift, and the new nurse is trying to give pain medication to one patient, provide comfort measures for another patient, and redo pain assessments on all her patients. Her documentation is incomplete. What should you do? 1. Offer to help her by performing the comfort measures 2. Let her struggle through so she can find her own way 3. Help her prioritize and delegate the tasks 4. Ask someone from the oncoming shift to help her LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Mr. H is given a dose of pain medication. One hour later he is anxious and appears uncomfortable and asks, "What's the matter? Is something wrong? I'm still hurting." What action should you take first? 1. Call the physician for a change in medication or dose 2. Initiate "nothing by mouth" status in case surgery is needed 3. Check for bladder distention and voiding 4. Reassure the patient that the hernia is not recurring LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Mr. L calls for pain medication. He described the pain caused by his kidney stone as excruciating. He is crying, diaphoretic, and pacing around the room. What is your priority action? 1. Instruct Mr. L to do deep breathing exercises 2. Remind Mr. L to use the PCA pump 3. Give Mr. L an "as needed" IV bolus as ordered 4. Call the physician immediately LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Mr. L reports that the pain has decreased compared with earlier, but now he is having other symptoms. Which symptom is of greatest concern? 1. Painless hematuria with small clots 2. Dull pain that radiates into the genitalia 3. Absence of pain that radiates into the genitalia 4. Sensation of urinary urgency LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Mr. O reports an increasing pain in the right abdomen. On physical examination, you noted hyperactive bowel sounds, a tense abdomen with guarding, and exquisite tenderness with gentle palpation. What is your priority action? 1. Give a PRN pain medication 2. Notify the physician of you findings 3.Take the complete set of vital signs 4.Assist him to change positions LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Ms. J is having severe pain and admits to it: however, she becomes very anxious when certain family members come and go and refuses to take the pain medication. Which adjunct medication would be most useful to Mr. J to help her manage these episodes? 1. Naproxen (naprosyn) 2. Doxepin (Sinequan) 3. Lorazepam (ativan) 4. Dicyclomine (bentyl) LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Which nonpharmacologic pain measure to help Ms. R relieve her early morning stiffness should be delegated to UAP? 1.Assisting Ma. R to get in a bathtub full of warm water 2.Sharing some relaxation techniques with Ms. R 3. Assisting Ms. R to take a warm shower 4.Evaluating the effectiveness of paraffin therapy LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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You are giving the end-of-shift report about Ms. R (rheumatoid arthritis) to the oncoming nurse. Place the following information in the correct order. 1. "She had shoulder pain (4 of 10) an was reluctant to move around." 2. "Do you have any questions for me?" 3. "Ms. R is a 55 yr old woman" 4. "She had shoulder arthroplasty 3 days ago" 5. "She received a PRN dose of Tylenol with codeine, and is now 1 of 10" 6. "The physical therapist must speak to Ms. R's daughter, so page him when he arrives" LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Mr. A reports left-sided anterior chest pain. What is your priority action? 1. Obtain an order for electrocardiogram and continuous telemetry monitoring. 2. Auscultate the lung fields and compare to baseline assessments. 3. Give a PRN pain medication and reevaluate after 30 minutes 4. Ask him to describe the pain and measure all vital signs LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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Ms. J's son repeatedly insists that Mr. J si not getting enough pain medication. He threatens to sue. you have used therapeutic communication skills with the sone and advocated for the patient with the physician. the physician says to you, "I'll be in tomorrow. Just tell the son to chill out." What is your best action? 1. Call another physician 2. Continue to use the current orders 3. Have the son call the physician 4. Notify the unit manager LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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One of the staff members is talking about Mr. A, who has bacterial pneumonia, in the medication room. "He complains all the time about pain everywhere. Well, he is going to have pain. He's a drug addict, so what does he expect?" What is your best response to this comment? 1. "All patients have a right to care regardless of race, creed, or other traits" 2. "I'll take Mr. A; I don't mind taking care of him'" 3. "You should think about how he really feels" 4. "What can we do to help Mr. A cope with his pain?" LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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You are preparing to give Mr. L pain medication, but you note that the IV site is infiltrated, so you inform him that the IV catheter will have to be reinserted. He yells at you, "What's wrong with you people?! Can't you do anything right?!" What is the best response? 1. "Let me call the physician, and I can get an order for an oral medication" 2. "This is not my fault, but if you will just give me a couple of minutes I can fix it" 3. "Let me call the nursing supervisor and you can talk to her about the situation" 4. "I know you are having pain. Let me restart your IV line right now" LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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You are talking to Ms. R (rheumatoid arthritis ) about discharge plans and follow-up appointments. She begins to cry and says, "I was so active and athletic when I was younger." What is the most therapeutic response? 1. "Your shoulder will progressively better with time and patience. Don't cry." 2."I can see that you are really upset. Is your shoulder hurting a lot right now?" 3."I know what you mean. I used to be able to o a lot more when I was younger too." 4."It is difficulty to deal with changes. What types of activities did you used to do?" LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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You decide to do a brief round of all the patients before shift report, to ensure safety and to help determine acuity and assignments. List the order in which you should briefly check in on these patients. 1. Ms. R 2. Mr. L 3. Mr. O 4. Mr. H 5. Ms. J 6. Mr. A __, __, __, __, __, __, LaCharity, Linda A.; Kumagai, Candice K.; Bartz, Barbara. Prioritization, Delegation, and Assignment - E-Book: Practice Excercises for the NCLEX Exam. Elsevier Health Sciences. Kindle Edition.
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