Delegation and Prioritization ch 1&2
family members are encouraging the client to tough out the pain rather than risk drug addiction to opioids. The nurse recognizes that the sociocultural dimension of pain is the current priority for the client. which question will the nurse ask? A)where is the pain located, and does it radiate to other parts of your body? B)how would you describe the pain and how is it affecting you C) what do you believe about pain medication and drug addiction D)how is pain affecting you activity level and you ability to function
c
which client is most likely to receive opioids for extended periods of time? A)client with fibromyalgia B)client with phantom limb pain in the leg C) client with progressive pancreatic cancer D)Client with trigeminal neuralgia
c
A patient who has cancer will need ongoing treatment for pain. Which brochure is the nurse most likely to prepare that addresses questions related to the first line treatment? A)an illustrated guide to the analgesic ladder B)common questions about radiation therapy C) how to make preparations for you cancer surgery D)how nerve blocks can help to manage cancer pain
A
The nurse is interviewing a patient who has treated several months ago for breast cancer. The patient reports taking NSAIDs for back pain. Which patient comment is cause for greatest concern? A)the NSAIDs are really not relieving the back pain B)the NSAIDs tablets are too large and they are hard to swallow C)I gained weight because I eat a lot before taking NSAIDs D) the NSAIDs are upsetting my stomach in the morning
A
The nurse is monitoring a patient who is at risk for spinal cord compression related to tumor growth. Which patient statement is most likely to suggest an early manifestation? A)last night my back really hurt and i had trouble sleeping B)my leg has been giving out when i try to stand C)my bowels are just not moving like they usually do D)when i try to pass urine i have difficulty starting the stream
A
A patient with lung cancer develops SIADH. After reporting symptoms of weight gain, weakness, and nausea and vomiting to the HCP, the nurse would anticipate with initial treatment for this patient? A)fluid bolus B)fluid restrictions C)urinalysis D)sodium restricted diet
B
A primary nursing responsibility is the prevention of lung cancer by assisting patients in cessation of smoking or other tobacco use. Which task would be appropriate to assign to an LPN? A)develop a quit plan B)explain how to apply a nicotine patch C)discuss strategies to avoid relapse D)suggest ways to deal with urges for tobacco
B
After chemo, a patient is being closely monitored for tumor lysis syndrome. Which lab result requires particular attention? A)platelet counts B)electrolyte levels C)hemoglobin levels D)hematocrit
B
For a patient with osteogenic sarcoma, which laboratory value causes the most concern? A)sodium level of 135 B)calcium level of 13 C)potassium level of 4.9 D)hematocrit of 40%
B
The nurse hears in hand-off reprot that the patinet with cancer received PRN oral dose of lorazepam. Whcih question is the oncoming nurse most likely to ask the off-going nurse? A)what did the patient say about the location and level of pain B)were you able to determine what was making the patient so anxious C)when is the patient allowed to have another does of lorazepam D)did the patient have a normal bowel movement after the med
B
The nurse is caring for a patient with Uterine cancer who is being treated with intracavity radiation therapy. UAP reports that the patient insisted on ambulating to the bathroom and now something feels like it is coming out. what is the priority action A)assess the UAPs knowledge; explain the rational for strict bed rest B)assess for dislodgment; use forceps to retrieve and a lead container to store as needed C)assess the patients knowledge of the treatment plan and her willingness to participate D)notify the HCP about dislodgment of radiation implant.
B
When care assignment are being made for pt w/ alterations related to GI cancer, which pt would be the most appropriate to assign to an LPN under the supervision of a team leader RN? A)a patient with severe anemia secondary to GI bleeding B)patient who needs enemas and antibiotics to control GI bacteria C)a patient who needs preop teaching for bowel resection D)pt who needs central line insertions for Chemo
B
Which assessment finding strongly suggests that the patient with cancer is having incident pain? A)frequently reports pain about 30-35 minutes before next scheduled dose B)demonstrates protectiveness of right arm whenever moving or standing up C)reports a continuous burning and tingling sensation felt in lower leg D)appears quiet, withdrawn and depressed when family leaves after visiting
B
the nurse asses the patient and determines that the pt is having frequent breakthrough cancer pain. Which member of the HC team is the nurse most likely to contact first? A)physical therapy to reevaluate routines B)HCP to review meds, dosage, and frequency C)UAP to provide more assistance with ADLs D)Psych clinical nurse specialist to evaluate psychogenic pain
B
which nurse is demonstrating a step in managing cancer pain by using ABCDE clinical approach to pain management as recommended by the AHRQ? A)asks if the time of the prescribed dose of medication can be changed B)asks the patient to describe the pain and uses a number pain scale C)asks the patient to participate and to contribute in pain management D)asks about pain management options that are appropriate for the patient
B
which cancer patient could be placed together as roommates? A)patient who has a very low neutrophil count B)patient who underwent debulking of a tumor to relieve pressure C)patient who just underwent a bone marrow transplant D)patient who had a laminectomy for spinal cord compression E)patient who is undergoing brachytherapy for prostate cancer F)patient with terminal cancer who is receiving end of life care.
B &D
An athletic young man was recently diagnosed with Ewing sarcoma. He has pain, low grade fever, and anemia. The surgeon recommends amputation of the right lower leg for an operable tumor. The patient tells the nurse that he is leaving the hospital to go on a long hiking trip. What is the priority nursing concept to consider at this time? A)Pain B)cellular regulation C)coping D)Adherence
C
a community health center is preparing a presentation on the prevention and detection of caner. which task would be best to assign to the LPN? A)explain screening exam and diagnostics for common cancer B)discuss how to plan a balanced diet and reduce fats and preservatives C)prepare a poster on the seven warning signs of cancer D)describe strategies for reducing risk factors such as smoking and obesity
C
A client is crying and grimacing but denies pain and refuses pain medication, because "my sibling is a drug addict and has ruined our lives." What is the priority intervention for this client? A)encourage expression of fears and past experiences B)provide accurate info about the use of pain med C)Explain that addiction is unlikely among acute care clients D)seek family assistance in resolving this problem
a
According to recent guidelines from the American Pain society in collaboration with the American Society of Anesthesiologists, what are the priority pain management strategies that the nurse would expect to see in the pain management for post surgical clients? select all A)acetaminophen and/or NSAIDs for management of postop pain in adults and children without contraindications B)surgical sit-specific peripheral regional anesthetic techniques in adults and children for procedures C)epidural analgesia for major thoracic and abdominal procedures if the client has risk for cardiac complications or prolonged ileus D)Multimodal therapy that could include opioids and nonopioid therapies, regional anesthetic techniques and nonpharm therapies E)long acting oral opioids, especially in immediately postop period for continuous around the clock relief F)neuraxial administration of mag, benzo, neostigmine, tramadol, or ketamine is recommended for post op pain
a,b,c,d
which client must be assigned to an experience RN? select all A)client who was in automobile crash and sustained multiple injuries B)client with chronic back pain related to workplace injury C)client who has returned from surgery and has a chest tube in place D)client with abdominal cramps related to food poisoning E) client with a severe headache of unknown origin F)client with chest pain who has a history of arteriosclerosis
a,c,e,f
For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take? A)closely assess for nonverbal signs such as grimacing or rocking B)obtain baseline behavioral indicators from family members C)note the time of and clients response to last dose of analgesic D)give the max PRN dose within the minimum time frame for relief
b
A client's family members comes to the nurse's station and says, he needs more pain medicine. he is still having a-lot of pain what is the nurse's best response. A)the HCP ordered the medicine to be given every 4 hrs. B)if med is given too frequently there are ill effects C)please tell him that i will be right there to check on him D)lets wait about 40 mins. if there he still hurts, ill call the HCP
c
A client's opioid therapy is being tapered off and the nurse is watchful for signs of withdrawal. what is one of the first signs of withdrawal? A)fever B)nausea C)diaphoresis D)abdominal cramping
c
Home health nurse discovers that an older adult client has been sharing his pain med with his daughter. despite the nurse's warnings of the dangers, he states, "my daughter cant afford to see a doctor or to buy medicine, so i must give her a few of my pain pills." which member of the HC team is the nurse most likely to consult first? A)HCP to renew the prescription so that client has enough medication C)pharmacist to monitor the frequency of the prescription refills C)Social worker to help the family locate resources for HC D)home health aid to watch for inappropriate med usage by family
c
In application of the priniciples of pain treatment what is the first consideration? A)treatment is based on client goals B)a multidisciplinary approach is needed C)clients perception of pain must be accepted D)drug side effects must be prevented and managed
c
The nurse is caring for an older woman with hepatic cancer. UAP informs the nurse that the patients LOC is diminished compared with earlier in the shift. Prioritize assessment steps 1 being first. 1)take vital signs, including pulse, respirations, bp and temp 2)check responsiveness and LOC 3)obtain a blood glucose reading; give glucose per protocol 4)check electrolyte values 5)check ammonia level 6)check pulse ox readings and administer oxygen as needed
2,6,1,3,4,5
The oncoming day shift nurse has just received hand over report from the night shift nurse. List the order of priority for assessing and caring for the following patients, 1 being first. 1)a patient who developed tumor lysis syndrome around 5 am 2)a patient who is currently pain free but had breakthrough pain during the night 3)a patient scheduled for exploratory laparotomy this morning 4)a patient with anticipatory nausea and vomiting for the past 24 hrs
1,3,2,4
The nurse is caring for a client who had abd surgery yesterday. the client is restless and anxious and tells the nurse the pain is getting worse despite the pain med. physical assessment finding include the following: 100.3F, 110 bpm, 24 breaths/min, 140/90. Abdomen rigid and tender, nurse decides to notify the clients provider. place the following report info in the correct SBAR order. 1)restless, and anxious, temp, pulse, resp rate, BP. abd rigid and tender to touch with hypoactive bowel sounds 2)abd surgery yesterday. morphine via PCA but says pain is getting worse 3)tried to make him comfy, he is willing to wait until next scheduled dose of pain med but i think his pain warrant evaluation 4)would you to give me an order for any lab tests or additional therapies 5)Nurse J from unit x. calling for MR.d who is reporting sever abd pain
5,2,1,3,4
the oncoming day shift nurse has received the shift report from the night nurse. The day shift nurse has done a quick check on all clients and has determined that all are stable and not in acute distress. Prioritize the order in which the oncoming nurse will care for the following clients. 1)adolescent who is a and o. he was admitted 2 days ago for treatment of meningitis. he reports a continuous headache that is partially relieved by meds 2)older man who underwent total knee surgery 2 days ago. Using a PCA pump frequently with good relief and occasionally asks for bolus doses 3) Middle age woman who is demanding and frequently calls for assistance. admitted for functional abd pain and is scheduled for diagnostic testing this morning 4)older woman with advanced Alzheimer who requires total care. struggles during ant type of nursing care and is difficult to assess her symptoms. waiting transfer to long term care 5)young man who was admitted with chest pain 2ndary to pneumothorax, Chest tube removed today and PCA pump will be dc
5,3,1,2,4
For a patient who is receiving chemotherapy, which laboratory result is or particular importance? A)WBC count B) prothrombin time C)electrolyte levels D)BUN level
A
The nurse is providing EOL care for a patient with terminal liver cancer. The patient is weak and restless. Her skin is cool and mottled. Dyspnea develops and the patient appears anxious and frightened. What should the nurse do first ? A)administered a PRN dose of morphine elixer B)alert the rapid response team and call the health care provider C)deliver breaths at 20 breaths/min with a bag valve mask and prepare for intubation D)Sit quietly with the patient and offer emotional support and comfort
A
The nurse is talking to a group of older women about breast cancer. Based on the most recent guidelines form the American Cancer Society and the American Society of Clinical oOncology, what will the nurse tell the group about the current recommendations for breast cancer screening? A)For older women in good general health and a life expectancy of 10 or more years, biennial or annual mammography screening is recommended B)for women older than the age of 55 years with average risk for breast cancer, mammography screening is recommended every 3-5 years C)for women older than the age of 70 with average risk for breast cancer annual screening mammography is not recommended D) Starting at age 40, all women with average risk for breast cancer should have annual clinical breast exam and mammogram screen
A
the nurse is caring for a pt with esophageal cancer. which task could be delegate to the UAP? A)assisting the patient with oral hygiene B)observing the patients response to feedings C) facilitating expression of grief or anxiety D)initiating daily weights
A
when staff assignment are made for the care of patients who are receiving chemo, what is the major consideration regarding chemo drugs? A)administration of chemotherapy requires precautions to protest self and others B)many chemo drugs are vesicants C)chemo drugs are frequently given through central venous access devices D)oral and venous routes of administration are most common
A
which pt is at greatest risk for pancreatic cancer? A)older African American man who smokes B)young whit obese woman with gallbladder disease C)young African American man with type 1 diabetes D)elderly white woman who has pancreatitis
A
On the first day post op, a client receiving an analgesic via PCA reports that the pain control is inadequate. what is the first action that the nurse should take? A)deliver the bolus dose per standing order B)contact the health care provider to increase the dose C)try nonpharm comfort D) assess the pain for location, quality, and intensity
d
In the care of a patient with neutropenia, what tasks should the nurse assign to the UAP to perform? select all A)taking vs q4hr B)reporting temp of more than 100.4 C)assessing for sore throat, cough, or burning with urination D)gathering the supplies to prepare the room for protective iso E)reporting super-infections such as candidiasis F)practicing good hand washing
A,B,D,F
People at risk are the target populations for cancer screening programs. Which of these asymptomatic patients need extra encouragement to participate in cancer screening? (Select all that apply.) A) A 21-year-old white American woman who is sexually inactive, for a Pap test B) A 30-year-old Asian-American woman, for an annual mammogram C) A 45-year-old African-American man, for a prostate-specific antigen test D) A 50-year-old African-American man, for a fecal occult blood test E) A 50-year-old white American woman, for a colonoscopy F) A 70-year-old Asian-American woman with normal results on three previous Pap tests, for a Pap test
A,C,D,E
for care of a patient who has oral cancer which task would be appropriate to assign to an LPN? A)assisting the patient to perform oral hygiene B)explaining when brushing and flossing are contraindicated C)giving antacids and sucralfate suspension as ordered D)recommending saliva substitutes
C
PT receiving chemo are at risk for thrombocytopenia related to chemo or disease processes. which actions are needed for pt who must be placed on bleeding precautions? select all A) provide mouthwash with alcohol for oral rinsing B)use paper tape on fragile skin C)provide soft toothbrush or oral sponge D)gently insert rectal suppositories E)avoid aspirin F)avoid overinflation of BP cuff
B,C,E,F
An experienced nurse is precepting a newly hired nurse who has 2 years of medical surgical experience but limited experience with patients who have cancer. the new hire seems to be consistently under medicating the patients pain. What should the preceptor do first? A)reassess all of the patients and administer additional pain medication PRN B)write an incident report and inform the nurse manger about the nurse's performance C)determine the new nurse's understanding and beliefs about caner pain and treatment D)ask the new nurse about past experience in adminisering pain medications
C
The HCP tells the patient with cancer that there will be an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. which patient statement is cause for greatest concern? A)my symptoms will eventually be cured, I'm so happy that i don't have to worry any longer B)my doctor is trying to help me control the symptoms'I am grateful for the extension of time with my family C)my pain will be relieved but i am going to die soon, i would like to have control over my own life and death D)initially i may have to take some time off work for my treatment, i can probably work full time in the future
C
The charge nurse discovers that two nurses have switched patients because Nurse A does not like to take care of patients with prostate cancer. Which action should the charge nurse take first? A)insist that they switch back to the original patient assignment and talk to each of them at the end of the shift B)allow them this flexibility' as long as the patients are well cared for it doesn't matter if the assignments are changed C)ask nurse A to explain her position regarding prostate cancer patients and seek alternatives to prevent future issues D)explain to Nurse a and b that all patines deserve kindness and care regardless of their condition or the nurse's personal feelings
C
The night shift nurse tells the oncoming dayshift nurse that the cancer patient in on round the clock dosing of morphine but the patient might be having end of dose pain. which question is most important to ask the night shift nurse A)how many times did you give a bolus dose B)did the patient tell that the pain was greater than 5 of 10 C)did you notify the HCP and were changes prescribed D)did you try any non-pharmaceutical therapies or adjuvant medications
C
The nurse is asked to float to a different nursing unit. During report the nurse is told that the patient is receiving IV administration of Vincristine that should be completed within the next 15 mins. The IV sit is intact and the patient is not having any problems with the infusion. The nurse is not certified in chemo admin. What is the priority action? A)ask the off-going nurse to stay until the vincristine infusion is done B)ask the off-going nurse about problems to expect with the vincristine infusions C)contact the charge nurse and discuss the lack o chemo certification D)look up drug side effects and monitor because the infusion is almost complete
C
for a patient receiving the chemo drug vincristine, which side effect should be reported to the HCP? A)fatigue B)nausea C)paresthesia D)anorexia
C
for a patient who is experiencing side effects of radiation therapy, which task would be the most appropriate to delegate to UAP? A)help the patient to identify patterns of fatigue B)recommending participation in a walking program C)reporting the amount and type of food consumed from the tray D)checking the skin for redness and irritation after the treatment
C
A 56 yo pt comes to a walk in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. there is a hx of polyps and family hx of cancer. while the nurse is trying to teach the pt about colonoscopy, pt becomes angry and threatens to leave. what is the priority nursing concept to consider in responding to this patient? A)elimination B)pt education C)cellular regulation D)anxiety
D
The home health nurse is reviewing the cancer patients medication list and sees that a biphosphonate med has been prescribed. which question is the nurse most likely to ask to evaluate the efficacy of the medication? A)has the med helped relieve the discomfort in your mouth B)have you noticed any increase or changed in you energy level C)has the medication helped to stop the nausea and vomiting D)has the med relieved the bone pain that you were having
D
The patient describes a burning sensation in the leg. The HCP tells the nurse that a medication will be prescribed for neuropathic pain 2ndary to chemo. the nurse is most likely to question prescription of which drug? A)imipramine B)carbamazepine C)gabapentin D)Morphine
D
an older patient needs treatment and relief for severe localized pain related to postherpetic neuralgia that developed during chemo. the nurse is most likely to question the prescription of which type of medication? A)lidocaine patch B)gabapentinoid C)capsaicin patch D)tricyclic antidepressant
D
the charge nurse of a long-term care facility is reviewing methods and assessment tools that nurses use for pain. which nurse is using the best method to assess pain? A)a behavioral assessment tool when the client is engaged in activities B) asks a client who doesn't speak english to point to the location of pain C)the same numerical rating scale every day for the same client D)asking the daughter of a confused client to described the clients pain
c
a client with diabetic neuropathy reports a burning, electrical type pain in the lower extremities that is worse at night and not responding to NSAIDs. which med will the nurse advocate for first A)gabapentin B)corticosteroids C)hydromorphone D)lorazepam
a
in the care of clients with pain and discomfort which task is most appropriate to delegate to UAP? A)assisting the client with preparation of a sitz bath B)monitoring the client for signs of discomfort while ambulating C)coaching the client to deep breathe during painful procedures D)evaluating relief after applying a cold compress
a
the client was prescribed a fentanyl patch for persistent severe pain. which client behavior most urgently requires correction? A)frequently likes to sit in the hot tube to reduce joint stiffness B)prefers to place the patch only on the upper anterior chest wall C)saves and resues the old patches when he can't afford new ones D)changes the patch every 4 days rather than the prescribed 72 hours
a
the nurse is caring for a postoperative client who reports pain. based on recent EBP guidelines, which approach would be best? A)multimodal strategies B)standing orders by protocol C)IV PCA D)opioid dosage based on valid numerical scale
a
the nurse is considering seeking clarification for several prescriptions of pan medication. which client circumstances is the priority concern A)35 yo opioid-naive adult will receive a basal dose of morphine IV PCA B) 65 yo will be discharge with prescriptions of NSAIDs C)25yo is prescribed as need IM analgesic for pain D) 45 yo taking oral fluids and foods has orders for IV morphine
a
the nurse is working with a HCP who prescribed opioid doses based on specific pain intensity rating. which client circumstance is cause for greatest concern? A)73 yo frail female client w/ hx of COPDis prescribed 4 mg IV morphine for pain 1-3 on scale of 0-10 B)25 yo postop male with hx of opioid addiction is given one tablet of oxy and acetaminophen for pain of 4-5 on scale 0-10 C)33 yo opioid-naive client who has severe migraine is given 5 mg IV morphine for 7-8 pain D)60 yo male with hx of RA is prescribed one tablet of hydromorphone for pain of 5-6
a
the nurse recognizes that there are ethical consideration in helping client achieve pain relief. which nursing action is the best example of the principle of nonmaleficence? A)client seems sedated but continues to ask for morphine, so the nurse conducts further assessment and seeks alternatives to morphine B)client has no known disease and no objective signs of poor health or injury but reports severe pain so nurse advocates for pain medication C)client is older, but is mentally alert and has good judgment, so the nurse encourages the client to verbalize personal goals for pain management D) client reportedly refuses medication but shows grimacing and reluctance to move, so the nurse explains the benefits of taking pain medication
a
when an analgesic is titrated to manage pain, what is the priority goal A)titrate to the smallest dose that provides relief with the fewest side effects B)titrate upward until the client is pain free or acceptable level is reached C)titrate down to prevent toxicity, overdose, and adverse effects D)titrate to dose that is adequate to meet the clients needs
a
Pain disorder and depression have been diagnosed for a client. He reports chronic low back pain and states. none fo these doctors has done anything to help. which client statement is cause for greatest concern? A)i twisted my back last night and now the pain is a lot worse B)I'm so sick o this pain. i think I'm going to find a way to end it C)occasionally, i buy pain killers from a guy in my neighborhood D)I'm going to sue you and the doctors, you are doing anything for me
b
Which postoperative client is manifesting the most serious negative effect of inadequate pain management? A)demonstrates continuous use of call bell relate to unsatisfied needs and discomfort B)develops venous thromboembolism related to immobility caused by pain and discomfort C)refuses to participate in physical therapy because of fear of pain caused by exercises D)feels depressed about loss of function ad hopeless about getting relief from pain
b
a client received PRN morphine, lorazepam, cyclobenzaprine. the UAP reports that the client has a respiratory rate of 10. what is the priority action A)call the health care provider to obtain an order for naloxone B)assess the clients responsiveness and resp status C)obtain a bag valve mask and deliver breaths at 20 breaths per min D)double check the prescription to see which drugs were ordered
b
the client is diagnosed by the ED HCP with an acute migraine. for which situation is most important to have a discussion with HCP before med is prescribed? A)HCP is considering dexamethasone to prevent reoccurrence, and the client has type 2 diabetes B)HCP is considering subq sumatriptan and the client took ergotamine 3 hr ago C) HCP is considering metoclopramide and this is a first time migraine for the client D)HCP is considering prochlorperazine, and the client drove himself to the hospital
b
the nurse assessing a client who has been receiving opioid meds via PCA. what is an early sign that alerts the nurse to possible adverse reaction? A)SOB B)difficult to arouse C)more anxious and nervous D)reports pain is worsening
b
the nurse is caring for a young client with type i diabetes who has sustained injuries when she tried to commit suicide by crashing her car. her BG level is 550, but she refuses insulin, however she wants the pain med. what is the best action? A)notify the charge and make arrangements to transfer to ICU B)explain significance of BD and insulin then call the HCP C)withhold the pain med until she agrees to accept the insulin D)give her the pain med and document the refusal of insulin
b
which client can be appropriately assigned to an LPN who will function under the supervision of an RN or team leader? select all A)client who needs preop teaching about the PCA B)client with a leg cast who needs neuro circ checks and PRN hydrocodone C)Client who underwent ta toe amputation and has diabetic neuropathic pain D) client with terminal cancer and severe pain who is refusing med E)Client who reports abd pain after being kicked punched and beaten F)Client with arthritis who needs scheduled pain mes and heat
b,c,f
which client can be appropriately assigned to a new grad RN who has recently completed orientation? select all A)anxious client with chronic pain who frequently uses the call button B)client on the second postop day who needs pain med before dressing changes C)client with AIDs who reports headache and abd and pleuritic chest pain D)client with chronic pain who is to be discharged with a new surgically implanted catheter E)Client who is reporting pin at the sit of peripheral IV line F)client with kidney stone who need frequent PRN pan med
b,e,f
for which client is IV morphine the first-line choice for pain? A)33 yo intrapartum client needs pain relief for labor contractions B)24 yo client reports severe HA related to being hit in the head C)56 yo client reports breakthrough bone pain relating to multiple myeloma D)73 yo client reports chronic pain associated with hip replacement surgery
c
Postop cline , the HCP prescribed multimodal therapy which includes acetaminophen, NSAID, PRN opioids, and nonpharm interventions. the client continuously asks for the PRN and the nurse suspect that the client may have a drug problem. which action by the nurse is best? A)administer acetaminophen and spend extra time with client C)explain the opioid med is reserved for moderate to severe pain C)give the opioid bc client deserves relief and drug abuse is unconfirmed D)Ask the HCP to validate suspicions of drug abuse and alter the opioid prescription
c
the health care prover prescribes 7 mg morphine IV prn. the nursing student prepares the medication shows the syringe to the instructor. what should the nursing instructor do first? A)tell the student to review the providers prescription before administering meds B)waste the medication and tell the student that remediation is required for serious error C)ask the student to demonstrate calculation and steps required to prepare the dose D)accompany the student to the clients room and observe as the med is given
c
the nurse is caring for a young man with a history of substance abuse who had exploratory abdominal surgery. there is a prescription to discontinue the morphine via PCA and to start oral meds. the client begs, please don't stop the morphine. my pain is really a lot worse today than it was yesterday. what is the best response? A)let me stop the pump and we can try oral pain medication to see if that relieves the pain B) i realize that you are scared of the pain, but we must try to wean you C)show me where you pain is and describe how it feels compared with yesterday D)lets take you vital signs then i will discuss you concerns with the hcp
c
which client has the most immediate need fo IV access to deliver immediate analgesia with rapid titration A)client who has a sharp chest pain that increases with cough and SOB B)client who reports excruciating lower back pain with hematuria C) client who is having an acute MI with severe chest pain D)client who is having a severe migraine with an elevated BP
c
A client has severe pain and bladder distention related to urinary retention and possible obstruction. An experience UAP states that she should receive training in indwelling catheter insertion a previous job. what task can be delegated to this UAP? A)assessing the bladder distention and the pain associated with urinary retention B)inserting the indwelling catheter after verifying her knowledge of sterile technique. C)evaluating the relief of pain and bladder distention after the catheter is inserted D)measuring the urine output after the catheter is inserted and obtain a specimen
d
A client with chronic pain reports to the charge nurse that the other nurses have not been responding to requests for pain medication. what is the charge nurse's initial action? A)check the medication administration records for the past several days B)Ask the nurse educator to provide in-service training about pain management C)perform a complete pain assessment on the client and take pain history D)have a conference with the staff nurses to assess their care of this client
d
The home health nurse is interviewing an older client with a history of mild HF and RA. the client reports feeling pretty good, except for the pain and stiffness in my joints when i first get out of bed. which member of the health care team would be the most appropriate to aid in the client's report of pain? A)health care provider to review the dosage and frequency of pain med B)physical therapist for evaluation of function and possible exercise therapy C) social worker to locate community resources for complementary therapy D)Unlicensed assistive personnel to help client with warm shower in the morning
d
What is the best way to schedule meds for a client with constant pain? A)PRN at client request B)before painful procedure C)IV bolus after pain assessment D)around the clock
d
an inexperience grad nurse is reviewing the MAR for a client who has PCA pump for pain management. the new nurse compares he MAE and HCP's prescription and both indicate that larger doses are prescribed at night compared with doses through the day. which member of the HC team should the nurse consult first? A)the client to see if he needs extra medication at night B)the HCP to verify that the larger amount is the correct dose C) the pharmacist to confirm he dosage on the original prescriptions D) the charge if this is a typical dosage for the nighttime PCA
d
the HCP has ordered a placebo for a client with chronic pain. the newly hired nurse feel very uncomfortable administering the med. what is the first action that the new nurse should take? A)prepare the med and hand it to the HCP. B)check the hospital policy regarding the use of a placebo C)follow a personal code of ethics and refuse to participate D)contact the charge nurse for advice and suggestions
d
the charge nurse is reviewing the records of clients who were assigned to a newly grad RN. The RN has correctly documented dose and time of the med, but there is no document regarding nonpharm measures. what action should the charge take first? A)make a not in the nurses file and continue to observe clinical performance B)refer the new nurse to the inservice eduction department C)quiz the nurse about knowledge of pain management and pharm D)Give praise for documenting dose and time and discuss documenting deficits.
d
the team providing emergency care to a client who received an excessive dose of opioid pain meds. which task is best to assign to the LPN A)calling the HCP to report SBAR B)giving naloxone and evaluating response to therapy C)monitoring the resp status for the first 30 D)applying oxygen per nasal cannula as ordered
d
which client is at greatest risk for resp depression while receiving opioids for analgesia? A)older adult client with chronic pain related to joint immobility B)client with heroin addiction and back pain C)young female client with advanced multiple myeloma D)opioid-naive adolescent with an arm fracture and cystic fibrosis
d
