A family member asks you, “Why can’t you give more medicine? He is still having a lot of pain.” What is your best response?
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Solution
“Please tell him that I will be right there to check of him.”
Directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next.
Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? (Choose all that apply.)
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Solution
A client second day post-op who needs pain medication prior to dressing changes
A second day postoperative client who needs medication prior to dressing changes has predictable and routine care that a new nurse can manage. Although clients with chronic pain can be relatively stable, the interaction with this client will be time consuming and may cause the new nurse to fall behind. The client with HIV has complex complaints that require expert assessment skills. The client pending discharge will need special and detailed instructions.
For a client who is taking aspirin, which laboratory value should be reported to the physician?
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Solution
PT 14 seconds
When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%, female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).
Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.)
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Solution
Answers: B, C.
The clients with the cast and the toe amputation are stable clients and need ongoing assessment and pain management that are within the scope of practice for an LPN/LVN under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and the terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication.
What is the best way to schedule medication for a client with constant pain?
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Solution
Around-the-clock
If the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control
Which non-pharmacological measure is particularly useful for a client with acute pancreatitis?
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Solution
Side-lying position with knees to chest and pillow against abdomen
The side-lying, knee-chest position opens retroperitoneal space and provides relief. The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain, especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain. The additional stimulation of massage may be distressing to the client.
Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)?
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Solution
Oral
If the gastrointestinal system is function, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms.
For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?
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Solution
Obtain baseline behavioral indicators from family members.
Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.
The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take?
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Solution
Contact the charge nurse for advice.
The charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following one’s own ethical code is correct, you must ensure that the client is not abandoned and that care continues.
In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant?
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Solution
Assist the client with preparation of a sitz bath.
The nursing assistant is able to assist the client with hygiene issues and knows the principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and evaluating outcomes are nursing responsibilities.
A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?
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Solution
Diaphoresis
Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.
A client appears upset and tearful, but denies pain and refuses pain medication, because “my sibling is a drug addict and has ruined out lives.” What is the priority intervention for this client?
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Solution
Encourage expression of fears on past experiences
This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.
Which client is at greater risk for respiratory depression while receiving opioids for analgesia
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Solution
A child with an arm fracture and cystic fibrosis
At greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors.
Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder.
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Solution
Answer: B, C, A.
Step 1 includes non-opioids and adjuvant drugs. Step 2 includes opioids for mild pain plus Step 1 drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain (replacing Step 2 opioids) and continuing Step 1 drugs and adjuvant drugs as needed.