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A client is put on twice-daily acctantimopohen (Tylenol) for actoarthritis. What finding in the clients health history would lead the nurse to consult with the provider over the choice of medication?
- A. 2 Space-year smoking history
- B. Drinking in 5 beers to day
- C. Previous peptic ulcer
- D. Taking warfarin (Coumadin)
Correct Answer: B
Rationale: The major serious side effect of acetaminophen is hepatotoxicity and liver damage. Drinking 3 to 5 beers each day may indicate underlying liver disease, which should be investigated prior to taking chronic acetaminophen. The nurse should relay this information to the provider. Smoking, previous peptic ulcer, or warfarin use are not related to acetaminophen side effects.
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A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia. The client scores a zero. What action by the nurse is best?
- A. Assess pain physiological indicators and vital signs.
- B. Do not give pain medication as no pain is indicated.
- C. To present the findings and continue to monitor.
- D. Try a human state of analgesic medication for pain.
Correct Answer: A
Rationale: Assessing pain in a nonverbal client is difficult despite the use of a scale specifically designed for this population. The nurse should next look at physiologic indicators of pain and vital signs for clues to the presence of pain. Even a low score on this index does not mean the client does not have pain, he or she may be holding very still to prevent more pain. Documenting pain is important but not the most important action in this case. The nurse can try a small dose of analgesia, but without having indices to monitor, it will be difficult to assess for effectiveness.
A client is being discharged from the hospital after surgery on hydrocodone and acetaminophen (Lorcet). What discharge instruction is most important for this client?
- A. Call the doctor if the Lorcet does not relieve your pain.
- B. Check any over-the-counter medications for acetaminophen.
- C. Eat more fiber and drink more water to prevent constipation.
- D. Keep your follow-up appointment with the surgeon as scheduled.
Correct Answer: B
Rationale: Advising the client to check over-the-counter medications for acetaminophen is critical to prevent exceeding the safe daily limit of 3000 mg, which could lead to hepatotoxicity. Other instructions are relevant but less critical for safety.
A faculty member explains the concepts of addiction, tolerance, and dependence to students. Which information is accurate? (Select all that apply.)
- A. Addiction involves psychological dependence
- B. Tolerance requires increasing doses for the same effect
- C. Dependence leads to withdrawal symptoms upon cessation
- D. Addiction is the same as physical dependence
- E. Tolerance develops only with opioid use
Correct Answer: A,B,C
Rationale: Addiction involves psychological dependence, tolerance requires increasing doses for the same effect, and dependence leads to withdrawal symptoms. Addiction is distinct from physical dependence, and tolerance can develop with various medications, not just opioids.
A nurse is caring for clients receiving opioid analgesics. Which actions help prevent unwanted sedation as a complication of these medications? (Select all that apply.)
- A. Avoid using other medications that cause sedation.
- B. Delay giving medication if the client is sleeping.
- C. Give the lowest dose that produces good control.
- D. Identify clients at high risk for unwanted sedation.
- E. Identify clients receiving non-opioid analgesia.
Correct Answer: A,C,D,E
Rationale: Sedation is a side effect of opioid analgesics. To prevent unwanted sedation, nurses should avoid sedative medications, use the lowest effective dose, identify high-risk clients, and monitor all clients receiving analgesia. Delaying medication for sleeping clients risks uncontrolled pain later.
A registered nurse (RN) and nursing student are caring for a client who is receiving pain medication via patient-controlled analgesia (PCA). What action by the student requires the RN to intervene?
- A. Assesses the clients pain level per agency policy
- B. Monitor the clients respiratory rate and sedation
- C. Presses the button when the client cannot reach it
- D. Reinforces client teaching about using the PCA pump
Correct Answer: C
Rationale: The client is the only person who should press the PCA button. If the client cannot reach it, the student should either question the client or adjust the button's position, not press it for the client. The other actions are appropriate.