Nokea
A client with lung cancer is being cared for by his wife at home. His pain is increasing in severity. The nurse recognizes that teaching has been effective when the wife does which of the following? Select all that apply.
- A. Administers long-acting or sustained-release oral pain formula (OxyContin) regularly around-the-clock.
- B. Administers immediate-release medication (oxycodone) for breakthrough pain.
- C. Avoids long-acting opioids due to her concern about addiction.
- D. Uses music for distraction as well as heat or cold in combination with medications.
- E. Substitutes acetaminophen (Tylenol) to avoid tolerance to the medications.
- F. Has her husband use a pain rating scale to measure the effectiveness at reaching his individual pain goal.
Correct Answer: A,B,D,F
Rationale: Effective pain management includes around-the-clock long-acting opioids (A), immediate-release opioids for breakthrough pain (B), non-pharmacologic methods like music or heat/cold (D), and using a pain scale to assess effectiveness (F). Avoiding long-acting opioids (C) or substituting acetaminophen (E) is not appropriate for severe cancer pain.
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A client has had multiple sclerosis (MS) for 15 years and has received various drug therapies. What is the primary reason why the nurse has found it difficult to evaluate the effectiveness of the drugs that the client has used?
- A. The client exhibits intolerance to many drugs.
- B. The client experiences spontaneous remissions from time to time.
- C. The client requires multiple drugs simultaneously.
- D. The client endures long periods of exacerbation before the illness responds to a particular drug.
Correct Answer: B
Rationale: Spontaneous remissions in MS make it challenging to attribute symptom improvement to drugs versus natural disease course. Intolerance, multiple drugs, or delayed responses are less primary factors.
Thirty people are injured in a train derailment. Ineffective and the transported to the hospital first?
- A. A 20-year-old who is unresponsive and has a high injury to his spinal cord.
- B. An 80-year-old who has a compound fracture of the arm.
- C. A 10-year-old with a laceration on his leg.
- D. A 25-year-old with a sucking chest wound.
Correct Answer: D
Rationale: A sucking chest wound is a life-threatening condition that can impair breathing and requires immediate intervention, prioritizing this patient for transport over others with less urgent injuries.
For the client who is experiencing expressive aphasia, which nursing intervention is most helpful in promoting communication?
- A. Speaking loudly.
- B. Using a picture board.
- C. Writing directions so client can read them.
- D. Speaking in short sentences.
Correct Answer: B
Rationale: A picture board is most helpful for expressive aphasia, allowing the client to point to images to communicate needs. Speaking loudly, writing directions, or short sentences are less effective for clients unable to verbalize.
The nurse should assess the client with bladder cancer for which of the following?
- A. Suprapubic pain.
- B. Dysuria.
- C. Painless hematuria.
- D. Urine retention.
Correct Answer: C
Rationale: Painless hematuria is a hallmark symptom of bladder cancer, often presenting as the initial sign due to tumor growth causing bleeding without associated pain.
A 28-year-old client with cancer is afraid of experiencing a febrile reaction associated with blood transfusions. He asks the nurse if this will happen to him. The nurse's best response is which of the following?
- A. Febrile reactions are caused when antibodies on the surface of blood cells in the transfusion are directed against antigens of the recipient.
- B. Febrile reactions can usually be prevented by administering antipyretics and antihistamines before the start of the transfusion.
- C. Febrile reactions are rarely immune-mediated and can be a sign of hemolytic transfusion.
- D. Febrile reactions primarily occur within 15 minutes after initiation of the transfusion and can occur during the blood transfusion.
Correct Answer: B
Rationale: Febrile reactions can often be prevented with premedication like antipyretics and antihistamines, which is a reassuring and accurate response for the client.