Nokea
A male patient reports to the home health nurse that he does not feel rested although he has slept 8 hours. For what should the nurse assess?
- A. Having vivid dreams
- B. Eating a heavy meal before going to bed
- C. Consuming an excessive amount of alcohol
- D. Taking an anxiolytic medication
Correct Answer: D
Rationale: Anxiolytic (antianxiety) medications interfere with REM sleep, which is when people achieve full rest.
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The nurse is using a pain scale of 0 to 10 to assess pain in a postoperative patient. What is considered the maximum pain level at which a patient can usually function effectively?
- A. 2
- B. 3
- C. 4
- D. 5
Correct Answer: C
Rationale: Most patients do not function effectively if the pain level exceeds 4 on a scale of 10.
A nurse is caring for a patient who requires long-term management for severe pain. What should be the drug of choice for this patient?
- A. Aspirin
- B. Morphine
- C. Oxycodone
- D. Acetaminophen
Correct Answer: B
Rationale: Morphine and hydromorphone are the opioids of choice for long-term management of severe pain.
When assessing pain which of the following is included in pain assessment?
- A. The initial assessment
- B. Discharge planning
- C. Assessing vital signs
- D. Care planning
Correct Answer: C
Rationale: Making pain a vital sign would ensure that pain is monitored on a regular basis.
What action should the nurse implement when assisting a postoperative patient with pain control and comfort?
- A. Pull the patient up in bed.
- B. Lift the patient up in bed.
- C. Tighten constricting bandages.
- D. Restrict fluid and dietary intake.
Correct Answer: B
Rationale: Pain control and comfort measures include loosening constricting bandages, lifting, not pulling the patient up in bed, and preventing constipation by encouraging appropriate fluid and dietary intake.
An American Indian patient requests that an egg yolk be placed in a saucer and put under his bed to absorb the pain. What should the nurse do?
- A. Explain that medication will relieve the pain better.
- B. Place the egg in a saucer under the bed.
- C. Ask the health care provider for permission.
- D. Warn that housekeeping staff will remove the egg.
Correct Answer: B
Rationale: The nurse should use methods of pain control that the patient believes will work.