Nokea
A nurse is preparing to give a client ketorolac (Toradol) intravenously for pain. Which assessment findings would lead the nurse to consult with the provider?
- A. Bilateral lung crackles
- B. Bilateral lung crackles
- C. Self-reported pain of 2010
- D. Urine output of 20 ml/2 hr
Correct Answer: D
Rationale: Drugs in this category can affect renal function. Clients should be adequately hydrated and demonstrate good renal function prior to receiving ketorolac. A urine output of 20 ml/2 hr is well below normal, and the nurse should consult with the provider about the choice of drug. Crackles and a pain report of 3 are not related.
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A hospitalized client uses a transdermal fentanyl (Duragesic) patch for chronic pain. What action by the nurse is most important for client safety?
- A. Assess and record the client pain every 4 hours.
- B. Ensure the client is eating a high-fiber diet.
- C. Monitor the clients bowel function every shift.
- D. Remove the old patch when applying the new one.
Correct Answer: D
Rationale: The old fentanyl patch should be removed when applying a new patch to prevent accidental overdose. The other actions are appropriate but not as critical for safety.
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 client who had surgery has extreme postoperative pain that is worsened when trying to participate in physical therapy. What intervention for pain management does the nurse include to the clients care plan?
- A. Pre-needed pain medication after therapy
- B. Pain medication is more consumers and more rate
- C. Pain medications prior to therapy only
- D. Round-the-clock analgesia with PRN analgesics.
Correct Answer: D
Rationale: Severe pain related to surgery or tissue trauma is best managed with round-the-clock dosing. Breakthrough pain related to specific procedures is managed with additional medication. Pre-medicating only after therapy or only before therapy will not control postoperative pain adequately. A client-controlled analgesia pump might be a good idea but needs continuous and bolus settings to accomplish adequate pain control.
A nurse is caring for a client on an epidural patient-controlled analgesia (PCA) pump. What action by the nurse is most important to ensure client safety?
- A. Assess and record the client every hour
- B. Have another nurse double-check the PCA pump settings
- C. Instruct the client to report any unrelieved pain
- D. Monitor for numbness and tingling in the legs
Correct Answer: B
Rationale: Epidural analgesia poses risks, and pump settings must be accurate to prevent overdose or underdose. Having another nurse double-check the settings is critical for safety. Frequent assessments, reporting unrelieved pain, and monitoring for numbness are important but secondary to ensuring correct pump settings.
A postoperative client is reluctant to participate in physical therapy. What action by the nurse is best?
- A. Ask the client why he is being uncooperative with therapy
- B. Ask the client about his pain goals and if they are being met
- C. Increase the dose of analgesia given prior to therapy sessions
- D. Tell the client that physical therapy is required to regain function
Correct Answer: B
Rationale: Adequate pain control is necessary for therapy participation. Asking about the client's pain goals and whether they are being met helps identify barriers to participation. Labeling the client as uncooperative is inappropriate, increasing medication without assessment may be unsafe, and stating therapy is required does not address the underlying issue.