Get Answer: Client Orders Pain Question Guide

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Original Question

A client has orders for PRN pain medication. Which of the following statements describes the most appropriate time to offer that medication to the client? A. “I will administer an analgesic before all activities.” B. “I will administer analgesics for maximum pain relief.” C. “I will administer analgesics only when requested by the family.” D. “I will administer analgesic when requested by the client.” The nurse is evaluating wound drainage every hour. Which of the following actions will help determine changes in the amount of wound drainage? A. Circling the outline wound drainage every hour. B. Weighing the client to estimate the weight of the saturated dressing. C. Counting each dressing as 1 mL of drainage D. Reinforcing the dressing every hour There are several non-pharmacological methods of pain relief that can be implemented between scheduled doses of pain medication. Which of the following is considered a non-pharmacological method of pain relief? A.Tighten constricting bandages B.Lying flat in bed C.Gentle heat D.Fluid and dietary restrictions Which of the following would be the best source to determine a client’s tolerance of pain and pain control? A. The provider B. The nurse C. The client’s family D. The client Which of the following statements demonstrates an understanding of the use of incentive spirometry? A. “Early ambulation and administration of blood thinners will prevent pulmonary embolism.” B. “Close monitoring of your oxygen saturation will detect hypoxemia.” C. “Use of an incentive spirometer will help prevent pneumonia.” D. “Administration of intravenous fluids will prevent or treat the fluid imbalance.” A client is experiencing respiratory distress. The client’s vital signs are as follows: BP 130/70; HR 90; RR 22; Saturation on room air-82%. Which of the following is the priority action? A. Infuse normal saline at 75 mL/hr B. Give methylprednisolone (Solu-Medrol) 1 g intravenously (IV) C. Place the client on supplemental oxygen D. Obtain blood, urine, and sputum for cultures The nurse is caring for a client in septic shock. The nurse notes that the rate and depth of respiration are markedly increased. The nurse interprets this as a possible manifestation of the respiratory system compensating for which condition? A.Respiratory acidosis B.Metabolic acidosis C.Metabolic alkalosis D.Respiratory alkalosis The nurse has reevaluated a postoperative client who was admitted from the post-anesthesia care unit (PACU). Which of the following findings is most concerning? A. Serous drainage on the surgical dressing B. Blood pressure of 106/70 mm Hg C. Temperature of 97.6 degrees F D. Urinary output of 20 mL/hr A nurse is contributing to a plan of care for a client who is experiencing pain. Which of the following is the priority in the plan of care? A. Administer pain medication as soon as the client requests it B. Individualize the pain medication regimen for the client C. Choose medications that have a low risk of addiction D. Use a variety of pain medications to avoid drug tolerance The nurse just completed wound care on a postoperative client and observed pale, red, watery drainage on the old dressing. Which type of drainage is this? A. Sanguineous drainage B. Purulent drainage C. Serous drainage D. Serosanguineous A client who is scheduled for surgery in one hour, asks the nurse about the risks of the surgical procedure. Which statement by the nurse is most appropriate? A. “I’ll contact the surgeon to come to speak to you.” B. “Your surgeon is very skilled; you will be fine.” C. “Why didn’t you ask this sooner?” D. “What are your concerns?” A nursing student asks if vitamins can promote healing. Which of the following vitamins is the best choice to promote wound healing? A. Vitamin C B. Vitamin E C. Vitamin B D. Vitamin A What are some of the responsibilities of the State Boards of Nursing? (Select all the apply). A. Issuing nurse licensure B. Disciplinary actions C. Regulate the practice of nursing within each state D. Requests hospital policy and procedure The nurse is caring for a client with septic shock. Which therapy specific to the management of shock for this client anticipate will be used? A. Colloids B. Antidysrhythmic C. Antibiotics D. Inotropic Which of the following interventions would be the best choice if a gauze dressing is difficult to remove from the incision? A. Moisten the dressing with sterile water B. Call the RN C. Cover the occlusive dressing D. Gently remove the gauze with sterile forceps Measures to prevent thrombophlebitis in a postoperative client include which of the following? (Select all the apply) A. Provide 2L of oxygen intermittently B. Application of sequential compression devices on the legs C. Early ambulation with sessions three times a day D. Promote sufficient hydration via oral and IV fluid E. Encourage leg exercises at least every 2 hours while awake A newly admitted client is diagnosed with sepsis. The provider orders include antibiotics, blood cultures, … (CBC), and Chem 7. Which of these orders must be completed first? A. Chem 7 B. Blood cultures C. Antibiotics D. CBC A client describes their pain level as a 5 out of 10. Which of the following statements is true when it comes to pain management A. Easily relieved if found early B. Easy to recognize C. Subjective for the client D. Objective for the nurse A nurse is collecting data for a client who had a right knee replacement and who returned from surgery 3 hours ago. Which findings would be most concerning? A. Right foot is warm to touch B. Capillary refill of 7 seconds on the right toes C. Swelling in the right knee D. Pain level of 8 on a 0-10 scale A client is two days postoperative from a right total knee replacement. The client complains of abdominal pain and that her bowels have not moved since before surgery. A focused assessment reveals the abdomen is slightly distended, and bowel sounds are absent in all four quadrants. Which of the following orders can be initiated? Select all that apply. A. Maintain NPO status B. Discontinue IV fluids C. Monitor intake & output D. Encourage ambulation E. Insert a nasogastric attached to intermittent suction A client who is receiving epidural analgesia has voided 30 mL in the last 4 hours. Which action should the nurse take first? A. Initiate a fluid bolus B. Stop the infusion of medication C. Palpate for bladder distention D. Order labs to evaluate renal function A client who is receiving epidural analgesia has voided 30 mL in the last 4 hours. Which action should the nurse take first? A. The client reports that long hours of standing worsen the abdominal pain B. The client reports sharp pain in their lower abdomen when standing C. The client complains of stomach pain following every meal D. The client reports a sharp pain in their abdomen Which Quality and Safety Education for Nurses (QSEN) competency focuses on the client as the source of control and full partner in providing compassionate and coordinated care based on respect for client’s preference, values, and needs? A. Safety B. Teamwork and collaboration C. Client-centered care D. Evidence-based practice The following data was obtained from a man who is 24 hours postoperative following abdominal surgery. A. Temperature of 99.3 degrees F B. BP 100/80 C. 24-hour urine output of 300 mL D. Pain rating of 4 on 1-10 scale level of 7.6g/dl and a hematocrit level of 30%, the nurse takes the clients temperature before hanging the blood transfusion and records 100.6 degrees f , which action should the nurse take? A, administer an antihistamine and begin the transfusion B, delay hanging the blood and notify the primary health care provided C, administer 2 tablets of acetaminophen and begin the transfusion D, begin the transfusions as prescribed After reinforcing teaching on infection control, the nurse asks the client if they have any questions. Which of the following responses would require additional reinforcement? A. “It is important that I get my whooping cough vaccination as directed by my health provider.” B. “It is important that I take my antibiotic until my symptoms have completely resolved.” C. “I should wash my hands before preparing my food.” D. “Getting plenty of sleep each night will help my immune system.” Older clients are often undertreated for pain. Which of the following would be considered a reason for undertreating older adults for pain? A. Older adults are at higher risk of addiction B. Pain sensation decreases with age C. Older adults cannot swallow pills A nurse collecting data on a postoperative client immediately on return from surgery. Initial findings include the following vital signs: BP 140/90, HR 80, RR 14, and T of 98 F. Vital signs taken 1 hour later are as follows: BP 130/84, HR 72, RR 16, T 98.6 F. What action should the nurse take next? A. Raise the heard of the bed 45 degrees B. Place a warmed blanket on the client C. Document the normal findings in the client’s record D. Notify the RN of a probably hemorrhage Which of the following will help promote wound healing? A. Offering fluids every 4 hours B. Encouraging the consumption of large meals C. Encourage the consumption of nutrients such as protein D. Encouraging up to 100 mL of daily fluid intake Morphine sulfate is administered for pain relief. Which medication should be kept available for the client being treated with analgesics? A. Ketorolac (Toradol) B. Atropine sulfate (Atropine) C. Acetylsalicylic acid (Aspirin) D. Naloxone (Narcan) A nursing student is assisting with the care of a new postoperative client wearing anti-embolic stockings. The nursing student asks when the anti-embolic stockings should be removed. Which of the following statements is most correct? A. The stockings should be removed when the client is ambulating B. The stockings should be removed for approx. 20 minutes each shift C. The stockings should remain in place continually for the first 24 hours The client is admitted with a diagnosis of rule out sepsis. Their temperature on admission is 100 degrees F. and the lab report of the white blood cell count/ WBC is 21,000. Which intervention would the nurse anticipate as an order? A. Deliver broad-spectrum antibiotic B. Blood transfusion C. NPO status D. Cooling baths Which of the following best describes the typical duration for an acute pain? A. More than one year B. One week C. At least nine months D. Less than six months A client with a history of cardiac problems is having severe chest pain , what should the nurse first respond to ? A, administer PRN pain medication B, evaluate the client’s pain C, initiate oxygen via nasal cannula D, call the primary care provider The Nurse Practice Act is an example of what type of law? A. Federal B. Civil C. Criminal D. Statutory A client has had abdominal surgery and is using an incentive spirometer. Which of the following is the most effective way to evaluate the effectiveness of the client’s use of the spirometer? A. The client can breathe more easily B. The client is ready to ambulate without pain C. The client has increased circulation in the extremities D. The client has stronger abdominal muscles

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