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Copy of Untitled Prezi

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Billy Tart

on 30 August 2013

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{Spot 12}- Which information, obtained by the nurse, is most likely to influence Wrenda's perception of her pain?
A) Wrenda's younger child is an infant, who feeds every 3 hours.
B) Wrenda's 4-year-old enjoys being the "big brother" to his baby sister.
C) Wrenda was a first grade teacher before having children but now stays home.
D) Wrenda's parents live in the same neighborhood and often help with the children.
{Spot 10} - To assess the quality of Wrenda's pain, the nurse asks which question?
A) "On a scale of 0 to 10, how would you rate your pain?"
B) "What word best describes the pain you are experiencing?"
C) "What actions do you take to relieve the pain?"
D) "What do you fear most about your pain?"
Which behavior that Wrenda exhibits supports her subjective report of acute pain?
A) Constant foot tapping
B) Excessive blinking.
C) Limited eye contact.
D) Frequent guarding.
To assess the quality of Wrenda's pain, the nurse asks which question?

A) "On a scale of 0 to 10, how would you rate your pain?"
B) "What word best describes the pain you are experiencing?"

C) "What actions do you take to relieve the pain?"
D) "What do you fear most about your pain?"
To determine the etiology of Wrenda's anxiety, what is the priority nursing intervention?
A) Refer the client to the clinic social worker.
B) Continue the interview with the client.
C) Review the healthcare provider's notes.
D) Recognize that pain causes anxiety.
What is the best goal for the nurse to include in the plan of care related to the problem statement of, "Acute pain related to strain on muscles with movement?"

A) Client reports pain of 1 on a 0-10 scale.
B) Client will verbalize pain control methods.
C) Client will not move or strain muscles.
D) Client will learn to live with long-term pain.
Spot 11
Before implementing any interventions, what action is most important for the nurse to take?
Non-Steroidal Antiinflammatory Drugs (NSAIDs)

The nurse consults with the clinic director, a pain management physician, who recommends the use of NSAIDs and alternating heat and cold applications, as well as back exercises. The nurse provides client teaching about these treatments. Wrenda tells the nurse that she will take the acetaminophen (Tylenol) that she already has at home.
What is the best goal for the nurse to include in the plan of care related to the problem statement of, "Acute pain related to strain on muscles with movement?"
A) Aspirin comes in children's doses, which can be given safely to 4-year-olds.
B) Buffered aspirin contains an ingredient that can be damaging to small children.
C) All aspirin products should be avoided in children unless specifically prescribed.
D) Ibuprofen products should be used for children with a virus.

A) "Warm moist compresses are a better choice because there is less chance of injury to your skin."
B) "A heating pad is more effective than moist compresses because it will penetrate more deeply into the muscles."
C) "Heating pads provide dry heat, which promotes vasoconstriction, reducing any muscle swelling that has occurred."
D) "The dry heat provided by your heating pad will help relieve your pain by promoting muscle relaxation."

A) The cold pack provides pain relief but does not heal the injury.
B) The cold applications should be alternated with the heating pad.
C) Cold reduces inflammation and prevents tissue swelling.
D) Excessive exposure to cold can damage the skin.

A) Reflex vasodilation occurs following the initial vasoconstricting effects of cold.
B) Cold causes a numbing sensation, which interferes with circulation at the site.
C) Debris from necrotic tissue collects at the site of vasoconstriction, causing inflammation.
D) Intradermal tissue blisters occur as the result of the damage caused by exposure to cold.

A) "Since you understand how the unit works, I will show you how to apply it."
B) "Pain relief is actually provided by delivering small electrical currents to the skin."
C) "The TENS unit is more useful for distraction than for providing biofeedback."
D) "The therapy provides both biofeedback and mild acupressure to control pain."
Which instruction(s) should the nurse include? (Select all that apply.)
Scheduled (controlled) Drugs
In addition to the TENS Unit, Wrenda has a prescription for a Schedule IV analgesic. The nurse recognizes that specific protocols are followed when a client is receiving scheduled (controlled) medications.
What characteristic of scheduled drugs results in the need for these specific protocols?
A) Large doses can be fatal.
B) Respiratory depression can occur.
C) There is a high potential for abuse.
D) Tolerance develops with repeated use.
The clinic stocks a small number of scheduled medications, so the nurse obtains a dose of the prescribed medication for Wrenda. At the end of the shift, the nurse counts the remaining medications with the oncoming nurse and notes that the count is not accurate.
Medication Administration: Intramuscular Injection
Five days later Wrenda returns to the pain clinic reporting that the medication, TENS unit, and other care measures have not been successful in reducing her pain, and that, in fact, the pain seems to be worsening. Wrenda is admitted to the medical center via the Emergency Department for diagnostic tests and pain management.
While Wrenda is in the emergency department, the healthcare provider prescribes an intramuscular (IM) injection of 60 mg of ketorolac (Toradol), a nonsteroidal antiinflammatory agent.
The nurse will first place the palm of the hand on what anatomical spot to locate the injection site?

A) The upper outer quadrant of the buttock.
B) The anterosuperior iliac spine.
C) The greater trochanter.
D) The iliac crest.

A) Observe for a small bleb around the tip of the needle.
B) Pull back on the syringe plunger and observe for blood.
C) Place a small sterile gauze pad close to the insertion site.
D) Slowly inject the medication into the muscle mass.
After completing Wrenda's admission to the medical unit, the staff nurse offers to guide Wrenda through a series of relaxation exercises. The nurse first plans to assist Wrenda with a guided imagery exercise. Wrenda states she would like to sit in the armchair in the room and identifies the image of watching a mountain sunset as being relaxing to her.
(Spot 2) Wrenda states the guided imagery exercise was helpful, and she is interested in learning additional exercises. The nurse guides Wrenda in a progressive relaxation activity. After first establishing a regular breathing pattern, the nurse tells Wrenda to locate an area where she can feel muscle tension.
Further assessment and testing indicates that Wrenda has a back problem that requires surgery, which is scheduled for the next day. The nurse knows that a patient-controlled analgesia (PCA) pump will be prescribed as part of Wrenda's postoperative care.
The nurse assesses Wrenda's pain and determines that the evaluation of her use of the PCA pump is correct. Wrenda's pain has lessened, and she no longer needs any demand doses of morphine. The nurse consults with the surgeon, and the morphine is discontinued. Wrenda's new prescription is for hydrocodone/acetaminophen (Vicodin), a medication that combines hydrocodone with acetaminophen.
Wrenda has also been receiving docusate sodium (Colace), a stool softener. She asks the nurse if this needs to be continued.
How should the nurse respond?
The nurse overhears two other nurses discussing Wrenda's pain management in the hallway. One nurse states that Wrenda is exhibiting drug-seeking behavior and is probably already addicted to her pain medications.
(Spot 1)
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A) Client reports pain of 1 on a 0-10 scale.
B) Client will verbalize pain control methods.
C) Client will not move or strain muscles.
D) Client will learn to live with long-term pain.
A) Place a copy of the plan of care in the client's chart.
B) Submit the plan of care to the nurse-manager.
C) Review interventions in a care plan manual.
D) Discuss the plan of care with the client.

What instruction should the nurse provide?
A) Tylenol is more useful for fever reduction than pain management.
B) Aspirin is a better choice than Tylenol, to prevent stomach distress.
C) Large doses of Tylenol are associated with kidney damage.
D) Tylenol does not have an antiinflammatory effect.
Wrenda decides to purchase buffered aspirin and asks if this medication is also safe to give her 4-year-old son since he occasionally experiences viral infections and becomes feverish.

What information should the nurse include in responding to Wrenda?
Wrenda tells the nurse that she has an electric heating pad at home that she used when she sprained her ankle.
How should the nurse respond?
Wrenda states that she has also been applying a cold pack an hour at a time to help heal her back as quickly as possible.
Which instruction is most important for the nurse to provide?
How should the nurse explain the mechanism that causes the skin to become reddened from prolonged exposure to cold?
Wrenda returns to the pain clinic in a week and reports that her pain has worsened. The pain management physician recommends the use of a Transcutaneous Electrical Nerve Stimulator (TENS) unit and prescribes a schedule IV opioid analgesic. Wrenda states to the nurse that she is familiar with the TENS Unit, calling it a biofeedback treatment.
What is the best response by the nurse?

A) After applying the electrodes, set the unit to provide continuous stimulation.
B) Be sure to use conducting gel or conductor pads when applying the electrodes to the skin.
C) Remove the electrodes and change sites each time the skin is stimulated.
D) Turn on the unit only when your pain medication does not provide relief.
E) Clean the skin where the electrodes will be placed and dry thoroughly.
A) Request that the oncoming nurse investigate the inaccurate count, and leave a written report for the first nurse.
B) Complete a variance report, documenting that the count was inaccurate, and submit the report to the pharmacist.
C) Review prescriptions for any scheduled drugs with all nurses with access to the medications to determine why the count is inaccurate.
D) Schedule a meeting with the medical director of the clinic to discuss methods to reduce drug errors by the nursing staff.
What action should the nurse implement?
A) Deltoid.
B) Ventrogluteal.
C) Dorsogluteal.
D) Abdomen, 2 inches from the umbilicus.
Since Wrenda is fairly thin, which site is the best choice for the injection?
Once the needle is inserted in the skin, what intervention should the nurse perform?
A) Help the client cross her legs in a semi-yoga position.
B) Encourage the client to lie down, rather than sit in a chair.
C) Include as many sensory images as possible in the experience.
D) Suggest that an image involving water may be more restful.
To ensure that the exercise is most effective, what action should the nurse implement?
What instruction should the nurse provide next?
A) Apply gentle pressure over the opposing muscle.
B) Apply firm pressure over the muscle.
C) Relax the muscle completely
D) Tense the muscle fully.
A) The day before the surgery is scheduled
B) While she is in the post-anesthesia care unit.
C) When she is in pain and wants to learn how to obtain relief.
D) After receiving a dose of medication from the PCA pump.
When is the best time to teach Wrenda about use of the PCA?
What is the rationale for combining these 2 ingredients?
A) The antagonistic effect of the 2 medications reduces the risk for adverse effects.
B) The synergistic effect of the 2 medications improves pain control.
C) The combination effect decreases the risk for significant allergic reactions.
D) The equianalgesic effect allows each medication to work more efficiently.
A) "You were receiving the docusate sodium (Colace) because morphine is very constipating. You will no longer need to take it."
B) "Schedule III medications such as hydrocodone/acetaminophen tend to be more constipating than schedule II medications such as morphine."
C) "The stool softener should have been discontinued as soon as your bowel sounds returned after surgery."
D) "You may need to continue the docusate sodium (Colace) because most opioid analgesics, including hydrocodone/acetaminophen (Vicodin), cause constipation."
What is the priority nursing intervention?

A) Assess the client for signs of drug-seeking behavior.
B) Ask the other nurses what behaviors they have observed.
C) Arrange to continue the conversation in a more private location.
D) Inform the other nurses that the client is not a drug addict.
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