The correct answer is D. "I will call for pain medication before the previous dose wears off."

Choice A rationale:

This statement indicates a misunderstanding of pain management. Avoiding medication to prevent addiction can lead to uncontrolled pain, which can hinder recovery and increase the risk of complications.

Choice B rationale:

While this statement shows the client is aware of their pain, waiting until it becomes intolerable can result in periods of severe discomfort and potential setbacks in recovery.

Choice C rationale:

Relying on a nurse to evaluate pain before requesting medication can delay pain relief, leading to unnecessary suffering and potential complications.

Choice D rationale:

This statement indicates an understanding of proactive pain management. By requesting medication before the previous dose wears off, the client helps maintain consistent pain control, which is crucial for recovery and preventing pain escalation.

Choice A rationale:

This statement is not accurate and may confuse the client. In a Patient-Controlled Analgesia (PCA) system, a predetermined dose is delivered when the patient activates the device. The dose is usually controlled to prevent excessive medication administration.

Choice B rationale:

This statement is correct. The essence of PCA is that the patient has control over administering their pain medication within set limits or time intervals. The patient can self-administer doses when needed, ensuring effective pain management.

Choice C rationale:

Allowing the partner to push the PCA button for the patient is not recommended. PCA systems are designed to be controlled by the patient themselves to prevent potential overdosing. Involving someone else in the administration can lead to safety concerns.

Choice D rationale:

PCA systems do not deliver medication into the muscle. They typically deliver medication intravenously (IV) or subcutaneously. This statement is inaccurate and could lead to misconceptions about how the PCA system works.

Choice A rationale:

Placing electrodes on all four extremities is not the initial step in using a Transcutaneous Electrical Nerve Stimulator (TENS) unit. It may not be necessary for the specific pain management needs of the patient and can be uncomfortable or impractical.

Choice B rationale:

This is the correct initial step when starting TENS treatment. The nurse should adjust the settings to a level below the threshold at which the patient feels a tingling sensation. This ensures that the treatment is comfortable and safe for the patient. The goal is to provide pain relief, not to induce discomfort.

Choice C rationale:

Turning the unit on before attaching it to the patient is not advisable. It's essential to connect the electrodes to the patient first and then turn on the TENS unit. This sequence helps prevent accidental electrical stimulation before the device is properly set up.

Choice D rationale:

Applying conductive jelly to uncoated electrodes is a step in preparing the electrodes for use, but it should be done after attaching the electrodes to the patient's skin. This choice does not address the initial step in TENS treatment, which is setting the stimulation level. .

Choice A rationale:
Patient-controlled analgesia (PCA) is a method of pain management that allows the patient to administer their own pain medication within specified limits, but it doesn't reduce the workload of the nurse. The nurse is responsible for setting up and monitoring the PCA pump, educating the patient, assessing their pain, and ensuring safety. Therefore, this choice is incorrect.
Choice B rationale:
PCA does not completely eliminate pain. It provides the patient with control over their pain relief by allowing them to self-administer medication within preset limits. However, it does not guarantee the complete absence of pain. Pain relief is provided within a safe dosage range, but some level of pain may still be experienced. Therefore, this choice is incorrect.
Choice C rationale:
PCA does not eliminate the risk of adverse drug effects entirely. The nurse must monitor the patient for signs of adverse effects, such as respiratory depression or sedation. While the patient has control over medication administration, there are still risks associated with opioid analgesics. Therefore, this choice is incorrect.
Choice D rationale:
The principal advantage of using patient-controlled analgesia (PCA) is that it reduces patient anxiety about pain by giving the patient more control over its management. This choice is correct because PCA empowers the patient to self-administer pain medication when needed, which can lead to better pain control and reduced anxiety. The nurse sets safe dosage limits and monitors the patient, ensuring safety while providing a sense of control.

Choice A rationale:

If a patient with a Fentanyl patch is experiencing symptoms like abnormal sleepiness, slurred speech, and unsteadiness when ambulating, it could indicate an overdose or adverse reaction to the Fentanyl. In such cases, the patch should be removed immediately to stop the further absorption of the drug. Wiping off the skin can also help remove any residual medication. This is the correct choice as it addresses the issue at its source.

Choice B rationale:

Applying ice to the skin around the Fentanyl patch is not the appropriate action in this situation. Ice will not counteract the effects of a Fentanyl overdose or adverse reaction. The priority is to remove the patch and seek medical attention.

Choice C rationale:

Elevating the head of the bed and offering coffee or cola may be useful in combating some forms of sleepiness but would not be effective for someone experiencing an overdose or adverse reaction to Fentanyl. This choice does not address the problem's root cause and is not the appropriate action to take.

Choice D rationale:

Putting up the side rails on the bed does not address the issue of Fentanyl patch overdose or adverse reactions. This choice is not relevant to the situation and should not be chosen.

Choice A rationale:

It is not advisable to use sedative pills for long periods of time without consulting a primary care provider. Prolonged use of sedatives can lead to dependence and other adverse effects. Therefore, this choice is incorrect.

Choice B rationale:

Using sedative pills for short periods of time without physician approval is not a safe practice. Even nonprescription medications, including over-the-counter sedatives, should be used under the guidance of a healthcare provider. This choice is incorrect.

Choice C rationale:

The best advice for the patient is to use sedative pills for short periods of time, but it is best to check with the primary care provider first. This is the most appropriate choice as it emphasizes short-term use while also promoting communication with a healthcare provider to ensure the medication's safety and effectiveness.

Choice D rationale:

Using sedative pills for long periods of time without primary care provider approval is not recommended. It can lead to potential risks and side effects associated with prolonged sedative use. Therefore, this choice is incorrect.

Choice A rationale:

Sleeping with the window open for fresh air may not be the best solution in this scenario. While fresh air can be beneficial for sleep, it might not effectively block out the noise from the freeway and the nearby apartment complex. Furthermore, depending on the climate and location, having the window open might lead to discomfort or temperature-related issues.

Choice B rationale:

Performing exercise at bedtime is not a recommended solution for someone experiencing difficulty sleeping due to external noise. Exercise before bedtime can increase alertness and make it even more challenging to fall asleep, especially if it's vigorous exercise. It may exacerbate the problem rather than alleviate it.

Choice C rationale:

Having a couple of drinks at bedtime is not a suitable solution for sleep problems. Alcohol can disrupt sleep patterns and lead to poor-quality sleep. It may help the patient fall asleep initially but can lead to frequent awakenings and a less restful night's sleep.

Choice D rationale:

The correct choice is to wear soft earplugs for sleep. Soft earplugs can effectively reduce or block out external noise, providing a quieter sleep environment. This is a practical and safe solution to address the noise issue in the patient's apartment complex. It promotes better sleep quality without any negative side effects.

Choice A rationale:

A patient with a decreased level of consciousness from a stroke may not be able to provide feedback or recognize discomfort or pain, which can increase the risk of burn injury when using a heating pad. This choice increases the risk rather than reducing it.

Choice B rationale:

A patient with neuritis secondary to diabetes has a decreased sensitivity in the affected area due to nerve damage. While this can be a challenging condition, it reduces the patient's ability to perceive heat and pain, making them less likely to realize if the heating pad becomes too hot. As a result, this patient has the least risk for burn injury when using the Aquathermia K pad.

Choice C rationale:

A severely sprained ankle is not related to the risk of burn injury from a heating pad. This choice is not relevant to the assessment of burn injury risk with the Aquathermia K pad.

Choice D rationale:

Impaired peripheral circulation can increase the risk of burn injury from a heating pad. Patients with compromised circulation have a reduced ability to dissipate heat, which can lead to localized overheating and potential burn injury. This choice increases the risk of injury. .

Choice A rationale:

NREM (Non-Rapid Eye Movement) sleep is characterized by slow-wave sleep and is often considered restorative. It is the stage of sleep where the body repairs and regenerates tissues, and it is essential for feeling rested and rejuvenated. NREM sleep consists of three stages, with stages 3 and 4 being the deepest and most restful, also known as slow-wave sleep. These stages are essential for physical recovery.

Choice B rationale:

NREM sleep is not characterized by irregular respirations. Irregular breathing patterns are more commonly associated with certain sleep disorders, such as sleep apnea, rather than NREM sleep itself.

Choice C rationale:

NREM sleep is not characterized by increased heart rate. In fact, during NREM sleep, the body typically experiences a decrease in heart rate and blood pressure. The body's physiological functions tend to slow down during NREM sleep to promote rest and recovery.

Choice D rationale:

NREM sleep is not characterized by daytime activity. In contrast, NREM sleep occurs during the night and is a state of deep rest, during which the body is not engaged in daytime activities. It is essential for physical and mental recovery, especially after a day of activity.

Choice A rationale:

The nurse recommends that normal sleep and rest patterns can best be acquired by suggesting that the patient exercises in the mornings. Morning exercise can help regulate the circadian rhythm and improve sleep-wake patterns. It helps to reset the internal body clock, making it easier to fall asleep at night. However, exercise should not be too close to bedtime, as it may have a stimulating effect.

Choice B rationale:

Taking a nap during the day may provide a short-term boost in alertness but is not recommended as the primary method to acquire normal sleep and rest patterns. Daytime naps should be brief (20-30 minutes) and should not interfere with nighttime sleep. Excessive daytime napping can disrupt the regular sleep cycle.

Choice C rationale:

Drinking wine is not a recommended approach for acquiring normal sleep and rest patterns. Alcohol consumption, especially in the evening, can disrupt sleep cycles and negatively affect the quality of sleep. It may lead to frequent awakenings during the night and contribute to sleep disturbances.

Choice D rationale:

Smoking cigarettes is not a recommended approach for acquiring normal sleep and rest patterns. Nicotine is a stimulant that can interfere with sleep by increasing alertness and heart rate. Smoking can contribute to sleep difficulties and should be avoided, especially close to bedtime. .