A client with a documented history of opioid abuse just had surgery and is prescribed a high dose of opioid analgesic. The nurse knows that an important consideration for this client is:

This client may have a high tolerance to opioids and require a higher dose for pain control

Clients with a history of opioid abuse should not be given an opioid analgesic

This client should wait until their pain is severe, 10/10 before taking a high dose opioid

The client's self-report of pain may not be trusted if they have a history of opioid abuse

Answer and Explanation

The Correct Answer is A

Choice A reason: This statement is true. This client may have a high tolerance to opioids and require a higher dose for pain control, as tolerance is a condition where the body becomes less responsive to the effects of a drug over time, and needs more of the drug to achieve the same effect. Tolerance can develop from chronic or repeated use of opioids, and can vary from person to person. The nurse should assess the client's pain level, history of opioid use, and response to the medication, and adjust the dose accordingly.

Choice B reason: This statement is false. Clients with a history of opioid abuse should not be denied an opioid analgesic, as opioids are effective and appropriate medications for acute pain management, especially after surgery. The nurse should not discriminate or stigmatize the client based on their history of opioid abuse, but rather provide compassionate and evidence-based care. The nurse should also use a multimodal approach to pain management, which involves using non-opioid analgesics, adjuvant medications, and non-pharmacological interventions, such as ice, heat, massage, or relaxation techniques.

Choice C reason: This statement is false. This client should not wait until their pain is severe, 10/10 before taking a high dose opioid, as this can result in poor pain control, increased stress, and delayed recovery. The nurse should encourage the client to take the medication as prescribed, and to report their pain level regularly. The nurse should also educate the client about the benefits of preventive analgesia, which involves taking the medication before the pain becomes severe, and maintaining a steady blood level of the drug.

Choice D reason: This statement is false. The client's self-report of pain may not be disregarded if they have a history of opioid abuse, as pain is a subjective and personal experience, and the client is the best judge of their own pain. The nurse should not assume that the client is exaggerating, lying, or drug-seeking, but rather respect and validate the client's pain report. The nurse should also use objective indicators of pain, such as vital signs, facial expressions, body movements, and behavioral changes, to support the client's pain assessment.

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Correct Answer is C

Explanation

Choice A reason: A 68-year-old patient with type 2 diabetes who has peripheral neuropathy and complains of burning foot pain is not the most urgent patient to assess. Peripheral neuropathy is a complication of diabetes that affects the nerves, especially in the feet and legs. It can cause symptoms such as numbness, tingling, burning, or pain. The nurse should assess the patient's foot condition, provide pain relief, and educate the patient on foot care. However, this patient is not in immediate danger, and can wait until the nurse finishes assessing the more critical patient.

Choice B reason: A 35-year-old patient with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL is not the most critical patient to assess. Type 1 diabetes is a condition where the pancreas does not produce any insulin, a hormone that helps the cells use glucose for energy. Patients with type 1 diabetes need to take insulin injections or use an insulin pump to control their blood glucose level. A blood glucose reading of 230 mg/dL is above the normal range of 70 to 130 mg/dL before meals, and indicates hyperglycemia (high blood sugar). The nurse should check the patient's insulin dose, monitor the patient's symptoms, and provide education on blood glucose management. However, this patient is not in life-threatening condition, and can wait until the nurse attends to the more serious patient.

Choice C reason: A 60-year-old patient with hyperosmolar hyperglycemic syndrome with dry oral mucosa and low urine output is the most important patient to assess. Hyperosmolar hyperglycemic syndrome (HHS) is a severe complication of diabetes that occurs when the blood glucose level is extremely high, usually above 600 mg/dL. HHS can cause dehydration, electrolyte imbalance, and coma. Dry oral mucosa and low urine output are signs of dehydration, which can lead to shock and organ failure. The nurse should assess the patient's vital signs, blood glucose level, fluid and electrolyte status, and neurological function. The nurse should also administer intravenous fluids, insulin, and electrolytes as prescribed by the health care provider. This patient is in a medical emergency, and needs immediate intervention.

Choice D reason: A 19-year-old patient with type 1 diabetes who was admitted with possible dawn phenomenon is not the most acute patient to assess. Dawn phenomenon is a condition where the blood glucose level rises in the early morning, usually between 2:00 AM and 8:00 AM. This is due to the release of hormones that increase the blood glucose level, such as growth hormone, cortisol, and glucagon. The nurse should review the patient's blood glucose records, adjust the insulin dose or timing, and provide education on how to prevent or manage the dawn phenomenon. However, this patient is not in a critical situation, and can wait until the nurse evaluates the more unstable patient.

A. Administer IV morphine sulfate 4 mg every 2 hours PRN B. Dextrose 5% in 0.9% sodium chloride, continuous infusion C. Infuse 5% dextrose in water at 125 mL/hr D. Neurologic assessment Q2 hours

Correct Answer is C

Explanation

Choice A reason: This statement is false. IV morphine sulfate is a pain medication that can be given as needed to the postoperative patient. It does not affect the serum sodium level.

Choice B reason: This statement is false. Dextrose 5% in 0.9% sodium chloride is a hypertonic solution that can be used to treat hyponatremia, or low serum sodium level. It provides both glucose and sodium to the patient.

Choice C reason: This statement is true. 5% dextrose in water is a hypotonic solution that can cause further dilution of the serum sodium level. It can worsen the hyponatremia and increase the risk of cerebral edema and seizures.

Choice D reason: This statement is false. Neurologic assessment Q2 hours is a necessary intervention for a patient with hyponatremia, as it can monitor for signs of neurologic deterioration such as confusion, lethargy, or coma.

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A client with a documented history of opioid abuse just had surgery and is prescribed a high dose of opioid analgesic. The nurse knows that an important consideration for this client is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After change-of-shift report, which patient will the nurse assess first?

Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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