A client with metastatic cancer reports a pain level of 10 on a pain scale of 0 to 10. Twenty minutes after the nurse administers an IV analgesic, the client reports no pain relief. Which intervention is most important for the nurse to include in this client’s plan of care?

Administer analgesics on a fixed and continuous schedule.

Frequently evaluate the client’s pain.

Replace transdermal analgesic patches every 72 hours.

Monitor client for break-through pain.

Answer and Explanation

The Correct Answer is A

Choice A reason: Administering analgesics on a fixed and continuous schedule is the most important intervention that the nurse should include in this client’s plan of care, because it can provide consistent and adequate pain relief for the client with metastatic cancer, who is likely to have chronic and severe pain. The nurse should follow the principles of cancer pain management, such as using the WHO analgesic ladder, titrating the dose according to the pain intensity, and using a multimodal approach that combines opioids, non-opioids, and adjuvants.

Choice B reason: Frequently evaluating the client’s pain is an important intervention that the nurse should include in this client’s plan of care, but it is not the most important one. Evaluating the client’s pain can help the nurse to assess the effectiveness of the analgesics, identify the characteristics and causes of the pain, and adjust the pain management plan accordingly. However, evaluating the pain alone is not enough to provide pain relief, and the nurse should also implement the appropriate interventions based on the evaluation.

Choice C reason: Replacing transdermal analgesic patches every 72 hours is not a relevant intervention that the nurse should include in this client’s plan of care, because it is not applicable to the client’s situation. Transdermal analgesic patches are a form of opioid delivery that can provide long-lasting pain relief, but they are not suitable for acute or breakthrough pain, and they have a delayed onset of action. The client in this scenario is receiving IV analgesics, which have a faster onset and shorter duration of action, and are more appropriate for acute or breakthrough pain.

Choice D reason: Monitoring the client for break-through pain is an important intervention that the nurse should include in this client’s plan of care, but it is not the most important one. Break-through pain is a sudden and transient increase in pain that occurs despite the use of regular analgesics, and it can be caused by various factors, such as movement, infection, or tumor progression. The nurse should monitor the client for break-through pain and administer rescue doses of analgesics as needed. However, monitoring the client for break-through pain is not enough to prevent or treat the pain, and the nurse should also administer analgesics on a fixed and continuous schedule to maintain a steady level of pain relief.

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Correct Answer is B

Explanation

Choice A reason: Corticosteroid cream was applied to eczema is not a useful information in determining the possible cause of the symptoms, because it is a treatment that can reduce the inflammation and itching of eczema, not a trigger that can worsen it. Corticosteroid cream should be used as prescribed by the doctor, and the nurse should instruct the client on how to apply it correctly and safely.

Choice B reason: A grandson and his new dog recently visited is a useful information in determining the possible cause of the symptoms, because it can indicate that the client was exposed to an allergen or an irritant that can trigger an eczema flare-up. Some people with eczema may have allergic reactions to animal dander, saliva, or fur, which can cause skin inflammation, redness, and itching. The nurse should ask the client about their history of allergies and their contact with the dog, and advise them to avoid or minimize exposure to potential allergens.

Choice C reason: An old friend with eczema came for a visit is not a useful information in determining the possible cause of the symptoms, because eczema is not a contagious condition that can be transmitted from person to person. Eczema is a chronic skin disorder that causes dry, itchy, and inflamed skin, and it is influenced by genetic, environmental, and immune factors. The nurse should reassure the client that eczema is not infectious and that they can maintain social relationships with other people with eczema.

Choice D reason: Recently received an influenza immunization is not a useful information in determining the possible cause of the symptoms, because there is no evidence that influenza immunization can cause or worsen eczema. Influenza immunization is a preventive measure that can protect the client from getting the flu, which can be a serious and sometimes fatal illness, especially for people with chronic conditions, such as eczema. The nurse should encourage the client to get vaccinated for influenza and other diseases, as recommended by the doctor.

A. Has everyone at home already had varicella? B. Have the antifungal creams been effective? C. Do you have any dry patches on your feet and hands? D. Do your family members share combs and brushes?

Correct Answer is A

Explanation

Choice A reason: Varicella is another name for chickenpox, which is caused by the varicella-zoster virus. Herpes zoster, also known as shingles, is a reactivation of the same virus that causes a painful rash along a nerve pathway. People who have had chickenpox are at risk of developing shingles later in life, especially if their immune system is weakened. Asking the client if everyone at home has already had varicella can help the nurse determine the risk of transmission and the need for isolation precautions.

Choice B reason: Antifungal creams are not effective for herpes zoster, which is caused by a virus, not a fungus. Antifungal creams are used to treat fungal infections, such as athlete's foot, ringworm, or candidiasis. Asking the client if the antifungal creams have been effective is not relevant to the condition and can indicate a lack of knowledge or a misdiagnosis.

Choice C reason: Dry patches on the feet and hands are not typical signs of herpes zoster, which usually causes a blistering rash along a nerve pathway. Dry patches on the feet and hands can be caused by other conditions, such as eczema, psoriasis, or diabetes. Asking the client if they have any dry patches on their feet and hands is not helpful to assess the condition and can divert the attention from the main problem.

Choice D reason: Sharing combs and brushes is not a common mode of transmission for herpes zoster, which is spread by direct contact with the fluid from the blisters. Sharing combs and brushes can transmit other infections, such as lice, scabies, or impetigo. Asking the client if their family members share combs and brushes is not pertinent to the condition and can imply a poor hygiene or a stigma.

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A client with metastatic cancer reports a pain level of 10 on a pain scale of 0 to 10. Twenty minutes after the nurse administers an IV analgesic, the client reports no pain relief. Which intervention is most important for the nurse to include in this client’s plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During a home visit, the nurse assesses the skin of a client with eczema who reports that an exacerbation of symptoms has occurred during the last week. Which information is most useful in determining the possible cause of the symptoms?

Correct Answer is B

Explanation

The nurse is assessing a client who has herpes zoster. Which question will allow the nurse to gather further information about this condition?

Correct Answer is A

Explanation

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