A hospice client who has been experiencing chronic pain is concerned that a transdermal analgesic will not adequately manage the pain. The client is unsatisfied with the sedation received from oral opioid medication. Which explanation by the nurse provides the best information to address this client's concern?

"The patch will work quickly and effectively to manage your pain."

"The patch will give you a longer duration of pain relief especially during sleep."

"The patch has creams and oils imbedded in it to prevent friction and shearing which can lead to skin breakdown."

"The patch will maintain consistent levels of the drug in your blood. We may be able to supplement with another pain medication until pain control is reached."

Answer and Explanation

The Correct Answer is D

A. "The patch will work quickly and effectively to manage your pain.": Transdermal patches have a slow onset of action, often taking 12 to 24 hours to reach therapeutic steady-state levels. Promising a "quick" result is medically inaccurate and mismanages the client's expectations for relief. Patches are designed for long-term maintenance rather than rapid acute analgesia.

B. "The patch will give you a longer duration of pain relief especially during sleep.": While true that patches provide long-acting relief, this statement does not address the client's primary concern about adequacy or previous dissatisfaction with sedation. It fails to explain the pharmacokinetic advantage of consistent dosing over intermittent oral boluses. It provides incomplete education regarding the transition.

C. "The patch has creams and oils imbedded in it to prevent friction and shearing which can lead to skin breakdown.": This is a physiological falsehood regarding the construction of transdermal delivery systems. Patches contain a drug reservoir and an adhesive, but they are not designed as skin-protective barriers against mechanical shearing. Their purpose is systemic drug delivery, not localized dermatological protection.

D. "The patch will maintain consistent levels of the drug in your blood. We may be able to supplement with another pain medication until pain control is reached.": Continuous delivery avoids the "peaks" and "troughs" associated with oral meds, which often cause excessive sedation at peak and pain at trough. Informing the client about supplemental "breakthrough" medication provides a safety net during the slow onset period of the transdermal system.

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Free Nursing Study Resources

Correct Answer is ["A","C","D","F"]

Explanation

A. Edema: Venous insufficiency leads to poor return of blood from the lower extremities, causing fluid accumulation in the interstitial tissues. This manifests as leg swelling (edema), which is a hallmark of venous disease.

B. Pale wound bed: A pale wound bed is more characteristic of arterial ulcers, which result from poor oxygenation and perfusion. Venous ulcers usually have a ruddy, beefy red wound bed due to adequate arterial inflow but impaired venous return.

C. Itchy dry scaly skin: Chronic venous stasis causes skin changes such as stasis dermatitis. Patients often report itching, dryness, and scaling due to impaired circulation and inflammatory changes in the skin.

D. Large amount of drainage: Venous ulcers typically produce copious exudate because of high hydrostatic pressure in the veins, which forces fluid out into the wound bed. This is one of the distinguishing features compared to arterial ulcers, which are usually dry.

E. Wound edges surrounded by calloused tissue: Calloused wound edges are more typical of neuropathic/diabetic ulcers, especially on pressure points of the foot. Venous ulcers usually have irregular, shallow edges without callus formation.

F. Hyperpigmentation of the skin surrounding the ulcerated area: Long-standing venous hypertension causes red blood cells to leak into surrounding tissues. Breakdown of hemoglobin deposits hemosiderin, leading to brownish discoloration (hyperpigmentation) around the ulcer site.

A. No adjustment unless the IV route was used B. A decreased dose due to declining physiological function C. An increased dose due to incomplete physiological functioning D. No adjustment as a greater therapeutic response is expected from the elderly client

Correct Answer is B

Explanation

A. No adjustment unless the IV route was used: The route of administration does not negate the necessity for dosage titration in geriatric populations. Intravenous delivery bypasses first-pass metabolism but still relies on hepatic and renal clearance. Pharmacokinetic changes in the elderly affect all systemic pharmacological interventions.

B. A decreased dose due to declining physiological function: Age-related reductions in glomerular filtration rate and hepatic blood flow prolong drug half-life. Accumulation of active metabolites increases the risk of systemic toxicity and adverse drug events. Lowering the total dose ensures plasma concentrations remain within the therapeutic window.

C. An increased dose due to incomplete physiological functioning: Raising the dosage in a client with impaired clearance would lead to dangerous drug accumulation. Incomplete physiological functioning implies a reduced capacity to process and eliminate chemical substances. This action would likely precipitate an overdose or severe side effects.

D. No adjustment as a greater therapeutic response is expected from the elderly client: While elderly clients may be more sensitive to certain drugs, this does not justify maintaining standard doses. A prolonged half-life indicates the drug persists in the bloodstream longer than intended. Adjustments are required to prevent physiological harm regardless of the perceived response.

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Naxlex Comprehensive Predictor Exams

In assessing a venous ulcer, which findings does the nurse anticipate being consistent with this type of wound? (Select all that apply)

Correct Answer is ["A","C","D","F"]

Explanation

If a medication remains in the body of an elderly client for a longer period of time resulting in a longer half-life of the medication, what dosage adjustment would the nurse anticipate to be prescribed?

Correct Answer is B

Explanation

The nurse is caring for a client who is being treated for opioid dependence. The client received their second dose of sublingual buprenorphine (Suboxone) at 0630. It is now 0800. Which of the following assessment finding(s) prompts the nurse to contact the healthcare provider?

A nurse is reviewing documentation describing a client's wound of right foot and heel. Which of the noted assessments indicate to the nurse that there is a problem with wound healing? (Select All That Apply)

The nurse is planning care for a client who is unconscious and immobile. Which physiological problem may result from cardiovascular changes for this client?

The healthcare provider has ordered hydrocolloid dressings as part of a wound treatment plan. In teaching the client how to perform the wound care, what purpose does the nurse identify for the use of the hydrocolloid dressings?

The nurse is caring for an immobile client and identifies these findings: Painful, persistent non-blanchable erythema at site of right greater trochanter. Skin remains intact. How would the nurse identify these findings in documentation?

Prior to the administration of morphine for a first day postoperative client who is experiencing severe pain, what action should the nurse perform first?

The nurse is reviewing the absorption of a client's prescribed medication. Which factor would influence the absorption of the medication?

A client, who has developed peritonitis, is receiving gentamicin 1 g IV q8h. The medication is administered on the following schedule: 0600, 1400, and 2200 and is to infuse for 30 minutes. The 1400 dose has begun infusing. When should the peak blood level be drawn?