A nurse is caring for a client who is using a patient-controlled analgesia (PCA) pump for postoperative pain management.
The nurse enters the room to find the client asleep and his partner pressing the button to dispense a dose of analgesia.
Which of the following responses should the nurse make?
"Your husband should decide when more medication is needed.”.
"Why do you think your husband needs more medication when he is asleep?".
"It's a good idea to help make sure your husband can sleep comfortably.”.
"Next time you think he needs more medication, call me and I'll push the button.”.
The Correct Answer is B
The correct answer is choice B. "Why do you think your husband needs more medication when he is asleep?"
Choice A rationale:
"Your husband should decide when more medication is needed.” This response is incorrect because it implies that the partner has the authority to decide when the client needs pain medication, which violates the purpose of a PCA pump. A PCA pump is specifically designed for client-controlled pain management, ensuring that the patient, not anyone else, controls when they receive pain medication. Allowing someone else to press the button can lead to overmedication and safety risks.
Choice B rationale:
"Why do you think your husband needs more medication when he is asleep?" This response is correct because it prompts the partner to reflect on their actions and provides an opportunity for the nurse to educate about the proper use of PCA pumps. It addresses the immediate issue without being confrontational and opens the door for further discussion on the importance of client safety and correct PCA use.
Choice C rationale:
"It's a good idea to help make sure your husband can sleep comfortably.” This response is incorrect as it endorses inappropriate and unsafe behavior. It encourages the partner to continue pressing the PCA button, risking the client's safety due to potential overmedication, which can lead to severe complications, such as respiratory depression.
Choice D rationale:
"Next time you think he needs more medication, call me and I'll push the button.” This response is incorrect because it contradicts PCA protocols and removes the control from the client. The nurse is responsible for monitoring the client’s pain and safety, not administering medication upon another person’s request. This approach also increases the risk of dosing errors and undermines the purpose of patient-controlled analgesia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice C rationale:
Keeping a night light on in the room is the most helpful intervention for a child having difficulty falling asleep. Night lights provide a comforting and soothing environment, reducing the fear of the dark and making the child feel secure. It also helps prevent complete darkness, which can be particularly helpful for children who may be afraid of the dark. This intervention promotes a positive sleep environment and can facilitate the child's ability to fall asleep.
Choice A rationale:
Giving juice and cookies before bedtime is not an appropriate intervention to help a child fall asleep. In fact, providing sugary snacks before bedtime can lead to increased activity and may make it even more challenging for the child to sleep.
Choice B rationale:
Having the parents bring a favorite blanket or pillow from home is a nice gesture and can provide comfort to the child, but it may not directly address the issue of falling asleep. While it can be part of creating a familiar and comforting sleep environment, it may not be sufficient on its own to help the child fall asleep.
Choice D rationale:
Turning off all the lights in the room may not be the best approach, as complete darkness can be frightening for some children. It's important to strike a balance between creating a soothing sleep environment and avoiding overwhelming darkness, which is why keeping a night light on is often a better option.
Correct Answer is D
Explanation
Choice A rationale:
Some older adults may indeed have concerns about taking pain medication, but this is not a primary reason for their hesitance to express pain. The fear of taking medication is not a universal characteristic of older adults.
Choice B rationale:
While older adults may be reluctant to bother nursing staff, this is not the primary reason for their reluctance to express pain. It is a consideration but not the main factor.
Choice C rationale:
The unawareness of discomfort is not a common reason for older adults to avoid expressing pain. Most older adults are aware of their discomfort but may not express it for other reasons.
Choice D rationale:
Older adults may have been culturally trained not to complain about pain or discomfort. In some cultures, stoicism and not burdening others with one's pain are highly valued. This cultural training can lead older adults to underreport their pain.
Choice E rationale:
Believing pain is a natural consequence of aging is a misconception, but it is not the primary reason why older adults may not express their pain. They may believe this, but cultural and societal factors have a more significant impact.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.