A nurse is caring for a postoperative client who has an IV PCA delivering opioids. The client rates their pain as 2 on a scale of 0 to 10 and has not pressed the button to deliver a bolus dose in over 2 hr. Which of the following actions should the nurse take?

Inform the provider that the PCA is not providing adequate pain relief.

Ask the provider for a prescription to decrease the continuous rate.

Instruct the client to push the button more frequently.

Instruct the client's caregiver to push the PCA button when the client is resting.

Answer and Explanation

The Correct Answer is B

A. Informing the provider that the PCA is not providing adequate pain relief is not accurate in this scenario because the client rates their pain as 2, indicating that they are experiencing minimal discomfort.
B. Asking the provider for a prescription to decrease the continuous rate is appropriate since the client has not needed to deliver any bolus doses for over 2 hours, suggesting that the current continuous rate may be higher than necessary for their pain level. Adjusting the PCA settings can help to prevent potential over-medication and side effects while maintaining adequate pain control.
C. Instructing the client to push the button more frequently is unnecessary as the client is already reporting low pain levels and has not expressed a need for additional medication.
D. Allowing the caregiver to push the PCA button when the client is resting is not recommended because PCA systems are designed for patient-controlled analgesia, ensuring that the patient manages their own pain without risking over-medication.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

A. Flex the client's knees:
While knee flexion can reduce back strain in some situations (e.g., when lying supine), it is not recommended during repositioning for a back injury as it may cause unnecessary spinal movement.

B. Roll the client as one unit in a smooth, continuous motion:
Logrolling maintains spinal alignment and reduces stress or twisting of the spine, which is crucial for clients with back injuries or spinal conditions.

C. Place the client on the side of the bed nearest the direction they will be turned:
The client should be positioned centrally on the bed to prevent falls and ensure adequate space for a safe, controlled logroll.

D. Place the client's arms at their sides:
The client’s arms should typically be crossed over their chest to prevent them from becoming trapped or causing unnecessary spinal movement during the roll.

A. Read the medication label twice prior to administration B. Use one patient identifier prior to medication administration C. Ask the client if they have ever taken a similar medication. D. Access the online drug formulary for an unfamiliar medication

Correct Answer is D

Explanation

A. While reading the medication label is important, doing it twice prior to administration may not be necessary and could consume additional time.
B. Using one patient identifier is a standard practice for medication administration, but it may not specifically address ensuring the safety of administering a medication for the first time.
C. While it's important to assess the client's history of medication use, asking if they have taken a similar medication may not provide sufficient information about the specific medication being administered.
D. Accessing the online drug formulary for an unfamiliar medication helps the nurse verify the medication's indications, contraindications, dosage, and administration considerations, ensuring safe administration.

View Question and Answer

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

A nurse is caring for a postoperative client who has an IV PCA delivering opioids. The client rates their pain as 2 on a scale of 0 to 10 and has not pressed the button to deliver a bolus dose in over 2 hr. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to reposition a client who has a lower back injury. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is preparing to administer a medication to a client for the first time. Which of the following actions should the nurse take to help ensure safe medication administration?

Correct Answer is D

Explanation

A nurse is caring for a client who has a colostomy. Which of the following actions should the nurse take?

A nurse is caring for a client who has severe rheumatoid arthritis in her hands and is unable to feed herself. For which of the following health care team members should the nurse request a referral from the provider?

A nurse is caring for a client who has a terminal illness. The client states, "I am not giving up. I want as much treatment as possible." Which of the following responses should the nurse make?

A nurse is caring for a client who is anxious about being admitted to a health care facility for the first time. Which of the following statements should the nurse make?

A nurse is preparing to administer several medications via an NG tube to a client who is receiving a continuous tube feeding. Which of the following actions should the nurse take?

A nurse manager overhears a nurse telling a client. "I will administer your medication by injection if you don't swallow your pills." The nurse manager should identify that the nurse is committing which of the following torts?

A nurse is collecting a blood pressure (BP) reading from a client who is sitting in a chair. The nurse determines that the client's BP is 158/96 mm Hg. Which of the following actions should the nurse take?

A nurse is preparing to perform an anthropometric assessment on a client. Which of the following client data should the nurse include?