A nurse is teaching a client who had a total knee arthroplasty about self-administering morphine via a patient-controlled analgesia (PCA) infusion device.
Which of the following client statements indicates an understanding of the teaching?
"I should only use the device when it's absolutely necessary.”.
"I'll be careful about pushing the button so I don't overdose.”.
"I will ask my family to push the dose button when I am asleep.”.
"I should tell the nurse if I can't control my pain with this device.”.
The Correct Answer is D
Choice A rationale
Patient-controlled analgesia is designed to allow patients to manage their pain proactively. Waiting until the pain is severe before using the device can lead to inadequate pain control and increased discomfort. The goal of PCA is to maintain a consistent level of analgesia by allowing the patient to self-administer small doses as needed.
Choice B rationale
PCA devices are programmed with safety limits, including lockout intervals and maximum doses, to prevent accidental overdosing. While the patient should understand how to use the button, the primary responsibility for preventing overdose lies with the device's safety mechanisms and the healthcare team's programming.
Choice C rationale
Allowing family members to push the PCA button bypasses the safety mechanisms built into the device, which are based on the patient's demand for pain relief. This practice can lead to over-sedation and respiratory depression if the patient is not the one experiencing the pain and needing the medication. The patient must be the only one to activate the PCA device.
Choice D rationale
If the PCA device is not effectively controlling the patient's pain, it indicates a need for reassessment of the medication, dosage, or delivery method. The nurse can then collaborate with the provider to make necessary adjustments to ensure adequate pain management. This statement demonstrates the client's understanding of the importance of communicating their pain level.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Stretching exercises primarily improve flexibility and range of motion by elongating muscles and connective tissues. While beneficial for overall fitness, they do not directly address bone density loss, which is the primary concern in osteoporosis. Osteoporosis requires weight-bearing activities to stimulate bone formation.
Choice B rationale
Riding a bicycle is a low-impact aerobic exercise that improves cardiovascular health and muscle strength. However, because it is non-weight-bearing, it does not provide the mechanical stress necessary to promote bone density and is therefore not the most effective exercise for osteoporosis management.
Choice C rationale
High-impact aerobics, such as jumping and running, can increase the risk of fractures in individuals with osteoporosis due to the stress placed on weakened bones. These types of exercises should generally be avoided to prevent injury.
Choice D rationale
Walking briskly is a weight-bearing exercise that applies moderate stress to the bones, stimulating osteoblast activity and promoting bone density. Regular brisk walking can help slow bone loss and reduce the risk of fractures in older adults with osteoporosis.
Correct Answer is B
Explanation
Choice A rationale
Weight loss can occur at various stages of rheumatoid arthritis due to chronic inflammation and increased metabolic demands. While it can be present later in the disease, it is not specifically identified as a late manifestation. Systemic inflammation leads to the release of pro-inflammatory cytokines, which can affect appetite and metabolism, contributing to weight changes throughout the course of the disease.
Choice B rationale
Knuckle deformities, such as swan neck and boutonniere deformities, are characteristic late manifestations of rheumatoid arthritis. These deformities result from chronic inflammation and synovial proliferation leading to damage of the tendons, ligaments, and joint capsule around the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Over time, this causes the characteristic changes in finger alignment.
Choice C rationale
Low-grade fever can be a systemic manifestation of the inflammatory process in rheumatoid arthritis, but it is more commonly seen during active flares and is not specifically classified as a late manifestation. The fever is a result of the release of pyrogens, such as interleukin-1 and tumor necrosis factor-alpha, during periods of heightened immune activity. Normal body temperature ranges from 97.8°F to 99.1°F (36.5°C to 37.3°C).
Choice D rationale
Anorexia, or loss of appetite, can be associated with the chronic pain and systemic inflammation of rheumatoid arthritis at any stage. Inflammatory cytokines can affect appetite regulation in the hypothalamus. While it might persist in later stages, it is not a definitive late manifestation compared to structural joint changes.
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