A patient has a morphine sulfate patient-controlled analgesia (PCA) to control postoperative pain. When the nurse enters the room, the patient complains of pain. The nurse's first response is which of the following?

Ask the patient to rate the pain on a 0-to-10 scale.

Call the physician or health care provider immediately.

Check the patency of the patient's intravenous line.

Speak to the patient in a calming tone to reduce anxiety.

Answer and Explanation

The Correct Answer is A

A. Ask the patient to rate the pain on a 0-to-10 scale. Pain is subjective, and the first step in pain management is assessment. Asking the patient to rate their pain helps determine the severity and whether adjustments to pain management are needed.
B. Call the physician or health care provider immediately. Contacting the provider may be necessary if the pain is uncontrolled, but the nurse must assess the pain level first before deciding if intervention is needed.
C. Check the patency of the patient's intravenous line. While an IV line is essential for PCA function, the priority is assessing the patient’s pain level before troubleshooting the equipment.
D. Speak to the patient in a calming tone to reduce anxiety. Although a calm demeanor is beneficial, it does not address the patient’s pain directly. Pain assessment is the first priority.

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Correct Answer is B

Explanation

A. Brachial artery. The brachial pulse is commonly used in infants but is not the best choice for assessing circulation in an unconscious adult.
B. Carotid artery. The carotid artery is the preferred site for assessing a pulse in an unconscious adult because it is a central pulse with strong circulation, even in low-perfusion states.
C. Radial artery. The radial pulse is a peripheral pulse and may be difficult to palpate if the patient has poor circulation or cardiac arrest. The carotid pulse is more reliable in emergencies.
D. Apical artery. There is no apical artery; the apical pulse is auscultated over the heart with a stethoscope and is not used in emergency pulse checks.

Correct Answer is ["2"]

Explanation

Calculation:

To determine the number of tablets per dose, use the formula:

Tablets per dose = Dose ordered/ Dose available

Given:

Ordered dose = 10 mg
Available dose = 5 mg per tablet

Tablets per dose = 10mg/ (5mg/tablet)

= 2 tablets

Thus, the nurse will administer 2 tablets per dose.

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A patient has a morphine sulfate patient-controlled analgesia (PCA) to control postoperative pain. When the nurse enters the room, the patient complains of pain. The nurse's first response is which of the following?

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