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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Elevated blood pressure. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure by relaxing blood vessels. It does not cause an increase in blood pressure.
B. Angioedema. A serious but rare side effect of ACE inhibitors like Lisinopril is angioedema, which involves swelling of the face, lips, tongue, or throat. This condition can be life-threatening due to airway obstruction, requiring immediate medical attention.
C. Intestinal ileus. Lisinopril does not typically cause an intestinal ileus. This condition is more commonly associated with medications that affect gastrointestinal motility, such as opioids or anticholinergics.
D. Delirium. While some medications can cause delirium, Lisinopril does not have central nervous system effects that would commonly lead to confusion or altered mental status.
Correct Answer is ["90"]
Explanation
Calculation:
To convert fluid ounces (FL OZ) to milliliters (mL), the conversion factor is:
1FL OZ = 30mL
Given:
= (3 FL OZ × 30mL)/1 FL OZ
= 90mL
Thus, 3 FL OZ = 90 mL.
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