A postoperative patient is using patient-controlled analgesia (PCA) pump. You will evaluate the effectiveness of the medication when

Family members report that pain has subsided

Vital signs have returned to baseline

Body language is incongruent with reports of pain relief

You compare assessed pain with baseline pain

Answer and Explanation

The Correct Answer is D

A. Family members report that pain has subsided. Pain is a subjective experience, and the patient's own report is the most reliable indicator of pain relief, not the observations of family members.
B. Vital signs have returned to baseline. While pain can affect vital signs, such as increasing heart rate or blood pressure, their return to normal does not necessarily indicate adequate pain relief. Some patients may still experience significant pain despite stable vital signs.
C. Body language is incongruent with reports of pain relief. Nonverbal cues can be helpful in assessing pain, but they should not override the patient’s self-reported pain level, which is the most accurate measure.
D. You compare assessed pain with baseline pain. The best way to evaluate the effectiveness of PCA analgesia is to assess the patient’s pain level before and after medication administration, comparing it to baseline pain. This provides an objective measure of pain relief.

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Correct Answer is ["15"]

Explanation

Calculation:

To determine the volume to administer, use the formula:

Volume = (Dose ordered/ Dose available)× mL per dose

Given:

Ordered dose = 37.5 mg
Available concentration = 12.5 mg/5 mL

Volume = (37.5/12.5)× 5mL

= 3× 5mL

= 15mL

Thus, the nurse will administer 15 mL.

A. 40-year-old with a pulse of 88 B. 18-year-old with a pulse rate of 140 after riding 2 miles on an exercise bike C. 50-year-old man with a BP of 112/60 mmHg on awakening in the morning D. 65-year-old with a respiratory rate of 10/min

Correct Answer is D

Explanation

A. 40-year-old with a pulse of 88. A resting pulse of 88 beats per minute is within the normal adult range (60–100 bpm) and does not require further assessment.
B. 18-year-old with a pulse rate of 140 after riding 2 miles on an exercise bike. An increased heart rate after exercise is a normal physiological response, and the heart rate should return to baseline after rest. No further assessment is needed unless tachycardia persists.
C. 50-year-old man with a BP of 112/60 mmHg on awakening in the morning. This blood pressure is within a normal range, especially in the early morning when BP is often lower. No additional assessment is required.
D. 65-year-old with a respiratory rate of 10/min. A normal respiratory rate for an adult is 12–20 breaths per minute. A respiratory rate of 10 is lower than normal and may indicate respiratory depression, which could be caused by medications such as opioids, neurological issues, or other conditions requiring further evaluation.

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A postoperative patient is using patient-controlled analgesia (PCA) pump. You will evaluate the effectiveness of the medication when

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Naxlex Comprehensive Predictor Exams

The physician orders Benadryl elixir 37.5 mg po for hives. Available: 12.5mg/5 mL. How many milliliters will the nurse administer?

Correct Answer is ["15"]

Explanation

Which assessment requires the nurse to assess the patient further?

Correct Answer is D

Explanation

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