The nurse has developed a pain management plan for a client who has a history of opioid drug abuse.
Which of the following statements by the client demonstrates understanding of the pain management plan?
“As soon as I feel any pain, I will ask the nurse to administer my medication.”
“My medication will be given at the scheduled times to best manage my pain.”
“The nurse will administer less pain medication than ordered due to my drug addiction.”
“I will not be allowed to take any narcotics for pain during my hospital admission.”.
The Correct Answer is B
“My medication will be given at the scheduled times to best manage my pain.” This statement demonstrates understanding of the pain management plan because it shows that the client knows the importance of preventing pain from becoming severe by taking medication regularly. Scheduled administration of analgesics is more effective than administering them on demand.
Choice A is wrong because it implies that the client will wait until the pain is severe before asking for medication, which can make it harder to control.
Choice C is wrong because it suggests that the client expects to receive inadequate pain relief due to their history of opioid abuse, which is not ethical or evidence-based.
Choice D is wrong because it indicates that the client believes they will be denied any narcotics for pain, which is also not ethical or
evidence-based. Clients with a history of opioid abuse can still receive opioids for acute pain, but they may need higher doses or more frequent administration to achieve adequate analgesia.
Normal ranges for vital signs are as follows: respiratory rate 12-20 breaths per minute, heart rate 60-100 beats per minute, blood pressure 120/80 mmHg, temperature 36.5-37.5°C (97.7- 99.5°F).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A 40-year-old client who has a blood pressure of 138/98 mm Hg should be referred for immediate treatment. This is because this client has grade 1 hypertension according to the International Society of Hypertension (ISH) guidelines, which define hypertension as a systolic blood pressure (SBP) of 140 mm Hg or higher and/or a diastolic blood pressure (DBP) of 90 mm Hg or higher in the office or clinic. This client also has a high risk of cardiovascular complications due to their age and elevated DBP.
Choice A is wrong because a 20-year-old client who has a blood pressure of 125/60 mm Hg does not have hypertension. This client has normal blood pressure according to the ISH guidelines, which define normal blood pressure as an SBP of less than 130 mm Hg and a DBP of less than 85 mm Hg in the office or clinic. This client also has a low risk of cardiovascular complications due to their age and low DBP.
Choice C is wrong because a 55-year-old client who has a blood pressure of 142/68 mm Hg does not need immediate treatment. This client has grade 1 hypertension according to the ISH guidelines, but their DBP is normal. The ISH guidelines recommend lifestyle interventions for three to six months before medication in patients with grade 1 hypertension and no comorbidities.
This client may have other risk factors that need to be assessed, such as obesity, diabetes, or smoking, but they do not require urgent referral.
Choice D is wrong because a 70-year-old client who has a blood pressure of 150/78 mm Hg does not need immediate treatment. This client has grade 1 hypertension according to the ISH guidelines, but their DBP is normal. The ISH guidelines recommend a target blood pressure of less than 140/90 mm Hg within three months for patients older than 65 years, and after three months reduce the target to less than 130/80 mm Hg.
This client may have other risk factors that need to be assessed, such as chronic kidney disease, heart failure, or atrial fibrillation, but they do not require urgent referral.
Correct Answer is B
Explanation
Self-determination. Self-determination is the ethical principle that respects the right of a person to make their own decisions. When a nurse respects the decision of a client who refuses a blood transfusion, the nurse is upholding this principle by acknowledging and protecting the client’s autonomy.
Choice A is wrong because beneficence is the ethical principle that involves actively seeking benefits or the promotion of good.
While a blood transfusion may be beneficial for the client, it is not the nurse’s role to impose their own judgment on the client’s choice.
Choice C is wrong because justice is the ethical principle that involves fairness and the just distribution of resources.
A blood transfusion is not a scarce resource that needs to be allocated among competing demands.
Choice D is wrong because fidelity is the ethical principle that involves keeping promises and being faithful to one’s commitments.
A blood transfusion is not a promise or a commitment that the nurse has made to the client.
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