The nurse is caring for a client who is experiencing chronic pain from metastatic cancer. Which principle of pain management is most effective for this client?

Administer the pain mediation around the clock if necessary.

Initiate techniques to limit the amount of opioids administered.

Administer the analgesic promptly as soon as the client's pain becomes severe.

Administer medications intravenously for greater duration of the drug's effectiveness.

Answer and Explanation

The Correct Answer is A

A. Administer the pain mediation around the clock if necessary: For chronic cancer pain, "around the clock" (ATC) dosing maintains a steady therapeutic plasma concentration of the analgesic. This prevents the "cycling" of pain and the difficult task of treating breakthrough pain after it has become severe. Steady-state dosing improves overall quality of life.

B. Initiate techniques to limit the amount of opioids administered: In terminal or metastatic cancer care, the priority is effective palliation and comfort rather than preventing opioid dependence or limiting dosages. Fear of addiction should not impede the administration of adequate analgesia for patients with life-limiting malignancies and severe pain.

C. Administer the analgesic promptly as soon as the client's pain becomes severe: Waiting for pain to become severe before medicating makes it much harder to achieve relief and often requires higher total doses. This "PRN" approach is less effective for chronic, persistent pain than a proactive, scheduled dosing regimen.

D. Administer medications intravenously for greater duration of the drug's effectiveness: The intravenous route actually has the shortest duration of action due to rapid distribution and elimination. For chronic pain, oral or transdermal routes are preferred as they provide a more sustained and long-lasting analgesic effect compared to IV boluses.

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Free Nursing Study Resources

Correct Answer is ["A","B"]

Explanation

A. Slough noted at the center of the wound: Slough consists of non-viable cellular debris and fibrin that provides a medium for bacterial growth and physically blocks the formation of new granulation tissue. Its presence indicates that the wound is stuck in the inflammatory phase and cannot progress to proliferation. It requires debridement to resume healing.

B. Maceration present at the base of the heel: Maceration occurs when the skin is exposed to excessive moisture for prolonged periods, causing it to become soft, white, and fragile. This compromises the integrity of the periwound skin and makes it susceptible to further breakdown or infection. It indicates poor management of wound exudate or moisture.

C. No indications of undermining present: Undermining is a negative finding where tissue destruction occurs underneath the intact skin at the wound margins. The "absence" of undermining is a positive sign that the wound is not tunneling or expanding deeper into the surrounding structures. It reflects a more stable and localized wound bed.

D. Absence of biofilm after mechanical debridement: Biofilms are complex communities of bacteria that are highly resistant to antibiotics and host immune responses. Removing them via debridement is a positive therapeutic outcome that allows the body's natural healing processes to take over. The absence of biofilm indicates a cleaner, more receptive wound bed.

A. intact blister B. undermining C. presence of slough D. blanchable erythema E. presence of granulation tissue

Correct Answer is A

Explanation

A. intact blister. A Stage 2 pressure injury presents as partial-thickness loss of the dermis or as a serum-filled bulla. The epidermis may be non-intact or appear as a tense, fluid-filled structure without deeper tissue involvement. This stage is characterized by a pink, painful wound bed without evidence of necrotic tissue.

B. undermining. This clinical finding involves the destruction of tissue under the intact skin along the wound margins, typically seen in Stage 3 or 4 injuries. Stage 2 lesions are superficial and do not extend into the subcutaneous fat or deeper fascia. The presence of such cavities indicates a more advanced degree of tissue destruction.

C. presence of slough. The identification of yellow, tan, or green devitalized tissue excludes the diagnosis of a Stage 2 injury by definition. Slough indicates a full-thickness wound where the depth of the injury is obscured by inflammatory exudate. Stage 2 wounds are defined by a clean, red-to-pink viable wound bed.

D. blanchable erythema. Skin that turns pale upon the application of pressure represents a reactive hyperemic response rather than a structural injury. This physiological state indicates intact microcirculation and does not meet the criteria for a pressure injury. Stage 2 involves a break in the skin or a persistent blister.

E. presence of granulation tissue. This beefy red, granular substance appears during the proliferative phase of healing in full-thickness wounds. Since Stage 2 injuries only involve the epidermis and partial dermis, they heal by re-epithelialization rather than the formation of granulation tissue. Its presence suggests a deeper, Stage 3 or 4 ulcer.

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The nurse is caring for a client who is experiencing chronic pain from metastatic cancer. Which principle of pain management is most effective for this client?

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing documentation describing a client's wound of right foot and heel. Which of the noted assessments indicate to the nurse that there is a problem with wound healing? (Select All That Apply)

Correct Answer is ["A","B"]

Explanation

The nurse is caring for a client with a Stage 2 pressure injury. Which assessment(s) would the nurse expect to observe? (Select all that apply)

Correct Answer is A

Explanation

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