The nurse is caring for a patient who took 60 acetaminophen tablets. Which resource will the nurse contact for treatment guidelines when the patient arrives in the emergency room?

Choice A reason: This is incorrect. Neuropathy due to uncontrolled diabetes is not an example of nociceptive pain. Neuropathy is a type of neuropathic pain, which is pain that is caused by damage or dysfunction of the nervous system. It can cause sensations of numbness, tingling, burning, or shooting pain in the affected area. It is not related to tissue injury or inflammation.

Choice B reason: This is incorrect. Phantom pain after amputation of a limb is not an example of nociceptive pain. Phantom pain is a type of neuropathic pain, which is pain that is felt in a body part that is no longer present. It can be triggered by memories, emotions, or stimuli. It is not related to tissue injury or inflammation.

Choice C reason: This is correct. Pain from rheumatoid arthritis joint damage is an example of nociceptive pain. Nociceptive pain is pain that is caused by tissue injury or inflammation. It can be triggered by mechanical, thermal, or chemical stimuli. It can cause sensations of aching, throbbing, or stabbing pain in the affected area.

Choice D reason: This is incorrect. Chronic nerve pain after shingles infection is not an example of nociceptive pain. Chronic nerve pain is a type of neuropathic pain, which is pain that is caused by damage or dysfunction of the nervous system. It can be caused by a viral infection, such as shingles, that affects the nerve fibers. It can cause sensations of burning, itching, or electric pain in the affected area. It is not related to tissue injury or inflammation.

Choice A reason: This is incorrect. Reporting the findings to the health care provider immediately is an important step, but not the priority action of the nurse. The nurse should first assess the patient for orthostatic hypotension, which is a common cause of sudden blood pressure drop.

Choice B reason: This is incorrect. Checking the patient’s apical rate to check for a pulse deficit is a relevant step, but not the priority action of the nurse. A pulse deficit is the difference between the apical and radial pulse rates. The nurse should first check the patient for orthostatic hypotension, which is a condition where the blood pressure drops when the patient changes position, causing dizziness and fainting.

Choice C reason: This is correct. Immediately checking the patient for orthostatic hypotension is the priority action of the nurse. Orthostatic hypotension is a condition where the blood pressure drops when the patient changes position, causing dizziness and fainting. It can be caused by dehydration, medications, blood loss, or autonomic nervous system disorders. The nurse should measure the patient’s blood pressure and heart rate while lying down, sitting, and standing, and observe for any signs of hypoperfusion, such as pallor, sweating, or confusion.

Choice D reason: This is incorrect. Elevating the head of the patient’s bed to at least 45 degrees is a helpful step, but not the priority action of the nurse. Elevating the head of the bed can improve the patient’s breathing and reduce the risk of aspiration, but it can also worsen the orthostatic hypotension by lowering the blood pressure further. The nurse should first check the patient for orthostatic hypotension and then adjust the bed position accordingly.