The practical nurse (PN) is managing a patient who is receiving fentanyl subcutaneously (SubQ) every hour for pain
control.
The patient’s pain level remains at 8 on a 10-point scale.
What is the most appropriate action for the PN to take?
Request an increased dose from the healthcare provider.
Continue monitoring the patient and assessing the pain level.
Initiate non-pharmacological methods of pain control.
Inform the patient about the potential addictiveness of the medication.
The Correct Answer is A
Choice A rationale
If a patient’s pain level remains high despite receiving regular doses of fentanyl, it may indicate
that the current dose is insufficient. The PN should report this to the healthcare provider, who
may decide to increase the dose.
Choice B rationale
While it’s important to continue monitoring the patient and assessing the pain level, this alone
may not be sufficient if the patient’s pain remains uncontrolled.
Choice C rationale
Non-pharmacological methods of pain control can be beneficial, but they are typically used in
conjunction with medication, not as a replacement for it when the pain level is high.
Choice D rationale
Informing the patient about the potential addictiveness of the medication is important, but it’s
not the most appropriate action to take in response to uncontrolled pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The patient is receiving a nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) for HIV
treatment and reports experiencing malaise, fatigue, and anorexia. These symptoms, along
with the observed increased respiratory rate, could be indicative of liver toxicity, a known
potential side effect of NRTIs. Therefore, reviewing liver function tests would be most
important in this case.
Choice B rationale
While arterial blood gases can provide valuable information about a patient’s respiratory
status, they may not be the most relevant in this context. The patient’s symptoms and the side
effect profile of NRTIs suggest that liver function may be a more pressing concern.
Choice C rationale
A complete blood count (CBC) can provide a broad overview of a patient’s general health, but it
may not provide the specific information needed to assess the patient’s current symptoms and
potential medication side effects.
Choice D rationale
A basic metabolic panel can provide information about a patient’s kidney function, electrolyte
levels, and blood sugar levels, among other things. However, given the patient’s symptoms and
medication regimen, liver function tests may be more relevant.
Correct Answer is A
Explanation
Choice A rationale
Given the client’s high blood pressure and complaint of a headache, it is important to continuously monitor the client’s cardiac status to detect any changes that may indicate worsening condition.
Choice B rationale
Placing an indwelling urinary catheter is not the immediate next step in this client’s care. While it may be necessary in some cases, it is not directly related to the client’s current symptoms.
Choice C rationale
Giving a fluid bolus is not the immediate next step in this client’s care. While it may be necessary in some cases, it is not directly related to the client’s current symptoms.
Choice D rationale
Drawing a basic metabolic panel (BMP) could be helpful in assessing the client’s overall health and kidney function, but it is not the immediate next step in this client’s care.
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