Medication Mania
For transdermal medications, it is important to remove the old before applying the new, clean the site prior to new application, and to rotate sites. True or False?
True
1. Remove the old patch
2. Cleanse the site
3. Rotate locations for patches to prevent skin irritation
A client requests pain medication for severe pain. Which should the nurse do first when responding to this client’s request?
A. Use distraction to minimize the client’s perception of pain.
B. Place the client in the most comfortable position possible.
C. Administer pain medication to the client quickly.
D. Assess the various aspects of the client’s pain.
D - Assess the client's pain first
All the factors that affect the pain experience should be assessed, including location; intensity; quality; duration; pattern; aggravating and alleviating factors; and physical, behavioral, and attitudinal responses. Assessment must precede intervention.
True or False: Palliative care includes hospice care, but not all palliative care is considered hospice care.
True
_______________________ is the ability to interact with and appreciate people of different cultures and beliefs.
Cultural Competence
What is an example of a patient experiencing neuropathic pain?
Postherpatic neuralgia, phantom limb pain after an amputation, diabetic neuropathy, carpal tunnel syndrome
How often should “docusate sodium 100 mg PO bid” be given?
A. Three times a day
B. Two times a day
C. Every other day
D. At bedtime
B - two times daily (BID)
Which client statement indicates that the client is experiencing neuropathic pain?
A. “My lower back has been hurting for months after the accident.”
B. “I stubbed my toe yesterday and it hurts really bad.”
C. “I have bad migraines and I can’t get relief.”
D. “I have burning and tingling in my feet.”
D - burning and tingling are common symptoms of neuropathic pain
A client receiving palliative care for metastatic cancer states, “I’m scared of what’s going to happen to me.” Which of the following responses by the nurse demonstrates therapeutic communication?
A. “You don’t need to be scared. We will keep you comfortable.”
B. “Why do you feel scared? Has something specific happened?”
C. “It sounds like you’re feeling afraid. Tell me more about what worries you.”
D. “Try not to think about that right now and focus on the positive.”
C - This is the most therapeutic response. Acknowledges emotion, encourages expression, and promotes open communication—this is the most therapeutic response.
The nurse is caring for a client receiving treatment for cancer in an inpatient unit. The client asks if she can practice yoga and meditation while hospitalized. What is the nurse’s best response?
A. “You can practice yoga and meditation as long as you remain in bed.”
B. “Let’s communicate with physical therapy to plan for safety.”
C. “It is best to rest while hospitalized.”
D. “Have you considered Reiki therapy?”
B - communication with PT for a safety plan
Safety first!
Hospice
Which characteristic is associated with a subcutaneous injection of 5000 units of heparin?
A. 3-mL syringe
B. 22-gauge needle
C. 11⁄2-inch needle length
D. 90-degree angle of insertion
D - 90 degree angle of insertion
Most doses of heparin are less than 1 mL. It would be difficult to withdraw an appropriate amount of heparin in a 3-mL syringe because the volume markings on the syringe are widely spaced.
A 22-gauge needle is too large and can cause unnecessary trauma and bleeding at the insertion site. A 25- or 26-gauge needle is adequate.
A 1 and 1⁄2-inch length needle is unnecessarily long and may enter a muscle rather than subcutaneous tissue.
The nurse is assessing a 4-year-old child during a sickle cell crisis. Which nursing action is appropriate in assessing the child’s pain level?
A. The Wong-Baker FACES Pain Rating Scale
B. The numerical rating scale
C. The visual analog scale
D. The simple descriptor scale
A - The Wong-Baker Faces scale
The Wong-Baker FACES scale is the most appropriate pain scale to use with children. It uses simple illustrations of faces to depict various levels of pain. It requires no numerical or reading skills. Although initially developed for use with children older than the age of 3, the scale has also proved to be extremely useful for adults with communication and cognitive impairments.
The nurse is providing an in-service to other nurses about end-of-life care. The nurse explains the difference between grief and bereavement. Which of the following best defines bereavement?
A. The outward, social expression of loss.
B. The inner feelings and outward expressions of people experiencing loss.
C. The distressing symptoms lasting at least 6 months after the death of a significant person.
D. A loss that is not validated or recognized by others.
B - the inner feelings and outward expressions of people experiencing loss
The home-care nurse is assessing a client and family members from a cultural perspective. Which is most important for the nurse to do?
A. Recall experiences of caring for clients with a similar background.
B. Recognize beliefs common to the client’s ethnic group.
C. Interview the members of the client’s family.
D. Use the client as the main source of data.
D - use the client as the main source of information.
The client is the center of the healthcare team and is the most important source of information about his or her perspective. Not all members of an ethnic group follow the same practices; therefore, individualized care relies on individualized cultural assessment.
The nurse is caring for clients receiving a variety of interventions for pain management. Which pain relief method has the shortest duration of action?
A. Client-controlled analgesia
B. Intramuscular sedatives
C. Intravenous narcotics
D. Regional anesthesia
C - IV narcotics have the shortest duration
The nurse is preparing to administer a tablet to a client. When should the nurse remove the medication from its unit-dose package?
A. Outside the door to the client’s room
B. When next to the client’s bed
C. In the medication room
D. At the medication cart
B - When next to client's bed
The medication should be opened at the bedside and administered immediately to the client, thereby limiting the potential for contamination. Reading the label immediately before opening the package is an additional safety check. Immediate administration prevents accidental disarrangement of medications that may result in a medication error.
At which time does a nurse medicate a client for pain for it to be considered preemptive analgesia?
A. Before a client goes to sleep
B. At equally distant times around the clock
C. As soon as a client reports the occurrence of pain
D. Before doing a dressing change that has been painful in the past
D - prior to a painful dressing change
Hospice care is provided to clients with a life expectancy of _______ months or less who decide to forego curative treatment.
Six
The nurse is providing an in-service to other healthcare professionals about Title VI of the Civil Rights Act. The nurse should explain that this regulation ensures health care equity by prohibiting discrimination in federally funded programs based on which of the following?
A. Gender identity
B. Age
C. Race, color, and national origin
D. Socioeconomic level
C - Race, color, and national origin.
Title VI of the Civil Rights Act of 1964 protects individuals from discrimination based on race, color, or national origin in any program or activity that receives federal financial assistance—including hospitals, clinics, and other healthcare organizations that receive Medicare/Medicaid funds.
Which information about a parenteral medication indicates that the nurse should use a filtered needle when preparing the medication?
A. Has to be reconstituted
B. Is supplied in an ampule
C. Appears cloudy in the vial
D. Is to be mixed with another medication
B - Is supplied in an ampule
This is a glass vial that has to be cracked open. Using a filter needle to draw up the medication catches any loose glass particles.
The nurse teaches a client about taking a sublingual nitroglycerin tablet. Which part of the body identified by the client indicates that the client understands the teaching?
A. “On my skin.”
B. “Inside my cheek.”
C. “Under my tongue.”
D. “In my eye on the lower lid.”
C- Under my tongue
Sublingual goes under the tongue to dissolve slowly. A buccal medication goes in the cheek.
What is one example of referred pain and one example of visceral pain?
Referred - heart attacked causing pain in the jaw or left arm, gallbladder causing pain between shoulders
Visceral pain - menstrual cramps, appendicitis, IBS or bowel disease
A nurse is caring for a client with end-stage heart failure who tells the nurse, “I don’t want any more hospitalizations. I just want to be comfortable at home.” The provider recommends hospice services. Which of the following statements by the nurse best explains the purpose of hospice care?
A. “Hospice focuses on curing your illness while managing your symptoms.”
B. “Hospice is for clients who want aggressive treatments to prolong life.”
C. “Hospice provides comfort-focused care when treatments are no longer effective.”
D. “Hospice will provide short-term rehabilitation therapy in your home.”
C - Hospice supports comfort, quality of life, and symptom relief for clients with a terminal illness who are expected to live 6 months or less and are no longer seeking curative treatment.
A 4-year-old client is admitted to the emergency department and diagnosed with leukemia. The parents are informed that their child has an excellent prognosis if treated with chemotherapy. The parents adamantly refuse drug therapy because it is not consistent with their religious beliefs. They believe that prayer can cure the client’s leukemia. What should the nurse do?
A. Encourage the parents to seek the prayers of one of their church’s clergy.
B. Explain to the parents how the chemotherapeutic regimen will cure the leukemia.
C. Talk with the nursing supervisor about referring this situation to the ethics committee.
D. Accept the decision based on the First Amendment of the Constitution of the United States.
C - Refer to Ethics Committee
This is an ethical dilemma because the client is a minor and the parents are refusing standard medical treatment for their child. An ethics committee is an advisory body with a multidisciplinary composition that facilitates the exploration and resolution of ethical issues that occur within the facility.
What are 3 physical assessment findings or symptoms that you may see at the end of life?
1. Weakness and fatigue, increased drowsiness, and sleeping more
2. Decrease in oral intake and decrease in the swallow reflex
3. Surges of energy
4. Changes in bowel and bladder habits
5. Decreased urine output
6. Cold and mottled extremities
7. Changes in vital signs
8. Changes in breathing patterns