Questions Part 2

1. On the first day after surgery, a client receiving an analgesic via PCA pump reports that the pain control is inadequate. What is the first action you should take?

 1.     Deliver the bolus dose per standing order.
 2.     Contact the physician to increase the dose.
 3.     Try nonpharmacologic comfort measures.
 4.     Assess the pain for location, quality, and intensity.

2. What is the best way to schedule medication for a client with constant pain?

 1.     PRN at the client's request
 2.     Before painful procedures
 3.     IV bolus after pain assessment
 4.     Around the clock

3. A client's family member says to you, "He needs more pain medicine. He is still having a lot of pain." What is your best response?

1.     "The physician ordered the medicine to be given every 4 hours."
2.     "If the medication is given too frequently, he could experience ill effects."
3.     "Please tell him that I will be right there to check on him."
4.     "Let's wait about 30 to 40 minutes. If there is no relief, I'll call the physician."

4. You are caring for a young man with a history of substance abuse who had exploratory abdominal surgery 4 days ago for a knife wound. There is an order to discontinue the PCA-delivered morphine and to start oral pain medication. The client begs, "Please don't stop the morphine. My pain is really a lot worse today than it was yesterday." What is the best response?

1.     "Let me stop the pump and we can try oral pain medication to see if it relieves the pain."
2.     "I realize that you are scared of the pain, but we must try to wean you off the pump."
3.     "Show me where your pain is and describe how it feels compared to yesterday."
4.     "Let me take your vital signs, and then I will call the physician and explain your concerns."

5. You are caring for a young client with diabetes who has sustained injuries when she tried to commit suicide by crashing her car. Her blood glucose level is 650 mg/dL, but she refuses insulin; however, she wants the pain medication. What is the best action?


1.     Notify the charge nurse and obtain an order for a transfer to intensive care.
2.     Explain that insulin is a priority and inform the health care provider. 
3.     Withhold the pain medication until she agrees to accept the insulin.
4.     Give her the pain medication and document the refusal of the insulin.

6. A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While you are trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority diagnosis?

1.     Diarrhea/Constipation related to altered bowel patterns
2.     Deficient Knowledge related to the disease process and diagnostic procedure
3.     Risk for Deficient Fluid Volume related to rectal bleeding and diarrhea
4.     Anxiety related to unknown outcomes and perceived threats to body integrity

7. Which patient is at greatest risk for pancreatic cancer?

1.     An elderly African-American man who smokes
2.     A young white obese woman with gallbladder disease
3.     A young African-American man with type 1 diabetes
4.     An elderly white woman who has pancreatitis

8. Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients who must be placed on bleeding precautions? (Select all that apply.)

1.     Provide mouthwash with alcohol for oral rinsing.
2.     Use paper tape on fragile skin.
3.     Provide a soft toothbrush or oral sponge.
4.     Gently insert rectal suppositories.
5.     Avoid aspirin or aspirin-containing products.
6.     Avoid overinflation of blood pressure cuffs.
7.     Pad sharp corners of furniture.

9. The physician tells the patient with cancer that there will be an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. Which patient statement would concern you the most?

1.     "My symptoms will eventually be cured; I'm so happy that I don't have to worry any longer."
2.     "My doctor is trying to help me control the symptoms; I am grateful for the extension of time with my family."
3.     "My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death."
4.     "Initially, I may have to take some time off of work for my treatments; I can probably work full time in the future."

 10. For a patient receiving the chemotherapeutic drug vincristine (Oncovin), which side effects should be reported to the physician?

1.     Fatigue
2.     Nausea and vomiting
3.     Paresthesia
4.     Anorexia

Questions Part 3