Lacharity Flashcards Chapters 1-21

Questions and Answers

What is your initial action when a client with chronic pain reports that nurses have not responded to requests for pain medication?

Ask the nurse educator to provide in-service training about pain management.

Check the medication administration records (MARs) for the past several days.

Perform a complete pain assessment on the client and take a pain history.

Have a conference with the nurses responsible for the care of this client. (correct)

Which question should you ask a client whose family believes they should 'tough out the pain'?

What information do you need about pain, healing, and addiction?

How is the pain affecting your activity level and your ability to function?

Where is the pain located, and does it radiate to other parts of your body?

How would you describe the pain, and how is it affecting you?

What do you believe about pain medication and drug addiction? (correct)

Which medication should you advocate for a client with diabetic neuropathy who reports burning, electrical-type pain?

Gabapentin (Neurontin) (correct)

Lorazepam (Ativan)

Corticosteroids

Hydromorphone (Dilaudid)

Which client is most likely to receive opioids for extended periods of time?

A client with progressive pancreatic cancer Signup and view all the answers

What action should you take first when reviewing the charts of clients assigned to a newly graduated RN who has correctly charted medication but not non-pharmaceutical measures?

Give praise for correctly charting the dose and time and discuss the deficits in charting. Signup and view all the answers

Which clients must be assigned to an experienced RN?

Client who was in an automobile crash and sustained multiple injuries Signup and view all the answers

What is the first consideration in the application of pain treatment principles?

The client's perception of pain must be accepted. Signup and view all the answers

Which client has the most immediate need for IV access to deliver immediate analgesia?

Client who is having an acute myocardial infarction with severe chest pain Signup and view all the answers

What is the priority goal when titrating an analgesic to manage pain?

Titrate to the smallest dose that provides relief with the fewest side effects. Signup and view all the answers

Which topic could you delegate to an experienced LPN/LVN for client education about non-pharmaceutical alternatives?

Application of heat and cold Signup and view all the answers

What is the priority action when a client receiving PRN morphine has a respiratory rate of 10/min?

Assess the client's responsiveness and respiratory status. Signup and view all the answers

Which client is at greatest risk for respiratory depression while receiving opioids?

Elderly client with chronic pain who has a hip fracture Signup and view all the answers

What is the priority intervention for a client who is crying but denies pain and refuses medication due to a family member's addiction?

Provide accurate information about the use of pain medication. Signup and view all the answers

What is one of the first signs of opioid withdrawal?

Diaphoresis Signup and view all the answers

What is the most appropriate task to delegate to a UAP in the care of clients with pain?

Assisting the client with preparation of a sitz bath Signup and view all the answers

What is the first action if ordered to administer a placebo to a client with chronic pain and you feel uncomfortable?

Contact the charge nurse for advice. Signup and view all the answers

What should be the first action for a cognitively impaired client who cannot accurately report pain?

Closely assess for nonverbal signs such as grimacing or rocking. Signup and view all the answers

Prioritize the order in which you will check on the following clients:

Adolescent with treatment for meningitis and a continuous headache = 2 Elderly man post knee replacement using PCA pump = 2 Middle-aged woman needing diagnostic testing = 3 Elderly woman with Alzheimer’s awaiting transfer = 4 Young man with chest pain from spontaneous pneumothorax = 1 Signup and view all the answers

What is the first action when a client receiving PCA reports inadequate pain control post-surgery?

Assess the pain for location, quality, and intensity. Signup and view all the answers

What task is best to delegate to the LPN/LVN when providing emergency care to a client who received an excessive dose of narcotic?

Giving the ordered dose of Narcan and evaluating the response. Signup and view all the answers

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

Around the clock Signup and view all the answers

Which clients can be assigned to an LPN/LVN under RN supervision?

Client with arthritis needing scheduled medications Signup and view all the answers

What client statement concerns you most regarding diagnosed pain disorder and depression?

I'm so sick of this pain. I think I'm going to find a way to end it. Signup and view all the answers

What task can be delegated to a UAP trained in Foley catheter insertion for a client with urinary retention?

Measuring urine output after catheter insertion Signup and view all the answers

What should be your best response to a young man with a history of substance abuse who begs not to stop morphine post-surgery?

Let me take your vital signs, and then I will call the physician. Signup and view all the answers

What is the blood glucose level for a young client with diabetes who is refusing insulin?

650 mg/dL Signup and view all the answers

Study Notes

Pain Management and Treatment Strategies

As charge nurse, assess staff performance and client requests for pain medication first before taking further actions.
The sociocultural aspect of pain should be prioritized when clients express beliefs influenced by family attitudes toward addiction.
Gabapentin is preferred for diabetic neuropathy pain; opioids are reserved for severe cases or when other treatments fail.
Clients with progressive cancer are likely to need long-term opioid therapy due to increasing pain demands as the disease progresses.
New nurses should receive positive reinforcement for correct charting while addressing areas needing improvement.

Client Assignments and Delegation

Assign experienced RNs to clients with complex needs, such as those with multi-trauma from accidents or post-operative recovery requiring chest tubes.
Non-pharmacological pain management approaches are essential; treatment should honor client goals and perceptions.
IV access for immediate pain relief is critical for clients in acute situations, such as myocardial infarction.

Pain Assessment and Interventions

Priority in analgesic titration is to find the smallest effective dose with minimal side effects; pain relief should not be overly aggressive.
Nonpharmacologic options for pain management, like heat application, can be delegated to LPNs/LVNs under supervision.

Respiratory Concerns and Medication Management

Monitor clients receiving opioids closely for respiratory depression, especially in vulnerable populations such as the elderly or those with a history of substance abuse.
In cases of suspected over-medication, assess the client’s respiratory status before initiating treatments like naloxone.
Withdrawal signs from opioid tapering often present as nausea or diaphoresis.

Ethical Considerations in Pain Management

When faced with administering a placebo for pain, explore hospital policies and consider personal ethics before proceeding.
For clients unable to communicate pain effectively, assess nonverbal cues and gather comprehensive data from family members.

Prioritization and Reporting

In urgent situations, use SBAR (Situation, Background, Assessment, Recommendation) for clear communication when informing providers of significant client changes.
Clients with chronic pain or complex health issues should be prioritized based on the severity of symptoms and their potential for complications.

Client Education and Family Involvement

Engage family members in discussions about pain management to ensure they understand the treatment plan and the importance of medication adherence.
Address misconceptions regarding pain medication and addiction proactively to support the client's autonomy and pain relief needs.

Conclusion

Proper assessment, delegation, and communication are vital to effective pain management and ensuring patient safety in nursing practice.

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Description

This quiz includes flashcards covering key concepts from Chapters 1-21 of Lacharity's 3rd Edition. Each question is designed to help reinforce understanding of nursing practices and patient care, particularly in pain management. Perfect for nursing students preparing for exams or clinical practice.