NCLEX RN prioritization delegation assignment EXAM A+ GRADE ASSURED COMPLETE SOLUTIONS AND VERIFIED ANSWERS LATEST UPDATE!!!!

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Exam Solution zm




Chapter 1 Prioritization Delegation and Assignment 20 zm zm zm zm zm zm




26 A+ GRADE ASSURED COMPLETE SOLUTIONS AND VE
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RIFIED ANSWERS (00025) zm zm




QUESTION 1 zm




A client with diabetic neuropathy reports a burning, electrical type pain in the lower
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extremities that is worse at night and not responding to nonsteroidal anti-
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inflammatory drugs. Which medication will the nurse advocate for *first*? •Gabapenti
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n •Corticosteroids •Hydromorphone •Lorazepam
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ANSWER

•Gabapentin •Gabapentin is an antieliptic drug, but it is also used to treat diabetic neuropathy. Corti
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costeroids are for pain associated with inflammation. Hydromorphone is a stronger opioid, but it is
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not the first choice for chronic pain that can be managed with other drugs. Lorazepam is an anxioly
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tic that may be prescribed as an adjuvant medication.
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QUESTION 2 zm




Which client is *most* likely to receive opioids for extended periods of time? •A client
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with fibromyalgia •A client with phantom limb pain in the leg •A client with progress
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ive pancreatic cancer •A client with trigeminal neuralgia
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ANSWER

•A client with progressive pancreatic cancer •Cancer pain generally worsens with disease progressio
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n, and the use of opioids is more generous. Fibromyalgia is more likely to be treated with nonopioi
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d and adjuvant medications. Trigeminal neuralgia is treated with antiseizure medications such as car
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bamazepine. Phantom limb pain usually subsides after ambulation begins.
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QUESTION 3 zm




The nurse is caring for a postoperative client who reports pain. Based on recent evide
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nce-
based guidelines, which approach would be *best*? •Multimodal strategies •Standing o
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, rders by protocol •Intravenous patient-
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controlled analgesia (PCA) •Opioid dosage based on valid numerical scale
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ANSWER

•Multimodal strategies •Multimodal therapies for postoperative clients include opioids and nonopioid
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mtherapies, regional anesthetic techniques, and nonpharmacologic therapies. This approach is thought
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mto be the most important strategy for pain management for most postoperative clients. Standing ord
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ers are less optimal because there is no consideration of individual needs or characteristics. PCA is
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one important element, but not all clients can manage PCA devices. Assessment tools are an importa
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nt part of overall management, but basing opioid dose on a numerical scale does not consider indivi
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dual client circumstances.
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QUESTION 4 zm




In application of the principle pain treatment, what is the *first* consideration? •Treat
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ment is based on client goals •A multidisciplinary approach is needed •Client's percep
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tion of pain must be accepted •Drug side effects must be prevented and managed
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ANSWER

•Client's perception of pain must be accepted •The client must be believed, and his or her experienc
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e of pain must be acknowledged as valid. The data gathered via client reports can then be applied t
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o the other options in developing the treatment plan.
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QUESTION 5 zm




When an analgesic is titrated to manage pain, what is the *priority* goal? •Titrate to t
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he smallest dose that provides relief with the fewest side effects •Titrate upward until
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the client is pain free or acceptable level is reached •Titrate downward to prevent to
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xicity, overdose, and adverse effects •Titrate to a dosage that is adequate to meet the
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client's subjective needs zm zm




ANSWER

•Titrate to the smallest dose that provides relief with the fewest side effects •The goal is to control
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pain while minimizing side effects. For severe pain, the medication can be titrated upward until the
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pain is controlled. Downward titration occurs when the pain begins to subside.
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QUESTION 6 zm




Which client is at *greatest* risk for respiratory depression while receiving opioids fo
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r analgesia? •Older adult client with chronic pain related to joint immobility •Client w
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ith a heroin addiction and back pain •Young female client with advanced multiple my
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eloma •Opioid-niave adolescent with an arm fracture and cystic fibrosis
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ANSWER