HESI RN COMPREHENSIVE EXIT EXAM

.A nurse is teaching a patient about patient-controlled analgesia (PCA). Which statement made by the patient indicates to the nurse that teaching is effective? a. “I will only need to be on this pain medication.” b. “I feel less anxiety about the possibility of overdosing.” c. “I can receive the pain medication as frequently as I need to.” d. “I need the nurse to notify me when it is time for another dose.” ANS: B A PCA is a device that allows the patient to determine the level of pain relief delivered, reducing the risk of overdose. The PCA infusion pumps are designed to deliver a specific dose that is programmed to be available at specific time intervals (usually in the range of 8 to 15 minutes) when the patient activates the delivery button. A limit on the number of doses per hour or 4-hour interval may also be set. This can help decrease a patient’s anxiety related to possible overdose. Its use also often eases anxiety because the patient is not reliant on the nurse for pain relief. Other medications, such as oral analgesics, can be given in addition to the PCA machine. One benefit of PCA is that the patient does not need to rely on the nurse to administer pain medication; the patient determines when to take the medication. 10.A nurse is caring for a patient who is experiencing pain following abdominal surgery. Which information is important for the nurse to share with the patient when providing patient education about effective pain management? “To prevent overdose, you need to wait to ask for pain medication a. until you begin to experience pain.” “You should take your medication after you walk to make sure you do b. not fall while you are walking.” “We should work together to create a schedule to provide regular c. dosing of medication.” “When you experience severe pain, you will need to take oral pain d. medications.” ANS: C One way to maximize pain relief while potentially decreasing opioid use is to administer analgesics around the clock (ATC) rather than on a prn basis. This approach ensures a more constant therapeutic blood level of an analgesic. Working with the patient to design a schedule allows the patient to be a full partner in the care provided. The nurse should not wait until pain is experienced because it takes medications 10-30 minutes to begin to relieve pain. The nurse administers pain medications before painful activities, such as walking, and administers intravenous medications when a patient is having severe pain. 11.A nurse is caring for a patient who recently had spinal surgery. The nurse knows that patients usually experience acute pain following this type of surgery. The patient refuses to get up and walk and is not moving around in the bed. However, the patient is stoic and denies experiencing pain at this time. What most likely explains this patient’s behavior? a. The surgery successfully cured the patient’s pain. The patient’s culture is possibly influencing the patient’s experience of b. pain. The primary health care provider did not prescribe the correct amount c. of medication. The nurse is allowing personal beliefs about pain to influence pain d. management at this time. ANS: B A patient’s culture or beliefs about pain often influence the patient’s expression of pain. In this case, the patient has just had surgery, and the nurse knows that this surgical procedure usually causes patients to experience pain. It is important at this time for the nurse to examine cultural and ethnic factors that are possibly affecting the patient’s lack of expression of pain at this time. Even if surgery corrects neurological factors that create chronic pain, surgery causes pain in the acute period. The patient has not taken any pain medication so this is an unrealistic assumption; most pain medications have standard dosages. The nurse is not allowing personal beliefs to influence pain management because the nurse is attempting to determine the reason why the patient is not verbalizing the experience of pain. 12.A nurse is providing discharge teaching for a patient with a fractured humerus. The patient is going home with hydrocodone. Which important patient education does the nurse provide? 2 a. “You need to drink plenty of fluids and eat a diet high in fiber.” “Narcotics can be addictive, so do not take them unless you are in b. severe pain.” “Be sure to eat a meal high in fat before taking the medication, to c. avoid a stomach ulcer.” “As your pain severity lessens, you will begin to give yourself once- d. daily intramuscular injections.” ANS: A