CA1 Flashcards

1
Q

All of the following is an example of non-invasive pain intervention. Which of following is not included?

Hypnosis
Acupuncture
Cutancous simulation
Rhizotomy

A

Rhizotomy

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2
Q

A client is scheduled for a surgery in the morning. Preoperative orders have been written. What is most important to do before surgery?

Secure consent
Remove all jewelry or tape wedding ring
Verify that all laboratory work is complete
Inform family next of kin

A

Secure consent

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3
Q

Your patient told you that his jaw pain is extending to his left arm. You are certain that this is what type of pain?

Referred pain
Intractable pain
Cutancous Pain
Radiating pain

A

Radiating pain

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4
Q

After the surgery, Mr Smith told you that his amputated left leg is in pain. You will determine this as:

Referred pain
Intractable pain
Phantom pain
Neuropathic pain

A

Phantom pain

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5
Q

Which of the commonly used pre-operative medications may lead to respiratory depression, hypotension, and decreased gastric mobility sometimes causing vomiting?

Mepcridine
Amlodipine
Atropine Sulfate
Epinephrine

A

Mepcridine

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6
Q

The physician has ordered a placebo for chronic pain client. You are a newly hired nurse, and you feel very uncomfortable administering the medication. What is the first actions that you should take?

A. Prepare the medication and hand it to the physician
B.Check the hospital policy regarding use of the placebo
C. Follow a personal code of ethics and refuse to give it
D. Contact the charge nurse for advise

A

D. Contact the charge nurse for advise

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7
Q

A nurse is caring for an obese patient who has had surgery. The nurse monitors this patient for what post operative complication?

Anesthetic agent interactions
Impaired wound healing
Hemorrhage
Gas pains

A

Impaired wound healing

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8
Q

In caring for a young child with pain, which assessment tool is the most useful?

Simple description pain intensity scale
0-10 numeric pain scale
Wong Baker pain-rating scale
All of the above

A

Wong Baker pain-rating scale

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9
Q

Which route of administration is preferred if immediate analgesia and rapid titration are necessary?

Intraosseous
Intraspinal
Intravenous
Sublingual

A

Intravenous

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10
Q

Upon using the PQRST pain assessment, your client told you that he has 7 score of severity. You are correct if you determine this as:

Mild
Moderate
Severe
None of the above

A

Severe

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11
Q

A responsibility of the nurse is the administration of preoperative medications to patients. Which statements describe the action of these medications? Select all that apply.

Diazepam is given to alleviate anxiety
Ranitidine is given to facilitate patient sedation
Atropine is given to decrease oral secretions
Morphine is given to depress respiratory function
Cimetidine is given to prevent laryngospasm
Fentanyl citrate is given to facilitate a sense of calm

A

Diazepam is given to alleviate anxiety
Atropine is given to decrease oral secretions
Fentanyl citrate is given to facilitate a sense of calm

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12
Q

A 72-year-old woman who is scheduled for a hip replacement is taking several medications on a regular basis. Which drug category might create a surgical risk for this patient?

Enoxaparin
Lactulose
Propofol
Milk of Magnesia

A

Enoxaparin

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13
Q

A client with chronic pain reports to you, the charge nurse, that the nurse has not been responding to requests for pain medication. What is your initial action?

A. Check the medication record and nurse’s noted for the past several days
B. Ask the nurse educator to give an in-service about pain management
C. Perform a complete pain assessment and history on the client
D. Have a conference with the nurse responsible for the care of the client

A

D. Have a conference with the nurse responsible for the care of the client

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14
Q

A level 4 student nurse asks you the difference of acute pain from chronic pain. Which of the following will you answer?

A. Less than 6 months o pain is chronic pain
B. Acute pain is characterized by a continual, persistent, and recurrent
C. Acute pain is irreversible and controllable
D. Chronic pain is more difficult to treat

A

D. Chronic pain is more difficult to treat

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15
Q

A nurse is teaching a man scheduled to have same-day surgery. Which teaching method would be most effective in preoperative teaching for ambulatory surgery?

Lecture
Discussion
Audio visuals
Written instructions

A

Written instructions

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16
Q

A nurse is teaching a man scheduled to have same-day surgery. Which teaching method would be most effective in preoperative teaching for ambulatory surgery?

Lecture
Discussion
Audio visuals
Written instructions

A

Written instructions

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17
Q

The client with a new trachcostomy has a soiled dressing, What is the best mursing intervention?

A. Cut stcrile 4 x 4 gauze to fit around the tracheostomy tube
B. Reinforce the dressing with sterile 4 x 4 gauze
C. Replace the dressing with clean, folded 4 x 4 gauze
D. Replace the dressing with sterile, folded 4 x 4 gauze

A

D. Replace the dressing with sterile, folded 4 x 4 gauze

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18
Q

Elective surgeries are an essential part of modern medicine, allowing individuals to address health issues proactively and improve their overall well-being. All of the following are examples of this surgery, except:

joint replacement
hysterectomy or tubal ligation
cataract removal
excision of angiosarcoma

A

excision of angiosarcoma

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19
Q

A female elient diagnosed with lung cancer is to have a leff lower lobectomy. What increases the client’s risk of developing postoperative pulmonary complications?

Height is 5 feet, 7 inches (170.2 cm), and weight is 110.1b (49.9 kg).
The client tends to keep her real feelings to herself.
She ambulates and can climb one flight of stairs with dyspnea
The client is 58 years of age

A

Height is 5 feet, 7 inches (170.2 cm), and weight is 110.1b (49.9 kg).

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20
Q

A patient is cheduled for lung decortication, sungery. As part of the post-operative care, what are the key nursing interventions to ensure the patient is adequately informed regarding the procedure and except?

A. Explain the procedure, ineluding what to expect before, during, and after surgery.
B. Administer supplemental akygon as noeded to maintain adequate oxygenation.
C. Perform chest physiotherapy, including postural drainoge, percussion, and vibration, to promote lung expansion and secretion clearance.
D. Perform dressing changes as per protocol, ensuring sterility and proper technique.

A

A. Explain the procedure, including what to expect before, during, and after surgery.

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21
Q

Which of the following is a primary indication for performing a tracheostomy?

Chronic sinusitis
Acute otitis media
Obstructive sleep apnea
Upper airway obstruction

A

Upper airway obstruction

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22
Q

Patients with a tracheostomy or endotracbeal tube need suctioning. Which nursing interventions apply to proper suctioning techniq ? Select all that apply

  • preoxygenate the patient for at least 30 seconds before suctioning
  • Instruct the patient that he or she is going to be suctioned
  • quickly insert the suction catheter until resistance is met
  • suction the patient for af least 30 seconds to remove seeretions
  • repeat suctioning as needed for to five total suction passes
A
  • preoxygenate the patient for at least 30 seconds before suctioning
  • Instruct the patient that he or she is going to be suctioned
  • quickly insert the suction catheter until resistance is met
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23
Q

This is a medically induced state of unconsciousness, used during surgical procedures to ensure the patient does not feel pain and remains completely unaware of the surgery.

Regional
General
Local
All of the above

A

General

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24
Q

CTT is a tube inserted in the pleural space to help re-expand the lungs. All of the following are correct statements: Select all that apply

  • There should be intermittent bubbling in the suction chamber to assure intactness of the system
  • Continuous bubbling indicates a good sign in the water seal chamber
  • Intermittent bubbling in the drainage chamber shows that the worsening atelectasis
  • Absence of bubbles means that the lung has totally re-expanded
A
  • Absence of bubbles means that the lung has totally re-expanded
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25
Q

An adult is about to have a tracheostomy performed . Which action is of the highest priority for the nurse before the procedure is done?

A. Establishing means of post-operative communication
B. Drawing blood for serum electrolytes and blood gases
C. Inserting an indwelling catheter and attaching it to dependent drainage
D. Doing a surgical prep of the neck and the upper chest wass

A

A. Establishing means of post-operative communication

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26
Q

Is a phenomenon where pain is felt in a part of the body that is different from the actual source of the pain. This happens because the nerves in our body are interconnected, and sometimes, the brain misinterprets the origin of the pain signal. Example of this pain includes Rovsing sign.

Referred pain
Deep somatic pain
Phantom pain
Intractable pain

A

Referred pain

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27
Q

This involve preparations to ensure that both the patient and healtheare team are well-prepared and informed, minimizing risks and enhuncing outcomes. This is also critical period before surgery, focused on preparing the patient physically and mentally for the upcoming procedure

Peri-operative nursing
Pre-operative phase
Intra-operative phase
Post-operative nursing

A

Pre-operative phase

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28
Q

What is the most important nursing procedure to perform prior to tracheostomy care to minimize the risk of infection?

Use curtain
Handwashing
Use sterile gloves
Proper wastc disposal

A

Handwashing

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29
Q

A nurse in a critical care unit is caring for a client who is postoperative following a right pneumonectomy. After extubation from the ventilator, in which of the following positions should client be placed?

Prone
Semi Fowler
Sims
on the nonoperative side

A

on the nonoperative side

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30
Q

A nurse in a critical care unit is caring for a client who is postoperative following a right pneumonectomy. After extubation from the ventilator, in which of the following positions should client be placed?

Prone
Semi Fowler
Sims
on the nonoperative side

A

on the nonoperative side

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31
Q

Which factor is a priority to evalunte when completing discharge planning for a clicnt who has had a lobectomy for treatment of lung cancer? Select all that apply.

A. the support available to assist the client at home
B. the distance the client lives from the hospital
C. the client’s ability to do home blood pressure monitoring
D. the client’s knowledge of the causes of lung cancer

A

A. the support available to assist the client at home

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32
Q

What is the normal tracheostomy cuff pressure?

30-40 mmHg
20-25 mmHg
15-20 mmHlg
40-55 mmHg

A

20-25 mmHg

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33
Q

A client has a new tracheostomy and is receiving 60% oxygen via tracheostomy collar. Which assessment finding requires immediate action by the nurse?

Constant, nonproductive coughing
Blood-tinged sputum
Rhonchi in upper lobes
Dry mucous membrane

A

Constant, nonproductive coughing

34
Q

A client hes a new tracheostomy and is roceiving 60% oxygen via trachcostomy collar. Which assesment finding roquires immnediate action by the nurse?

Constant, nonproductive coughing
Blood-tinged sputum
Rhonchi in upper lobes
Dry mucous membranes

A

Constant, nonproductive coughing

35
Q

A 45-yeer-old patient, Mr. Santos, has Just undergone major abdominal surgery. He is experiencing severe postoperative pain and has been prescribed morphine for pain management. The nurse would be concerned if

The client stated that the pain score is 9 over 10
RASS score of +2
Upon assessment, the vitals arc BP 100/60, Temp 99F, and 90 O2Sat
All of the above

A

Upon assessment, the vitals arc BP 100/60, Temp 99F, and 90 O2Sat

36
Q

Which clinical finding in a patient with a recent tracheostomy is the most serious and requires immediate intervention?

A. increased cough and difficulty expectorating seeretions
B. food particles in the tracheal secretions
C. pulsating tracheostomy tube in synchrony with the heartbcat
D. set tidal volume on the ventilator not being received by the patient

A

C. pulsating tracheostomy tube in synchrony with the heartbcat

37
Q

When teaching a client to deep breathe effectively after a lobectomy, what should the nurse instruct the client to do?

A. Contract the abdominat muscles; take a slow, deep breath through the nose, hold it for 3 to seconds: and then exhale.
B. Contract the abdominal muscles, take a deep breath through the mouth, and ethale slowly as if trying to blow out a candle.
C. Relax the abdominal museles: lake a slow. deep breath through the nose; and hold it for 3 to 5 seconds
D. Relax abdominal muscles, take a deep breath through the mouth, and exhale slowly over 10 seconds.

A

A. Contract the abdominat muscles; take a slow, deep breath through the nose, hold it for 3 to seconds: and then exhale.

38
Q

Which of the following is not true regarding the use of CTT?

A. This device usually has 3 chambers, namely, Collection, Water Sealed, and Suction Control Chambers. Used in patients with pneumothorax, hemothorax, and empyema
B. Clamping during transport may cause the development of tension pneumothorax. Milking or stripping the chest tube may increase the intra-plural pressure
C. A nurse may aseptically remove the CTT by carefully instructing the patient to do Valsalva maneuver and give analgesics 30mins before the procedure. Client should be sent immediately for an X-ray
D. None of the above

A

C. A nurse may aseptically remove the CTT by carefully instructing the patient to do Valsalva maneuver and give analgesics 30mins before the procedure. Client should be sent immediately for an X-ray

39
Q

This is n severe, persistent, and often dobilliating type of pain that cannot be adequately controlled or relieved by standard medical treatments

Intractable pain
Ncuropathic pain
Chronic pain
Radiating pain

A

Intractable pain

40
Q

After undergoing a lett pncumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:

Monitor fluctuations in the water-seal chamber
Clamp the chest tube once every shift
Encourage coughing and deep breathing
Milk the chest tube every 2 hours

A

Encourage coughing and deep breathing

41
Q

The client is being discharged home with a tracheostomy. Which statement by the client indicates the need for further teaching about tracheostomy care?

A. “ I can only take baths, no showers.
B. “I can put normal saline in my tracheostomy to keep the seeretions from getting thick”
C. “Lshould put cotton or foam over the tracheostomy hole.”
D. “I will have to learn to suction myself”

A

A. “ I can only take baths, no showers.

42
Q

A nurse is caring for a patient with a tracheostomy. The nurse notes that the patient has gurgling sounds coming from the trach site, he is breathing rapidly, and he is trying to cough. Which action should the nurse perform next?

A. Suction the opening and the trach tubing
B. Assess the patientsklung sounds
C. Replace the trach tubing with an Ambu-bag and provide measured breaths
D. Check the capillary refill in the fingertips

A

A. Suction the opening and the trach tubing

43
Q

A client who underwent a lobectomy and has a water seal chest drainage system is breathing with a little more effort and at a faster rate than 1 hour ago. The client’s pulse rate is also increased. The nurse should:
- check the tubing to ensure that the client is not lying on it or kinking it.
- increase the suction
- Lower the drainage bottles 2-3 feet (61-91.4 cm) below the level of clients chest
- ensure that the chest tube has two clamps on it to prevent air leaks

A
  • check the tubing to ensure that the client is not lying on it or kinking it.
44
Q

The client with a new tracheostomy has a soiled dressing. What is the best nursing intervention?

  • Cut sterile 4 x 4 gauze to fit around the trachcostomy tube
  • Reinforce the dressing with sterile 4 x 4 gauze
  • Replace the dressing with clean, folded 4 x 4 gauze
  • Replace the dressing with sterile, folded 4 x 4 gauze
A
  • Replace the dressing with sterile, folded 4 x 4 gauze
45
Q

Elective surgeries are an essential part of modem medicine, allowing individuals to address health issues proactively and improve their ovcrall well-being. All of the following are examples of this surgery, except:

  • joint replacement
  • hysterectomy or tubal ligation
  • cataract removal
  • excision of angiosarcoma
A
  • excision of angiosarcoma
46
Q

A female client diagnosed with lung cancer is to have a left lower lobectomy. What increases the client’s risk of developing postoperative pulmonary complications?
- Height is 5 feet, 7 inches (170.2 cm) and weight is 110 lb (49.9 kg).
- The client tends to keep her real feelings to herself.
- She ambulates and can climb one flight of stairs withat dyspnea.
- The client is 58 years of age.

A
  • Height is 5 feet, 7 inches (170.2 cm) and weight is 110 lb (49.9 kg).
47
Q

A patient is scheduled for lung decortication surgery. As part of the post-operative care, what are the key nursing interventions to ensure the patient is adequately informed regarding the procedure, except?
- Explain the procedure, including what to expect before, during, and after surgery.
- Administer supplemental oxygen as needed to maintain adequate oxygenation.
- Perform chest physiotherapy, including postural drainage, percussion, and vibration, to promote lung expansion and secretion clearance.
- Perform dressing changes as per protocol, ensuring sterility and proper technique.

A
  • Explain the procedure, including what to expect before, during, and after surgery.
48
Q

Which of the following is a primary indication for performing a tracheostomy?

  • Chronic sinusitis
  • Acute otitis media
  • Obstructive sleep apnea
  • Upper airway obstruction
A
  • Upper airway obstruction
49
Q

Patients with a tracheostomy or endotracheal tube need suctioning. Which nursing interventions apply to proper suctioning technique? SATA

  • preoxygenate the patient for at least 30 seconds before suctioning
  • instruct the patient that he or she is going to be suctioned
  • quickly insert the suction catheter until resistance is met
  • suction the patient for at least 30 seconds to remove secretions
  • repeat suctioning as needed for to five total suction passes
A
  • preoxygenate the patient for at least 30 seconds before suctioning
  • instruct the patient that he or she is going to be suctioned
  • quickly insert the suction catheter until resistance is met
50
Q

This is a medically induced state of unconsciousness, used during surgical procedures to ensure the patient does not feel pain and romains completely unaware of the surgery.

Regional
General
Local
All of the above

A

General

51
Q

CTT is a tube inserted in the pleural space to help re-expand the lungs. All of the following are correct statements: SATA
- There should be intermittent bubbling in the suction chamber to assure intactness of the system
- Continuous bubbling indicates a good sign in the water seal chamber
- Intermittent bubbling in the drainage chamber shows that the worsening atelectasis
- Absence of bubbles means that the lung has totally re-expanded

A
  • Absence of bubbles means that the lung has totally re-expanded
52
Q

An adult is about to have a tracheostomy performed. Which action is of the highest priority for the nurse before the procedure is done?

  • Establishing means of post-operative communication
  • Drawing blood for serum electrolytes and blood gases
  • Inserting an indwelling catheter and attaching it to dependent drainage
  • Doing a surgical prep of the neck and the upper chest wass
A
  • Establishing means of post-operative communication
53
Q

Is a phenomenon where pain is felt in a part of the body that is different from the actual source of the pain. This happens because the nerves in our body are interconnected, and sometimes the brain misinterprets the origin of the pain signal. Example of this pain includes Rovsing sign.

Referred pain
Deep somatic pain
Phantom pain
Intractable pain

A

Referred pain

54
Q

This involve preparations to ensure that both the patient and healthcare team are well-prepared and informed, minimizing risks and enhancing outcomes. This is also critical period before surgery, focused on preparing the patient physically and mentally for the upcoming procedure.

Peri-operative nursing
Pre-operative phase
Intra-operative phase
Post-operative nursing

A

Pre-operative phase

55
Q

What is the most important nursing procedure to perform prior to trachcostomy care to minimize the risk of infection?

Use curtain
Handwashing
Use sterile gloves
Proper waste disposal

A

Handwashing

56
Q

A nurse in a critical care unit is caring for a client who is postoperative following a right pneumonectomy. After extubution from the ventilator, in which of the following positions should client be placed?

Prone
Semi Fowler
Sims
On the nonoperative side

A

On the nonoperative side

57
Q

Which factor is a priority to evaluate whon completing discharge planning for a client who has had a lobectomy for treatment of lung cancer? SATA
- the support available to assist the client at home
- the distance the client lives from the hospital
- the client’s ability to do home blood pressure monitoring
- the client’s knowledge of the causes of lung cancer

A
  • the support available to assist the client at home
58
Q

What is the normal tracheostomy cuff pressure?

30-40 mmHg
20-25 mmHg
15-20 mmHg
40-55 mmHg

A

20-25 mmHg

59
Q

A client has a new tracheostomy and is receiving 60% oxygen via tracheostomy collar. Which assessment finding requires immediate action by the nurse?

Constant, nonproductive coughing
Blood-tinged sputum
Rhonchi in upper lobes
Dry mucous membranes

A

Constant, nonproductive coughing

60
Q

A 45-year-old patient, Mr. Santos, has just undergone major abdominal surgery. He is experiencing severe postoperative pain and has been prescribed morphine for pain management. The nurse would be concern if:

  • The client stated that the pain score is 9 over 10
  • RASS score of +2
  • Upon assessment the vitals are BP 100/60, Temp 99F, and 90 02Sat
  • All of the above
A
  • Upon assessment the vitals are BP 100/60, Temp 99F, and 90 02Sat
61
Q

Which clinical finding in a patient with a recent tracheostomy is the most serious and requires immediate intervention?

  • increased cough and difficulty expectorating secretions
  • food particles in the tracheal secretions
  • pulsating tracheostomy tube in synchrony with the heartbeat
  • set tidal volume on the ventilator not being received by the patient
A
  • pulsating tracheostomy tube in synchrony with the heartbeat
62
Q

When teaching a client to deep breathe effectively after a lobectomy, what should the nurse instruct (I point) the client to do?
- Contract the abdominal muscles; take a slow, deep breath through the nose; hold it for 3 to seconds; and then exhale
- Contract the abdominal muscles, take a deep breath through the mouth, and exhale slowly as if trying to blow out a candle.
- Relax the abdominal muscles; take a slow, deep breath through the nose; and hold it for 3 to 5 seconds
- Relax abdominal muscles, take a deep broath through the mouth, and exhale slowly over 10 seconds.

A
  • Contract the abdominal muscles; take a slow, deep breath through the nose; hold it for 3 to seconds; and then exhale
63
Q

Which of the following is not true regarding the use of CTT?

  • This device usually has 3 chambers namcly, Collection, Water Sealed, and Suction Control Chambers. Used in patients with pneumothorax, hemothorax, and empyema.
  • Clamping during transport may cause the development of tension pneumothorax. Milking or stripping the chest tube may increase the intra-pleural pressure.
  • A nurse may aseptically remove the CTT by carefully instructing the patient to do Valsalva maneuver and give analgesics 30mins before the procedure. Client should be sent immediately for an Xray
  • None of the above
A
  • A nurse may aseptically remove the CTT by carefully instructing the patient to do Valsalva maneuver and give analgesics 30mins before the procedure. Client should be sent immediately for an Xray
64
Q

This is a severe, persistent, and often debilitating type of pain that cannot be adequately controlled or relieved by standard medical treatments.

Intractable pain
Neuropathic pain
Chronic pain
Radiating pain

A

Intractable pain

65
Q

After undergoing a lefi pneumonectomy, a fomale patient has a chest tube in place for drainage. When caring for this patient, the nurse mus

  • Monitor fluctuations in the water-scal chamber
  • Clamp the chest tube once every shin
  • Encourage coughing and deep breathing
  • Milk the chest tube every 2 hours
A
  • Encourage coughing and deep breathing
66
Q

The client is being discharged home with a tracheostomy. Which statement by the client indicates the need for further teaching about tracheostomy care?

  • “I can only take baths, no showers.”
  • “I can put normal saline in my tracheostomy to keep the secretions from getting thick.”
  • “I should put cotton or foam over the tracheostomy hole.”
  • “I will have to leam to suction myself.”
A
  • “I can only take baths, no showers.”
67
Q

A nurse is caring for a patient with a trachcostomy. The nurse notes that the patient has gurgling sounds coming from the trach site, he is breathing rapidly, and he is trying to cough. Which action should the nurse perform next?

  • Suction the opening and the trach tubing
  • Assess the patients lung sounds
  • Replace the trach tubing with an Ambu-bag and provide two measured breaths
  • Check the capillary refill in the fingertips
A
  • Suction the opening and the trach tubing
68
Q

All of the following is an example of non-invasive pain intervention. Which of following is not included?

Hypnosis
Acupuncture
Cutaneous simulation
Rhizotomy

A

Rhizotomy

69
Q

A client is scheduled for a surgery in the morning. Preoperative orders have been written. What is most important to do before surgery?

  • Secure consent
  • Remove all jewelry or tape wedding ring
  • Verify that all laboratory work is complete
  • Inform family next of kin
A
  • Secure consent
70
Q

Your patient told you that his jaw pain is extending to his left arm. You are certain that this is what type of pain?

  • Referred pain
  • Intractable pain
  • Cutaneous pain
  • Radiating pain
A
  • Radiating pain
71
Q

After the surgery, Mr Smith told you that his amputated left leg is in pain. You will determine this as:

Referred pain
Intractable pain
Phantom pain
Neuropathic pain

A

Phantom pain

72
Q

Which of the commonly used pre-operative medications may lead to respiratory depression, hypotension, and decreased gastric mobility sometimes causing vomiting?

Meperidine
Amlodipine
Atropine Sulfate
Epinephrine

A

Meperidine

73
Q

The physician has ordered a placebo for chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first actions that you should take?

  • Prepare the medication and hand it to the physician
  • Check the hospital policy regarding use of the placebo
  • Follow a personal code of ethics and refuse to give it
  • Contact the charge nurse for advise
A
  • Contact the charge nurse for advise
74
Q

A nurse is caring for an obese patient who has had surgery. The nurse monitors this patient for what post operative complication?

  • Anesthetic agent interactions
  • Impaired wound healing
  • Hemorrhage
  • Gas pains
A
  • Impaired wound healing
75
Q

In caring for a young child with pain, which assessment tool is the most useful?

  • Simple description pain intensity scale
  • 0-10 numeric pain scale
  • Wong Baker pain-rating scale
  • All of the above
A
  • Wong Baker pain-rating scale
76
Q

Which route of administration is preferred if immediate analgesia and rapid titration are necessary?

Intraosseous
Intraspinal
Intravenous
Sublingual

A

Intravenous

77
Q

Upon using the PQRST pain assessment, your client told you that he has 7 score of severity. You are correct if you determine this as:

Mild
Moderate
Severe
None of the above

A

Severe

78
Q

A responsibility of the nurse is the administration of preoperative medications to patients. Which statements describe the action of these medications? Select all that apply.

  • Diazepam is given to alleviate anxiety
  • Ranitidine is given to facilitate patient sedation
  • Atropine is given to decrease oral secretions
  • Morphine is given to depress respiratory function
  • Cimetidine is given to prevent laryngospasm
  • Fentanyl citrate is given to facilitate a sense of calm
A
  • Diazepam is given to alleviate anxiety
  • Atropine is given to decrease oral secretions
  • Fentanyl citrate is given to facilitate a sense of calm
79
Q

A 72-year-old woman who is scheduled for a hip replacement is taking a several medications on a regular basis. Which drug category might create a surgical risk for this patient?

Enoxaparin
Lactulose
Propofol
Milk of Magnesia

A

Enoxaparin

80
Q

A client with chronic pain reports to you, the charge nurse, that the nurse has not been responding to requests for pain medication. What is your initial action?

  • Chech the medication record and nurse’s noted for the past several days
  • Ask the nurse educator to give an in-service about pain management
  • Perform a complete pain assessment and history on the client
  • Have a conference with the nurse responsible for the care of the client
A
  • Have a conference with the nurse responsible for the care of the client
81
Q

A level 4 student nurse asks you the difference of acute pain from chronic pain. Which of the following will you answer?

  • Less than 6 months of pain is chronic pain
  • Acute pain is characterized by a continual, persistent, and recurrent
  • Acute pain is irreversible and controllable
  • Chronic pain is more difficult to treat
A
  • Chronic pain is more difficult to treat
82
Q

A nurse is teaching a man scheduled to have same-day surgery. Which teaching method would be most effective in preoperative teaching for ambulatory surgery?

Lecture
Discussion
Audio visuals
Written instructions

A

Written instructions