A client receives an oral pain medication. In 1 hour the nurse should:

Complete a report

Call the client's provider

Reassess the client

Notify the nurse manager

Answer and Explanation

The Correct Answer is C

A reason:

Completing a report is not the priority action after administering pain medication. Reassessing the client's pain level and effectiveness of the medication is more crucial at this point.

B reason:

Calling the client's provider may be necessary if there are issues or if the pain is not managed, but the first step should be reassessing the client to determine the need for further action.

C reason:

Reassessing the client is correct. This helps determine the effectiveness of the pain medication and the need for additional interventions. It is important to monitor and document the client's response to the medication.

D reason:

Notifying the nurse manager is not the first action needed. The nurse manager can be informed if there are significant issues, but reassessing the client comes first to understand the medication's impact.

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Correct Answer is A

Explanation

A reason: Remove the catheter and insert another into a different site. If a client reports pain at the IV insertion site, it may indicate improper placement or irritation. Removing the catheter and inserting another into a different site can help alleviate the discomfort and ensure proper IV access. This is the appropriate action in response to the client's complaint.

B reason: Administer an analgesic PO. While administering an oral analgesic may help with general pain, it does not address the specific issue of pain at the IV insertion site. It is important to first ensure the IV is properly placed and not causing irritation.

C reason: Request a prescription for placement of a central venous access device. A central venous access device is not typically necessary for outpatient procedures that require only peripheral IV access. This option is overly invasive and not appropriate for the situation described.

D reason: Administer a local anesthetic. Administering a local anesthetic can provide temporary relief, but it does not address the underlying cause of the pain at the IV insertion site. Ensuring proper placement by repositioning or replacing the catheter is a more appropriate initial response.

Correct Answer is ["740"]

Explanation

To convert the fluid intake to mL:

4 oz juice = 120 mL
6 oz tea = 180 mL
Ice chips melt to half their volume = 50 mL
IV bolus = 150 mL
8 oz broth = 240 mL

Adding these values gives: 120 + 180 + 50 + 150 + 240 = 740 mL

Therefore, the nurse should record a total intake of 740 mL.

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A client receives an oral pain medication. In 1 hour the nurse should:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing a client for outpatient surgery. After the nurse inserts the IV catheter, the client reports pain in the insertion area. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

A nurse is completing an 8-hour I&O record for a client who consumed 4 oz juice, 6 oz tea, a 100 mL cup full of ice chips, an IV bolus of 150 mL, and 8 oz broth. The nurse should record how many mL of intake on the client's record?

Correct Answer is ["740"]

Explanation

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