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.

A. Determine the time the client last received pain medication. B. Measure the client's vital signs, including temperature. C. Ask the client to rate her pain on a scale from 0 to 10. D. Reposition the client and offer her a back rub.

Correct Answer is C

Explanation

A reason:

Determining the time the client last received pain medication is important, but it should be done after assessing the current pain level. The nurse needs to know the severity of the pain to decide the next steps.

B reason:

Measuring the client's vital signs, including temperature, is also important, especially to rule out complications like infection. However, addressing the client's immediate pain should take priority to provide relief and then proceed with further assessments.

C reason:

Asking the client to rate her pain on a scale from 0 to 10 is correct. This provides a clear understanding of the pain's intensity, which is essential for determining the appropriate intervention. It allows the nurse to gauge the severity of the pain and respond accordingly.

D reason:

Repositioning the client and offering a back rub can help alleviate discomfort, but these actions should follow the pain assessment to ensure the interventions are appropriate based on the pain's severity and nature.

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

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