A nurse is caring for a client who is 6 hr postoperative following an open reduction internal fixation to the left hip. The nurse should use which of the following routes to administer pain medication?
Intravenous
Oral
Sublingual
Intramuscular
The Correct Answer is A
Postoperative pain management requires rapid onset of action to maintain the client within a therapeutic comfort window. During the immediate post-anesthesia period (the first 24 hours), the gastrointestinal tract may have decreased motility, making systemic absorption via the bloodstream the most reliable method. Effective analgesia is crucial for early mobilization and preventing complications like venous thromboembolism.
Rationale:
A. The intravenous route is the priority for a client who is only 6 hours postoperative because it provides immediate bioavailability and rapid peak effect. Following a major orthopedic surgery like a hip fixation, pain levels are typically high and require the fast-acting relief that IV opioids or non-opioids provide. This route allows for precise titration of the medication based on the client’s immediate pain response.
B. The oral route is generally avoided in the very early postoperative period due to the risk of postoperative ileus and nausea related to anesthesia. Oral medications have a slower onset of action, typically taking 30 to 60 minutes to reach peak effect, which is insufficient for acute, severe surgical pain. This route is more appropriate once the client is stable and bowel sounds have returned.
C. Sublingual administration is useful for certain medications but is not the standard of care for acute postoperative pain following major surgery. Most potent surgical analgesics are not formulated for sublingual use. The nurse requires a route that can deliver a wide range of analgesic agents reliably, making the intravenous route superior for the immediate recovery phase of a hip surgery.
D. The intramuscular route is generally discouraged for postoperative pain because it is painful, results in inconsistent absorption, and has a slower onset than the intravenous route. Repeated IM injections can cause tissue damage and hematomas, especially in surgical clients who may be on anticoagulants. Modern nursing practice favors IV access for acute pain to ensure consistent and rapid relief.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Clozapine is an atypical antipsychoticused for treatment-resistant schizophrenia. It carries a black box warning for agranulocytosis, a severe reduction in granulocytes that predisposes patients to fatal sepsis. Monitoring the absolute neutrophil count and leukocytelevels is a mandatory safety requirement for this therapy.
Rationale:
A.A BMI of 28 indicates that the client is overweight, which is a common metabolic side effect of clozapine therapy. While weight gain should be managed through diet and lifestyle interventions, it does not represent an acute, life-threatening emergency. The nurse should document this finding but prioritize more urgent hematological complications during the assessment.
B.A fasting blood glucose of 180 mg/dL indicates hyperglycemia, reflecting the metabolic dysregulation often induced by second-generation antipsychotics. Clozapine can cause insulin resistance and new-onset diabetes mellitus. While this requires medical management and potential pharmacotherapy, it is not as immediately life-threatening as the risk of profound immunosuppression and systemic infection.
C.An LDL level of 220 mg/dL signifies hyperlipidemia, which increases the long-term risk of cardiovascular disease in patients taking clozapine. Dyslipidemia is a recognized adverse effect of the medication's impact on metabolic pathways. Although this value requires follow-up and statin therapy, it does not necessitate immediate notification compared to an urgent hematological crisis.
D.A WBC count of 2,500/mm3 is a critical finding indicating severe leukopenia and a high risk for agranulocytosis. This condition compromises the immune system, making the client highly vulnerable to life-threatening infections. The nurse must report this to the provider immediately, withhold the medication, and initiate protective isolation protocols to prevent the development of sepsis.
Correct Answer is A
Explanation
The shingles vaccine (specifically live attenuated versions) is contraindicated or requires caution in individuals who are immunocompromised. Certain medications exert an immunosuppressiveeffect by interfering with cellular replication or the inflammatory response, which can lead to uncontrolled viral replicationof the vaccine strain in the host.
Rationale:
A.Methotrexate is an immunosuppressant and antimetabolite that inhibits dihydrofolate reductase, leading to reduced white blood cell activity. Because the vaccine for shingles (Zostavax) contains live virus, patients on methotrexate may not be able to mount an appropriate immune response or may develop the infection. Caution or contraindication is necessary depending on the dose and the specific type of vaccine.
B.Estrogen replacement therapy does not significantly alter the immune system's ability to respond to vaccines. It is a hormone used to manage menopausal symptoms or osteoporosis and does not cause the leukopenia or immunosuppression associated with chemotherapy or autoimmune treatments. There is no contraindication for shingles immunization based on the use of estrogen medications in an adult client.
C.Esomeprazole is a proton pump inhibitor used to reduce gastric acid secretion and treat gastroesophageal reflux disease. It does not have any systemic effect on the immune response or the efficacy of viral vaccines. Patients taking esomeprazole can safely receive the shingles vaccine without additional precautions regarding their immunological status or ability to process the immunization.
D.Metformin is an oral antidiabetic agent that improves insulin sensitivity and has no known immunosuppressive properties. It does not interfere with the body's ability to produce antibodies or manage the live attenuated virus found in certain vaccines. Therefore, a prescription for metformin would not serve as a reason for caution when scheduling a shingles immunization for a senior client.
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