A nurse is caring for a client who is postoperative following arthroscopy and reports a pain level of 6 on a scale of 0 to 10 after receiving ketorolac 1 hr ago.
Which of the following actions should the nurse take?
Tell the client they can have another dose of ketorolac in 3 hr.
Administer oxycodone 5 mg orally.
Give acetaminophen 650 mg rectally.
Document that the client is exhibiting drug-seeking behaviors.
The Correct Answer is B
Choice A rationale:
Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) used for pain relief after surgery. However, it’s not typically administered every 3 hours. Overuse can lead to serious side effects.
Choice B rationale:
If the client’s pain level remains high after receiving ketorolac, administering an opioid medication like oxycodone may be appropriate.
Choice C rationale:
While acetaminophen can be used for pain relief, rectal administration is not typically the first choice for postoperative pain management.
Choice D rationale:
It’s inappropriate to label a patient as exhibiting drug-seeking behaviors simply because their reported pain level remains high after medication. Pain is subjective and should be addressed appropriately.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Injecting the medication at least 5 cm (2 in) from the umbilicus is not a standard guideline for IM injections. The site of injection depends on factors such as the volume of medication and patient’s age and muscle mass.
Choice B rationale:
Using the Z-track technique to administer the medication is correct. This technique helps to seal the medication in muscle tissue, reducing leakage into subcutaneous tissue.
Choice C rationale:
Giving the medication without aspirating prior to injection is not recommended. Aspiration ensures that the needle is not in a blood vessel before injecting.
Choice D rationale:
Administering the medication with a 27-gauge '/,-inch needle may not be appropriate for an IM injection, especially for adults. A longer and larger gauge needle is typically used for IM injections.
Correct Answer is D
Explanation
Choice A rationale:
Mixing insulin lispro and insulin glargine in the same syringe is not recommended. Insulin glargine has a different pH and mixing it with other insulins could affect its action.
Choice B rationale:
Insulin glargine is a long-acting insulin that is typically given once a day. It provides a steady level of insulin over a 24-hour period.
Choice C rationale:
Shaking insulin vials is not recommended as it can lead to inaccurate dosing. Instead, insulin vials should be gently rolled between the hands to ensure proper mixing.
Choice D rationale:
Insulin lispro is a rapid-acting insulin and should be taken right before a meal. This helps to control the blood glucose spike that occurs after eating.
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