A nurse is caring for a client who is using a patient-controlled analgesia (PCA) pump for postoperative pain management.
The nurse enters the room to find the client asleep and his partner pressing the button to dispense a dose of analgesia.
Which of the following responses should the nurse make?
"Your husband should decide when more medication is needed.”.
"Why do you think your husband needs more medication when he is asleep?".
"It's a good idea to help make sure your husband can sleep comfortably.”.
"Next time you think he needs more medication, call me and I'll push the button.”.
The Correct Answer is B
The correct answer is choice B. "Why do you think your husband needs more medication when he is asleep?"
Choice A rationale:
"Your husband should decide when more medication is needed.” This response is incorrect because it implies that the partner has the authority to decide when the client needs pain medication, which violates the purpose of a PCA pump. A PCA pump is specifically designed for client-controlled pain management, ensuring that the patient, not anyone else, controls when they receive pain medication. Allowing someone else to press the button can lead to overmedication and safety risks.
Choice B rationale:
"Why do you think your husband needs more medication when he is asleep?" This response is correct because it prompts the partner to reflect on their actions and provides an opportunity for the nurse to educate about the proper use of PCA pumps. It addresses the immediate issue without being confrontational and opens the door for further discussion on the importance of client safety and correct PCA use.
Choice C rationale:
"It's a good idea to help make sure your husband can sleep comfortably.” This response is incorrect as it endorses inappropriate and unsafe behavior. It encourages the partner to continue pressing the PCA button, risking the client's safety due to potential overmedication, which can lead to severe complications, such as respiratory depression.
Choice D rationale:
"Next time you think he needs more medication, call me and I'll push the button.” This response is incorrect because it contradicts PCA protocols and removes the control from the client. The nurse is responsible for monitoring the client’s pain and safety, not administering medication upon another person’s request. This approach also increases the risk of dosing errors and undermines the purpose of patient-controlled analgesia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is D. "I will call for pain medication before the previous dose wears off."
Choice A rationale:
This statement indicates a misunderstanding of pain management. Avoiding medication to prevent addiction can lead to uncontrolled pain, which can hinder recovery and increase the risk of complications.
Choice B rationale:
While this statement shows the client is aware of their pain, waiting until it becomes intolerable can result in periods of severe discomfort and potential setbacks in recovery.
Choice C rationale:
Relying on a nurse to evaluate pain before requesting medication can delay pain relief, leading to unnecessary suffering and potential complications.
Choice D rationale:
This statement indicates an understanding of proactive pain management. By requesting medication before the previous dose wears off, the client helps maintain consistent pain control, which is crucial for recovery and preventing pain escalation.
Correct Answer is B
Explanation
Choice A rationale:
Sedatives and hypnotics are not typically recommended for long-term relief of sleep problems. They are more commonly used for short-term management of insomnia or acute sleep disturbances. Using these medications for an extended period can lead to tolerance, dependence, and potential side effects.
Choice B rationale:
Neuritis secondary to diabetes is not directly related to the use of sedatives and hypnotics for sleep. This choice does not affect the true or false statement about the long-term use of these medications.
Choice C rationale:
A severely sprained ankle does not impact the use of sedatives and hypnotics for sleep. This choice is not relevant to the true or false statement regarding the long-term use of these medications.
Choice D rationale:
Impaired peripheral circulation is not a determining factor for the long-term use of sedatives and hypnotics for sleep. This choice does not influence the true or false statement in question.
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