A nurse is collecting data from a client who is postoperative and received hydromorphone 4 mg PO 15 min ago. The client tells the nurse, "My pain level is still 8 on a 0 to 10 scale." Which of the following actions should the nurse take first?
Contact the provider to prescribe more pain medication for the client.
Teach the client relaxation techniques for the treatment of acute pain.
Document the client's reaction to the administration of medication.
Reevaluate the client's response to the medication in 30 min.
The Correct Answer is D
The first action the nurse should take is to reevaluate the client's response to the medication in 30 min. Hydromorphone has an onset of action of 15 to 30 minutes when taken orally ¹. Therefore, it may take some time for the medication to reach its full effect.
Option a is incorrect because it may not be necessary to contact the provider for more pain medication until after reevaluating the client's response to the medication.
Option b is incorrect because teaching relaxation techniques may not provide immediate relief for acute pain.
Option c is incorrect because documenting the client's reaction to the administration of medication should be done after reevaluating their response to the medication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Keeping a baby rear-facing in the car seat until they reach the age of 2 years old or until they reach the maximum height and weight limits recommended by the car seat manufacturer is a crucial safety guideline. Rear-facing car seats provide better support for a baby's head, neck, and spine in the event of a crash, reducing the risk of severe injuries.
"I should place my baby in the car seat at a 90-degree angle." The correct positioning for a rear-facing car seat is typically between a 30 to 45-degree angle. This angle helps ensure the baby's airway remains open and prevents their head from flopping forward.
"I should position the car seat's retainer clip at the level of my baby's belly button." The retainer clip of the car seat should be positioned at armpit level, not at the level of the baby's belly button. The retainer clip is designed to secure the harness straps and should be placed across the chest, resting on the bony part of the shoulders.
"I should enable the airbag when my baby is in the front seat of the car." It is not safe to have a rear-facing car seat with a baby in the front seat of a vehicle with an active airbag. Airbags can pose a significant risk to infants due to the force with which they deploy. It is recommended to place a rear-facing car seat in the back seat of the vehicle and disable the airbag in the front passenger seat if the baby needs to ride in the front.
It is important for parents to receive proper education on car seat safety and follow the guidelines set forth by car seat manufacturers, national recommendations, and local laws and regulations.
Correct Answer is C
Explanation
Ciprofloxacin is an antibiotic commonly prescribed for the treatment of various bacterial infections. It belongs to a class of medications known as fluoroquinolones. One potential side effect of ciprofloxacin is increased sensitivity to sunlight, which can lead to a higher risk of sunburn. Therefore, it is important for the client to take precautions, such as using sunscreen, wearing protective clothing, and avoiding excessive sun exposure while taking this medication.
"Take an antacid if the medication causes gastrointestinal upset": Ciprofloxacin can be taken with or without food, but it should not be taken with antacids, calcium supplements, or other products containing aluminum, magnesium, or calcium, as they can interfere with the absorption of the medication. If gastrointestinal upset occurs, it is generally recommended to take the medication with food to minimize this side effect.
"Restrict your daily fluid intake while taking this medication": There is no need to restrict fluid intake while taking ciprofloxacin unless specifically instructed by the healthcare provider.
Adequate hydration is important to maintain overall health and prevent potential complications.
"Expect to experience diarrhea while taking this medication": Diarrhea can be a potential side effect of ciprofloxacin, but it is not a universal experience for all individuals taking the medication. It is more appropriate to inform the client about the potential side effects of ciprofloxacin, including gastrointestinal upset, and to encourage them to report any significant or persistent symptoms to their healthcare provider
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today