A nurse is teaching a client about using a PCA device for postoperative pain management. Which of the following statements should the nurse make?
You will have control of administering your own pain medication
The pain medication is delivered into your muscle
Your partner can push the PCA button for you if you are asleep
A large dose of pain medication is given with each injection
The Correct Answer is A
A) "You will have control of administering your own pain medication":
This statement accurately describes the function of a PCA (Patient-Controlled Analgesia) device, where the client has control over administering their own pain medication within preset limits. Empowering the client to manage their pain helps promote autonomy and individualized pain management.
B) "The pain medication is delivered into your muscle":
This statement is incorrect because PCA devices typically deliver medication intravenously, not into the muscle. It's important for the client to understand the route of administration to use the device effectively and safely.
C) "Your partner can push the PCA button for you if you are asleep":
Allowing someone else to activate the PCA button for the client can lead to overmedication and is not recommended. PCA devices are designed for the client to self-administer medication based on their own pain experience and need.
D) "A large dose of pain medication is given with each injection":
This statement is inaccurate because PCA devices are programmed to deliver a controlled dose of medication with each activation, usually within safe limits set by the healthcare provider. The doses are typically set to avoid overdosing while providing effective pain relief.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Increased blood pressure:
In hypovolemia, the body experiences a significant loss of blood volume, which leads to a reduction in the amount of blood available to circulate through the vessels. This causes a drop in blood pressure, known as hypotension, rather than an increase. The body tries to compensate for the lower blood volume by constricting blood vessels and increasing heart rate, but this typically isn't sufficient to increase blood pressure to normal levels.
B. Decreased heart rate:
The body's natural response to hypovolemia includes an increase in heart rate, known as tachycardia, as the heart attempts to pump the remaining blood more efficiently to vital organs. This compensatory mechanism aims to maintain cardiac output despite the decreased blood volume.
C. Dyspnea:
Dyspnea, or difficulty breathing, can occur in many medical conditions, including heart failure and respiratory issues. While it can be seen in severe cases of hypovolemia, particularly if the condition leads to shock and subsequent multi-organ failure, it is not a primary or specific sign of hypovolemia.
D. Weak pulse:
A weak pulse is a primary and direct manifestation of hypovolemia. Due to the reduced volume of circulating blood, the heart has less blood to pump with each contraction, leading to a weaker pulse. This symptom indicates a decreased perfusion pressure, which is characteristic of hypovolemia. The body's compensatory mechanisms include vasoconstriction and an increased heart rate, but these measures often result in a pulse that is rapid but weak.
Correct Answer is B
Explanation
A. Chronic drainage of fluid through the incision site:
While chronic drainage of fluid through the incision site can be a sign of wound complications, such as infection or poor wound healing, it is not as specific an indicator of impending wound dehiscence as the patient's report of "something giving way."
B. Report by patient that something has given way:
A patient reporting that something has given way is a significant indicator of potential wound dehiscence. Wound dehiscence refers to the partial or complete separation of the layers of a surgical wound, which can occur due to various factors such as poor wound healing, infection, or increased intra-abdominal pressure. Patients may describe a sensation of "something giving way" or "popping" if the wound starts to separate.
C. Drainage that is odorous and purulent:
Odorous and purulent drainage from an incision site may indicate an infection, which can contribute to wound dehiscence. However, this finding alone may not necessarily indicate immediate wound dehiscence.
D. Protrusion of visceral organs through a wound opening:
Protrusion of visceral organs through a wound opening is a severe complication known as evisceration, which is the most advanced stage of wound dehiscence. While this finding is indicative of a significant wound complication, it typically occurs after the initial separation of wound layers. Therefore, it is not an early sign that would alert the nurse to potential wound dehiscence
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