A patient with a deep partial thickness burn has been receiving hydromorphone through patient-controlled analgesia (PCA) for 1 week. The nurse caring for the patient during the previous shift reports that the patient wakes up frequently during the night reporting pain. What action by the nurse is appropriate?
Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.
Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
Consult with the health care provider about using a different treatment protocol to control the patient's pain.
Administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.
The Correct Answer is C
C. This option is appropriate as the current treatment protocol is not effectively managing the patient's pain. The nurse can collaborate with the healthcare provider to reassess the patient's pain management needs and explore alternative strategies or adjustments to the PCA regimen.
A. This approach may lead to overmedication and increase the risk of adverse effects such as respiratory depression or sedation.
B. Requesting a bolus dose when the patient awakens with pain could be a part of the solution, but it should be carefully evaluated within the context of the overall pain management plan.
D. Administering scheduled doses of morphine from the PCA machine without the patient's input or based solely on time intervals is not recommended.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Preventing hip flexion of the affected extremity is often a key component of postoperative care following total hip arthroplasty. This helps prevent dislocation of the new hip joint and promotes proper healing.
B. While some caution is necessary to prevent excessive movement that could strain the surgical site, complete avoidance of movement in the affected leg is not recommended.
C. Ensuring that the client's heels are touching the bed is not typically a specific intervention related to postoperative care following total hip arthroplasty.
D. Positioning the lower extremities so that they are touching is not typically a specific intervention related to postoperative care following total hip arthroplasty.
Correct Answer is B
Explanation
B. Alcohol consumption, especially beer and spirits, is associated with an increased risk of gout attacks as it can elevate uric acid levels in the body. Limiting alcohol intake can help prevent gout attacks.
A. While adequate hydration is important for overall health, limiting fluid intake to 1 liter per day may not be appropriate, especially considering that hydration can help prevent gout attacks.
C. While aspirin is commonly used for pain relief, it is not typically recommended for gout management.
D. High-purine foods such as red meat, organ meats, and certain seafood can exacerbate gout symptoms by increasing uric acid levels in the body. Therefore, closely following a high-purine diet would likely worsen gout symptoms rather than improve them.
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