1. You are the charge nurse. A client with chronic pain reports to you that the nurses
have not been responding to requests for pain medication. What is
... [Show More] your initial action?
1. Check the medication administration records (MARs) for the past several days.
2. Ask the nurse educator to provide in-service training about pain management.
3. Perform a complete pain assessment on the client and take a pain history.
4. Have a conference with the nurses responsible for the care of this client. - 1. Ans: 4
Have a conference with the nurses responsible for the care of this client.
As charge nurse, you must assess the performance and attitude of the staff in relation
to this client. After data are gathered from the nurses, additional information can be
obtained from the records and the client as necessary. The educator may be of
assistance if a knowledge deficit or need for performance improvement is the problem.
Focus: Supervision, prioritization
2. Family members are encouraging your client to "tough out the pain" rather than risk
drug addiction to narcotics. The client is stoically abiding. You recognize that the
sociocultural dimension of pain is the current priority for the client. Which question will
you ask?
1. "Where is the pain located, and does it radiate to other parts of your body?"
2. "How would you describe the pain, and how is it affecting you?"
3. "What do you believe about pain medication and drug addiction?"
4. "How is the pain affecting your activity level and your ability to function?"
5. "What information do you need about pain, healing, and addiction?" - 2. Ans: 3 "What
do you believe about pain medication and drug addiction?"
Beliefs, attitudes, and familial influence are part of the sociocultural dimension of pain.
Location and radiation of pain address the sensory dimension. Describing pain and its
effects addresses the affective dimension. Activity level and function address the
behavioral dimension. Asking about knowledge addresses the cognitive dimension.
Focus: Prioritization
3. A client with diabetic neuropathy reports a burning, electrical-type pain in the lower
extremities that is worse at night and not responding to nonsteroidal anti-inflammatory
drugs. Which medication will you advocate for first?
1. Gabapentin (Neurontin)
2. Corticosteroids
3. Hydromorphone (Dilaudid)
4. Lorazepam (Ativan) - 3. Ans: 1. Gabapentin (Neurontin)
Gabapentin is an antiepileptic drug, but it is also used to treat diabetic neuropathy.
Corticosteroids are for pain associated with inflammation. Hydromorphone is a stronger
opioid, and it is not the first choice for chronic pain that can be managed with other
drugs. Lorazepam is an anxiolytic that may be ordered as an adjuvant nedication.
Focus: Prioritization
4. Which client is most likely to receive opioids for extended periods of time?
1. A client with fibromyalgia
2. A client with phantom limb pain in the leg
3. A client with progressive pancreatic cancer
4. A client with trigeminal neuralgia - 4. Ans: 3. A client with progressive pancreatic
cancer
Cancer pain generally worsens with disease progression, and the use of opioids is more
generous. Fibromyalgia is more likely to be treated with nonopioid and adjuvant
medications. Trigeminal neuralgia is treated with antiseizure medications such as
carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.
Focus: Prioritization
5. As the charge nurse, you are reviewing the charts of clients who were assigned to the
care of a newly graduated RN. The RN has correctly charted dose and time of
medication, but there is no documentation regarding nonpharmaceutical measures.
What action should you take first?
1. Make a note in the nurse's file and continue to observe clinical performance.
2. Refer the new nurse to the in-service education department.
3. Quiz the nurse about knowledge of pain management and pharmacology.
4. Give praise for correctly charting the dose and time and discuss the deficits in
charting. - 5. Ans: 4. Give praise for correctly charting the dose and time and discuss
the deficits in charting.
In supervision of the new RN, good performance should be reinforced first and then
areas of improvement can be addressed. Asking the nurse about knowledge of pain
management is also an option; however, it would be a more indirect and timeconsuming approach. Making a note and watching do not help the nurse to correct the
immediate problem. In-service training might be considered if the problem persists.
Focus: Supervision, delegation
6. Which clients must be assigned to an experienced RN? (Select all that apply.)... [Show Less]