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RN Adolescents EAQ. 1
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RN Adolescents EAQ. 1
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RN Adolescents EAQWhich pain scale would the nurse use to measure the intensity of pain in toddlers? -
ANSWER: FACES scale
Which nonpharmacological nursing intervention is effective in helping relieve
postoperative pain? - ANSWER: Repositioning.
Reason: Acute postoperative pain always requires the use of analgesics, but
nonpharmacological interventions such as repositioning the client can help relieve
pain. Ambulation is not specifically used to decrease postoperative pain. Purse-
lipped breathing is primarily used to improve ventilation. Deep breathing and
coughing are used to clear the respiratory tract.
Which statement is an accurate description of dysmenorrhea? - ANSWER: Pain with
menses.
Reason: Dysmenorrhea is defined as pain with menses. Endometrial hyperplasia
results from anovulation and persistent estrogen stimulation. Bleeding between
menses is metrorrhagia. Heavy bleeding with menses is menorrhagia.
When providing postoperative teaching, which rationale would the nurse give to
explain the purpose of administering an opioid analgesic via epidural catheter? -
ANSWER: Relieves abdominal pain
Reason: Analgesics alleviate pain by binding with opioid receptors in the brain, thus
altering the perception of and response to pain; patient-controlled analgesia (PCA)
via an epidural catheter gives the client control over medication administration and
usually results in the client using less medication. Opioids do not facilitate oxygen
use; they decrease the respiratory rate, and less oxygen is used; the client should be
monitored. Although decreasing anxiety and restlessness may be responses to an
opioid, they are not the primary reason why opioids are used after abdominal
surgery. Opioids are not given to dilate blood vessels; antianginal medications and
vasodilators are used for this purpose
Which caring intervention helps provide comfort, dignity, respect, and peace to a
client? - ANSWER: Relieving pain and suffering
A client presents to the health care facility with abdominal pain. Which question
would the nurse ask the client to obtain information about concomitant symptoms?
- ANSWER: "What other discomfort do you experience?"
Reason: Symptoms that accompany the primary symptom of the illness and worsen
the health condition are called concomitant symptoms. An example is nausea that
may accompany the primary symptom of pain. The nurse assesses the quality of the
pain by asking the client to describe it. The nurse gathers information about the
location of the illness by asking the client to identify the exact location. The nurse
tries to understand the precipitating factors by asking the client about the activities
that aggravate the pain
, A client receives intrathecal morphine to control severe postoperative pain. Which
action will the nurse include as part of the client's initial 24-hour postoperative care
plan? - ANSWER: Monitoring of respiratory rate hourly
Reason: Intrathecal morphine can depress respiratory function depending on the
level it reaches within the spinal column; hourly assessments during the first 12 to 24
hours will allow for early intervention with an antidote if respiratory depression
needs to be corrected. Bradycardia, not tachycardia, and hypotension occur.
Administering naloxone every 3 to 4 hours is too infrequent if the client's
respirations are depressed. The recommended adult dosage usually is 0.4 to 2 mg
every 2 to 3 minutes, if indicated. CNS depression occurs secondary to hypoxia.
Which herbal therapies can be recommended to a client with breast pain? Select all
that apply. One, some, or all responses may be correct. - ANSWER: Chaste tree fruit,
Bugleweed, Chamomile
Reason: Herbal therapies for breast pain include chamomile, bugleweed, and chaste
tree fruit. Dong quai is recommended for menstrual cramping and dysmenorrhea.
Black cohosh root eases premenstrual discomfort and tension.
Which finding is an indication of ulcer perforation in a client with peptic ulcer disease
(PUD)? Select all that apply. One, some, or all responses may be correct. - ANSWER:
Back and shoulder pain, Nausea and vomiting, Rigid abdomen, Hypotension,
Tachycardia
Reason: Perforation of an ulcer can cause tachycardia and hypotension (both caused
by fluid volume shifts from the vascular compartment to the abdominal cavity). A
client with a perforated ulcer would have a hard, rigid abdomen (caused by tensed
muscles) and nausea and vomiting. Back and shoulder pain can occur as a result of
irritation of the phrenic nerve.
Which action puts a client at risk for low back injury and pain? - ANSWER: Smoking
tobacco
Reason: Smoking is a risk factor for low back pain and injury because it causes
constriction of blood flow. Regular swimming exercise helps strengthen the back.
Vitamin D supplementation works with calcium to strengthen the musculoskeletal
system. Prolonged sitting can be augmented with a foot stool and ergonomic chair to
support the back.
When the nurse is analyzing an electrocardiogram (ECG), which waveform illustrates
atrial depolarization? - ANSWER: a
Reason: Option a reflects the P wave; it represents the electrical impulse starting at
the sinus node and spreading throughout the atria (atrial depolarization). Waveform
b reflects the QRS complex; it represents depolarization of the ventricles. Option c
reflects the T wave; it represents repolarization of the ventricles. Waveform d
reflects the U wave; it is believed to reflect late ventricular repolarization or
repolarization of the Purkinje fibers; it is sometimes identified in clients with
hypokalemia.
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