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Chapter 2 - Prioritization, Delegation, and Assignment 2024/2025 already graded A+
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Chapter 2 - Prioritization, Delegation, andAssignment
The patient describes a burning sensation in the leg. The health care provider tells the nurse
that a medication will be prescribed for neuropathic pain secondary to chemotherapy. The nurse
is *most* likely to question the prescription of which drug?
•Imipramine
•Carbamazepine
•Gabapentin
•Morphine - ANS•Morphine
•Morphine is usually not prescribed for neuropathic pain because pain relief response is poor.
Other medications, some antidepressants (e.g., imipramine) and some anticonvulsants (e.g.,
carbamazepine and gabapentin), provide better relief.
A patient who has cancer will need ongoing treatment for pain. Which brochure is the nurse
most likely to prepare that addresses questions related to the first-line treatment of cancer pain?
•"An Illustrated Guide to the Analgesic Ladder"
•"Common Questions About Radiation Therapy"
•"How to Make Preparations for Your Cancer Surgery"
•"How Nerve Blocks Can Help to Manage Cancer Pain" - ANS•"An Illustrated Guide to the
Analgesic Ladder"
•Analgesic drugs are the first-line treatment for cancer pain management. If pain is not
controlled by medication, other options are available, including radiation, surgery, and nerve
blocks.
Which nurse is demonstrating the *first* step in managing cancer pain by using the ABCDE
(ask, believe, choose, deliver, and empower) clinical approach to pain management as
recommended by the Agency for Healthcare Research and Quality?
•Nurse J asks if the time of the prescribed dose of medication can be changed
•Nurse K asks the patient to describe pain and uses a numerical pain scale
•Nurse L asks the patient to participate and to contribute in pain management
•Nurse M asks about pain management options that are appropriate for the patient - ANS•Nurse
K asks the patient to describe pain and uses a numerical pain scale
•Asking the patient to describe the pain is the first step. The ABCDE step-by-step clinical
approach includes ask, believe, choose, deliver, and empower (or enable).
,The nurse assesses the patient and determines that the patient is having frequent breakthrough
cancer pain. Which member of the health care team is the nurse most likely to contact *first*?
•Physical therapist to reevaluate physical therapy routines
•Health care provider to review medication, dosage, and frequency
•Unlicensed assistive personnel to provide more assistance with activities of daily living
•Psychiatric clinical nurse specialist to evaluate psychogenic pain - ANS•Health care provider to
review medication, dosage, and frequency
•Breakthrough pain is defined as rapid onset, short duration, and moderate to severe; a
temporary exacerbation related to poorly controlled around-the-clock dosing of background
pain. Frequent breakthrough pain suggests that the around-the-clock dosing needs
reevaluation, so the nurse would contact the health care provider and advocate for a change of
medication or dose or frequency.
The night shift nurse tells the oncoming dayshift nurse that the cancer patient is on
around-the-clock dosing of morphine but that the patient might be having end-of-dose pain.
Which question is the *most* important to ask the night shift nurse?
•"How many times did you have to give a bolus dose of morphine?"
•"Did the patient tell you that the pain was greater than a 5/10?"
•"Did you notify the health care provider (HCP), and were changes prescribed?"
•"Did you try any nonpharmaceutical therapies or adjuvant medications?" - ANS•"Did you notify
the health care provider (HCP), and were changes prescribed?"
•The nurse might ask any of these questions, but the most important question is whether the
HCP was notified and if any changes were made to address the patient's pain. If the HCP was
not called during the night (which is often the case), then the day shift nurse must assess the
patient's current pain, talk to him or her directly about last night's pain, and gather data about
the frequency of bolus doses and other options that were tried. Data about last night's care
should be available in the patient's record if it is not mentioned in report.
The nurse is caring for a patient with esophageal cancer. Which task could be delegated to
unlicensed assistive personnel (UAP)?
•Assisting the patient with oral hygiene
•Observing the patient's response to feedings
•Facilitating expression of grief or anxiety
•Initiating daily weights - ANS•Assisting the patient with oral hygiene
•Oral hygiene is within the scope of duties of the UAP. It is the responsibility of the nurse to
observe response to treatments and to help the patient deal with loss or anxiety. The UAP can
, be directed to weigh the patient but should not be expected to know when to initiate that
measurement.
A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent
diarrhea and constipation for the past several months. There is a history of polyps and a family
history of colorectal cancer. While the nurse is trying to teach about colonoscopy, the patient
becomes angry and threatens to leave. What is the *priority* nursing concept to consider in
responding to this patient?
•Elimination
•Patient education
•Cellular regulation
•Anxiety - ANS•Anxiety
•The patient's physical condition is currently stable, but emotional needs are affecting his or her
ability to receive the information required to make an informed decision. The other concepts are
relevant, but if the patient leaves the clinic, the interventions may be delayed or ignored.
Which patient is at *greatest* risk for pancreatic cancer?
•An older African-American man who smokes
•A young white obese woman with gallbladder disease
•A young African-American man with type 1 diabetes
•An elderly white woman who has pancreatitis - ANS•An older African-American man who
smokes
•Pancreatic cancer is more common in African Americans, men, and smokers. Other associated
factors include older age, alcohol use, diabetes, obesity, history of pancreatitis, exposure to
organic chemicals, consumption of a high-fat diet, and previous abdominal irradiation.
Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or
disease processes. Which actions are needed for patients who must be placed on bleeding
precautions? *Select all that apply.*
•Provide mouthwash with alcohol for oral rinsing
•Use paper tape on fragile skin
•Provide a soft toothbrush or oral sponge
•Gently insert rectal suppositories
•Avoid aspirin or aspirin-containing products
•Avoid overinflation of blood pressure cuffs - ANS•Use paper tape on fragile skin
•Provide a soft toothbrush or oral sponge
•Avoid aspirin or aspirin-containing products
•Avoid overinflation of blood pressure cuffs
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