The correct answer is choice C. Assess the patient’s leg for circulation, sensation, and movement.

This is because the patient’s symptoms of pain, tingling, and numbness in his left leg could indicate a potential complication of impaired blood flow or nerve damage after surgery.The nurse should prioritize assessing the patient’s leg for any signs of compromised circulation, sensation, or movement before administering any pain medication.

Choice A is wrong because administering morphine sulfate 2 mg IV bolus without assessing the patient’s leg could mask the symptoms of a serious problem and delay appropriate interventions.Morphine sulfate is a potent opioid analgesic that can cause respiratory depression, sedation, and constipation.

Choice B is wrong because administering ibuprofen 400 mg PO without assessing the patient’s leg could also mask the symptoms of a serious problem and delay appropriate interventions.Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal bleeding, renal impairment, and increased risk of cardiovascular events.

Choice D is wrong because reassessing the patient’s pain in 15 minutes without assessing the patient’s leg could result in the worsening of the patient’s condition and increased risk of complications.The nurse should not delay assessing the patient’s leg for any signs of impaired circulation, sensation, or movement.

The correct answer is choice B. Administer Percocet every six hours around the clock for two days.

This is because the patient has been receiving a continuous infusion of morphine via a PCA pump, which means that they have a steady level of opioids in their system.

If the PCA pump is discontinued abruptly and the patient is switched to oral analgesics PRN, they may experience withdrawal symptoms and inadequate pain relief.

Therefore, the patient needs to receive a scheduled dose of oral opioids for at least two days to prevent a sudden drop in opioid blood concentration and to maintain adequate analgesia.

After two days, the patient’s pain level and opioid requirement may be reassessed and the oral analgesics may be tapered or given PRN as needed.

Choice A is wrong because a higher dose of Percocet is not necessary if the patient reports satisfactory pain relief with the current PCA settings.The equivalent oral dose of morphine for the patient’s average PCA consumption is about 120 mg per day (20 mg x 6 doses), which is equivalent to about 80 mg of oxycodone per day (1.5 x 120 mg).

The prescribed dose of Percocet is 20 mg of oxycodone per day (5 mg x 4 doses), which is about 25% of the patient’s previous opioid requirement.This reduction is appropriate to account for incomplete cross-tolerance between different opioids.

Choice C is wrong because stopping morphine one hour before giving Percocet will not prevent a gap in analgesia.The half-life of morphine is about 2 to 4 hours, which means that it takes about 10 to 20 hours for morphine to be eliminated from the body.

Therefore, stopping morphine one hour before giving Percocet will not significantly reduce the morphine blood concentration and will not avoid the risk of additive effects or overdose.

Choice D is wrong because giving Percocet only if the patient reports breakthrough pain will not provide adequate pain relief for the patient who has been receiving a continuous infusion of morphine via a PCA pump.

The patient may experience withdrawal symptoms and increased pain sensitivity if the opioid blood concentration drops suddenly.

Therefore, the patient needs to receive a scheduled dose of oral opioids for at least two days to prevent a gap in analgesia and to allow a smooth transition from IV to oral opioids.

The correct answer is choice A, C and E. These statements indicate that the client understands the teaching about nonpharmacological pain management techniques.

• Choice A is correct becausemeditationcan help the client relax and cope with pain by reducing stress and anxiety.

• Choice C is correct becausedistractioncan help the client divert attention from pain by engaging in enjoyable or stimulating activities.

• Choice E is correct becauseheatcan help the client soothe the painful area by increasing blood flow and relaxing muscles.

• Choice B is wrong becausecold packsshould not be applied to the painful area for more than15 minutesat a time, as they can cause tissue damage or frostbite.

• Choice D is wrong becausemassageshould not be done with firm pressure, as it can aggravate the pain or cause injury.Gentle massage may be beneficial for some clients.

The correct answer is choice C) Chest pain.

This is because chest pain can be a sign of a serious cardiovascular event, such as a heart attack or stroke, which can be fatal.

Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that belongs to the class of cyclooxygenase-2 (COX-2) inhibitors.These drugs can increase the risk of cardiovascular thrombotic events, especially in patients with a history of heart disease or risk factors.

Therefore, the nurse should instruct the client to report chest pain immediately and seek emergency medical attention.

Choice A) Constipation is wrong because it is not a common or serious side effect of celecoxib.

Constipation can be caused by many factors, such as diet, dehydration, lack of exercise, or other medications.It can be managed by increasing fluid and fiber intake, using laxatives or stool softeners as needed, and consulting a doctor if it persists or worsens.

Choice B) Nausea is wrong because it is a common but mild side effect of celecoxib that usually goes away with time or can be reduced by taking the medication with food or milk.

Nausea is not a sign of a serious adverse reaction and does not require immediate medical attention.

Choice D) Headache is wrong because it is also a common but mild side effect of celecoxib that can be treated with over-the-counter pain relievers, such as acetaminophen or ibuprofen.

However, the client should avoid taking aspirin or other NSAIDs with celecoxib, as this can increase the risk of gastrointestinal bleeding and ulcers

The correct answer is choice D) “Aspirin can cause gastrointestinal bleeding.”

This is because aspirin is a salicylate that works by reducing substances in the body that cause pain, fever, and inflammation, but also prevents blood clots from forming in the arteries.This can increase the risk of bleeding, especially in the stomach or gut.

Choice A) “Aspirin can be taken with alcohol.” is wrong because alcohol can also increase the risk of bleeding and interact with aspirin.

Choice B) “Aspirin can be taken on an empty stomach.” is wrong because aspirin can irritate the stomach lining and cause heartburn, nausea, or vomiting.It is better to take aspirin with food or water.

Choice C) “Aspirin can be taken with antacids.” is wrong because antacids can reduce the effectiveness of aspirin and interfere with its absorption.It is better to avoid taking antacids within two hours of taking aspirin.

The correct answer is choiceA,B , andD.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can cause gastric irritation and bleeding.Therefore, the nurse should instruct the client to take ibuprofen with food or milk to reduce the risk of stomach ulcers.The nurse should also advise the client to avoid alcohol while taking ibuprofen, as alcohol can increase the risk of gastrointestinal bleeding and liver damage.Additionally, the nurse should tell the client to report any signs of gastrointestinal bleeding, such as black or tarry stools, abdominal pain, or vomiting blood, to the healthcare provider immediately.

ChoiceCis wrong because taking ibuprofen on an empty stomach can increase the risk of gastric irritation and bleeding.

ChoiceEis wrong because taking ibuprofen with antacids can reduce the effectiveness of ibuprofen and interfere with its absorption.Antacids can also cause adverse effects such as diarrhea, constipation, or electrolyte imbalance.

Therefore, the nurse should not recommend taking ibuprofen with antacids.

The correct answer is choice A. Hepatic necrosis.Acetaminophen (APAP) is a common cause of drug-induced liver injury and can lead to hepatic necrosis, especially in patients who have chronic hepatitis C.APAP is metabolized by the liver and produces a toxic intermediate called N-acetyl-p-benzoquinone imine (NAPQI), which can deplete glutathione and damage hepatocytes.Patients who have chronic hepatitis C may have reduced glutathione levels and increased oxidative stress, making them more susceptible to APAP toxicity.

Choice B. Pulmonary fibrosis is wrong because APAP does not cause pulmonary fibrosis.

Pulmonary fibrosis is a chronic lung disease that involves scarring of the lung tissue and impaired gas exchange.Some drugs that can cause pulmonary fibrosis are amiodarone, bleomycin, methotrexate and nitrofurantoin.

Choice C. Pancreatitis is wrong because APAP does not cause pancreatitis.

Pancreatitis is an inflammation of the pancreas that can result from gallstones, alcohol abuse, hypertriglyceridemia, hypercalcemia, infections, trauma or certain medications.

Some drugs that can cause pancreatitis are azathioprine, valproic acid, didanosine and pentamidine.

Choice D. Cardiac dysrhythmias is wrong because APAP does not cause cardiac dysrhythmias.

Cardiac dysrhythmias are abnormal heart rhythms that can result from electrolyte imbalances, ischemia, myocardial infarction, heart failure, congenital defects or certain medications.

Some drugs that can cause cardiac dysrhythmias are digoxin, quinidine, sotalol and erythromycin.

The correct answer is choice A. Avoid driving while taking this medication.The nurse should instruct the client to avoid driving or operating heavy machinery while taking acetaminophen and hydrocodone (Vicodin) because these medications can cause drowsiness, dizziness, and impaired mental function.The nurse should also warn the client about the risk of addiction, overdose, and death from misuse of this medication.

Choice B is wrong because taking this medication on an empty stomach can increase the risk of nausea and vomiting.The nurse should advise the client to take this medication with food or milk to prevent stomach upset.

Choice C is wrong because increasing the intake of foods rich in vitamin K is not relevant to taking acetaminophen and hydrocodone (Vicodin).Vitamin K is involved in blood clotting and may interact with some anticoagulant medications, but not with this medication.

Choice D is wrong because limiting fluid intake to prevent fluid retention is not necessary for a client taking acetaminophen and hydrocodone (Vicodin).This medication does not cause fluid retention or edema.The nurse should encourage the client to drink plenty of fluids to prevent constipation, which is a common side effect of opioid medications.

The correct answer is choice A, B, and C. These are all liver enzymes that can indicate hepatotoxicity (liver damage) from acetaminophen overdose.

The normal ranges for these enzymes are:

• AST: 10 to 40 U/L

• ALT: 7 to 56 U/L

• ALP: 45 to 115 U/L

Choice D and E are wrong because they are indicators of renal function, not liver function.

The normal ranges for these values are:

• BUN: 7 to 20 mg/dL

• Creatinine: 0.6 to 1.2 mg/dL

The correct answer is choice A. The client reports a pain level of 4 on a scale of 0 to 10.This indicates that the PCA pump is effective in reducing the client’s pain, which is the primary symptom of sickle cell crisis.

Choice B is wrong because a respiratory rate of 12 breaths per minute is normal and does not indicate the effectiveness of the PCA pump.

Choice C is wrong because a blood pressure of 140/90 mm Hg is high and may indicate hypertension, which is a complication of sickle cell disease.

Choice D is wrong because a pulse oximetry reading of 95% is normal and does not indicate the effectiveness of the PCA pump.

Normal ranges for vital signs are:

• Respiratory rate: 12-20 breaths per minute

• Blood pressure: <120/80 mm Hg

• Pulse oximetry: >95%

The correct answer is choice C.The client should take this medicationregularlyas prescribed to maintain a steady level of analgesia and prevent breakthrough pain.

Taking the medication only when the pain is severe can lead to inadequate pain relief and increased side effects.

Choice A is wrong because drinking plenty of fluids and eating high-fiber foods can help prevent constipation, which is a common adverse effect of opioids.

Choice B is wrong because avoiding driving or operating heavy machinery is a safety precaution for clients taking opioids, as they can cause drowsiness and impaired judgment.

Choice D is wrong because reporting any signs of allergic reaction is an important instruction for clients taking any medication, especially opioids, which can cause severe hypersensitivity reactions.

The correct answer is choice A) Respiratory rate: 10 breaths/min.This indicates that the patient may be experiencing respiratory depression, which is a serious adverse effect of buprenorphine and other opioids.

Respiratory depression can lead to hypoxia, brain damage, or death if not treated promptly.

The normal respiratory rate for adults is 12 to 20 breaths/min.

Choice B) Blood pressure: 110/70 mm Hg is wrong because this is within the normal range for adults, which is 90/60 to 120/80 mm Hg.Buprenorphine can cause hypotension as a side effect, but this is not evident in this case.

Choice C) Heart rate: 72 beats/min is wrong because this is also within the normal range for adults, which is 60 to 100 beats/min.Buprenorphine can cause bradycardia as a side effect, but this is not evident in this case.

Choice D) Temperature: 37°C is wrong because this is the normal body temperature for humans.Buprenorphine can cause hyperthermia as a side effect, but this is not evident in this case.

The correct answer is choice B.Methadone blocks the euphoric effects of heroin and discourages its use.Methadone is a synthetic opioid analgesic that produces a cross-tolerance to other narcotics, thereby preventing the user from feeling the high of heroin.Methadone also reduces withdrawal symptoms and cravings for heroin.

Choice A is wrong because methadone does not prevent withdrawal symptoms, but rather reduces them.

Choice C is wrong because methadone does not stimulate opioid receptors, but rather occupies them and blocks their activation by heroin.

Choice D is wrong because methadone does not reverse the respiratory depression caused by heroin overdose, but rather carries a risk of overdose itself.

The correct answer is choice B and C.Oxycodone (OxyContin) is a potent opioid analgesic that can causeconstipation,drowsiness,nausea,pruritus, andvomitingas common side effects.

To prevent constipation, the patient should be encouraged to drink plenty of fluids and eat high-fiber foods.To prevent respiratory depression and sedation, the patient should be advised to avoid alcohol and other CNS depressants while taking oxycodone.

Choice A is wrong because monitoring vital signs regularly is not specific to oxycodone use, but rather a general nursing intervention for any patient with chronic pain.

Choice D is wrong because acetaminophen (Tylenol) can interact with oxycodone and increase the risk of liver damage.

The patient should not take any other pain medications without consulting the prescriber.

Choice E is wrong because a patient-controlled analgesia (PCA) pump is not used for long-term pain management, but rather for acute or postoperative pain.Oxycodone (OxyContin) is formulated as an extended-release tablet that provides sustained pain relief for up to 12 hours.

The correct answer is choice A.Blurred vision is a common side effect of gabapentin and should be reported to the doctor.

Blurred vision can affect the patient’s ability to perform daily activities and may indicate a serious problem with the eyes or the brain.

Choice B is wrong because constipation is not a common side effect of gabapentin.

Constipation can be caused by other factors such as diet, dehydration, or lack of physical activity.

Choice C is wrong because dry mouth is a common side effect of gabapentin and does not usually require medical attention.

Dry mouth can be relieved by drinking water, chewing sugar-free gum, or using saliva substitutes.

Choice D is wrong because tinnitus is not a common side effect of gabapentin.

Tinnitus is a ringing or buzzing sound in the ears that can be caused by many conditions such as ear infections, hearing loss, or exposure to loud noises.

The correct answer is choice A. Serum calcium.Etidronate is a bisphosphonate that inhibits bone resorption and reduces the risk of skeletal complications in patients with cancer-related bone pain.However, it can also cause hypocalcemia (low serum calcium levels) as a side effect, which can lead to muscle spasms, numbness, tingling, seizures, and cardiac arrhythmias.

Therefore, the nurse should monitor the patient’s serum calcium levels regularly and supplement with calcium and vitamin D if needed.

Choice B. Serum potassium is wrong because etidronate does not affect potassium levels.Potassium is mainly regulated by the kidneys and can be altered by renal impairment, dehydration, acid-base imbalance, or medications such as diuretics or potassium-sparing agents.

Choice C. Serum creatinine is wrong because etidronate does not affect creatinine levels.

Creatinine is a waste product of muscle metabolism that is excreted by the kidneys.It reflects the glomerular filtration rate (GFR) and can be elevated in renal dysfunction or dehydration.

Choice D. Serum albumin is wrong because etidronate does not affect albumin levels.

Albumin is a protein that is synthesized by the liver and helps maintain fluid balance and transport substances in the blood.It can be decreased in liver disease, malnutrition, inflammation, or protein-losing conditions.

The correct answer is choice A, B, D, and E.Hydroxyzine is an antihistamine that hasantiemeticandsedativeeffects that are thought to be mediated by its actions in the brain.It can alsodecrease anxietyrelated to pain by inhibiting the hypothalamic H-1 histamine receptors.Hydroxyzine may also have apotentiatingeffect on other analgesics, although the evidence for this is not conclusive.

Choice C is wrong because hydroxyzine does not have any anti-inflammatory properties.It is a competitive antagonist of histamine H1-receptors, not a cyclooxygenase inhibitor.

The correct answer is choice B. Check the client’s allergy history.

This is because morphine sulfate is a medication that can cause severe allergic reactions in some people, such as anaphylaxis, which can be life-threatening.

Therefore, the nurse should always check the client’s allergy history before administering any medication, especially opioids.

Choice A is wrong because assessing the client’s respiratory rate is not the first action the nurse should take.

Although morphine sulfate can cause respiratory depression, which is a serious side effect that needs to be monitored, the nurse should first ensure that the client is not allergic to the medication.

Choice C is wrong because reviewing the client’s medication record is not the first action the nurse should take.

Although morphine sulfate can interact with other medications, such as sedatives, antidepressants, or alcohol, which can increase the risk of respiratory depression or overdose, the nurse should first ensure that the client is not allergic to the medication.

Choice D is wrong because verifying the dosage with another nurse is not the first action the nurse should take.

Although morphine sulfate is a high-alert medication that requires double-checking to prevent medication errors, the nurse should first ensure that the client is not allergic to the medication.

The correct answer is choice D. Serum bilirubin.The nurse should monitor the client’s serum bilirubin level closely because acetaminophen, a non-opioid analgesic, can cause hepatotoxicity and acute liver failure in cases of overdose.

Serum bilirubin is a marker of liver function and damage.

A high level of serum bilirubin indicates jaundice, a sign of liver injury.

Choice A is wrong because serum creatinine is a marker of kidney function and damage.Acetaminophen has limited nephrotoxicity compared to NSAIDs.

Choice B is wrong because serum potassium is not directly affected by acetaminophen.

Serum potassium is an electrolyte that reflects fluid and acid-base balance in the body.

Choice C is wrong because serum albumin is a protein that is synthesized by the liver.

Although serum albumin may be low in chronic liver disease, it is not a sensitive indicator of acute liver injury caused by acetaminophen overdose.

Normal ranges for serum bilirubin are 0.3 to 1.2 mg/dL for adults and 1 to 12 mg/dL for newborns.

Normal ranges for serum creatinine are 0.6 to 1.2 mg/dL for men and 0.5 to 1.1 mg/dL for women.

Normal ranges for serum potassium are 3.5 to 5 mEq/L for adults and children.

Normal ranges for serum albumin are 3.4 to 5.4 g/dL for adults and children.

The correct answer is choice A, B, C, and D.Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that has anti-inflammatory, analgesic, and antipyretic effects.It works by inhibiting the synthesis of prostaglandins, which are involved in inflammation, pain, and fever.However, ibuprofen can also cause adverse effects such as gastric irritation, bleeding complications, renal impairment, and hypersensitivity reactions.

Therefore, the nurse should instruct the client to:

• Take ibuprofen with food or milk to prevent gastric irritation.This will reduce the direct contact of the drug with the stomach lining and decrease the risk of ulcers and bleeding.

• Drink at least 2 liters of fluid per day to prevent renal impairment.This will help maintain adequate hydration and renal perfusion and prevent the accumulation of ibuprofen in the kidneys.

• Avoid alcohol and other NSAIDs to prevent bleeding complications.Alcohol and other NSAIDs can increase the risk of gastric bleeding by interfering with the protective effects of prostaglandins on the stomach mucosa.

• Report any signs of hypersensitivity such as rash, itching, or wheezing.These may indicate an allergic reaction to ibuprofen that can be serious or life-threatening.

Choice E is wrong because ibuprofen does not affect blood pressure significantly.However, some other NSAIDs such as celecoxib may increase the risk of cardiovascular events such as thrombosis, myocardial infarction, and stroke.Therefore, clients with hypertension or cardiovascular disease should use NSAIDs with caution and monitor their blood pressure regularly.

The correct answer is choice A, B, C and E.These actions by the nurse help facilitate the pain assessment by using a consistent and clear method to measure the patient’s pain level, enhancing the visibility and understanding of the scale, repeating the information for clarity and accuracy, and giving the patient enough time to respond without rushing or interrupting.

Choice D is wrong because asking about the present level of pain rather than the pain history is more relevant for pain management, not the pain assessment.The pain history provides valuable information about the onset, duration, frequency, quality, intensity, location, and aggravating or relieving factors of the pain.

The correct answer is choice A. Intensity.Intensity is one of the key components of pain assessmentand it is measured by asking a client to rate his or her current level of discomfort on a scale of 0-10.

This helps to quantify the severity of pain and monitor its changes over time.

Choice B. Quality is wrong because quality refers to the nature or characteristics of pain, such as burning, stabbing, throbbing, etc.It is usually assessed by asking the client to describe the pain in his or her own words.

Choice C.Onset is wrong because onset refers to the time when the pain started or what triggered it.It is usually assessed by asking the client about the mechanism of injury or etiology of pain, if identifiable.

Choice D.Duration is wrong because duration refers to how long the pain lasts or how often it occurs.It is usually assessed by asking the client about the course or temporal pattern of pain, such as constant, intermittent, or episodic.

The correct answer is choice A, B, C, and E. The nurse should use the following strategies to assess this client’s pain:

• Ask yes or no questions: This can help the client to communicate their pain level and location with minimal language difficulty.

• Use a visual analog scale (VAS): This is a self-report pain scale that uses a line with endpoints labeled as “no pain” and “worst pain imaginable”.The client can point to a position on the line that corresponds to their pain intensity.VAS has been shown to be feasible, valid, and reliable for stroke patients with mild-to-moderate aphasia.

• Observe for nonverbal cues: This can include facial expressions, body movements, vocalizations, and changes in vital signs that may indicate pain.Nonverbal cues are especially important for clients with severe aphasia who cannot use self-report scales.

• Involve family members or caregivers: They can provide information about the client’s pain history, preferences, and behaviors that may indicate pain.They can also help the nurse to communicate with the client and interpret their responses.

Choice D is wrong because open-ended questions require more complex language skills and may frustrate the client with aphasia.The nurse should use simple and direct questions that can be answered with yes or no, gestures, or pointing.

The correct answer is choice C.The patient should remove the old patch before applying a new one to avoid overdose and adverse effects of fentanyl.Fentanyl patches are designed to deliver a constant amount of opioid analgesic over a period of time, usually 72 hours.

Therefore, changing the patch every other day (choice A) would result in inadequate pain relief and withdrawal symptoms.

Applying the patch to a hairy area (choice B) would interfere with the absorption of the drug and reduce its effectiveness.

Cutting the patch in half (choice D) would damage the integrity of the patch and cause erratic or rapid release of the drug, which could be fatal.Fentanyl patches should be applied to a clean, dry, hairless area of intact skin on the upper torso or upper arm.

The correct answer is choice D. The patient will experience improved mental status and oxygenation.This is because naloxone is a medication that can rapidly reverse an opioid overdose by blocking the effects of opioids and restoring normal breathing.Naloxone can be given as a nasal spray or an injection.

Choice A is wrong because naloxone does not increase euphoria and sedation, but rather reverses them by blocking opioid receptors.

Choice B is wrong because naloxone does not cause severe withdrawal symptoms and agitation, but rather mild to moderate ones that are not life-threatening.

Choice C is wrong because naloxone does not decrease respiratory rate and blood pressure, but rather increases them by reversing opioid overdose.

Normal ranges for respiratory rate are 12 to 20 breaths per minute and for blood pressure are 90/60 mmHg to 120/80 mmHg.

The correct answer is choice A, B, C and E.Aspirin is a medication that can prevent cardiovascular events by inhibiting platelet aggregation and reducing inflammation.

However, aspirin also has some side effects that the patient should be aware of and report to the doctor if they occur.

Choice A is correct because taking aspirin with food or milk can reduce the risk of stomach irritation and ulcers that aspirin can cause.

Choice B is correct because aspirin can increase the risk of bleeding and bruising due to its antiplatelet effect.The patient should monitor for signs of bleeding such as black, tarry stools, bloody or cloudy urine, vomiting of blood or material that looks like coffee grounds, and unusual bleeding or bruising.

Choice C is correct because taking other NSAIDs (nonsteroidal anti-inflammatory drugs) concurrently with aspirin can increase the risk of stomach ulcers and bleeding.

NSAIDs include ibuprofen, naproxen, diclofenac, and others.

Choice D is wrong because tinnitus (ringing in the ears) is a sign of aspirin toxicity and should not be ignored.The patient should stop taking aspirin and seek medical attention if they experience tinnitus, confusion, hallucinations, rapid breathing, or seizures.

Choice E is correct because enteric-coated tablets can reduce the gastric irritation caused by aspirin by delaying its release until it reaches the small intestine.However, enteric-coated tablets may not be as effective as regular tablets in preventing cardiovascular events.