4. A nurse is caring for a client who is receiving morphine via a
patient-controlled analgesia (PCA) infusion
device after abdominal surgery. Which of the following
statements indicates that the client knows how to
use the device?
A. "I'll wait to use the device until it's absolutely necessary."
B. "I'll be careful about pushing the button so I don't get an
overdose."
C. "I should tell the nurse if the pain doesn't stop after I use this
device."
D. "I will ask my son to push the dose button when I am
sleeping."
C. "I should tell the nurse if the pain doesn't stop after I use this
device."
,5. A nurse is monitoring a client who is receiving opioid
analgesia for adverse effects of the medication.
Which of the following effects should the nurse anticipate?
(Select all that apply.)
A. Urinary incontinence
B. Diarrhea
C. Bradypnea
D. Orthostatic hypotension
E. Nausea
C. Bradypnea
D. Orthostatic hypotension
E. Nausea
A nurse is caring for a client who has been sitting in a chair for 3
hr. Which of the following problems is the client at risk for
developing?
A. Stasis of secretions
B. Muscle atrophy
C. Pressure ulcer
D. Fecal impaction
, C. CORRECT: Unrelieved pressure over a bony prominence for
too long increases the risk for skin breakdown.
.
A nurse is caring for a client who is on bed rest. Which of the
following interventions should the nurse implement to maintain
the patency of the client's airway?
A. Encourage isometric exercises.
B. Suction every 8 hr.
C. Give low-dose heparin.
D. Promote incentive spirometer use.
D. CORRECT: Using an incentive spirometer helps keep the
airways open and prevents atelectasis.
A nurse is caring for a client who is postoperative. Which of the
following nursing interventions reduce the risk of thrombus
development? (Select all that apply.)
A. Instruct the client not to use the Valsalva maneuver.
B. Apply elastic stockings.
C. Review laboratory values for total protein level.
D. Place pillows under the client's knees and lower extremities.
E. Assist the client to change position often.
B. CORRECT: Elastic stockings promote venous return and
prevent thrombus formation.
E. CORRECT: Frequent position changes prevent venous stasis.
A nurse is instructing a client who is postoperative about the
sequential compression device the provider has prescribed.
Which of the following client statements should indicate to the