The patient still complains of pain after administration of the ordered analgesic. The nurse changes the nursing care plan because the:
1. patient's pain threshold has risen.
2. patient's pain threshold has lowered.
3. patient has become addicted.
4. patient is seeking attention.
2
The sensation of pain is perceived as increased when the pain threshold is lowered. There are not enough data in the situation to lead to the assumption of addiction or attention seeking.
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Susan, gravida 2, para 1, is admitted to the labor and delivery unit in labor. She states that she had a cesarean delivery with her first pregnancy. The most critical information the nurse must obtain at this point is:
a. her estimated date of delivery. b. the onset of contractions. c. the type of uterine incision Susan had. d. when Susan ate last and what she consumed.
The nurse is caring for a client with the diagnosis of colon cancer with metastasis to the liver. Which statement made by the client indicates an understanding of the diagnosis?
A) "Once the colon tumor is removed, I will be fine." B) "I will be happy once all the cancer is cut out." C) "How could I be so unlucky to get cancer twice?" D) "My cancer has now spread to my liver."
A client has been prescribed trimethoprim-sulfamethoxazole (Septra) for treatment of a urinary tract infection. Which comments, made by the client, would the nurse discuss with the prescriber before allowing the client to leave the clinic?
1. "My husband and I plan to start a family as soon as possible." 2. "I forgot to take my potassium supplement today." 3. "Is it okay to take this with my warfarin?" 4. "It is so cloudy today." 5. "My 80-year-old mother is coming to visit today."
MC Clinical Situation: You have just completed an admission assessment on the following client, and based on the collected data, you begin the client care plan
The client is a 39-year-old single male admitted for upper right-quadrant pain following a week-long episode of flu-like symptoms. He has not eaten for 7 days and presents with signs and symptoms of dehydration and malnutrition. He has not been out of bed during the week. He lives alone and states he either buys frozen foods or eats in fast-food restaurants. The question below refers to the client care plan. (When filling in the content in the care plan, remember that the material is not necessarily related. This exercise is designed to determine your care plan knowledge base, not your medical knowledge.) Based on the collected data, select the letter of the short-term goal that is the most appropriate. Write the selected short-term goal in the appropriate section of the care plan. A. Improved skin turgor within 24 hours. B. Respiration unlabored and 20/minute. C. Able to ambulate without assistance. D. Noncompliance related to poor dietary habits.