A patient experiencing chronic pain as a result of metastatic cancer has a new order for fentanyl (Duragesic) transdermal patch. The initial patch is applied at 8 AM on Monday
At 8 PM on Monday, the patient reports a pain level of 8. The nurse's best response is to
a. immediately contact the physician.
b. reassess pain level in 30 to 45 minutes.
c. remove current patch and reapply a new patch.
d. provide a PRN analgesic medication as ordered.
ANS: D
The fentanyl (Duragesic) patch takes approximately 12 to 24 hours for the initial patch of medication to reach a steady blood level, so other analgesics must be used during this time. Therefore, it is not necessary to immediately contact the physician. The patient is reporting severe pain and requires immediate intervention to help relieve this discomfort.
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The patient's heart rate is 70 beats per minute, but the P waves come after the QRS complex. The nurse correctly determines that the patient's heart rhythm is:
a. a normal junctional rhythm. b. an accelerated junctional rhythm. c. a junctional tachycardia. d. atrial fibrillation.
A patient has been brought to the dermatology clinic after a mole excision on the back of his neck. A keloid has formed in this area. The nurse knows that the treatment plan for this patient may consist of which of the following interventions?
A) Topical corticosteroid B) Intralesional corticosteroid C) Biopsy D) Chemotherapy
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A client with hypothyroidism is told by the health care provider that the thyroid-stimulating hormone level is elevated. The client says to the nurse, "I don't understand why my TSH is high. I thought I had low thyroid levels."
The most appropriate response by the nurse is: 1. "You probably misunderstood your health care provider." 2. "TSH is a hormone released by the pituitary that signals your thyroid to make hormones. When the thyroid can't respond, the pituitary keeps trying to send its signal, and the TSH keeps going up." 3. "TSH is not thyroid hormone. When thyroid values are low, other lab tests are performed to see how you tolerate the low levels." 4. "TSH is an incomplete thyroid hormone. Because it cannot bind to tissues, it builds up in the bloodstream."