A registered nurse (RN) and nursing student are caring for a ...

[abern]

A registered nurse (RN) and nursing student are caring for a client who is receiving pain medication via patient-controlled analgesia (PCA). What action by the student requires the RN to intervene?
 
  a. Assesses the client's pain level per agency policy
  b. Monitors the client's respiratory rate and sedation
  c. Presses the button when the client cannot reach it
  d. Reinforces client teaching about using the PCA pump

Question 2

A client is put on twice-daily acetaminophen (Tylenol) for osteoarthritis. What finding in the client's health history would lead the nurse to consult with the provider over the choice of medication?
 
  a. 25-pack-year smoking history
  b. Drinking 3 to 5 beers a day
  c. Previous peptic ulcer
  d. Taking warfarin (Coumadin)

[Bigfoot1984]

Answer to Question 1

ANS: C
The client is the only person who should press the PCA button. If the client cannot reach it, the student should either reposition the client or the button, and should not press the button for the client. The RN should intervene at this point. The other actions are appropriate.

Answer to Question 2

ANS: B
The major serious side effect of acetaminophen is hepatotoxicity and liver damage. Drinking 3 to 5 beers each day may indicate underlying liver disease, which should be investigated prior to taking chronic acetaminophen. The nurse should relay this information to the provider. Smoking is not related to acetaminophen side effects. Acetaminophen does not cause bleeding, so a previous peptic ulcer or taking warfarin would not be a problem.

[abern]

Excellent

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TYSM