A patient with colorectal cancer has continuous, poorly localized abdominal pain at an intensity of 5 on a scale of 0 to 10. How does the nurse teach the patient to use pain medications?

Correct Answer: A

Rationale: In the context of pharmacological management of pain in patients with colorectal cancer, the correct answer is A) On an around-the-clock schedule. This approach is based on the principles of pain management, specifically when dealing with moderate to severe pain that is persistent. Continuous, poorly localized abdominal pain at an intensity of 5 on a scale of 0 to 10 indicates the need for scheduled, around-the-clock pain medication to maintain a consistent level of pain relief. By administering pain medications on a regular schedule, the patient can achieve better pain control and prevent peaks and troughs in pain relief. Option B) As often as necessary to keep the pain controlled may lead to inadequate pain management as it relies on reactive dosing rather than proactive scheduling. This approach can result in inconsistent pain relief and may not address the continuous nature of the pain experienced by the patient. Option C) By alternating two different types of drugs to prevent tolerance is not the most appropriate strategy in this scenario. While drug rotation can be beneficial in certain cases to prevent tolerance or side effects, in the case of persistent, moderate to severe pain, a consistent, scheduled regimen is more effective. Option D) When the pain cannot be controlled with distraction or relaxation overlooks the need for pharmacological intervention in managing persistent pain associated with colorectal cancer. While non-pharmacological strategies like distraction and relaxation techniques can complement pain management, they are not sufficient on their own to address the level of pain described in the question. In an educational context, it is crucial for nurses to understand the principles of pain management, including the use of scheduled pain medication for persistent pain. By implementing an around-the-clock dosing schedule, nurses can help patients achieve optimal pain control, improve quality of life, and promote adherence to the prescribed pain management regimen. Education on the rationale behind scheduled pain medication administration is essential to ensure safe and effective pain management in patients with colorectal cancer.

Correct Answer: A

Rationale: The correct answer is A) He is experiencing spiritual distress. This comment from the terminally ill man indicates a deep existential crisis and a struggle with questions of meaning and purpose, which are often signs of spiritual distress. Recognizing this allows the nurse to address not just the physical symptoms but also the patient's emotional and spiritual needs. Option B) This man most likely will not have a peaceful death is incorrect because the patient's existential questioning does not necessarily predict the peacefulness of his death. It is more about his internal struggle rather than an indicator of the manner of his death. Option C) He needs to be reassured that his feelings are normal is incorrect because while reassurance is important, it does not fully address the depth of the patient's spiritual distress and existential questioning. Option D) This patient should be referred to a clergyman for a discussion of his beliefs is incorrect as the nurse plays a crucial role in addressing spiritual distress in patients. Referring the patient to a clergyman should be done in collaboration with the patient's wishes and beliefs, not as the first line of intervention. In an educational context, this question highlights the importance of holistic care in nursing, where addressing the spiritual and emotional needs of patients is as vital as managing their physical symptoms, especially in end-of-life care. Nurses need to be equipped with skills to recognize and support patients experiencing spiritual distress to provide comprehensive and compassionate care.

Correct Answer: D

Rationale: The correct answer is option D, "Do you have any preferences for what happens if you are dying?" This question is appropriate because it allows the nurse to understand the patient's cultural beliefs and preferences regarding end-of-life care. Culturally competent care involves respecting and integrating the patient's cultural values into their care plan. Option A, "If you die, will you want an autopsy?" is inappropriate as it is direct and insensitive, lacking cultural sensitivity and respect for the patient's beliefs. Option B, "Are you interested in learning about palliative or hospice care?" assumes the patient's preferences without allowing them to express their own beliefs. Option C, "Are you interested in learning about palliative or hospice care?" is also limiting as it assumes the patient's interest without exploring their individual cultural perspectives. In an educational context, understanding cultural competence in healthcare is crucial for providing patient-centered care. Nurses need to be sensitive to patients' cultural beliefs and practices to provide holistic care that respects individual preferences and values. Asking open-ended questions like the one in option D fosters communication, builds trust, and ensures that care is tailored to the patient's unique cultural background.

Correct Answer: A

Rationale: In the case of acute gout, the correct treatment is option A) Nonsteroidal anti-inflammatory medications and colchicine. This is because gout is caused by the build-up of uric acid crystals in the joints, leading to inflammation and pain. Nonsteroidal anti-inflammatory drugs help reduce inflammation and pain, while colchicine works by decreasing the inflammatory response to uric acid crystals. Option B) Allopurinol and aspirin is incorrect because allopurinol is used for long-term management of gout by lowering uric acid levels, not for acute episodes. Aspirin can actually worsen gout by increasing uric acid levels. Option C) Antibiotics and acetaminophen is incorrect because gout is not caused by an infection, so antibiotics are not indicated. Acetaminophen can help with pain relief but does not address the underlying inflammation caused by uric acid crystals. Option D) Bisphosphonates and calcium are unrelated to the treatment of acute gout. Bisphosphonates are used for osteoporosis and calcium supplementation is for bone health, not for gout management. Educationally, understanding the appropriate pharmacological management of acute gout is crucial for healthcare professionals to provide effective care and alleviate symptoms for patients. It is essential to differentiate between acute and chronic gout treatments to ensure optimal outcomes and prevent complications associated with this condition.

Correct Answer: D

Rationale: The correct answer is D) To reduce postoperative swelling. After carpal tunnel surgery, it is essential to keep the hand and arm elevated above the heart level to reduce swelling in the operated area. Elevation helps to promote venous return and decreases the accumulation of fluid in the tissues, which in turn minimizes swelling and aids in the healing process. Option A) To reduce lymphatic drainage is incorrect because elevation actually helps to improve lymphatic drainage by reducing fluid build-up in the tissues. Option B) To restrict hand movements is incorrect as the primary purpose of elevation is to reduce swelling and promote healing, not to restrict movements. Option C) To decrease the possibility of nosocomial infection is also incorrect as elevating the hand and arm above the heart level is not directly related to preventing infection; proper hygiene and wound care are more critical in preventing nosocomial infections. In an educational context, understanding the rationale behind postoperative care instructions is crucial for healthcare professionals to provide optimal care to patients. By knowing the reason behind specific interventions such as keeping the hand and arm elevated after carpal tunnel surgery, healthcare providers can effectively explain the importance to patients like Anne, ensuring compliance and promoting successful recovery.