On the first postoperative day following a bowel resection, the patient complains of abdominal and incisional pain rated 9 on a scale of 0 to 10. Postoperative orders include morphine, 4 mg IV q2 hr, for pain and may repeat morphine, 4 mg IV, for breakthrough pain. The nurse determines that it has been only 2 hours since the last dose of morphine and wants to wait a little longer. What effect does the nurse’s action have on the patient?

Correct Answer: C

Rationale: The correct answer is C) Contributes to unnecessary suffering and physical and psychosocial dysfunction. In this scenario, the nurse's decision to delay giving pain medication to a patient experiencing severe pain rated at 9 out of 10 can lead to increased suffering for the patient. Acute pain management is crucial in postoperative care to promote comfort, aid in recovery, and prevent complications such as delayed mobilization and respiratory complications. Option A is incorrect because withholding pain medication based on fear of addiction or toxic effects can compromise effective pain management, leading to increased suffering and potential complications for the patient. Option B is incorrect because appropriate pain management, including timely administration of analgesics, is essential in preventing respiratory dysfunction related to inadequate pain control. Delaying pain medication can actually increase the risk of respiratory complications due to uncontrolled pain. Option D is incorrect as it does not address the immediate need for effective pain management in this situation. While it is important to start with the lowest effective dose of analgesics and titrate as needed, it is equally crucial to ensure timely pain relief for patients experiencing severe pain. In an educational context, this scenario highlights the importance of prompt pain assessment and management in postoperative care. Nurses should prioritize adequate pain relief to enhance patient comfort, facilitate recovery, and improve overall outcomes. Delaying pain medication in the presence of severe pain can lead to unnecessary suffering and hinder the patient's physical and psychosocial well-being.

Correct Answer: C

Rationale: In the context of pharmacology, particularly in postoperative pain management, the rationale for not initiating PCA analgesic with a basal dose lies in the risk of adverse respiratory outcomes. Providing a basal dose along with patient-controlled analgesia can increase the total opioid dose received by the patient, potentially leading to respiratory depression, especially in opioid-naive individuals like the 68-year-old patient in this scenario. Option A, opioid overdose, is not the primary concern in this scenario as the focus is on preventing adverse respiratory outcomes. Option B, nausea and itching, are common side effects of opioids but are not as critical as respiratory depression. Option D, lack of pain control, can be addressed by appropriate titration of the PCA dose based on the patient's needs without the need for a basal dose. Educationally, this scenario highlights the importance of individualizing pain management strategies and carefully monitoring for potential complications when using opioids, especially in vulnerable populations like postoperative patients. Understanding the rationale behind not initiating a basal dose with PCA can help healthcare providers optimize pain management while minimizing risks associated with opioid use.

Correct Answer: B

Rationale: In this scenario, the nurse's priority should be to address the family members' behavior as it pertains to the patient's well-being. Option B, taking the family members aside and explaining that the patient may be able to hear them, is the correct choice because it focuses on the immediate emotional and psychological needs of the patient. This action promotes a therapeutic environment for the patient by ensuring that the family communicates appropriately in the presence of the terminally ill individual. Option A is incorrect as simply asking the family members to leave the room does not address the underlying issue of their behavior impacting the patient. Option C is also incorrect because it dismisses the family's concerns without providing emotional support or guidance. Option D, while emphasizing the importance of the patient's autonomy, does not address the current situation of the family arguing at the bedside. Educationally, this scenario highlights the importance of holistic care in nursing practice, especially in end-of-life situations. Nurses must not only attend to the physical needs of the patient but also address the emotional and psychological aspects of care, including family dynamics and communication. By choosing option B, the nurse demonstrates empathy, communication skills, and the ability to advocate for the patient's emotional well-being during a critical time.

Correct Answer: D

Rationale: In this scenario, the most appropriate action by the nurse is option D: Use any methods that make the patient more comfortable. When a patient is in the last stages of life and experiencing shortness of breath and air hunger, the priority shifts from aggressive medical interventions to providing comfort and palliative care. Administering oxygen may not be effective or necessary at this stage as the patient's body may not be able to utilize it efficiently. Administering bronchodilators is not appropriate as the issue is not solely related to bronchoconstriction. Administering antianxiety agents may not address the root cause of the distress. Educationally, this question highlights the importance of palliative care and symptom management in end-of-life situations. Nurses need to prioritize comfort, dignity, and quality of life for patients in their final stages. Understanding the principles of palliative care and symptom management is crucial for providing holistic and patient-centered care in such sensitive situations.

Correct Answer: A

Rationale: In this scenario, option A is the most appropriate response to Joan's apprehension about undergoing bronchoscopy. This response acknowledges Joan's feelings of distress and offers reassurance by informing her that she will be asleep during the procedure. Additionally, it demonstrates empathy by suggesting that her physician can address any further concerns she may have, emphasizing patient-centered care and promoting trust between the patient and healthcare team. Option B is incorrect because simply stating that the physician has performed the procedure frequently does not address Joan's specific concerns or offer her any reassurance about the procedure itself. Option C is not an appropriate response as it shifts the focus away from Joan's feelings and experiences to the responder's own past experience, which may not be relevant or comforting to Joan. Option D is also incorrect as it dismisses Joan's apprehension without providing any meaningful information or empathy towards her feelings, which may further increase her anxiety. In an educational context, this question highlights the importance of effective communication and empathy in healthcare interactions. It emphasizes the significance of acknowledging and addressing patient concerns, building rapport, and providing appropriate support to ensure patient comfort and trust in the care they receive.