A client who had abdominal surgery is receiving patient-controlled analgesia (PCA) intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is experiencing pain still. What should the nurse do first?a. Monitor the client's pain level for another hour. b. Determine the integrity of the intravenous delivery system.c. Reprogram the pump to deliver a bolus dose every eight minutes.d. Arrange for the client to be evaluated by the health care provider.

1. A client who had abdominal surgery is receiving patient-controlled analgesia (PCA) intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is experiencing pain still. What should the nurse do first?

a. Monitor the client's pain level for another hour.

b. Determine the integrity of the intravenous delivery system.

c. Reprogram the pump to deliver a bolus dose every eight minutes.

d. Arrange for the client to be evaluated by the health care provider.

B!

The nurse filling out an incident or variance report needs to state only the objective facts surrounding the incident, no opinion or speculation. In an incident report fault or blame is subjective and should not be implied. It is not necessary to include names except for those of witnesses. Speculations or opinions as to the reason why the ordered restraints were not on the client are subjective and not appropriate to include in an incident or variance report.
A!

Orange and apple juices each contain 1 mg of sodium per 100 grams. Dried apricots contain 8 mg of sodium per 100 grams. Peas contain 35 mg of sodium per 100 grams; both items contain more sodium than orange and apple juices. Carrots contain 47 mg of sodium per 100 grams. Celery contains 126 mg of sodium per 100 grams; both these items contain more sodium than orange and apple juices. Tomato juice contains 200 mg of sodium per 100 grams. Grape juice contains 2 mg of sodium per 100 grams; both these items contain more sodium than orange and apple juices.

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B!

Initially, integrity of the intravenous system should be verified to ensure that the client is receiving medication. The intravenous tubing may be kinked or compressed, or the catheter may be dislodged. Continued monitoring will result in the client experiencing unnecessary pain. The nurse may not reprogram the pump to deliver larger or more frequent doses of medication without a health care provider's prescription. The health care provider should be notified if the system is intact and the client is not obtaining relief from pain. The prescription may have to be revised; the basal dose may be increased, the length of the delay may be reduced, or another medication or mode of delivery may be prescribed.