After completing the following case study, submit 2 NCLEX style questions related to the topics covered in the case study. (Students are expected to write their own questions. Refrain from using outside resources). Please provide a rationale for the correct answers to your questions.
Gout:
A patient arrives at the urgent care clinic complaining of right great toe joint pain. They deny injury but state they are in severe pain. As you complete your assessment you notice there is redness and swelling of just this joint.
What do you suspect the provider will diagnose this patient with?
What medications do you anticipate the provider will order for this patient?
What should this patient be monitored for if the provider orders the medications to treat this disorder?
Pain:
As a nurse in the ED, your patient is dropped off by her friends at the front door. As they dropped her off, they tell you she accidentally took too much morphine.
What do you anticipate will be ordered to reverse the effects of morphine?
About 15 minutes later she becomes less responsive and her vital signs change.
What should you do next? Which vital sign should you monitor for when a patient takes morphine?
How does this reversal drug work?
Mrs. W. is a 76-year-old female client who has been diagnosed with osteoarthritis of the right knee. She also has a history of hypertension and is taking a diuretic and an ACE inhibitor to manage her blood pressure. She is being seen at the medical clinic with complaints of increasing pain in her knee. She states that she has been researching herbal and dietary supplements and has recently started taking glucosamine, chondroitin, ginkgo, and ginseng for her arthritis. She also takes one aspirin a day to keep me from having a heart attack. During this visit, she is given a prescription for ibuprofen.
Discuss the potential interactions that may occur when the ibuprofen is added to the other drugs and supplements that Mrs. W. is currently taking.
What areas should the nurse include when teaching Mrs. W. regarding the ibuprofen?
PCA pump:
Your patient returns from the operating room with an order for a patient-controlled analgesia pump.
What is the priority teaching you should provide to this patient and their family regarding the PCA pump?
You hear the patients wife say she will push the button for him when he is sleeping. What would you do as the nurse when you hear this statement?
On your next shift, this same patient complains that the pump must not be working since they are still in pain.
What would you ask the provider to increase to help better control the pain of this patient?
Severe vs Moderate pain:
A patient put on their call light. When you go to their room to see what they need they state that they have pain. You ask them to rate it on a numeric pain scale and they report it to be a 9/10. You understand this is moderate to severe pain. When you look in their medical administration record, they have a PRN order for both 650 mg acetaminophen and 1mg morphine IV.
Which medication would you decide is more appropriate for this patient?
What will you monitor this patient for after you administer the medication?
Acetaminophen overdose:
A patient comes to the ED after her family found her at home with two empty bottles of acetaminophen and a note stating she no longer wished to live.
What do you anticipate will be ordered to help reverse the effects of acetaminophen? Describe its mechanism of action.
What will you monitor? Include laboratory studies and signs and symptoms of organ failure.
GI disorders/Pain:
You are working your first shift in the post-anesthesia care unit. As you are watching your preceptor you notice he gives ondansetron over thirty seconds and asks you to monitor this patient as he goes to see a different patient. As you monitor this patient you notice a change in this patients heart rhythm on the telemetry monitor.
What is likely the cause of this heart rhythm change?
What is the proper timing to give this medication?
What is the first thing you would do in this situation?
Dopamine antagonist- prochlorperazine:
A patient you are caring for is prescribed a dopamine antagonist- prochlorperazine to help treat their chemotherapy-induced nausea and vomiting.
What are some of the adverse effects of this medication?
Your patient is asking you what they can do to help prevent the adverse effects. What education would you provide to this patient to help overcome the adverse effects?
Laxative:
You hear a nurse aide tell a patient that they can take laxatives as often as needed to treat constipation as a bonus it will help you to drop a few pounds.
What should you as the nurse do?
What are some contradictions to a patient being on laxative?
What are some alternatives to the use of laxatives?
Peptic Ulcer:
Mary is a 70-year-old attorney who has self-treated her heartburn for years by drinking large amounts of antacids. She finally made an appointment with her family practice physician who referred her to a gastroenterologist. Her physician instructed her to stop taking the antacids.
Why did the physician ask her to stop taking the antacids? Include mode of action and side effects
What diagnostic tests would the healthcare provider perform to determine treatment for the patient?
The patient is diagnosed with a peptic ulcer and placed on the following medications: omeprazole, bismuth subsalicylate, tetracycline, and metronidazole. The patient asks the nurse why she is taking so many medications when she is not feeling any pain now. What instructions will the nurse provide to the patient regarding the reason, administration, and adverse effects of each of the medications?
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