Level: Clinical
Difficulty: Medium
Subtopic: Opioids and pain medications
NCLEX: A 55-year-old client in postanesthesia care is being evaluated for opioid analgesia after surgery. Assessment dat…
Pharmacology Pharmacological and Parenteral Therapies
Case Study
A 55-year-old client in postanesthesia care is being evaluated for opioid analgesia after surgery. Assessment data include the client has new facial swelling and difficulty swallowing after the first dose. Which finding requires the nurse to intervene immediately?
Question
A. The new finding that has new facial swelling and difficulty swallowing after the first dose.
B. A stable, long-standing finding that matches the expected care plan.
C. A comfort request with unchanged vital signs and no new symptoms.
D. Routine data unchanged from the prior assessment.
B. A stable, long-standing finding that matches the expected care plan.
C. A comfort request with unchanged vital signs and no new symptoms.
D. Routine data unchanged from the prior assessment.
Rationale
Correct answer: A. The new finding that has new facial swelling and difficulty swallowing after the first dose.
Rationale: Follow-up items test whether the nurse recognizes cues that are new, acute, or inconsistent with stability and need prompt nursing action.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Follow-up items test whether the nurse recognizes cues that are new, acute, or inconsistent with stability and need prompt nursing action.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.