A nurse is assessing a client for acute postoperative pain. Which of the following actions should the nurse take first?
Provide an analgesic for pain.
Obtain a self-report from the client.
Observe the client's behaviors.
Develop a behavioral pain score.
The Correct Answer is B
A. Provide an analgesic for pain. Administering medication is important but should be done after assessing the pain.
B. Obtain a self-report from the client. The client's self-report is the most reliable indicator of pain and should be obtained first.
C. Observe the client's behaviors. Observing behaviors is helpful but should follow the self-report to validate the client's experience.
D. Develop a behavioral pain score. This can be useful for non-verbal clients, but the self-report is the primary method of assessment for verbal clients.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Align the bottom of the meniscus of the liquid with the container scale. This ensures accurate measurement of the liquid medication.
B. Turn the bottle so the label is visible when pouring. The label should be facing the nurse to prevent spilling medication on it and making it unreadable.
C. Place the medication cap on the table with the inside of the cap facing down. The cap should be placed with the inside facing up to maintain cleanliness and prevent contamination.
D. Hold the medication cup when pouring from the bottle. The medication cup should be placed on a flat surface to ensure accurate measurement and avoid spills.
Correct Answer is A
Explanation
A. "Use moist heating pads on your joints." Moist heat can help relieve pain and stiffness in joints affected by osteoarthritis. It promotes blood flow and relaxation of muscles around the joint.
B. "Place a large pillow under your head." While proper head support is important for comfort, a large pillow might not be the best option as it can cause neck strain and is not specifically related to managing osteoarthritis pain.
C. "Do not perform muscle strengthening exercises." Muscle strengthening exercises are actually recommended for managing osteoarthritis as they help support and stabilize joints, reducing pain and improving function.
D. "Position a heavy bag of ice over your joints." While cold therapy can be useful for acute pain or inflammation, a heavy bag of ice can cause discomfort and potential tissue damage. Cold packs or ice bags used for short periods are more appropriate.
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