A nurse is reinforcing teaching with a client about the use of transcutaneous electrical nerve stimulation (TENS) to manage chronic pain.
Which of the following statements by the client indicates the need for further teaching?

The correct answer is choice B. "Why do you think your husband needs more medication when he is asleep?"

Choice A rationale:

"Your husband should decide when more medication is needed.” This response is incorrect because it implies that the partner has the authority to decide when the client needs pain medication, which violates the purpose of a PCA pump. A PCA pump is specifically designed for client-controlled pain management, ensuring that the patient, not anyone else, controls when they receive pain medication. Allowing someone else to press the button can lead to overmedication and safety risks.

Choice B rationale:

"Why do you think your husband needs more medication when he is asleep?" This response is correct because it prompts the partner to reflect on their actions and provides an opportunity for the nurse to educate about the proper use of PCA pumps. It addresses the immediate issue without being confrontational and opens the door for further discussion on the importance of client safety and correct PCA use.

Choice C rationale:

"It's a good idea to help make sure your husband can sleep comfortably.” This response is incorrect as it endorses inappropriate and unsafe behavior. It encourages the partner to continue pressing the PCA button, risking the client's safety due to potential overmedication, which can lead to severe complications, such as respiratory depression.

Choice D rationale:

"Next time you think he needs more medication, call me and I'll push the button.” This response is incorrect because it contradicts PCA protocols and removes the control from the client. The nurse is responsible for monitoring the client’s pain and safety, not administering medication upon another person’s request. This approach also increases the risk of dosing errors and undermines the purpose of patient-controlled analgesia.

Choice A rationale:

Culture can influence a person's perception and expression of pain. It's important to consider cultural factors when assessing and managing pain because beliefs and attitudes about pain can vary significantly among different cultural groups. This can affect how pain is experienced and communicated.

Choice B rationale:

Psychological factors, such as anxiety, depression, and coping mechanisms, play a significant role in the experience of pain. Assessing psychological factors is essential for a comprehensive understanding of the patient's pain experience and developing appropriate pain management strategies.

Choice C rationale:

Understanding the patient's history of pain is crucial for a focused pain assessment. Previous experiences with pain, including the cause, intensity, and effectiveness of previous pain management strategies, can provide valuable insights into the current pain situation.

Choice D rationale:

Assessing contributing factors, such as concurrent medical conditions, injuries, or environmental factors, is essential to determine the underlying causes of pain and develop an effective pain management plan.

Choice E rationale:

Verbal indicators are essential for assessing pain. Patients often describe their pain in words, and understanding their descriptions and expressions of pain is fundamental to evaluating its intensity, location, quality, and duration.