An accident arrives at the emergency department (ED) with severe right lower quadrant abdominal pain.
To assess the intensity of the client's pain, which approach should the nurse use?
Ask the client to describe the pain.
Provide a numeric pain scale.
Identify effective pain relief measures.
Observe body language and movement.
The Correct Answer is B
The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient’s self-reporting is widely considered as the key to effective pain management 1.
According to good practice guidelines, clinicians must accept a patient’s statement, regardless of their own opinions 1.
Choice A is not the answer because asking the client to describe the pain does not provide an objective measure of pain intensity 1.
Choice C is not the answer because identifying effective pain relief measures does not assess the intensity of the client’s pain 1.
Choice D is not the answer because observing body language and movement does not provide an objective measure of pain intensity 1.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D","E"]
Explanation
A. Solid stool with red streaks may indicate lower gastrointestinal bleeding and requires further evaluation.
B. Formed but soft stool is a normal finding and does not require follow-up.
C. Brown liquid stool may suggest diarrhea or malabsorption issues, warranting further assessment.
D. A tarry appearance can indicate upper gastrointestinal bleeding and requires prompt follow-up.
E. Multiple hard pellets may indicate constipation or dehydration and should be addressed.
Correct Answer is C
Explanation
This response shows that the nurse is willing to listen and provide support to the client.
It also allows the client to decide if they want to talk and share their feelings.
Choice A is not correct because it is not the most therapeutic response.
While it does encourage the client to talk about their visit with their significant other, it does not show that the nurse is willing to listen and provide support.
Choice B is not correct because it is not the most therapeutic response.
While it does acknowledge that the client may be feeling lonely, it does not show that the nurse is willing to listen and provide support.
Choice D is not correct because it is not the most therapeutic response.
While it does encourage the client to talk about their visit, it does not show that the nurse is willing to listen and provide support.
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