An adult male with a right below the knee amputation is complaining of sharp pain in the removed limb.
What is the best response from the nurse?
"What is your pain level on a scale of 0-10?".
"It is not possible to experience pain, the limb and nerves were removed.”.
"You are not experiencing pain.”.
"I understand you are in pain, please rate your pain on a scale of 0-10, and I will get a mirror to assess the area.”. .
The Correct Answer is D
Choice A rationale:
Asking the patient to rate their pain on a scale of 0-10 is a good initial response to assess the severity of pain. However, it should be followed by a more comprehensive assessment, which may include addressing the patient's concern about pain in the removed limb and providing appropriate interventions.
Choice B rationale:
Telling the patient that it is not possible to experience pain because the limb and nerves were removed is inaccurate and insensitive. This response does not address the patient's reported pain and may be perceived as dismissive.
Choice C rationale:
Telling the patient that they are not experiencing pain is both inaccurate and dismissive of the patient's reported pain. This response does not demonstrate empathy or a patient-centered approach to care.
Choice D rationale:
"I understand you are in pain, please rate your pain on a scale of 0-10, and I will get a mirror to assess the area" is the best response. This response acknowledges the patient's pain, uses a pain assessment scale to quantify the pain, and offers a solution to assess the area with a mirror. It demonstrates empathy and a proactive approach to addressing the patient's concern. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Oxymorphone is not an NSAID (Non-Steroidal Anti-Inflammatory Drug). It is an opioid analgesic, which is used for more severe pain relief. It is not suitable for managing swelling and pain caused by an injury.
Choice B rationale:
Ibuprofen is an NSAID and is an appropriate choice for managing pain and swelling associated with injuries like the patient's knee injury. NSAIDs work by reducing inflammation, which can help alleviate pain and discomfort in such cases.
Choice C rationale:
Acetaminophen is not an NSAID. It is classified as an analgesic and antipyretic, and while it can help with pain relief, it may not be as effective in reducing inflammation, which is essential in cases of swelling due to an injury.
Choice D rationale:
Aspirin is an NSAID, but it is not the best choice for this patient. Aspirin is known to have a higher risk of gastrointestinal side effects, and there are other NSAIDs like ibuprofen that are generally preferred for pain management and inflammation without the same level of side effects.
Correct Answer is C
Explanation
Choice A rationale:
False. Pain should not be assessed only for patients who complain of pain. Pain assessment should be a routine part of patient care, as not all patients may be able to verbalize their pain or may underreport it. Identifying and addressing pain is crucial for patient well-being.
Choice B rationale:
False. Pain treatment does not necessarily end at discharge. The management of pain may continue beyond the hospital setting, and a plan for pain management post-discharge may be needed. This ensures that patients receive appropriate pain relief and support during their recovery.
Choice C rationale:
True. According to the Joint Commission's standards, all patients have the right to appropriate assessment of pain. This means that every patient, regardless of their condition or the presence of pain complaints, should have their pain assessed and managed as necessary.
Choice D rationale:
False. Pain treatment is not solely based on objective data collected by the nurse. Pain is a subjective experience, and it is essential to consider the patient's self-report of pain, in addition to any objective data, when determining the appropriate treatment. Objective data can help, but it should not be the sole basis for pain management.
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