The nurse is assessing a group of clients for somatic pain. Which of the following client's would be experiencing this type of pain?

The client with a left lower extremity fracture.

The client with a bowel obstruction.

The client with a skin tear to the upper extremity.

The client with pneumonia.

Answer and Explanation

The Correct Answer is A

A. The client with a left lower extremity fracture. Somatic pain is related to damage to body tissues, such as fractures. This type of pain is typically localized and can be acute or chronic.

B. The client with a bowel obstruction. Pain from a bowel obstruction is typically visceral rather than somatic, as it involves internal organs.

C. The client with a skin tear to the upper extremity. While this involves the skin, it is typically considered superficial somatic pain, but the context of the question suggests a deeper musculoskeletal issue.

D. The client with pneumonia. Pain from pneumonia is usually visceral due to inflammation in the lungs.

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Correct Answer is C

Explanation

A. Assess the patient for physiological indicators of pain. While assessing physiological indicators (such as increased heart rate, blood pressure, or sweating) can provide clues about pain, these signs are not always reliable and can be influenced by other factors. This option does not directly address the patient’s verbal and non-verbal communication about their pain.

B. Observe the patient for behavior that is indicative of pain. Observing the patient’s behavior can be helpful, but it is not sufficient on its own. The patient’s cultural background may influence how they express pain, and relying solely on observation might lead to underestimating their pain.

C. Involve the patient in the pain assessment by asking more direct questions. This is the best option because it respects the patient’s cultural background and encourages a more accurate and detailed assessment of their pain. By asking direct questions, the nurse can gain a better understanding of the patient’s pain experience and provide appropriate care.

D. Compare the patient's facial expression to a FACES pain scale. Using a FACES pain scale can be useful, especially for patients who have difficulty verbalizing their pain. However, this option does not involve the patient in a more detailed discussion about their pain, which is crucial given the cultural context and the patient’s reluctance to openly admit to pain.

A. Displacement B. Rationalization C. Dissociation D. Projection

Correct Answer is B

Explanation

A. Displacement: Displacement involves transferring feelings to a less threatening object or person, which is not applicable to the client’s statement.

B. Rationalization: Rationalization involves justifying behaviors or feelings with logical reasons. The client’s statement reflects an unrealistic view rather than justifying actions.

C. Dissociation: Dissociation involves a disconnection from thoughts or feelings, which is not reflected in the client's statement.

D. Projection: Projection involves attributing one’s own feelings or thoughts to others. The client is expressing their own feelings about the wheelchair rather than attributing them to others.

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The nurse is assessing a group of clients for somatic pain. Which of the following client's would be experiencing this type of pain?

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Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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