The nurse is conducting a focused assessment of a client who is experiencing pain. Which question should the nurse ask the client?

When did your pain symptoms begin?"

"Do you think you know what caused the swelling?

"What brings you to the clinic today?"

"Can you go over what you said about nothing relieving the pain?

Answer and Explanation

The Correct Answer is A

A. "When did your pain symptoms begin?" When conducting a focused assessment on pain, the nurse should gather specific details about the onset, location, duration, characteristics, and aggravating/relieving factors. Asking when the pain symptoms began helps clarify the onset, which is critical in assessing the pain's cause and severity.

B. "Do you think you know what caused the swelling?": This is less focused on pain and more on swelling, which may not be the client's main concern.

C. "What brings you to the clinic today?": While this is a good general question, it is not focused on pain and would not gather specific pain-related information.

D. "Can you go over what you said about nothing relieving the pain?": This question is not as open-ended or specific to a focused pain assessment as asking about onset.

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Correct Answer is B

Explanation

A. Intake and output: Although helpful, intake and output measurements can sometimes be inaccurate, as not all fluid retention may be recorded.

B. Daily weight: Daily weight measurements are the most reliable way to assess fluid retention because changes in body weight accurately reflect gains or losses in body fluid, especially in clients with chronic kidney disease.

C. Sodium level: Sodium levels can indicate fluid imbalances, but they do not directly measure fluid volume excess.

D. Skin tenting: Skin tenting is used to assess dehydration, not fluid retention, and is not a reliable measure in chronic kidney disease.

A. Cleanses the ear molds with isopropyl alcohol to remove cerumen B. Turns off the hearing aids when not in use C. Inspects the ear molds to determine the ear canal portion D. Turns the volume all the way down before inserting the hearing aids E. Ensures that the ears are not blocked with cerumen

Correct Answer is ["B","C","D","E"]

Explanation

A. Cleanses the ear molds with isopropyl alcohol to remove cerumen: Alcohol is not recommended for cleaning hearing aids, as it can damage the device. A mild soap and water solution or a designated cleaning tool is preferable.

B. Turns off the hearing aids when not in use: Turning off hearing aids conserves battery life, which is a proper maintenance practice.

C. Inspects the ear molds to determine the ear canal portion: Properly positioning the hearing aids ensures correct use and comfort.

D. Turns the volume all the way down before inserting the hearing aids: This prevents a sudden loud noise that could startle the client and allows them to adjust to a comfortable volume after insertion.

E. Ensures that the ears are not blocked with cerumen: Blocked cerumen can interfere with hearing aid functionality, so this is an essential step.

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The nurse is conducting a focused assessment of a client who is experiencing pain. Which question should the nurse ask the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has a medical history of chronic kidney disease for fluid volume excess. Which assessment data provides the most reliable measure of fluid retention?

Correct Answer is B

Explanation

A nurse at a long-term care facility is assessing a client who just received hearing aids. Which of the following actions should indicate to the nurse that the client understands how to use the hearing aids? (Select all that apply.)

Correct Answer is ["B","C","D","E"]

Explanation

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The nurse is conducting a focused assessment of a client who is experiencing pain. Which question should the nurse ask the client?