The nurse is working at a pain clinic and is preparing orientation for new staff nurses. Which of the following definitions of pain would the nurse correctly choose to include in the orientation?
Pain is an unpleasant sensation, typically experienced upon movement.
Pain is validated by the nurse determining the cause of pain.
Pain is whatever the person experiencing it says it is.
Pain is very subjective, so observations must be used to determine the levels and intensity.
The Correct Answer is C
"Pain is whatever the person experiencing it says it is," to include in the orientation. This definition reflects the concept of pain as a subjective experience that cannot be directly observed or measured, but only reported by the individual experiencing it. It emphasizes the importance of believing and acknowledging the patient's report of pain, and not relying solely on objective indicators or assumptions about the cause or intensity of pain. This definition also aligns with current standards of pain assessment and management, which prioritize patient-centered care and the use of self-report measures to guide treatment decisions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The normal range for respiratory rate in adults is typically between 12 to 20 breaths per minute, butsome individuals may have a slightly higher or lower respiratory rate within the normal range.
Options a and b are incorrect. Bowel sounds of 5-30 per minute are within the normal range, but this finding alone does not indicate that the patient is ready to go home. Capillary refill of greater than 3 seconds is considered abnormal and may indicate poor peripheral perfusion.
Option d is also incorrect. A heart rate of 10 is extremely low and would be considered bradycardia. This could indicate an underlying medical issue and would require further assessment and intervention before the patient is discharged.
Correct Answer is ["A"]
Explanation
To map the client's abdomen into four quadrants, the nurse should use the umbilicus as the landmark to perform this assessment. The abdomen is divided into four quadrants by drawing an imaginary line from the center of the umbilicus to the pubic symphysis and another line from the center of the umbilicus to the xiphoid process of the sternum. This helps in identifying the location of any potential abdominal discomfort or tenderness.
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