Which nonpharmacologic pain treatment should the nurse avoid using in an older adult who shows signs of confusion?

Music

Aromatherapy

Heat application

Distraction

Guided Imagery

Answer and Explanation

The Correct Answer is E

A. Music can be a soothing nonpharmacologic method to reduce pain and may help with relaxation, even for confused patients, as it typically doesn’t require cognitive engagement.
B. Aromatherapy is generally safe and may offer calming effects for older adults without relying heavily on cognitive processing.
C. Heat application is a physical pain relief method, and as long as safety precautions are taken, it can be used effectively in confused patients.
D. Distraction can be a beneficial technique for pain relief and is often effective without requiring cognitive engagement.
E. Guided Imagery should be avoided in confused older adults, as it relies on the patient's ability to follow instructions and visualize mental images, which can be challenging and potentially frustrating for someone with cognitive impairment.

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Correct Answer is D

Explanation

A. A pulse of 60 is low but does not necessarily indicate a need to stop suctioning if the patient remains stable otherwise.
B. A pulse of 90 is within normal limits and does not require stopping suctioning.
C. An oxygen saturation of 92% is slightly low but still acceptable; suctioning can continue if the client is stable.
D. An oxygen saturation of 89% is below the acceptable threshold and indicates hypoxia, prompting the nurse to stop suctioning immediately to avoid further compromising the client's respiratory status.
E. A blood pressure of 130/80 is within normal limits and does not warrant cessation of suctioning.

A. A client demonstrates how to inject insulin into the abdomen B. A client attends a course on exercise techniques C. A client watches the nurse apply a dressing D. A client lists food choices that are considered part of a healthy diet E. A client nods when told how to take the blood pressure medication

Correct Answer is ["A","D"]

Explanation

A. Demonstrating an insulin injection shows hands-on learning and mastery of the skill.
B. Attending a course does not confirm comprehension or skill.
C. Watching a nurse apply a dressing does not guarantee learning; active participation is necessary.
D. Listing healthy food choices indicates understanding of dietary education.
E. Nodding does not confirm learning; it may only indicate acknowledgment.

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Which nonpharmacologic pain treatment should the nurse avoid using in an older adult who shows signs of confusion?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to suction a client. The pulse is 65 and pulse oximetry is 94%. Which finding will cause the nurse to stop suctioning?

Correct Answer is D

Explanation

Which of the following scenarios gives the most absolute confirmation client learning has taken place? Select all that apply.

Correct Answer is ["A","D"]

Explanation

A client asks the nurse to describe what causes a murmur. What would be the correct response by the nurse?

The nurse is reviewing the risk factors for a blood clot in a vein. Which of these situations can put a client at higher risk for developing a blood clot in a vein? Select all that apply.

A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of providing culturally responsive care?

A client with chronic cancer pain describes the pain as "sharp, tingling, with numbness. The nurse would document the pain as what?

When listening to heart sounds, which valve closures are heard best at the base of the heart. Select all that apply.

When the nurse manager is evaluating the care of a client receiving oxygen through a nasal cannula, which finding indicates a need for more staff education about oxygen therapy?

When performing a cardiovascular assessment, what would the nurse understand about an S3 heart sound? Select all that apply