A client in the PACU with a left below-the-knee amputation complains of pain in her left big toe. Which of the following would the nurse do first?
Show the patient that her leg is gone
Administer the prescribed pain medication
Explain and educate the patient that the pain is real
Tell the patient that it is not possible to feel pain in her toes
The Correct Answer is B
Choice A reason: Showing the patient that her leg is gone does not address the immediate concern of pain management.
Choice B reason: Administering the prescribed pain medication is the first step in managing phantom pain, which is a common experience for amputees.
Choice C reason: While it is important to validate the patient's experience of pain, the first action should be to address the pain medically.
Choice D reason: Telling the patient that it is not possible to feel pain in her toes is incorrect and dismissive of the phenomenon of phantom pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: The recovery position is not typically recommended for patients with acute pulmonary edema as it does not facilitate optimal breathing.
Choice B reason: The prone position is not generally recommended for acute pulmonary edema as it may not aid in improving oxygenation or breathing.
Choice C reason: The sitting up position, especially at an angle of 45 degrees or greater, is recommended for patients with acute pulmonary edema as it helps to facilitate breathing and decrease venous return to the heart.
Choice D reason: The Trendelenburg position is not recommended for acute pulmonary edema as it can increase the pressure in the chest and worsen breathing difficulties.
Correct Answer is B
Explanation
Choice A reason: Dumping syndrome is not commonly associated with dysphagia post-stroke.
Choice B reason: Aspiration is a significant risk for patients with dysphagia following a stroke and should be closely monitored to prevent complications like aspiration pneumonia.
Choice C reason: Gastroesophageal reflux disease may occur but is not the most immediate concern for stroke patients with dysphagia.
Choice D reason: Peptic ulcer disease is not directly related to dysphagia and is less likely to be an immediate complication post-stroke.
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