A nurse is applying a cold compress for a client who has pain and minor swelling in a sutured laceration on the forearm. Which of the following assessments should the nurse use to determine whether the treatment is effective?
Asking the client to rate the pain
Having the client perform range-of-motion of the affected arm
Monitoring the client's pulse rate
Inspecting the site for reduced swelling
The Correct Answer is A
A. Asking the client to rate the pain: Pain rating provides a subjective measure of the intervention’s effectiveness in reducing discomfort.
B. Having the client perform range-of-motion of the affected arm: This assessment is not specific to determining the effectiveness of cold therapy; it is more related to mobility or rehabilitation.
C. Monitoring the client's pulse rate: While pain can affect pulse rate, this is an indirect and nonspecific measure of pain or swelling reduction.
D. Inspecting the site for reduced swelling: Swelling reduction can be an indicator of decreased inflammation, but it does not provide a direct assessment of the client’s pain levels.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Patient-centered care: Nursing education heavily emphasizes patient-centered care, as it is foundational to nursing practice and critical for promoting client well-being.
B. Teamwork and collaboration. While teamwork is taught, it is often more extensively developed in clinical practice settings.
C. Evidence-based practice. Although evidence-based practice is a focus in nursing education, new graduates often require additional experience to apply it effectively.
D. Quality improvement. Quality improvement processes are introduced in nursing school but may not be as emphasized compared to patient-centered care.
Correct Answer is B
Explanation
A. Encourage visitors throughout the day: Increased visitor interactions may worsen sensory overload by adding more stimuli.
B. Provide the client with earplugs. Earplugs help reduce environmental noise and sensory input, addressing the client's sensory overload and promoting rest and comfort.
C. Spread client care activities throughout the shift: Consolidating care activities, rather than spreading them out, minimizes interruptions and helps reduce sensory input.
D. Keep the door to the client's room open: Keeping the door open can increase noise and stimuli, exacerbating sensory overload.
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