A nurse is assessing a client for acute postoperative pain. Which of the following actions should the nurse take first?

Provide an analgesic for pain.

Obtain a self-report from the client.

Observe the client's behaviors.

Develop a behavioral pain score.

Answer and Explanation

The Correct Answer is B

A. Provide an analgesic for pain. Administering medication is important but should be done after assessing the pain.
B. Obtain a self-report from the client. The client's self-report is the most reliable indicator of pain and should be obtained first.
C. Observe the client's behaviors. Observing behaviors is helpful but should follow the self-report to validate the client's experience.
D. Develop a behavioral pain score. This can be useful for non-verbal clients, but the self-report is the primary method of assessment for verbal clients.

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Correct Answer is B

Explanation

A. Hold sterile supplies 7.6 cm (3 in) above the sterile field. Sterile supplies should be held at least 15-20 cm (6-8 inches) above the sterile field to avoid contamination.
B. Drop sterile objects toward the center of the sterile field. This minimizes the risk of contamination by keeping the edges of the field sterile.
C. Open the first flap of the sterile tray packaging toward himself. The first flap should be opened away from the nurse to avoid reaching over the sterile field.
D. Hold bottles of sterile fluid with the label facing outward. The label should face inward (toward the nurse) to protect it from spills and ensure visibility of the label.

Correct Answer is "{\"xRanges\":[333.4270782470703,393.4270782470703],\"yRanges\":[222.1666259765625,282.1666259765625]}"

Explanation

Granulation tissue is a key component of the healing process for wounds and appears as new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. It typically appears red or pink, indicating the presence of new blood vessels (capillaries). It has a moist, bumpy, or grainy texture. The tissue might look uneven or pebbled. It progressively covers the wound bed, starting from the edges and moving toward the center, eventually filling the wound cavity.

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A nurse is assessing a client for acute postoperative pain. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing a sterile field for a procedure the provider will perform at the client's bedside. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is assessing a client's wound in the stages of healing. Which of the following areas of the wound represents granulation tissue? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)

Correct Answer is "{\"xRanges\":[333.4270782470703,393.4270782470703],\"yRanges\":[222.1666259765625,282.1666259765625]}"

Explanation

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