A nurse is caring for a group of clients who have chronic pain. Which of the following clients should the nurse identify as a candidate for occupational therapy?

A client who has a PCA for chronic pain following a laminectomy

A client who has Alzheimer's disease and is experiencing abdominal pain

A client who has migraines and is experiencing nausea and vomiting

A client who has painful hands due to degenerative joint disease

Answer and Explanation

The Correct Answer is D

A. A client who has a PCA for chronic pain following a laminectomy: This client is receiving patient-controlled analgesia (PCA) to manage post-surgical pain. The primary focus is pharmacologic pain control, and occupational therapy is not the first-line intervention for acute post-surgical pain management.

B. A client who has Alzheimer's disease and is experiencing abdominal pain: Occupational therapy focuses on improving functional abilities, mobility, and daily activities rather than addressing acute internal pain such as abdominal pain. Management of this client’s pain would involve medical assessment and treatment rather than OT intervention.

C. A client who has migraines and is experiencing nausea and vomiting: Migraine management is primarily medical, focusing on pharmacologic therapy and symptom relief. Occupational therapy is not indicated for acute episodic pain like migraines with associated nausea and vomiting.

D. A client who has painful hands due to degenerative joint disease: Occupational therapy is appropriate for chronic musculoskeletal conditions like degenerative joint disease. OT can help the client maintain hand function, adapt daily activities, improve fine motor skills, and manage chronic pain through therapeutic techniques and assistive devices.

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Correct Answer is A

Explanation

A. Determine the client's Glasgow Coma Scale score: Assessing the client’s neurological status using the Glasgow Coma Scale (GCS) is the first action because it establishes a baseline for consciousness, guides priority interventions, and helps detect early deterioration. Rapid neurological assessment is critical in closed head injuries to identify life-threatening changes.

B. Prepare the client for an MRI of the brain: Imaging is important for diagnosis, but it is not the first action. The client’s neurological status must be assessed and stabilized before sending them for diagnostic procedures to ensure safety during transport and imaging.

C. Administer mannitol IV bolus to the client: Mannitol is used to reduce intracranial pressure, but administering it before assessing neurological status may not be indicated. Treatment should be guided by the assessment findings, including GCS and signs of increased intracranial pressure.

D. Insert an indwelling urinary catheter for the client: Catheterization may be necessary for monitoring output in critically ill clients, but it is not a priority over assessing neurological status. Maintaining airway, breathing, and circulation, and assessing neurologic function take precedence in head injury care.

A. "Your device is set to allow you to deliver small doses more frequently." B. "Using this device allows you to use less medication than other methods." C. "Your family member can push the PCA button for you if you're sleeping" D. "You will need to keep track of each dose you administer to avoid taking too much."

Correct Answer is A

Explanation

A. "Your device is set to allow you to deliver small doses more frequently.": PCA (patient-controlled analgesia) allows the client to self-administer small, controlled doses of pain medication as needed. This statement accurately explains how the device works and emphasizes client control within safe limits.

B. "Using this device allows you to use less medication than other methods.": While PCA can improve pain management, it does not necessarily reduce the total amount of medication used. The primary benefit is timely pain relief and maintaining therapeutic levels, not automatically using less medication.

C. "Your family member can push the PCA button for you if you're sleeping": Only the client should activate the PCA device to prevent overdose. Allowing others to push the button, a practice called “PCA by proxy,” is unsafe and can lead to serious complications.

D. "You will need to keep track of each dose you administer to avoid taking too much.": The PCA device is programmed with safety limits, including lockout intervals, to prevent overdose. The client does not need to manually track doses, as the device automatically controls and records administration.

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A nurse is caring for a group of clients who have chronic pain. Which of the following clients should the nurse identify as a candidate for occupational therapy?

Nursing Test Bank

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