A nurse is preparing for a home visit with a client who is postoperative following an above-the-knee amputation. Which of the following questions should the nurse plan to ask first?
"Have you scheduled an appointment with the prosthetist?"
"Do you feel your pain is controlled well?
"Are you aware of any support groups in the area?"
"Have you been exercising your other extremities?"
The Correct Answer is B
A. While scheduling an appointment with the prosthetist is important, the client's comfort and pain control take precedence, especially in the immediate postoperative period. Addressing pain concerns is a priority to ensure the client's well-being.
B. "Do you feel your pain is controlled well?" is the first question to ask. Assessing pain is crucial to understanding the client's level of comfort and ensuring that appropriate measures are in place for pain management. This information can guide further interventions and adjustments to the care plan.
C. Inquiring about support groups in the area is an important aspect of the client's overall well-being and adjustment to the amputation. However, pain control is an immediate concern, and addressing it takes precedence during the initial home visit.
D. Asking about exercising other extremities is relevant for the client's overall mobility and
rehabilitation. However, pain control assessment should be prioritized as it directly impacts the client's ability to participate in rehabilitation activities.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["4"]
Explanation
To calculate the volume (mL) that the nurse should administer per dose, you can use the following formula:
- Volume (mL) = Dose (units)/Concentration (units/mL)
In this case:
- Volume = 400,000 units/100,000 units/mL
- Volume=4mL
Therefore, the nurse should administer 4 mL of Mycostatin oral suspension per dose.
Correct Answer is A
Explanation
A. Engage the client in a repetitive activity as a distraction:
This is the correct answer. Redirecting the client's focus to a repetitive and calming activity can help distract them from the source of agitation and potentially de-escalate the situation.
B. Place the client in a seclusion room:
Seclusion should only be used in situations where it is absolutely necessary for the safety of the client or others. Placing a client with dementia in seclusion is not the first choice and should be avoided if possible.
C. Apply wrist restraints to the client:
Restraints should be a last resort and used only when there is an imminent risk of harm to the client or others. Restraints can escalate agitation and should not be the initial response.
D. Administer PRN haloperidol IM to the client:
The use of medication should be considered later in the escalation process and after other non-pharmacological interventions have been attempted. It is not the first intervention, especially when there are non-pharmacological options available.
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