A nurse is reinforcing teaching with a client about using guided imagery to manage chronic pain.
Which of the following statements by the client indicates an understanding of this technique?

“I’ll learn to notice the sensation of muscle tension.”

“I’ll listen to my favorite music to take my mind off the pain.”

“I’ll use focused breathing to control my pain.”.

“I’ll think about my grandfather’s farm to reduce pain.”.

Answer and Explanation

The Correct Answer is D

The correct answer is choice D. “I’ll think about my grandfather’s farm to reduce pain.” This statement indicates an understanding of guided imagery, which is a relaxation technique that aims to help lower the levels of stress hormones and pain perception by imagining a scene that involves each of the senses and positive emotions.

Guided imagery can help to distract from pain signals and reduce anxiety, which can also contribute to pain.

Choice A is wrong because it does not involve creating a specific imagined reality, but rather noticing the sensation of muscle tension, which may increase awareness of pain.

Choice B is wrong because it does not involve using all of the senses and emotions, but rather listening to music, which may be relaxing but not as effective as guided imagery for pain relief.

Choice C is wrong because it does not involve imagining a scene, but rather using focused breathing to control pain, which is another relaxation technique but not guided imagery.

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Correct Answer is C

Explanation

- When coordinating the care of a group of clients with assistive personnel (AP), it's important to delegate tasks appropriately based on the AP's scope of practice and training. Here are the tasks that can be assigned to the AP:

Measure the intake and output of a client who has received furosemide: This task involves recording fluid intake and output, which is typically within the scope of practice for an AP, as long as they have been trained in the proper procedure and documentation.

Check a client’s peripheral IV site for redness or swelling: This task involves basic assessment and can be assigned to an AP, as long as they are familiar with the signs of potential complications related to IV sites and have been trained in the facility's protocol for reporting any issues.

Reinforcing teaching with a client about crutch-gait walking: Education and reinforcement of information provided by healthcare professionals can often be delegated to APs, especially if they have received training on the specific topic. However, it's important to ensure that the AP is knowledgeable about crutch-gait walking and the information they are reinforcing.

The task related to assessing pain (e.g., assessing the pain level of a client who has received acetaminophen) should generally be performed by a licensed healthcare provider, such as a nurse. Assessment of pain requires a deeper understanding of the client's pain experience and may involve making clinical decisions related to pain management.

A. Use a communication board to interact with the client. B. Ask an assistive personnel who speaks the same language as the client to interpret. C. Use the Face, Legs, Activity, Cry, Consolability (FLACC) scale to measure the client’s pain level. D. Use the FACES pain scale to gauge the client’s level of pain.

Correct Answer is A

Explanation

The correct answer is choice A. Use a communication board to interact with the client.

A communication board is a tool that allows the client to point to words, pictures, or symbols that express their needs, feelings, or pain level.

This is an effective way to communicate with a client who speaks a different language than the nurse and is unable to verbalize their pain.

Choice B is wrong because an assistive personnel who speaks the same language as the client is not a qualified interpreter and may not be able to convey the client’s pain accurately or maintain confidentiality.

Choice C is wrong because the FLACC scale is a measurement used to assess pain for children between the ages of 2 months and 7 years or individuals that are unable to communicate their pain.

It is not appropriate for a client who is 6 hours postoperative and can communicate their pain using a communication board.

Choice D is wrong because the FACES pain scale is a self-report measure of pain intensity developed for children.

It uses facial expressions to rate the severity of pain in children from 0-103.

It is not suitable for a client who speaks a different language than the nurse and may not understand the meaning of the faces.

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A nurse is reinforcing teaching with a client about using guided imagery to manage chronic pain. Which of the following statements by the client indicates an understanding of this technique?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is coordinating the care of a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse not assign to the AP?

Correct Answer is C

Explanation

A nurse is caring for a client who speaks a different language than the nurse and is 6 hr postoperative. Which of the following actions should the nurse take to determine the client’s level of pain?

Correct Answer is A

Explanation

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A nurse is reinforcing teaching with a client about using guided imagery to manage chronic pain.
Which of the following statements by the client indicates an understanding of this technique?