A nurse manager is teaching a newly licensed nurse about pain management for an older adult client. Which of the following statements by the nurse indicates an understanding of the teaching?

Rationale:

• Temperature: The child’s temperature is 37.4°C (99.3°F), which is mildly elevated. Crohn’s disease typically causes intermittent fever during flare-ups. Appendicitis often presents with a higher fever in later stages. Intussusception can cause low-grade fever due to bowel inflammation, making it the most consistent with this finding.
• Vomiting: Vomiting is uncommon in Crohn’s disease unless there’s obstruction or severe disease. In appendicitis, vomiting usually follows the onset of pain and is related to peritoneal irritation. Intussusception often involves vomiting early due to intermittent bowel obstruction, making it consistent with this client’s symptoms.
• Pain rating: A FLACC score of 5 indicates moderate pain. Crohn’s pain tends to be chronic and crampy rather than episodic. Appendicitis pain worsens over time and becomes localized, typically in the right lower quadrant. Intussusception causes intermittent, severe abdominal pain with sudden relief, matching the child’s pain episodes and behavior.
• Abdominal findings: Crohn’s disease rarely produces a palpable abdominal mass or sudden distension. Appendicitis can cause right-sided tenderness and decreased bowel sounds but does not typically involve a mass. Intussusception often presents with a distended abdomen, hypoactive bowel sounds, and a sausage-shaped mass in the right upper quadrant, as described.
• Stool: Crohn’s disease can lead to bloody, mucus-filled stools due to ulceration in the intestinal lining. Appendicitis does not typically alter stool characteristics unless perforation occurs. Intussusception is well known for producing “currant jelly” stools, composed of blood and mucus, aligning with this child’s bowel movement description.

Rationale for Correct Choices:

• Auditory hallucinations: The client reports hearing voices telling them to act (“I'm being told that it's better to end myself...”), which is a clear example of auditory hallucinations. These are a core positive symptom of schizophrenia and often command in nature.
• Echolalia: The client repeating the nurse’s words indicates echolalia, which reflects disorganized thought and speech. It is another classic positive symptom of schizophrenia and demonstrates impaired cognitive filtering.

Rationale for Incorrect Choices:

• Magical thinking: Magical thinking involves believing one’s thoughts can cause events in the physical world, such as thinking they can control others with their mind. This is not evident in the client’s current statements.
• Thought deletion: Thought deletion is the belief that external forces are removing thoughts from one’s mind. The client does not express this; instead, they report added stimuli (voices), not missing thoughts.
• Boundary impairment: Boundary impairment involves difficulty recognizing personal space or ownership, such as using others’ belongings inappropriately. This behavior has not been described in the current assessment.