A patient is receiving an ice massage for relief of muscle spasms in the neck.
The patient complains that the ice is making the pain worse.
Most helpful response from the nurse would be:.
"I will go get an ice pack to place on your neck.”.
"I will stop these cold applications.
"The alteration of hot and cold application is very helpful for your spasms.”.
"I know it is uncomfortable right now, but it will get better in a few minutes.”.
The Correct Answer is B
Choice A rationale:
Offering an ice pack to place on the neck would not be an appropriate response in this situation. The patient has already complained that the ice massage is making the pain worse, so providing additional cold application may exacerbate their discomfort.
Choice B rationale:
The most helpful response in this scenario is to acknowledge the patient's discomfort and stop the cold application. Not everyone responds positively to cold therapy, and it's essential to respect the patient's feedback and provide alternative methods for pain relief.
Choice C rationale:
Alternating hot and cold applications may be helpful for some patients, but in this case, the patient has already expressed that the ice massage is exacerbating their pain. Suggesting this approach without addressing the patient's immediate concern is not appropriate.
Choice D rationale:
While it's true that the discomfort from the ice massage may subside in a few minutes, it's important to prioritize the patient's comfort and address their pain immediately. Continuing an intervention that is causing increased pain is not in the patient's best interest.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choice B. "Why do you think your husband needs more medication when he is asleep?"
Choice A rationale:
"Your husband should decide when more medication is needed.” This response is incorrect because it implies that the partner has the authority to decide when the client needs pain medication, which violates the purpose of a PCA pump. A PCA pump is specifically designed for client-controlled pain management, ensuring that the patient, not anyone else, controls when they receive pain medication. Allowing someone else to press the button can lead to overmedication and safety risks.
Choice B rationale:
"Why do you think your husband needs more medication when he is asleep?" This response is correct because it prompts the partner to reflect on their actions and provides an opportunity for the nurse to educate about the proper use of PCA pumps. It addresses the immediate issue without being confrontational and opens the door for further discussion on the importance of client safety and correct PCA use.
Choice C rationale:
"It's a good idea to help make sure your husband can sleep comfortably.” This response is incorrect as it endorses inappropriate and unsafe behavior. It encourages the partner to continue pressing the PCA button, risking the client's safety due to potential overmedication, which can lead to severe complications, such as respiratory depression.
Choice D rationale:
"Next time you think he needs more medication, call me and I'll push the button.” This response is incorrect because it contradicts PCA protocols and removes the control from the client. The nurse is responsible for monitoring the client’s pain and safety, not administering medication upon another person’s request. This approach also increases the risk of dosing errors and undermines the purpose of patient-controlled analgesia.
Correct Answer is B
Explanation
The correct answer is B. Responsibility.
Choice A rationale:
“Fairness.” Fairness involves treating all clients equally and without bias. While fairness is an important aspect of professionalism, it is not specifically demonstrated by evaluating the effectiveness of pain medication.
Choice B rationale:
“Responsibility.” Responsibility refers to the nurse’s duty to provide safe and effective care. By checking the client to evaluate the effectiveness of pain medication, the nurse is fulfilling their responsibility to monitor the client’s response to treatment and ensure their comfort and well-being.
Choice C rationale:
“Confidence.” Confidence involves the nurse’s self-assurance in their skills and knowledge. While confidence is important in nursing practice, it is not the primary component demonstrated in this scenario.
Choice D rationale:
“Advocacy.” Advocacy involves supporting and speaking up for the client’s needs and preferences. Although advocacy is a crucial part of nursing, the act of evaluating pain medication effectiveness is more directly related to the nurse’s responsibility to provide appropriate care.
By demonstrating responsibility, the nurse ensures that the client’s pain management is effective and that any necessary adjustments to the treatment plan are made.
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