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
Choice A rationale:
A patient with a decreased level of consciousness from a stroke may not be able to provide feedback or recognize discomfort or pain, which can increase the risk of burn injury when using a heating pad. This choice increases the risk rather than reducing it.
Choice B rationale:
A patient with neuritis secondary to diabetes has a decreased sensitivity in the affected area due to nerve damage. While this can be a challenging condition, it reduces the patient's ability to perceive heat and pain, making them less likely to realize if the heating pad becomes too hot. As a result, this patient has the least risk for burn injury when using the Aquathermia K pad.
Choice C rationale:
A severely sprained ankle is not related to the risk of burn injury from a heating pad. This choice is not relevant to the assessment of burn injury risk with the Aquathermia K pad.
Choice D rationale:
Impaired peripheral circulation can increase the risk of burn injury from a heating pad. Patients with compromised circulation have a reduced ability to dissipate heat, which can lead to localized overheating and potential burn injury. This choice increases the risk of injury. .
Correct Answer is A
Explanation
Choice A rationale:
If a patient with a Fentanyl patch is experiencing symptoms like abnormal sleepiness, slurred speech, and unsteadiness when ambulating, it could indicate an overdose or adverse reaction to the Fentanyl. In such cases, the patch should be removed immediately to stop the further absorption of the drug. Wiping off the skin can also help remove any residual medication. This is the correct choice as it addresses the issue at its source.
Choice B rationale:
Applying ice to the skin around the Fentanyl patch is not the appropriate action in this situation. Ice will not counteract the effects of a Fentanyl overdose or adverse reaction. The priority is to remove the patch and seek medical attention.
Choice C rationale:
Elevating the head of the bed and offering coffee or cola may be useful in combating some forms of sleepiness but would not be effective for someone experiencing an overdose or adverse reaction to Fentanyl. This choice does not address the problem's root cause and is not the appropriate action to take.
Choice D rationale:
Putting up the side rails on the bed does not address the issue of Fentanyl patch overdose or adverse reactions. This choice is not relevant to the situation and should not be chosen.
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