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 C
Explanation
Choice A rationale:
Increasing pain over several hours is not a typical sign of a fentanyl patch overdose. Fentanyl is a potent opioid, and overdose symptoms often involve respiratory depression, altered mental status, and other serious issues. While it is possible for a patient to experience increased pain if the fentanyl patch is not providing adequate pain relief, this is not a specific sign of overdose.
Choice B rationale:
An itchy red rash on the skin is not a sign of a fentanyl patch overdose but can be associated with skin irritation or allergies to the adhesive in the patch. It's important to differentiate between a skin reaction and an overdose when evaluating patients using fentanyl patches. Overdose symptoms are more severe and life-threatening.
Choice C rationale:
Confusion and the inability to walk normally are characteristic signs of a fentanyl patch overdose. Fentanyl is a potent opioid, and overdose can lead to central nervous system depression, resulting in confusion, altered mental status, and difficulty with coordination and walking. These symptoms are serious and require immediate medical attention.
Choice D rationale:
Headache and nausea are not specific signs of a fentanyl patch overdose. While opioid overdose can cause various symptoms, such as respiratory depression and altered mental status, headache and nausea are not among the primary indicators. However, individual responses to medications can vary, and some patients may experience these symptoms as part of a broader set of overdose signs.
Correct Answer is D
Explanation
Choice A rationale:
The CPAP device should not fit loosely on the face. It should fit snugly to create a proper seal and maintain positive airway pressure. A loose-fitting CPAP mask may not effectively treat obstructive sleep apnea (OSA).
Choice B rationale:
The CPAP device typically delivers consistent pressure throughout both inhalation and exhalation. It does not deliver less pressure during exhalation. The purpose of CPAP is to maintain a constant pressure to keep the airway open during both phases of the respiratory cycle.
Choice C rationale:
The CPAP device does not require an invasive ventilation tube. It uses a mask that covers the nose or both the nose and mouth to deliver positive airway pressure. It is non-invasive and is designed to keep the airway open by delivering pressurized air.
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