The nurse is providing postoperative care for an adolescent who underwent a left leg amputation due to osteosarcoma.
The adolescent reports experiencing phantom limb pain.
Which non-pharmacological intervention should the nurse provide?
Reassure that this can be a normal post-surgical sensation.
Guide in moving the non-affected limb to override the sensation being experienced.
Explain that the sensations of tingling and pain are not real.
Affirm that a prosthetic with physical therapy will gradually improve the symptoms.
The Correct Answer is A
Choice A rationale
Reassuring the adolescent that experiencing phantom limb pain can be a normal post-surgical sensation is the correct choice. Phantom limb pain is a common occurrence after amputation and can be very distressing for the patient. The nurse should validate the patient’s experience and provide reassurance. Non-pharmacological interventions such as mirror therapy, visualization, and other cognitive-behavioral strategies can also be helpful.
Choice B rationale
Guiding the patient in moving the non-affected limb to override the sensation being experienced is not the most appropriate intervention. While some therapies for phantom limb pain involve focusing on the remaining limb, this should be done under the guidance of a trained therapist.
Choice C rationale
Telling the patient that the sensations of tingling and pain are not real is not an appropriate intervention. Although the limb is no longer there, the pain that the patient is experiencing is very real. It is important to validate the patient’s experience and provide appropriate interventions.
Choice D rationale
Affirming that a prosthetic with physical therapy will gradually improve the symptoms is not the most appropriate intervention. While using a prosthetic and engaging in physical therapy can help with overall recovery and adaptation after amputation, they do not directly address phantom limb pain. The pain is a result of mixed signals from the brain and nerves, and it requires specific interventions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While regular monitoring of blood sugar levels is important in managing diabetes, checking every four to six hours every day may not be necessary for all patients. The frequency of blood glucose monitoring should be individualized based on the type and severity of the diabetes, the patient’s blood glucose control, and the patient’s specific needs.
Choice B rationale
Keeping diabetic medication on schedule as prescribed is crucial in managing blood glucose levels and preventing complications related to diabetes. This indicates that the patient has understood the importance of medication adherence in diabetes management.
Choice C rationale
While it’s recommended to limit alcohol consumption, restricting alcoholic beverages to no more than 1-2 per week is not a standard guideline for all patients with diabetes. The effects of alcohol on blood glucose levels can vary depending on several factors, including the amount of alcohol consumed, the presence of food, and the individual’s overall diabetes management.
Choice D rationale
Limiting daily fat intake to 15% of total calories is not a standard recommendation for patients with diabetes. The American Diabetes Association recommends individualized medical nutrition therapy to manage diabetes, which may include monitoring carbohydrate intake and considering the quality of fats and proteins in the diet.
Correct Answer is A
Explanation
Choice A rationale
Histamine H2-receptor antagonists, also known as H2 blockers, are medications that help reduce the production of gastric acid. They achieve this by blocking H2 receptors in the parietal cells of the stomach, which are responsible for secreting hydrochloric acid (HCl)12. This reduction in acid secretion can help treat conditions such as peptic ulcers, gastroesophageal reflux disease (GERD), and Zollinger-Ellison syndrome, which are all conditions that can be exacerbated by excessive stomach acid.
Choice B rationale
While H2 blockers do help manage the symptoms of peptic ulcer disease, they do not directly destroy the microorganisms causing inflammation in the stomach. The primary cause of peptic ulcers is a bacterium called Helicobacter pylori, and the treatment for an H. pylori infection typically involves a combination of antibiotics and proton pump inhibitors, not H2 blockers.
Choice C rationale
H2 blockers do not neutralize hydrochloric acid (HCl) in the stomach. Instead, they work by reducing the amount of acid produced by the stomach. Antacids, not H2 blockers, are the class of drugs that work by neutralizing stomach acid.
Choice D rationale
H2 blockers do not inhibit the action of acetylcholine by blocking parasympathetic nerve endings. Anticholinergic medications are the ones that work by blocking the action of acetylcholine, a neurotransmitter that transmits signals in the nervous system.
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