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The patient complains of fatigue and joint pain and reports that they are unable to walk due to pain in the knees. What is the most appropriate statement by the nurse?
"You should avoid walking. This might be osteoporosis."
"You just have arthritis and should take some ibuprofen."
"Please tell me more about when your pain started."
"You need to lose weight or the pain won't go away."
The Correct Answer is C
Choice A reason: This is an incorrect statement because it is not based on any assessment or diagnosis. Osteoporosis is a condition that affects the bones, not the joints. It also does not cause fatigue. The nurse should not make assumptions or give advice without proper evaluation.
Choice B reason: This is an incorrect statement because it is dismissive and insensitive. Arthritis is a general term that covers many types of joint inflammation and pain. It is not a simple condition that can be treated with just ibuprofen. The nurse should not minimize the patient's concerns or prescribe medication without a doctor's order.
Choice C reason: This is the correct statement because it shows empathy and interest in the patient's situation. It also helps the nurse gather more information about the onset, duration, frequency, and severity of the pain. This can help the nurse identify possible causes and plan appropriate interventions.
Choice D reason: This is an incorrect statement because it is rude and judgmental. Weight loss may or may not help with joint pain, depending on the underlying cause. The nurse should not blame the patient or make them feel guilty. The nurse should focus on the patient's current symptoms and needs, not their appearance or lifestyle.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","E"]
Explanation
Choice A reason: Increased agitation is a nonverbal sign of pain, because it indicates that the client is restless, uncomfortable, or distressed by the pain. Agitation can manifest as fidgeting, tossing, turning, moaning, or groaning.
Choice B reason: Decreased attention span is not a nonverbal sign of pain, but rather a cognitive or behavioral sign of pain. Decreased attention span means that the client has difficulty focusing, concentrating, or remembering things, which can be affected by pain. However, decreased attention span is not a direct expression of pain, but rather a consequence of pain.
Choice C reason: Grimacing is a nonverbal sign of pain, because it indicates that the client is experiencing facial muscle tension, contraction, or distortion due to the pain. Grimacing can manifest as frowning, wrinkling the forehead, pursing the lips, or clenching the teeth.
Choice D reason: Reported pain of 5/10 is not a nonverbal sign of pain, but rather a verbal sign of pain. Reported pain of 5/10 means that the client has communicated the intensity of their pain using a numerical scale, which is a subjective and selfreported measure of pain. However, reported pain of 5/10 is not a direct expression of pain, but rather a description of pain.
Choice E reason: Increase in heart rate is a nonverbal sign of pain, because it indicates that the client is experiencing physiological changes due to the pain. Increase in heart rate can manifest as tachycardia, palpitations, or arrhythmias.
Correct Answer is C
Explanation
Choice A reason: "In order to avoid flareups of Raynaud's, ensure to keep cool." is not a correct answer, because it can worsen the symptoms of Raynaud's phenomenon. Raynaud's phenomenon is a condition that causes the blood vessels in the fingers and toes to narrow and spasm in response to cold or stress, resulting in reduced blood flow and color changes. Keeping cool can trigger or aggravate the spasms and decrease the blood flow.
Choice B reason: "In order to avoid flareups of Raynaud's, ensure you wear sunscreen." is not a correct answer, because it is not related to Raynaud's phenomenon. Sunscreen is a protective measure for clients with lupus, who may have increased sensitivity to ultraviolet rays and increased risk of skin damage and flareups. However, sunscreen does not prevent or treat Raynaud's phenomenon, which is caused by cold or stress, not by sun exposure.
Choice C reason: "In order to avoid flareups of Raynaud's, ensure you wear gloves in winter." is a correct answer, because it can help prevent or reduce the symptoms of Raynaud's phenomenon. Wearing gloves in winter can keep the hands warm and prevent the blood vessels from narrowing and spasming due to cold. This can improve the blood flow and prevent color changes, numbness, pain, or ulcers in the fingers.
Choice D reason: "In order to avoid flareups of Raynaud's, ensure you brush your teeth for two minutes." is not a correct answer, because it is not related to Raynaud's phenomenon. Brushing the teeth for two minutes is a good oral hygiene practice that can prevent dental problems, such as plaque, cavities, or gingivitis. However, brushing the teeth does not affect the blood vessels in the fingers and toes, nor does it prevent or treat Raynaud's phenomenon.
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