Nokea
A client with Paget's disease is hospitalized for an unrelated issue. The client reports pain and it is not yet time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
- A. Administering pain medication
- B. Applying a heating pad
- C. Providing a massage
- D. Referring the client to a support group
- E. Using a bed cradle to lift sheets off the feet
Correct Answer: B,C
Rationale: Heat and massage are nonpharmacologic comfort measures for Paget's disease pain that can be delegated to a UAP. Administering medication and referrals are nursing responsibilities, and a bed cradle is unnecessary.
You may also like to solve these questions
A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client's psychosocial needs?
- A. Assess coping skills and support systems
- B. Explain that the surgery leads to a longer life expectancy
- C. Refer the client to the social worker or hospital chaplain
- D. Reinforce physical therapy to aid with ambulating normally
Correct Answer: A
Rationale: Assessing coping skills and support systems is the first step in addressing psychosocial needs, as it identifies the client's resources and challenges. Explaining life expectancy does not address psychosocial needs directly, referrals may follow assessment, and physical therapy focuses on physical rather than psychosocial needs.
A client has an ingrown toenail. About what self-management measure does the nurse teach the client?
- A. Long-term antibiotic use
- B. Shoe padding
- C. Toenail trimming by the client
- D. Warm moist soaks and proper nail trimming by a podiatrist
Correct Answer: D
Rationale: Proper treatment for an ingrown toenail includes warm moist soaks and professional nail trimming by a podiatrist to prevent recurrence. Long-term antibiotics are unnecessary, shoe padding does not treat the condition, and self-trimming can worsen it.
A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first?
- A. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 6 weeks ago
- B. Client taking ibandronate (Boniva) who cannot remember when the last dose was
- C. Client taking raloxifene who reports leg swelling 6 weeks ago
- D. Client taking risedronate (Actonel) who reports occasional dyspepsia
Correct Answer: C
Rationale: Leg swelling in a client taking raloxifene suggests possible deep vein thrombosis, a serious adverse effect requiring immediate attention. Flank pain from 6 weeks ago is less urgent, forgetting a dose of ibandronate is not immediately critical, and dyspepsia with risedronate is a common side effect that can be managed later.
A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best?
- A. The feet have less blood flow, so healing is slower
- B. The bones in your feet are hard to operate on
- C. The surrounding bones and tissue are damaged
- D. Healing depends on your overall health
Correct Answer: A
Rationale: The feet, being distal to the heart, have reduced blood flow compared to other areas, which slows healing after surgery like a bunionectomy with osteotomy. The other options are less accurate or incomplete explanations.
A client is admitted with a large draining wound on the leg. What action does the nurse take first?
- A. Administer ordered antibiotics
- B. Insert an intravenous line
- C. Give pain medications if needed
- D. Obtain cultures of the leg wound
Correct Answer: D
Rationale: Obtaining wound cultures is the priority to identify the causative organism before administering antibiotics, which could alter culture results. IV insertion and pain management follow, as they are secondary to accurate diagnosis.