Nokea
The client had a mastectomy and lymph node dissection three (3) years ago and has experienced postmastectomy pain (PMP) since. Which intervention should the nurse implement?
- A. Have the client see a psychologist because the pain is not real.
- B. Tell the client the pain is the cancer coming back.
- C. Refer the client to a physical therapist to prevent a frozen shoulder.
- D. Discuss changing the client to a more potent narcotic medication.
Correct Answer: C
Rationale: PMP can lead to shoulder immobility; physical therapy prevents frozen shoulder, per evidence-based practice. Psychological dismissal, cancer assumptions, or narcotics are inappropriate.
You may also like to solve these questions
The nurse is teaching a class on chronic pain to new graduates. Which information is most important for the nurse to discuss?
- A. The nurse must believe the client's report of pain.
- B. Clients in chronic pain may not show objective signs.
- C. Alternate pain-control therapies are used for chronic pain.
- D. Referral to a pain clinic may be necessary.
Correct Answer: A
Rationale: Believing the client’s pain report is critical, as pain is subjective, per pain management guidelines. Objective signs, therapies, or referrals are secondary.
The nurse is caring for clients on a medical floor. Which client should the nurse assess first after the shift report?
- A. The client with arterial blood gases of pH 7.36, Paco2 40, HCO3 26, Pao2 90.
- B. The client with vital signs of T 99°F, P 101, R 28, and BP 120/80.
- C. The client complaining of pain at a '10' on a 1-to-10 scale who can't localize it.
- D. The client who is postappendectomy with pain at a '3' on a 1-to-10 scale.
Correct Answer: C
Rationale: Severe pain (10/10), especially nonlocalizable, may indicate a serious condition (e.g., ischemia), requiring immediate assessment. Normal ABGs, mild vital sign changes, or mild post-op pain are less urgent.
The male client asks the nurse, 'Should I designate my wife as durable power of attorney for health care?' Which statement would be the nurse's best response?
- A. Yes, she should be because she is your next of kin.
- B. Most people don't allow their spouse to do this.
- C. Will your wife be able to support your wishes?
- D. Your children are probably the best ones for the job.
Correct Answer: C
Rationale: Choosing a proxy involves ensuring they’ll honor the client’s wishes, a key consideration. Kinship, rarity, or children are less relevant without this focus.
The nurse must be knowledgeable of ethical principles. Which is an example of the ethical principle of justice?
- A. The nurse administers a placebo, and the client asks if it will help the pain.
- B. The nurse accepts a work assignment in an area in which he or she is not experienced.
- C. The nurse refuses to tell a family member the client has a positive HIV test.
- D. The nurse provides an indigent client with safe and appropriate nursing care.
Correct Answer: D
Rationale: Justice ensures equitable care, like providing safe care to an indigent client. Placebos (deception), incompetence, or confidentiality are unrelated to justice.
The client is being discharged from the hospital for intractable pain secondary to cancer and is prescribed morphine, a narcotic. Which statement indicates the client understands the discharge instructions?
- A. I will be sure to have my prescriptions filled before any holiday.
- B. There should not be a problem having the prescriptions filled anytime.
- C. If I run out of medications, I can call the HCP to phone in a prescription.
- D. There are no side effects to morphine I should be concerned about.
Correct Answer: A
Rationale: Filling prescriptions before holidays ensures access to narcotics, reflecting understanding of controlled substance challenges. Other statements are inaccurate or unsafe.