1An oriented patient has recently had surgery. Which
action is best for the nurseto take to assess this
patient’s pain?
a. Assess the patient’s
... [Show More] body language.
b. Ask the patient to rate the level of pain.
c. Observe the cardiac monitor for increased heart rate.
d. Have the patient describe the effect of pain on the ability
to cope.
ANS: B
One of the most subjective and therefore most useful
characteristics for reporting pain is its severity.
Therefore, the best way to assess a patient’s painis to
ask the patient to rate the pain. Nonverbal
communication, such as body language, is not as
effective in assessing pain, especially when the patient
is oriented. Heart rate sometimes increases when a
patient is in pain, but this is not a symptom that is
specific to pain. Pain sometimes affects a patient’s
ability to cope, but assessing the effect of pain on coping
assesses the patient’sability to cope; it does not assess
the patient’s pain.
2.A nurse is caring for a patient who recently had abdominal
surgery and is experiencing severe pain. The patient’s blood
pressure is 110/60 mm Hg,
and heart rate is 60 beats/min. Additionally, the
patient does not appear tobe in any distress. Which
response by the nurse is most therapeutic?
“Your vitals do not show that you are having pain; can you
describe
a. your pain?”
b. “OK, I will go get you some narcotic pain relievers
immediately.”
c. “What would you like to try to alleviate your pain?”
d. “You do not look like you are in pain.”
ANS: C
Be sure the patient is a partner in making decisions
about the best approaches for managing pain. A patient 20
knows the most about his or her pain and is an important 5
partner in selecting successful pain therapies. The nurse
must believe that a patient is in pain whenever the
patient reports that he or she is in
pain, even if the patient does not appear to be in pain.
The nurse must be careful to not judge the patient based
on vital signs or nonverbal communication and must not
assume that the patient is seeking narcotics. Thepatient
is a partner in pain management, so going to get
narcotics to treat the pain without consulting with the
patient first is not appropriate. [Show Less]