The nurse caring for a client diagnosed with pancreatic cancer understands that the key to effective pain management is: (SELECT ALL THAT APPLY)
pain control options should be appropriate to the setting.
delivery of pain relief interventions should be timely and logical.
asking about pain once a shift.
belief that pain is what the client reports it is.
most effective when provided by a team approach.
Correct Answer : A,B,D,E
A. Pain control options should be appropriate to the setting because different environments (e.g., home vs. hospital) may require different approaches to pain management, ensuring that the interventions align with the patient's needs and the context.
B. Timely and logical delivery of pain relief interventions is critical for effective pain management. Delays in treatment can lead to unnecessary suffering and complicate the overall management of the patient's condition.
C. Asking about pain only once a shift is insufficient for effective pain management. Pain can fluctuate frequently, especially in a client with cancer, so regular assessment is essential to address pain promptly.
D. Believing that pain is what the client reports it to be is fundamental to effective pain management. Pain is subjective, and clients' experiences and expressions of pain should be taken seriously to guide appropriate interventions.
E. A team approach is often the most effective for pain management, as it allows for a comprehensive plan that integrates multiple perspectives and disciplines, including nursing, medical, and possibly palliative care professionals, ensuring a holistic approach to managing pain.
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Correct Answer is B
Explanation
A. Inserting an oral airway and suctioning may be indicated for airway management, but the primary concern is the impaired function of the glossopharyngeal and vagus nerves, which affects swallowing and the risk of aspiration.
B. Withholding oral fluids or foods is crucial because impaired function of these cranial nerves increases the risk of aspiration and can lead to choking or pneumonia, making this the priority action.
C. Speaking clearly while facing the client is a good communication practice but does not address the immediate concern of impaired swallowing and risk of aspiration.
D. Applying artificial tears is important for protecting the cornea, but it is not directly related to the functions of CN IX and CN X or the immediate management of swallowing difficulties.
Correct Answer is B
Explanation
A. A soft, low sofa can make it difficult for the client to rise and sit safely after surgery, which may risk hip dislocation.
B. A dining room chair with armrests provides support for the client to help them sit down and stand up safely, making this the most appropriate choice.
C. A canvas lawn chair typically does not provide adequate support or height, which can complicate the sitting and standing process post-surgery.
D. A desk type, swivel chair may not be stable or supportive enough for the client, increasing the risk of falls or injury after the hip replacement.