A client with chronic back pain tells the nurse that the pain is worse today than usual. What would the nurse do first?

Correct Answer: C

Rationale: The nurse would first assess the client further when chronic back pain worsens, as a change could signal new injury, inflammation, or disease progression needing specific intervention. Assessment (e.g., pain scale, triggers) informs targeted action. Choice A, administering an analgesic, risks masking symptoms without understanding the causechronic pain regimens adjust based on data, not reflex. Choice B, massaging the back, might help but could worsen undiagnosed issues (e.g., herniation); assessment precedes nonpharmacological attempts. Choice D, telling the client to relax, dismisses the escalationrelaxation doesn't address why pain intensified. Choice C is correct, embodying nursing's systematic approachdetailing pain's quality, onset, or radiation ensures accurate diagnosis and management, like adjusting medication or consulting a provider, preventing harm and optimizing relief for chronic pain flare-ups.

Correct Answer: B

Rationale: A burning sensation suggests neuropathic pain, as it reflects nerve damage or dysfunction (e.g., from diabetes), producing sensations like burning, tingling, or shooting pain, distinct from somatic pain's mechanical origin. Somatic pain (e.g., fractures) is musculoskeletal, not neural. Choice A, dull ache, aligns with somatic pain (e.g., arthritis), not neuropathy's sharp or electric quality. Choice C, localized swelling, indicates somatic injury or inflammation, not nerve-based pain, which lacks physical signs. Choice D, muscle stiffness, ties to somatic issues (e.g., tension), not neuropathic hallmarks. Choice B is correct, guiding nurses to differentiate pain typeneuropathic burning prompts adjuvants (e.g., gabapentin) versus somatic's analgesics, ensuring precise treatment based on the leg pain's neural etiology.

Correct Answer: A

Rationale: The nurse would assess the level of sedation next, as opioids commonly cause drowsiness by depressing the central nervous systema key side effect impacting safety (e.g., falls) and dosing adjustments. Post-relief monitoring prioritizes this. Choice B, blood pressure, may drop with opioids, but sedation's immediacy and frequency make it more urgent to check. Choice C, appetite, isn't a primary concernnausea, not hunger, is more typical. Choice D, range of motion, improves with pain relief but isn't a side effect to assess; it's secondary. Choice A is correct, reflecting nursing vigilanceassessing sedation (e.g., drowsiness scale) ensures the opioid's benefit (pain relief) doesn't compromise safety, guiding interventions like timing or dose tweaks.

Correct Answer: B

Rationale: The nurse would assess gastrointestinal discomfort next, as NSAIDs (e.g., ibuprofen) commonly cause stomach irritation or ulcers by inhibiting prostaglandins that protect the gastric lininga frequent side effect needing monitoring post-relief. Choice A, respiratory rate, is key with opioids, not NSAIDs, which rarely affect breathing. Choice C, level of sedation, suits CNS depressants (e.g., narcotics), not NSAIDs, which don't typically drowsy. Choice D, blood pressure, may shift slightly with NSAIDs (e.g., fluid retention), but GI issues are more immediate and common. Choice B is correct, reflecting nursing vigilanceassessing for nausea, pain, or bleeding ensures NSAID benefits (pain relief) don't mask GI risks, prompting interventions like food intake or antacids to protect the stomach.

Correct Answer: D

Rationale: Heart sounds S1 and S2, known as 'lub' and 'dub,' have distinct characteristics based on their anatomical origins and auscultation points. S1, caused by the closure of the mitral and tricuspid valves, is loudest at the apex of the heart (near the left fifth intercostal space), where the mitral valve's sound is most prominent. S2, resulting from the closure of the aortic and pulmonic valves, is loudest at the base (second right and left intercostal spaces), where these valves are closest to the chest wall. Choice D correctly states this: 'S1 is loudest at the apex, and S2 is loudest at the base.' Choice A is incorrect because S1 and S2 do not sound equally loud across the entire cardiac area; their intensity varies by location. Choice B is wrong because S1 is actually louder, not fainter, at the apex, and Choice C is inaccurate since S2 is louder, not fainter, at the base. Understanding these auscultatory landmarks is crucial for accurate cardiac assessment, and Choice D reflects the physiological reality of heart sound distribution, making it the correct answer.