ATI RN
ATI Custom Fundamentals Chapter 31 ALL Questions
Extract:
Question 1 of 5
A patient experiencing pain states that guided imagery has made the pain more manageable in the past. To assist this patient,the nurse should:
Correct Answer: D
Rationale: The correct answer is D because reading from a script that helps the patient visualize a restful place utilizes guided imagery, which has been effective in managing the patient's pain in the past. This technique can help the patient relax and distract from the pain.
Choice A is incorrect as it does not directly address the patient's pain management through guided imagery.
Choice B is incorrect as finding a focal point does not actively engage the patient in guided imagery.
Choice C is incorrect as providing a back rub focuses on physical comfort rather than mental relaxation.
Question 2 of 5
A nurse is assessing the status of a patient who is sleeping. Which assessment data indicate that the patient is most likely in stage 3 of non-rapid eye movement (NREM) sleep?
Correct Answer: D
Rationale: The correct answer is D: Decreased respirations, slow heart rate. Stage 3 of NREM sleep is characterized by deep sleep with slow brain waves. During this stage, the body enters a state of deep relaxation, leading to decreased respiratory rate and a slow heart rate. This indicates that the patient is in a deep stage of sleep.
Choices A, B, and C all include rapid heart rates, which are not consistent with the characteristics of stage 3 NREM sleep.
Therefore, they are incorrect.
Question 3 of 5
A patient is receiving an ice massage for relief of muscle spasms in the neck. The patient complains that the ice is making the pain worse. Most helpful response from the nurse would be:
Correct Answer: B
Rationale: The correct answer is B: I will stop these cold applications. Ice is typically used to reduce inflammation and numb pain. In this scenario, if the patient is experiencing increased pain with ice massage, it indicates that the cold application is not suitable for them. Stopping the cold application is crucial to prevent further aggravation of the pain. Continuing with the ice massage may exacerbate the muscle spasms and discomfort. It is important for the nurse to respond promptly to the patient's feedback and adjust the treatment accordingly to ensure the patient's comfort and well-being.
Incorrect choices:
A: Providing an ice pack would continue the cold application, worsening the pain.
C: Alternating hot and cold applications may not be appropriate if the patient is experiencing increased pain with ice.
D: Telling the patient to wait for the pain to improve may lead to unnecessary discomfort and potential harm.
Question 4 of 5
A nurse is collecting data on a client following administration of an opioid narcotic. Which of the following findings indicates a decrease in the client's pain?
Correct Answer: B
Rationale: The correct answer is B: The client is asleep. When a client is asleep after receiving an opioid narcotic, it indicates a decrease in pain as opioids can induce sedation. This is because opioids work by binding to opioid receptors in the brain and spinal cord, which can reduce the perception of pain. Elevated blood pressure (
A), increased respiratory rate (
C), and diaphoresis (
D) are not direct indicators of a decrease in pain following opioid administration. Elevated blood pressure may be a response to pain, increased respiratory rate may indicate respiratory distress, and diaphoresis may be a side effect of opioids rather than a direct indicator of decreased pain.
Question 5 of 5
The nurse outlines the four phases of nociceptive pain as: (Select all that apply.)
Correct Answer: A,B,D,E
Rationale: The correct phases of nociceptive pain are transduction, transmission, perception, and modulation. Transduction refers to the conversion of noxious stimuli into electrical signals. Transmission involves the propagation of these signals to the spinal cord and brain. Perception is the conscious awareness and interpretation of pain signals by the brain. Modulation is the process of regulation and control of pain signals.
Choices C is incorrect as it does not represent a phase of nociceptive pain.
Choice F and G are not provided.
Therefore, the correct phases are A, B, D, and E as they accurately represent the sequential processes of nociceptive pain.