When caring for an older adult client who does not speak English, which assessment tool is the most appropriate for the nurse to use to assess this client's pain?
1. The FACES rating scale
2. An interpreter
3. The client's affect
4. The client's vital signs
Correct Answer: 1
An interpreter might not always be readily available, so the FACES rating scale can be used because it is not necessary to use language. If an interpreter is available the nurse can ask the interpreter to discuss the pain in more detail, but the FACES rating scale will help the nurse to respond to the client's pain appropriately and quickly without waiting for an interpreter. Affect and vital signs might not be accurate indicators of the client's discomfort.
You might also like to view...
When describing the action of cholinesterase inhibitors to a class of nursing students, the instructor would include which of the following about their action? Select all that apply
A) The drugs decrease the level of acetylcholine in the CNS. B) They inhibit the breakdown of acetylcholine. C) The drugs slow neural destruction. D) They stop neural breakdown. E) The drugs increase excitatory neurotransmitters in the CNS.
The culturally sensitive nurse will recognize that an older adult patient with a high-context ethnic background will appreciate
a. not having a treatment scheduled during a favorite television program. b. both a written and verbal explanation de-scribing how to monitor her blood sugar levels. c. a concise explanation as to why her phys-ical therapy appointment has been can-celed. d. having a conversation about her grand-children while her dressing is changed.
During your preoperative assessment in the preoperative holding area, the client says, "I think I need to wait until later to have this surgery done. The last time I had surgery I think there were some problems with the pain medication used."
Which of the following nursing diagnoses should you consider for this client? 1. Anxiety related to fear of the unknown 2. Distrust related to anesthesia 3. Deficit knowledge related to anesthesia 4. Malignant hyperthermia related to past anesthesia problems
The nurse is assessing the client's neck. Which should the nurse recognize is an abnormal finding?
A. The tracheal cartilage does not move when the client swallows. B. The thyroid has no palpable nodules. C. The client's carotid arteries are visibly pulsating. D. The neck is symmetrical.