Answer to Question 1
C
Offering the client a pain scale allows the client the opportunity to describe the intensity of the pain. Effective and unbiased pain assessment is best achieved by making a validated pain as-sessment using pain assessment instruments that are developmentally appropriate, reliable, valid, and applicable for clinical use.
Asking the client what precipitates the pain does not assess intensity, but rather is an assessment of the pain pattern.
Asking the client about the location of the pain does not assess the intensity of the client's pain.
To determine the quality of the client's pain, the nurse may ask open-ended questions to find out about the sensation experienced.
Answer to Question 2
C
When teaching a functionally illiterate client, the nurse should use simple terminology and avoid medical jargon. The nurse should incorporate familiar terminology to enhance the client's under-standing.
The nurse should use simple analogies and real-life examples.
The nurse should ask for return demonstrations, as this provides the opportunity to clarify in-structions and the time to review procedures.
Although teaching sessions may be kept short, they should be scheduled at more frequent inter-vals.
Rinne Test, Assessing Bone Conduction
Assessing for Chvostek's Sign
Vertebral compression Fractures of the spine (vertebra) can cause severe ”band-like” pain that radia
Assessing Accomodation
Sample client goals from the Wellness Massage Pyramid.
The nurse begins the general survey