Chapter 12: Pain Management

A teenage client is undergoing a dressing change to burns on the thigh. The client refuses pain medication and states, "I do not hurt, and I don't need it." He is withdrawn, grimaces, and turns away during the dressing change. He was last medicated 8 hours ago. What is the best statement by the nurse?

"I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication."

Which statement made by a client with cancer who has moderate to severe pain and was prescribed oxymorphone indicates further instruction is required?

"I will take this medication with breakfast for the best results."

Which substance reduces the transmission of pain?

Endorphins

A client being treated for rheumatoid arthritis has been prescribed a glucocorticosteroid. How should the nurse best ensure this client's safety during treatment?

Ensure the client knows to taper down the dose if it is discontinued by the care provider.

About which issue should the nurse inform clients who use pain medications on a regular basis?

Inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesics consistently without consulting a physician.

The nurse is administering an analgesic to an older adult patient. Why is it important for the nurse to assess the patient carefully?

Older people are more sensitive to drugs.

The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting:

Severity of the pain as judged by the patient

The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain?

Diaphoresis

The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe?

Gabapentin

When taking a client history, the nurse notes that the client is taking herbal remedies in addition to acetaminophen. Which herb, when taken in conjunction with acetaminophen, enhances the risk of bleeding?

Ginkgo

The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply.

"How long have you experienced this pain?" "Please point to where you are experiencing pain." "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." "What aggravates your chest pain?"

A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client

"Only you are to push the button for medication."

The nurse is assessing a client who has been taking up to 4 grams of acetaminophen every day for undiagnosed pain. What reaction due to ingestion of acetaminophen will the nurse assess for?

Abrupt onset of rash and pruritus

A client with appendicitis has had an appendectomy. After surgery, what type of pain does the nurse anticipate the client will have?

Acute pain

How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?

Administering the analgesics on a regular basis

A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain?

Administer analgesics around the clock.

A client who is prescribed morphine for undiagnosed abdominal pain reports that he is allergic to morphine. The nurse questions the client about his allergic reaction; the client responds that when he took it in the past, he experienced itching. The nurse plans to

Administer prescribed diphenhydramine (Benadryl).

The nurse understands that which statement is true about tolerance and addiction?

Although clients may need increasing levels of opioids, they are not addicted.

A client recovering from hip surgery is receiving morphine through a patient-controlled analgesia (PCA) infusion pump with a set basal rate. What action is most important for the nurse to implement?

Assess the client's respiratory status

When applying a fentanyl patch, the last dose of sustained-release morphine should be administered at what point?

At the same time the first patch is applied

The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for?

Bradypnea

When a nurse asks a patient to describe the quality of the pain, what type of descriptive term does the nurse expect the patient to use?

Burning

Which of the following nursing interventions contributes to achieving a client's pain relief?

Collaborate with the client about his or her goal for a level of pain relief.

When using transdermal Fentanyl, the nurse and patient should be aware of which sign or symptom of Fentanyl overdose?

Confusion

The nurse is administering a narcotic analgesic for the control of a newly postoperative client's pain. What medication will the nurse administer to this client?

Fentanyl (Duragesic)

A client arrives in the orthopedic clinic with complaints of twisting the right ankle while playing softball. The nurse collects data including complaints of pain and swelling in the right ankle. What intervention will the nurse provide that will decrease vasodilation and reduce localized swelling?

Ice bag

A client is recovering from abdominal surgery and sleeping. The client had received an opioid medication 3 hours ago. The client's son requests pain medication for the client, stating "I do not want her to wake up in pain." The first nursing action is

Instruct the son about lack of client consent.

Which of the following is a physiologic response to pain?

Pallor

Which phase of pain transmission occurs when the one is made aware of pain?

Perception

Which is a true statement regarding placebos?

Placebos should never be used to test a client's truthfulness about pain.

The nurse is caring for a patient who has been hospitalized on several occasions for lower abdominal pain related to Crohn's disease. How may this chronic pain be described?

Prolonged in duration

An elderly client has a fractured hip and is in Buck's traction. The client is disoriented and cannot express herself. At 0730 the client was calm. Now, at 0930, the client is restless and agitated. The nurse reviews the medication administration record. The last dose of opioid was at 0330. The nurse assesses the client's agitation may be from

Recurring pain

The nurse's major area of assessment for a patient receiving patient-controlled analgesia is assessment of what system?

Respiratory

A new surgical patient has been prescribed an opioid analgesic intravenously for pain control. The nurse should be aware of which most serious adverse effect of this medication?

Respiratory depression

Which of the following is a true statement with regards to the preventative approach to the use of analgesics?

Smaller doses of medication are needed.

Which of the following is a reliable source for quantifying pain?

The client's description of the pain

The nurse needs to carefully monitor a client with traumatic injuries. Which action by the nurse demonstrates understanding of the most essential component of the client's pain assessment?

The nurse administers pain medication based on the client's reported pain level.

The nurse informs the patient that a preventive approach for pain relief will be used, involving nonsteroidal anti-inflammatory drugs. What will this mean for the patient?

The pain medication will be administered before the pain is experienced.

A client comes to the clinic and informs the nurse that he needs more analgesics for chronic pain. The client states that the medication is not as strong, and he requires more than the prescribed dose. What does the nurse suspect is occurring with the client?

Tolerance

An adult with severe cognitive impairment has had a surgical procedure, and the nurse is having a difficult time assessing the level of pain the client is having postoperatively. What method can the nurse use to obtain data about the client's pain?

Use behavioral comparison of the client's current and previous behavior patterns.

Regarding tolerance and addiction, the nurse understands that

although clients may need increasing levels of opioids, they are not addicted.

The client is taking oxycodone (Oxycontin) for chronic back pain and reports decreased pain relief when he began taking a herb to improve his physical stamina. The nurse asks if the herb is

ginseng

A nurse is caring for a client with pain. What should the nurse monitor for when administering intravenous acetaminophen?

hepatotoxicity

A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends

increasing the amount of bran and fresh fruits and vegetables

A nurse is caring for client receiving fentanyl through an epidural catheter. What medication should be readily available for the client who is experiencing respiratory depression?

naloxone

A nurse can administer analgesics through various routes. Which medication routes provide absorption into the systemic circulation? Select all that apply.

rectal oral mucosa subcutaneous epidural space

A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing?

visceral

A client is reporting her pain as "8" on a 0-to-10 pain intensity scale. Then, the client states the pain is "3." Before the nurse leaves the room, the client states her pain is "6." The best action of the nurse is to

Obtain a pain scale with faces for the client to measure her pain.

A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client

That medication will be prescribed for pain relief

A client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. The client is without breakthrough pain at this point in time. How would this client's pain be classified?

neuropathic and chronic