Chapter 35: Comfort and Pain Management Prep U

A postoperative vaginal hysterectomy client complains of pain that is more intense than this morning. This factor should be explained to the client as "Your present pain is worse because you had your packing removed." "Acute pain tends to increase during the day and is called a routine pain response" "I will call your doctor because you may have loosened sutures when walking." "You will need more pain medication as the days progress."

"Acute pain tends to increase during the day and is called a routine pain response"

The nurse is caring for a client newly diagnosed with chronic pain. When preparing to educate the client regarding chronic pain and management they ask who should be involved in the teaching. Which response is best? "Your spouse or caregiver." "Anyone you think needs to know." "Your best friend." "One of your neighbors will do."

"Anyone you think needs to know."

The nurse is taking a history for a pregnant client who has been seen for chronic headaches for 2 years. Today, the client reports a headache that feels different than the normal headaches she has experienced in the past. Which assessment question helps the nurse assess quality of pain? "Can you describe the type of pain you are having?" "When did your pain begin?" "Could you please rate your pain on a 1-10 scale?" "How long have you experienced this pain?"

"Can you describe the type of pain you are having?"

The nurse is taking a history for a client who is being seen for chronic unrelieved back pain. Which assessment question helps the nurse assess duration of pain? "Have you had this pain before?" "How long have you experienced this pain?" "When did your pain begin?" "Could you please rate your pain on a 1-10 scale?"

"How long have you experienced this pain?"

After the nurse has instructed a client with low-back pain about the use of a transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what? "Wearing the TENS unit should not interfere with my daily activities." "I could use the TENS unit if I feel pain somewhere else on my body." "One advantage of the TENS unit is it increases blood flow." "I may need fewer pain medications with the TENS unit in place."

"I could use the TENS unit if I feel pain somewhere else on my body."

A client receiving epidural analgesia asks the nurse to put the head of the bed all the way down to sleep better. What is the correct response by the nurse? "It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to minimize the risk of respiratory depression." "It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to prevent accidental dislodgement of the catheter." "It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to decrease the risk of severe migraine headaches." "It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to increase the effectiveness of the spinal analgesia."

"It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to minimize the risk of respiratory depression."

The nurse witnesses a caregiver interacting with a client with chronic pain. When helping the client get dressed, the caregiver appears hurried and frustrated, and speaks to the client angrily. What is the appropriate nursing response? "You are clearly angry and should not be here." "Let me help you dress the client while we talk about home health resources that can assist when the client goes home." Use therapeutic silence and let the caregiver and client continue interacting. "Stop talking to your loved one like that."

"Let me help you dress the client while we talk about home health resources that can assist when the client goes home."

The nurse is caring for a client utilizing a Patient Controlled Analgesia (PCA) pump that is programmed to allow a bolus dose every 10 minutes. The client is sleeping with visitors at the bedside. Which of the following instructions should the nurse give the client's visitors? "Push the button on the pump every 10 minutes." "Remind the client to push the button more often than every 10 minutes." "Only the client should push the pump button." "Push the pump button when you think the client is in pain."

"Only the client should push the pump button."

Two hours after receiving a pain medication, the client reports still suffering from pain. Which response is most appropriate? "Have you ever had pain like this before?" "Do you need your pain medication now?" "Tell me more about your pain." "Tell me where your pain is located."

"Tell me more about your pain."

A client has been prescribed patient-controlled analgesia and the nurse is setting up the system and educating the client about safe and effective use of PCA. Which teaching point should the nurse provide to the client? "The pump is programmed with safeguards to limit the possibility overmedication." "If you feel severe pain, either push the button yourself or ask one of your family members to push the button." "I'll have the unit's care aide come check on you every few minutes after I set up the system." "We'll be monitoring your use of the system closely, to ensure you don't develop an addiction to your pain medication."

"The pump is programmed with safeguards to limit the possibility overmedication."

A client has just been started on opioid analgesia for pain control. The nurse assesses the client's level of sedation using a sedation scale and notes that the client is awake and alert. The nurse would assign which rating? S 1 2 3

1

A nurse attempts to arouse a postoperative client and finds him frequently drowsy and drifting off during conversation. What would be the sedation score for this client? 1 3 2 4

3

A nurse attempts to relieve the pain of a client by using cutaneous stimulation. Which of the following describes usage of this technique? A nurse uses deep-breathing exercises to distract a client from his pain. A nurse guides a client to use imagery. A nurse applies intermittent heat and cold to a client's leg. A nurse distracts the client by playing his favorite music.

A nurse applies intermittent heat and cold to a client's leg.

The nurse is caring for a client with chronic back pain due to inoperable spinal stenosis. Which strategies, suggested by the nurse, may help to decrease the client's back pain? Requesting an opioid prescription from the health care provider Adding the use of hot or cold packs for pain control Maintaining strict bed rest to relieve pain Referring for a surgical consult to validate the diagnosis

Adding the use of hot or cold packs for pain control

A client is prescribed pain medication every 4 to 6 hours as needed. When the nurse enters the client's room to administer the medication, the client is laughing with visitors. The client's pulse rate is 64, respirations 16, and blood pressure 120/80. The client reports pain and wants the medication. What is the most appropriate action by the nurse? Administer the pain medication. Reassess the need for pain medication in 30 minutes. Hold the pain medication at this time. Encourage the client to use alternative pain relief measures.

Administer the pain medication.

The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opioid anesthesia, the nurse observes the client's respiratory rate decrease to 8 breaths per minute. What is the priority action by the nurse? Administer a lower dose of the analgesic for the next dose Begin CPR Place the client in the supine position Administration of 0.4 mg of naloxone

Administration of 0.4 mg of naloxone

A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the nurse's best intervention in this situation? Distract the boy so he does not notice his pain. Ignore the boy's pain if he is not complaining about it. Ask the boy to draw a cartoon about the color or shape of his pain. Medicate the boy with analgesics to reduce the anxiety of experiencing pain.

Ask the boy to draw a cartoon about the color or shape of his pain.

The nurse is conducting an admission assessment, and asks the client what medication is taken for pain. The client responds, "I take a little white pill to control my pain, but I don't know the name of it," and presents the nurse with a plastic baggie full of white pills. What is the priority nursing intervention? Document what the client states. Tell the healthcare provider that the client is unsure of the pain medication taken. Ask the client if he or she has the bottle the drug was dispensed in from the pharmacy. Call the pharmacy to attempt to identify the pill.

Ask the client if he or she has the bottle the drug was dispensed in from the pharmacy.

The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate? Select all that apply. Assess for pain control 30 minutes after administering an analgesic. Delegate pain assessment to the UAP. Provide pain medication before activity that may increase pain. Consider cultural implications of the perception of pain. Infer that the client who does not complain has no pain.

Assess for pain control 30 minutes after administering an analgesic. Provide pain medication before activity that may increase pain. Consider cultural implications of the perception of pain.

A nurse giving a client a massage notes the presence of a nonblanching reddened area on the client's sacrum. What is the nurse's best action? Avoid massaging the area and apply a thin layer of a topical antibiotic ointment. Avoid massaging this area and report the finding to the health care provider. Massage the area in an attempt to restore adequate circulation. Gently massage the region, document the finding, and verbally report it to the health care provider.

Avoid massaging this area and report the finding to the health care provider.

A neonatal nurse is caring for a 2-day-old infant who experienced shoulder subluxation during delivery. What pain assessment scale should the nurse use to assess this client's pain? Wong-Baker CRIES Pain Scale PAINAD Scale FLACC Scale

CRIES Pain Scale

The nurse is evaluating pain of several clients who had hip replacement surgery. Which client is most likely to have the greatest perceived pain? Client who sleeps through the night without waking Client listening to favorite music Client who feels in control of the situation Client who is anxious about discharge

Client who is anxious about discharge

The nurse is implementing environmental changes to promote a client's comfort and pain management. Which action is an example of this type of intervention? Smoothing out the wrinkles in the client's bed linen Closing the client's room door to reduce unnecessary noises Assisting the client to change positions to maintain body alignment Offering the client an appropriate book to read or music to listen to

Closing the client's room door to reduce unnecessary noises

A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a client being discharged. What process is involved in this pain relief measure? Biofeedback mechanism Patient-controlled analgesia (PCA) Guided imagery Cutaneous stimulation

Cutaneous stimulation

The young female client had emergency surgery for appendicitis. She is a cigarette smoker, is breast-feeding her infant, and expressed a desire to continue to breast-feed when discharged from the hospital. The surgeon has prescribed acetaminophen/oxycodone for pain relief at home. What instructions would the nurse include when providing discharge teaching? Select all that apply. Client is allowed to have one drink of alcohol each day. Keep a diary to record level of pain and time medication is taken. You may smoke cigarettes during the day but not at night. Do not drive a vehicle while taking this medication. You must check with your primary care provider before breast-feeding your infant. For better absorption, take your pain medication on an empty stomach.

Do not drive a vehicle while taking this medication. You must check with your primary care provider before breast-feeding your infant. Keep a diary to record level of pain and time medication is taken.

The nurse is developing a discharge teaching plan for clients taking opioid pain medication. What education should the nurse include? Select all that apply. Avoid dairy products. Take opioid medication on an empty stomach. Do not smoke without someone else present. Avoid alcohol. Do not drive while taking opioid medication.

Do not smoke without someone else present. Avoid alcohol. Do not drive while taking opioid medication.

How should the nurse position the head of the bed for a client receiving epidural opioids? Trendelenburg Reverse Trendelenburg Flat Elevated 30 degrees

Elevated 30 degrees

The nurse is admitting a dying client with osteosarcoma. Which nursing action is priority? Compare the client's current assessment with previous admission assessment Assess the client's serum albumin level Educate the client/caregiver about signs of impending death Examine the effectiveness of the current pain regimen

Examine the effectiveness of the current pain regimen

A client comes to the emergency department complaining of a shooting pain in his chest. When assessing the client's pain, which behavioral response would the nurse expect to find? Decreased heart rate High blood pressure Guarding of the chest area Increased respiratory rate

Guarding of the chest area

The spouse of a client with cancer asks why the client's breakthrough doses of morphine have recently needed to be higher and more frequent for the client to achieve pain relief? Which response by the nurse is appropriate? Higher doses are needed because the client has developed a tolerance to the morphine. The morphine is having more drug interactions with the client's other medications, requiring a higher dose. The client is now addicted to the morphine and requires higher doses. The higher dose is due to the client's physical dependence on the morphine.

Higher doses are needed because the client has developed a tolerance to the morphine.

A 77-year-old woman is on the nurse's unit s/p left knee replacement. The client typically stools every morning but has not had a bowel movement in 3 days. The nurse knows that which medication places the client at increased risk for constipation? Hydromorphone Acetaminophen Furosemide Psyllium

Hydromorphone

The nurse recognizes which statement is true of chronic pain? It is always present and intense. It may cause depression in clients. It disappears with treatment. It can be easily described by the client.

It may cause depression in clients.

A 92-year-old woman is on an inpatient unit following hip replacement surgery. The nurse asks her if she is in pain, and she tells the nurse that she is fine. The nurse knows what to be true regarding pain in the older adult? Select all that apply. Older adults have decreased opioid receptors. Older adults are less likely to feel pain than younger adults. Older adults often believe that pain is a consequence of growing older. Older adults are more likely to be disabled by pain than younger adults.

Older adults have decreased opioid receptors. Older adults often believe that pain is a consequence of growing older. Older adults are more likely to be disabled by pain than younger adults.

A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client? Nonopioid analgesics Opioid analgesics NSAIDs Corticosteroids

Opioid analgesics

Which principle should the nurse integrate into the pain assessment and pain management of pediatric clients? The developing neurologic system of children transmits less pain than in older clients. A numeric scale should be used to assess pain if the child is older than 5 years of age. Pharmacologic pain relief should be used only as an intervention of last resort. Pain assessment may require multiple methods in order to ensure accurate pain data.

Pain assessment may require multiple methods in order to ensure accurate pain data.

The nurse is preparing a care plan for a client receiving opioid analgesics. Which factors associated with opioid analgesic use will the nurse include in the plan of care? Observing for diarrhea Assessing for impaired urinary elimination Preventing constipation Observing for bowel incontinence

Preventing constipation

Question 15 of 20 Which is the priority assessment for a nurse caring for a client with a Patient Controlled Analgesia (PCA) pump? Cardiovascular Respiratory Neuromuscular Peripheral Vascular

Respiratory

A client who is living with chronic pain has received a health care provider's order for TENS. When applying the device to the client's skin, the nurse should do what action? Start with the lowest intensity and gradually increase it to the appropriate level. Turn on the unit shortly before applying the electrodes to the client's skin. Administer analgesia 30 minutes before beginning a TENS session. Disinfect with chlorhexidine the areas where the electrodes will be applied

Start with the lowest intensity and gradually increase it to the appropriate level.

When assessing a client on PCA therapy, the nurse finds the client to be drowsy, with minimal or no response to physical stimulation, scoring a 4 on the Pasero & McCaffery Sedation Scale. What is the nurse's best action? Stop the PCA infusion, increase the frequency of sedation and respiratory rate monitoring to every 15 minutes, rouse the client, and encourage deep breathing. Stop the PCA infusion, check the medication level, and restart the infusion at a lower dose. Stop the medication infusion immediately and notify the primary care provider; prepare to administer oxygen and naloxone. Stop the infusion and report the incident to the nurse manager in charge; follow the protocol of oxygen and naloxone administration.

Stop the medication infusion immediately and notify the primary care provider; prepare to administer oxygen and naloxone.

The nurse is caring for a client whose pain is being treated with epidural analgesia. Which nursing action is most appropriate? The nurse should expect slight resistance during the removal of the epidural catheter. The anesthesiologist/pain management team should be notified immediately if the client's respiratory rate is below 10 breaths/min. If a client is experiencing adverse effects, a peripheral IV line should be inserted to allow immediate administration of emergency drugs, if warranted. If the client develops a headache, an opioid analgesic may be administered along with the epidural analgesia.

The anesthesiologist/pain management team should be notified immediately if the client's respiratory rate is below 10 breaths/min.

A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse caring for the client explains the functioning of PCA. What is the mainadvantage of PCA? The client is able to have long hours of rest. The client is actively involved in pain management. The client requires less nursing care. The client obtains pain relief slowly and steadily.

The client is actively involved in pain management.

A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system? Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression. Thorough client education is necessary to prevent overdoses. The dose that is delivered when the client activates the machine is preset. An antidote is automatically delivered if the client exceeds the recommended dose.

The dose that is delivered when the client activates the machine is preset.

Which statement accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain? The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. This approach can only be used with oral analgesics. The PCA pump is not effective for chronic pain. A PCA pump must be used and monitored in a health care facility.

The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval.

The nurse is employing gate theory in the care of a client with pain in the lower back. What actions by the nurse may assist in pain relief for the client? Administer opioid analgesics Have the client perform active exercises to stretch the back muscles Use massage and heat application to the lower back Encourage the client to have an epidural steroid injection

Use massage and heat application to the lower back

You are a new nurse in an ambulatory care setting. You know that the Joint Commission requires that pain be addressed at each visit. When is the most appropriate time to do so? Before the client is discharged At several points throughout your history-taking The first question you ask the client When obtaining client vital signs

When obtaining client vital signs

When the male client on his first postoperative day after chest surgery appears stoic and does not ask for any pain medication, the nurse should: document the client's lack of medication. ask the client's family if he ever uses pain medicines. actively solicit information about the client's pain level. assume the client does not need medication.

actively solicit information about the client's pain level.

A middle-age client tells the nurse that the client's neck pain reduced considerably after the client underwent a treatment in which thin needles were inserted into the skin. What kind of pain relief treatment did the client undergo? biofeedback rhizotomy transcutaneous electrical nerve stimulation acupuncture

acupuncture

When performing an assessment on a client with chronic pain, the nurse notes that the client frequently shifts conversational topics. What does the nurse determine this may indicate? anxiety boredom depression moodiness

anxiety

The nurse works in a pain clinic and sees clients who have various conditions resulting in pain. A number of modalities are prescribed for the clients' treatments. For which client will the nurse question a prescription for a transcutaneous electrical nerve stimulator (TENS)? client who is postoperative for surgery to the leg client who is 4 months' pregnant older adult client who has degenerative joint disease client who plans to use it on an as needed basis

client who is 4 months' pregnant

The nurse is assessing a client for the chronology of the pain she is experiencing. Which interview question is considered appropriate to obtain this data? How would you describe your pain? How would you rate the pain on a scale of 0 to 10? How does the pain develop and progress? What do you do to alleviate your pain and how well does it work?

how does the pain develop and progress?

A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a PRN drug regimen as an effective method of pain control would be the client: in the early postoperative period. experiencing acute pain. in the postoperative stage with occasional pain. experiencing chronic pain.

in the postoperative stage with occasional pain.

A nurse is assessing a client's pain. The nurse notes which database finding that is indicative of acute pain? pupil constriction decreased pulse rate increased blood pressure decreased respiratory rate

increased blood pressure

A nurse is administering prescribed medicine to a client who experienced acute pain in the lower back after a motor vehicle accident. The client tells the nurse that compared to the previous week, his pain had reduced considerably. Which phase of pain is the client experiencing? transmission transduction modulation perception

modulation

The nurse preparing to admit a client receiving epidural opioids should make sure that which of the following medications is readily available on the unit? Digoxin Furosemide Lisinopril Naloxone

naloxone

The nurse preparing to admit a client receiving epidural opioids should make sure that which of the following medications is readily available on the unit? Naloxone Lisinopril Digoxin Furosemide

naloxone

The nurse is preparing a care plan for a client receiving opioid analgesics. Which factors associated with opioid analgesic use will the nurse include in the plan of care? Preventing constipation Observing for diarrhea Assessing for impaired urinary elimination Observing for bowel incontinence

preventing constipation

A client who has been harassed at her place of work tells the nurse, "Every time I think of my job, I get a debilitating headache and have to go lie down to make the pain go away." Which nursing intervention will the nurse perform to practice according to the Gate Control Theory? contacting the health care provider to prescribe opioid medication asking if pain is produced by smells or sounds providing temple massage when head hurts teaching the client to remove items from the home that remind them of work

providing temple massage when head hurts

A client tells a nurse, "I have this pounding feeling on the side of my head, like someone is hitting my head with a hammer." The nurse should identify what characteristic of pain assessment? threshold temporal pattern quality frequency

quality

A client describes pain in the lower leg and has been diagnosed with a herniated lumbar disk. The pain in the leg is what type of pain? referred pain acute pain chronic pain limited pain

referred pain

A PCA has been ordered for a client who is experiencing significant postoperative pain. To minimize the risk of adverse effects of this therapy, the nurse should perform what action? Teach the client to perform deep-breathing and coughing exercises. Apply sequential compression stockings. Arrange for a high-protein, low-residue diet. Encourage the client to drink an 8-oz glass of water every 2 hours.

teach the client to perform deep-breathing and coughing exercises.

Who is the authority on the presence and extent of pain experienced by a client? an anesthesiologist a nurse a surgeon the client

the client

the nurse is caring for a client who reports nausea and vomiting for 1 week. How will the nurse document this type of pain? Select all that apply. neuropathic visceral acute referred chronic

visceral acute