chapter 35 craven
The action of ibuprofen is to A)Provide narcotic pain relief B)Have a antiprostaglandin effect on the CNS C)Close the gate of the A-delta fibers D)Enhance the endorphins of the CNS
have a antiprostaglandin effect on the CNS
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? -"When did your pain begin?" - "Have you had this pain before?" - "Could you please rate your pain on a 1-10 scale?" -"How long have you experienced this pain?"
how long have you experienced this pain
The nurse has completed a preoperative teaching session with a client who will receive morphine via a patient-controlled analgesia (PCA) pump after surgery. Which statement by the client indicates the need for further teaching? -"I will remind my family member to push the PCA pump button for me if I doze off during the day." -"I will let my nurse know if the pain medication is not effective enough to help me move after surgery." - "I can push the button whenever I feel pain." - "I will use the PCA pump until oral pain medication controls my pain."
i will remind my family member to push the PCA pump button for me if i doze off during the day
The nurse is caring for four clients. Which client does the nurse identify as the most likely to have undertreated pain? Select all that apply. -18-year-old with a broken ulna - 29-year-old who has a speech impediment -34-year-old with schizophrenia - 41-year-old who is from a different country - 53-year-old with recurrent pancreatitis -60-year-old with early onset dementia
29 year old who has a speech impediment 34 year old with schizophrenia 41 year old who is from a different country 60 year old with early onset dementia
After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client? -1 - 2 -3 -4
3
A sudden blow to the head results in pain that is transmitted by which type of fibers? A)A-delta B)B-gamma C)C fibers D)D-delta
A-delta
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. - Delegate pain assessment to the UAP. -Assess for pain control 30 minutes after administering an analgesic. - Consider cultural implications of the perception of pain. -Infer that the client who does not complain has no pain. -Provide pain medication before activity that may increase pain.
Assess for pain control 30 minutes after administering an analgesic. Consider cultural implications of the perception of pain. Provide pain medication before activity that may increase pain.
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. -Do not drive a vehicle while taking this medication. -Client is allowed to have one drink of alcohol each day. -You may smoke cigarettes during the day but not at night. - You must check with your primary care provider before breast-feeding your infant. -For better absorption, take your pain medication on an empty stomach. -Keep a diary to record level of pain and time medication is taken.
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 preparing to administer narcotic analgesics to an older adult client having acute joint pain. The nurse is aware that the client has a history of impaired drug excretion and should do which of the following? Select all that apply. -Provide mild intellectual stimulation to prevent lethargic behavior. - Monitor the client for seizure activity. - Administer a p.r.n. dose of a hypnotic to prevent insomnia. - Assess the client orientation before and after administration. - Monitor the client for signs of psychosis.
Monitor the client for seizure activity. Assess the client orientation before and after administration. Monitor the client for signs of psychosis.
Which of the following guidelines regarding pain should be included in the nurse's teaching plan for a group of parents with infants and toddlers? A)Toddlers are often reluctant to express pain B)Pain can be a source of fear and threat to the toddler's security C)Infants cannot express pain until 8 months of age D)Toddlers often try to be brave and not cry
Pain can be a source of fear and threat to the toddler's security
Which of the following describes the correct use of a TENS unit? - The electrodes should be placed over the carotid sinus nerves or over pharyngeal muscles. -The unit should be turned on when repositioning or removing electrodes. - TENS should not be used when the etiology of the pain is unknown. -For acute pain, a recommended pulse of 30 to 50 microseconds should be used.
TENS should not be used when the etiology of the pain is unknown
A client with chronic lower back pain has been ordered transcutaneous electrical nerve stimulation (TENS). What should the nurse consider when using a TENS device? -TENS is a noninvasive pain management technique that relieves pain by providing psychological relief. -TENS stimulates large-diameter fibers to inhibit the transmission of painful impulses. -TENS is most beneficial when used to treat pain that is generalized and diffuse. -A TENS unit should not be used for more than 6 to 8 minutes at one time.
TENS stimulates large-diameter fibers to inhibit the transmission of painful impulses.
Which statement accurately represents a consideration when using an epidural analgesia for client pain management? -If the client develops a headache, a mild analgesic may be administered along with the epidural. -The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min. - If a client is experiencing adverse effects, a peripheral IV line should be installed to allow immediate administration of emergency drugs, if warranted. - Slight resistance should be felt during the removal of an epidural catheter.
The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min.
A nurse is caring for a client who was administered opioid narcotics. The client reports constipation. What is another potential side effect of opioid narcotics? -sedation -anxiety -diarrhea -insomnia
sedation
The nurse is performing assessments for clients admitted in the emergency department. Which client is most likely experiencing somatic pain? -A client suspected to have a perforated peptic ulcer - A client who has a sprained ankle - A client with chest pain who is having a myocardial infarction -A client who has appendicitis
a client who has a sprained ankle
A nurse is performing pain assessments on clients in a physician's office. Which clients would the nurse document as having acute pain? Select all that apply. -a client who is having a myocardial infarction - A client who has diabetic neuropathy - A client who presents with the signs and symptoms of appendicitis - A client who fell and broke an ankle -A client who has rheumatoid arthritis - A client who has bladder cancer
a client who is having a myocardial infarction A client who presents with the signs and symptoms of appendicitis A client who fell and broke an ankle
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 guides a client to use imagery. - A nurse uses deep-breathing exercises to distract a client from his pain. - 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 clients leg
The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opiod 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 child describes intense pain in the chest and head while eating a popsicle. The pain the child is experiencing is termed A)Fear B)Allodynia C)Thermal stimulation D)Hyperalgesia
allodynia
During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is: -surgery. -relaxation techniques. -cutaneous stimulation. -analgesics.
analgesics
The nurse is administering medications to a patient with neuropathic pain. The patient asks why he is getting an antidepressant medication because he is not depressed. Which of the following is the best response by the nurse? A)"All patients with pain have at least some depression." B)"Antidepressants have been shown to have pain-relieving qualities in patients with neuropathic pain." C)"Treating your depression, even if you don't think you have it, will help control your pain." D)"The doctor thinks it will help with your pain."
antidepressants have been shown to have pain-relieving qualities in patients with neuropathic pain
A client is receiving patient-controlled epidural analgesia (PCEA) following abdominal surgery. While assessing the client, the client states, "I've started having some back pain." The nurse should: -assess for epidural hematoma. - inspect the client's skin for signs of internal hemorrhage. -assess the client's reflexes. - assess the client's cognition using the Glasgow Coma Scale.
assess for epidural hematoma
How may a nurse demonstrate cultural competence when responding to clients in pain? -Treat every client exactly the same, regardless of culture. -Be knowledgeable and skilled in medication administration. -Know the action and side effects of all pain medications. -Avoid stereotypical responses to pain in clients.
avoid stereotypical responses to pain in clients
A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as: -biofeedback. -transcutaneous electrical nerve stimulation (TENS). -hypnosis. - Therapeutic Touch (TT).
biofeedback
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? -"When did your pain begin?" - "Can you describe the type of pain you are having?" -"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 identifies the pain described by a patient whose back discomfort began after an automobile accident and has persisted for 8 months as A)Acute B)Recurrent C)Chronic D)Malignant
chronic
The nurse is caring for a client who has had back pain for 2 years, following a fall from a ladder. How does the nurse going off-shift report this kind of pain to the oncoming nurse? Select all that apply. - acute -chronic -cutaneous -somatic -visceral
chronic somatic
A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and become chronic. What is a characteristic of chronic pain? -Chronic pain will lead to psychological imbalance. -Chronic pain has far-reaching effects on the client. -Chronic pain can be severe in its initial stages. -Chronic pain eases with healing and eventually disappears.
chronic pain has far reaching effects on the client
An 80-year-old woman has been suffering from knee pain for the past 3 years. The patient requires a knee replacement and has diminished mobility. The most appropriate nursing diagnosis is A)Chronic pain related to knee disability as defined by guarded gait B)Acute pain related to degenerative joint disease as evidenced by static gait C)Altered mobility related to pain as defined by guarded gait D)Inability to perform activities of daily living related to chronic pain
chronic pain related to knee disability as defined by guarded gait
The physician has ordered a patient controlled analgesia (PCA) pump for a patient. Which assessment finding would cause the nurse to question the order? A)B/P 178/92 and pulse 118 B)Confused to time and place C)Right shoulder immobilizer in place D)Rates pain an 8 on a 1 to 10 scale
confused to time and place
A client is prescribed oxycodone for pain relief. After teaching the client about the medication and common side effects, the nurse determines that the education was successful when the client identifies which side effect as most common? -vomiting -pruritus -constipation -delirium
constipation
Endogenous opioids such as endorphins A)Excite neural pathways B)Contribute to analgesia C)Cause muscle spasms D)Release neurotensin
contribute to analgesia
A client reports throbbing pain caused by a laceration that occurred to the finger while cutting vegetables. Which terminology should the nurse use to document this pain? Select all that apply. -cutaneous -somatic -neuropathic -acute -chronic
cutaneous acute
When asking an older adult client about abdominal pain, the client reports, "I don't want to be a bother because nothing hurts too much." The nurse notes that the client grimaces and splints the abdomen when moving. What is the appropriate nursing action? -Document the client's statement, and do nothing further. -Remind the client that pain can be tolerated instead of using addictive pain medication. -Gently mention that the client appears to be experiencing pain that can be treated. - Confirm that age is the reason for many types of pain.
gently mention that the client appears to be experiencing pain that can be treated
A nurse is assessing a patient's pain. The nurse notes which of the following database findings that is indicative of acute pain? A)Pupil constriction B)Decreased pulse rate C)Increased blood pressure D)Decreased respiratory rate
increased blood pressure
Which client population is at high risk for inadequate pain management? Select all that apply. - infants - young children -clients who have dementia -clients whose primary language is different from that of the health care team -clients who have significant visual impairment - clients who have a decreased level of consciousness
infants young children clients who have dementia clients whose primary language is different from that of the health care team clients who have a decreased level of consciousness
The nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. The nurse notes that the client's respiratory rate is 10 breaths per minute. The client is somnolent, with minimal response to physical stimulation. The nurse should prepare to administer which medication? -Intravenous naloxone -Intravenous flumazenil -Oral modafinil -Nebulized albuterol
intravenous naloxone
Which statement is true of chronic pain? -It lasts for less than 6 months. - It is always present and intense. -It interferes with normal functioning. - It disappears with treatment.
it interferes with normal functioning
Why is acute pain said to be protective in nature? -It warns an individual of tissue damage or disease. - It enables the person to increase personal strength. -As a subjective experience, it serves no purpose. -As an objective experience, it aids diagnosis.
it warns an individual of tissue damage or disease
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? -transduction - transmission - perception - modulation
modulation
A postoperative client who has been receiving morphine for pain management is exhibiting a depressed respiratory rate and is not responsive to stimuli. Which drug has the potential to reverse the respiratory-depressant effect of an opioid? - Diphenhydramine - Atropine - Epinephrine -Naloxone
naloxone
A postoperative client who has been receiving morphine for pain management is exhibiting a depressed respiratory rate and is not responsive to stimuli. Which drug has the potential to reverse the respiratory-depressant effect of an opioid? - Diphenhydramine -Atropine -Naloxone - Epinephrine
naloxone
A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing? -cutaneous pain -visceral pain -chronic pain -neuropathic pain
neuropathic pain
When a 17-year-old male athlete injures his knee during basketball practice and refuses to go to the school nurse, he states he does not have pain. The school nurse assesses the student's knee and recognizes that by stating he does not have pain the student is A)Not injured B)In need of counseling C)Not showing weakness to his peers D)Ignoring the pain
not showing weakness to his peers
A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client? -NSAIDs -Corticosteroids -Opioid analgesics -Nonopioid analgesics
opioid analgesics
A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA) by a physician. What is an advantage that PCA offers? -The client has complete control over the timing and quantity of doses. - Pain can be kept within a consistently tolerable level. -The small doses of opioids delivered by PCA offer instant relief. - Higher individual dosages reduce side effects.
pain can be kept within a consistently tolerable level
Which of the following actions is most appropriate for the nurse to take in response to the patient's request for pain medication on his first postoperative day? The patient has an order for a narcotic analgesic every 3 to 4 hours and he received his last dose 3 hours earlier. A)Contact the physician for a change in medication B)Tell the patient that the pain cannot be severe C)Document and ask the patient to wait 1 hour D)provide the patient with pain medication
provide the patient with pain medication
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? -frequency -quality -temporal pattern -threshold
quality
Which assessment finding is consistent with the presence of pain? - decreased blood pressure - decreased pulse -euphoria -restlessness
restlessness
A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his left leg, and the pain is worse with ambulation. The nurse will document this type of pain as: -cutaneous pain. - visceral pain. -somatic pain. -phantom pain.
somatic pain
The most important pathway for pain sensation is the A)Corticospinal tract B)Dorsal horn neural tract C)Afferent tract D)Spinothalamic tract
spinothalamic tract
A nurse is caring for a patient who is receiving morphine via a patient controlled analgesia (PCA) pump. When assessing the patient, she notes that his respiratory rate is 4. What should the nurse do first? A)Notify the physician B)Stop the PCA pump C)Administer naloxone D)Increase the primary IV rate
stop the PCA pump
Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique? -Visual distraction -Auditory distraction -Tactile kinesthetic distraction -Project distraction
tactile kinesthetic distraction
Two hours after receiving a pain medication, the patient states he still is suffering from pain. Which question is appropriate to ask the patient first? A)"Do you need your pain medication now?" B)"Please describe your pain on a scale of 0 to 10." C)"Tell me where your pain is located." D)"Tell me more about your pain."
tell me more about your pain
When assessing a patient's pain, the nurse should question the patient about location, intensity, quality of the pain, and A)Pain tolerance B)Level of consciousness C)Temporal pattern D)Objective signs
temporal pattern
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 main advantage of PCA? -The client obtains pain relief slowly and steadily. -The client requires less nursing care. - The client is able to have long hours of rest. -The client is actively involved in pain management.
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? -Thorough client education is necessary to prevent overdoses. -Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression. -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.
the dose that is delivered when the client activates the machine is present
The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which response is most appropriate? -"The mild electrical impulses block the pain signal before it can reach the brain." -"The electrode patches generate heat and decrease muscle tension." -"The machine tricks the mind into believing the pain does not exist." - "The electricity produces numbness and alters tissue sensitivity."
the mild electrical impulses block the pain signal before it can reach the brain
A nurse implements cutaneous stimulation for a client as part of a strategy for pain relief. Which nursing action exemplifies the use of this technique? -The nurse plays soft music in the client's room. -The nurse assists the client to focus on something pleasant rather than on pain. -The nurse gives the client a massage before bed. - The nurse teaches the client deep breathing techniques for relaxation.
the nurse gives the client a massage before bed
Which statement accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain? -This approach can only be used with oral analgesics. - A PCA pump must be used and monitored in a health care facility. -The PCA pump is not effective for chronic pain. - The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval.
the pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval
A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator may be responsible for this increased level of comfort? -the release of serotonin -the release of melatonin -the release of endorphins -the release of dopamine
the release of endorphins
A physician is explaining to the client the role of endogenous opioids in the transmission of pain. What happens when endogenous opioids are released? - They bind to sites on the nerve cell's membrane. -They react with acetylcholine and serotonin. - They occupy cell receptors for neurotransmitters. - They block glutamate receptors and peptides.
they bind to sites on the nerve cells membrane
The wife of a client with cancer is concerned that her husband's breakthrough doses of morphine have recently needed to be larger and more frequent in order for him to achieve pain relief. The nurse would recognize that the client is likely showing the effects of: - addiction. -physical dependence. - drug interactions. -tolerance.
tolerance
Epidural analgesia is appropriate for postoperative analgesia and can be administered via continuous infusion pump, or by a patient-controlled epidural analgesia pump (PCEA). True False
true
Patient-controlled analgesia (PCA) can be used with oral analgesic agents to treat mild to moderate postoperative pain. True False
true
A student nurse is preparing a presentation on pain management. What information regarding nonpharmacological interventions should he include? Select all that apply. A)Use cold packs for muscle spasms and surgical site pain. B)Dry heat penetrates deeper than moist heat. C)Ice packs should not be left on longer than 20 minutes. D)Massage can stimulate circulation. E)Distraction is useful for short pain periods.
use cold packs for muscle spasms and surgical site pain ice packs should not be left on longer than 20 minutes massage can stimulate circulation distraction is useful for short pain periods
A male college student age 20 years has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is the client most likely experiencing? -referred pain -cutaneous pain -visceral pain -somatic pain
visceral pain
A nurse is caring for a client with dull ache in her abdomen. On the way to the health care facility, the client vomits and shows symptoms of pallor. What kind of pain is the client experiencing? -visceral pain -cutaneous pain -somatic pain -neuropathic pain
visceral pain