Chapter 44 - Pain Management

Primary, secondary or tertiary intention? Pressure Ulcer

Tertiary

Stage __ ulcers affect the top two layers of skin, as well as fatty tissue.

3

Which of the following is most appropriate when the nurse assesses the intensity of the client's pain? 1. Ask about what precipitates the pain. 2. Question the client about the location of the pain. 3. Offer the client a pain scale to objectify the information. 4. Use open-ended questions to find out about the sensation.

3. Offer the client a pain scale to objectify the information

Stage __ ulcers are deep wounds that may impact muscle, tendons, ligaments, and bone.

4

Stage __ ulcers have not yet broken through the skin

1

The nurse on a postoperative care unit is assessing the quality of the client's pain. In order to obtain this specific information about the pain experience from the client, the nurse should ask: 1. "What does your discomfort feel like?" 2. "What activities make the pain worse?" 3. "How much does it hurt on a scale of 0 to 10?" 4. "How much discomfort are you able to tolerate?"

1. "What does your discomfort feel like?"

The daughter of an 88-year-old female client tells the nurse that her mother has recently quit going on walks in the neighborhood because of pain in her legs. Which of the following is the best response from the nurse? 1. "I would like to speak with your mother to get more information." 2. "Older people frequently suffer from arthritis that can cause leg pain." 3. "Your mother probably has poor circulation in her legs, which is causing the pain." 4. "She is lucky to be as healthy as she is at her age."

1. " I would like to speak with your mother to get information."

The nursery nurse is explaining postcircumcision care to a new mother. Which of the following statements by the new mother indicates that additional teaching needs to occur? 1. "Babies don't experience pain, so I don't need to worry about hurting him when I touch the penis." 2. "I need to be careful not to put his diaper on too tight to avoid discomfort." 3. "I can comfort my baby following the procedure by holding him." 4. "The health care provider will numb the area before performing the procedure."

1. "Babies don't experience pain, so i don't need to worry about hurting him when i touch the penis."

Which of the following statements by the nurse reflects a need for immediate follow-up regarding the physical effects of chronic pain on body function? 1. "His pulse and blood pressure are within his normal baseline limits, so I'm sure the pain medication is working." 2. "Please take his pulse and blood pressure, and let me know if they are elevated above his normal baselines." 3. "If his pulse and blood pressure are above his normal baseline, let me know, and I will medicate him for pain." 4. "Unmanaged pain usually manifests itself in both an elevated pulse and blood pressure."

1. "His pulse and blood pressure are within his normal baseline limits, so i'm sure the pain medication is working"

Nurses working with clients in pain need to recognize and avoid common misconceptions and myths about pain. In regard to the pain experience, which of the following is correct? 1. The client is the best authority on the pain experience. 2. Chronic pain is mostly psychological in nature. 3. Regular use of analgesics leads to drug addiction. 4. The amount of tissue damage is accurately reflected in the degree of pain perceived.

1. The client is the best authority on the pain experience

A 44-year-old client shares with the admitting nurse that the client is having epigastric pain that the client identifies as a 7 on a 0 to 10 scale. In order to plan for the pain management of this client, which is the most appropriate response from the nurse? 1. "What would be a satisfactory level of pain control for us to achieve?" 2. "You don't look like you're in that much pain." 3. "You'll be pain-free following your surgery." 4. "I've cared for a client with a nail in his head who only rated his pain as a 5; are you sure your pain is a 7?"

1."What would be a satisfactory level of pain control for us to achieve?"

Stage __ ulcers have a break in the top two layers of skin

2

Which of the following statements made by a nurse shows the greatest understanding of the personal nature of the pain experience? 1. "I have experienced pain before, and so I have great compassion for anyone dealing with pain." 2. "People handle pain differently, but everyone in pain is only interested in having the pain stop." 3. "Managing a client's pain is the single most important thing a nurse can do for a client experiencing pain." 4. "I can only accept what the client reports concerning the pain being felt and attempt to intervene successfully in its management."

4. " I can only accept what the client reports concerning the pain being felt and attempt to intervene successfully in its management."

Taking into consideration the hospice client's chronic pain from bone cancer, the most appropriate person to collaborate with regarding management of pain is: 1. Occupational therapist to devise a splint for the client's leg 2. Physical therapist to determine exercises to strengthen the leg muscles 3. Art therapist to provide creative therapy as a diversion 4. An oncology nurse

4. An oncology nurse

A client with chronic pain states, "I just want to be pain-free. Do something to make that happen." The most therapeutic response is: 1. "Together we will all work at making your pain tolerable." 2. "I will do everything I can to manage your pain; I promise." 3. "Are you feeling depressed or anxious because of your pain?" 4. "You sound anxious. Would you like something for your nerves?"

1. "Together we will all work at making your pain tolerable."

When a client's husband questions how a patient-controlled analgesia (PCA) pump works, the nurse explains that the client: 1. Has control over the frequency of the intravenous (IV) analgesia 2. Can choose the dosage of the drug received 3. May request the type of medication received 4. Controls the route for administering the medication

1. Has control over the frequency of the intravenous (IV) analgesia

The greatest barrier to a 3-year-old client's ability to self-assess her pain is: 1. A limited vocabulary 2. Increased separation anxiety 3. Reluctance to talk to strangers 4. Inability to grasp the concept of pain

1.A limited vocabulary

A client who had knee replacement surgery the previous day refuses to take any pain medication, even though he rates his pain as an 8 on a 0 to 10 scale. Upon questioning the client the nurse learns that the reason for refusing pain medication is because he is concerned about injuring the knee and not feeling it. The best information that the nurse can provide this client is to explain that: 1. The pain medication will help speed his recovery time 2. He need not worry about becoming addicted to the pain medication 3. He will not be perceived as weak for taking the pain medication 4. He is being a difficult client and needs to comply with the health care provider's orders

1.The pain medication will help speed his recovery time

Which of the following statements made by a nurse requires follow-up with additional instruction regarding the personal nature of pain? 1. "I have experienced pain before, and so I have great compassion for anyone dealing with pain." 2. "My postsurgical clients get the prescribed pain medications on schedule with no diversion from that schedule." 3. "If I were experiencing severe pain, I certainly would want someone to devote their time to managing for me." 4. "Clients don't always request pain medication, and so I always ask them if they want it according to the schedule."

2. "My postsurgical clients get the prescribed pain medications on schedule with no diversion from the schedule."

A nonpharmacological approach that the nurse may implement for clients experiencing pain that focuses on promoting pleasurable and meaningful stimuli is: 1. Acupressure 2. Distraction 3. Biofeedback 4. Hypnosis

2. Distraction

The client is experiencing breakthrough pain while receiving opioids. An order is written for the client to receive a transmucosal fentanyl "unit." In teaching about this medication, the nurse should instruct the client to: 1. Swab the unit over the cheeks 2. Do not chew the unit after administration 3. Take no more than two units per episode of discomfort 4. Allow the unit to dissolve slowly in the mouth over 15 minutes or more

2. Do not chew the unit after administration

The nurse recognizes that the most likely reason a runner who has injured his ankle during a race is not aware of it until after he crosses the finish line is that: 1. The emotional exhilaration of running the race masked the pain of the injury 2. His endorphin levels were high as a result of the physical stressors of the race 3. He was mentally distracted by the need to concentrate on the ever-changing nature of the race 4. The physical effects of the injury slowly increased during the race and reached pain-producing capacity only after the race

2. His endorphin levels were high as a result of the physical stressors of the race

The nurse knows that a PCA pump would be most appropriate for the client who: 1. Has psychogenic discomfort 2. Is recovering after a total hip replacement 3. Experiences renal dysfunction 4. Recently experienced a cerebrovascular accident (stroke)

2. Is recovering after a total hip replacement

The home care nurse notes that a 67-year-old female diabetic client's blood glucose level has been elevated since she strained her back the previous week. The client states that she cannot understand why her blood glucose level is elevated. The nurse suspects the most likely cause for the elevated blood sugar is: 1. The decreased activity level of the client since the injury 2. Parasympathetic stimulation from the body's normal response to pain 3. The client is consuming more food as a comfort measure 4. The client may not be taking her medication as ordered

2.Parasympathetic stimulation from the body's normal response to pain

Which of the following statements made by a client reporting severe pain expresses the most insight into how pain impacts a client's energy reserves? 1. "I can't sleep if I don't get something for this pain." 2. "If only I could get an hour when I was free of this pain." 3. "I'm exhausted physically and emotionally trying to live with this pain." 4. "I don't see how I can continue to cope with this pain; I need some relief."

3. "I'm exhausted physically and emotionally trying to live with this pain."

An older client with mild musculoskeletal pain is being seen by the primary care provider. The nurse anticipates that treatment of this client's level of discomfort will include: 1. Fentanyl 2. Diazepam 3. Acetaminophen 4. Meperidine hydrochloride

3. Acetaminophen

The nurse caring for a terminally ill client with liver cancer understands which of the following goals would be most appropriate? 1. Increasingly administer narcotics to oversedate the client and thereby decrease the pain. 2. Continue to change the analgesics until the right narcotic is found that completely alleviates the pain. 3. Adapt the analgesics as the nursing assessment reveals the need for specific medications. 4. Withhold analgesics because they are not being effective in relieving discomfort.

3. Adapt the analgesics as the nursing assessment reveals the need for specific medications.

When caring for a client who is experiencing continuous severe pain, the nurse should expect that the pain management plan would include: 1. Focusing on intramuscular administration of analgesics 2. Waiting for pain to become more intense before administering opioids 3. Administering opioids with nonopioid analgesics for severe pain experiences 4. Administering large doses of opioids initially to clients who have not taken the medications before

3. Administering opioids with nonopioid analgesics for severe pain experiences

A client who is scheduled for the second in a series of painful dressing changes asks for "my pain medication now so it's working when the dressing is changed" is most likely expressing: 1. A great fear of the expected pain 2. A need to be in control of his pain 3. An understanding that it is easier to prevent the pain than to stop the pain 4. An acceptance of the pain that the dressing change will obviously cause him

3. An understanding that it is easier to prevent the pain than to stop the pain

Before inserting a Foley catheter, the nurse explains that the client may feel some discomfort. This is an example of: 1. Distraction 2. Reducing pain perception 3. Anticipatory response 4. Self-care maintenance

3. Anticipatory response

The nurse should describe pain that is causing the client a "burning sensation in the epigastric region" as: 1. Referred 2. Radiating 3. Deep or visceral 4. Superficial or cutaneous

3. Deep or visceral

Which of the following symptoms would the nurse expect with a client who is experiencing acute pain? 1. Bradycardia 2. Bradypnea 3. Diaphoresis 4. Decreased muscle tension

3. Diaphoresis

Which of the following is the most appropriate nursing intervention for a client who is receiving epidural analgesia? 1. Change the tubing every 48 to 72 hours. 2. Change the dressing every shift. 3. Secure the catheter to the outside skin. 4. Use a bulky occlusive dressing over the site.

3. Secure the catheter to the outside skin

A client with a history of chronic back pain is questioning the need to "keep asking for pain medication," fearing that he will be viewed as being weak by his family. The most therapeutic nursing response to this client would be: 1. "Chronic back pain is very difficult to deal with; utilize the pain medication because that's what it's there for." 2. "Your family won't think you're weak; they want you to be comfortable, and the medication will help." 3. "Taking the medication as prescribed will help you to be more active; your family will be happy you can do things with them again." 4. "It's important that you manage your pain as effectively as possible; it really doesn't matter what other people think about you."

3."Taking the medication as prescribed will help you to be more active; your family will be happy you can do things with them again."

A client with chronic pain presents in the emergency department of the local hospital stating "I just can't take this anymore." On questioning the client, the nurse discovers that the client have experienced chronic pain since being involved in an accident 2 years previously. The client states that he has been labeled a "drug seeker" because he is looking for relief for the pain and feels hopeless, angry, and powerless to do anything about the situation. The nurse understands that this client is at risk for: 1. Criminal activity 2. Opioid abuse 3. Suicide 4. Drug addiction

3.Suicide

Which of the following statements made by the nurse regarding the client's self-assessment of pain requires immediate follow-up regarding the personal nature of pain? 1. "The medication should be providing enough relief; try to ambulate her." 2. "I've never known anyone to have such pain after that procedure." 3. "He should be able to ambulate with only minimal pain by now." 4. "She says she's in pain, but she doesn't act like she is in pain."

4. "She says she's in pain, but she doesn't act like she is in pain."

The nurse is attempting to ambulate an older adult client who recently experienced a fall at the assisted living facility where he resides. The client is reluctant to walk and consents to move only to the chair, reporting that "it hurts too much to walk." Which of the following nursing interventions is most therapeutic regarding this client? 1. Allow the client to remain in bed in order to conserve his energy. 2. Transfer him to the chair, realizing some activity is preferable to none. 3. Call his health care provider to discuss the apparent ineffectiveness of his pain medications. 4. Assess the client for other factors that may be affecting his ability and motivation to ambulate.

4. Assess the client for other factors that may be affecting his ability and motivation to ambulate

The nurse is attempting to ambulate a postoperative client who continues to rate his pain as a 7 on a scale of 0 to 10, with 10 being the most severe. The client is reluctant to walk and consents to move only to the chair, reporting that "it hurts too much to walk." The nurse's primary concern regarding the client's recovery related to his pain experience is that: 1. His pain medications are not effectively managing his pain 2. He does not fully understand the importance of ambulation 3. He is expending too much of his energy dealing with the pain 4. He is not ready to participate in the activities needed to recover quickly

4. He is not ready to participate in the activities needed to recover quickly

The nurse inquires of a postoperative client as to the need for pain medication. The client denies the need then but 30 minutes later reports, "I am really in a lot of pain. Can you bring me my pain pill now?" The nurse recognizes that the most immediate need for client education is related to explaining that: 1. His oral medication will take approximately 30 minutes to affect his pain 2. There may be a need to administer his pain medication via the intravenous route 3. Pain medication is more effective if blood levels are maintained at a constant level 4. His pain will be more effectively managed if he reports a need for pain medication while the pain is still tolerable

4. His pain will be more effectively managed if he reports a need for pain medication while the pain is still tolerable

A client is having severe, continuous discomfort from kidney stones. Based on the client's experience, the nurse anticipates which of the following findings in the client's assessment? 1. Tachycardia 2. Diaphoresis 3. Pupil dilation 4. Nausea and vomiting

4. Nausea and vomiting

n creating the plan of care for a newly diagnosed breast cancer client, the nurse is concerned about pain control. The client has expressed an interest in relaxation therapy as a complementary pain therapy. The nurse knows that the best time to teach the client is: 1. Immediately following the client's mastectomy 2. Before giving pain medication to evaluate if the complementary therapy works 3. Immediately preceding surgery 4. When the client is comfortable

4. When the client is comfortable

The nurse is caring for a cognitively impaired client who has experienced a painful procedure. The nurse is most effective in determining the client's pain medication needs when using which of the following assessment methods? 1. Medicating the client with the as-needed (prn) analgesic as often as ordered 2. Utilizing the pain face scale to assess the client's pain experience 3. Asking the client to rate his or her pain on a scale of 1 to 10, with 10 being the most severe pain 4. Observing the client's body movements and facial expressions for typical pain behaviors

4. observing the client's body movements and facial expressions for typical pain behavior

Which of the following outcomes are directly related to functional impairment of the older client experiencing pain? (Select all that apply.) 1. Inability to prepare food to meet nutritional requirements 2. Inability to exit home quickly in the case of a fire 3. Development of skin breakdown on buttocks 4. Development of an irregular heart rhythm 5. Displaying signs of clinical depression 6. Feeling alone, unloved, and forgotten

ANS: 1, 2, 3, 5, 6 Once an older client suffers pain, there can be serious impairment of functional status. Pain has the potential to reduce mobility, activities of daily living (ADLs), social activities outside the home, and activity tolerance. There is no apparent connection between pain and the development of a dysrhythmia.

Which one of the following nursing interventions for a client in pain is based on the gate- control theory? 1. Giving the client a back massage 2. Changing the client's position in bed 3. Giving the client a pain medication 4. Limiting the number of visitors

ANS: 1 The gate-control theory suggests that cutaneous stimulation activates larger, faster- transmitting A-beta sensory nerve fibers. This decreases pain transmission through small- diameter A-delta and C fibers. A back massage is a nursing intervention based on the gate-control theory. Changing the client's position in bed is not a form of cutaneous stimulation used to relieve pain. Giving the client a pain medication is a pharmacological approach to relieving pain. Limiting the number of visitors may provide a quiet environment conducive to relaxation, but it is not based on the gate-control theory.

The nurse on a postoperative care unit is assessing the quality of the client's pain. In order to obtain this specific information about the pain experience from the client, the nurse should ask: 1. "What does your discomfort feel like?" 2. "What activities make the pain worse?" 3. "How much does it hurt on a scale of 0 to 10?" 4. "How much discomfort are you able to tolerate?"

ANS: 1 To determine the quality of the client's pain the nurse might say, "What does your discomfort feel like?" It is more accurate to have clients describe the pain in their own words whenever possible. Inquiring about what activities make the pain worse is a type of question directed at determining the pain pattern. Having the client rate his or her pain on a pain scale is a method of measuring the intensity of pain. To determine the client's expectations, the nurse may ask the client, "How much discomfort are you able to tolerate?"

The nurse recognizes which of the following client outcomes as being a result of ineffective pain management? (Select all that apply.) 1. Client expressing feelings of despair and hopelessness 2. Inability to self-ambulate distance from bed to bathroom 3. Stage 1 pressure ulcer development on coccyx and left hip 4. Client rating pain as 4 on a scale of 0 to 10 30 minutes after pain medication 5. Postponement of discharge because of the inability to perform activities of daily living 6. Postponement of physical therapy because of client's inability to tolerate knee flexion

ANS: 1, 2, 3, 5, 6 Acute pain seriously threatens a client's recovery by resulting in prolonged hospitalization, increased risks of complications from immobility, and delayed rehabilitation. Physical or psychological progress is delayed as long as acute pain persists because the client focuses all energy on pain relief. A pain rating of 4 reflects tolerable pain, which may be a realistic expectation in some cases of chronic pain

Which of the following client outcomes reflect the positive aspects of effective pain management? (Select all that apply.) 1. The client with arthritis in both hands knitting for pleasure 2. A client rating his chronic back pain as a 3 on a scale of 0 to 10 3. A client with type 2 diabetes walking 5 miles in a Fourth of July parade 4. A client who has undergone surgery ambulating to the bathroom on the first postoperative day 5. A client with knee replacement surgery returning to his job as a mail carrier 6. A client with terminal cancer going home on outpatient chemotherapy

ANS: 1, 2, 4, 5, 6 Effective pain management improves quality of life, reduces physical discomfort, promotes earlier mobilization and return to work, results in fewer hospital/clinic visits, and shortens hospital stays, thus reducing health care costs. The remaining option does not involve a client who is normally dealing with pain.

The nurse should describe pain that is causing the client a "burning sensation in the epigastric region" as: 1. Referred 2. Radiating 3. Deep or visceral 4. Superficial or cutaneous

ANS: 3 Deep or visceral pain is diffuse and may radiate in several directions. Visceral pain may be described as a burning sensation. Referred pain is felt in a part of the body separate from the source of pain, such as with a myocardial infarction, in which pain may be referred to the jaw, left arm, and left shoulder. Radiating pain feels as though it travels down or along a body part, such as low back pain that is accompanied by pain radiating down the leg from sciatic nerve irritation. Superficial or cutaneous pain is of short duration and is localized as in a small cut.

Which of the following is most appropriate when the nurse assesses the intensity of the client's pain? 1. Ask about what precipitates the pain. 2. Question the client about the location of the pain. 3. Offer the client a pain scale to objectify the information. 4. Use open-ended questions to find out about the sensation.

ANS: 3 Descriptive scales are a more objective means of measuring pain intensity. Asking the client what precipitates the pain does not assess intensity, but rather it is an assessment of the pain pattern. Asking the client about the location of 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

A priority nursing intervention when caring for a client who is receiving an epidural infusion for pain relief is to: 1. Use aseptic technique 2. Label the port as an epidural catheter 3. Monitor vital signs every 15 minutes 4. Avoid supplemental doses of sedatives

ANS: 3 When clients are receiving epidural analgesia, monitoring occurs as often as every 15 minutes, including assessment of respiratory rate, respiratory effort, and skin color. Complications of epidural opioid use include nausea and vomiting, urinary retention, constipation, respiratory depression, and pruritus. A common complication of epidural anesthesia is hypotension. Assessing vital signs is the priority nursing intervention. Because of the catheter location, strict surgical asepsis is needed to prevent a serious and potentially fatal infection. To reduce the risk for accidental epidural injection of drugs intended for IV use, the catheter should be clearly labeled "epidural catheter." Supplemental doses of opioids or sedative/hypnotics are avoided because of possible additive central nervous system adverse effects

Primary, secondary or tertiary intention? Alteration in wound healing process.

S

Primary, secondary or tertiary intention? pressure sores

S

Primary, secondary or tertiary intention? Surgical wound contaminated

Secondary

35. The nurse is administering ibuprofen (Advil) to an older patient. Which assessment data causes the nurse to hold the medication? (Select all that apply.) a. Patient states allergy to aspirin. b. Patient states joint pain is 2/10 and intermittent. c. Patient reports past medical history of gastric ulcer. d. Patient reports last bowel movement was 4 days ago. e. Patient experiences respiratory depression after administration of an opioid medication.

Answer: A, C Rationale: NSAIDs can cause bleeding, especially in the gastrointestinal (GI) tract; therefore, NSAIDs are most likely contraindicated in this patient. Patients with an allergy to aspirin or have asthma are sometimes also allergic to other NSAIDs. The nurse needs to verify that the health care provider is aware of the history of GI bleeding and of allergy to aspirin before administering ibuprofen. NSAIDs do not interfere with bowel function and are used for the treatment of mild to moderate acute intermittent pain. NSAIDs also do not suppress the central nervous system by causing respiratory depression.

4. A nurse is planning care for an older-adult patient who is experiencing pain. Which statement made by the nurse indicates the supervising nurse needs to follow up? a. "As adults age, their ability to perceive pain decreases." b. "Older patients may have low serum albumin in their blood, causing toxic effects of analgesic drugs." c. "Patients who have dementia probably experience pain, and their pain is not always well controlled." d. "It is safe to administer opioids to older adults as long as you start with small doses and frequently assess the patient's response to the medication."

Answer: a. "As adults age, their ability to perceive pain decreases." Rationale: Aging does not affect the ability to perceive pain. This misconception must be corrected by the supervising nurse. All the other statements are true and require no follow-up. Opioids are safe to use in older adults as long as they are slowly titrated and the nurse frequently monitors the patient. Patients with dementia most likely experience unrelieved pain because their pain is difficult to assess. Older adults frequently eat poorly, resulting in low serum albumin levels. Many drugs are highly protein bound. In the presence of low serum albumin, more free drug (active form) is available, thus increasing the risk for side and/or toxic effects.

3. A nurse teaches the patient about the gate control theory. Which statement made by a patient reflects a correct understanding about the relationship between the gate control theory of pain and the use of meditation to relieve pain? a. "Meditation controls pain by blocking pain impulses from coming through the gate." b. "Meditation alters the chemical composition of pain neuroregulators, which closes the gate." c. "Meditation will help me sleep through the pain because it opens the gate." d. "Meditation stops the occurrence of pain stimuli."

Answer: a. "Meditation controls pain by blocking pain impulses from coming through the gate." Rationale: According to this theory, gating mechanisms located along the central nervous system regulate or block pain impulses. Pain impulses pass through when a gate is open and are blocked when a gate is closed. Nonpharmacologic pain-relief measures, such as meditation, work by closing the gates, which keeps pain impulses from coming through. Meditation does not open pain gates or stop pain from occurring. Meditation also does not have an effect on pain neuroregulators.

26. The nurse is teaching a student nurse about pain assessment scales. Which statement by the student indicates effective teaching? a. "You cannot use a pain scale to compare the pain of my patient with the pain of your patient." b. "When patients say they don't need pain medication, they aren't in pain." c. "A patient's behavior is more reliable than the patient's report of pain." d. "Pain assessment scales determine the quality of a patient's pain."

Answer: a. "You cannot use a pain scale to compare the pain of my patient with the pain of your patient." Rationale: Do not use a pain scale to compare the pain of one patient to that of another. Pain is subjective and cannot be compared to the pain of another patient. Some patients do not express their pain (stoic) or do not wish to take medications to relieve the pain. This does not mean they aren't in pain. A patient's behavior is not more reliable than the patient's report of pain. Pain scales help determine severity or intensity, not quality.

12. A nurse is providing discharge teaching for a patient with a fractured humerus. The patient is going home with hydrocodone. Which important patient education does the nurse provide? a. "You need to drink plenty of fluids and eat a diet high in fiber." b. "Narcotics can be addictive, so do not take them unless you are in severe pain." c. "Be sure to eat a meal high in fat before taking the medication, to avoid a stomach ulcer." d. "As your pain severity lessens, you will begin to give yourself once-daily intramuscular injections."

Answer: a. "You need to drink plenty of fluids and eat a diet high in fiber." Rationale: A common side effect of opioid analgesics is constipation. Therefore, the nurse encourages the patient to drink fluids and eat fiber to prevent constipation. Although medications can be irritating to the stomach, eating a diet high in fat does not prevent gastric ulcers. To best manage pain, the patient needs to take pain medication before painful procedures or activities or before pain becomes severe. As the patient's pain gets better, the strength of the medications will decrease. IM, IV, and topical analgesics are used for more severe and chronic pain.

23. A nurse is caring for a group of patients. Which patient will the nurse see first? a. A patient who received morphine and has a pulse of 62 beats/min, respirations 10 breaths/min, and blood pressure 110/60 mm Hg b. A patient lying very still in bed who reports no pain but is pale with warm, dry skin c. A patient with severe pain who is nauseated and feels like he or she is about to vomit d. A patient writhing and moaning from abdominal pain after abdominal surgery

Answer: a. A patient who received morphine and has a pulse of 62 beats/min, respirations 10 breaths/min, and blood pressure 110/60 mm Hg Rationale: A respiratory rate of 10 indicates respiratory depression. A rare adverse effect of opioids in opioid-naïve patients (patients who have used opioids around the clock for less than approximately 1 week) is respiratory depression. Naloxone (Narcan) may be administered. While the other patients are experiencing pain and do need to be seen, they are not the priority since respirations are not affected.

31. The nurse is caring for a group of patients. Which task may the nurse delegate to the nursing assistive personnel (NAP)? a. Administer a back massage to a patient with pain. b. Assessment of pain for a patient reporting abdominal pain. c. Administer patient-controlled analgesia for a postoperative patient. d. Assessment of vital signs in a patient receiving epidural analgesia.

Answer: a. Administer a back massage to a patient with pain. Rationale: A massage may be delegated to an NAP. Pain assessment is a nursing function and cannot be delegated to an NAP. Administration of patient-controlled analgesia (PCA) cannot be delegated to an NAP. Assessment of vital signs is a licensed nursing function; the NAP can take vital signs for a patient receiving epidural analgesia.

32. A nurse is caring for a patient with chronic pain from arthritis. Which action is best for the nurse to take? a. Give pain medications around the clock. b. Administer pain medication before any activity. c. Give pain medication after the pain is a 7/10 on the pain scale. d. Administer pain medication only when nonpharmacological measures have failed.

Answer: a. Give pain medications around the clock. Rationale: When a patient with arthritis has chronic pain, the best way to manage pain is to take medication regularly throughout the day to maintain constant pain relief. "Before any activity" is nonspecific, and the medication may not have time to work before activity. If the patient waits until having pain (7/10) to take the medication, pain relief takes longer. Nonpharmacological measures are used in conjunction with medications unless requested otherwise by the patient.

5. The nurse is caring for two patients; both are having a hysterectomy. The first patient is having the hysterectomy after a complicated birth. The second patient has uterine cancer. What will most likely influence the experience of pain for these two patients? a. Meaning of pain b. Neurological factors c. Competency of the surgeon d. Postoperative support personnel

Answer: a. Meaning of pain Rationale: The degree and quality of pain perceived by a patient are related to the meaning of the pain. The patient's perception of pain is influenced by psychological factors, such as anxiety and coping, which in turn influence the patient's experience of pain. Each patient's experience is different. Neurological factors can interrupt or influence pain perception, but neither of these patients is experiencing alterations in neurological function. The knowledge, attitudes, and beliefs of nurses, health care providers, the surgeon, and other health care personnel about pain affect pain management but do not necessarily influence a patient's pain perceptions.

29. A nurse is caring for a patient with rheumatoid arthritis who is now going to be taking 2 acetaminophen (Tylenol) tablets every 6 hours to control pain. Which part of the patient's social history is the nurse most concerned about? a. Patient drinks 1 to 2 glasses of wine every night. b. Patient smokes 2 packs of cigarettes a day. c. Patient occasionally uses marijuana. d. Patient takes antianxiety medication

Answer: a. Patient drinks 1 to 2 glasses of wine every night. Rationale: The major adverse effect of acetaminophen is hepatotoxicity (liver toxicity). Because both alcohol and acetaminophen are metabolized by the liver, when taken together, they can cause liver damage. Smoking cigarettes and smoking marijuana are not healthy behaviors, but their effects on health are not affected by acetaminophen. Antianxiety medications can be taken with acetaminophen.

22. The nurse is caring for a 4-year-old child who has pain. Which technique will the nurse use to best assess pain in this child? a. Use the FACES scale. b. Check to see what previous nurses have charted. c. Ask the parents if they think their child is in pain. d. Have the child rate the level of pain on a 0 to 10 pain scale.

Answer: a. Uses the FACES scale. Rationale: The FACES scale assesses pain in children who are verbal. Because a 4-year-old is verbal, this is an appropriate scale to use with this child. Assessing pain intensity in children requires special techniques. Young children often have difficulty expressing their pain. Parents' statement of pain is not an effective way to assess pain in children because children's statements are the most important. The 0 to 10 pain scale is too difficult for a 4-year-old child to understand. Previous documentation by nurses will tell you what the child's pain has been but will not tell you the child's current pain intensity.

9. A nurse is teaching a patient about patient-controlled analgesia (PCA). Which statement made by the patient indicates to the nurse that teaching is effective? a. "I will only need to be on this pain medication." b. "I feel less anxiety about the possibility of overdosing." c. "I can receive the pain medication as frequently as I need to." d. "I need the nurse to notify me when it is time for another dose."

Answer: b. "I feel less anxiety about the possibility of overdosing." Rationale: A PCA is a device that allows the patient to determine the level of pain relief delivered, reducing the risk of overdose. The PCA infusion pumps are designed to deliver a specific dose that is programmed to be available at specific time intervals (usually in the range of 8 to 15 minutes) when the patient activates the delivery button. A limit on the number of doses per hour or 4-hour interval may also be set. This can help decrease a patient's anxiety related to possible overdose. Its use also often eases anxiety because the patient is not reliant on the nurse for pain relief. Other medications, such as oral analgesics, can be given in addition to the PCA machine. One benefit of PCA is that the patient does not need to rely on the nurse to administer pain medication; the patient determines when to take the medication.

24. A nurse is caring for a patient with chronic pain. Which statement by the nurse indicates an understanding of pain management? a. "This patient says the pain is a 5 but is not acting like it. I am not going to give any pain medication." b. "I need to reassess the patient's pain 1 hour after administering oral pain medication." c. "It wasn't time for the patient's medication, so when it was requested, I gave a placebo." d. "The patient is sleeping, so I pushed the PCA button."

Answer: b. "I need to reassess the patient's pain 1 hour after administering oral pain medication." Rationale: Be sure to evaluate after an appropriate period of time. For instance, oral medications usually peak in about 1 hour, whereas IVP medications peak in 15 to 30 minutes. Ask a patient if a medication alleviates the pain when it is peaking. Because oral medications usually peak in about an hour, you need to reassess the patient's pain within an hour of administration. Nurses must believe any patient report of pain, even if nonverbal communication is not consistent with pain ratings. The patient is the only person who should push the PCA button. Pushing the PCA when a patient is sleeping is dangerous and may lead to narcotic overdose or respiratory depression. Giving the patient a placebo and telling the patient it is medication is unethical.

25. The nurse is assessing how a patient's pain is affecting mobility. Which assessment question is most appropriate? a. "Have you considered working with a physical therapist?" b. "What activities, if any, has your pain prevented you from doing?" c. "Would you please rate your pain on a scale from 0 to 10 for me?" d. "When does your pain medication typically take effect on your pain?"

Answer: b. "What activities, if any, has your pain prevented you from doing?" Rationale: Because the nurse is interested in knowing whether the patient's pain is affecting mobility, the priority assessment question is to ask the patient how the pain affects ability to participate in normal activities of daily living. Although a physical therapist is a good resource to have, especially if pain is severely affecting mobility, considering working with a physical therapist does not describe the effect of pain on the patient's mobility. Assessing quality of pain and effectiveness of pain medication does not help the nurse to understand how it is affecting the patient's mobility.

17. The nurse is caring for a patient to ease modifiable factors that contribute to pain. Which areas did the nurse focus on with this patient? a. Age and gender b. Anxiety and fear c. Culture and ethnicity d. Previous pain experiences and cognitive abilities

Answer: b. Anxiety and fear Rationale: Some examples of modifiable contributors to pain are anxiety and fear. The nurse can take measures to ease the patient's anxiety and fear related to pain. Age, gender, culture, ethnicity, cognitive abilities, and previous pain experience are all nonmodifiable factors that the nurse can help the patient to understand, but the nurse cannot alter them.

1. An oriented patient has recently had surgery. Which action is best for the nurse to take to assess this patient's pain? a. Assess the patient's body language. b. Ask the patient to rate the level of pain. c. Observe the cardiac monitor for increased heart rate. d. Have the patient describe the effect of pain on the ability to cope.

Answer: b. Ask the patient to rate the level of pain. Rationale: One of the most subjective and therefore most useful characteristics for reporting pain is its severity. Therefore, the best way to assess a patient's pain is to ask the patient to rate the pain. Nonverbal communication, such as body language, is not as effective in assessing pain, especially when the patient is oriented. Heart rate sometimes increases when a patient is in pain, but this is not a symptom that is specific to pain. Pain sometimes affects a patient's ability to cope, but assessing the effect of pain on coping assesses the patient's ability to cope; it does not assess the patient's pain.

34. The nurse is caring for an infant in the intensive care unit. Which information should the nurse consider when planning care for this patient? a. Infants cannot be assessed for pain. b. Infants respond behaviorally and physiologically to painful stimuli. c. Infants cannot tolerate analgesics owing to an underdeveloped metabolism. d. Infants have a decreased sensitivity to pain when compared with older children.

Answer: b. Infants respond behaviorally and physiologically to painful stimuli. Rationale: Infants cannot verbally express their pain, but they do express pain with behavioral cues (facial expressions, crying) and physiological indicators (changes in vital signs). Infants can tolerate analgesics, but proper dosing and close monitoring are essential. Infants and older children have the same sensitivity to pain. Pain can be assessed even though the neonate cannot verbalize; the nurse can observe behavioral clues. Nurses use behavioral cues and physiological responses to assess pain in infants.

7. A patient is receiving opioid medication through an epidural infusion. Which action will the nurse take? a. Restrict fluid intake. b. Label the tubing that leads to the epidural catheter. c. Apply a gauze dressing to the epidural catheter insertion site. d. Ask the nursing assistive personnel to check on the patient at least once every 2 hours.

Answer: b. Label tubing that leads to the epidural catheter. Rationale: To reduce the accidental administration of IV medications into the epidural catheter, the tubing that leads to the epidural catheter needs to be labeled clearly. The epidural insertion site needs to be covered by a transparent dressing to prevent infection and allow the nurse to assess the site. Patients receiving epidural anesthesia need to be monitored every 15 minutes until stabilized and then at least hourly for 12 to 24 hours.

13. A patient arrives at the emergency department experiencing a headache and rates the pain as 7 on a 0 to 10 pain scale. Which nonpharmacological intervention does the nurse implement for this patient while awaiting orders for pain medication from the health care provider? a. Reassures the patient that the provider will come to the emergency department soon b. Softly plays music that the patient finds relaxing c. Frequently reassesses the patient's pain scores d. Teaches the patient how to do yoga

Answer: b. Softly plays music that the patient finds relaxing Rationale: The appropriate nonpharmacological pain-management intervention is to quietly play music that the patient finds relaxing. Music diverts a person's attention away from pain and creates relaxation. Reassessing the patient's pain scores is done during evaluation. Building the patient's expectation of the provider's arrival does not address the patient's pain. Although yoga promotes relaxation, nurses teach relaxation techniques only when a patient is not experiencing acute pain. Because the patient is having acute pain, this is not an appropriate time to provide patient teaching.

33. A nurse is caring for a patient who fell on the ice and has connective tissue damage in the wrist and hand. The patient describes the pain as throbbing. Which type of pain does the nurse document in this patient's medical record? a. Visceral pain b. Somatic pain c. Centrally generated pain d. Peripherally generated pain

Answer: b. Somatic pain Rationale: Somatic pain comes from bone, joint, connective tissue, or muscle. Visceral pain arises from the visceral (internal) organs such as the GI tract and pancreas. Peripherally generated pain in the peripheral nerves can be caused by polyneuropathies or mononeuropathies. Centrally generated pain results from injury to the central or peripheral nervous system, causing deafferentation or sympathetically maintained pain.

28. The nurse is assessing a patient for opioid tolerance. Which finding supports the nurse's assessment? a. The patient needed a substantial dose of naloxone (Narcan). b. The patient needs increasingly higher doses of opioid to control pain. c. The patient no longer experiences sedation from the usual dose of opioid. d. The patient asks for pain medication close to the time it is due around the clock.

Answer: b. The patient needs increasingly higher doses of opiod to control pain. Rationale: Opioid tolerance occurs when a patient needs higher doses of an opioid to control pain. Naloxone (Narcan) is an opioid antagonist that is given to reverse the effects of opioid overdose. Taking pain medications regularly around the clock is an effective way to control pain. The pain medication for this patient is most likely effectively managing the patient's pain because the patient is not asking for the medication before it is due. A patient no longer experiencing a side effect (sedation) of an opioid does not indicate opioid tolerance.

16. A patient who had a motor vehicle crash 2 days ago is experiencing pain and is receiving patient-controlled analgesia (PCA). Which assessment finding indicates effective pain management with the PCA? a. The patient is sleeping and is difficult to arouse. b. The patient rates pain at a level of 2 on a 0 to 10 scale. c. The patient has sufficient medication left in the PCA syringe. d. The patient presses the control button to deliver pain medication.

Answer: b. The patient rates pain at a level of 2 on a 0 to 10 scale. Rationale: A level of 2 on a scale of 0 to 10 is evidence of effective pain management. The effectiveness of pain-relief measures is determined by the patient. If the patient is satisfied with the amount of pain relief, then pain measures are effective. A patient who is sleeping and is difficult to arouse is possibly oversedated; the nurse needs to assess this patient further. The amount of medication left in the PCA syringe does not indicate whether pain management is effective or not. Pressing the button shows that the patient knows how to use the PCA but does not evaluate pain management.

11. A nurse is caring for a patient who recently had spinal surgery. The nurse knows that patients usually experience acute pain following this type of surgery. The patient refuses to get up and walk and is not moving around in the bed. However, the patient is stoic and denies experiencing pain at this time. What most likely explains this patient's behavior? a. The surgery successfully cured the patient's pain. b. The patient's culture is possibly influencing the patient's experience of pain. c. The primary health care provider did not prescribe the correct amount of medication. d. The nurse is allowing personal beliefs about pain to influence pain management at this time.

Answer: b. The patient's culture is possibly influencing the patient's experience of pain. Rationale: A patient's culture or beliefs about pain often influence the patient's expression of pain. In this case, the patient has just had surgery, and the nurse knows that this surgical procedure usually causes patients to experience pain. It is important at this time for the nurse to examine cultural and ethnic factors that are possibly affecting the patient's lack of expression of pain at this time. Even if surgery corrects neurological factors that create chronic pain, surgery causes pain in the acute period. The patient has not taken any pain medication so this is an unrealistic assumption; most pain medications have standard dosages. The nurse is not allowing personal beliefs to influence pain management because the nurse is attempting to determine the reason why the patient is not verbalizing the experience of pain.

10. A nurse is caring for a patient who is experiencing pain following abdominal surgery. Which information is important for the nurse to share with the patient when providing patient education about effective pain management? a. "To prevent overdose, you need to wait to ask for pain medication until you begin to experience pain." b. "You should take your medication after you walk to make sure you do not fall while you are walking." c. "We should work together to create a schedule to provide regular dosing of medication." d. "When you experience severe pain, you will need to take oral pain medications."

Answer: c. "We should work together to create a schedule to provide regular dosing of medication." Rationale: One way to maximize pain relief while potentially decreasing opioid use is to administer analgesics around the clock (ATC) rather than on a prn basis. This approach ensures a more constant therapeutic blood level of an analgesic. Working with the patient to design a schedule allows the patient to be a full partner in the care provided. The nurse should not wait until pain is experienced because it takes medications 10-30 minutes to begin to relieve pain. The nurse administers pain medications before painful activities, such as walking, and administers intravenous medications when a patient is having severe pain.

2. A nurse is caring for a patient who recently had abdominal surgery and is experiencing severe pain. The patient's blood pressure is 110/60 mm Hg, and heart rate is 60 beats/min. Additionally, the patient does not appear to be in any distress. Which response by the nurse is most therapeutic? a. "Your vitals do not show that you are having pain; can you describe your pain?" b. "OK, I will go get you some narcotic pain relievers immediately." c. "What would you like to try to alleviate your pain?" d. "You do not look like you are in pain."

Answer: c. "What would you like to try to alleviate your pain?" Rationale: Be sure the patient is a partner in making decisions about the best approaches for managing pain. A patient knows the most about his or her pain and is an important partner in selecting successful pain therapies. The nurse must believe that a patient is in pain whenever the patient reports that he or she is in pain, even if the patient does not appear to be in pain. The nurse must be careful to not judge the patient based on vital signs or nonverbal communication and must not assume that the patient is seeking narcotics. The patient is a partner in pain management, so going to get narcotics to treat the pain without consulting with the patient first is not appropriate.

20. The nurse has brought a patient the scheduled pain medication. The patient asks the nurse to wait to give pain medication until the time for the dressing change, which is 2 hours away. Which response by the nurse is most therapeutic? a. "This medication will still be providing you relief at the time of your dressing change." b. "OK, swallow this pain pill, and I will return in a minute to change your dressing." c. "Would you like medication to be given for dressing changes in addition to your regularly scheduled medication?" d. "Your medication is scheduled for this time, and I can't adjust the time for you. I'm sorry, but you must take your pill right now."

Answer: c. "Would you like medication to be given for dressing changes in addition to your regularly scheduled medication?" Rationale: Additional doses of medication can be given to patients in certain circumstances, as with an extensive dressing change, when the health care provider is notified that more medication is needed. It is the nurse's responsibility to communicate with the provider and with the patient about a pain-control plan that works for both. By asking to hold off on the dose, the patient is indicating that the dressing changes are extremely painful. The regularly scheduled dose might not be as effective for the patient 2 hours later when the dressing change is scheduled. Oral medications take 30 to 60 minutes to take effect. If the nurse began the dressing change right then, the medication would not have been absorbed yet. The patient has the right to refuse to take a medication.

6. The nurse is preparing pain medications. To which patient does the nurse anticipate administering an opioid fentanyl patch? a. A 15-year-old adolescent with a fractured femur b. A 30-year-old adult with cellulitis c. A 50-year-old patient with prostate cancer d. An 80-year-old patient with a broken hip

Answer: c. A 50-year-old patient with prostate cancer Rationale: Transdermal fentanyl (patch), which is 100 times more potent than morphine, is available for opioid-tolerant patients with cancer or chronic pain (prostate cancer). It delivers predetermined doses that provide analgesia for up to 72 hours. The other patients are expected to experience acute pain (fractured femur, cellulitis, and broken hip). Therefore, they will most likely benefit from oral or IV opioids for short-term pain relief.

21. A nurse receives an order from a health care provider to administer hydrocodone and acetaminophen (Vicodin ES 7.5/750), to a patient who is experiencing 8/10 postsurgical pain. The order is to give 2 tablets every 6 hours by mouth as needed for pain. What is the nurse's next best action? a. Give the Vicodin ES to the patient immediately because the patient is experiencing severe pain. b. Ask the health care provider for a nonsteroidal antiinflammatory drug (NSAID) order. c. Ask the health care provider to verify the dosage and frequency of the medication. d. Give the Vicodin ES in addition to playing soothing music for the patient.

Answer: c. Ask the health care provider to verify the dosage and frequency of medication. Rationale: The maximum 24-hour dosage for acetaminophen is 4 grams. If the patient took 2 tablets of Vicodin ES every 6 hours, the patient would take in 6 grams of acetaminophen in 24 hours (2 tablets = 750 + 750 = 1500 4 [could have 4 doses in 24 hours every 6 hours] = 6000 mg = 6 g). This exceeds the safe dosage of acetaminophen, so the best action is to question this order. Giving the medication as ordered would possibly result in the patient's taking more acetaminophen than is considered a safe dose. Acetaminophen overdose can result in liver failure. NSAIDs are used to treat mild to moderate pain. At this moment, the patient is experiencing severe pain. Implementing music therapy is a nursing intervention and is an independent nursing action that can be instituted with pain medication, but the possible acetaminophen dose is the priority.

18. The nurse is evaluating the effectiveness of guided imagery for pain management as used for a patient who has second- and third-degree burns and needs extensive dressing changes. Which finding best indicates the effectiveness of guided imagery? a. The patient's facial expressions are stoic during the procedure. b. The patient rates pain during the dressing change as a 6 on a scale of 0 to 10. c. The patient's need for analgesic medication decreases during the dressing changes. d. The patient asks for pain medication during the dressing changes only once throughout the procedure.

Answer: c. The patient's need for analgesic medication decreases during the dressing changes. Rationale: If the patient needs less pain medication during dressing changes, then guided imagery is helping to manage the patient's pain. The purpose of guided imagery is to allow the patient to alter the perception of pain. Guided imagery works in conjunction with analgesic medications, potentiating their effects. A rating of 6 on a 0 to 10 scale indicates that the patient is having moderate pain and shows that this patient is not experiencing pain relief at this time. A person who is stoic is not showing feelings, which makes it difficult to know whether or not the patient is experiencing pain. Having to ask for pain medication during the dressing changes indicates the guided imagery is not effective.

14. A patient who has had type 2 diabetes for 26 years is beginning to experience peripheral neuropathy in the feet and lower leg. The nurse is providing education to the patient to prevent injury to the feet by wearing shoes or slippers when walking. Which statement made by the nurse best explains the rationale for this instruction? a. "Wearing shoes blocks pain perception and helps you adapt to pain, which ends up protecting your feet." b. "Shoes provide nonpharmacological pain relief to people with diabetes and peripheral neuropathy." c. "The neurological gates open when wearing shoes, which protects your feet." d. "If you step on something without shoes, you might not feel it; this could possibly cause injury to your foot."

Answer: d. "If you step on something without shoes, you might not feel it; this could possibly cause injury to your foot." Rationale: Any factor that interrupts or influences normal pain reception or perception (e.g., spinal cord injury, peripheral neuropathy, or neurological disease) affects a patient's awareness of and response to pain. The patient will no longer have protective reflexes to prevent injury to the feet. Wearing shoes prevents the patient from injuring the feet because they protect the feet. Shoes do not block pain perception, and they do not help people adapt to pain. Shoes are not a form of nonpharmacological pain relief. Wearing shoes will not have an effect on opening or closing the pain gates.

30. The nurse is caring for a patient who suddenly experiences chest pain. What is the nurse's first priority? a. Call the rapid response team. b. Start an intravenous (IV) line. c. Administer pain-relief medications. d. Ask the patient to rate and describe the pain.

Answer: d. Ask the patient to rate and describe the pain. Rationale: The nurse's ability to establish a nursing diagnosis, plan and implement care, and evaluate the effectiveness of care depends on an accurate and timely assessment. The other responses are all interventions; the nurse cannot know which intervention is appropriate until the nurse completes the assessment.

19. A nurse is providing medication education to a patient who just started taking ibuprofen. Which information will the nurse include in the teaching session? a. Ibuprofen helps to depress the central nervous system to decrease pain perception. b. Ibuprofen reduces anxiety, which will help you cope with your pain. c. Ibuprofen binds with opiate receptors to reduce your pain. d. Ibuprofen inhibits the production of prostaglandins.

Answer: d. Ibuprofen inhibits the production of prostaglandins. Rationale: NSAIDs like ibuprofen likely work by inhibiting the synthesis of prostaglandins to inhibit cellular responses to inflammation. Ibuprofen does not depress the central nervous system, nor does it enhance coping with pain. Opioids bind with opiate receptors to modify perceptions of pain

8. A woman is in labor and refuses to receive any sort of anesthesia medication. Which alternative treatment is best for this patient? a. Transcutaneous electrical nerve stimulation (TENS) b. Herbal supplements with analgesic effects c. Pudendal block (regional anesthesia) d. Relaxation and guided imagery

Answer: d. Relaxation and guided imagery Rationale: In the case of a patient in labor, relaxation with guided imagery is often an effective supplement for pain management because it provides women with a sense of control over their pain. Relaxation and guided imagery can be used during any phase of health or illness. TENS units are typically used to manage postsurgical and procedural pain. Herbal supplements need to be evaluated for safety during pregnancy. Additionally, some patients consider herbal supplements to be another form of medication, and they are not typically used to control acute pain. A pudendal block is a type of regional anesthesia (injection or infusion of local anesthetics to block a group of sensory nerve fibers); use of it does not respect the patient's wishes for nonpharmacological pain control.

27. The nurse is administering pain medication for several patients. Which patient does the nurse administer medication to first? a. The patient who needs to be premedicated before walking b. The patient who has a PCA running that needs the syringe replaced c. The patient who needs to take a scheduled dose of maintenance pain medication d. The patient who is experiencing 8/10 pain and has an immediate order for pain medication

Answer: d. The patient who is experiencing 8/10 pain and has an immediate order for pain medication. Rationale: Immediate (STAT) medications need to be given as soon as possible. In addition, this patient is the priority because of the report of severe pain. The other patients need pain medication, but their situations are not as high a priority as that of the patient with the STAT medication order.

15. A nurse is assessing a patient who started to have severe pain 3 days ago. When the nurse asks the patient to describe the pain, the patient states, "The pain feels like it is in my stomach. It is a burning pain, and it spreads out in a circle around the spot where it hurts the most." Which type of pain does the nurse document the patient is having at this time? a. Superficial pain b. Idiopathic pain c. Chronic pain d. Visceral pain

Answer: d. Visceral pain Rationale: Visceral pain arises from visceral organs, such as those from the gastrointestinal tract. Visceral pain is diffuse and radiates in several directions and can have a burning quality. Superficial pain has a short duration and is usually a sharp pain arising from the skin. Pain of an unknown cause is called idiopathic pain. Chronic pain lasts longer than 6 months.

Primary, secondary or tertiary intention? Surgical wound, closed

Primary

Primary, secondary or tertiary intention? an abdominal wound that is kept open in order to allow drainage, and then later closed

T