Chapter 9: Assessing Pain
A client is reporting pain and rates it as 7 on a scale of 1 to 10. When the nurse asks him to describe the pain, he states, "It feels like a knife is stabbing or cutting me." The nurse knows that this type of pain is conducted by which fibers?
A-delta fibers Explanation: A-delta fibers are myelinated and conduct impulses rapidly, resulting in pain being described as sharp or stabbing. C fibers are unmyelinated and cause pain that is achy and ongoing. There are no known AC or P fibers related to pain.
A nurse is assessing the effect of a client's chronic back pain on his affective dimension. Which question should the nurse ask for this assessment?
How does the pain influence your overall mood? Explanation: The question regarding the influence of the pain on mood would address the client's affective dimension, which includes feelings and emotions that result from the pain. The question regarding medical conditions would help assess the client's physical dimension. The question regarding the location of the pain would address the client's sensory dimension. The question regarding the client's education would address his cognitive dimension.
Beliefs of health care providers can serve as barriers to an accurate assessment of a client's pain. Which of the following beliefs will not be likely to impair the assessment of pain?
Infants can feel pain and may respond with crying or agitation. Explanation: It is hard to evaluate pain in neonates and infants. Behaviors that indicate pain are used to assess their pain. Crying and not being able to be consoled indicate pain in this population.
A nurse begins to assess pain in a client admitted to the hospital for new onset of severe nausea and vomiting. What question should the nurse ask the client to assess the pattern of pain?
"How often do you experience the pain?" Explanation: The nurse uses a mnemonic device including but not limited to OLD CART or COLDSPA to elicit information from a client about the pain. The nurse should assess for patterns by asking questions that elicit information about what makes the pain better or worse. Asking the client how often the pain occurs will help the nurse understand the course of the pain and if there is any pattern that may help identify the source of the pain. Asking about onset of the pain is essential to determine the severity of the situation. Therapies alert the nurse to the effect of treatment modalities that have or have not been successful in alleviating the pain. Location helps to identify the underlying cause.
The nursing instructor is teaching a class about how to assess pain in older adults. The teachers tells the students that problems can arise in certain circumstances. The instructor realizes the need for more teaching about pain in the elderly when one of the students replies:
"Pain is a natural part of aging." Explanation: Pain is prevalent in older adults; however, some of them mistakenly believe pain to be a normal part of aging. Older clients may be afraid to report pain for many different reasons. They may not want pain to interfere with their independence. They may worry that medical attention to their pain will lead to costly tests. They also may fear that healthcare providers will not see them as "good" clients if they mention pain, and so they try to mask it.
Which of the following clients would be classified as having chronic pain?
A client with rheumatoid arthritis Explanation: Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Acute pain is generally rapid in onset, varies in intensity from mild to severe. After its underlying cause is resolved, acute pain disappears. It should end once healing occurs.
As a nurse is adjusting a client's hospital bed, the nurse accidently pinches a finger between the bed and the wall. Which of the following components is involved in the transduction of the pain the nurse feels?
A-delta and C fibers Explanation: The nurse is experiencing nociceptive or somatic pain. A-delta fibers are large nerve fibers covered with myelin that conduct pain impulses rapidly. The sharp or stabbing pain the nurse feels as the finger is pinched involves these fibers. C fibers are smaller, unmyelinated nerve fibers that conduct pain impulses more diffusely and slowly. The achy pain that lingers after the nurse has withdrawn the finger—that the nurse might "shake off"—involves these fibers. Neuronal plasticity refers to changes in pain signal processing due to a prolonged stimulus; the result is chronic sensation of pain after the original stimulus is removed. There are no "K-fibers" or "L-beta fibers."
The nurse is working on a pediatric unit caring for a 4-year-old who is recovering from the surgical repair of the pelvis. When assessing the client's pain, what is the most appropriate pain assessment tool for the nurse to use?
ACES Pain Scale Explanation: Children 2 years and older can identify pain and point to its location. You can use a facial expression scale for children starting at approximately 3 years. The FACES scale uses six faces ranging from happy with a wide smile to sad with tears on the face.
A pathophysiology instructor is discussing pain and its treatment across cultures. The instructor points out that clients from racial and ethnic minorities often receive less pain medication compared to Caucasians for what specific conditions?
Acute pain in the ED Explanation: African Americans, Hispanic Americans, and other clients of racial and ethnic minority heritage receive less pain medication compared to Caucasians across a range of conditions, including cancer pain, acute postoperative pain, chest pain, acute pain presenting in the ED, and chronic low back pain. This disparity may be the result of client variables such as nociceptive differences, communication processes, or pain behaviors.
A client presents to the health care clinic with reports of a 2-day history of sore throat, ear pressure, fever, and stiff neck. The client states she has taken Tylenol and lozenges without relief. Which nursing diagnosis can be confirmed by this data?
Acute pain related to sore throat Explanation: The client describes pain of 2 days' duration, which is within the definition for acute pain. The client did not describe or display any major defining characteristics of anxiety such as restlessness, concern about lifestyle changes, or sleep disturbances. The stiff neck was not confirmed by objective data collected by the nurse. No evidence exists for the client to have risk for deficient fluid volume.
A post-operative client is observed breathing 24 breaths/minute while complaining of 10/10 abdominal pain. The client's oxygen saturation is 90% on 2 liters nasal cannula. What is the nurse's priority action?
Administer prescribed analgesia as ordered. Explanation: The client is complaining of a the highest level of pain at 10/10. Therefore, the increased respirations and low oxygen saturation are likely a result of hypoventilation due to pain. Acute pain that is not adequately treated can impair pulmonary function. When the client is suffering from an intense amount of time, the client may not be very receptive to teaching and explanations. The client may have the desire to cough and deep breathe but is unable to due to the intensity of pain. The client can still breathe on his/her own, so an ambu bag is not needed.
Which of the dimensions of pain listed is being assessed by the question "How does the pain treatment you are getting affect your overall mood?"
Affective. Explanation: The affective dimension concerns feelings, sentiments, and emotions related to the pain experience. The pain can affect the emotions and the emotions can affect the perception of pain.
During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is which of the following?
Analgesics Explanation: Analgesics are most often the primary treatment measure for pain, although a growing trend involves the integration of complementary, nonpharmacologic measures with conventional medicine.
How may a nurse demonstrate cultural competence when responding to clients in pain?
Avoid stereotyping responses to pain by clients. Explanation: Culture influences an individual's response to pain. It is particularly important to avoid stereotyping responses to pain because the nurse frequently encounters clients who are in pain or anticipating it will develop. A form of pain expression that is frowned on in one culture may be desirable in another cultural group.
The nurse is caring for a client who is experiencing visceral pain. What is this client's most likely diagnosis?
Appendicitis Explanation: Visceral pain originates from abdominal organs; clients often describe this pain as crampy or gnawing.
The nurse should assess for which pain complaints from a client diagnosed with Type II Diabetes Mellitus?
Burning, tingling Explanation: The nurse should assess for neuropathic pain associated with diabetic neuropath. Neuropathic pain: Pain that results from damage to nerves in the peripheral or central nervous system (Staats, et al., 2004). Examples of neuropathic pain include diabetic peripheral neuropathy, post herpetic neuralgia, and postmastectomy pain. You should also be alert for the common terms that clients use to report neuropathic pain, such as burning, painful tingling, pins and needles, and painful numbness.
In preparing a care plan for a client receiving opioid analgesics, the nurse selects which of the following as an applicable nursing diagnosis associated with side effects of opioid use?
Constipation Explanation: The most common side effects associated with opioid use are sedation, nausea, and constipation. Respiratory depression is also a commonly feared side effect of opioid use.
A male client with a history of a back injury 2 months ago has been taking daily doses of narcotic pain medication. He is currently hospitalized with a leg fracture after falling down the stairs. He complains of 10/10 pain in his back and leg after taking pain medication one hour ago. What is the nurse's best action?
Consult with the healthcare provider about increasing the dose of medication. Explanation: Clients with a history of opioid tolerance pose difficult challenges for pain assessment (D'Arcy, 2014). They have an altered physiologic response to the pain stimulus, and the repeated use of opioids causes their bodies to become more sensitive to pain. This sensitivity is called opioid hyperalgesia and can occur as soon as 1 month after opioid use begins. Not only are clients with opioid tolerance more sensitive to pain, they face a high level of bias from health care providers. Because these clients are more sensitive to pain, they often report high levels of pain with little relief from usual doses of opioids. They are often labeled as drug seeking.
A nurse assesses a client with acute small-bowel obstruction who reports intermittent pain. He only noticed symptoms of this condition earlier today. Which questions are appropriate for the nurse to ask when assessing the client's pain? Select all that apply.
Describe the pain. Where is the pain located? When did the pain start? Explanation: The nurse should ask the client to describe the pain, its location, and its starting time. When the client describes the pain in his or her own words, it will indicate the source and type of the pain. The location of the pain helps to identify the underlying cause. The onset of pain is an essential indicator for the severity of the situation, as well as the fact that it suggests a source. Stating past experiences with pain and the therapies used earlier are inappropriate in this case because the client's condition is acute, not chronic; thus, he would have no past experiences with this condition or with therapies used to treat this condition. Moreover, these two questions are part of the personal health history and are not specific to the client's chief complaint.
Which of the following is not released during the stress response?
Dopamine Explanation: The stress response causes the release of epinephrine, norepinephrine, and cortisol.
A client has been taught relaxation exercises before beginning a painful procedure. What chemicals are believed to be released in the body during relaxation to relieve pain?
Endorphins Explanation: Endorphins, which are opioid neuromodulators, are produced at neural synapses at various points in the CNS pathway. They have prolonged analgesic effects and produce euphoria. It is suggested that they may be released when measures such as skin stimulation and relaxation techniques are used.
The nurse is working in the post anesthesia care unit and assessing pain in a 6 month old infant. Which method should the nurse use to assess the infant's pain?
FLACC scale. Explanation: The FLACC (Face, Legs, Activity, Cry, Consolability) scale was originally designed to measure acute postoperative pain in children 2 months to 7 years old. Heart rate and respirations are part of an infant pain assessment; however the FLACC scale is the most comprehensive tool. The BPIQ (brief pain impact questionnaire) is used mainly to assess chronic pain in adults.
The nurse is caring for a 4-week-old postoperative client. The most appropriate pain assessment tool would be the:
Face, Legs, Activity, Cry, Consolability Scale Explanation: The Face, Legs, Activity, Cry, Consolability Scale is the appropriate pain assessment tool for a 4-week-old postoperative client. This tool measures pain using observable behaviors as pain indicators. The FACES Pain Scale is appropriate for children age 3 and older, using six faces ranging from happy with a wide smile to sad with tears on the face. The other two scales are appropriate for use with older children and adults. The Numeric Pain Intensity Scale is a one-dimensional pain scale using an 11-poing Likert-type scale ranging from 0 to 10, where 0 means "no pain" and 10 means "worst possible pain." The Combined Thermometer Scale looks like a thermometer and has both numbers that increase from the bottom up and descriptor words to measure pain intensity.
A nurse assesses a cognitively impaired adult client who grimaces and points to the right knee following a motor vehicle accident. Which pain scale would be most appropriate for the nurse to use to assess the client's pain?
Faces Pain Scale Explanation: The nurse should use the Faces Pain Scale (FPS) to rate the pain felt by the client. The FPS shows different facial expressions; the client is asked to choose the face that best describes the intensity or level of pain being experienced. This tool is best suited for cognitively impaired adults. A Verbal Descriptor Scale (VDS) ranges pain on a scale between mild, moderate, and severe. The Numeric Rating Scale (NRS) rates pain on a scale from 0 to 10: 0 reflects no pain and 10 reflects pain at its worst. It has been shown to be best for older adults with no cognitive impairment. The Visual Analog Scale (VAS) rates pain on a 10-cm continuum numbered from 0 to 10: 0 reflects no pain and 10 reflects pain at its worst. These scales would require verbal communication between the client and the nurse.
Nurses use the FLACC scale to assess pain in children ages 2 months to 7 years. This scale uses which of the following indicators? (Select all that apply.)
Facial expression Leg movements Activity Cry Ability to console client
The nursing student asks the nurse what would be an example of visceral pain. What would be the correct response by the nurse?
Gallbladder pain Explanation: Visceral pain originates from abdominal organs, such as the gallbladder. Burns cause cutaneous pain, which is derived from the dermis, epidermis, and subcutaneous tissues. Referred pain originates from a specific site, but is experienced in another site along the innervating spinal nerve, such as occurs with cardiac pain. Somatic pain originates from skin, muscles, bones, and joints, such as arthritic pain.
When reviewing a client's medication administration record, the nurse should plan to administer a medication containing which substance that blocks pain sensations?
Gamma-aminobutyric acid Explanation: Pain-facilitating substances: • Substance P • Bradykinin • Glutamate Pain-blocking substances: • Serotonin • Opioids (both natural and synthetic) • Gamma-aminobutyric acid: gabapentin (Neurontin) and pregabalin (Lyrica)
What is the most commonly accepted theory of pain?
Gate control theory Explanation: Currently, the theory of pain with the widest acceptance is the gate control theory. The other three options do not represent a theory of pain.
A client on a medical-surgical unit reports pain of 10 on a scale of 0 to 10 and wants more pain medication. The nurse does not think the pain is as bad as the client says. The physician left orders for prn morphine for breakthrough pain. What is the priority nursing action?
Give the prn morphine Explanation: Pain is what the client says it is, and it exists whenever the client says it does. It would not be appropriate to hold the medic
A client complains of pain in several areas of the body. How should the nurse assess this client's pain?
Have the client rate each location separately. Explanation: When assessing pain location, ask the client to point to the painful area. If more than one area is painful, have the client rate each one separately, and note which area is the most painful. Marking each site is not necessary practice for assessing pain. Pain is a subjective sensation for the client. Radiating pain is notable, because such radiation may affect treatment choices.
A student nurse learns that especially in the very young and very old pain can be inadequately treated. What else would the student learn about inadequate pain treatment in the very young?
It can lead to neurodevelopmental problems Explanation: Inadequate pain treatment can lead to a delay in healing and behavioral consequences, such as learning disabilities, psychiatric disorders, and neurodevelopmental problems. It does not increase hormonal disorders, nutritional deficiencies, or client compliance with medication.
The U.S. government has created guidelines for health care providers caring for clients in pain. Which of the following reflect these guidelines?
Joint Commission Standards for Pain Management. Explanation: Joint Commission Standards for Pain Management were revised and published in 2000-2001. The standards require health care providers and organizations to improve pain assessment and management for all clients.
The nurse understands the importance of performing an accurate pain assessment. In addition to having the client rate the pain on a pain scale, other things to assess are the following: (Check all that apply.)
Location and duration Quality and description Alleviating and aggravating factors Explanation: In a pain assessment. the nurse asks the client to use a pain scale to rate the intensity of the pain. Other areas to assess are location and duration, quality and description, and any alleviating or aggravating factors. Although the nurse would want to assess the client's allergies before giving pain medications, diet is not included, nor is urinary output or oxygenation.
A construction worker in his mid-40s suffered a severe laceration on his leg while on the job site. Soon after he arrives at the emergency room, a nurse assesses his pain. The client states that pain, although severe, has lessened since the accident first occurred. The nurse knows that the pain message likely has been inhibited by release of endorphins and other neurotransmitters. Which physiological process does this represent?
Modulation Explanation: Modulation is the physiological process whereby brain stem neurons release endogenous neurotransmitters (e.g., endorphins, enkephalins, and serotonin), which inhibit the transmission of pain. Transduction is the process whereby injured tissue releases chemicals that affect nociceptors, sending the pain message up the sensory neuron. Transmission is the process whereby the pain impulse from the nociceptors relays the pain from the spinal cord to the brain. Perception is the process whereby pain is perceived in the brain.
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?
Modulation Explanation: The client is in the modulation phase of pain, during which the brain interacts with the spinal nerves in a downward fashion to subsequently alter the pain experience. The client is not in the transduction, transmission, or perception phase of pain. Transduction phase refers to the conversion of chemical information at the cellular level into electrical impulses that move toward the spinal cord. In transmission phase, the stimuli move from the peripheral nervous system toward the brain, and the perception phase occurs when the pain threshold is reached.
A client recovering from a stroke complains of pain. The nurse suspects this client is most likely experiencing which type of pain?
Neuropathic Explanation: Neuropathic pain can occur from central nervous system brain injury caused by a stroke. Nociceptive pain is caused by tissue damage. Somatic pain is another term used for nociceptive pain. Idiopathic pain does not have an identified cause.
When clients report pain, it is important to find the source. When clients describe pain as "burning, painful numbness, or tingling," the source is more than likely:
Neuropathic Explanation: Visceral pain originates from abdominal organs and is often described as crampy or gnawing. Somatic pain originates from the skin, muscles, bones, and joints. Referred pain originates from a specific site, but the client experiencing the pain feels it at another site along the innervating spinal nerve. Neuropathic pain is described as burning, painful numbness, or tingling.
A 12-year-old boy has reported to the emergency department after having fallen off his bicycle and sustained what appear to be minor injuries. The nurse is assessing him for pain. Which of the following objective findings would most tend to indicate pain?
Nodding up and down in response to questions Explanation: Nodding up and down or saying, "yeah, yeah," may not indicate a client's positive response to questions, but rather may indicate just listening or not wanting to be negative, as responding verbally or in detail would require too much effort while the client is in pain. The other findings listed would all tend to indicate a lack of pain: upright posture, sustained eye contact, and maintaining a consistent position and posture.
Which of the following cultural expressions of pain would be likely to be found in a person of Hispanic culture?
Pain must be endured to perform gender role duties, but response to it is very expressive. Explanation: In the Hispanic culture pain response is often very expressive, though pain must be endured to perform gender role duties.
Which of the following principles should the nurse integrate into the pain assessment and pain management of pediatric clients?
Pain assessment may require multiple methods in order to ensure accurate pain data. Explanation: It is often necessary to use more than one technique for pain assessment in children. Though their neurological system is indeed developing, children feel pain acutely, and it is inappropriate to withhold analgesics until they are a "last resort." It is simplistic to specify a numeric pain scale for all clients above a certain age; the assessment tool should reflect the client's specific circumstances, abilities, and development.
A client is admitted for treatment of pneumonia. When conducting a pain assessment, which area on the diagram provided should the nurse expect the client to experience referred pain because of this health problem?
Pain generating from the lung and diaphragm is referred to the left side of the neck.
A nurse is caring for an elderly client who is unable to walk without a support due to knee pain. During his initial assessment, however, the client does not mention pain. Which of the following beliefs common in elderly clients may cause them to underreport their pain?
Pain is a normal part of aging Explanation: When assessing elderly clients, the nurse should remember that they often underreport pain. Many elderly people believe that pain is a normal part of aging, may be a punishment for past actions, may result in a loss of independence, and may indicate that death is near. Elderly clients usually do not believe that pain is harmless, that medicine will eliminate pain, or that pain will draw the family closer to the elderly client.
The charge nurse on a geriatric unit should further educate a new staff nurse who makes which statement?
Pain sensation is diminished in older adults. Explanation: Little is known about the effect of increased age on pain perception. No evidence suggests that pain sensation is diminished in older adults, which is a common misperception. Transmission along the A-delta and C fibers may become altered with aging, but it is not clear how this change affects the pain experience. Studies of sensitivity and pain tolerance have indicated that changes in pain perception are probably not clinically significant. Because older people are likely to experience more adverse effects from analgesia, especially from opiates, health care providers may undertreat pain in older adults.
A client enters the emergency department moaning and complaining of severe pain in his lower back. Which of the following clinical manifestations should the nurse expect to see in this client as a physiologic response to pain? Select all that apply.
Perspiration Increased heart rate Sleeplessness Explanation: Sleeplessness, perspiration, and increased heart rate are physiologic responses to pain. Pain elicits a stress response in the human body that triggers the sympathetic nervous system. Hyperglycemia, not hypoglycemia, and decreased, not increased, intestinal motility are physiologic responses to pain.
The nurse is using the Visual Analog Scale to assess pain of an adult client. The nurse instructs the client to:
Place a mark on a 100-mm line with "no pain" at one end and "worst possible pain" at the other Explanation: The Visual Analog Scale is a 100-mm line with "no pain" at one end and "worst possible pain" at the other. The Numeric Pain Intensity Scale is a one-dimensional pain scale using an 11-poing Likert-type scale ranging from 0 to 10, where 0 means "no pain" and 10 means "worst possible pain." The Combined Thermometer Scale looks like a thermometer and has both numbers that increase from the bottom up and descriptor words to measure pain intensity. The Brief Pain Impact Questionnaire is a short questionnaire comprised of open ended questions to assess pain
The client comes to the emergency department reporting indigestion and left arm pain. The physician orders an EKG along with drawing of cardiac enzymes. When the results are back, the client is informed of the diagnosis of heart attack. The indigestion and arm pain are examples of which of the following?
Referred pain Explanation: Referred pain originates from a specific site, but the person feels the pain at another site along the innervated spinal nerve. An example is cardiac pain that the person experiences as arm pain and indigestion. Visceral pain originates from abdominal organs. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. Somatic pain originates from skin, muscles, bones, and joints.
Which assessment finding is consistent with the presence of pain?
Restlessness Explanation: Common assessment findings that are present when a client is in pain include restlessness, grimacing, crying, clenching fists, guarding of the painful area, increased blood pressure and pulse, and reported pain.
A client who suffers from arthritis complains of sharp pain in her knees and elbows. The nurse recognizes this is what type of pain?
Somatic Explanation: Pain nociception has various locations. Visceral pain originates from abdominal organs; clients often describe this pain as crampy or gnawing. Somatic pain originates from skin, muscles, bones, and joints; clients usually describe somatic pain as sharp (D'Arcy, 2014). Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. It is often burning or sharp, such as with a partial-thickness burn. Referred pain originates from a specific site, but the person experiencing it feels the pain at another site along the innervating spinal nerve.
A client recovering from abdominal surgery is complaining of pain. The nurse realizes that the client is most likely experiencing which type of pain?
Somatic Explanation: Somatic pain is caused by tissue damage, which would occur after abdominal surgery. Psychogenic pain relates to factors that influence the client's report of pain such as anxiety and depression. Idiopathic pain does not have an identified cause. Neuropathic pain results from direct injury to the peripheral or central nervous system.
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 which of the following?
Somatic pain Explanation: Somatic pain is diffuse or scattered pain, and it originates in tendons, ligaments, bones, blood vessels, and nerves. Cutaneous pain usually involves the skin or subcutaneous tissues. Visceral pain is poorly localized and originates in body organs. Phantom pain occurs in an amputated leg for which receptors and nerves are clearly absent, but the pain is a real experience for the client.
Which of the following statements most accurately conveys an aspect of the gate-control theory?
Specialized cells can decrease pain transmission by exciting inhibitory neurons. Explanation: According to the gate-control theory, the excitation of inhibitory interneurons can inhibit pain. Peripheral receptors, the spinal cord, and the brain are all involved in the process, and endorphins can decrease pain. The gate-control theory identifies the way that pain and emotional state affect each other.
An elderly farmer has sustained severe injuries after a serious accident involving a combine harvester. At the hospital, he tells the nurse that he thinks the pain he is feeling now is "payback" for living a "mean, selfish life." The nurse recognizes that this response by the man indicates which dimension of pain?
Spiritual dimension Explanation: The spiritual dimension refers to the meaning and purpose that the person "attributes to the pain, self, others, and the divine." In this case, it seems that the man is interpreting his accident and subsequent pain as divine retribution for his past wrongdoings. The cognitive dimension concerns "beliefs, attitudes, intentions, and motivations related to the pain and its management." The sociocultural dimension concerns the influences of the client's social context and cultural background on the client's pain experience. The affective dimension concerns feelings, sentiments, and emotions related to the pain experience.
The nurse is explaining the difference between acute pain and chronic pain to the client. Which should the nurse include in the explanation?
The cause of acute pain can be identified. Explanation: Acute pain is of short duration and has an identifiable cause. Chronic pain lasts beyond the normal healing period of 3 to 6 months. Neuropathic pain results from damage to nerves in the peripheral or central nervous system.
A nurse is meeting for the first time a 42-year-old client whose visit to the clinic has been prompted by her chief complaint of ongoing lower back pain. Which of the following approaches to pain assessment should the nurse use when assessing the client's pain?
The nurse should use a pain assessment tool that is simple but still addresses the major parameters of pain. Explanation: Pain assessment requires an instrument that is easy to use, clinically valid, and easy to evaluate. An instrument that is too detailed is a liability; while the nurse should be responsive to the client's priorities and identified needs, it would inappropriate to wholly delegate the character and direction of assessment to the client. Pain assessment is highly dependent on subjective data, and these findings would not be minimized or discounted.
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 endorphins Explanation: Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that certain measures such as skin stimulation and relaxation techniques release endorphins.
The Joint Commission mandates that nurses assess and reassess a client's pain level. A nurse's healthcare facility mandates pain reassessment at 30 minutes for any drug given intravenously. This mandate is based on what?
The time it takes a pain medication to decrease pain intensity Explanation: Most healthcare facilities have a standard time frame for reassessment, such as 1 hour for oral medication and 30 minutes for pain medication given intravenously. Standards are based on the time it takes a pain medication to provide a noticeable decrease in pain intensity. The mandate from The Joint Commission does not look at the half-life of the pain medication, because the half-life would differ from drug to drug, and no drug is listed in the question. The pain medication does not block pain, but decreases the pain intensity. Research does not support that intravenous medication take half as long to work as oral medication, because this information depends on the individual drug and the chemical makeup of the drug.
A client injures his thumb by accidently slamming the car door shut on it. He arrives at the emergency department in intense pain. Which of the following processes is associated with the transduction process of this pain?
Tissue injury leading to inflammation Explanation: Transduction of pain begins when a mechanical, thermal, or chemical stimulus results in tissue injury or damage, resulting in an inflammatory process. The transmission process is initiated by this inflammatory process, resulting in the conduction of an impulse in the primary afferent neurons to the dorsal horn of the spinal cord. The process of pain perception involves the hypothalamus and limbic system, which are responsible for the emotional aspect of the pain perception, and the frontal cortex, which is responsible for the rational interpretation and response to pain. Modulation changes or inhibits the pain message relay in the spinal cord.
What is the element of pain transmission that causes nociceptors to perceive a nerve impulse?
Transduction Explanation: In transduction, noxious stimuli create enough of an energy potential to cause nociceptors (free nerve endings) to perceive a nerve impulse. Transmission is when the neuronal signal moves from the periphery to the spinal cord and up to the brain. Perception is when higher areas of the brain perceive the impulse being transmitted as pain. Modulation is the action of inhibitory and facilitating input from the brain modulating or influencing sensory transmission at the level of the spinal cord.
A nurse is caring for a client whose injured cells are releasing chemicals such as substance P, prostaglandins, bradykinin, histamine, and glutamate. Which phase of pain is the client experiencing?
Transduction Explanation: The client is going through the transduction phase, which is the first phase of pain in which injured cells release chemicals such as substance P, prostaglandins, bradykinin, histamine, and glutamate. The client is not going through the transmission, perception, or modulation phase of pain. Transmission is the phase during which stimuli move from the peripheral nervous system toward the brain. Perception occurs when the pain threshold is reached. Modulation is the last phase of pain impulse transmission, during which the brain interacts with the spinal nerves to alter the pain experience.
A nursing instructor is teaching the class about different theories of pain. The instructor informs the students that the most common clinical interpretation of pain transmission is called "nociception." The instructor includes the following components in nociception: (Check all that apply.)
Transduction Modulation Perception Transmission Explanation: The most common clinical interpretation of pain is a concept called nociception, which means the perception of pain by sensory receptors located throughout the body and nociceptors. The following are the four steps in nociception: transduction, transmission, perception, and modulation. Initiation is not associated with this process.
The nurse is assessing a client with a history of drug addiction. What will be helpful in determining interventions that will be most beneficial for providing adequate pain relief to this client?
Using in-depth questions to collect significant data about the client's pain Explanation: Use of in-depth questions to collect all the significant data from the pain assessment will be the biggest help in determining what types of interventions will be most beneficial for providing adequate pain relief to the client. Objective data are not shared by the client, and subjective data are not what the nurse notes during the assessment-these are what the client shares about the pain. While assessing a client's pain, the nurse needs to gather more information than is freely shared by the client.
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 Explanation: The client is experiencing visceral pain, which is associated with disease or injury. It is sometimes referred or poorly localized as it is not experienced in the exact site where an organ is located. In cutaneous pain, the discomfort originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma. Somatic pain develops from injury to structures such as muscles, tendons, and joints. Neuropathic pain is experienced days, weeks, or even months after the source of the pain has been treated and resolved.
A client has a severe abdominal injury with damage to the liver and colon from a motorcycle crash. What type of pain will predominate?
Visceral pain Explanation: Visceral pain is poorly localized and originates in body organs in the thorax, cranium, and abdomen. The pain occurs as organs stretch abnormally and become distended, ischemic, or inflamed.
Mark is a 20-year-old college student who 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 Mark most likely experiencing?
Visceral pain Explanation: Visceral pain occurs when organs stretch abnormally and become distended, ischemic, or inflamed. Appendicitis is characterized by inflammation of the vermiform appendix. Cutaneous pain is superficial and somatic pain is more commonly associated with tendons, ligaments, and bones. Referred pain is perceived distant from its point of origin, but this client's pain is sensed near the location of his appendix.
Acute pain can be differentiated from chronic pain because
acute pain is associated with a recent onset of illness or injury with a duration of less than 6 months, whereas chronic pain persists longer than 6 months. Explanation: Acute pain is usually associated with a recent injury or illness and lasts less than 6 months.
When assessing the client for pain, the nurse should
believe the client when he or she claims to be in pain. Explanation: "Pain is whatever the person says it is." It is important to remember this definition when assessing and treating pain.
A client describes pain in the soles of both feet as constantly burning. Which type of pain should the nurse suspect this client is experiencing?
neuropathic Explanation: Pain resulting from direct injury to the peripheral or central nervous system is termed neuropathic. Over time, neuropathic pain may become independent of the inciting injury and be described as burning. Somatic pain originates from skin, muscles, bones, and joints and is usually described as sharp. Referred pain is pain felt in a body area, away from the pain source. Visceral pain originates from abdominal organs and is usually described as cramping or gnawing.
