Chapter 9 Nursing Care of Patients in Pain

The nurse is explaining the pain response process to a patient experiencing chronic pain. In which order should the nurse identify the steps in the neural pain pathway? Place in order the steps of the process. Choice 1. In the thalamus and cerebral cortex, the pain impulse becomes pain when the sensation reaches conscious levels and is perceived and evaluated by the person experiencing the sensation. Choice 2. Dorsal horn synapses relay impulses up the spinal cord. Spinal neurons transmit the impulses via axons that cross over to the spinothalamic tract. Choice 3. The impulses ascend the spinothalamic tracts and pass through the medulla and midbrain to the thalamus. Choice 4. A noxious stimulus is perceived by cutaneous nociceptors and then transmitted through A-delta (AΔ) and even smaller C nerve fibers to the spinal cord dorsal horn.

. Answer: 4, 2, 3, 1 Explanation: Choice 1. This is the final step in the neural pain pathway. Choice 2. This is the second step in the neural pain pathway. Choice 3. This is the third step in the neural pain pathway. Choice 4. This is the first step in the neural pain pathway.

The nurse plans to assess a patient's pain perception. What should the nurse use for this assessment? A. PQRST guide B. FACES scale C. Psychological evaluation tool D. Biofeedback rating

. Answer: A Explanation: A. A patient's pain perception can be assessed by using the PQRST technique: P = What precipitated (triggered, stimulated) the pain? Has anything relieved the pain? What is the pattern of the pain? Q = What is the quality and quantity of the pain? Is it sharp, stabbing, aching, burning, stinging, deep, crushing, viselike, or gnawing? R = What is the region (location) of the pain? Does the pain radiate to other areas of the body? S = What is the severity of the pain? And T = What is the timing of the pain? When does it begin, how long does it last, and how is it related to other events in the patient's life? 1. The FACES scale is a pain-rating tool. 2. Use of a psychological evaluation tool is not indicated. 4. A biofeedback rating would not address all areas of a pain assessment.

A patient with a long history of pain rarely appears to be in pain and often forgoes the use of pain medication. What does the nurse realize about this patient? A. The patient has a high pain tolerance. B. The patient has a low pain tolerance. C. The patient is addicted to pain medication. D. The patientdoes not really have pain

. Answer: A Explanation: A. Pain tolerance describes the amount of pain a person can tolerate before outwardly responding to it. A patient with a high tolerance to pain would rarely report pain or need analgesic management. 2. With a low tolerance, the patient would be verbalizing pain and requesting medication. 3. If addicted, the patient would eventually need more medication, not less, to manage the pain. 4. There is no evidence that the patient is not in pain.

A patient reports experiencing deep, burning pain. In which way is this patient's pain being transmitted in the body? A. A-delta fibers B. Endorphins C. C fibers D. Dynorphins

1. Answer: C Explanation: C. The pain from deep body structures, such as muscles and viscera, is primarily transmitted by C fibers, producing diffuse burning or aching sensations. 2. A-delta fibers are myelinated and transmit impulses rapidly. They produce what is called fast pain or first pain, which is sharp, well-defined pain typically accompanying cuts, electric shocks, or the impact of a blow. 3. Endorphins are endogenous opioids that block the transmission of painful impulses. 4. Dynorphins are endogenous opioids that block the transmission of painful impulses.

A patient is being treated for chronic pain. What should the nurse keep in mind when assessing this patient's level of pain? A. The pain rating may be inconsistent with the underlying pathology. B. There is usually a clear, physiologic cause. C. Pain typically lasts 2 months or less. D. The pain reported is usually less severe than acute pain.

1. Answer: A Explanation: A. The patient might not exhibit signs of pain such as elevations in vital signs, grimacing, writhing, or moaning. 2. There may not be an identified physiologic cause. 3. Chronic pain may persist for longer than 2 months. 4. There is no indication that chronic pain is less severe than acute pain, although in some instances it may be more diffuse.

A patient asks why pain was felt in the left arm during a myocardial infarction. How should the nurse respond? A. "Cardiac pain is generally unexplainable." B. "Were you doing some physical activity with your arm just prior to the event?" C. "What you are describing relates to psychogenic pain." D. "Pain in the arm related to cardiac tissue damage is a type of referred pain."

1. Answer: D Explanation: D. Referred pain is pain perceived in an area distant from the stimulus. Visceral sensory fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue areas of the body. 2. Cardiac pain is explainable. 3. Physical activity did not trigger the pain. 4. Psychogenic pain occurs in the absence of a diagnosed physiological cause or event.

The nurse is ranking a patient's prescribed pain medications according to their strengths. Using the WHO analgesic ladder, in what order, from weakest to strongest, should the nurse rank the medications? Choice 1. Morphine sulfate 5 mg IV Choice 2. Ibuprofen 400 mg PO with the anticonvulsant gabapentin (Neurontin) 300 mg PO Choice 3. Propoxyphene HCL (Darvon) 250 mg PO Choice 4. Acetaminophen (Tylenol) 325 mg PO

Answer: 4, 2, 3, 1 Explanation: Choice 1. Morphine is the strongest of these pain medications. It is an opioid. Choice 2. Ibuprofen is a nonopioid and is the second weakest of these medications. Choice 3. Propoxyphene is the second strongest of these medications. Choice 4. Tylenol is the weakest of these medications.

The patient complaining of pain has been waiting for medication to relieve the pain. What should the nurse understand about this patient? A. The patient just wants medication. B. The patient's pain is real. C. The patient wants attention. D. The patient is demanding.

Answer: B Explanation: B. If the patient says he or she has pain, the patient is in pain. All pain is real. 2. Nurses should not be judgmental when responding to a patient's report of pain. This is a common bias and is a barrier to effective pain management. 3. This is the nurse's interpretation. 4. This is the nurse's interpretation.

The nurse is preparing to apply a transdermal analgesic patch to a patient. In what order should the nurse administer this medication? Place in order the steps of the process. Choice 1. Choose a new site and cleanse and dry an upper torso location. Choice 2. Clip chest hair and open the medication package. Choice 3. Keep the patch intact for 72 hours. Choice 4. Place the patch, making sure all edges are in contact with the skin.

Answer: 1, 2, 4, 3 Explanation: Choice 1. A transdermal patch is applied to a clean, dry area on the upper torso. Choice 2. If hair is present, it should be clipped before applying the patch. Choice 3. The patch is effective for about 72 hours. Choice 4. Apply the patch immediately after opening the package, ensuring complete contact with the skin, especially around the edges.

A patient receiving morphine sulfate 10 mg intramuscularly every 4 hours is being switched to an oral dose. Calculate the oral dosage range using the equianalgesic dosing formula: ________ mg. Record your answer rounding to the nearest whole number, using a dash ("-") to indicate the range.

Answer: 30-60 Explanation: The oral dose is 3 to 6 times the IM dose.

A patient is prescribed a fentanyl patch to administer 100 mcg/hour, uses one patch for 72 hours, and then is changed to an intravenous infusion of morphine 8 hours into the second patch. How many mg of the medication did the patient receive while wearing the patch? Record your answer rounding to the nearest whole number.

Answer: 320 mg Explanation: Fentanyl 100 mcg/hr is equivalent to 4 mg/hr morphine IV. If the first patch was for 72 hours and the second patch was for 8 hours, the patient wore the patch for a total of 80 hours. Multiply the equivalent dose of 4 mg × 80 = 320 mg.

A patient reports the inability to sleep through the night because of leg pain. What will the nurse most likely assess in this patient? A. A decrease in pain B. A decrease in anxiety C. An increase in pain D. An increase in concentration

Answer: C Explanation: C. Pain interferes with a person's ability to fall asleep and stay asleep and can induce fatigue. Fatigue can lower pain tolerance. The nurse will most likely assess an increase in pain in the patient who is unable to sleep. 2. There will not be a decrease in pain. 3. Anxiety may increase the perception of pain, and pain may cause more anxiety. 4. The patient in pain often has difficulty concentrating.

The nurse is caring for a patient recovering from surgery. Which intervention will provide the most pain relief for the patient? A. Offer pain relief before the patient complains of pain. B. Wait until the patient can describe the pain specifically. C. Assess the pain level every 4 hours around the clock. D. Allow the patient to "sleep off" the anesthesia, then offer pain medication.

Answer: A Explanation: A. Anticipating a patient's pain will ensure a more manageable pain experience than will waiting until the patient complains of pain. 2. Pain management needs to be implemented before the patient describes specific postoperative pain. 3. The patient should not be awakened to assess pain unless there are other significant nonverbal signs during sleep that indicate the patient is in pain. These can include grimacing, moaning, thrashing, or guarding of a surgical site. 4. Pain management needs to be implemented before the patient "sleeps off" anesthesia.

The nurse is assessing a patient's vital signs. What should the nurse include in this assessment? A. Peripheral pulses B. Pain level C. Ability to ambulate D. Urine output

Answer: A Explanation: A. Assessment of peripheral pulses is done to check for presence and strength; it is not routinely done to assess a pulse rate. 2. Pain is increasingly being referred to as the "fifth vital sign," with recommendations to include pain assessment in every vital signs assessment. 3. Ambulation is not a vital sign. 4. Urine output is not a vital sign.

A patient has a history of scoliosis and back pain. For which type of pain should the nurse plan care for this patient? A. Chronic nonmalignant pain B. Recurrent acute pain C. Ongoing time-limited pain D. Chronic malignant pain

Answer: A Explanation: A. Chronic nonmalignant pain is non-life-threatening pain that nevertheless persists beyond the expected time for healing. Chronic lower back pain falls into this category. 1. Recurrent acute pain is characterized by relatively well-defined episodes of pain interspersed with pain-free episodes. 2. Ongoing time-limited pain is not a commonly used term for pain. 3. Malignancy is not mentioned as a cause of the pain.

A patient with depression reports having unrelenting pain over the last several weeks. What should the nurse consider as contributing to this patient's amount of pain? A. Depression can cause an increase in pain sensations. B. The pain medication has not been working. C. Medication to treat the depression is interfering with the control of pain. D. The patient is exaggerating the amount of pain.

Answer: A Explanation: A. Depression is clearly linked to pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, leading to an increase in pain sensations. 2. The nurse has no way of knowing if the patient's pain medication is not controlling the pain. 3. There is also no way of knowing if the medication used to treat the patient's depression is interfering with the control of pain. 4. The nurse cannot assume that the patient is exaggerating the amount of pain.

The nurse is assessing a patient's response to pain. Why should the nurse do this for every patient situation? A. Everyone has a unique tolerance to pain. B. Everyone has the same pain threshold. C. Everyone perceives painful stimuli at the same intensity. D. Most people have the same pain response to surgery.

Answer: A Explanation: A. Each person's pain tolerance is different and will need to be assessed on an individual basis. 2. Everyone does not have the same pain threshold. 3. Everyone perceives pain at a different intensity. 4. Different people have a different pain response to surgery.

A patient with severe nerve pain from spinal cord compression is considering surgery to sever the nerves and relieve the pain. What should the nurse encourage the patient to consider prior to having this surgery? A. There may be loss of motor function associated with the nerves that will be severed. B. The surgery will need to be repeated when the nerves regenerate. C. Pain medication will still be needed after the surgery. D. The patient will be a paraplegic after the surgery.

Answer: A Explanation: A. Motor function loss is an unwelcome side effect of some surgeries, so the patient needs to consider the amount and degree of potential motor loss. 2. The nerves will not regenerate, so surgery will not need to be repeated. 3. Pain medication may or may not be needed after the surgery. 4. Not all surgeries to sever nerves to control pain result in paraplegia.

A patient is receiving a narcotic for severe acute pain. What should the nurse encourage the patient to consume in greater quantities due to the pain medication? A. Fiber B. Vitamin D C. Protein D. Carbohydrates

Answer: A Explanation: A. Patients receiving narcotics are at risk for constipation. Increasing fiber in the diet will help to reduce this effect. 2. Increasing vitamin D is not specifically related to the effects of a narcotic medication. 3. Increasing protein is not specifically related to the effects of a narcotic medication. 4. Increasing carbohydrates is not specifically related to the effects of a narcotic medication.

A patient recovering from a broken leg asks why the pain is so sharp. What should the nurse explain about acute pain? Select all that apply. A. The pain signal travels along nerve fibers to the spinal cord. B. The pain signal travels up to the brain portion called the thalamus. C. The pain signal spreads throughout the cortex, limbic system, and brainstem. D. The pain signal releases catecholamines. E. The pain signal reduces blood flow to the gut.

Answer: A, B, C Explanation: A. With sharp local pain, nociceptors transmit pain stimuli along myelinated fibers to the spinal cord. B. With sharp local pain, nociceptors transmit pain stimuli along myelinated fibers to the spinal cord, where it travels via the neospinothalamic tract to the thalamus. C. With sharp local pain, the stimulus is distributed from the thalamus to the somatosensory cortex (perception and interpretation), the limbic system (emotional responses to pain), and brainstem centers (autonomic nervous system responses). 1. The release of catecholamines explains the cardiovascular response to pain. 2. The reduction of blood flow to the gut explains why nausea and vomiting occur with pain.

A patient refusing to take pain medication for chronic back pain is asked to rate the pain on a scale from 0 to 10. What is the nurse attempting to do with this patient? A. Determine if the patient should remain in the hospital B. Decide if the patient is being argumentative C. Assess the patient's level of pain D. Figure out if the patient should leave the hospital against medical advice

Answer: C Explanation: C. The most reliable indicator of the presence and degree of pain is the patient's own statements about the pain. Pain rating scales ensure consistent communication about the pain level. 2. The nurse is not attempting to question the patient's admission or stay in the hospital. 3. The nurse is not attempting to decide if the patient is being argumentative. 4. The nurse is not attempting to decide whether the patient should leave the hospital against medical advice.

A patient recovering from abdominal surgery is refusing pain medication because of the fear of becoming addicted even though pain is rated as 10 out of 10. What statement should the nurse include as part of the patient's education? Select all that apply. A. There is little to no risk of addiction when taking narcotics for pain. B. Untreated pain can result in poor wound healing. C. Dehydration can result from poorly managed pain. D. Patients with uncontrolled pain can develop altered immune function. E. Family members will not want to visit patients showing visible signs of pain.

Answer: A, B, D Explanation: A. A common myth among healthcare professionals is that using opioids for pain treatment poses a real threat of addiction. Actually, when the medications are used as recommended, there is little to no risk of addiction. B. Pain causes physiological consequences, including poor wound healing. D. Pain causes physiological consequences, including altered immune function. 4. There is no evidence that poor pain relief causes dehydration. 5. There is no evidence that poor pain relief causes family members to refuse to visit.

A patient is prescribed hydrocodone (Vicodin) for severe tooth pain. What should the nurse instruct the patient about taking this mediation? Select all that apply. A. Avoid all alcohol B. Do not take with over-the-counter medications. C. Do not operate machinery. D. Expect some respiratory depression. E. Increase the intake of fluids and fiber.

Answer: A, C, D, E 1, 2, 4, 5 Explanation: A. The nurse should instruct the patient to avoid drinking alcohol while taking this medication. C. The nurse should instruct the patient to use caution or avoid driving when taking this medication. D. The nurse should instruct the patient to increase the intake of fluids and fiber to prevent constipation. E. The nurse should instruct the patient not to take over-the-counter medications unless approved by the healthcare provider. 3. Respiratory depression can occur when taking this medication; however, it is not an expected effect and should be reported to the healthcare provider.

A homebound hospice patient receiving opioid pain medication continues to experience pain. Which nonpharmacologic complementary methods should the nurse instruct the patient? Select all that apply. A. Guided imagery C. Progressive muscle relaxation B. Acupuncture D. Regional pain management E. Distraction

Answer: A, C, E Explanation: A. Guided imagery can be taught to the patient by the nurse. C. Progressive muscle relaxation can be taught to the patient by the nurse. E. Distraction can be taught to the patient by the nurse. 4. Acupuncture cannot be taught to the patient by the nurse. Acupuncture can only be provided by persons with special training. 5. Regional pain management is not an alternative complementary therapy.

The nurse is managing care for a group of patients with pain. For which health problem should the nurse expect the patient to experience acute pain? A. Phantom limb pain B. Cholecystectomy C. Complex regional pain syndrome D. Degenerative joint disease

Answer: B Explanation: B. Acute pain has a sudden onset, is usually self-limited, and is localized. The cause of acute pain generally can be identified. It generally results from tissue injury from trauma, surgery, or inflammation. Surgical pain such as after gallbladder removal is considered acute pain. 2. The neuropathic pain associated with amputation, phantom limb pain, may not begin immediately and may become a chronic problem. 3. Complex regional pain syndrome is a chronic exaggerated response to a painful stimulus. 4. Degenerative joint disease is chronic; the accompanying joint pain is also chronic.

A patient with a history of lumbar spinal cord nerve compression continues to complain of burning pain. Which type of pain should the nurse realize this patient is experiencing? A. Myofascial pain syndrome B. Complex regional pain syndrome C. Chronic postoperative pain D. Phantom limb pain

Answer: B Explanation: B. Complex regional pain syndrome is a neuropathic pain that results from nerve damage. It is characterized by continuous severe, burning pain. These conditions follow peripheral nerve damage and present the symptoms of pain, vasospasm, muscle wasting, and vasomotor changes. 2. Myofascial pain syndrome is a condition marked by injury to or disease of muscle and fascial tissue. 3. This pain was not described as chronic. 4. No amputation has been performed that might explain phantom limb pain.

The nurse is helping a patient in pain by gently massaging the painful area. Which type of pain control is the nurse using? A. Acupuncture B. Cutaneous stimulation C. Biofeedback D. Guided imagery

Answer: B Explanation: B. Cutaneous stimulation is a nonpharmacological approach to pain management that may be accomplished by massage, vibration, applying heat and cold, and therapeutic touch. 1. There is no mention of the use of acupuncture needles. 2. Biofeedback does not involve massage. 3. Guided imagery does not involve massage.

A patient with chronic pain reports rarely sleeping more than 3 hours a night. Which health problem is this patient at risk for developing? A. Chronic insomnia B. Depression C. High pain tolerance D. Adult attention deficit disorder

Answer: B Explanation: B. Depression is clearly linked to pain, and insomnia is an associated symptom of chronic pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, which leads to an increase in pain sensations. 1. There is no evidence to support the risk of chronic insomnia, although insomnia is associated with chronic pain. 3. There is no evidence to support inferences concerning pain tolerance. 4. There is no evidence to support the risk of adult attention deficit disorder.

A patient is watching a comedy on the television and has not requested pain medication for over 6 hours. Which form of pain control is this patient using? A. Meditation B. Distraction C. Guided imagery D. Biofeedback

Answer: B Explanation: B. Distraction involves redirecting attention away from the pain and onto something the patient finds more pleasant. Participating in an activity that promotes laughter has been found to be highly effective in pain relief. Laughing for 20 minutes or more is known to produce an increase in endorphins that may continue to relieve pain even after the patient stops laughing. 2. Meditation is a process of emptying the mind of all sensory data and, typically, concentrating on a single object, word, or idea. This activity produces a deeply relaxed state in which oxygen consumption decreases, muscles relax, and endorphins are produced. 3. Guided imagery is use of the mind to create a scene or sensory experience that relaxes the muscles and moves the attention away from the pain experience. 4. In biofeedback, electrodes placed on the skin transform data into visual cues so the patient learns to recognize stress-related responses and replace them with relaxation responses.

The nurse is using the neuromatrix theory when determining a patient's pain. On what should the nurse focus when completing this assessment? A. Specificity B. Cultural and genetic factors C. Pattern D. Previous sensitization

Answer: B Explanation: B. The neuromatrix theory of pain integrates cultural and genetic factors with basic neurophysiological function. According to this theory, the brain contains a body-self neuromatrix, a widely distributed network of neurons that are affected by both genetic factors and sensory experiences. The neuromatrix integrates multiple sources of input in addition to the stimuli of pain and touch. Other sensory systems that help interpret the input, such as attention, expectation, personality, culture, innate pain modulation systems, and components of stress-regulation systems, all contribute to the pain experience for the individual. 2. Specificity theories describe nerve impulses of varying intensity terminating in pain centers in the forebrain. 3. Pattern theories describe nerve impulses of varying intensity terminating in pain centers in the forebrain. 4. According to the pain sensitization theory, painful signals create a cascade of changes in the nervous system, which increases the responsiveness of the peripheral and central neurons. These changes increase the response to future signals and amplify pain.

The nurse is planning care for a patient with chronic pain. Which pain control goal would be most appropriate for this patient? A. Reduce the sympathetic stress response. B. Reduce the focus on pain. C. Be completely pain-free. D. Improve patient outcomes.

Answer: B Explanation: B. With chronic pain, the pain itself becomes the problem, creating physical, psychosocial, and economic stresses on the affected individual and the family. Furthermore, emotional and psychologic factors can cause the pain itself or make it worse. 2. Reducing the sympathetic pain response would be an appropriate acute pain management goal. 3. Being completely pain-free might be an unattainable goal for a patient with chronic pain. 4. Improving patient outcomes would be an appropriate acute pain management goal.

After completing an assessment, the nurse determines that a patient experiencing pain should avoid taking NSAIDs. What information caused the nurse to make this determination? Select all that apply. A. The patient has a pacemaker inserted for atrial fibrillation. B. The patient takes medication for peptic ulcer disease. C. The patient had a total hip and total knee replacement a year ago. D. The patient takes medication and vitamin K for a clotting disorder. E. The patient performs peritoneal self-dialysis for chronic kidney failure

Answer: B, D, E 1, 4, 5 Explanation: B. NSAIDs are not recommended for use in people with peptic ulcer disease. D. NSAIDs are not recommended for use in people with bleeding disorders. E. NSAIDs are not recommended for use in people with kidney or liver disease. 2. A pacemaker would not be a contraindication for using NSAIDs. 3. Total joint replacements are not a reason to contraindicate NSAIDs.

The nurse is caring for older patients in a long-term-care facility. Which factor should the nurse consider when managing pain in these patients? Select all that apply. A. Increased A fiber transmission increases the potential for addiction in older adults. B. An increased risk of depression in older adults is related to chronic pain. C. Less reporting of referred pain may mask myocardial infarction in older adults. D. Delirium should be evaluated as pain. E. Assessment of pain in the cognitively impaired older adult is not possible.

Answer: B,C, D Explanation: B. There is an increased risk of depression in the older patient experiencing chronic pain. C. Older adults are less likely to report referred pain, meaning they may present in a different manner than younger adults. This may lead to problems diagnosing patients appropriately. D. The older adult may present with manifestations such as delirium rather than subjective reports of pain. 1. There is actually decreased fiber transmission and no greater risk of dependence with older adults. 4. Research has shown the numeric rating, verbal descriptor, and FACES rating scales to be effective with older adults. These scales are also effective with cognitively impaired older adults, although the FACES scale is the preferred tool.

A patient who is receiving around-the-clock pain medication complains of an acute exacerbation of pain. What should the nurse do to help this patient? A. Talk with the patient through the pain. B. Encourage the patient to ignore the pain. C. Provide the medication prescribed for breakthrough pain. D. Give the patient a nonsteroidal anti-inflammatory drug (NSAID).

Answer: C Explanation: C. Breakthrough pain (BTP) occurs in patients who are receiving long-acting analgesics for chronic pain. It is a transitory experience of moderate to severe pain that is often precipitated by coughing or movement but may occur spontaneously. Short-acting opioids for this type of pain should be administered as needed in addition to the ATC dose for chronic, persistent pain. 2. The pain must be addressed; it is not appropriate to talk with the patient through the pain. 3. The pain must be addressed; it is not appropriate to encourage the patient to ignore the pain. 4. NSAIDs can only be given with the physician's order.

A patient with chronic pain is desperately searching for something to relieve the pain. What should the nurse recommend for this patient? A. A thorough analysis of the pain to determine if it is truly pain B. Avoiding the use of narcotics C. A pain medication schedule to help avoid the onset of pain D. Evaluation by a psychiatrist to determine if the patient is depressed

Answer: C Explanation: C. It is now widely accepted that anticipating pain has a noticeable effect on the amount of pain a patient experiences. Offering pain relief before a pain event is well on its way can lessen the pain. 1. The pain has already been identified as being real and chronic in nature. 2. Avoidance of narcotics may not meet the patient's immediate needs. 3. There is no mention of a depressed state, only the patient's need to address the pain.

After assessing a patient for pain, the nurse concludes that the pain is caused by a mechanical stimulus. What should the nurse consider as a possible cause of this patient's pain? A. Burn B. Frostbite C. Muscle tear D. Myocardial infarction

Answer: C Explanation: C. Mechanical causes of pain include spasm, compression, or extreme muscle stretch or contraction. A muscle tear creates pain from a mechanical source. 2. A burn involves pain from a thermal source. 3. Frostbite involves pain from a thermal source. 4. Myocardial infarction involves pain from a chemical source.

A female patient reports having pain so severe that it limits the ability to get out of bed at home. What should the nurse realize is contributing to this patient's pain? A. Overuse of alcohol B. Overuse of pain medication C. Gender D. Too much sleep and rest

Answer: C Explanation: C. The pain threshold is the point at which a stimulus elicits a response. Clinical and animal studies show that women have a lower pain threshold and experience a higher intensity of pain than men. 2. Alcohol may raise pain tolerance; however, there is no evidence that the patient is using alcohol. 3. Medications may raise pain tolerance. 4. Sleep and rest may raise pain tolerance.

A patient has periodic severe nerve pain that is not well controlled with pain medication. Which pain management approach should be considered for this patient? A. A nonsteroidal anti-inflammatory drug (NSAID) B. A narcotic C. An antidepressant D. A local anesthetic

Answer: C Explanation: C. Antidepressants within the tricyclic and related chemical groups act on the production and retention of serotonin in the CNS, thus inhibiting pain sensation. They also promote normal sleeping patterns, which further alleviates the suffering of the patient in pain. They are useful with neuropathic pain. 1. The NSAID group can have serious side effects, including bleeding tendencies, and would not be appropriate in a long-term situation. 2. Other medications are prescribed before introducing narcotics. 4. A local anesthetic would not be appropriate for long-term pain management.

A patient with bone pain complains that the pain is more intense when being repositioned in bed. For which type of pain should the nurse plan care? A. Central B. Nociceptive C. Incident D. Neuropathic

Answer: C 2 Explanation: A. Incident or episodic pain is predictable, precipitated by an event or activity such as coughing, changing position, or being touched. 1. Central pain is caused by a lesion or damage in the brain or spinal cord 3. Nociceptive pain is caused by stimulation of peripheral or visceral pain receptors. 4. Neuropathic pain arises as a consequence of a lesion or disease affecting the somatosensory system.

A patient with chronic pain is prescribed an anticonvulsant medication. What should the nurse instruct the patient to expect when taking this medication? Select all that apply. A. Less nausea B. Improved mobility C. Reduced pain D. Improved sleep E. Reduced urine output

Answer: C, D Explanation: C. Anticonvulsants are frequently used with opioids in pain control because these drugs reduce pain. D. Anticonvulsants are frequently used with opioids in pain control because these drugs reduce sleep disruption. 1. Anticonvulsants are not prescribed to reduce nausea. 4. Anticonvulsants are not prescribed to improve mobility. 5. Anticonvulsants should not adversely affect renal functioning.

A patient with chronic orthopedic pain is considering the use of a transcutaneous electrical nerve stimulator to reduce the pain. What advantage of using this device should the nurse review with the patient? A. Is low in cost B. Can be used by all patients C. Can relieve all types of pain D. Avoids the adverse effects of pain medication

Answer: D Explanation: D. A transcutaneous electrical nerve stimulator has the advantages of avoidance of adverse drug effects, patient control, and good interaction with other therapies. 2. Disadvantages of this device are the cost and the need for expert training. 3. This device is not effective at relieving pain for all patients. Patients with pacemakers should not use this device. 4. This device is not effective at relieving all types of pain.

A patient is seen talking and laughing in the clinic's waiting room yet complains of excruciating pain. What should the nurse realize this patient is demonstrating? A. The desire for narcotics B. Denial C. Fake pain D. Inconsistent behavioral response to pain

Answer: D Explanation: D. Behavioral responses to pain may or may not coincide with the patient's report of pain and are not very reliable cues to the pain experience. The nurse needs to manage the pain if the patient verbalizes that it is present, even if the nonverbal signs are not congruent. 1. No mention is made of the patient requesting narcotics. 2. Behavioral responses to pain may or may not coincide with the patient's report of pain and are not very reliable cues to the pain experience. 3. The nurse cannot decide if the patient's pain is real.

A patient with chronic pain is being started on a "patch." What should the nurse instruct the patient about this pain-relieving delivery system? A. It will not work as well as oral pain medications. B. The patient will never experience breakthrough pain. C. The patient will never overdose with this delivery method. D. The dosage will be lower in the beginning.

Answer: D Explanation: D. Dosages for the "patch" start low and are increased as deemed necessary by the healthcare provider. 1. The transdermal, or patch, form of medication is increasingly being used because it is simple, painless, and delivers a continuous level of medication. The continuous dosage is an advantage over oral medications. Transdermal medications are easy to store and apply, and reapplying every 72 hours enhances compliance. 3. Additional short-acting medication is often needed for breakthrough pain. 4. Overdosage can occur with this route.

A patient scheduled for knee surgery expects to experience less pain than what was experienced 20 years ago after a similar surgery. What should the nurse respond to this patient? A. "You are most likely correct." B. "It should not be quite as bad with the newer technology." C. "Pain responses diminish with age." D. "There might be more pain, because the pain response can get worse with aging."

Answer: D Explanation: D. Pain tolerance decreases with aging, perhaps related to the prevalence of chronic pain in this population. 2. The nurse should not agree that the patient will have less pain because this may not occur. 3. The amount of pain may or may not be impacted by the use of newer technology. 4. The pain response does not diminish with age.

A patient who is 2 hours postoperative following bowel resection surgery has four standing orders for pain medication. Which medication should the nurse consider providing to the patient for pain? A. The one that will be given intramuscularly to work quickly. B. The one that is ordered on a prn basis. C. The one to be administered orally. D. The one that is to be administered intravenously by the patient and is under patient control.

Answer: D Explanation: D. Patient-controlled analgesia allows self-management of pain and is a common method of administering postoperative pain medication. The advantages to this method are dose precision, timeliness, and convenience. 2. The medication that is administered intramuscularly is not typically recommended for moderate-to-severe pain that will require more than one dose. 3. A prn medication administered 2 hours after a major surgery would not be the most effective. 4. An oral medication administered 2 hours after a major surgery would not be the most effective.

A patient with a history of chronic pain reports doing things to help the body make a natural pain reliever. What should the nurse realize this patient is describing? A. A theory of denial B. A belief in alternative methods C. A reason to reduce the amount of pain medication prescribed D. The body's ability to make endorphins

Answer: D Explanation: D. There is a pain inhibitory center within the dorsal horns of the spinal cord. The exact nature of this inhibitory mechanism is unknown. However, the most clearly defined chemical inhibitory mechanism is fueled by endorphins (endogenous opioids), which are naturally occurring morphine-like peptides that are present in neurons in the brain, spinal cord, and gastrointestinal tract. Endorphins work by binding with opiate receptors on the neurons to inhibit pain impulse transmission. 1. The patient is not denying the pain. 2. Alternative methods have not been employed. 3. There was no discussion of pain medication amounts.