Davis Edge: Chapter 21 Pain

An individual having a heart attack often feels severe pain in the left arm and jaw. Which type of pain is this an example of? 1. Visceral pain 2. Phantom pain 3. Referred pain 4. Psychogenic pain

Answer: 3 Option 1: Visceral pain describes pain that occurs through stimulation of deep internal pain sensors. Option 2: Phantom pain occurs in an area of the body that is no longer there, as it has been removed. Option 3: Referred pain is felt in an area away from the source of the pain. Option 4: Psychogenic pain has no identifiable cause, and it likely originates in the mind.

Which are methods of nonpharmaceutical pain management? Select all that apply. 1. Cutaneous therapy 2. Acupuncture 3. Application of heat and cold 4. Reorientation 5. Instructing the client to think about something else

Answer: 1, 2, 3 Option 1: Cutaneous therapy, such as a TENS unit, provides superficial stimulation to provide distraction from actual pain. Option 2: Acupuncture is the application of extremely fine needles to the pain site. This stimulates the endogenous analgesia system. Option 3: Application of heat and cold can reduce inflammation, which causes pain. Option 4: Reorientation can help with confused clients, but it is not a method of pain control. Option 5: Distraction can be effective, but instructing the client to ignore pain is not a means of pain management.

Which type of cutaneous pain control would best benefit a client who is afraid of needles? 1. Transcutaneous electrical nerve stimulator (TENS) 2. Percutaneous electrical stimulation (PENS) 3. Spinal cord stimulator 4. Acupuncture

Answer: 1 Option 1: A TENS unit consists of an electrode pad placed on the skin over the affected area and stimulates A-delta nerve fibers. It is noninvasive and would be best for a client who is afraid of needles. Option 2: A PENS unit adds needle probes placed through the skin to stimulate peripheral sensory nerves. This is invasive and will not be best for a client who is afraid of needles. Option 3: A spinal cord stimulator is surgically implanted, which may be problematic for a client with a fear of needles. Option 4: Acupuncture involves the insertion of needles at pain points. This is invasive and would not work for a client afraid of needles.

Which intervention should the nurse include in the plan of care to prevent atelectasis in a client with postoperative pain from abdominal surgery? 1. Control pain 2. Assess incision 3. Apply TED hose 4. Administer antibiotics

Answer: 1 Option 1: A client who is in pain will not take deep breaths nor use an incentive spirometer. Therefore, the nurse should manage the client's pain. Option 2: The nurse would assess the incision to determine healing and presence of infection, but this would not prevent atelectasis. Option 3: TED hose prevent deep vein thrombosis from occurring postoperatively. Applying TED hose does not manage a client's pain. Option 4: The nurse would give antibiotics to prevent or treat infection. It would not be an appropriate intervention to prevent atelectasis.

The nurse is working for a client in labor who is reporting a lot of pain. Which type of cutaneous pain management may be most beneficial for this client? 1. Effleurage 2. Acupressure 3. Acupuncture 4. Myofascial release

Answer: 1 Option 1: Effleurage is a type of cutaneous skin stimulation that has been proven effective in managing pain during labor. Option 2: Acupressure involves the placement of fingertips on pressure points. There are other more effective ways to manage labor pain. Option 3: A client in labor would not be able to handle needles placed in pressure points as in acupuncture. Option 4: Myofascial release involves using hands to apply pressure to overused and injured muscles. This would not be appropriate for a client in labor.

The nurse is planning to use guided imagery for a client who reports severe pain related to rheumatoid arthritis. How would the nurse perform this intervention? 1. Use descriptive words, music, and thoughts to elicit relaxation. 2. Utilize hands to direct energy fields surrounding the body. 3. Instruct the client to sit in a comfortable position and tense and relax muscle groups. 4. Take slow deep breaths when inhaling and exhaling at a rate of 5 to 8 breaths per minute.

Answer: 1 Option 1: In guided imagery, the nurse uses descriptive words, music, and thoughts to produce images in the client's mind of places and positive thoughts. Option 2: Therapeutic touch, not guided imagery, uses a person's hands to direct the energy fields that surround the body. Option 3: Progressive muscle relaxation involves tensing muscle groups then relaxing them. This is not how the nurse implements guided imagery. Option 4: Diaphragmatic breathing, not guided imagery, involves slow deep breathing at a rate of 5 to 8 breaths per minute.

Based on origin, which type of pain is a burn from touching a hot pan? 1. Superficial pain 2. Deep somatic pain 3. Visceral pain 4. Referred pain

Answer: 1 Option 1: Superficial pain occurs on the surface of the skin. Option 2: Deep somatic pain occurs deep in connective tissue and tends to last longer. Option 3: Visceral pain is caused by stimulation of deep internal pain sensors. Option 4: Referred pain occurs in an area separate from the original site.

The health-care provider prescribed opioid narcotic analgesics to a client with terminal cancer. For which side effects should the nurse assess? Select all that apply. 1. Constipation 2. Nausea and vomiting 3. Respiratory depression 4. Fluid volume overload 5. Gastrointestinal bleeds 6. Drowsiness and sedation

Answer: 1, 2, 3, 6 Option 1: Opioid narcotic analgesics can slow down peristalsis and lead to opioid-induced constipation. Therefore, the nurse should assess the client's bowel pattern. Option 2: Opioid narcotic analgesics can lead to nausea and vomiting. Therefore, the nurse should assess the client's appetite and presence of nausea and vomiting. Option 3: Respiratory depression can occur with clients taking opioid narcotic analgesics. The nurse should assess the client's respiratory rate and pattern. Option 4: Fluid volume overload is not a side effect of opioid narcotic analgesics. Option 5: Nonsteroidal anti-inflammatory medications can cause gastrointestinal bleeding. This is not a side effect of opioid narcotic analgesics. Option 6: Drowsiness and sedation is a side effect of opioid narcotic analgesics, so the nurse should assess the client's level of consciousness.

The nurse is planning to begin an animal therapy program for clients with chronic pain and is seeking administrative approval for this project. Which benefits of animal therapy should the nurse explain to the administration? Select all that apply. 1. Clients report feeling better. 2. Clients have lower cortisol levels. 3. Clients are placed in a very relaxed state. 4. Clients require lower doses of pain medication. 5. Clients report harmony between the mind and body.

Answer: 1, 2, 4 Option 1: Clients report feeling better and have an improved sense of well-being when they experience animal therapy. Option 2: Clients who experience animal therapy have lower cortisol levels. Option 3: Clients undergoing hypnosis report being in a very relaxed state. Option 4: Research has shown that clients who receive animal therapy require lower doses of pain medication. Option 5: Guided imagery, not animal therapy, causes harmony between the mind and body.

Which are descriptive words for the quality of pain? Select all that apply. 1. Sharp 2. Burning 3. Chronic 4. Sudden 5. Tingling

Answer: 1, 2, 5 Option 1: Quality of pain describes how the pain feels to the client. Option 2: Burning is a descriptive word for the quality of pain. Option 3: Chronic is not used to describe the quality of pain. Option 4: Sudden refers to the onset of pain, not a description of the quality of pain. Option 5: Tingling is a description of the quality of pain.

Which are ways pain is classified and described? Select all that apply. 1. Origin 2. Intensity 3. Whether there is a visible sign of pain 4. How the client reacts to the pain 5. Quality

Answer: 1, 2, 5 Option 1: The place in the body where the pain originates is used to describe pain. Option 2: The intensity of the pain as described by the client is used to classify the pain. Option 3: A visible sign of pain is not a way of classifying and describing pain. Option 4: Reaction to the pain may be part of documentation, but it is not a descriptive classification of pain. Option 5: The quality of the pain, as described by the client, is a way to classify and describe pain.

The nurse educator is teaching a group of nurses about pain control in older adults. What should the nurse include in the presentation regarding older clients reporting pain? Select all that apply. 1. Cognitive impairment can impair the ability to report pain. 2. Untreated pain can lead to bipolar disorder or schizophrenia. 3. Discomfort may only be evident in nonverbal signs such as grimacing. 4. Twenty-five percent of nursing home residents have unreported pain. 5. Pain that is not adequately treated can lead to a client having too much sleep.

Answer: 1, 3 Option 1: An older client may not have the cognitive ability to understand how to report pain. Option 2: When an older client has untreated pain, it can lead to confusion and depression, not bipolar disorder or schizophrenia. Option 3: The nurse may have to use nonverbal signs of pain such as grimacing or labored breathing to determine if an elderly client is in pain. Option 4: Seventy-five percent of nursing home clients have unreported pain. Option 5: Clients with untreated pain can cause a lack of sleep, not too much sleep.

Which types of mechanical stimuli that leads to pain would the nurse find in a client who is bedridden? Select all that apply. 1. Friction 2. Surgical 3. Pressure 4. Shearing 5. Phantom

Answer: 1, 3, 4 Option 1: Friction is a common problem in bedridden clients as two surfaces (the client and the sheets) rub against each other. This is a mechanical stimulus. Option 2: If a client had a surgical procedure, this would be a mechanical stimulus for postoperative pain. This client is bedridden, so this is not a problem. Option 3: Pressure placed on a bony prominence can be the mechanical stimulus that causes pain. Option 4: Shearing is a mechanical stimulus that happens from a client sliding down in bed. This can cause pain. Option 5: Phantom pain occurs after a client undergoes an amputation and experiences pain from the missing limb. It does not involve a mechanical stimulus.

The nurse is educating a group of clients in a community center about the use of over-the-counter pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). What information would be most important to include? Select all that apply. 1. Take NSAIDs with food or meals. 2. Use of aspirin can prolong bleeding time. 3. Use of two NSAIDs simultaneously can control pain. 4. Use of ibuprofen is safer than prescription NSAIDs. 5. Use of acetaminophen is an effective anti-inflammatory medication.

Answer: 1, 3, 4 Option 1: NSAIDs should be taken with food to decrease gastric irritation. Option 2: Aspirin inhibits platelet aggregation and can place a client at risk for bleeding. Pressure should be applied to all cuts. Option 3: Older adults should not combine NSAIDs because it can lead to renal failure, heart failure, and hypertension. Option 4: Ibuprofen and aspirin are safer than prescription NSAIDs because prescription NSAIDs cause more side effects. Option 5: Acetaminophen is a non-opioid analgesic and has no anti-inflammatory effects.

Which are the most common emotions associated with pain? Select all that apply. 1. Fear 2. Euphoria 3. Frustration 4. Anger 5. Boredom

Answer: 1, 3, 4 ption 1: Fear is commonly associated with pain. Option 2: Euphoria is a feeling of joy and happiness, and it is not usually associated with pain. Option 3: Many people who suffer from pain, especially chronic pain, may feel frustrated. Option 4: Anger is a common emotional reaction to pain. Option 5: Pain rarely elicits a feeling of boredom.

Which safety instructions should the nurse provide to the client using hot or cold for pain relief? Select all that apply. 1. Cover the heating pad or hot pack with a towel. 2. Do not leave the heating pad on for longer than 30 minutes. 3. Check skin frequently for color changes related to the heat. 4. Use moist heat or cold packs, as this is safer for longer periods of time. 5. Notify the health-care provider of any damage to the skin from hot or cold packs.

Answer: 1, 3, 5 Option 1: The client should avoid making direct contact between the skin and the heating pad or hot pack, as direct contact could cause burns. Option 2: The heating pad should only be left on for 15 minutes, not 30 minutes. This prevents skin damage from burns. Option 3: The client should check the skin frequently for any color changes such as redness, cyanosis, or blanching due to heat or cold application. Option 4: Moisture in hot and cold packs intensifies the heat and cold and can cause skin damage. Option 5: The nurse would instruct the client to notify the health-care provider if any skin damage is noted from the use of hot or cold.

When administering long-term use of analgesics to a client, which actions should the nurse take to optimize pain management? Select all that apply. 1. Determine the dosage to relieve the pain to the desired level. 2. Use the minimum dosage of the analgesic. 3. Wait until the pain is unbearable before administering analgesia. 4. Assess how long the dose lasts. 5. Administer the next dose before the previous dose wears off.

Answer: 1, 4, 5 Option 1: Different people require different doses for effective pain management. Option 2: The nurse should use the appropriate dose for the client for effective pain control. Option 3: The goal with managing pain with analgesics is to "stay ahead" of the pain. Option 4: When administering long-term use of analgesics, the nurse should note how long previous doses last Option 5: If pain begins to return, the nurse should administer the next dose as soon as possible.

What are the most common side effects of opioids? Select all that apply. 1. Drowsiness 2. Irritability 3. Itching 4. Nausea 5. Constipation

Answer: 1, 4, 5 Option 1: Drowsiness is a very common side effect of opioids. Option 2: Irritability is not a common side effect of opioids. Option 3: Itching is not a common side effect of opioids. Option 4: Nausea is a common, although often temporary, side effect of opioids. Option 5: Constipation is frequently seen in opioid use.

In which way is pain positive? 1. Keeps the person having pain more alert 2. Warns of bodily injury 3. May diminish over time 4. May interfere with quality of life

Answer: 2 Option 1: Increased alertness is not necessarily positive. Option 2: Pain has a protective function, can warn of bodily injury, and can change behavior or actions. Option 3: Pain may diminish over time, but this is not positive. Option 4: Pain interfering with quality of life is not positive.

According to the gate-control theory of pain, which type of fibers inhibit the client's perception of pain? 1. Mu fibers 2. A-delta fibers 3. Alpha fibers 4. Sigma fibers

Answer: 2 Option 1: Mu fibers do not inhibit a client's pain perception. Mu fibers work with pain medication. Option 2: A-delta fibers excite inhibitory neurons in the area of injury to inhibit the pain sensation. Option 3: Alpha fibers rapidly transmit pain signals, but they do not inhibit pain sensation. Option 4: Sigma fibers are poorly understood, but they are not known to inhibit pain perception.

A nurse obtains a client's vital signs. The client's vital signs are normal, but the client states the pain is 8 out of 10. What should the nurse assume about the client's pain? 1. Vital signs are normal; the client is not being honest about pain. 2. The client is experiencing severe pain of 8 out of 10. 3. The client does not understand the pain scale. 4. The vital signs should be taken again, as they may be inaccurate.

Answer: 2 Option 1: Normal vital signs are not an indication of absence of pain. Option 2: When a client reports pain, the nurse must believe the report, despite vital signs. Option 3: The nurse must assess the client's subjective pain and believe the client's assessment of it. Option 4: The client may be having severe pain, despite having normal vital signs.

When is it appropriate to use a placebo? 1. If the nurse suspects a client is becoming addicted to pain medications 2. In certain approved clinical trials 3. If the provider thinks the pain is psychosomatic 4. If the client does not appear to be in pain

Answer: 2 Option 1: Suspecting the development of dependency is not a reason to administer a placebo. Option 2: It is only acceptable to use a placebo in approved clinical trials. Option 3: It is not appropriate to administer a placebo for suspected psychosomatic pain. Option 4: Appearance of pain is very subjective, and judgments should not be made in determining whether pain control is provided.

A nurse is assessing pain in a client using the pain scale. The client is crying from pain and is barely able to speak. The client describes his or her pain as a 2 on a scale of 0 to 10. What can the nurse assume? 1. The client is overly sensitive to pain. 2. The client may not understand the pain scale. 3. The client is not being honest about the pain. 4. The client's analgesic medication has not taken effect yet.

Answer: 2 Option 1: The nurse cannot make an assumption about a client's sensitivity to pain based on a subjective description of the pain. Option 2: If the client is obviously in extreme pain, the nurse may want to describe the pain scale using a different approach. Option 3: The nurse must believe the client's self-assessment of pain. Option 4: The nurse cannot assume the pain medication is not working based on pain assessment.

The nurse asks a client who underwent a hip replacement to rate his or her pain level. The client states it is a 6 on a scale of 0 to 10 but is fine with this level and does not want pain medication. What should be the nurse's next action? 1. Reassess the pain level in one hour. 2. Explain it is better to take medication when pain is minimal. 3. Inform the health-care provider that the client's pain is under control. 4. Instruct the client that taking pain medication after surgery does not cause an addiction.

Answer: 2 Option 1: The nurse should continually assess the client's pain level, but this would not be the next action. Option 2: The nurse should explain to the client that for postoperative pain, it is best to take the pain medicine before the pain level increases and gets out of control. Option 3: The nurse should not inform the health-care provider that the pain level is under control because the client has a pain level of 6 on a scale of 0 to 10. Option 4: The nurse should not assume that this is the reason the client is refusing pain medication. The nurse would need to ask the client what the reasons are for not wanting the medication.

A physician injects lidocaine into the area around a laceration prior to placing sutures. Which type of pain control is this? 1. Topical anesthesia 2. Local anesthesia 3. Nerve block 4. Epidural anesthesia

Answer: 2 Option 1: Topical anesthesia involves applying a substance to the surface of the skin to provide pain reduction. Option 2: Local anesthesia is the injection of anesthetics into a very small part of the body to numb the area. Option 3: Nerve blocks are the injection of an anesthetic agent into a network of nerves that supplies a particular part of the body. Option 4: Epidural anesthesia provides numbness to specific areas based on nerve bundles in the spine.

Which step in the pain process describes the movement of the sensation of pain from peripheral nerves to the spinal cord? 1. Transduction 2. Transmission 3. Perception 4. Modulation

Answer: 2 Option 1: Transduction is when painful stimuli trigger the release of substances that trigger inflammatory chemicals. Option 2: Transmission is the movement of the sensation of pain from peripheral nerves to the spinal cord. Option 3: Perception is when the awareness and interpretation of pain occurs in the central nervous system. Option 4: Modulation is the response to pain to either facilitate or inhibit the pain response.

The nurse is reviewing laboratory data for a client who sustained a hip fracture and reports continuous pain. The nurse notices the client has a blood glucose level of 200 mg/dL, and the client has no history of diabetes mellitus. Which hormone release would cause hyperglycemia in the client? Select all that apply. 1. Insulin 2. Cortisol 3. Glucagon 4. Growth hormone 5. Antidiuretic hormone (ADH)

Answer: 2, 3 Option 1: Insulin is a hormone that is released when pain is untreated. Insulin lowers blood glucose levels; it does not raise it. Option 2: Cortisol is a glucocorticoid hormone released when a client has uncontrolled pain. Cortisol raises blood glucose levels. Option 3: Glucagon is a hormone that treats hypoglycemia and can elevate blood glucose levels in a client with uncontrolled pain. Option 4: Growth hormone is released when a client has uncontrolled pain; however, it does not elevate blood glucose levels. Option 5: ADH is released when a client experiences uncontrolled pain and causes water retention; not hyperglycemia.

Which interventions should the nurse include when managing pain in a client? Select all that apply. 1. Have the family visit. 2. Provide a back rub. 3. Reposition the client. 4. Administer intramuscular medication. 5. Determine the effectiveness of pain medication.

Answer: 2, 3, 5 Option 1: A client who is in pain most often prefers to not have visitors. This would not be the best intervention. Option 2: A back rub may help relax the client and relieve pain. Option 3: Repositioning is an intervention that can help manage pain in a client. Option 4: The nurse should use the least invasive means for pain management. This would include oral or intravenous pain medication, not intramuscular. Option 5: The nurse would need to assess if the current pain management system is effective. The regimen may need to be altered.

Which areas of the brain are stimulated by the hypothalamus when a person experiences pain? Select all that apply. 1. Parietal lobe 2. Limbic system 3. Frontal cortex 4. Occipital lobe 5. Somatosensory cortex

Answer: 2, 3, 5 Option 1: The parietal lobe is responsible for taste and touch, not pain. Option 2: The hypothalamus is stimulated during pain and involves the limbic system, which causes the emotional reactions to stimuli. Option 3: The frontal cortex is responsible for thought and reason. This is stimulated by the hypothalamus when pain occurs. Option 4: The occipital lobe of the brain is responsible for hearing and vision. It is not stimulated by the hypothalamus. Option 5: The somatosensory cortex is stimulated by the hypothalamus and it perceives and interprets physical sensations.

A nurse notes a history of peripheral neuropathy in the medical record of a client. What should the nurse include in the assessment of this client? Select all that apply. 1. Deep diffuse pain 2. Numbness of the feet 3. Cramping and achiness 4. Feeling of pins and needles 5. Itching on the soles of the feet

Answer: 2, 4, 5 Option 1: Deep diffuse pain is noted in a client with somatic nociceptive pain, not neuropathic pain. Option 2: A client with peripheral neuropathy reports numbness in the feet, as this reflects neuropathic pain. Option 3: Visceral nociceptive pain is described as cramping and aching. This is not accurate for neuropathic pain. Option 4: Many clients with neuropathic pain report feelings of pins and needles in the affected areas. Option 5: Peripheral neuropathic pain can cause itching on the soles of the feet.

A client has an epidural catheter that provides pain control. The client is sweating, appears anxious, and complains of increasing pain. Which action should the nurse take? 1. Tell the client he is getting pain relief through the epidural catheter. 2. Increase the dose of the epidural catheter. 3. Check the tubing connections for leaks. 4. Turn off the epidural catheter.

Answer: 3 Option 1: Instructing the client about pain management is not an appropriate action. Option 2: Increasing the epidural dose is a provider decision, and if the client has increasing pain, it may not help. Option 3: If tubing has become disconnected, it is likely that the client is not receiving the medication. Option 4: It is not appropriate to turn off the epidural catheter, especially if the client is still having pain.

Which describes the duration or intensity of pain a person can endure? 1. Pain threshold 2. Pain modulation 3. Pain tolerance 4. Pain perception

Answer: 3 Option 1: Pain threshold is the point at which the brain recognizes a stimulus such as pain. Option 2: Pain modulation changes a perception of pain by inhibiting brain signals. Option 3: Pain tolerance is the duration or intensity of pain a person can endure. Option 4: Perception of pain is the recognition that a stimulus is pain.

The nurse administered a narcotic analgesic to a client who underwent an amputation below the knee a week ago and reports phantom pain. Which statement best explains this type of pain? 1. Phantom pain is pain that has no physiological cause and is in the client's mind. 2. Phantom pain is pain that is superficial and in the subcutaneous tissues of the amputation. 3. Phantom pain is pain that the client experiences as a result of the amputated limb. 4. Phantom pain is pain caused by the stimulation of deep internal pain receptors and is considered achy and widespread.

Answer: 3 Option 1: Psychogenic pain, not phantom pain, is pain that has no physical cause but is perceived in the client's mind. Option 2: Cutaneous pain involves pain that is superficial. It is located in the subcutaneous tissues, but it is not related to the amputation. Option 3: Clients who undergo an amputation commonly feel pain from the area where the limb is missing. This is called phantom pain. Option 4: Visceral pain occurs from deep internal pain receptors being stimulated. The pain is widespread and achy. This is not phantom pain.

The nurse reassesses the client 30 minutes after administering a narcotic analgesic and notices the client has a respiratory rate of 6 breaths per minute. What should be the nurse's first intervention? 1. Perform cardiopulmonary resuscitation. 2. Notify the primary health-care provider. 3. Administer a dose of naloxone (Narcan). 4. Schedule an immediate breathing treatment.

Answer: 3 Option 1: The nurse does not perform cardiopulmonary resuscitation, as the client is breathing. Option 2: The nurse notifies the primary health-care provider; however, this is not the nurse's first intervention. Option 3: The nurse first administers a dose of naloxone (Narcan) because the client is experiencing respiratory depression from the narcotic analgesic. Option 4: The client has no evidence of difficulty breathing. Therefore, the nurse does not schedule a breathing treatment.

Which type of client might be suitable for surgical interruption of a pain pathway? 1. A person who has multiple fractures from a motor vehicle crash 2. An elderly female client who has shingles 3. A late-stage cancer client with intractable pain 4. A person who does not have any identified source of pain, but states he or she is in pain

Answer: 3 Rationales Option 1: A person with pain from fractures sustained during trauma will heal from the injuries. Option 2: Shingles is very painful, but surgical interruption of pain pathways is not indicated for flare-ups. Option 3: A client who has terminal cancer and severe intractable pain is a candidate for surgical interruption of pain pathways. Option 4: The source of the pain should be identified, as correcting the cause of the pain must be implemented first.

The nurse is caring for a 65-year-old client with a compression fracture of the spine with decreased mobility as well as intractable pain. The nurse requests a prescription for TED hose. The health-care provider prescribes TED hose and aspirin 81 mg PO QD. Which factors indicate the need for the TED hose and the aspirin? Select all that apply. 1. Age 2. Osteoporosis 3. Intractable pain 4. Decreased mobility 5. Compression fracture

Answer: 3, 4 Option 1: The age does not place the client at higher risk for deep vein thrombosis. Age would be a factor for possible osteoporosis that led to the compression fracture. Option 2: There is no indication that the client has osteoporosis, nor is it a risk factor for deep vein thrombosis. Option 3: Intractable pain causes hypercoagulation and increased cardiac workload. This places the client at risk for deep vein thrombosis and myocardial ischemia. Option 4: A client with decreased mobility is at higher risk for blood clot formation due to decreased circulation. Option 5: The compression fracture can increase pain for the client, but it does not require TED hose or aspirin therapy.

At which times should the nurse assess pain levels on a client in the hospital? Select all that apply. 1. In the morning 2. Before meals 3. On admission 4. With vital signs 5. Prior to procedures 6. After giving pain medication

Answer: 3, 4, 5, 6 Option 1: The morning is a wide span of time and not specific enough. Option 2: Blood glucose levels are usually taken before meals; pain levels do not need to be taken before meals. Option 3: A client's pain level should be obtained on admission to a facility. This serves as a baseline. Option 4: Pain is considered the fifth vital sign, and a client's pain level should be assessed with vital signs. Option 5: If a procedure may be painful, the nurse should assess a client's pain level prior to the procedure to determine the need for pain medication. Option 6: The nurse should assess a client's pain level 30 minutes after giving pain medication to assess effectiveness.

How does cognitive impairment affect a person's level of pain? 1. Those with cognitive impairment will not feel pain as intensely. 2. Cognitive impairment increases sensation of pain. 3. Cognitive impairment does not affect management of pain. 4. A person with cognitive impairment may not be able to identify or verbalize being in pain.

Answer: 4 Option 1: Cognitive impairment does not affect pain perception. Option 2: Cognitive impairment does not increase sensation of pain. Option 3: Cognitive impairment should not have an effect on management of pain. Option 4: Those with cognitive impairments can still feel pain, but they may not be able to identify or report the sensation as pain.

Which client would be most appropriate to use a PCA (patient-controlled analgesia) device? 1. An elderly female client with dementia 2. A 5-year-old child who has had an appendectomy 3. A 45-year-old female who has been in an MVA and has a skull fracture 4. A 55-year-old man who has undergone an elective knee replacement surgery

Answer: 4 Option 1: Dementia is a contraindication for PCA use. Option 2: A child of this age is not able to follow the directions involved in using the PCA. Option 3: The skull fracture may indicate a brain injury, which is a contraindication for PCA. Option 4: The client is likely awake and oriented, and able to manage his own pain medication delivery.

In which client would patient-controlled analgesia (PCA) be contraindicated? 1. A 30-year-old client with fractures from a motor vehicle accident 2. A 45-year-old client who underwent a total abdominal hysterectomy 3. A 60-year-old client who underwent a total knee replacement surgery 4. A 75-year-old client with a history of Alzheimer's disease who fell at home

Answer: 4 Option 1: It is appropriate for the health-care provider to prescribe PCA to a 30-year-old client with fractures from a motor-vehicle accident, as the client is able to manage the device. Option 2: A 45-year-old client who underwent a total abdominal hysterectomy should be able to handle the PCA device. Option 3: It would be an appropriate order for a 60-year-old client to have PCA after a total knee replacement. Option 4: A client with Alzheimer's disease may not have the cognitive ability to manage the PCA device. This would be contraindicated.

The health-care provider prescribes mu agonist opioids for a client with terminal cancer who needs pain management for breakthrough pain. What is the rationale for this prescription? 1. Mu agonist opioids have a daily dose limit. 2. Mu agonist opioids can be given with agonist-antagonists. 3. Mu agonist opioids are used to control pain around the clock. 4. Mu agonist opioids control pain in between long-acting pain medications.

Answer: 4 Option 1: Mu agonist opioids can be increased as long as adverse effects do not occur. There is no daily dose limit. Option 2: Agonist-antagonist opioids are contraindicated with mu agonist opioids. Option 3: Long-acting opioid analgesics are given around the clock. Mu agonist opioids are given for pain in between doses of long-acting analgesics. Option 4: Breakthrough pain management is given with mu agonist opioids administered in between doses of long-acting pain medications.

Terms such as mild, moderate, severe, or excruciating describe which characteristic of pain? 1. Quality 2. Periodicity 3. Duration 4. Intensity

Answer: 4 Option 1: Quality describes the client's subjective description of the pain. Option 2: Periodicity describes how frequently the pain occurs. Option 3: Duration is the length of time since pain onset. Option 4: Intensity describes how strongly the pain is felt.

The nurse is informing a client of the need for a new intravenous (IV) line to be inserted. The client begins crying and shaking uncontrollably and says, "I can't go through this again!" Which factor is influencing this pain? 1. Confusion 2. Depression 3. Helplessness 4. Previous experience

Answer: 4 Option 1: The client is not experiencing confusion, as there are other emotions the client is experiencing. Option 2: There is no evidence that the client is sad or depressed. The client is experiencing other factors that influence pain. Option 3: Helplessness is not influencing this client's perception of pain. There are other factors that are causing the client's reaction. Option 4: Clients who have had numerous negative pain experiences may be more anxious about another potentially painful experience.

The client with a diagnosis of multiple myeloma calls the nurse and reports pain of 9 on a scale of 0 to 10 and requests something for the pain. Which type of pain would the nurse document in the health record? 1. Visceral pain 2. Radiating pain 3. Cutaneous pain 4. Deep somatic pain

Answer: 4 Option 1: Visceral pain is pain that is experienced in organs caused by stimulation of deep internal pain receptors. This client would not experience visceral pain. Option 2: Radiating pain would be pain such as a client with myocardial pain experiences that refers to the jaw or left arm. Multiple myeloma does not cause radiating pain. Option 3: Cutaneous pain is superficial and in the subcutaneous tissue. A client with a small cut or burn would experience cutaneous pain. Option 4: Deep somatic pain is experienced in clients with cancer including multiple myeloma. The pain is more diffuse and lasts longer. The nurse would document that the client has deep somatic pain.

The nurse is assessing the pain level for a client with Alzheimer's disease using the Pain Assessment in Advanced Dementia (PAINAD) Scale. The client displays Cheyne-Stokes respirations, occasional groaning, facial grimacing, fidgeting, and distraction by touch. Based on these assessment findings, what would the nurse rate the client's pain level?

Answer: 7 Using the PAINADS, the nurse rates the client's pain level according to the Cheyne-Stokes respirations - 2, occasional groaning - 1, facial grimacing - 2, fidgeting -1, and distraction by touch -1. The pain rates at a 7.