Fundamentals PrepU - Chapter 28: Pain Management
The nurse is taking a history for a pregnant client who has been seen for chronic headaches for 2 years. Today, the client reports a headache that feels different than the normal headaches she has experienced in the past. Which assessment question helps the nurse assess quality of pain? A) "Can you describe the type of pain you are having?" B) "How long have you experienced this pain?" C) "Could you please rate your pain on a 1-10 scale?" D) "When did your pain begin?"
A) "Can you describe the type of pain you are having?" Explanation: Asking the client to describe the pain establishes quality. Asking the client to rate pain on a 1-10 scale reflects intensity. Asking how long the pain has existed reflects duration. Asking when the pain began reflects onset.
The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which response is most appropriate? A) "The mild electrical impulses block the pain signal before it can reach the brain." B) "The electrode patches generate heat and decrease muscle tension." C) "The electricity produces numbness and alters tissue sensitivity." D) "The machine tricks the mind into believing the pain does not exist."
A) "The mild electrical impulses block the pain signal before it can reach the brain." Explanation: Transcutaneous Electrical Nerve Stimulation (TENS) is a machine that sends electrical current that travels through electrodes and into the skin stimulating specific nerve pathways to produce a tingling or massaging sensation that reduces the perception of pain. The unit does not generate heat, trick the mind, or produce numbness.
A health care provider prescribes transcutaneous electrical nerve stimulation (TENS) for a client with back pain. Which information does the client need to know to administer this treatment? A) "You should not place the electrodes on your neck." B) "Apply the electrodes to both sides of your back at the same time." C) "You should use the TENS unit at night only." D) "You can expect skin redness under electrodes."
A) "You should not place the electrodes on your neck." Explanation: TENS is a nonpharmacologic, noninvasive method and has no toxic side effects. The user should never apply electrodes to the neck, as doing so may lower blood pressure and cause spasms. The TENS unit should not be applied to both sides of the back at the same time. The TENS unit may be used at any time during the day. Redness of the skin at the site of electrodes is not to be expected and should be reported to the health care provider.
How may a nurse demonstrate cultural competence when responding to clients in pain? A) Avoid stereotypical responses to pain in clients. B) Know the action and side effects of all pain medications. C) Treat every client exactly the same, regardless of culture. D) Be knowledgeable and skilled in medication administration.
A) Avoid stereotypical responses to pain in clients. Explanation: Culture influences an individual's response to pain. It is particularly important for nurses to avoid stereotypical responses to pain because they frequently encounter clients who are in pain or who anticipate that it will develop. A form of pain expression that is frowned upon in one culture may be desirable in another cultural group. Nurses should treat every client exactly the same but be aware of cultural influence in providing care. Medication knowledge is essential, but nurses should understand the cultural influence of pain and use of medication.
A nurse is assessing a mentally challenged adult client who is in pain after a fall from a staircase. Which scale should the nurse use to assess the client's pain? A) FACES scale B) word scale C) linear scale D) numeric scale
A) FACES scale Explanation: The nurse should use the Wong-Baker FACES scale, which is best for children and clients who are culturally diverse or mentally challenged. Nurses generally use a numeric scale, a word scale, or a linear scale to quantify the pain intensity of adult clients who can express their pain intensity in words, numbers, or linear fashion.
The client is a new admission who reports lower right quadrant abdominal pain. The client is scheduled for an emergency appendectomy. What question(s) will the nurse ask the client in relation to the pain? Select all that apply. A) How do you rate your pain on a scale of 0 to 10? B) How would you describe the pain? C) What medication have you taken to relieve the pain? D) Does anything make the pain worse? E) When did your pain begin?
A) How do you rate your pain on a scale of 0 to 10? B) How would you describe the pain? C) What medication have you taken to relieve the pain? D) Does anything make the pain worse? E) When did your pain begin? Explanation: All of these questions are appropriate for a pain assessment. They are part of a comprehensive pain assessment, which is to be performed on the client's admission to a clinical facility. The nurse wants to quantify the client's pain as well as wants to qualify the client's pain by asking for a description of the pain in the client's own words. The nurse asks about the onset, which is when the pain began. It is important to know what medications the client has taken for pain relief. For this client, it is extremely important, because the client is going for emergency surgery. These medications could affect the client's outcome for the surgery.
A postoperative client who has been receiving morphine for pain management is exhibiting a depressed respiratory rate and is not responsive to stimuli. Which drug has the potential to reverse the respiratory-depressant effect of an opioid? A) Naloxone B) Atropine C) Diphenhydramine D) Epinephrine
A) Naloxone Explanation: Naloxone is an opioid antagonist that reverses the respiratory-depressant effect of an opioid. Diphenhydramine is an antihistamine mainly used to treat allergies. Atropine is a medication to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate and to decrease saliva production during surgery. It is typically given intravenously or by injection into a muscle. Epinephrine injection is used for emergency treatment of severe allergic reactions (including anaphylaxis) to insect bites or stings, medicines, foods, and other options but not for opioids.
A client with back pain is prescribed a transcutaneous electrical nerve stimulation (TENS) unit. Which information will the nurse provide to educate the client about the use of this device? A) Place an electrode from each channel on either side of the painful area. B) Use the unit for no more than 5 minutes at a time. C) Use your fingers to apply gentle pressure with the device. D) Notice the sensation of heat which means the device is working.
A) Place an electrode from each channel on either side of the painful area. Explanation: To treat painful areas, the client will place one electrode from each channel on either side of the painful area. The TENS unit may be applied intermittently throughout the day or worn for extended periods of time, depending on the provider's order. TENS is a noninvasive alternative technique that involves electrical stimulation of large-diameter fibers to inhibit transmission of painful impulses carried over small-diameter fibers. Heat is not a component of TENS therapy. There is no need to apply pressure with the fingers when using TENS.
Which of the following describes the correct use of a TENS unit? A) TENS should not be used when the etiology of the pain is unknown. B) The electrodes should be placed over the carotid sinus nerves or over pharyngeal muscles. C) The unit should be turned on when repositioning or removing electrodes. D) For acute pain, a recommended pulse of 30 to 50 microseconds should be used.
A) TENS should not be used when the etiology of the pain is unknown. Explanation: TENS should not be used when the etiology of the pain is unknown because it may mask a new pathology. The electrodes should never be placed over the carotid sinus nerves or over laryngeal or pharyngeal muscles. The unit should be turned off to remove or reposition electrodes; for acute pain, the pulse should be 60 to 100 microseconds.
Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique? A) Tactile kinesthetic distraction B) Visual distraction C) Auditory distraction D) Project distraction
A) Tactile kinesthetic distraction Explanation: Examples of tactile kinesthetic distraction include holding or stroking a loved one, pet, or toy; rocking; and slow rhythmic breathing. Project distraction includes playing a challenging game or performing meaningful work. Visual distraction can be accomplished through reading or watching television. Auditory distraction may occur when one listens to music.
The nurse is caring for a client who has come to the emergency department reporting chest pain rated at 9 on a scale of 1 to 10. The pain shoots down the left arm and started 45 minutes ago. How will the nurse document this pain in the electronic health record? Select all that apply. A) acute B) cutaneous C) chronic D) visceral E) referred
A) acute D) visceral E) referred Explanation: Visceral pain (discomfort arising from internal organs) is associated with disease or injury. It is sometimes referred or poorly localized. Referred pain (discomfort perceived in a general area of the body, usually away from the site of stimulation) is not experienced in the exact site where an organ is located. Acute pain (discomfort that has a short duration) lasts for a few seconds to less than 6 months.
The nurse is caring for a client who has had back pain for 2 years, following a fall from a ladder. How does the nurse going off-shift report this kind of pain to the oncoming nurse? Select all that apply. A) chronic B) visceral C) cutaneous D) acute E) somatic
A) chronic E) somatic Explanation: Somatic pain develops from injury to structures such as muscles, tendons, and joints. Chronic pain is discomfort that lasts longer than 6 months.
Which medication would the nurse most likely see on the medication administration record (MAR) of a client with diabetic neuropathy? A) gabapentin B) morphine C) lorazepam D) hydromorphone
A) gabapentin Explanation: Gabapentin is used to treat nerve pain.
Which client population is at high risk for inadequate pain management? Select all that apply. A) infants B) young children C) clients who have a decreased level of consciousness D) clients whose primary language is different from that of the health care team E) clients who have significant visual impairment F) clients who have dementia
A) infants B) young children C) clients who have a decreased level of consciousness D) clients whose primary language is different from that of the health care team F) clients who have dementia Explanation: Risks for inadequate pain control include dementia and young age. Impairments to communication, such as language barriers and decreased cognition, are risk factors as well. Visual impairment is unlikely to influence pain management.
A group of nursing students is reviewing information about the pain process. The students demonstrate understanding of the information when they identify stimulation of which as the first component in the transmission of the pain stimulus? A) nociceptors B) C-fibers C) spinothalamic tract D) A-delta fibers
A) nociceptors Explanation: The first step in pain impulse transmission occurs in the periphery at the sight of injury. Energy is converted from one form to another and injured cells release substances that activate or sensitize nearby nociceptors. Nociceptors are located on two types of peripheral nerve cells (A-delta fibers and C-fibers) that are responsible for transmitting pain sensations from the tissues to the central nervous system (CNS). A-delta fibers give rise to bright, sharp, well-localized pain that is immediately associated with the injury. Slow-conducting C-fibers cause a second pain sensation that is dull, poorly localized, and persistent after injury. The spinothalamic tract transmits ascending impulses via secondary afferent neurons toward the brain and thalamus for interpretation.
The nurse is visiting a client at home who is recovering from a bowel resection. The client reports constant pain and discomfort and displays signs of depression. When assessing this client for pain, what should be the nurse's focal point? A) reviewing and revising the pain management treatment plan B) administering a placebo and performing a reassessment of the pain C) judging whether the client is in pain or is just depressed D) beginning pain medications before the pain is too severe
A) reviewing and revising the pain management treatment plan Explanation: The nurse's focal point should be on reviewing and revising the pain management treatment plan presently in place. The client is status-post bowel resection, so administering a placebo is not the correction option, and could be ethically wrong. The nurse would possibly do a depression assessment, but if the client is reporting constant pain, the pain management plan must be reviewed and revised. The question does not address if the client is taking pain medications, so the option addressing beginning pain medications before the pain is too severe is not correct.
A cyclist reports to the nurse that they are experiencing pain in the tendons and ligaments of the left leg, and the pain is worse with ambulation. The nurse will document this type of pain as: A) somatic pain. B) visceral pain. C) phantom pain. D) cutaneous pain.
A) 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.
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? A) visceral pain B) cutaneous pain C) somatic pain D) neuropathic pain
A) visceral pain Explanation: The client is experiencing visceral pain, which is associated with disease or injury. It is sometimes 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 nurse is performing pain assessments on clients in a health care provider's office. Which clients would the nurse document as having acute pain? Select all that apply. A) A client who has bladder cancer B) A client who is having a myocardial infarction C) A client who has rheumatoid arthritis D) A client who presents with the signs and symptoms of appendicitis E) A client who has diabetic neuropathy F) A client who fell and broke an ankle
B) A client who is having a myocardial infarction D) A client who presents with the signs and symptoms of appendicitis F) A client who fell and broke an ankle Explanation: The client having an MI, the client presenting with signs and symptoms of appendicitis, and the client with a broken ankle would be having acute pain. Clients with diabetic neuropathy, rheumatoid arthritis, and bladder cancer would have chronic pain.
The nurse is caring for a client who has a long history of using opioid pain medication. Which action will the nurse take to further assess the client's pain and provide pain relief? A) Observe the client's behavior when the nurse is not with the client. B) Acknowledge the pain as the client reports it and administer pain medication as prescribed. C) Report the client to the health care provider for seeking drugs. D) Take the client's vital signs often to observe for changes that may indicate pain.
B) Acknowledge the pain as the client reports it and administer pain medication as prescribed. Explanation: Pain is subjective and the nurse must acknowledge pain as the client reports it. Observing the client's behavior is not an appropriate nursing intervention, as pain is a self-reported finding. Taking the client's vital signs would help in administering pain medications, as pain medicine can lower a client's blood pressure and heart rate. The nurse will not report the client to the health care provider; this is making assumptions about the client.
The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opioid anesthesia, the nurse observes the client's respiratory rate decrease to 8 breaths per minute. What is the priority action by the nurse? A) Begin CPR B) Administration of 0.4 mg of naloxone C) Place the client in the supine position D) Administer a lower dose of the analgesic for the next dose
B) Administration of 0.4 mg of naloxone Explanation: The client is experiencing impending respiratory arrest due to the effect of the medication and this should be reversed immediately prior to arrest. This is the priority action and will correct the respiratory depression immediately. CPR is not indicated at this time, because the client is not in full arrest. Placing the client in the supine position may decrease respirations further.
When performing a pain assessment on a client, the nurse observes that the client guards his arm, which was fractured in a car accident, and he refuses to move out of his chair. The nurse notes this reaction as what type of pain response? A) Physiologic B) Behavioral C) Affective D) Psychosomatic
B) Behavioral Explanation: Behavioral (voluntary) responses would include moving away from painful stimuli, grimacing, moaning, crying, restlessness, protecting the painful area, and refusing to move the limb. Physiologic (involuntary) responses would include increased blood pressure, increased pulse and respiratory rates, pupil dilation, muscle tension and rigidity, pallor (due to peripheral vasoconstriction), increased adrenaline output, and increased blood glucose. Psychological responses would include exaggerated weeping and restlessness, withdrawal, stoicism, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, and powerlessness.
A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and become chronic. What is a characteristic of chronic pain? A) Chronic pain eases with healing and eventually disappears. B) Chronic pain has far-reaching effects on the client. C) Chronic pain can be severe in its initial stages. D) Chronic pain will lead to psychological imbalance.
B) Chronic pain has far-reaching effects on the client. Explanation: Chronic pain has far-reaching effects on the client because the discomfort lasts longer than 6 months. Chronic pain is not as severe in the initial stage as acute pain, but does not disappear eventually with pain medication. Chronic pain need not always lead to psychological imbalance.
Nurses assess clients who have physiologic responses to pain. Which examples of pain response are physiologic responses? Select all that apply. A) Protecting the painful area B) Nausea and vomiting C) Increased blood pressure D) Muscle tension and rigidity E) Exaggerated weeping and restlessness F) Grimacing and moaning
B) Nausea and vomiting C) Increased blood pressure D) Muscle tension and rigidity Explanation: Increased blood pressure, muscle tension and rigidity, and nausea and vomiting are examples of physiologic responses to pain. Exaggerated weeping and restlessness are examples of affective responses to pain. Protecting the painful area, grimacing, and moaning are examples of behavioral responses to pain.
A nurse is caring for an older adult client who is unable to walk without a support due to knee pain. During the initial assessment, however, the client does not mention pain. Which conversation about pain will the nurse initiate with the client? A) Pain is harmless. B) Pain is not a normal part of aging. C) Pain can be eliminated with medication. D) Pain will draw families closer to the client.
B) Pain is not a normal part of aging. Explanation: When assessing older adult clients, the nurse should remember that they often underreport pain. Many older adults 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. Older adult clients usually do not believe that pain is harmless, that medicine will eliminate pain, or that pain will draw the family closer to them.
A nurse is preparing to give a client a massage. What action should the nurse perform during this intervention? A) Massage the client's shoulder, entire back, areas over iliac crests, and sacrum with deep, penetrating, up-and-down motions. B) Using a light, gliding stroke, apply lotion to the client's shoulders, back, and sacral area. C) Knead the client's skin using effleurage (gently alternating grasping and compression motions). D) Start by placing hands beside each other at the top of the client's spine and stroke downward to the buttocks in slow, continuous strokes.
B) Using a light, gliding stroke, apply lotion to the client's shoulders, back, and sacral area. Explanation: Lotion should be applied using light, gliding strokes (effleurage). The massage should begin at the base of the client's spine and work up and down the back using circular stroking motions.
A client is prescribed oxycodone for pain relief. After teaching the client about the medication and common side effects, the nurse determines that the education was successful when the client identifies which side effect as most common? A) delirium B) constipation C) vomiting D) pruritus
B) constipation Explanation: Full agonists such as morphine or oxycodone are most commonly associated with constipation. Other side effects may include vomiting, sedation, nausea, pruritus, respiratory depression, and delirium.
The nurse is conducting an assessment of a client who has chronic joint pain and renal insufficiency. In the client record, which adjuvant drug(s) will the nurse expect to find in the client's treatment history? Select all that apply. A) moderate-dosage codeine sulfate B) glucosamine as a nutritional supplement C) selective serotonin reuptake inhibitor (SSRI) D) daily meperidine E) anticonvulsant
B) glucosamine as a nutritional supplement C) selective serotonin reuptake inhibitor (SSRI) E) anticonvulsant
A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a PRN drug regimen as an effective method of pain control would be the client: A) experiencing acute pain. B) in the postoperative stage with occasional pain. C) in the early postoperative period. D) experiencing chronic pain.
B) in the postoperative stage with occasional pain. Explanation: A PRN (as needed) medication would be most appropriate for a client in the postoperative stage with occasional pain. A client in the early postoperative period would benefit from the dosage of pain medication with around the clock dosing. A client experiencing chronic pain would benefit from the dosage of pain medication with around the clock dosing. A client experiencing acute pain would benefit from the dosage of pain medication with around the clock dosing.
Which of the following nonpharmacologic pain relief measures has been found to be effective for soothing agitated newborns and comatose clients? A) distraction B) music C) imagery D) humor
B) music Explanation: Listening to music can relax, soothe, decrease pain, and provide distraction. It has proven effective for soothing agitated newborns and comatose clients. Distraction, something that prevents someone from giving full attention to something else, can be used for school aged children and older. Imagery means to use figurative language to represent objects, actions, and ideas in such a way that it appeals to our physical senses. Imagery is used for adolescents and older clients.
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? A) the release of melatonin B) the release of endorphins C) the release of serotonin D) the release of dopamine
B) 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.
A male college student age 20 years has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is the client most likely experiencing? A) cutaneous pain B) visceral pain C) referred pain D) somatic pain
B) 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. 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.
The nurse is taking a history for a client who is being seen for chronic unrelieved back pain. Which assessment question helps the nurse assess duration of pain? A) "Have you had this pain before?" B) "When did your pain begin?" C) "How long have you experienced this pain?" D) "Could you please rate your pain on a 1-10 scale?"
C) "How long have you experienced this pain?" Explanation: Asking how long the pain has existed reflects duration. Asking when the pain began reflects onset. Asking if the client has had this pain before reflects patterns. Asking the client to rate pain on a 1-10 scale reflects intensity.
The nurse has entered the room of a client who is postoperative day 1 and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of PRN analgesia and, on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. How should the nurse respond to the client's concerns? A) "Actually, people who are not addicted to drugs before their surgery never develop a tolerance or addiction during their recovery." B) "The hospital has excellent resources for dealing with any addiction that might result from the medications you take to control your pain." C) "Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery." D) "You should remind yourself that treating your pain is important now, and that dealing with any resulting dependency can come later."
C) "Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery." Explanation: There is little danger of addiction to pain medications used in the postoperative management of pain. This acute condition of pain will subside over time and the client needs to be educated about this. The client does not need to be told that the dependency will occur later as most clients wean themselves off pain medication as the pain subsides over time. The client does not need to be told about hospital resources as this is not appropriate at this moment. People who are addicted to drugs do become more tolerant during their recovery which means they need more medication to decrease the pain.
A client has been reluctant to ask for breakthrough doses of the opioid prescribed, despite showing signs of pain. The client states to the nurse, "I don't want to become addicted to the medication." How should the nurse respond to the client's statement? A) "If you start needing more doses to control your pain, then we'll address the question of addiction." B) "It's best to focus on controlling your pain and not worry about issues like addiction." C) "There's only an extremely small chance that you will become addicted to this drug." D) "You could become addicted, but there are excellent resources available in the hospital to deal with that development."
C) "There's only an extremely small chance that you will become addicted to this drug." Explanation: Physical dependence and tolerance are expected responses to longer-term opioid use, but clients treated with opioids for pain rarely develop addiction. Despite the very low risk of addiction, it would be inappropriate for the nurse to dismiss the client's concerns such as telling them they will become addicted and the hospital has resources or telling the client to focus on controlling your pain or needing more doses to control the pain.
After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client? A) 1 B) 3 C) 4 D) 2
C) 4 Explanation: The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows:1 = awake and alert; no action necessary2 = occasionally drowsy but easy to arouse; requires no action3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.
A nurse assesses a client who was administered an opioid analgesic and finds the client unresponsive to shaking and stimulation. Which is the nurse's immediate plan of action? A) Call a code blue B) Contact the health care provider C) Administer naloxone D) Notify the family
C) Administer naloxone Explanation: Naloxone is an opioid antagonist that reverses the respiratory depressant effects of opioids. If stimulation is ineffective in arousing a client using opioids, naloxone can be used. When the client is alert and the respiratory rate is greater than 9 breaths/min, the opioids may be resumed. A code blue is not appropriate, as there is no indication that the client is without pulse or respiration. However, being prepared for this action is necessary. The nurse will contact the health care provider but first needs to take action to prevent further deterioration of the client's condition. The family must be notified but the most pressing matter is the care of the client.
A client is experiencing acute pain following the amputation of a limb. What nursing interventions would be most appropriate when treating this client? A) Increase and decrease the serum level of the analgesic as needed. B) Do not provide analgesia if there is any doubt about the likelihood of pain occurring. C) Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. D) Treat the pain only as it occurs to prevent drug addiction.
C) Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. Explanation: The client would benefit from the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. The phantom pain is real pain and should be treated as such. The nurse would not increase and decrease the serum level of the analgesic as needed. The nurse would not doubt the client's report of pain and would not withhold analgesia if she doubted the likelihood of the pain occurring.
Which statement is true of chronic pain? A) It lasts for less than 6 months. B) It disappears with treatment. C) It interferes with normal functioning. D) It is always present and intense.
C) It interferes with normal functioning. Explanation: Chronic pain is pain that may be limited, intermittent, or persistent but that lasts for 6 months or longer and interferes with normal functioning. It is commonly characterized by periods of remission and exacerbation.
A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client? A) Corticosteroids B) Nonopioid analgesics C) Opioid analgesics D) NSAIDs
C) Opioid analgesics Explanation The nurse would expect to administer opioid analgesics to a client with severe pain following a mastectomy. Nonopioid analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), are usually the drugs of choice for both acute and persistent moderate chronic pain. Corticosteroids would be used to address inflammation and swelling.
Which circumstance may preclude the use of cutaneous stimulation to relieve a client's pain? A) The client has a history of heart disease. B) The client is receiving both scheduled and breakthrough analgesia. C) The client has difficulty localizing his pain. D) The client's pain is chronic rather than acute.
C) The client has difficulty localizing his pain. Explanation: Cutaneous stimulation requires that the client be able to localize his pain. It may be used on both chronic and acute pain, and neither analgesics nor heart problems contraindicate the use of cutaneous stimulation.
A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain? A) six hours after administering a prescribed analgesic B) after the client is discharged from the health care facility C) individualized based on the client's situation D) once per day when the pain is a potential problem
C) individualized based on the client's situation Explanation: Current emphasis is on pain assessment and management of acute and chronic pain that is individualized and includes recognition, management, and referral of clients with addiction. When administering a prescribed analgesic, the nurse should assess pain before implementing a pain-management intervention, and again 30 minutes later. The nurse should assess the client's pain when the client is admitted to, not discharged from, the health care facility. Similarly, the nurse should assess pain when appropriate whenever pain is an actual or potential problem.
Which client would be the best candidate to receive epidural analgesia for pain management? A) A client who experiences frequent episodes of lower back pain B) A client who is experiencing an acute onset of chest pain C) A client with an inoperable brain tumor D) A client recovering from recent hip replacement surgery
D) A client recovering from recent hip replacement surgery Explanation: Epidural analgesia is being used more commonly to provide pain relief during the immediate postoperative phase and for chronic pain situations. Epidural pain management is also being used in children with terminal cancer and children undergoing hip, spinal, or lower-extremity surgery. Pain that is less severe or pain with an acute onset is not normally treated in this way. A brain tumor may or may not have manifestations that require an epidural analgesia.
The nurse is performing assessments for clients admitted in the emergency department. Which client is most likely experiencing somatic pain? A) A client with chest pain who is having a myocardial infarction B) A client who has appendicitis C) A client suspected to have a perforated peptic ulcer D) A client who has a sprained ankle
D) A client who has a sprained ankle Explanation: Somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep somatic pain. Visceral pain, or splanchnic pain, is poorly localized and originates in body organs in the thorax, cranium, and abdomen. Visceral pain is one of the most common types of pain produced by disease, and occurs as organs stretch abnormally and become distended, ischemic, or inflamed such as with a ruptured peptic ulcer or appendicitis. A client having a myocardial infarction with chest pain is experiencing referred pain.
The nurse is caring for a client who frequently comes to the emergency department (ED) reporting a headache that is an 8 or 9 on a pain scale of 1 to 10. The client is noted to be laughing while on the phone and chatting with staff after reporting a headache that is a 10. Which action will the nurse perform prior to initiating treatment? A) Discuss observations with the client B) Contact the pain clinic for further assessment C) Request a lower dose of medication from the health care provider D) Assess for nonverbal cues to pain
D) Assess for nonverbal cues to pain Explanation: The nurse must not make assumptions about how a client experiences or interprets pain; the nurse should acknowledge the pain as the client reports it. At the same time, the nurse will fully assess the client and document any nonverbal clues to pain observed. Contacting the pain clinic should be an intervention at the time of discharge. Requesting a lower dose of pain medication is not appropriate. Discussing the observations with the client may allow for communication regarding the client's care, but the nurse should acknowledge the pain level as the client reports it, as pain is subjective.
Which principle should the nurse integrate into the pain assessment and pain management of pediatric clients? A) A numeric scale should be used to assess pain if the child is older than 5 years of age. B) The developing neurologic system of children transmits less pain than in older clients. C) Pharmacologic pain relief should be used only as an intervention of last resort. D) Pain assessment may require multiple methods in order to ensure accurate pain data.
D) 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 neurologic 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.
Which statement accurately represents a consideration when using an epidural analgesia for client pain management? A) Slight resistance should be felt during the removal of an epidural catheter. B) If the client develops a headache, a mild analgesic may be administered along with the epidural. C) If a client is experiencing adverse effects, a peripheral IV line should be installed to allow immediate administration of emergency drugs, if warranted. D) The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min.
D) The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min. Explanation: The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min or has unmanaged pain, leakage at the insertion site, fever, inability to void, paresthesia, itching, or headache. No other medications should be administered; a peripheral IV line should already be in place. Resistance should not be felt when removing an epidural catheter.
A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse caring for the client explains the functioning of PCA. What is the main advantage of PCA? A) The client requires less nursing care. B) The client is able to have long hours of rest. C) The client obtains pain relief slowly and steadily. D) The client is actively involved in pain management.
D) The client is actively involved in pain management. Explanation: Patient-controlled analgesia (PCA) gives the client the advantage of playing an active role in pain management, as the client is allowed to self-administer medication. Pain relief is rapid, not slow and steady, because the drug is delivered intravenously. PCA does not replace nursing care or reduce the amount of care that the client requires.
A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as: A) transcutaneous electrical nerve stimulation (TENS). B) Therapeutic Touch (TT). C) hypnosis. D) biofeedback.
D) biofeedback. Explanation: Biofeedback is a technique that uses a machine to monitor physiologic responses through electrode sensors on the client's skin. The unit transforms the data into a visual display, and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. Transcutaneous electrical nerve stimulation (TENS) is a noninvasive alternative technique that involves electrical stimulation of large-diameter fibers to inhibit transmission of painful stimuli carried over small-diameter fibers. Hypnosis is an alteration in a person's state of consciousness so that pain is not perceived as it normally would be. Therapeutic Touch involves using one's hands to direct an energy exchange consciously from the practitioner to the client in order to facilitate healing or pain relief.
A client reports throbbing pain caused by a laceration that occurred to the finger while cutting vegetables. Which terminology should the nurse use to document this pain? Select all that apply. A) chronic B) neuropathic C) somatic D) cutaneous E) acute
D) cutaneous E) acute Explanation: Cutaneous pain originates at the skin level and is commonly experienced as a sensation resulting from some form of trauma. Acute pain lasts for a few seconds to less than 6 months. Therefore, the nurse documents that the client has acute, cutaneous pain. Somatic, visceral, referred, chronic, and neuropathic pain are not demonstrated in this scenario.
Who is the authority on the presence and extent of pain experienced by a client? A) a nurse B) an anesthesiologist C) a surgeon D) the client
D) the client Explanation: The only one who can be a real authority on whether, and how, an individual is experiencing pain is that individual. A surgeon is responsible for pain associated with surgery, but the client is the one that communicates the experience to the nurse. An anesthesiologist is a health care provider who provides anesthesia during the surgical process. They are responsible for the care of the client during surgery.
A nurse is caring for a client with cancer who is experiencing pain. What would be the most appropriate assessment of the client's pain? A) nonverbal cues of the client B) the nurse's impression of the client's pain C) the client's recent responses to pain and to pain medication D) the client's pain based on a pain rating
D) the client's pain based on a pain rating Explanation: The client's assessment of pain, based on a pain rating, is the most appropriate assessment data. The pain is rated on a 0 to 10 scale and nursing actions are then implemented to reduce the pain. The nurse's impression of pain and nonverbal clues are subjective data which should be considered, but which are not more important than the pain rating. Pain relief after nursing intervention is appropriate, but is a part of evaluation.
Epidural analgesia is appropriate for postoperative analgesia and can be administered via continuous infusion pump, or by a patient-controlled epidural analgesia pump (PCEA). False or True?
True
