MNL Acute and Chronic Pain
Tim Jones is an 8-year-old male who is admitted to the inpatient medical-surgical unit at your hospital for a surgical repair of a broken arm. On assessment, you notice Tim is lying in bed grimacing. His assessment reveals an elevated HR, elevated BP, perspiration, and rapid shallow breathing. Which type of pain is Tim experiencing? Referred pain Neuropathic pain Chronic pain Acute pain
Acute Pain Acute pain occurs as a result of a single event. Physiologic responses are tachycardia, hypertension, tachypnea, and increased perspiration. The other types of pain are not supported by the assessment findings.
Which question is inappropriate to ask during the pain assessment? Have you been in pain before? What is causing the pain? Does anything make the pain better? Are you really sure you are in pain?
Are you really sure you are in pain? Appropriate questions for the nurse to ask when assessing pain include asking what is causing the pain, what things make the pain better, and if the client has experienced this type of pain in the past. Asking the client if he or she is really in pain is not therapeutic. Pain is a subjective experience.
The nurse is teaching a client prevention methods for pain. Which items will the nurse include in the teaching session? (Select all that apply.) Avoiding risky behaviors Exercising daily Ignoring symptoms Taking medications as prescribed Eating a balanced diet
Avoiding risky behaviors Exercising daily Eating a balanced diet Pain prevention methods that the nurse will include in the teaching include the importance of exercise, eating a balanced diet, and avoiding risky behaviors. Ignoring symptoms is not a prevention strategy. Taking medications as prescribed is a treatment method and not a prevention method.
Jackie Gardner is a 20-year-old college cheerleader who is brought to the emergency department (ED) after landing incorrectly during a stunt and injuring her right ankle. The ED healthcare provider makes the diagnosis of a right ankle fracture and orders an IV narcotic for pain relief while waiting for the orthopedic surgeon to evaluate her injury. Thirty minutes after you administer the medication, you return to evaluate her response to the medication. Which will you include in your evaluation? Client's reported pain level Client's sleep patterns Ability to move ankle Respiratory status Vital signs
Client's reported pain level Respiratory status Vital signs Ongoing monitoring of the client who has been administered a narcotic pain medication includes vital signs, respiratory status, and the client's reported pain level. These indicators help determine the effectiveness of the medication and alert the nurse to possible side or adverse effects. The surgeon will evaluate the client's ankle further. It is not necessary to evaluate the client's sleep patterns at this time.
A client with a life-threatening illness has been treated with repeated doses of opioids over a period of several weeks. Which symptoms obtained in the assessment indicate the client is experiencing side effects related to medication administration? (Select all that apply.) Constipation Sweating Pruritus Vomiting Sedation
Constipation Pruritus Vomiting Sedation Opioid side effects include constipation, sedation, pruritus, and vomiting. Sweating can occur with opioid withdrawal but is not a side effect related to opioid administration.
The nurse is providing home care instructions to a client with chronic pain. Which items are appropriate for the nurse to include in the teaching session? (Select all that apply.) Having resuscitation equipment ready for use, if necessary Eating a balanced diet Administering pain medications by the intramuscular (IM) route Maintaining adequate hydration Using assistive devices
Eating a balanced diet Maintaining adequate hydration Using assistive devices Appropriate home care instructions for the nurse to provide a client with chronic pain include maintaining adequate hydration, eating a balanced diet, and appropriate use of assistive devices. The nurse would not provide instruction on administering intramuscular pain medications or having resuscitative equipment ready for use for a client being discharged home.
Which pain tool is most appropriate to use when assessing a preschool-age client who is experiencing pain? Verbal descriptor scale Faces rating scale Numerical rating scale FLACC scale
Faces rating scale The Faces rating scale is most appropriate to use when assessing pain for a preschool-age client. A numerical rating scale can be used for clients who understand the meaning of a numerical scale. The FLACC scale is appropriate for assessing neonatal and infant pain. A verbal descriptor scale is most appropriate for clients who cannot use the other types of pain scales.
Nurses taking care of clients experiencing pain should understand that the acute pain stimulates the adrenergic nervous system, which will result in which physiologic change? Bradycardia Increased perspiration Pupil constriction Hypotension
Increased perspiration Acute pain stimulates the adrenergic nervous system and results in physiologic changes, including tachycardia, tachypnea, hypertension, pupil dilation, pallor, increased perspiration, and increased secretion of catecholamine and adrenocorticoid hormones.
Casey Alexander, a 14-year-old high school football player, is admitted to your unit with shingles (varicella zoster). He has painful lesions on his face and down one side of his neck. His mother has decided to remain with him while he is on isolation precautions and unable to leave his hospital room. After administering the prescribed analgesic, which age-appropriate complementary therapy would you encourage the mother to do? Blowing bubbles with her son Reading a story to her son Swaddling her son Inviting friends to visit
Inviting friends to visit Complementary methods of pain management for the pediatric client should be age appropriate. Inviting friends to visit provides both a distraction and a means of social support for the adolescent client. Inviting friends to visit will allow the client to focus on others rather than pain. The other interventions are not age appropriate for the adolescent client.
Pretest Question 2 The nurse is caring for an older adult client on a medical-surgical unit who had abdominal surgery for mass removal one day ago. Which clinical manifestations of pain are typical for an older adult client? A) Loss of appetite B) Decreased energy C) Guards abdomen D) Cries inconsolably E) Changes in sleep patterns
Loss of appetite Decreased energy The older adult client will often exhibit decreased energy and a loss of appetite when experiencing pain.
Which clinical manifestations indicate a client is experiencing breakthrough pain? (Select all that apply.) Muscle tension Limited mobility Change in appetite Slow movement Sleep disturbance
Muscle tension Limited mobility Clients diagnosed with chronic pain may experience breakthrough pain, an exacerbation of pain that may be a response to a trigger or to inadequately controlled chronic pain. Manifestations of breakthrough pain include limited mobility and muscle tension. Changes in appetite and sleep disturbances occur with unrelieved pain. Slow movements occur with acute pain.
Pretest Question 5 The nurse is caring for a client with a history of chronic unrelieved pain related to leukemia. Which intervention of last resort might be considered for this client? A) Muscle-relaxation techniques B) Oral analgesics C) Guided imagery D) Nerve block
Nerve block A client with chronic unrelieved pain that can occur with cancer would be a candidate for a nerve block
What are the two main categories of pain? Phantom and cycogenic Acute and chronic Nociceptive and neuropathic Breakthrough and central
Nociceptive and neuropathic Pain is classified by its origin, or the starting point of the pain signal. The two main categories of pain are nociceptive and neuropathic. Other classifications of pain include acute, chronic, breakthrough, central, phantom, and cycogenic.
Pretest Question 3 The nurse is caring for several clients who are receiving pharmacologic treatments for pain. Which type of treatment is the client who can self-administer a preset dose of intravenous opioids receiving? A) Epidural injection B) IM opioid injection C) Transdermal patch D) PCA
PCA The PCA is a patient-controlled analgesic pump that allows the client to self-administer a preset dose of intravenous opioids
The nurse is caring for a client receiving analgesics for pain. Which medication is considered a coanalgesic? Prednisone Aspirin Acetaminophen Morphine
Prednisone Prednisone is a corticosteroid that is considered a coanalgesic, a medication that may enhance pain relief when used in conjunction with an analgesic. Aspirin and acetaminophen are nonopioid analgesics. Morphine is an opioid analgesic.
The nurse is caring for a client who is experiencing acute pain. Which independent nursing intervention is appropriate for this client? Placing a transdermal patch Asking the client what methods enhance comfort Repositioning for comfort Administering a nonopioid analgesic
Repositioning for comfort Repositioning the client for comfort is an independent intervention that the nurse can implement for this client. Administering a nonopioid analgesic and placing a transdermal patch both require a health care provider prescription. Asking the client what methods enhance comfort is a nursing assessment not intervention.
Pretest Question 1 The nurse administers an opioid analgesic to a client experiencing acute pain. Which assessment finding requires priority intervention from the nurse? A) Respiratory depression B) Pupil dilation C) Tachycardia D) Constipation
Respiratory depression Any client experiencing respiratory depression after the administration of opioid analgesics requires priority intervention
Pretest Question 6 The nurse is assessing a client with rheumatoid arthritis. Which assessment data is typical for clients experiencing continuous, chronic pain? A) Respiratory rate of 20 B) BP 120/80 mmHg C) Temperature of 97 degrees°F D) Dilated pupils E) Heart rate of 80 beats per minute
Respiratory rate of 20 BP 120/80 mmHg Heart rate of 80 beats per minute Clients with chronic pain often have normal heart and respiratory rates, and normal blood pressure. Temperature remains normal in the presence of chronic pain. Dilated pupils often occur with acute pain, not chronic pain.
Pretest Question 4 The nurse is planning care for a client experiencing acute pain. What will the nurse include in the health history portion of the nursing assessment? A) Inspecting injuries B) Using a developmentally appropriate tool C) Monitoring vital signs D) Assessing facial expressions
Using a developmentally appropriate tool The nurse will use a developmentally appropriate pain assessment tool during the health history portion of the nursing assessment
Which diagnostic test for diagnosing pain is a self-reporting tool? Visual analog scale Serum cortisol levels Heart rate assessment Blood pressure monitoring
Visual analog scale The visual analog scale is a self-reporting tool that is used to diagnose pain. Serum cortisol levels may be tested to identify stress. Blood pressure monitoring and a heart rate assessment are vital sign assessments. Changes in vital signs can be indictors for diagnosing pain.
Pain is described as 3 types of experience:
physical cognitive emotional
Nociception involves transmission of pain impulses from the site of injury to which structures? Tendons and ligaments Brain and muscles Spinal cord and brain Muscles and spinal cord
Spinal cord and brain Nociception is the transmission of pain impulses from the site of injury to the A-delta and C fibers to the dorsal horn of the spinal cord and brain.
Which collaborative therapy for treating pain is considered a complementary or alternative method? Radioablation Nerve block Implanted electrotherapy devices Transcutaneous electrical nerve stimulation
Transcutaneous electrical nerve stimulation Transcutaneous electrical nerve stimulation is a complementary or alternative method used to treat pain. Radioblation, nerve block, and implanted electrotherapy devices are considered invasive therapies.
