N206 Ch. 34 Comfort and Pain PrepU Q

While caring for a client with chronic pain, the nurse talks with a family member. Which family member statement does the nurse identify as consistent with caregiver role strain? - "Even when I do extra tasks around the house, I'm glad to help my loved one." - "I feel badly because my loved one is in pain all of the time." - "Our insurance company finally found a way to cover my loved one's care." - "Sometimes it seems like I can never get a moment to myself."

"Sometimes it seems like I can never get a moment to myself." Explanation: Caregiver role strain may be exhibited by statements of exhaustion, frustration, or seeming overwhelmed. If the client states that time to themselves is rare, he or she may be feeling consumed with care for the client with chronic pain. Feeling badly regarding a loved one's pain, discussing insurance coverage, and helping the loved one by doing household tasks do not indicate caregiver role strain.

After the nurse has instructed a client with low-back pain about the use of a transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what? - "Wearing the TENS unit should not interfere with my daily activities." - "I could use the TENS unit if I feel pain somewhere else on my body." - "I may need fewer pain medications with the TENS unit in place." - "One advantage of the TENS unit is it increases blood flow."

"I could use the TENS unit if I feel pain somewhere else on my body." Explanation: The client needs further instruction when she says she can use the TENS unit on other areas of the body. Such a statement would indicate that the client does not understand that the unit should be used as prescribed by the physician in the location defined by the physician.

A nurse is evaluating the effectiveness of the preoperative education regarding pain control. Which statement by the client would indicate a need for further education? - "I will push my PCA button before I get up to go to the bathroom." - "I will make sure to drink plenty of water so I don't get constipated from the pain medication." - "I will have my wife push the PCA button when I'm asleep." - "I will bring my favorite music to listen to after my surgery."

"I will have my wife push the PCA button when I'm asleep." Explanation: The client should be the only one to administer medication via the PCA pump. Using the pump prior to getting out of bed and/or ambulating will help decrease the pain. Distraction is an effective nonpharmacologic means of dealing with pain. Constipation is a common side effect from many pain medications. Increasing fluid intake is one way of attempting to prevent it.

The nurse has completed a preoperative education session with a client who will receive morphine via a patient-controlled analgesia pump (PCA) after surgery. Which statements by the client indicates the need for further education? - "I will let my nurse know if the pain medication is not effective enough to help me move after surgery." - "I will use the PCA pump until oral pain medication controls my pain." - "I will remind my family member to push the PCA pump button for me if I doze off during the day." - "I can push the button whenever I feel pain."

"I will remind my family member to push the PCA pump button for me if I doze off during the day." Explanation: Sedation that prevents the client from delivering a dose of opioid contributes to the safety of intravenous PCA drug administration. If the client is too sleepy to push the button (or asks that it be pushed), the button should not be pushed.

A nurse is performing pain assessments on clients in a physician's office. Which clients would the nurse document as having acute pain? Select all that apply. - A client who fell and broke an ankle - A client who presents with the signs and symptoms of appendicitis - A client who has diabetic neuropathy - A client who is having a myocardial infarction - A client who has bladder cancer - A client who has rheumatoid arthritis

- A client who is having a myocardial infarction - A client who presents with the signs and symptoms of appendicitis - 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 manager hears a nurse and a nurse aide talking about a female client who reports pain of 8 out of 10 on a 1-10 after a Caesarean birth to deliver twins. The nurse states, "I don't believe this client has any pain at all. I'm sure she is just drug seeking." What is the appropriate nurse manager action? - Write the nurse up for disciplinary action. - Continue listening to the conversation before intervening. - Ask the nurse to speak privately for a moment, and educate about bias in pain treatment. - Enter the conversation and tell the nurse and UAP that this type of discussion will not be tolerated

- Ask the nurse to speak privately for a moment, and educate about bias in pain treatment. Explanation: Research has shown that treatment bias may delay pain-relieving measures. The nurse manager should privately and professionally educate the nurse, and then subsequently educate the nurse aide. Addressing the concern quickly is important so the client can receive appropriate care and pain management. Entering the conversation is not the best action to educate the nurse and disciplinary action doesn't help to immediately address the current situation.

The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate? (Select all that apply.) - Consider cultural implications of the perception of pain. - Delegate pain assessment to the UAP. - Assess for pain control 30 minutes after administering an analgesic. - Infer that the client who does not complain has no pain. - Provide pain medication before activity that may increase pain.

- Assess for pain control 30 minutes after administering an analgesic. - Consider cultural implications of the perception of pain. - Provide pain medication before activity that may increase pain. Explanation: Pain assessment should never be delegated to a UAP. Pain medication should be given in advance of an activity that may increase pain. The nurse should consider cultural implications associated with pain, and assess for pain control after medication is given. Assumptions should not be made about pain.

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.) - somatic - acute - cutaneous - neuropathic - referred - visceral - chronic

- chronic - 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. Other answers are incorrect.

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? - 1 - 2 - 3 - 4

3 Explanation: The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: 1 = awake and alert; no action necessary 2 = occasionally drowsy but easy to arouse; requires no action 3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose 4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

A middle-age client tells the nurse that the client's neck pain reduced considerably after the client underwent a treatment in which thin needles were inserted into the skin. What kind of pain relief treatment did the client undergo? - biofeedback - acupuncture - transcutaneous electrical nerve stimulation - rhizotomy

Acupuncture Explanation: The client underwent acupuncture. Acupuncture is a pain-management technique in which long, thin needles are inserted into the skin. Transcutaneous electrical nerve stimulation (TENS) and biofeedback are nonsurgical and nondrug procedures used to treat pain. TENS is a medically prescribed pain-management technique that delivers bursts of electricity to the skin and underlying nerves. In biofeedback, a client learns to control or alter a physiologic phenomenon. Rhizotomy involves the surgical sectioning of a nerve root close to the spinal cord.

A client states that he is pain and requests the ordered pain medication. When entering the client's room, the client is laughing with visitors and does not appear to be in pain. What is the appropriate action by the nurse? - Reassess the client's pain in 30 minutes. - Administer the pain medication. - Contact the client's physician. - Hold the pain medication.

Administer the pain medication. Explanation: Pain is considered to be present whenever the client states it is. Therefore, the nurse should administer the client's pain medication. It would be inappropriate to delay administration or to hold the medication. There is no indication that the client's physician needs to be notified at this time.

A client who is in pain strikes out at a nurse who is attempting to perform a bed bath. This client is displaying which pain response? - Involuntary - Physiologic - Affective - Behavioral

Affective Explanation: The client would be displaying the affective pain response by striking out at the nurse. Other responses of affective pain response would be exaggerated weeping and restlessness, withdrawal, stoicism, anxiety, depression, fear, anger, anorexia, fatigue, and hopelessness. 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. Behavioral (voluntary) responses would include moving away from painful stimuli, grimacing, moaning, crying, restlessness, protecting the painful area, and refusing to move the limb.

A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the nurse's best intervention in this situation? - Distract the boy so he does not notice his pain. - Ask the boy to draw a cartoon about the color or shape of his pain. - Medicate the boy with analgesics to reduce the anxiety of experiencing pain. - Ignore the boy's pain if he is not complaining about it.

Ask the boy to draw a cartoon about the color or shape of his pain. Explanation: Asking the boy to draw a cartoon about the color or shape of his pain is an excellent intervention by the nurse. The child could be in pain and not complaining, so ignoring the boy's pain is not correct. Distracting the boy so he does not notice his pain would not be appropriate. Medicating the boy with analgesics to reduce the anxiety of experiencing the pain is not correct. Addressing the anxiety does not address the pain.

The nurse is conducting an admission assessment, and asks the client what medication is taken for pain. The client responds, "I take a little white pill to control my pain, but I don't know the name of it," and presents the nurse with a plastic baggie full of white pills. What is the priority nursing intervention? - Call the pharmacy to attempt to identify the pill. - Tell the healthcare provider that the client is unsure of the pain medication taken. - Document what the client states. - Ask the client if he or she has the bottle the drug was dispensed in from the pharmacy.

Ask the client if he or she has the bottle the drug was dispensed in from the pharmacy. Explanation: The priority nursing intervention is to ask the client for the original bottle that the drug was dispensed into from the pharmacy. This will provide the most accurate identification of the medication. Other interventions can subsequently be implemented.

A client prescribed pain medication around the clock experiences pain one hour before the next dose of the pain medication is due. Which is the most appropriate action by the nurse? - Assess for medication order for breakthrough pain. - Administer the next dose of the pain medication. - Tell the client he has to wait for one hour. - Assess the client for signs of narcotic addiction.

Assess for medication order for breakthrough pain. Explanation: Breakthrough pain is a temporary flare-up of moderate to severe pain that occurs even when the client is taking pain medication around the clock. It can occur before the next dose of analgesic is due (end of dose pain). It is treated most effectively with supplemental doses of a short-acting opioid taken on an "as needed basis." Therefore, the client should check the orders for breakthrough pain medication.

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: - Hypnosis - Biofeedback - Therapeutic Touch (TT) - Transcutaneous electrical nerve stimulation (TENS).

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.

The nurse is evaluating pain of several clients who had hip replacement surgery. Which of the following clients is most likely to have the greatest perceived pain? - Client who sleeps through the night without waking - Client who is anxious about discharge - Client who feels in control of the situation - Client listening to their favorite music

Client who is anxious about discharge Explanation: Anxiety, lack of sleep, and feelings of powerlessness decrease a client's ability to cope with pain and increase the perception of pain. Therefore, the client most likely to have the greatest perceived pain is the client who is anxious about discharge.

A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a client being discharged. What process is involved in this pain relief measure? - Cutaneous stimulation - Client-controlled analgesia - Biofeedback mechanism - Transcutaneous electrical nerve stimulation

Cutaneous stimulation Explanation: Cutaneous stimulation techniques include acupressure, massage, application of heat and cold, and transcutaneous electrical nerve stimulation (TENS).

Which of the following is considered to be the most potent neuromodulators? - Efferent - Enkephalins - Endorphins - Efferent

Endorphins Explanation: Endorphins and enkephalins are opioid neuromodulators. Endorphins are powerful pain blocking chemicals with prolonged analgesic effects. Enkephalins are considered less potent. There are no neuromodulators called efferent or afferent

Which medication would the nurse most likely see on the medication administration record (MAR) of a client with diabetic neuropathy? - Lorazepam - Hydromorphone - Morphine - Gabapentin

Gabapentin Explanation: Gabapentin is used to treat nerve pain.

A client comes to the emergency department complaining of a shooting pain in his chest. When assessing the client's pain, which behavioral response would the nurse expect to find? - High blood pressure - Decreased heart rate - Guarding of the chest area - Increased respiratory rate

Guarding of the chest area Explanation: A person's behavioral response to pain can be demonstrated by protecting or guarding the painful area, grimacing, crying, or moaning. Increased blood pressure and respiratory rate are typical physiologic (sympathetic) responses to moderate pain. Decreased heart rate is a typical physiologic (parasympathetic) response to severe pain.

The nurse recognizes which of the following statements is true of chronic pain? - It can be easily described by the client. - It is always present and intense. - It may cause depression in clients. - It disappears with treatment.

It may cause depression in clients. Explanation: Chronic pain may lead to withdrawal, depression, anger, frustration, and dependency. Clients have difficulty describing chronic pain because it may be poorly localized. Moreover, health care personnel have difficulty assessing it accurately because of the unique responses of individual clients to persistent pain. Chronic pain is commonly characterized by periods of remission and exacerbation.

The nurse preparing to admit a client receiving epidural opioids should make sure that which of the following medications is readily available on the unit? - Lasix - Narcan - Digoxin - Lopressor

Narcan Explanation: The nurse should ensure that Narcan is readily available on the unit, as it can reverse the respiratory depressant effects of opioids.

A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client? - Nonopioid analgesics - Corticosteroids - NSAIDs - Opioid analgesics

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 non-steroidal 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 principle should the nurse integrate into the pain assessment and pain management of pediatric clients? - A numeric scale should be used to assess pain if the child is older than 5 years of age. - The developing neurologic system of children transmits less pain than in older clients. - Pharmacologic pain relief should be used only as an intervention of last resort. - Pain assessment may require multiple methods in order to ensure accurate pain data.

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 guideline regarding pain should be included in the nurse's education plan for a group of parents with infants and toddlers? - Toddlers are often reluctant to express pain. - Infants cannot express pain until 8 months of age. - Pain can be a source of fear and threat to the toddler's security. - Toddlers often try to be brave and not cry.

Pain can be a source of fear and threat to the toddler's security. Explanation: During the toddler and preschool years, children are achieving a sense of autonomy. Because pain can be a source of fear and threat to security, children respond with crying, anger, physical resistance, or withdrawal.

A nurse has attended a pain control workshop and learned about the psychological and physiological basis of placebos. What principle should guide the use of placebos in the treatment of pain? - Placebos involve the use or deception and are considered unethical in most circumstances. - Placebos should be used if the client provides written consent for their use. -

Placebos involve the use or deception and are considered unethical in most circumstances. Explanation: Placebos have been shown to have some efficacy in the control of pain. However, because they involve deception they are usually considered unethical. In most circumstances, this fact overrides their possible efficacy. When a client is informed that a pill is a placebo, it loses the essential characteristic of a placebo.

A client has an order for a narcotic analgesic every 3 to 4 hours and he received his last dose 3 hours earlier. Which action is most appropriate for the nurse to take in response to the client's request for pain medication on his first postoperative day? - Contact the physician for a change in medication. - Document and ask the client to wait 1 hour. - Tell the client that the pain cannot be severe. - Provide the client with pain medication.

Provide the client with pain medication. Explanation: Inadequate or poor pain assessment is a leading factor in poor pain control, because the health care professional may not know a client has pain. The nurse must provide the next dose of pain medication.

A client who has been harassed at her place of work tells the nurse, "Every time I think of my job, I get a debilitating headache and have to go lie down to make the pain go away." Which nursing intervention will the nurse perform to practice according to the Gate Control Theory? - providing temple massage when head hurts - contacting the healthcare provider to prescribe opioid medication - teaching the client to remove items from the home that remind them of work - asking if pain is produced by smells or sounds

Providing temple massage when head hurts Explanation: Administering temple massage reflects the Gate-Control Theory. The other actions support other theories.

The nurse caring for a client receiving epidural opioids should assess for which of the following side effects? (Select all that apply.) - Urinary retention - Hypertension - Nausea - Pruritis - Infection

Pruritis Urinary retention Nausea Infection Explanation: The nurse should assess for side effects that include, hypotension, pruritus, urinary retention, nausea and vomiting, infection, and respiratory depression.

Which of the following is the priority assessment for a nurse caring for a client with a Patient Controlled Analgesia (PCA) pump? - Peripheral Vascular - Respiratory - Neuromuscular - Cardiovascular

Respiratory Explanation: The priority assessment for the nurse caring for a client with a PCA pump is respiratory, with particular attention to the respiratory rate and pattern. Too much narcotic or a displaced catheter may allow the medication to have a depressant effect on the brainstem center, causing life-threatening respiratory depression.

A nurse is caring for a client who was administered opioid narcotics. The client reports constipation. What is another potential side effect of opioid narcotics? - Diarrhea - Sedation - Anxiety - Insomnia

Sedation Explanation: Opioids and opiates can cause sedation, nausea, and constipation. They also can cause respiratory depression, which is the main side effect to watch for with narcotics. Opioids and opiates do not lead to anxiety, diarrhea, or insomnia in clients.

A client has required frequent scheduled and breakthrough doses of opioid analgesics in the 6 days since admission to the hospital. The client's medication regimen may necessitate which intervention? - Supplementary oxygen and chest physiotherapy - Frequent turns and application of skin emollients - Stool softeners and increased fluid intake - Calorie restriction and dietary supplements

Stool softeners and increased fluid intake Explanation: The most common side effect of opioid use is constipation. Consequently, stool softeners and increased fluid intake may be indicated. Opioids may cause respiratory depression, but this fact in and of itself does not create a need for oxygen supplementation or chest physiotherapy. The use of opioids does not create a need for calorie restriction, supplements, frequent turns, or the use of skin emollients.

Which statements accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain? - A PCA pump must be used and monitored in a health care facility. - The PCA pump is not effective for chronic pain. - The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. - This approach can only be used with oral analgesics.

The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. Explanation: The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. This approach can be used with oral analgesic agents as well as with infusions of opioid analgesic agents by intravenous, subcutaneous, epidural, and perineural routes. This drug delivery system may be used to manage acute and chronic pain in a health care facility or the home.

Besides controlling pain of the post-abdominal surgery client with narcotics, the nurse suggests to the client that he: - Use distraction - Focus on pain relief - Describe the pain - Think about the next dose.

Use distraction. Explanation: Distraction is useful when clients are undergoing brief periods of sharp, intense pain, such as dressing changes, wound débridement, biopsy, or incident pain from shifting positions.

Besides controlling pain of the post-abdominal surgery client with narcotics, the nurse suggests to the client that he: - use distraction. - think about the next dose. - focus on pain relief. - describe the pain.

Use distraction. Explanation: Distraction is useful when clients are undergoing brief periods of sharp, intense pain, such as dressing changes, wound débridement, biopsy, or incident pain from shifting positions.

A nurse is caring for a client who complains of an aching pain in the abdomen. The nurse also noted that the client is guarding the area. What kind of pain is the client experiencing? - Cutaneous pain - Visceral pain - Neuropathic pain - Somatic pain

Visceral pain Explanation: The client is experiencing visceral pain, which is poorly localized and originates in body organs in the thorax, cranium, and abdomen. A reflex contraction or spasm of the abdominal wall, called guarding, may occur as a protective mechanism to prevent additional trauma to underlying structures. 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 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? - Cutaneous pain - Visceral pain - Somatic pain - Referred pain

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 triage nurse is assessing a 5-year-old client who has come to the emergency department with a caregiver after falling off of a skateboard. Which pain assessment tool will the nurse choose to use? - numeric scale - Wong-Baker FACES® scale - word scale - visual analog scale

Wong-Baker FACES® scale Explanation: Children as young as 3 years of age can use the Wong-Baker FACES® scale. A word, numeric, or visual analog scale are more appropriate for adults.

When the male client on his first postoperative day after chest surgery appears stoic and does not ask for any pain medication, the nurse should: - document the client's lack of medication. - assume the client does not need medication. - actively solicit information about the client's pain level. - ask the client's family if he ever uses pain medicines.

actively solicit information about the client's pain level. Explanation: Some cultures see pain tolerance as a virtue; often men are expected to tolerate pain more stoically than women do. Health care providers need to recognize the client's cultural beliefs and not impose their own judgments.