Chapter 9: Assessing Pain

A client is reporting pain and rates it as 7 on a scale of 1 to 10. When the nurse asks him to describe the pain, he states, "It feels like a knife is stabbing or cutting me." The nurse knows that this type of pain is conducted by which fibers?

A-delta fibers

A client recovering from a stroke complains of pain. The nurse suspects this client is most likely experiencing which type of pain?

Neuropathic

A client who suffers from arthritis complains of sharp pain in her knees and elbows. The nurse recognizes this is what ty.pe of pain?

Somatic

A nurse enters a client's room to conduct an assessment. The client is crying and states they have so much pain. What is the best response of the nurse?

"Could you tell me more about your pain?"

Recently, lung cancer has metastasized to the bones of a 68-year-old client, precipitating a sudden increase in his pain. The client's wife and daughter are concerned about the consequent increase in the amount of hydromorphone the client requires, citing the risk of addiction. How can the nurse best respond to the family's concern?

"There's a very minimal risk of addiction, and controlling his pain is our first concern."

Pain is whatever the client says it is. Self-report is the gold standard for assessing pain; however, nurses learn when assessing pain to assess the following as well: (Check all that apply.)

1. Decreased urine output 2. Grimacing 3. Rocking 4. Increased heart rate 5. Increased blood pressure

A nurse assesses a client with acute small-bowel obstruction who reports intermittent pain. He only noticed symptoms of this condition earlier today. Which questions are appropriate for the nurse to ask when assessing the client's pain? Select all that apply.

1. Describe the pain. 2. Where is the pain located? 3. When did the pain start?

An older adult comes to the clinic reporting pain in the right lower quadrant. When assessing the client's pain, what elements would the nurse include? Select all that apply.

1. Intensity 2. Quality 3. Location

The nurse understands the importance of performing an accurate pain assessment. In addition to having the client rate the pain on a pain scale, other things to assess are the following: (Check all that apply.)

1. Location and duration 2. Quality and description 3. Alleviating and aggravating factors

A client enters the emergency department moaning and complaining of severe pain in his lower back. Which of the following clinical manifestations should the nurse expect to see in this client as a physiologic response to pain? Select all that apply.

1. Perspiration 2. Increased heart rate 3. Sleeplessness

A client recovering from total knee replacement is experiencing severe pain. Where should the nurse expect the client to rate this pain on the following scale?

8

A pathophysiology instructor is discussing pain and its treatment across cultures. The instructor points out that clients from racial and ethnic minorities often receive less pain medication compared to Caucasians for what specific conditions?

Acute pain in the ED

A client presents to the health care clinic with reports of a 2-day history of sore throat, ear pressure, fever, and stiff neck. The client states she has taken Tylenol and lozenges without relief. Which nursing diagnosis can be confirmed by this data?

Acute pain related to sore throat

A client on a medical-surgical unit reports pain of 10 on a scale of 0 to 10 and wants more pain medication. The nurse does not think the pain is as bad as the client says. The physician left orders for prn morphine for breakthrough pain. What is the priority nursing action?

Give the prn morphine

Beliefs of health care providers can serve as barriers to an accurate assessment of a client's pain. Which of the following beliefs will not be likely to impair the assessment of pain?

Infants can feel pain and may respond with crying or agitation.

Mr. Garcia comes to the office for a rash on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. On examination, the nurse notes a rash with small blisters (vesicles) on a background of reddened skin. The rash overlies an entire rib on his right side. What type of pain is this?

Neuropathic

When clients report pain, it is important to find the source. When clients describe pain as "burning, painful numbness, or tingling," the source is more than likely:

Neuropathic

Which of the following principles should the nurse integrate into the pain assessment and pain management of pediatric clients?

Pain assessment may require multiple methods in order to ensure accurate pain data.

Which of the following cultural expressions of pain would be likely to be found in a person of Hispanic culture?

Pain must be endured to perform gender role duties, but response to it is very expressive.

The charge nurse on a geriatric unit should further educate a new staff nurse who makes which statement?

Pain sensation is diminished in older adults.

Which of the following statements most accurately conveys an aspect of the gate-control theory?

Specialized cells can decrease pain transmission by exciting inhibitory neurons.

An elderly farmer has sustained severe injuries after a serious accident involving a combine harvester. At the hospital, he tells the nurse that he thinks the pain he is feeling now is "payback" for living a "mean, selfish life." The nurse recognizes that this response by the man indicates which dimension of pain?

Spiritual dimension

Pain is frequently a motivator for people to seek health care and is considered the fifth vital sign. TRUE OR FALSE

TRUE

The nurse is explaining the difference between acute pain and chronic pain to the client. Which should the nurse include in the explanation?

The cause of acute pain can be identified.

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?

The release of endorphins

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?

Visceral pain

A post-operative client is observed breathing 24 breaths/minute while complaining of 10/10 abdominal pain. The client's oxygen saturation is 90% on 2 liters nasal cannula. What is the nurse's priority action?

Administer prescribed analgesia as ordered.

The nurse should assess for which pain complaints from a client diagnosed with Type II Diabetes Mellitus?

Burning, tingling

In preparing a care plan for a client receiving opioid analgesics, the nurse selects which of the following as an applicable nursing diagnosis associated with side effects of opioid use?

Constipation

A male client with a history of a back injury 2 months ago has been taking daily doses of narcotic pain medication. He is currently hospitalized with a leg fracture after falling down the stairs. He complains of 10/10 pain in his back and leg after taking pain medication one hour ago. What is the nurse's best action?

Consult with the healthcare provider about increasing the dose of medication.

A nurse assesses a cognitively impaired adult client who grimaces and points to the right knee following a motor vehicle accident. Which pain scale would be most appropriate for the nurse to use to assess the client's pain?

Faces Pain Scale

The nursing student asks the nurse what would be an example of visceral pain. What would be the correct response by the nurse?

Gallbladder pain

What is the most commonly accepted theory of pain?

Gate control theory

A client complains of pain in several areas of the body. How should the nurse assess this client's pain?

Have the client rate each location separately.

The U.S. government has created guidelines for health care providers caring for clients in pain. Which of the following reflect these guidelines?

Joint Commission Standards for Pain Management.

A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing?

Neuropathic pain

A client recovering from abdominal surgery is complaining of pain. The nurse realizes that the client is most likely experiencing which type of pain?

Somatic

When assessing the client for pain, the nurse should

believe the client when he or she claims to be in pain.

A client reports pressure in the chest but describes pain in the jaw and right arm. Based on these findings, the nurse determines that the client may be experiencing which of the following types of pain?

referred