Coursepoint Ch 9: Assessing Pain: The 5th Vital Sign

Which of the following is not released during the stress response? A) Epinephrine B) Norepinephrine C) Dopamine D) Cortisol

C) Dopamine

A client was administered PO pain medications at 1530. By what time should the nurse re-assess and document the effects of the pain medication? A) 1630. B) 1930. C) 2130. D) By end of shift.

A

The nurse is assessing a client with a history of drug addiction. What will be helpful in determining interventions that will be most beneficial for providing adequate pain relief to this client? A) Gathering information that the client wants to share about his pain B) Using in-depth questions to collect significant data about the client's pain C) Collecting objective data that the client chooses to share D) Collecting subjective data that the nurse notes during assessment

B) Using in-depth questions to collect significant data about the client's pain

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. A) Hypoglycemia B) Perspiration C) Increased heart rate D) Increased intestinal motility E) Sleeplessness

B, C, E

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 endorphins B) The release of insulin C) The release of melatonin D) The release of dopamine

A) The release of endorphins

What is the element of pain transmission that causes nociceptors to perceive a nerve impulse? A) Transduction B) Transmission C) Perception D) Modulation

A) Transduction

A client recovering from abdominal surgery is complaining of pain. The nurse realizes that the client is most likely experiencing which type of pain? A) Psychogenic B) Idiopathic C) Neuropathic D) Somatic

D) Somatic

The nursing instructor is teaching a class about how to assess pain in older adults. The teachers tells the students that problems can arise in certain circumstances. The instructor realizes the need for more teaching about pain in the elderly when one of the students replies: A) "Pain is a natural part of aging." B) "Patients may fear that uncontrolled pain will affect their independence." C) "Older clients may worry that reporting pain will lead to costly tests." D) "Patients are reluctant to report pain because they want to be considered as 'good' clients."

A) "Pain is a natural part of aging."

The nurse administers pain medication to a client at 1600. At what time should the nurse return to reassess the client's pain level? A) 1630 B) 1730 C) 2000 D) 2030

A) 1630

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? A) Acute pain in the ED B) Chronic pain from fibromyalgia C) Broken limbs D) Head injuries

A) Acute pain in the ED

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? A) Administer prescribed analgesia as ordered. B) Teach and encourage incentive spirometry use. C) Explain why deep breathing and coughing is important. D) Manually ventilate client with ambu bag at bedside.

A) Administer prescribed analgesia as ordered.

During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is which of the following? A) Analgesics B) Surgery C) Relaxation techniques D) Cutaneous stimulation

A) Analgesics

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? A) Constipation B) Diarrhea C) Impaired urinary elimination D) Bowel incontinence

A) 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? A) Consult with the healthcare provider about increasing the dose of medication. B) Inform the client that the next dose of medication is due in one more hour. C) Request a psychiatric evaluation for drug seeking behavior. D) Tell the client to take his own prescription medication.

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

The nurse is caring for a 4-week-old postoperative client. The most appropriate pain assessment tool would be the: A) Face, Legs, Activity, Cry, Consolability Scale B) FACES Pain Scale C) Numeric Pain Intensity Scale D) Combined Thermometer Scale

A) Face, Legs, Activity, Cry, Consolability Scale

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? A) Give the prn morphine B) Hold the medication and wait 30 minutes C) Call the physician to check the order D) Document the client's pain rating on a scale of 0 to 10

A) Give the prn morphine

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

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

The nurse is using the Visual Analog Scale to assess pain of an adult client. The nurse instructs the client to: A) Place a mark on a 100-mm line with "no pain" at one end and "worst possible pain" at the other B) Rate their pain using a 0 to 10 scale where 0 means "no pain" and 10 means "worst possible pain" C) Select a number with descriptors located on a thermometer that describe their pain D) Complete a short questionnaire comprised of open-ended questions to describe their pain

A) Place a mark on a 100-mm line with "no pain" at one end and "worst possible pain" at the other

The nurse is assessing hospitalized post-operative pain and has asked the client to rate his pain, describe it, state the location and onset of when it started. What other question should the nurse include in this pain assessment? A) Provoking and alleviating factors B) Availability of medication C) Financial resources to obtain medication D) Medications taken in the past

A) Provoking and alleviating factors

In addition to pain intensity, what is another basic element of a pain assessment? A) Quality B) Focused goal C) History D) Preferred assessment tool

A) Quality

The nurse is assessing the pain of an older adult client who is recovering from a right hip open reduction procedure. What element would the nurse know it is important to review to best understand the client's pain? A) Sleep patterns B) Family history C) Genetic history D) Elimination pattern

A) Sleep patterns

A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his left leg, and the pain is worse with ambulation. The nurse will document this type of pain as which of the following? A) Somatic pain B) Cutaneous pain C) Visceral pain D) Phantom pain

A) Somatic pain

The nurse is explaining the difference between acute pain and chronic pain to the client. Which should the nurse include in the explanation? A) The cause of acute pain can be identified. B) The duration of chronic pain is short. C) Chronic pain is caused by damage to nerves. D) Acute pain lasts longer than 3 to 6 months.

A) The cause of acute pain can be identified.

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

Mark is a 20-year-old college student who 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 Mark most likely experiencing? A) Visceral pain B) Referred pain C) Cutaneous pain D) Somatic pain

A) Visceral pain

After assessing a client in pain, the nurse A) documents the exact description given by the client. B) chooses from the list of pain descriptors what best reflects the client's description. C) asks the family to describe how they view the client's pain. D) documents how he or she best sees the client's pain.

A) documents the exact description given by the client.

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. A) Describe the pain. B) Where is the pain located? C) When did the pain start? D) Mention past experiences with pain. E) What therapies were used?

A, B, C

A nurse is assessing a client for pain who was in a car accident. Which Joint Commission standards should the nurse follow in this case? Select all that apply. A) Recognize the right of clients to appropriate assessment and management of pain B) Screen for the existence of pain C) Assess the nature and intensity of pain in the client D) Watch client's facial expressions, grimaces, and body movements E) Record pain assessment whenever pain increases in the body

A, B, C

Which would the nurse recognize as an example of visceral pain? Select all that apply. A) Liver pain B) Gallbladder pain C) Pancreatic pain D) Burn pain E) Muscular pain

A, B, C

Nurses use the FLACC scale to assess pain in children ages 2 months to 7 years. This scale uses which of the following indicators? (Select all that apply.) A) Facial expression B) Vital signs C) Leg movements D) Activity E) Cry F) Ability to console client

A, C-F

A nursing instructor is teaching students how to assess a client's pain. The instructor emphasizes that there are many misconceptions about pain. The instructor realizes that a student needs further direction when the student states: A) "Patients with chronic illnesses can have chronic pain." B) "Nurses are the best authority on pain." C) "Acute pain can be as intense as chronic pain." D) "Chronic pain can be referred to as persistent pain."

B) "Nurses are the best authority on pain."

A client who has had a recent below-knee amputation tells the nurse that he feels as though his toes are cramping. What would the nurse say in return? A) "Oh, that is all in your mind. Just forget it." B) "That is called phantom pain, and it is not unusual." C) "Well, that is really strange. I will notify the doctor." D) "I think it might be good to refer you to a psychiatrist."

B) "That is called phantom pain, and it is not unusual."

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) C fibers B) A-delta fibers C) AC fibers D) P fibers

B) A-delta fibers

A client recovering from a motor vehicle crash sustained right rib fractures and a fractured pelvis. The nurse is reviewing the client's metabolic panel lab results and notes a blood glucose of 130 mg/dL; the client has no history of diabetes. What is the nurse's best initial action? A) Request a prescription for regular insulin. B) Ask the client if she was in pain when the labs were drawn. C) Verify the result by performing a capillary stick. D) Assess for cold, clammy skin.

B) Ask the client if she was in pain when the labs were drawn.

A nurse is caring for a 4-year-old client who is crying and appears to be in pain. The nurse begins to assess the pain by showing pictures on a chart and asking the client to point to the one that best represents the pain he is experiencing. This is an example of which of the following: A) FLACC scale B) FACES scale C) VISUAL analog scale D) Numeric scale

B) FACES scale

The nurse is working in the post anesthesia care unit and assessing pain in a 6 month old infant. Which method should the nurse use to assess the infant's pain? A) Measure heart rate. B) FLACC scale. C) Count respirations. D) BPIQ tool.

B) FLACC scale.

What is the most commonly accepted theory of pain? A) Pain stimulus theory B) Gate control theory C) Pain transmission theory D) Gatekeeper theory

B) Gate control theory

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? A) Old people have more pain which is to be expected. B) Infants can feel pain and may respond with crying or agitation. C) A sleeping person feels no pain. D) Persons asking for pain medication but who are showing no other evidence of pain are just addicted to the medication.

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

A client recovering from a stroke complains of pain. The nurse suspects this client is most likely experiencing which type of pain? A) Nociceptive B) Neuropathic C) Somatic D) Idiopathic

B) 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: A) Visceral B) Neuropathic C) Somatic D) Referred

B) Neuropathic

The client comes to the emergency department reporting indigestion and left arm pain. The physician orders an EKG along with drawing of cardiac enzymes. When the results are back, the client is informed of the diagnosis of heart attack. The indigestion and arm pain are examples of which of the following? A) Visceral pain B) Referred pain C) Cutaneous pain D) Somatic pain

B) Referred pain

A client who suffers from arthritis complains of sharp pain in her knees and elbows. The nurse recognizes this is what type of pain? A) Visceral B) Somatic C) Cutaneous D) Referred

B) Somatic

The nurse enters an older client's room to assess for pain and discovers the client is hard of hearing. What is the nurse's best action? A) Utilize the FLACC scale. B) Speak to the client face to face. C) Suggest client purchase a hearing aid. D) Ask client to numerically rate pain in a high-pitched voice.

B) Speak to the client face to face.

The Joint Commission mandates that nurses assess and reassess a client's pain level. A nurse's healthcare facility mandates pain reassessment at 30 minutes for any drug given intravenously. This mandate is based on what? A) The research supporting intravenous medications given for pain take half as long to work as oral medications B) The time it takes a pain medication to decrease pain intensity C) The time it takes a pain medication to block pain in a client D) The median half-life of an intravenous pain medication

B) The time it takes a pain medication to decrease pain intensity

The nurse should assess for which pain complaints from a client diagnosed with Type II Diabetes Mellitus? A) Sharp, stabbing B) Aching, gnawing C) Burning, tingling D) Pain only on movement

C) Burning, tingling

The nurse is working on a pediatric unit caring for a 4-year-old who is recovering from the surgical repair of the pelvis. When assessing the client's pain, what is the most appropriate pain assessment tool for the nurse to use? A) Face, Legs, Activity, Cry, Consolability Scale B) Visual Analog Scale C) FACES Pain Scale D) Numeric Pain Intensity Scale

C) FACES Pain Scale

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? A) Verbal Descriptor Scale B) Numeric Rating Scale C) Faces Pain Scale D) Visual Analog Scale

C) Faces Pain Scale

A 12-year-old boy has reported to the emergency department after having fallen off his bicycle and sustained what appear to be minor injuries. The nurse is assessing him for pain. Which of the following objective findings would most tend to indicate pain? A) Upright posture while sitting B) Sustained eye contact with the nurse C) Nodding up and down in response to questions D) Maintaining a consistent position and posture

C) Nodding up and down in response to questions

The charge nurse on a geriatric unit should further educate a new staff nurse who makes which statement? A) Transmission of pain along A-delta and C fibers may be altered in older adults. B) There is little information about the effects of increased age on pain. C) Pain sensation is diminished in older adults. D) Older adults tend to be undertreated for pain.

C) Pain sensation is diminished in older adults.

Which of the following statements most accurately conveys an aspect of the gate-control theory? A) The transmission and sensation of pain exist completely within the spinal cord. B) Substances such as endorphins are noted to increase pain sensation. C) Specialized cells can decrease pain transmission by exciting inhibitory neurons. D) Pain transmission and emotional state exist independently of each other.

C) Specialized cells can decrease pain transmission by exciting inhibitory neurons.

A client injures his thumb by accidently slamming the car door shut on it. He arrives at the emergency department in intense pain. Which of the following processes is associated with the transduction process of this pain? A) Inflammation leading to conduction of an impulse to the spinal cord B) Emotional response and rational interpretation and response C) Tissue injury leading to inflammation D) Changes or inhibitions to the pain message relay in the spinal cord

C) Tissue injury leading to inflammation

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? A) Cognitive dimension B) Sociocultural dimension C) Affective dimension D) Spiritual dimension

D) Spiritual dimension

A client describes pain in the soles of both feet as constantly burning. Which type of pain should the nurse suspect this client is experiencing? A) somatic B) referred C) visceral D) neuropathic

D) neuropathic

A client who is cringing says that the pain is the worse that it has ever been. If using the numeric pain intensity scale, which number is the client describing? A) 2 B) 4 C) 7 D) 10

D) 10

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? A) Anxiety related to prolonged pain B) Impaired physical mobility related stiff neck C) Risk for deficient fluid volume related to fever D) Acute pain related to sore throat

D) Acute pain related to sore throat

How may a nurse demonstrate cultural competence when responding to clients in pain? A) Treat every client exactly the same, regardless of culture. B) Be knowledgeable and skilled in medication administration. C) Know the action and side effects of all pain medications. D) Avoid stereotyping responses to pain by clients.

D) Avoid stereotyping responses to pain by clients.

A client complains of pain in several areas of the body. How should the nurse assess this client's pain? A) Ask the client to rate the area with the highest pain level. B) Mark each site on the client's body with a marker. C) If pain does not radiate, there is no need to rate that area. D) Have the client rate each location separately.

D) Have the client rate each location separately.

A nurse is using the FLACC (Face, Legs, Activity, Cry, Consolability) scale for pediatric pain assessment to assess for pain in a 6-month-old client. Which of the following findings on this assessment tool would indicate the strongest pain in the client? A) Occasional grimace or frown B) Whimpering C) Lying quietly D) Kicking

D) Kicking

A construction worker in his mid-40s suffered a severe laceration on his leg while on the job site. Soon after he arrives at the emergency room, a nurse assesses his pain. The client states that pain, although severe, has lessened since the accident first occurred. The nurse knows that the pain message likely has been inhibited by release of endorphins and other neurotransmitters. Which physiological process does this represent? A) Transduction B) Transmission C) Perception D) Modulation

D) Modulation