Davis- Ch. 31: Pain

Andrew is experiencing signs of appendicitis with right lower quadrant pain. He is being prepared for surgery. What type of pain is he experiencing? 1. ACUTE PAIN 2. CHRONIC PAIN 3. INTRACTABLE PAIN

1. ACUTE PAIN Acute pain is of rapid onset and short duration, usually only a few months. It is usually associated with injury or surgery and may be indicative of a more significant injury.

Which type of client might be suitable for surgical interruption of a pain pathway? 1. A person who has multiple fractures from a motor vehicle crash 2. An elderly female client who has shingles 3. A late-stage cancer client with intractable pain 4. A person who does not have any identified source of pain, but states he or she is in pain

3. A late-stage cancer client with intractable pain (candidate for surgical interruption of pain pathways) [WRONG] 1. A person who has multiple fractures from a motor vehicle crash (will heal from the injury) 2. An elderly female client who has shingles (very painful, but surgical interruption of pain pathways is not indicated for flare-ups) 4. A person who does not have any identified source of pain, but states he or she is in pain (source of the pain should be identified, as correcting the cause of the pain must be implemented first)

A student nurse enters the room of a client and begins the assessment while the registered nurse observes. Which action made by the student nurse requires correction by the registered nurse? 1. Ask any visitors to leave the room. 2. Turn on the lights in the client's room. 3. Leave the door open to allow lighting. 4. Gather all supplies prior to entering the room.

3. Leave the door open to allow lighting. (the nursing student should close the door and/or pull the curtain around the client to provide privacy) [WRONG] 1. Ask any visitors to leave the room. (would ask visitors to leave as this would provide the most privacy for the client) 2. Turn on the lights in the client's room. (should ensure there is adequate lighting in order to assess the skin color and any abnormalities) 4. Gather all supplies prior to entering the room. (should bring in all needed supplies to prevent going in and out of the room during the assessment)

Anne is experiencing chest pain and shortness of breath. She has tachycardia, hypertension, and tachypnea. Which nonverbal response is demonstrated? 1. PSYCHO- LOGICAL PAIN RESPONSE 2. BEHAVIORAL PAIN RESPONSE 3. PHYSIO- LOGICAL PAIN RESPONSE

3. PHYSIO- LOGICAL PAIN RESPONSE the physiological pain response is involuntary and includes both sympathetic and parasympathetic responses. The sympathetic responses are seen in acute pain and include increased systolic blood pressure, heart rate, respiratory rate, dilated blood vessels to the brain, increased alertness, dilated pupils, and rapid speech. The parasympathetic responses are a result of deep or prolonged pain and include decreased diastolic blood pressure, syncope, decreased heart rate, changeable breathing patterns, withdrawal, constricted pupils, and slow, monotonous speech.

Which describes the duration or intensity of pain a person can endure? 1. Pain threshold 2. Pain modulation 3. Pain tolerance 4. Pain perception

3. Pain tolerance (duration or intensity of pain of person can endure) [WRONG] 1. Pain threshold (is the point at which the brain recognizes a stimulus such as pain) 2. Pain modulation (changes a perception of pain by inhibiting brain signal) 4. Pain perception (recognition that a stimulus is pain)

Which type of pain scale uses illustrations to help describe pain? 1. THE SIMPLE DESCRIPTOR SCALE 2. THE NUMERICAL RATING SCALE 3. THE WONG-BAKER FACES PAIN RATING SCALE

3. THE WONG-BAKER FACES PAIN RATING SCALE The Wong-Baker FACES pain rating scale was originally designed for children but is now used in many settings, especially for those with communication or cognitive impairments. This scale is also helpful if the client speaks a different language from that of the healthcare providers.

The parents and their toddler present to the clinic for a well-child check-up. Which differences would the nurse incorporate into the assessment since the client is a child? Select all that apply. 1. Allow the toddler to make choices. 2. Let the child play with the equipment. 3. Administer needed immunizations last. 4. Hold the toddler against the parent's chest. 5. Promote and support the child's independence.

1. Allow the toddler to make choices. (allow the child choices such as removing the shirt or being weighted first; this will encourage cooperation) 3. Administer needed immunizations last. (nurse should perform all invasive procedures last as this can upset the toddler and make it difficult to complete the exam) [WRONG] 2. Let the child play with the equipment. (preschool aged child can be allowed to examine and play with the equipment, but not a toddler, as the equipment may have small pieces that could be dangerous) 4. Hold the toddler against the parent's chest. (infants may be more comfortable being held against the parent's chest) 5. Promote and support the child's independence. (for preschoolers for child's independence)

The nurse is caring for a client with untreated prolonged pain sustained in an automobile accident. Which assessment findings could result from the pain? Select all that apply. 1. Atelectasis 2. Fever 3. Hypertension 4. Nausea and vomiting 5. Increased urine output

1. Atelectasis 2. Fever 3. Hypertension 4. Nausea and vomiting

How does cognitive behavior therapy help with pain? 1. Attempts to alter negative thought patterns. 2. Draws the patient's mind away from the pain. 3. It is sequential muscle relaxation. 4. Has the patient use calming images.

1. Attempts to alter negative thought patterns. (CBT helps with depression and anxiety, which both play a role in pain)

Which actions should the nurse include when preparing to auscultate lung sounds in a client with congestive heart failure. Select all that apply. 1. Auscultate each side and compare findings. 2. Document the findings in the client's medical record. 3. Ask the client to take slow breaths through his/her nose. 4. Use the diaphragm of the stethoscope to listen to lung sounds. 5. Listen to inspiration on one side and expiration on the other side.

1. Auscultate each side and compare findings. (auscultate side to side, going down from the apex to the bases) 2. Document the findings in the client's medical record. (all assessment findings should be documented in the medical record) 4. Use the diaphragm of the stethoscope to listen to lung sounds. (diaphragm side, not the bell side, should be used to auscultate lung sounds) [WRONG] 3. Ask the client to take slow breaths through his/her nose. (the pt should take a slow, deep breaths through the mouth, not the nose) 5. Listen to inspiration on one side and expiration on the other side. (should listen to one full breathing cycle in each location; including inspiratory and expiratory cycles)

The nurse is providing comfort to a person who has fallen on the hiking trail and broken his ankle. Which techniques can be used until medical help arrives? Select all that apply. 1. Massage 2. Controlled breathing 3. Meditation 4. Imagery 5. Relaxation

1. Massage 2. Controlled breathing 3. Meditation 4. Imagery 5. Relaxation

Which of the following would be an instance to use a topical pain reliever? 1. Before giving an injection to a child 2. Before major surgery 3. Before a colonoscopy 4. As an adjuvant after surgery

1. Before giving an injection to a child (topical relief will help child to not fear injection) [WRONG] 2. Before major surgery (Anesthesia is given before surgery, so topical anesthetic is unnecessary) 3. Before a colonoscopy (no need) 4. As an adjuvant after surgery (will not help with the pain from incision or surgery)

Elenore is an older adult who lives alone and has fallen and fractured her hip. She cannot get to the phone to call for help. Her pain worsens as time passes and she becomes confused as she waits for someone to find her. What factors are exacerbating the situation? Select all that apply. 1. Cognitive impairment 2. Need to be independent 3. Hunger 4. Helplessness 5. Fear

1. Cognitive impairment 4. Helplessness 5. Fear

The nurse is assessing a client after an abdominal surgery who speaks a different language. Which nonverbal assessment changes could indicate pain is present? Select all that apply. 1. Confusion 2. Moaning 3. Irritability 4. Poor eye contact 5. Restlessness

1. Confusion 2. Moaning 3. Irritability 5. Restlessness

Ron is experiencing phantom pain after a left below-the-knee amputation. Which pain intervention would be most beneficial? 1. Contralateral Stimulation 2. Massage 3. Application of Cold 4. Immobilization 5. Application of Heat 6. Distraction 7. Relaxation Techniques 8. Expressive Writing

1. Contralateral Stimulation Phantom pain occurs when a limb has been amputated. The client will continue to feel pain as though the extremity were still present. Doctors once believed this postamputation phenomenon was psychological, but experts now recognize that these real sensations originate in the spinal cord and brain. Contralateral stimulation is the stimulation of the skin in an area opposite to the painful site by scratching, rubbing, or applying heat or cold. In this case, the stimulation would occur to the right lower leg.

Which safety instructions should the nurse provide to the client using hot or cold for pain relief? Select all that apply. 1. Cover the heating pad or hot pack with a towel. 2. Do not leave the heating pad on for longer than 30 minutes. 3. Check skin frequently for color changes related to the heat. 4. Use moist heat or cold packs, as this is safer for longer periods of time. 5. Notify the health-care provider of any damage to the skin from hot or cold packs.

1. Cover the heating pad or hot pack with a towel. 3. Check skin frequently for color changes related to the heat. 5. Notify the health-care provider of any damage to the skin from hot or cold packs. [WRONG] 2. Do not leave the heating pad on for longer than 30 minutes. (should only be left on for 15 mins, not 30 mins; prevent skin damage from burns) 4. Use moist heat or cold packs, as this is safer for longer periods of time. (moisture in heat and cold pacts intensifies the heat and cold can cause skin damage)

Which are methods of nonpharmaceutical pain management? Select all that apply. 1. Cutaneous therapy 2. Acupuncture 3. Application of heat and cold 4. Reorientation 5. Instructing the client to think about something else

1. Cutaneous therapy (such as TENs unit, provides superficial stimulation to provide distraction from actual pain) 2. Acupuncture (application of extremely fine needles to the pain site; stimulates the endogenous analgesia system) 3. Application of heat and cold (can reduce inflammation, which causes pain)

The nurse is assessing the lungs of a client and notes slight crackles as well as regular breath sounds in both lung fields. The client appears to be in no respiratory distress and has an oxygen saturation of 98% on room air. What should be the nurse's first intervention? 1. Have the client cough and listen again. 2. Notify the primary health care provider. 3. Administer a nebulizer breathing treatment. 4. Document the findings in the medical record.

1. Have the client cough and listen again. (sometimes minor crackles or wheezes can be cleared by simply encouraging the client to cough) [WRONG] 2. Notify the primary health care provider. (would not notify the primary health care provider as the client is not in distress) 3. Administer a nebulizer breathing treatment. (the pt has a normal oxygen saturation and is in no distress; this would not be the nurse's first interventions) 4. Document the findings in the medical record. (not the first intervention made by the nurse' findings would be documented when the assessment is complete)

The nurse is preparing for heat and cold application. Which of the following statements are true? Select all that apply. 1. Heat/cold devices should be used intermittently. 2. Heat/cold devices can cause superficial tissue damage. 3. Heat/cold devices should never come in direct contact with the skin. 4. Heat/cold devices are safe to use for all clients. 5. Heat/cold devices should be in place for 30 minutes at a time.

1. Heat/cold devices should be used intermittently. 2. Heat/cold devices can cause superficial tissue damage. 3. Heat/cold devices should never come in direct contact with the skin.

What is pain tolerance? 1. How much pain a person can endure. 2. Perceiving the pain as worse than it should be. 3. Experiencing pain when being touched. 4. When the brain experiences the pain.

1. How much pain a person can endure. (different for everyone; also change for the person depending on the circumstances)

The nurse working in a clinic is preparing to assess a female adolescent. Which education should the nurse provide during the examination? Select all that apply. 1. Minimize unhealthy food choices. 2. Let the client help with the exam. 3. Refrain from use of tobacco products. 4. Allow the teenager to examine the equipment. 5. Identify any risk factors for depression or suicide.

1. Minimize unhealthy food choices. (consume a healthy diet) 3. Refrain from use of tobacco products. (tobacco products in cigarettes and chewing can lead to different cancers; should educate the teenagers regarding these hazards) 5. Identify any risk factors for depression or suicide. (include information about identifying risk factors for depression or suicide)

What are the three classifications of analgesics? Select all that apply. 1. Nonopiods 2. Opiods 3. Nerve block 4. Adjuvants 5. Sucrose

1. Nonopiods (first line in treating pain; they are medications like Acetamyacin and ibuprofen) 2. Opiods (stronger medications that may be addictive) 4. Adjuvants (enhance the action of the opioids and can increase pain control)

Which pain scales are used to determine a client's level of pain? Select all that apply. 1. Numeric 2. FACES 3. Visual analog scale 4. The intensity word scale 5. OPQRST-AAA

1. Numeric 2. FACES 3. Visual analog scale

Ralph has degenerative joint disease and experiences pain with any physical activity, including waking. He is irritable and wants to be left alone to sleep all the time. Which nonverbal response is being demonstrated? 1. PSYCHO- LOGICAL PAIN RESPONSE 2. BEHAVIORAL PAIN RESPONSE 3. PHYSIO- LOGICAL PAIN RESPONSE

1. PSYCHO- LOGICAL PAIN RESPONSE Psychological or affective responses are a result of the mental impact of the pain. These can include anxiety, depression, anger, fear, exhaustion, hopelessness, and irritability.

What are three words that are used across cultures to describe pain? Choose all that apply. 1. Pain 2. Stinging 3. Hurt 4. Ache 5. Throbbing

1. Pain (discomfort) 3. Hurt 4. Ache

The nurse is speaking with a group of nursing students about the use of heat and ice for pain control. Which situations are best for this modality? Select all that apply. 1. Pain from obstetric procedures 2. Acute abdominal pain 3. Migraine headache 4. Activity-induced muscle pain 5. Low back pain with spasticity

1. Pain from obstetric procedures 4. Activity-induced muscle pain 5. Low back pain with spasticity (for menstural periods too)

What is the most reliable indicator of pain? 1. Patient's self-report 2. The actions of the patient 3. Grimacing and crying of the patient 4. The report of the night nurse.

1. Patient's self-report [WRONG] 2. The actions of the patient (may not act like they're in pain, when in fact that they are) 3. Grimacing and crying of the patient (outward indicators of the pt's experiences) 4. The report of the night nurse. (they cannot really know about the pt's lived experiences)

What type of pain scale consists of a horizontal line delineating "No pain" on one end and "Worst pain imaginable" on the other? 1. THE VISUAL ANALOG SCALE 2. THE NUMERICAL RATING SCALE 3. THE SIMPLE DESCRIPTOR SCALE

1. THE VISUAL ANALOG SCALE With the visual analog scale (VAS), a patient points to the location on the horizontal line that reflects his or her current pain level. It is simple and quick, but can be confusing because of its abstract nature.

Which are reasons for a nurse to perform a nursing assessment of a client? Select all that apply. 1. To obtain baseline information 2. To develop a plan for nursing care 3. To evaluate effectiveness of interventions 4. To receive reimbursement for services provided 5. To determine the presence of disease and its pathology

1. To obtain baseline information (assess a pt on first visit or encounter to obtain baseline information; used to determine change in health) 2. To develop a plan for nursing care (physical assessment is used to obtain data to develop a plan of nursing care for a client) 3. To evaluate effectiveness of interventions (part of nursing process; therefore, it is to determine if interventions are effective) [WRONG] 4. To receive reimbursement for services provided (A NP or physician assess a pt and documents these findings to receive reimbursement for service provided) 5. To determine the presence of disease and its pathology (primary health care provider performs a medical assessment of a pt to determine the presence of disease and its pathology)

Which is the process of nociceptors becoming activated by the perception of mechanical, chemical, and thermal stimuli? 1. Transduction 2. Transmission 3. Perception 4. Modulation

1. Transduction (initial process that occurs and begins the sensation of pain) [WRONG] 2. Transmission (nerve impulses that carry the stimulus to the spinal cord) 3. Perception (conscious realization by the nervous system of pain) 4. Modulation (inhibition or facilitation of pain signals)

The nurse is caring for a client with postsurgical pain. At what point is it important to assess the pain level? Select all that apply. 1. When there are nonverbal cues of pain 2. At the beginning of the shift 3. After physical activity 4. Every 30 minutes during the shift 5. Before physical activity

1. When there are nonverbal cues of pain 2. At the beginning of the shift 3. After physical activity 5. Before physical activity

Adrianne is in labor. She is moaning and crying out during contractions. Which nonverbal response is being demonstrated? 1. PSYCHO- LOGICAL PAIN RESPONSE 2. BEHAVIORAL PAIN RESPONSE 3. PHYSIO- LOGICAL PAIN RESPONSE

2. BEHAVIORAL PAIN RESPONSE Behavioral pain response is considered voluntary and assessments include withdrawing from painful stimuli, moaning, facial grimacing, crying, agitation, and guarding the painful area.

Roseanne has rheumatoid arthritis. The pain impairs her ability to be physically active. She has bad days and worse days, but the pain is always there. 1. ACUTE PAIN 2. CHRONIC PAIN 3. INTRACTABLE PAIN

2. CHRONIC PAIN Chronic pain lasts several months or longer and may interfere with activities of daily living. It is often a result of a progressive disorder and can come and go with remission and exacerbation. It often is accompanied by a psychological pain response.

Which factors should the nurse incorporate into the assessment of an older client according to the acronym SPICES? Select all that apply. 1. Seizures 2. Confusion 3. Incontinence 4. Skin breakdown 5. Evidence of falls 6. Problems with mobility

2. Confusion 3. Incontinence 4. Skin breakdown 5. Evidence of falls SPICES --> skin integrity; problems eating; incontinence; confusion; evidence of falls; and sleep disturbance

The nurse is caring for a client after a large abdominal surgery. He is restless and uncomfortable. Which positioning change could be most beneficial? Select all that apply. 1. Fetal position 2. Head elevation 3. Head of bed flat 4. Side-lying 5. Trendelenburg

2. Head elevation 4. Side-lying

Esther puts on her call light during the night, telling the nurse that her back aches from being in bed so long and she cannot sleep.Which pain intervention would be most beneficial?Make the Connection. Drag and drop proper term that is best exemplified by each case scenario. 1. Contralateral Stimulation 2. Massage 3. Application of Cold 4. Immobilization 5. Application of Heat 6. Distraction 7. Relaxation Techniques 8. Expressive Writing

2. Massage Massage is effective in relaxing muscles, reducing pain, and promoting sleep. The nurse should use slow, long strokes for the best level of relaxation, especially in the laboring and bed-bound client. The nurse should obtain verbal consent first because some people are uncomfortable being touched.

Which type of pain assessment tool rates pain on a scale of 0 to 10? 1. THE VISUAL ANALOG SCALE 2. THE NUMERICAL RATING SCALE 3. THE SIMPLE DESCRIPTOR SCALE

2. THE NUMERICAL RATING SCALE The numerical rating scale uses the numbers 0 to 10 to rate the pain. A rating of "0" is no pain and a "10" is the worse pain possible. Patients choose a number from 0 to 10 to denote their pain level. This is the most commonly used pain scale for adults because it gives objective data for pain assessment comparisons.

Pain intensity words (adjectives) are used to describe pain. Which type of pain scale is this? 1. THE WONG-BAKER FACES PAIN RATING SCALE 2. THE SIMPLE DESCRIPTOR SCALE 3. THE INTENSITY WORD SCALE

2. THE SIMPLE DESCRIPTOR SCALE This simple descriptor scale uses words such as mild, moderate, and severe to explain pain level. Nurses should use a few descriptive words to prevent confusion.

A nurse obtains a client's vital signs. The client's vital signs are normal, but the client states the pain is 8 out of 10. What should the nurse assume about the client's pain? 1. Vital signs are normal; the client is not being honest about pain. 2. The client is experiencing severe pain of 8 out of 10. 3. The client does not understand the pain scale. 4. The vital signs should be taken again, as they may be inaccurate.

2. The client is experiencing severe pain of 8 out of 10. (when pt receives pain, the nurse must believe the report, despite vital signs)

Where does phantom pain feel like it originates? 1. The mind 2. The limb 3. The joint 4. The muscle

2. The limb (burning, tangling, and pain in the limb that has been removed)

In which way is pain positive? 1. Keeps the person having pain more alert 2. Warns of bodily injury 3. May diminish over time 4. May interfere with quality of life

2. Warns of bodily injury (has a protective function, can warn of bodily injury, and can change behavior or actions) [WRONG] 1. Keeps the person having pain more alert (increased alertness is not necessarily positive) 3. May diminish over time (this is not positive) 4. May interfere with quality of life (not positive)

The nurse reassesses the client 30 minutes after administering a narcotic analgesic and notices the client has a respiratory rate of 6 breaths per minute. What should be the nurse's first intervention? 1. Perform cardiopulmonary resuscitation. 2. Notify the primary health-care provider. 3. Administer a dose of naloxone (Narcan). 4. Schedule an immediate breathing treatment.

3. Administer a dose of naloxone (Narcan). (the pt is experiencing respiratory depression from narcotic analgesic) [WRONG] 1. Perform cardiopulmonary resuscitation. (does not perform as the pt is breathing) 2. Notify the primary health-care provider. (not the first nurse intervention) 4. Schedule an immediate breathing treatment. (no evidence of difficulty breathing; does not schedule a breathing treatment)

Tim, a teenager, lands on his knee during a basketball game and it begins to swell. The nurse in the audience comes to assist with his discomfort. Which pain intervention would be most beneficial? 1. Contralateral Stimulation 2. Massage 3. Application of Cold 4. Immobilization 5. Application of Heat 6. Distraction 7. Relaxation Techniques 8. Expressive Writing

3. Application of Cold Cold application causes vasoconstriction and can help prevent swelling and bleeding. It is especially effective in reducing pain as a result of procedures. Cold devices should never be in direct contact with the skin as this can cause frostbite. Take a break at least every 15 minutes.

A client presents to the emergency room and is diagnosed with an exacerbation of chronic obstructive pulmonary disease and is in distress. Which is the best type of assessment for the nurse perform for this client? 1. Ongoing assessment 2. System-specific assessment 3. Focused-physical assessment 4. Comprehensive physical examination

3. Focused-physical assessment (appropriate for a pt in an emergent situation such as respiratory distress) [WRONG] 1. Ongoing assessment (performed throughout a nurse's shift after an initial assessment is performed) 2. System-specific assessment (assessing one specific system; pt wound benefit from a system-specific assessment; however since pt is in respiratory distress, the nurse should focus on cardiac status as well as to determine if oxygenation problems are causing cardiac problems) 4. Comprehensive physical examination (performed at an initial home health visit, not in an emergent situation)

Keith experienced a back injury at work. The pain shoots down his left leg and he can't find a comfortable position that relieves his distress. He's tried every pain management suggestion and multiple prescription pain medications with minimal relief. 1. ACUTE PAIN 2. CHRONIC PAIN 3. INTRACTABLE PAIN

3. INTRACTABLE PAIN Intractable pain is highly resistant to relief. It is especially frustrating for the patient and caregiver because multiple interventions and medications are tried without adequate pain relief.

In which order should the nurse perform an abdominal assessment for a client with a suspected bowel obstruction? 1. Palpation 2. Percussion 3. Inspection 4. Auscultation of major arteries 5. Auscultation of major bowel sounds

3. Inspection 5. Auscultation of major bowel sounds 4. Auscultation of major arteries 2. Percussion 1. Palpation (the normal order would be inspect, palpate, percuss, and auscultate; however, palpate and percuss can interfere with bowel sounds, since this client has a suspected bowel obstruction, and the nurse should inspect then auscultate; auscultate the bowel sound then the major arteries; then perform percussion and then palpate the abdomen

The nurse enters the room of a client and, without the use of the stethoscope, can hear the client wheezing. How should the nurse document this finding in the medical record? 1. Wheezes noted upon inspection. 2. Wheezes noted upon percussion. 3. Wheezes noted upon direct auscultation. 4. Wheezes noted upon indirect auscultation.

3. Wheezes noted upon direct auscultation. (without the use of a stethoscope) [WRONG] 1. Wheezes noted upon inspection. (inspect involves sight to note abnormalities; wheezes are only heard) 2. Wheezes noted upon percussion. (lung sounds percussed in a client with emphysema could sound like a hyper-resonant sound) 4. Wheezes noted upon indirect auscultation. (require a stethoscope to hear)

In which client would patient-controlled analgesia (PCA) be contraindicated? 1. A 30-year-old client with fractures from a motor vehicle accident 2. A 45-year-old client who underwent a total abdominal hysterectomy 3. A 60-year-old client who underwent a total knee replacement surgery 4. A 75-year-old client with a history of Alzheimer's disease who fell at home

4. A 75-year-old client with a history of Alzheimer's disease who fell at home (may not have the cognitive ability to manage the PCA device; would be contraindicated) [WRONG] 1. A 30-year-old client with fractures from a motor vehicle accident (the pt is able to manage the device) 2. A 45-year-old client who underwent a total abdominal hysterectomy (should be able to handle the PCA device) 3. A 60-year-old client who underwent a total knee replacement surgery (appropriate order for a 60 year old pt to have PCA after a total knee replacement)

How does cognitive impairment affect a person's level of pain? 1. Those with cognitive impairment will not feel pain as intensely. 2. Cognitive impairment increases sensation of pain. 3. Cognitive impairment does not affect management of pain. 4. A person with cognitive impairment may not be able to identify or verbalize being in pain.

4. A person with cognitive impairment may not be able to identify or verbalize being in pain. (can still feel pain, but they may not be able to identify or report the sensation as pain)

The client with a diagnosis of multiple myeloma calls the nurse and reports pain of 9 on a scale of 0 to 10 and requests something for the pain. Which type of pain would the nurse document in the health record? 1. Visceral pain 2. Radiating pain 3. Cutaneous pain 4. Deep somatic pain

4. Deep somatic pain (experienced in pt with cancer including multiple myeloma; pain is more diffuse and lasts longer; nurse would document that the client has deep somatic pain) [WRONG] 1. Visceral pain (pain that is experienced in organs caused by stimulation of deep internal pain receptors; this pt wound not experience visceral pain) 2. Radiating pain (pt with myocardial pain experiences that refers to the jaw or left arm; multiple myeloma does not cause radiating pain) 3. Cutaneous pain (superficial and in the sub-q tissue; client with small cut or burn wound experience cutaneous pain)

Sarah fell while downhill skiing and fractured her tibia. The bone has a compound fracture and has broken through the skin. Which pain intervention would be most beneficial? 1. Contralateral Stimulation 2. Massage 3. Application of Cold 4. Immobilization 5. Application of Heat 6. Distraction 7. Relaxation Techniques 8. Expressive Writing

4. Immobilization Immobilization of a painful body part with splints can offer some relief. Because Sarah will need to be moved, splinting is especially helpful in preventing further tissue damage and minimizing pain.

In the figure, what type of pain management system is depicted? 1. Rectal 2. Intra-articular pain pump 3. Peripheral nerve catheter 4. Patient-controlled analgesic

4. Patient-controlled analgesic (PCA provides the pt control over how much medications is administered via the red button; it is appropriate only for pt who are cognitively intact

The nurse is teaching a family about phantom pain. Which statement is correct? 1. The pain is deadened from the surgery. 2. Phantom pain occurs before an amputation. 3. Phantom pain is a psychological condition. 4. Phantom pain is real and should be treated as such.

4. Phantom pain is real and should be treated as such.

Katrina is experiencing lower abdominal cramping from her menstrual cycle. Which pain intervention would be most beneficial? 1. Contralateral Stimulation 2. Massage 3. Application of Cold 4. Immobilization 5. Application of Heat 6. Distraction 7. Relaxation Techniques 8. Expressive Writing

5. Application of Heat Heat promotes circulation and reduces muscle spasms from menstrual cramping. It can also be used to manage low back pain and treat nausea, vomiting, and diarrhea. Heat devices should never be in direct contact with the skin because they can cause burns, and they should be used intermittently for no more than 15 minutes.

The nurse just gave an immunization to Jonathan, a 2-year-old. Which pain intervention would be most beneficial? 1. Contralateral Stimulation 2. Massage 3. Application of Cold 4. Immobilization 5. Application of Heat 6. Distraction 7. Relaxation Techniques 8. Expressive Writing

6. Distraction Distraction allows the nurse to pull the patient's attention away from the pain by focusing on toys, videos, or sound. It is most effective with children for mild to moderate pain and for brief periods of time.

Michael experiences chronic low back pain. The pain is especially significant while bending to put on his socks and shoes. Which pain intervention would be most beneficial? 1. Contralateral Stimulation 2. Massage 3. Application of Cold 4. Immobilization 5. Application of Heat 6. Distraction 7. Relaxation Techniques 8. Expressive Writing

7. Relaxation Techniques Relaxation techniques are useful for reducing chronic pain. For Michael, knowing that bending exacerbates the pain will make it worse with anticipation. Relaxation techniques would help minimize the discomfort.

Donna would like a way to manage her pain on a long-term basis. She struggles with the emotions that come from living with chronic pain. Which pain intervention would be most beneficial? 1. Contralateral Stimulation 2. Massage 3. Application of Cold 4. Immobilization 5. Application of Heat 6. Distraction 7. Relaxation Techniques 8. Expressive Writing

8. Expressive Writing Expressive writing helps reduce chronic pain by allowing for an outlet of emotions, fear, and frustration common when dealing with pain on a daily basis.