Med/Surg
A client arrives in the orthopedic clinic with complaints of twisting the right ankle while playing softball. The nurse collects data including complaints of pain and swelling in the right ankle. What intervention will the nurse provide that will decrease vasodilation and reduce localized swelling?
Ice bag
The preferred route of administration of medication in the most acute care situations is through which of the following routes?
Intravenous
The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse why he has had to keep getting larger doses of his pain medication, although they do not seem to affect him. What is the nurse's best response
"Over time you become more tolerant of the drug."
A teenage client is undergoing a dressing change to burns on the thigh. The client refuses pain medication and states, "I do not hurt, and I don't need it." He is withdrawn, grimaces, and turns away during the dressing change. He was last medicated 8 hours ago. The best statement by the nurse is
"Please explain why you say you do not hurt when I see you grimacing during the dressing change."
An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical client rates her pain as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the client is exaggerating and does not need pain medication. What is the nurse's best response?
"Unless there is strong evidence to the contrary, we should take the client's report at face value.'"
A physician orders morphine sulfate 1 mg IV stat for chest pain. The drug is available in 2 mg per 1 mL syringe. How many mL does the nurse administer?
0.5
The nurse is to administer meperidine (Demerol) 75 mg intramuscularly to a client. The medication is supplied in an ampule of 50 mg/mL. How many milliliters should the nurse administer to the client?
1.5 The dose ordered is 75 mg. The dose available is 50 mg. The quantity is 1 mL. 75 mg/50 mg x 1 mL = 1.5 mL.
The nurse is caring for a client with acute pain. The nurse is aware that the client's pain has lasted for less than?
6 months
Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission?
A child quickly removing a hand when touching a hot object
A nurse on an oncology unit has arranged for an individual to lead meditation exercises for clients who are interested in this nonpharmacologic method of pain control. The nurse should recognize the use of what category of nonpharmacologic intervention?
A mind-body method
The nurse has assessed a client's pain subsequent to a broken ankle. How would the nurse categorize and document the client's pain?
Acute
Acute pain can be distinguished from chronic pain by assessing which characteristic?
Acute pain is specific and localized.
A 75-year-old client had surgery for a hip fracture yesterday. The client is under stress because of the pain, the medications, sleep deprivation, and hospital surroundings. Which nursing intervention to treat the client's pain should the nurse question when ordered by the doctor?
Advil for pain management
A client has just returned from the postanesthesia care unit (PACU) following left tibia open reduction internal fixation (ORIF). The client is reporting pain, and the nurse is preparing to administer the client's first scheduled dose of hydromorphone. Prior to administering the drug, you would prioritize what assessment?
Allergy status
A client being treated for rheumatoid arthritis has been prescribed a type of drug that is commonly used for joint inflammation. The nurse will administer an initial dose as an injection, and the client will continue taking an oral form of the medication. Which type of analgesic drug will the nurse administer
Corticosteroid
A client is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the client's pain in the plan of nursing care, the nurse should consider what characteristic of cancer pain?
Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications.
A client receives hydromorphone 2 mg intravenously for report of postoperative pain. Fifteen minutes later, the nurse notes respirations are 6 breaths/minute and the client is nonresponsive. The nurse administers prescribed naloxone (Narcan). The next time the client reports pain, the best nursing action is:
Consult with the healthcare provider to reduce the dose.
The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain?
Diaphoresis
The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain?
Diaphoresis Explanation: Observe behavioral signs, e.g., facial expressions, crying, restlessness, diaphoresis (sweating), and changes in activity. A pain behavior in one patient may not be in another. Try to identify pain behaviors that are unique to the patient ("pain signature"). Increased heart rate, blood pressure, and respiratory rate would be more likely to be associated with pain rather than decreased levels of these measures.
Which of the following is the appropriate intervention to avoid physical dependence on drugs in a client?
Discontinue drugs gradually.
Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain?
Do not administer if respirations are less than 12 Per Min
The nurse caring for an older adult client with osteoarthritis is reviewing the client's chart. This client is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this client?
Drug interactions
Two patients on your unit have recently returned to the postsurgical unit after knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most plausible rationale for understanding the patients' different perceptions of pain?
Endorphin levels may vary between patients, affecting the perception of pain.
The nurse needs to carefully monitor a patient with traumatic injuries. How often should the nurse check and document the patient's pain?
Every time the patient's vital signs are assessed
A 20-year-old man has presented to the emergency department with a 24-hour history of abdominal pain. The nurse who is admitting the patient notes that he is diaphoretic, wincing, and guarding the lower right quadrant of his abdomen. The nurse asks the patient to rate his pain on a scale of 1 to 10, to which the patient responds, "One or two." How should the nurse best respond to this patient's statement?
Explain the 0-to-10 pain scale in greater detail. Explanation: While it is important to accept a patient's self-report of pain, this does not mean that further education about pain scales is not sometimes necessary. This is especially the case when there is a clear inconsistency between patient's subjective pain report and the nurse's assessment findings. Thus, further teaching should take place prior to choosing an intervention or documenting the patient's pain as "slight."
The nurse is administering a narcotic analgesic for the control of a newly postoperative patient's pain. What medication will the nurse administer to this patient?
Fentanyl (Duragesic)
About which of the following issues should the nurse inform patients who use pain medications on a regular basis?
Inform the primary health care provider about the use of Salicylates before any procedure, and avoid OTC analgesics consistently without consulting a physician
A client is recovering from abdominal surgery and sleeping. The client had received an opioid medication 3 hours ago. The client's son requests pain medication for the client, stating "I do not want her to wake up in pain." The first nursing action is?
Instruct the son about lack of client consent. Explanation: One of the client's rights is to participate in management of his or her own care. The nurse follows the nursing process by assessing the client's perception of pain but does not awaken the client to do this. The nurse can administer the pain medication only after assessment. The nurse does not administer the pain medication but does take the opportunity to educate the son.
When drafting a nursing care plan for a patient in pain, it is important for the nurse to determine if the pain is acute or chronic. Choose an example of chronic pain.
Intervertebral disk herniation
A client's intractable neuropathic pain is being treated using a multimodal approach to analgesia. After administering a recently increased dose of IV morphine to the client, the nurse has returned to assess the client and finds the client unresponsive to verbal and physical stimulation with a respiratory rate of five breaths per minute. The nurse has called a code blue and should anticipate the administration of what drug?
Naloxone
Opioid analgesics are effective pain management tools for many clients. A significant portion of a nurse's practice is older adults who suffer from chronic pain. What impact does a client's age have on initial dosing?
Older clients should receive a reduced dose.
Which phase of pain transmission occurs when the one is made aware of pain?
Perception
Which of the following is a true statement regarding placebos?
Placebos should never be used to test the person's truthfulness about pain.
The nurse is assessing a client's pain while the client awaits a cholecystectomy. The client is tearful, hesitant to move, and grimacing, but rates his pain as a 2 at this time on a 0-to-10 pain scale. How should the nurse best respond to this assessment finding?
Reinforce teaching about the pain scale number system.
The home health nurse is developing a plan of care for a client who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the client teaching?
Self-care and safety
The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting:
Severity of the pain as judged by the patient
A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client
That medication will be prescribed for pain relief
The nurse in a pain clinic is caring for a client who is suffering from long-term, intractable pain. The pain team feels that first-line pharmacologic and nonpharmacologic methods of pain relief have been ineffective. What recommendation should guide this client's subsequent care?
The client may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options.
The nurse is to administer meperidine (Demerol) 75 mg intramuscularly to a client. The medication is supplied in an ampule of 50 mg/mL. How many milliliters should the nurse administer to the client? Enter the correct number ONLY.
The dose ordered is 75 mg. The dose available is 50 mg. The quantity is 1 mL. 75 mg/50 mg x 1 mL = 1.5 mL.
When completing a teaching plan for a patient receiving patient-controlled analgesia (PCA), which component would be importance to stress?
The pump will deliver a preset amount of medication. A patient experiencing pain can administer small amounts of medication directly into the IV, subcutaneous, or epidural catheter by pressing a button. The pump then delivers a preset amount of medication. The patient should not wait until the pain is severe to push the button. Even if the patient pushes the button multiple times in rapid succession, no additional doses are released because of the preset lock-out time. Sedation can occur with the use of the PCA pump. Assessment of respiratory status remains a major nursing role.
Lily Martin, a 75-year-old female, is admitted to your hospital unit with generalized abdominal pain, nausea and vomiting, and hypotension. She has not passed stool in over one week and is visibly uncomfortable. What type of pain would you expect Lily to be experiencing?
Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Visceral pain usually is diffuse, poorly localized, and accompanied by autonomic nervous system symptoms such as nausea, vomiting, pallor, hypotension, and sweating.
A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends
increasing the amount of bran and fresh fruits and vegetables
According to The Joint Commission's pain assessment and management standards, which of the following are essential components of a comprehensive pain assessment?
location, onset, alleviating factors, and aggravating factors
A client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. The client is without breakthrough pain at this point in time. How would this client's pain be classified?
neuropathic and chronic
