Pain Management

The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply. -"How long have you experienced this pain?" -"Please point to where you are experiencing pain." -"You've never had this pain before, have you?" -"Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." -"What aggravates your chest pain?"

"How long have you experienced this pain?" "Please point to where you are experiencing pain." "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." "What aggravates your chest pain?" rationale: The nurse needs to assess pain as to intensity, timing, location, and aggravating factors. Assessing frequency is important, but the statement "You've never had this pain before, have you" is leading and nontherapeutic.

The advance practice nurse is treating a client experiencing a neuropathic pain syndrome. Which statements by the client demonstrates an understanding of concepts related to neuropathic pain? -"Neuropathic pain will only last a few days and is easily treated with COX-2 analgesic agents." -"Neuropathic pain is the body's normal response to tissue damage that causes pain." -"When the inflammation in my foot resolves, I will no longer have pain from neuropathy." -"My phantom limb pain serves no purpose, and I may need to take antidepressants to help."

"My phantom limb pain serves no purpose, and I may need to take antidepressants to help." rationale: Neuropathic pain is chronic and not treated with COX-2 analgesics. Neuropathic pain is an abnormal processing of sensory input by the peripheral or central nervous system or both. Neuropathic pain may occur in the absence of tissue damage and inflammation. Neuropathic pain serves no useful purpose. Evidence-based guidelines recommend the tricyclic antidepressants desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor) and the SNRIs duloxetine (Cymbalta) and venlafaxine (Effexor) as first-line options for treatment of neuropathic pain.

A client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. The initial surgeries occurred more than 2 months ago, and the nurse is concerned about the repeated requests. What does the nurse suspect to be the cause of the client's frequent appeals for pain medication? -tolerance -addiction -drug allergy -poor quality control by the drug manufacturer

-tolerance rationale: Tolerance is a condition in which a client needs larger doses of a drug to achieve the same effect as when first administered; it may not develop until an opioid drug is used regularly for 4 weeks or more. Activation of NMDA receptors is believed to decrease the effect of opioids, resulting in the need for higher doses to achieve a therapeutic effect. The development of tolerance is not an indication of addiction; rather, the client's request for pain-relieving drugs more often is a consequence of poor pain control. Addiction is a repetitive pattern of drug seeking and drug use to satisfy a craving for a drug's mind-altering or mood-altering effects. Although opioid drugs can result in addiction, there is very little evidence that those who require narcotics for legitimate pain actually become addicted. An allergic reaction to a drug could present many symptoms, such as a rash, hives, or difficulty breathing, but it would not result in a client requesting increased medication. Most prescription drugs are manufactured using strict quality control standards, so poor quality control is not likely to be a reason for the client's request for increased medication.

How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client? -Administering the analgesics every three hours -Administering the analgesics intravenously -Administering the analgesics on an as-needed basis -Administering analgesics with increased dosage

Administering the analgesics every three hours rationale: Scheduling the administration of analgesics every three hours, rather than on an as-needed basis, often affords a uniform level of pain relief. Administering the analgesics intravenously or with increased dosage is not advisable unless prescribed by the physician.

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? -Use of transcutaneous electrical nerve stimulator (TENS) -Advil for pain management -Morphine rather than Advil for pain management -Acetaminophen for pain management

Advil for pain management Rationale: NSAIDs such as Advil increase the risk of gastrointestinal (GI) toxicity in individuals >60 years of age and should be assessed further before administration. Many risk factors exist for opioid-induced respiratory depression in individuals >65 years old; a thorough respiratory assessment is indicated. Acetaminophen should be used for mild pain. Nonpharmacologic methods of pain management, such as TENS, are acceptable in this situation. Society has proposed that opioids are a safer choice than NSAIDs in many older adults because of the increased risk for NSAID-induced adverse GI effects in that population.

The nurse understands that which statement is true about tolerance and addiction? -Although clients may need increasing levels of opioids, they are not addicted. -Tolerance to opioids is uncommon. -Addiction to opioids commonly develops. -The nurse must be primarily concerned about development of addiction by a client in pain.

Although clients may need increasing levels of opioids, they are not addicted. Rationale: Physical tolerance usually occurs in the absence of addiction. Tolerance to opioids is common. Addiction to opioids is rare and should never be the primary concern for a client in pain.

When caring for a patient who is deaf, which of the following should be used to elicit information regarding the patient's level of pain? -An outside interpreter should be used. -Computer-generated speech -Use of Braille -Verbally asking the rate of pain

An outside interpreter should be used. rationale: For people who are deaf of hard of hearing, outside interpreters (i.e., not family members) should be used. For people with disabilities that result in communication impairment, computer-generated speech may be useful. For people who are blind and who know how to read Braille, pain assessment instruments can be obtained in Braille. The patient is deaf, so verbally asking to rate the pain on a scale would be inappropriate.

A home health nurse is visiting a client who has been taking the same dose of acetaminophen/hydrocodone for 2 months. To monitor for the presence of expected side effects of this medication, what should the nurse include in the assessment of the client? -Observe respiratory rate and depth. -Assess level of consciousness. -Take the client's blood pressure. -Ask about the client's bowel pattern.

Ask about the client's bowel pattern. rationale: Opioids can result in delayed gastric emptying, slowed bowel motility, and decreased peristalsis, all of which result in slow-moving, hard stool that is difficult to pass. Constipation is a very common side effect of narcotics and can continue to be a problem, even with chronic administration. Although respiratory depression, decreased level of consciousness, and hypotension are common side effects of acute use of narcotics, these effects are not expected to occur with chronic use at the same dose.

When administering a fentanyl patch, the last dose of sustained-release morphine should be administered at what point? -Immediately after the morning shower -Before respiratory assessment -At the same time the first patch is applied -There are no administration requirements

At the same time the first patch is applied rationale: Because it takes 12 to 18 hours for the fentanyl concentrations to increase gradually from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied. The skin must be clean and dry before applying the patch; no shower is required. Respiratory assessment must be conducted before applying the fentanyl patch.

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 -Refuse to administer the pain medication. -Administer the prescribed medication. -Instruct the son about lack of client consent. -Wake the client and ask about her pain rating.

Instruct the son about lack of client consent. rationale: 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.

Which route of administration of medication is preferred in the most acute care situations? -Epidural -Intravenous -Subcutaneous -Intramuscular

Intravenous Rationale: The intravenous route is the preferred parenteral route in most acute care situations because it is much more comfortable for the client and peak serum concentrations and pain relief occur more rapidly and reliably. Epidural administration is used to control postoperative and chronic pain. Subcutaneous administration results in slow absorption of medication. Medication administered intramuscularly is absorbed more slowly than intravenously administered medication.

The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient? -Older people are expected to experience chronic pain. -Older people have a decreased pain threshold. -Older people experience reduced sensory perception. -Older people have increased sensory perception.

Older people experience reduced sensory perception. Rationale: Pain affects individuals of every age, sex, race, and socioeconomic class (American Geriatrics Society, 2009; Johannes, Le, Zhou, et al., 2010; Walco, Dworkin, Krane, et al., 2010).

A client has been prescribed a fentanyl patch for pain control. The nurse understands that this patch should be replaced every -12-24 hours. -24-36 hours. -36-60 hours. -48-72 hours.

48-72 hours. rationale: Fentanyl patches should be replaced every 48-72 hours, depending on patient response. The other time frames are incorrect.

The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for? -Asystole -Hypertension -Bradypnea -Tachycardia

Bradypnea rationale: Most patients experience sedation at the beginning of opioid therapy and whenever the opioid dose is increased significantly. If left untreated, excessive sedation can progress to clinically significant respiratory depression (bradypnea, or reduced breathing rate).

Which of the following nursing interventions contributes to achieving a client's pain relief? -Minimize the client's description of pain or need for pain relief. -Collaborate with the client about his or her goal for a level of pain relief. -Use all forms of available pain management techniques. -Prevent the client from self-administering analgesics.

Collaborate with the client about his or her goal for a level of pain relief. Rationale: The nurse should collaborate with each client about his or her goal for a level of pain relief; this helps implement interventions for achieving the goal. The client's description of pain or need for pain relief should never doubted or minimized. The client need not refrain from self-administering analgesics; providing a client with equipment to self-administer analgesics promotes a more consistent level of pain relief. The nurse should also inform the client of available pain management techniques and incorporate any preferences or objections to interventions for pain management that the client may have when establishing a plan of care; using all forms of available pain management techniques is not necessary.

When using transdermal Fentanyl, the nurse and patient should be aware of which sign or symptom of Fentanyl overdose? -Confusion -Hyperalertness -Hyperventilation -Insomnia

Confusion Rationale: Patients should be informed about signs and symptoms of fentanyl overdose such as shallow or difficulty breathing, extreme sleepiness, confusion, sedation. Hyperalertness, hyperventilation, and insomnia would not occur.

A client informs the nurse that he has been taking ibuprofen every 6 hours for 3 weeks to help alleviate the pain of arthritis. The client has a history of a gastric ulcer and is taking a proton pump inhibitor for the treatment of this disorder. What should the nurse instruct the client about the use of the ibuprofen? -"You should never take ibuprofen; it can cause considerable problems." -"Ibuprofen is contraindicated when taking a proton pump inhibitor." -"It would be best to contact the physician prior to take any over-the-counter medications." -"Don't you know that you can cause bleeding when you take that medication so often?"

It would be best to contact the physician prior to take any over-the-counter medications." rationale: Clients should not use an over-the-counter analgesic agent, such as aspirin, ibuprofen, or acetaminophen, consistently to treat chronic pain without first consulting a physician. Ibuprofen is not contraindicated when taking a proton pump inhibitor. Option D is accusatory and not a therapeutic response

The nurse has given an older adult an oral opioid for postoperative pain. What should the nurse do first to make the pain medication more effective? -Consult with the health care prescriber to include hydroxyzine with the opioid. -Provide the client with a fresh gown. -Position the client for comfort. -Encourage the client to eat crackers.

Position the client for comfort. rationale: The nurse should provide a comfort level with positioning first. Hydroxyzine may be given with opioid analgesics. However, elderly clients are more susceptible to adverse reactions of this medication, and alternative measures should be tried first. Providing a fresh gown will not make the medication more effective. Ingesting food with an opioid medication does not make the medication more effective.

A new surgical patient has been prescribed an opioid analgesic intravenously for pain control. The nurse should be aware of which most serious adverse effect of this medication? -Respiratory depression -Nausea and vomiting -Constipation -Pruritus

Respiratory depression Rationale: Respiratory depression is the most serious adverse effect of opioid analgesic agents administered by IV, subcutaneous, or epidural routes. The other side effects can occur with administration of opioids but are not the most serious.

Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy? -Risk for injury -Risk for impaired gas exchange -Diarrhea -Altered mobility

Risk for impaired gas exchange rationale: Problems that may develop with opioid and opiate therapy include risk for impaired gas exchange related to respiratory depression, constipation related to slowed peristalsis, and risk for injury related to drowsiness and unsteady gait.

A client comes to the clinic and informs the nurse that he needs more analgesics for chronic pain. The client states that the medication is not as strong, and he requires more than the prescribed dose. What does the nurse suspect is occurring with the client? -Addiction -Tolerance -Physical dependence -Withdrawal symptoms

Tolerance Rationale: Tolerance is a condition in which a client needs increasingly larger doses of a drug to achieve the same effect as when the drug was first administered. Addiction refers to a repetitive pattern of drug seeking and drug use to satisfy a craving for a drug's mind-altering or mood-altering effects. Physical dependence means that a person experiences physical discomfort, known as withdrawal symptoms.

A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect? -Placebo -Dependence -Tolerance -Addiction

addiction rationale: Addiction is a behavioral pattern of substance use characterized by a compulsion to take the substance primarily to experience its psychic effects. Placebo effect is analgesia that results from the expectation that a substance will work, not from the actual substance itself. Dependence occurs when a client who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued. Tolerance occurs when a client who has been taking opioids becomes less sensitive to their analgesic properties.

When taking a client history, the nurse notes that the client has been taking herbal remedies in addition to acetaminophen for several years. Based on the admission history, the nurse understands that the client is experiencing which type of pain? -Breakthrough pain -Chronic pain -Acute pain -Neuropathic pain

chronic pain rationale: Chronic pain persists over a course of time, in this case several years. Acute pain has a relatively short duration. Breakthrough pain is acute exacerbations of pain periodically experienced by clients with a normally controlled pain management regimen.

The client is taking oxycodone (Oxycontin) for chronic back pain and reports decreased pain relief when he began taking a herb to improve his physical stamina. The nurse asks if the herb is -valerian -kava-kava -chamomile -ginseng

ginseng rationale: Ginseng may inhibit the analgesic effects of an opioid, such as oxycodone. The other herbs listed (valerian, kava-kava, and chamomile) may increase central nervous system depression.

A nurse is caring for a client with pain. What should the nurse monitor for when administering intravenous acetaminophen? -hepatotoxicity -renal toxicity -bleeding -gastrointestinal effects

hepatotoxicity rationale: The nurse will need to monitor the client receiving acetaminophen for hepatotoxicity. Intravenous acetaminophen should not cause renal toxicity, bleeding, and gastrointestinal effects.

The nurse sees an order for a lidocaine 5% patch. What use is approved for by the US Food and Drug Administration for this patch? -postherpetic neuralgia -epidural anesthesia -general anesthesia -diabetic neuropathy

postherpetic neuralgia rationale: A lidocaine 5% patch has been shown to be effective in postherpetic neuralgia. Lidocaine 5% patch has not been approved for epidural anesthesia, general anesthesia, or diabetic neuropathy.

A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing? -visceral -neuropathic -deeper somatic -chronic

visceral rationale: 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. Neuropathic pain is pain that is processed abnormally by the nervous system. Deeper somatic pain such as that caused by trauma produces localized sensations that are sharp, throbbing, and intense. Chronic pain has a duration longer than 6 months.

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 -Anticipated harmful effects of the pain experience -Anticipated duration of the pain -Medical interventions for pain management

Severity of the pain as judged by the patient rationale: The patient's perception of pain severity should always be the primary consideration. It forms the baseline for all management.

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? -Warm compresses -Ice bag -Elevation of the extremity -Injection of a steroid into the joint space

ice bag Rationale: Pain associated with injury is best treated initially with cold applications such as an ice bag or chemical pack. The cold decreases vasodilation which reduces localized swelling, which may be useful for minor or moderate pain. Heat will increase vasodilation. Elevation of the extremity will not decrease vasodilation. It is beyond the scope of practice for the nurse to inject steroids into the joint space.

Which of the following is a disadvantage to using the IV route of administration for analgesics? -Short duration -Slower entry into bloodstream -No risk of respiratory depression -Long duration

short duration Rationale: Disadvantages of using the IV route for analgesic administration include short duration, the occurrence of possible respiratory depression, and that careful dosage calculations are needed. Intramuscular analgesics have a slower entry into the bloodstream.

A client has been given a patient-controlled analgesia (PCA) device to control postoperative pain. The client expresses concern about administering too much of the analgesic and accidentally overdosing. What topic should the nurse teach the client about? -the limits on dose and frequency that are programmed into the PCA -the fact that naloxone will be kept readily available at all times -the use of non-pharmacologic pain interventions to minimize use of the PCA -the importance of limiting the use of the PCA to no more than twice per hour

the limits on dose and frequency that are programmed into the PCA Rationale: Patient-controlled analgesia (PCA) devices allow clients to self-administer their own narcotic analgesic using an intravenous pump system and pressing a handheld button. The dose and time intervals between doses are programmed into the device to prevent accidental overdose. Dosing may or may not be more than twice per hour. Naloxone treats overdoses, but this will not likely alleviate the client's concerns about overdosing in the first place. The client may benefit from non-pharmacologic pain measures, but should not be encouraged to minimize the use of the PCA or to endure pain.

A clinic nurse assesses a client with diabetes who reports taking naproxen (Aleve) and the herb bilberry for osteoarthritis. To assess for an adverse reaction between naproxen and bilberry, the nurse asks the client -"Do you bleed easily?" -"Have you been constipated?" -"Has your blood sugar been elevated more than usual?" -"Have you noticed an increase in your pain levels?"

"Do you bleed easily?" rationale: Naproxen, a nonsteroidal anti-inflammatory drug, with the herb bilberry may enhance a client's risk for bleeding. Diarrhea, constipation, or both are frequent adverse reactions to naproxen but not bilberry. Bilberry may cause hypoglycemia. Naproxen does not. There should not be an increased level of pain as a result of the interaction of naproxen and bilberry.

The nurse is obtaining data regarding medications the client is taking on a regular basis. The client states he is taking duloxetine, an antidepressant for the treatment of neuropathic pain. What type of therapy does the nurse understand the client is receiving? -Adjuvant drug therapy -Replacement drug therapy -Alternate drug therapy -Withdrawal therapy

Adjuvant drug therapy Rationale: Adjuvant drugs are medications that are ordinarily administered for reasons other than treating pain. Duloxetine is used to treat depression but is being used for neuropathic pain for this client.

A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain? -Administer oral opioids as needed. -Provide patient-controlled analgesia. -Administer pain medication through a transdermal patch. -Administer analgesics around the clock.

Administer analgesics around the clock. rationale: Because assessing pain medication needs in a client with end-stage dementia is difficult, analgesics should be administered around the clock. Clients at this stage of dementia typically can't request oral pain medications when needed. They're also unable to use patient-controlled analgesia devices. Transdermal patches are used to manage chronic pain; not postoperative pain.

How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client? -Administering the analgesics on a regular basis -Administering the analgesics intravenously -Administering the analgesics on an as-needed per client request -Administering analgesics with increased dosage

Administering the analgesics on a regular basis Rationale: Routine scheduling of the administration of analgesics, rather than on an as-needed basis, often affords a uniform level of pain relief. Administering the analgesics intravenously or with increased dosage is not advisable unless prescribed by the physician.

The client, newly admitted to the hospital, is unsure of home medications and is wearing a transdermal fentanyl patch. What is most important for the nurse to do first? -Remove the old patch -Check the dose -Teach about adverse reactions -Ask about constipation

Check the dose rationale: The dosage of any medication should be checked for correctness. This is basic medication administration to prevent error. The nurse will also perform the other options listed.

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 -Chronic -Intermittent -Visceral

Chronic Rationale: Acute pain is of early onset and associated with an injury. Pain decreases as healing occurs. Chronic pain is constant or intermittent and persists beyond the healing time.

The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain? -Diaphoresis -Bradycardia -Hypotension -Decreased respiratory rate

Diaphoresis Rationale: 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 withdrawal on drugs in a client? -Administer adjuvant drugs along with the prescribed drug. -Administer subtherapeutic doses. -Increase dosage of the drug. -Discontinue drugs gradually.

Discontinue drugs gradually. rationale: To avoid withdrawal symptoms, drugs that are known to cause physical dependence are discontinued gradually. The most appropriate nursing action to avoid tolerance is to consult with the physician for an increased dosage of the drug. Subtherapeutic dosages and adjuvant drugs are not needed to avoid physical dependence of drugs in a client.

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. What is the best statement by the nurse? -"You are so brave to not take your pain medication when the dressing change will hurt." -"If you need pain relief, I can give you some medication when I have completed the dressing change." -"I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication." -"You are so right to not take your pain medication. You can become dependent on the medication."

"I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication." rationale: The nurse needs to explore the reason a client denies pain when pain is expected during a treatment, as with a dressing change to burns, and when the client grimaces during the dressing change. The nurse needs to educate clients about effects of pain on recovery. The nurse also cannot ignore that pain relief will hasten recovery. The nurse should not allow the client to associate pain with his dressing changes.

A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies -"I will notify your physician." -"What do you mean by the word sick?" -"A lot of people have a similar problem with this medication." -"A nausea medication has been prescribed that I will give you."

"What do you mean by the word sick?" Rationale: Nausea may occur with opioid use; however, before taking any other action, the nurse needs to clarify that this is what the client means by the word "sick."

A preventative approach to pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) means that the medication is given: -Before pain becomes severe. -Before pain is experienced. -When pain is at its peak. -When the level of pain tolerance has been exceeded.

-Before pain is experienced. rationale: NSAIDs are most effective for preventive pain management when administered on a fixed-schedule (i.e., every 3-4 hours) to prevent the pain experience. When combined with an opioid, the medication regimen is highly effective in managing moderate to severe pain.

The nurse is assessing a client's level of pain. How is the pain best described? -An unpleasant sensation of physical hurt or discomfort that can be caused by disease, injury, or surgery. -An unpleasant sensation created by emotional states such as fear, frustration, anger, or depression. -A chronic, unpleasant sensation that occurs due to disease affecting one or more body systems. -An unpleasant sensation that occurs due to malfunctioning of the nervous system.

An unpleasant sensation of physical hurt or discomfort that can be caused by disease, injury, or surgery. rationale: Pain is a privately experienced, unpleasant sensation usually associated with disease, injury, or surgery. Although pain can have an emotional component, referred to as suffering, this is not the source of all pain. Although pain can be the result of disease, it can also be caused by injury, surgery, emotional or mental conditions, or other causes. Pain is a normal aspect of nervous system functioning. Neuropathic pain is pain that is processed abnormally by the nervous system.

A client recovering from hip surgery is receiving morphine through a patient-controlled analgesia (PCA) infusion pump with a set basal rate. What action is most important for the nurse to implement? -Assess the client's respiratory status -Instruct the client about bolus doses -Ask the client about pain status -Obtain consent for PCA by proxy

Assess the client's respiratory status Rationale: A basal rate is a continuous infusion of the medication. Assessment of the client's respiratory status is a major nursing responsibility and the most important one listed per Maslow's hierarchy of needs. The nurse will instruct the client about bolus doses for increased pain or painful activities and assess pain status. There is no information in the stem of the question to support the need for consent for PCA by proxy.

A client who fell at home is hospitalized for a hip fracture. The client is in Buck's traction, anticipating surgery, and reports pain as "2" on a pain intensity scale of 0 to 10. The client also exhibits moderate anxiety and moves restlessly in the bed. The best nursing intervention to address the client's anxiety is to -Administer the prescribed alprazolam (Xanax). -Assess the reason for the client's anxiety. -Administer the prescribed dose of morphine. -Assist the client out of bed and into a chair.

Assess the reason for the client's anxiety. Rationale: Following the steps of the nursing process, the nurse needs to assess the reason for the client's anxiety. The client could be anxious about impending surgery, an unattended pet, a sick family member, etc. Then, the nurse intervenes appropriately by obtaining the assistance the client may need or administering anti-anxiety medication. The question is asking about treatment for anxiety. Pain medication should not be administered for anxiety. The nurse will not assist the client to a chair, because the client is on bedrest and in Buck's traction.

The nurse is administering a narcotic analgesic for the control of a newly postoperative client's pain. What medication will the nurse administer to this client? -Midazolam (Versed) -Ibuprofen (Motrin) -Acetaminophen (Tylenol) -Fentanyl (Duragesic)

Fentanyl (Duragesic) rationale: Opioid and opiate analgesics such as morphine and fentanyl (Duragesic) are controlled substances referred to as narcotics. The other medications are not opioid analgesics and should not be given for a newly postoperative client.

The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe? -Tramadol -Ketamine -Gabapentin -Hydromorphone

Gabapentin rationale: The anticonvulsant gabapentin is a first-line analgesic agent for neuropathic pain. Tramadol is designated as a second-line analgesic agent for the treatment of neuropathic pain. Ketamine is used as a third-line analgesic agent for refractory acute pain. Hydromorphone is a first-line opioid not used as an analgesic agent for neuropathic pain.

When taking a client history, the nurse notes that the client is taking herbal remedies in addition to acetaminophen. Which herb, when taken in conjunction with acetaminophen, enhances the risk of bleeding? -Echinacea -Ginkgo -Willow -Kava

Ginkgo Rationale: Ginkgo, when taken with acetaminophen, enhances the risk of bleeding. Echinacea, willow, and kava, when taken with acetaminophen, increase the potential for hepatotoxicity and nephrotoxicity.

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 -nociceptive and chronic -nociceptive and acute -neuropathic and acute

Neuropathic and chronic Rationale: When classified according to its source, pain can be categorized as nociceptive or neuropathic. When classified according to its onset, intensity, and duration, pain can be categorized as either acute or chronic. Because the client is without breakthrough pain at this time, he has no acute pain. Nociceptive pain is transmitted from a point of cellular injury to the brain. This is not the type of pain related to long-term diabetes mellitus. Neuropathic pain sustained by injury or dysfunction of the peripheral or central nervous systems. This type of pain is related to long-term diabetes mellitus. Acute pain is pain or discomfort of short duration: from a few seconds to less than 6 months. This is not the type of pain related to long-term diabetes mellitus.

A client is reporting her pain as "8" on a 0-to-10 pain intensity scale. Then, the client states the pain is "3." Before the nurse leaves the room, the client states her pain is "6." The best action of the nurse is to -Obtain a pain scale with faces for the client to measure her pain. -Average the numbers and report that number as the client's level of pain. -Medicate the client for pain based on the highest number of "8." -Record each of the numbers the client stated for her pain.

Obtain a pain scale with faces for the client to measure her pain. rationale: Various scales are helpful to clients trying to describe pain intensity. If the client cannot use one scale, such as the numeric pain intensity scale, the nurse uses another pain intensity scale that the client finds easy to understand and use. The nurse does not average the numbers, medicate based on the highest number, nor record each of the numbers the client stated.

Which of the following is a physiologic response to pain? -Bradycardia -Dry skin -Pallor -Hypotension

Pallor rationale: Physiologic responses to pain include pallor, tachycardia, diaphoresis, and hypertension.

Which is a true statement regarding placebos? -A placebo effect is an indication that the client does not have pain. -Placebos should never be used to test a client's truthfulness about pain. -A placebo should be used as the first line of treatment for a client. -A positive response to a placebo indicates that the client's pain is not real.

Placebos should never be used to test a client's truthfulness about pain. Rationale: Many pain guidelines, position papers, nurse practice acts, and hospital policies nationwide agree that placebos should not be used to assess or manage pain in any client, regardless of age or diagnosis. Perception of pain is highly individualized. A placebo effect is a true physiologic response. A placebo should never be used as a first line of treatment. Reduction in pain as a response to placebo should never be interpreted as an indication that the person's pain is not real.

A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be: -Attributed to a specific cause. -Prolonged in duration. -Rapidly occurring and subsiding with treatment. -Separate from any central or peripheral pathology.

Prolonged in duration. rationale: A major distinguishing characteristic between acute and chronic pain is its duration. Chronic is always prolonged.

Which of the following is a reliable source for quantifying pain? -The client's vital signs -The nature of the client's injury or condition -The client's description of the pain -The extent of the client's injury

The client's description of the pain rationale: The client's description of the pain is the only reliable source for quantifying pain. Physiologic data such as vital signs or the extent or nature of the injury do not indicate the amount of pain.

The nurse informs the patient that a preventive approach for pain relief will be used, involving nonsteroidal anti-inflammatory drugs. What will this mean for the patient? -The pain medication will be administered before the pain becomes severe. -The pain medication will be administered before the pain is experienced. -The pain medication will be administered when the pain is at its peak. -The pain medication will be administered when the level of pain tolerance has been exceeded.

The pain medication will be administered before the pain is experienced. rationale: Two basic principles of providing effective pain management are preventing pain and maintaining a pain intensity that allows the patient to accomplish functional or quality-of-life goals with relative ease (Pasero, Quinn et al., 2011). Accomplishment of these goals may require the mainstay analgesic agent to be administered on a scheduled around-the-clock (ATC) basis, rather than PRN (as needed) to maintain stable analgesic blood levels.

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 surgeon making an incision to perform surgery -A mother in labor utilizing imagery to reduce pain -A patient taking tramadol to enhance pain management

A child quickly removing a hand when touching a hot object Rationale: Transduction, the first process involved in nociception, refers to the processes by which a noxious stimulus, such as a burn, releases of a number of excitatory compounds, which move pain along the pain pathway. Transmission, the second process involved in nociception, is responsible for a rapid reflex withdrawal from painful stimulus. The third process involved in nociception is perception. Imagery is based on the belief that the brain processes can strongly influence pain perception. A dual-mechanism analgesic agent, such as tramadol, involves many different neurochemicals as in the process of modulation.

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 the best example of chronic pain. -A migraine headache -Intervertebral disk herniation -Angina -Appendicitis

Intervertebral disk herniation rationale: Chronic pain is found with degeneration or traumatic conditions and can sometimes be the cause of the patient's primary disorder. The other three choices refer to acute pain. Migraines could be chronic pain but are not the best example here.

A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing? -Breakthrough pain -Neuropathic pain -Visceral pain -Referred pain

Neuropathic pain Rationale: An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Chronic pain sufferers may have periods of acute pain, which is referred to as breakthrough pain. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is a term used to describe discomfort that is perceived in a general area of the body but not in the exact site where an organ is anatomically located.

Which phase of pain transmission occurs when the one is made aware of pain? -Transmission -Modulation -Transduction -Perception

Perception Rationale: Perception is the pain process where one becomes aware of the pain as a result of neural activity. Modulation involves the response to noxious stimuli. Transduction refers to the processes by which noxious stimuli activate primary afferent neurons called nociceptors. Transmission describes the action potential that is created by transduction being transmitted along fibers.

A client being treated for rheumatoid arthritis has been prescribed a glucocorticosteroid. How should the nurse best ensure this client's safety during treatment? -Ensure the client knows to taper down the dose if it is discontinued by the care provider. -Educate the client about the need to avoid grapefruit and grapefruit juice during treatment. -Teach the client the signs and symptoms of gastrointestinal bleeding. -Educate the client about the difference between tolerance and dependence.

Ensure the client knows to taper down the dose if it is discontinued by the care provider. rationale: Corticosteroids must be tapered slowly in order to prevent an adrenal crisis. These medications do not normally cause dependence and they do not pose a risk for GI bleeding. Grapefruit is not contraindicated.

Prostaglandins are chemical substances with what property? -Increase the sensitivity of pain receptors -Reduce the perception of pain -Inhibit the transmission of pain -Inhibit the transmission of noxious stimuli

Increase the sensitivity of pain receptors rationale: Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin. Endorphins and enkephalins reduce or inhibit transmission or perception of pain. Morphine and other opioid medications inhibit the transmission of noxious stimuli by mimicking enkephalin and endorphin.

The nurse understands that which of the following physiologic changes that influence the pain response occur in the gerontologic population? -Increased sensitivity to medications -Lower blood levels of medications -Faster metabolism of medications -Decreased use of prescription and over-the-counter (OTC) medications

Increased sensitivity to medications Rationale: The older population experiences increased sensitivity to medication and increased risk for drug toxicity. They tend to have higher blood level of medications due to a slower metabolism. In this population, there is also an increased use of prescription and OTC medications.

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 -Chronic -Intermittent -Visceral

acute rationale: Acute pain is of early onset and associated with an injury. Pain decreases as healing occurs. Chronic pain is constant or intermittent and persists beyond the healing time.

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 -ingesting up to 6 glasses of fluids per day -increasing the amount of bran and fresh fruits and vegetables -using milk of magnesia 30 mL every day -inserting a bisacodyl (Dulcolax) rectal suppository every morning

increasing the amount of bran and fresh fruits and vegetables rationale: Constipation is a common problem with the use of opioid medications, such as methadone. Activities to prevent constipation include increasing bran and fresh fruits and vegetables in the diet. The client should ingest 8 to 10 glasses of fluids per day. Milk of magnesia may be used if no bowel movement is produced in 3 days. Milk of magnesia is not to be used daily. A glycerin suppository, not bisacodyl, may be used to make the bowel movement less painful.

A client is on a second round of radiation therapy for an inoperable tumor, and asks the nurse for medication to help with pain. The nurse suspects that the client's pain is the result of nerve damage from the radiation. Which type of pain is the client likely experiencing? -neuropathic pain -somatic pain -visceral pain -referred pain

neuropathic pain rationale: Neuropathic pain can affect cancer patients due to nerve damage from chemotherapy or radiation therapy. Somatic pain is caused by damage or disorders that affect bones, joints, muscles, skin, or other structures. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is pain felt in the body in a location that is different from the actual source of the pain.

A client sustained second- and third-degree burns to the chest and neck 4 days ago and is now refusing analgesics stating, "I don't want to become addicted to pain medication." What is the best response by the nurse? -"I don't blame you for feeling that way; we have people who do become addicted." -"Don't worry about this now; take the pain medications, and we will worry about addiction later." -"Although misusing the medication may cause addiction, there is little evidence that those who require narcotics for legitimate pain become addicted." -"The physician has ordered the medication every 4 hours, and you must take it so that you will heal quicker."

"Although misusing the medication may cause addiction, there is little evidence that those who require narcotics for legitimate pain become addicted." rationale: Addiction refers to a repetitive pattern of drug seeking and drug use to satisfy a craving for a drug's mind-altering or mood-altering effects. Although opioid drugs can result in addiction, there is very little evidence that those who require narcotics for legitimate pain actually become addicted. The other options are nontherapeutic responses to the client's concern about addiction.

A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client: -"Whenever you hurt, push the button." -"Only you are to push the button for medication." -"Wait until your pain is severe before pushing the button." -"This will completely relieve your pain."

"Only you are to push the button for medication" Rationale: With a PCA machine, clients control the administration of their pain medication within prescribed parameters. Family members or other visitors should not push the button on the PCA machine for the client; doing so overrides the safety features of the machine. Clients may become frustrated if pushing the button frequently does not result in pain relief. The nurse needs to instruct the client about time limits. Other instructions include not waiting until the pain is severe before pushing the button and that the PCA machine is used to control pain.

The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to -Notify the surgeon of the client's goal of "0." -Educate the client that this goal may not be achievable. -Plan to use medication and nonpharmacologic interventions. -Ensure the client is prescribed large doses of opioids -postoperatively.

-Educate the client that this goal may not be achievable. rationale: The client's goal of complete elimination of pain may be unrealistic. The nurse needs to first teach the client about setting an achievable goal. The nurse will plan to use a combination of pharmacologic and nonpharmacologic interventions for pain relief. The nurse may need to notify the surgeon of the client's goal of "0" for pain relief. The nurse does not ensure large doses of opioids are prescribed for the client. Many factors go into the prescription of medication for pain relief, including the client's response to the medication.

The nurse is assessing a client who has been taking up to 4 grams of acetaminophen every day for undiagnosed pain. What reaction due to ingestion of acetaminophen will the nurse assess for? -Excessive clotting of blood -Abrupt onset of rash and pruritus -Shortness of breath -Sensitivity to hot and cold temperatures

Abrupt onset of rash and pruritus Rationale: The use of acetaminophen increases the risk of hepatotoxicity. Initial signs and symptoms of a drug-induced hepatitis include an abrupt onset of a rash and pruritus. Initial effects would not include excessive clotting of blood, shortness of breath, or sensitivity to hot and cold temperatures.

Prior to starting a peripheral intravenous line on a patient, what intervention can the nurse provide to decrease the pain from the needle puncture? -Give an oral opioid analgesic 30 minutes before the procedure. -Apply diclofenac gel over the site 1 hour before the procedure. -Apply eutectic mixture of local anesthetic cream 30 minutes prior to the procedure. -Inject lidocaine 2% with epinephrine locally around the potential procedure site.

Apply eutectic mixture of local anesthetic cream 30 minutes prior to the procedure. rationale: The topical route of administration is used for both acute and chronic pain. For example, the nonopioid diclofenac is available in patch and gel formulations for application directly over painful areas. Local anesthetic creams, such as EMLA (eutectic mixture or emulsion of local anesthetics) and L.M.X.4 (lidocaine cream 4%), can be applied directly over the injection site prior to painful needle stick procedures, and the lidocaine patch 5% is often used for well-localized types of neuropathic pain, such as postherpetic neuralgia.

An older adult is being treated with opioids for pain relief. Which of the following should the nurse strongly recommend to this client? -Exercise regularly. -Avoid harsh sunlight. -Follow a bowel regimen. -Reduce fiber intake.

Follow a bowel regimen Rationale: The nurse should ensure that a bowel regimen to prevent constipation is started when any older adult is treated with opioids. A high-fiber diet along with increased fluids should be encouraged. The client should not reduce fiber intake because this increases the risk for constipation. Exercising regularly or avoiding harsh sunlight have no effects on the drug therapy.

About which issue should the nurse inform clients who use pain medications on a regular basis? -Avoid harsh sunlight for 2 hours after administering analgesic agents or salicylates. -Inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesics consistently without consulting a physician. -Minimize fiber intake during the therapy. -Consume the medications just before or along with meals.

Inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesics consistently without consulting a physician. Rationale: Clients should be advised to inform the primary health care provider or dentist before any procedure when they use pain medications, especially salicylates or nonsteroidal anti-inflammatory agents, on a regular basis. Over-the-counter analgesic agents, such as aspirin, ibuprofen, or acetaminophen, should not be avoided consistently to treat chronic pain without consulting a physician. Pain medications administered 30 to 45 minutes before meals may enable the client to consume an adequate intake, while a high-fiber diet may help ease constipation related to narcotic analgesics. Clients need not avoid harsh sunlight after administering analgesic agents because these drugs do not cause photosensitivity.

Which phase of pain transmission occurs when the brain experiences pain at a conscious level? -Transmission -Modulation -Transduction -Perception

Perception Rationale: Perception is the phase of impulse transmission during which the brain experiences pain at a conscious level, but many concomitant neural activities occur almost simultaneously. Transmission is the phase during which peripheral nerve fibers from synapses with neurons in the spinal cord. Modulation is the last phase of pain impulse transmission, during which the brain interacts with the spinal nerves in a downward fashion to alter the pain experience. Transduction is the conversion of chemical information in the cellular environment to electrical impulses that move toward the spinal cord.

Which condition is a heightened response that occurs after exposure to a noxious stimulus? -Pain tolerance -Sensitization -Pain threshold -Dependence

Sensitization rationale: Sensitization is a heightened response that occurs after exposure to a noxious stimulus. Pain tolerance is the maximum intensity or duration of pain that a person is willing to endure. Pain threshold is the point at which a stimulus is perceived as painful. Dependence occurs when a client who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued.

Which of the following is a true statement with regards to the preventative approach to the use of analgesics? -Smaller doses of medication are needed. -It promotes tolerance to analgesic agents -The use increases peaks and troughs in the serum level. -Larger doses of medication are needed.

Smaller doses of medication are needed. Rationale: Smaller doses of medication are needed with the preventative approach, because the pain does not escalate to a level of severe intensity. A preventative approach may result in the administration of less medication over a 24-hour period, helping prevent tolerance to analgesic agents and decreasing the severity of side effects. The preventative approach reduces the peaks and troughs in the serum level and provides more pain relief with fewer side effects.

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: -About activities that would distract him from pain -That the nurse will notify the surgeon of his fear -How anxiety could increase his pain perception -That medication will be prescribed for pain relief

That medication will be prescribed for pain relief Rationale: Pain is expected postoperatively, and the client should be reassured that medication will be prescribed to relieve pain. The client may have less pain knowing that measures will be taken to reduce it. Diversional activities may be used in addition to analgesics. Anxiety about pain could increase the client's perception of pain. Another nursing activity is being an advocate for the client and notifying his surgeon of the client's fear.

A client reports abdominal pain as "8" on a pain intensity scale of 0-10 thirty minutes after receiving an opioid intravenously. Her past medical history includes partial-thickness burns to approximately 60% of her body several years ago. The nurse assesses -That the client's past experiences with pain may influence her perception of current pain -That based on her past experiences the client's perception of pain should be less -That the client has become dependent on drugs from her previous experience of burns -That the client is experiencing pain relating to the burn injuries from several years ago

That the client's past experiences with pain may influence her perception of current pain Rationale: Clients who have had previous experiences with pain are usually more frightened about subsequent painful events, as in the client who experienced partial-thickness burns to more than 60% of her body. The clients in these situations are less able to tolerate pain. Insufficient data in the stem support that the client is dependent on drugs or that this current pain is related to the client's previous burn injuries.

The nurse needs to carefully monitor a client with traumatic injuries. Which action by the nurse demonstrates understanding of the most essential component of the client's pain assessment? -The nurse administers ketorolac upon admission to the unit. -The nurse validates the client's report of pain by assessing the client's blood pressure. -The nurse administers pain medication based on the client's reported pain level. -The nurse assesses the response to medication after every meal consumed by the client.

The nurse administers pain medication based on the client's reported pain level. rationale: Clients quickly adapt physiologically despite pain and may have normal or below normal vital signs in the presence of severe pain. The overriding principle is that the absence of an elevated blood pressure or heart rate does not mean the absence of pain. The ability of an individual to give a report of pain, especially its intensity, is the most essential component of pain assessment. Pain does not need to be assessed an hour after analgesics are administered or after every meal consumed by the client. Pain medication should not routinely be administered to a client upon admission to the unit.

A client reports having joint pain that has gotten worse over the last year despite gradually increasing doses of an OTC pain reliever. Which type of pain will the nurse document as the chief complaint? -chronic pain -acute pain -referred pain -breakthrough pain

chronic pain rationale: This client is experiencing chronic pain, which is pain or discomfort that lasts for a period longer than 6 months. Pain or discomfort with a short duration is acute pain. It is associated with trauma, injury, or surgery. Referred pain is pain felt in the body in a location that is different from the actual source of the pain. Breakthrough pain is a period of acute pain experienced by those suffering from chronic pain.

When a client who has been taking opioids becomes less sensitive to the drug's analgesic properties, that client is said to have developed a(n) -addiction. -dependence. -tolerance. -balanced analgesia.

tolerance rationale: Tolerance is a normal response that occurs with regular administration of an opioid and is characterized by the need for higher doses to maintain the same level of pain relief. Addiction refers to a behavioral pattern of substance use characterized by a compulsion to take the drug primarily to experience its psychic effects. Dependence occurs when a client who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued. Balanced analgesia occurs when the client is using more than one form of analgesia concurrently to obtain more pain relief with fewer side effects.

The nurse is caring for a client with kidney stones who is complaining of severe pain. What type of pain does the nurse understand this client is experiencing? -Somatic Pain -Visceral Pain -Neuropathic Pain -Chronic Pain

visceral pain rationale: Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Somatic pain is caused by mechanical, chemical, thermal, or electrical injuries or disorders affecting bones, joints, muscles, skin, or other structures composed of connective tissue. Neuropathic pain is pain that is processed abnormally by the nervous system. Chronic pain is discomfort that lasts longer than 6 months and is almost totally opposite from those of acute pain.