Pain Management

1. A patient suddenly develops right lower-quadrant pain, nausea, vomiting, and rebound tenderness. How should the nurse classify this patient's pain? 1)Acute 2)Chronic 3)Intractable 4)Neuropathic

1 Acute pain typically has a short duration and a rapid onset. Chronic pain lasts longer than 6 months and interferes with daily activities. Intractable pain is chronic and highly resistant to relief. Neuropathic pain is a type of chronic pain that occurs from injury to one or more nerves.

Despite being provided with interventions, a client continues to experience extreme pain. What should the nurse do to enhance this client's comfort? 1)Determine whether the plan was implemented correctly. 2)Increase the use of nonpharmacological interventions. 3)Ask the healthcare provider to change pain medication. 4)Determine whether the client is being truthful when evaluating pain level.

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A patient diagnosed with lung cancer who is receiving morphine (MS Contin) complains of constipation. Which instruction by the nurse might help relieve the patient's constipation? Select all that apply. 1)"Be sure the amount of fruit, vegetables, and fiber in your diet is adequate." 2)"Drink at least eight 8-ounce glasses of water each day." 3)"Avoid using stool softeners because they may become habit forming." 4)"Increase your exercise routine to include 1 hour of exercise a day." 5)"Take a laxative every day."

1,2 1)"Be sure the amount of fruit, vegetables, and fiber in your diet is adequate." 2)"Drink at least eight 8-ounce glasses of water each day."

A 73-year-old patient admitted after a stroke has expressive aphasia. Which pain intensity scale would be appropriate to use with this patient? Select all that apply. 1)Visual analog 2)Numerical rating 3)Wong-Baker FACES rating 4)Simple descriptor 5)Revised Faces Pain Scale

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Nursing assistive personnel (NAP) ask why so many clients seem to be complaining of pain. What should the nurse emphasize to the NAP about pain? Select all that apply. 1)Pain is subjective. 2)Pain is measured objectively. 3)Pain is whatever the client says it is. 4)Pain exists when the client says it does. 5)Your expectations of clients' pain are influenced by individual values.

1,3,4,5 1)Pain is subjective. 3)Pain is whatever the client says it is. 4)Pain exists when the client says it does. 5)Your expectations of clients' pain are influenced by individual values.

A patient prescribed a nonsteroidal anti-inflammatory drug (NSAID), naproxen (Aleve, Naprosyn), for treatment of arthritis complains of stomach upset. What should the nurse instruct the patient to do? 1)Notify the prescriber immediately. 2)Take the medication with food. 3)Take the medication with 8 ounces of water. 4)Take the medication before bedtime.

2 (NSAID), naproxen (Aleve, Naprosyn) ，Take the medication with food. The nurse should instruct the patient to take the medication with food to lessen gastric irritation. Taking the medication with 8 ounces of water will not decrease gastric irritation. Taking the medication just before bedtime may cause gastric reflux, increasing gastric irritation. Although indigestion is an unwanted side effect of naproxen, it is not an emergency that requires the prescriber to be notified immediately. However, prior to giving naproxen, be sure the patient has not had ulcers, stomach bleeding, or severe kidney or liver problems. If so, the patient is not a candidate for treatment with naproxen.

Which side effects associated with opioid use may improve after taking a few doses of the drug? 1)Constipation 2)Drowsiness 3)Dry mouth 4)Difficulty with urination

2 Drowsiness and nausea are side effects of opioid therapy that commonly improve after a few doses are administered. Other side effects include constipation, vomiting, dry mouth, and difficulty with urination. These side effects do not typically lessen with use.

In which process do peripheral nerves carry the pain message to the dorsal horn of the spinal cord? 1)Transduction 2)Transmission 3)Perception 4)Modulation

2 Peripheral nerves carry the pain message to the dorsal horn of the spinal cord during a process known as transmission. In a process called transduction, specialized nociceptors convert potentially damaging mechanical, thermal, and chemical stimuli into electrical activity that leads to the experience of pain. Perception involves the recognition of pain by the frontal cortex of the brain. During modulation, pain signals can be facilitated or inhibited, and the perception of pain can be changed.

A patient who underwent a left above-the-knee amputation complains of pain in his left foot. The nurse should document this finding as what type of pain? 1)Psychogenic 2)Phantom 3)Referred 4)Radiating

2 The nurse should document this finding as phantom pain. Phantom pain is pain that is perceived to originate in an area that has been amputated. Psychogenic pain refers to pain experienced by a person which does not match the symptoms or the apparent source of pain. It is thought to arise from psychological factors and is disproportional to the painful stimuli. Referred pain occurs in an area distant from the original site. Radiating pain starts at the source but extends to other locations.

Which nursing diagnosis is most appropriate for the patient who returns from the postanesthesia care unit after undergoing right hemicolectomy surgery for colon cancer? 1)Acute pain secondary to surgery 2)Acute pain (abdominal) secondary to surgery for colon cancer 3)Chronic pain secondary to cancer diagnosis 4)Chronic pain (abdominal) secondary to abdominal surgery

2 The nurse should identify a diagnosis by specifying the location of the pain and any precipitating or etiological factors. This patient is experiencing acute abdominal pain that is related to his surgery for colon cancer; therefore, a nursing diagnosis that specifies the surgery is the most appropriate diagnosis for this patient. In addition, options listing chronic pain are incorrect because the pain is acute, not chronic.

A patient had a bowel resection 5 days ago. Which request by the patient might alert the nurse that the patient has a history of substance abuse? 1)Oral pain medication once every 6 to 8 hours 2)Patient-controlled analgesic ( PCA ) 3)Oral pain medications instead of the IM form 4)Only nonpharmacological pain measures

2 The patient underwent surgery 5 days ago; if there are no complications, it is unlikely that he would require frequent dosing of analgesic. The nurse should recognize this behavior as a possible indicator of current substance abuse or addiction. Requesting oral pain medications every 6 to 8 hours is a typical behavior for a patient 5 days after surgery.

After undergoing dural puncture while receiving epidural pain medication, a patient complains of a headache. Which action can help alleviate the patient's pain? 1)Encourage the client to ambulate to promote flow of spinal fluid. 2)Offer caffeinated beverages to constrict blood vessels in his head. 3)Encourage deep breathing and coughing to increase CSF pressure. 4)Restrict oral fluid intake to prevent excess spinal pressure.

2 Treatment for a headache that occurs as a result of dural puncture consists of bedrest, analgesics as prescribed, and liberal hydration. Caffeine and a dark, quiet environment may also be helpful.

The nurse administers acetaminophen 325 mg and codeine 30 mg orally to a patient complaining of a severe headache. When should the nurse reassess the patient's pain? 1)15 minutes after administration 2)60 minutes after administration 3)90 minutes after administration 4)Immediately before the next dose is due

2 oral pain medication 30 to 60 minutes after administration. IV medications 10 to 15 minutes after administration.

Which expected outcome is best for the patient with a nursing diagnosis of Acute Pain related to movement and secondary to surgical resection of a ruptured spleen and possible inadequate analgesia? 1)The patient will verbalize a reduction in pain after receiving pain medication and repositioning. 2)The patient will rest quietly when undisturbed. 3)On a scale of 0 to 10, the patient will rate pain as a 3 while in bed or as a 4 during ambulation. 4)The patient will receive pain medication every 2 hours as prescribed

3 A low pain rating is the best expected outcome for the patient with a nursing diagnosis of Acute Pain secondary to surgical resection of a ruptured spleen and possible inadequate analgesia because it is specific and measurable. The patient verbalizing reduced pain is not specific enough. The nurse needs to know how much pain relief is achieved. A numeric score gives a clearer indication of the effectiveness of analgesia. The patient might have experienced a reduction in pain, but his pain level might still be intolerable. Saying the patients pain is relieved because he is resting quietly does not address the pain relief while he is awake. Some patients will sleep in an attempt to cope with pain, so this outcome could lead to inaccurate evaluation. Providing pain medication is a nursing intervention, not an expected outcome.

A patient who sustained rib fractures in a motor vehicle accident is complaining that his pain medication is ineffective. Inadequate pain control places this patient at risk for which complication? 1)Metabolic alkalosis 2)Pneumothorax 3)Pneumonia 4)Hemothorax

3 Pain associated with rib fractures causes splinting. Splinting often causes the patient to breathe shallowly and avoid deep coughing to expel sputum, which can lead to pneumonia. Rib fractures can also lead to complications such as pneumothorax and hemothorax; however, they do not result from inadequate pain control.

Which pain management task can be safely delegated to nursing assistive personnel (NAP)? 1)Assessing the quality and intensity of the patient's pain 2)Evaluating the effectiveness of pain medication 3)Providing a therapeutic back massage 4)Administering an oral dose of acetaminophen

3 The nurse can safely delegate providing a back massage for the patient in pain. the nurse should responsibility of assessing the patients pain, monitoring the patients response to pain management strategies, administering medications (including over-the-counter preparations), or evaluating the pain management plan.

How should the nurse classify pain that a patient with lung cancer is experiencing? 1)Radiating 2)Deep somatic 3)Visceral 4)Referred

3 Visceral pain is commonly experienced in the abdominal cavity, cranium, or thorax. Lung cancer produces visceral pain. Radiating pain starts at the source and extends to other locations. Deep somatic pain is typically caused by fracture, sprain, arthritis, and bone cancer. Referred pain occurs in an area distant from the original site.

A patient reports using music therapy to help control chronic pain. Music therapy works by prompting the release of endogenous opioids during which stage of the pain process? 1)Perception 2)Transduction 3)Transmission 4)Modulation

4 Music therapy can prompt the release of endogenous opioids during the modulation stage, which is the stage of the pain process where the perception of pain changes. It is not during the perception (recognizing the pain sensation), transmission (relaying the pain message), or transduction (converting potentially damaging stimuli into electrical activity leading to pain sensation).

A patient with Raynaud's disease receives no symptomatic relief with diltiazem (Cardizem). Which surgical intervention might be a treatment option for this patient to help provide symptomatic relief? 1)Cordotomy 2)Rhizotomy 3)Neurectomy 4)Sympathectomy

4 Sympathectomy severs the pathways to the sympathetic nervous system. The procedure improves vascular blood supply and eliminates vasospasm. It is effective for treatment of pain associated with vascular disorders, such as Raynauds disease. Cordotomy interrupts pain and temperature sensation below the tract that is severed. This procedure is commonly performed to relieve trunk and leg pain. Rhizotomy interrupts the anterior or posterior nerve route located between the ganglion and the cord. It is commonly used to treat head and neck pain. Neurectomy is used to eliminate intractable localized pain. The pathways of peripheral or cranial nerves are interrupted to block pain transmission.

After receiving ibuprofen (Motrin) 800 mg orally for right hip pain, the patient states that his pain is 8 out of 10 on the numerical pain scale. Which action should the nurse take? 1)Use nonpharmacological therapy while waiting 3 more hours before the next dose. 2)Administer an additional 800-mg oral dose of ibuprofen right away. 3)Do nothing because the patient's facial expression indicates he is comfortable. 4)Notify the prescriber that the current pain management plan is ineffective.

4 The nurse should notify the prescriber that the current pain management plan is ineffective. The nurse should not delay treatment for 3 hours when the next dose of medication is due. The nurse cannot administer an extra dose of ibuprofen without a prescribers order to do so. Ibuprofen 800 mg is a maximum dose for most individuals. The nurse should not assume that the patient is not in pain simply because he appears comfortable; pain is what the patient states it is.

The nurse is caring for a patient who has severe abdominal pain caused by acute cholecystitis. The nurse recognizes which type of pain is this patient experiencing? a. Visceral pain b. Somatic pain c. Radiating pain d. Referred pain

ANS: A Visceral pain arises from the organs of the body and occurs when inflammation and tissue damage occur, such as with cholecystitis. Somatic pain occurs when there is tissue damage to skin, muscle, joints, and bones. Referred pain occurs when the discomfort is felt at a location other than the origin of the pain. Radiating pain extends to another area of the body

The nurse is checking on the patient after administering pain medication 30 minutes previously. Which assessment finding best indicates to the nurse that the pain medication was effective? a. The patient is sleeping quietly. b. The patient states a reduction of the pain. c. The patient's respirations are slow and regular. d. The patient's blood pressure has returned to baseline.

ANS: B The best way for the nurse to determine that the pain medication was effective is for the patient to state a reduction of the pain. The other assessment findings cannot definitively determine whether the patient is still in pain.

The nurse is caring for a patient with severe chronic pain and applied the first 50 mcg transdermal fentanyl (Duragesic) patch 2 hours ago. The patient states that the pain is presently rated at 9 on a 1 to 10 scale. What is the nurse's best action? a. Instruct the patient that the fentanyl patch will start to work soon. b. Check the provider's orders for a short-acting narcotic medication to administer for breakthrough pain. c. Give the patient a gentle back rub and encourage guided imagery. d. Apply a second 25-mcg transdermal fentanyl patch now.

ANS: B Transdermal administration of medication does not become effective for 12 to 16 hours after application. Short-acting narcotic medication should be given in the meantime to make the patient comfortable.

An older adult receiving hospice care has dementia as a result of metastasis to the brain and bone cancer has progressed to an advanced stage. Why might the client fail to request pain medication as needed? 1)Experiences less pain than in earlier stages of cancer 2)Cannot communicate the character of his pain effectively 3)Recalls pain at a later time than when it occurs 4)Relies on caregiver to provide pain relief without asking

Cannot communicate the character of his pain effectively There is no evidence to suggest that patients with dementia and other forms of cognitive impairment do not experience pain. It is most likely that they cannot effectively communicate the intensity or quality of pain and are therefore at risk for underassessment of pain and inadequate pain relief. Be aware of behavioral cues indicating pain rather than relying on verbal report.

A nurse is planning care for an older-adult patient who is experiencing pain. Which statement made by the nurse indicates the supervising nurse needs to follow up? a. "As adults age, their ability to perceive pain decreases." b. "Older patients may have low serum albumin in their blood, causing toxic effects of analgesic drugs." c. "Patients who have dementia probably experience pain, and their pain is not always well controlled." d. "It is safe to administer opioids to older adults as long as you start with small doses and frequently assess patient's response to the medication."

a. "As adults age, their ability to perceive pain decreases." Aging does not affect the ability to perceive pain. This misconception must be corrected by the supervising nurse. All the other statements are true and require no follow-up. Opioids are safe to use in older adults as long as they are slowly titrated and the nurse frequently monitors the patient. Patients with dementia most likely experience unrelieved pain because their pain is difficult to assess. Older adults frequently eat poorly, resulting in low serum albumin levels. Many drugs are highly protein bound. In the presence of low serum albumin, more free drug (active form) is available, thus increasing the risk for side and/or toxic effects.

A nurse is caring for a group of patients. Which patient will the nurse see first? a. A patient who received morphine and has a pulse of 62 beats/min, respirations 10 breaths/min, and blood pressure 110/60 mm Hg b. A patient lying very still in bed who reports no pain but is pale with warm, dry skin c. A patient with severe pain who is nauseated and feels like he or she is about to vomit d. A patient writhing and moaning from abdominal pain after abdominal surgery

a. A patient who received morphine and has a pulse of 62 beats/min, respirations 10 breaths/min, and blood pressure 110/60 mm Hg A respiratory rate of 10 indicates respiratory depression. A rare adverse effect of opioids in opioid- naïve patients (patients who have used opioids around the clock for less than approximately 1 week) is respiratory depression. Naloxone (Narcan) may be administered. While the other patients are experiencing pain and do need to be seen, they are not the priority since respirations are not affected.

The nurse is caring for two patients; both are having a hysterectomy. The first patient is having the hysterectomy after a complicated birth. The second patient has uterine cancer. What will most likely influence the experience of pain for these two patients? a. Meaning of pain b. Neurological factors c. Competency of the surgeon d. Postoperative support personnel

a. Meaning of pain The degree and quality of pain perceived by a patient are related to the meaning of the pain. The patient's perception of pain is influenced by psychological factors, such as anxiety and coping, which in turn influence the patient's experience of pain. Each patient's experience is different. Neurological factors can interrupt or influence pain perception, but neither of these patients is experiencing alterations in neurological function. The knowledge, attitudes, and beliefs of nurses, health care providers, the surgeon, and other health care personnel about pain affect pain management but do not necessarily influence a patient's pain perceptions.

A nurse is caring for a patient with rheumatoid arthritis who is now going to be taking 2 acetaminophen (Tylenol) tablets every 6 hours to control pain. Which part of the patient's social history is the nurse most concerned about? a. Patient drinks 1 to 2 glasses of wine every night. b. Patient smokes 2 packs of cigarettes a day. c. Patient occasionally uses marijuana. d. Patient takes antianxiety medications.

a. Patient drinks 1 to 2 glasses of wine every night. The major adverse effect of acetaminophen is hepatotoxicity (liver toxicity). Because both alcohol and acetaminophen are metabolized by the liver, when taken together, they can cause liver damage. Smoking cigarettes and smoking marijuana are not healthy behaviors, but their effects on health are not affected by acetaminophen. Antianxiety medications can be taken with acetaminophen.

The nurse is caring for a 4-year-old child who has pain. Which technique will the nurse use to best assess pain in this child? a. Use the FACES scale. b. Check to see what previous nurses have charted. c. Ask the parents if they think their child is in pain. d. Have the child rate the level of pain on a 0 to 10 pain scale.

a. Use the FACES scale. The FACES scale assesses pain in children who are verbal. Because a 4-year-old is verbal, this is an appropriate scale to use with this child. Assessing pain intensity in children requires special techniques. Young children often have difficulty expressing their pain. Parents' statement of pain is not an effective way to assess pain in children because children's statements are the most important. The 0 to 10 pain scale is too difficult for a 4-year-old child to understand. Previous documentation by nurses will tell you what the child's pain has been but will not tell you the child's current pain intensity

A nurse is teaching a patient about patient-controlled analgesia (PCA). Which statement made by the patient indicates to the nurse that teaching is effective? a. "I will only need to be on this pain medication." b. "I feel less anxiety about the possibility of overdosing." c. "I can receive the pain medication as frequently as I need to." d. "I need the nurse to notify me when it is time for another dose."

b. "I feel less anxiety about the possibility of overdosing." A PCA is a device that allows the patient to determine the level of pain relief delivered, reducing the risk of overdose. The PCA infusion pumps are designed to deliver a specific dose that is programmed to be available at specific time intervals (usually in the range of 8 to 15 minutes) when the patient activates the delivery button. A limit on the number of doses per hour or 4-hour interval may also be set. This can help decrease a patient's anxiety related to possible overdose. Its use also often eases anxiety because the patient is not reliant on the nurse for pain relief. Other medications, such as oral analgesics, can be given in addition to the PCA machine. One benefit of PCA is that the patient does not need to rely on the nurse to administer pain medication; the patient determines when to take the medication.

A nurse is caring for a patient with chronic pain. Which statement by the nurse indicates an understanding of pain management? a. "This patient says the pain is a 5 but is not acting like it. I am not going to give any pain medication." b. "I need to reassess the patient's pain 1 hour after administering oral pain medication." c. "It wasn't time for the patient's medication, so when it was requested, I gave a placebo." d. "The patient is sleeping, so I pushed the PCA button."

b. "I need to reassess the patient's pain 1 hour after administering oral pain medication." Be sure to evaluate after an appropriate period of time. For instance, oral medications usually peak in about 0.5 - 1 hour, whereas IVP medications peak in 15 to 30 minutes. Ask a patient if a medication alleviates the pain when it is peaking. Because oral medications usually peak in about an hour, you need to reassess the patient's pain within an hour of administration. Nurses must believe any patient report of pain, even if nonverbal communication is not consistent with pain ratings. The patient is the only person who should push the PCA button. Pushing the PCA when a patient is sleeping is dangerous and may lead to narcotic overdose or respiratory depression. Giving the patient a placebo and telling the patient it is medication is unethical.

The nurse is assessing how a patient's pain is affecting mobility. Which assessment question is most appropriate? a. "Have you considered working with a physical therapist?" b. "What activities, if any, has your pain prevented you from doing?" c. "Would you please rate your pain on a scale from 0 to 10 for me?" d. "When does your pain medication typically take effect on your pain?"

b. "What activities, if any, has your pain prevented you from doing?" Because the nurse is interested in knowing whether the patient's pain is affecting mobility, the priority assessment question is to ask the patient how the pain affects ability to participate in normal activities of daily living. Although a physical therapist is a good resource to have, especially if pain is severely affecting mobility, considering working with a physical therapist does not describe the effect of pain on the patient's mobility. Assessing quality of pain and effectiveness of pain medication does not help the nurse to understand how it is affecting the patient's mobility.

The nurse is caring for a patient to ease modifiable factors that contribute to pain. Which areas did the nurse focus on with this patient? a. Age and gender b. Anxiety and fear c. Culture and ethnicity d. Previous pain experiences and cognitive abilities

b. Anxiety and fear 其他因素护士不可以改变，护士可以缓解病人的焦虑和恐惧 Some examples of modifiable contributors to pain are anxiety and fear. The nurse can take measures to ease the patient's anxiety and fear related to pain. Age, gender, culture, ethnicity, cognitive abilities, and previous pain experience are all nonmodifiable factors that the nurse can help the patient to understand, but the nurse cannot alter them.

An oriented patient has recently had surgery. Which action is best for the nurse to take to assess this patient's pain? a. Assess the patient's body language. b. Ask the patient to rate the level of pain. c. Observe the cardiac monitor for increased heart rate. d. Have the patient describe the effect of pain on the ability to cope.

b. Ask the patient to rate the level of pain. One of the most subjective and therefore most useful characteristics for reporting pain is its severity. Therefore, the best way to assess a patient's pain is to ask the patient to rate the pain. Nonverbal communication, such as body language, is not as effective in assessing pain, especially when the patient is oriented. Heart rate sometimes increases when a patient is in pain, but this is not a symptom that is specific to pain. Pain sometimes affects a patient's ability to cope, but assessing the effect of pain on coping assesses the patient's ability to cope; it does not assess the patient's pain.

The nurse is caring for an infant in the intensive care unit. Which information should the nurse consider when planning care for this patient? a. Infants cannot be assessed for pain. b. Infants respond behaviorally and physiologically to painful stimuli. c. Infants cannot tolerate analgesics owing to an underdeveloped metabolism. d. Infants have a decreased sensitivity to pain when compared with older children.

b. Infants respond behaviorally and physiologically to painful stimuli. Infants cannot verbally express their pain, but they do express pain with behavioral cues (facial expressions, crying) and physiological indicators (changes in vital signs). Infants can tolerate analgesics, but proper dosing and close monitoring are essential. Infants and older children have the same sensitivity to pain. Pain can be assessed even though the neonate cannot verbalize; the nurse can observe behavioral clues. Nurses use behavioral cues and physiological responses to assess pain in infants.

A patient is receiving opioid medication through an epidural infusion. Which action will the nurse take? a. Restrict fluid intake. b. Label the tubing that leads to the epidural catheter. c. Apply a gauze dressing to the epidural catheter insertion site. d. Ask the nursing assistive personnel to check on the patient at least once every 2 hours.

b. Label the tubing that leads to the epidural catheter. To reduce the accidental administration of IV medications into the epidural catheter, the tubing that leads to the epidural catheter needs to be labeled clearly. The epidural insertion site needs to be covered by a transparent dressing to prevent infection and allow the nurse to assess the site. Patients receiving epidural anesthesia need to be monitored every 15 minutes until stabilized and then at least hourly for 12 to 24 hours.

A patient arrives at the emergency department experiencing a headache and rates the pain as 7 on a 0 to 10 pain scale. Which nonpharmacological intervention does the nurse implement for this patient while awaiting orders for pain medication from the health care provider? a. Reassures the patient that the provider will come to the emergency department soon b. Softly plays music that the patient finds relaxing c. Frequently reassesses the patient's pain scores d. Teaches the patient how to do yoga

b. Softly plays music that the patient finds relaxing The appropriate nonpharmacological pain-management intervention is to quietly play music that the patient finds relaxing. Music diverts a person's attention away from pain and creates relaxation. Reassessing the patient's pain scores is done during evaluation. Building the patient's expectation of the provider's arrival does not address the patient's pain. Although yoga promotes relaxation, nurses teach relaxation techniques only when a patient is not experiencing acute pain. Because the patient is having acute pain, this is not an appropriate time to provide patient teaching.

A nurse is caring for a patient who fell on the ice and has connective tissue damage in the wrist and hand. The patient describes the pain as throbbing. Which type of pain does the nurse document in this patient's medical record? a. Visceral pain b. Somatic pain c. Centrally generated pain d. Peripherally generated pain

b. Somatic pain Somatic pain comes from bone, joint, connective tissue, or muscle. Visceral pain arises from the visceral (internal) organs such as the GI tract and pancreas. Peripherally generated pain in the peripheral nerves can be caused by polyneuropathies or mononeuropathies. Centrally generated pain results from injury to the central or peripheral nervous system, causing deafferentation or sympathetically maintained pain.

A patient who had a motor vehicle crash 2 days ago is experiencing pain and is receiving patient- controlled analgesia (PCA). Which assessment finding indicates effective pain management with the PCA? a. The patient is sleeping and is difficult to arouse. b. The patient rates pain at a level of 2 on a 0 to 10 scale. c. The patient has sufficient medication left in the PCA syringe. d. The patient presses the control button to deliver pain medication.

b. The patient rates pain at a level of 2 on a 0 to 10 scale. A level of 2 on a scale of 0 to 10 is evidence of effective pain management. The effectiveness of pain-relief measures is determined by the patient. If the patient is satisfied with the amount of pain relief, then pain measures are effective. A patient who is sleeping and is difficult to arouse is possibly oversedated; the nurse needs to assess this patient further. The amount of medication left in the PCA syringe does not indicate whether pain management is effective or not. Pressing the button shows that the patient knows how to use the PCA but does not evaluate pain management.

A nurse is caring for a patient who recently had spinal surgery. The nurse knows that patients usually experience acute pain following this type of surgery. The patient refuses to get up and walk and is not moving around in the bed. However, the patient is stoic and denies experiencing pain at this time. What most likely explains this patient's behavior? a. The surgery successfully cured the patient's pain. b. The patient's culture is possibly influencing the patient's experience of pain. c. The primary health care provider did not prescribe the correct amount of medication. d. The nurse is allowing personal beliefs about pain to influence pain management at this time.

b. The patient's culture is possibly influencing the patient's experience of pain. A patient's culture or beliefs about pain often influence the patient's expression of pain. In this case, the patient has just had surgery, and the nurse knows that this surgical procedure usually causes patients to experience pain. It is important at this time for the nurse to examine cultural and ethnic factors that are possibly affecting the patient's lack of expression of pain at this time. Even if surgery corrects neurological factors that create chronic pain, surgery causes pain in the acute period. The patient has not taken any pain medication so this is an unrealistic assumption; most pain medications have standard dosages. The nurse is not allowing personal beliefs to influence pain management because the nurse is attempting to determine the reason why the patient is not verbalizing the experience of pain.

A nurse is caring for a patient who recently had abdominal surgery and is experiencing severe pain. The patient's blood pressure is 110/60 mm Hg, and heart rate is 60 beats/min. Additionally, the patient does not appear to be in any distress. Which response by the nurse is most therapeutic? a. "Your vitals do not show that you are having pain; can you describe your pain?" b. "OK, I will go get you some narcotic pain relievers immediately." c. "What would you like to try to alleviate your pain?" d. "You do not look like you are in pain."

c. "What would you like to try to alleviate your pain?" Be sure the patient is a partner in making decisions about the best approaches for managing pain. A patient knows the most about his or her pain and is an important partner in selecting successful pain therapies. The nurse must believe that a patient is in pain whenever the patient reports that he or she is in pain, even if the patient does not appear to be in pain. The nurse must be careful to not judge the patient based on vital signs or nonverbal communication and must not assume that the patient is seeking narcotics. The patient is a partner in pain management, so going to get narcotics to treat the pain without consulting with the patient first is not appropriate.

The nurse is preparing pain medications. To which patient does the nurse anticipate administering an opioid fentanyl patch? a. A 15-year-old adolescent with a fractured femur b. A 30-year-old adult with cellulitis c. A 50-year-old patient with prostate cancer d. An 80-year-old patient with a broken hip

c. A 50-year-old patient with prostate cancer Transdermal fentanyl (patch), which is 100 times more potent than morphine, is available for opioid- tolerant patients with cancer or chronic pain (prostate cancer). It delivers predetermined doses that provide analgesia for up to 72 hours. The other patients are expected to experience acute pain (fractured femur, cellulitis, and broken hip). Therefore, they will most likely benefit from oral or IV opioids for short-term pain relief.

The nurse is evaluating the effectiveness of guided imagery for pain management as used for a patient who has second- and third-degree burns and needs extensive dressing changes. Which finding best indicates the effectiveness of guided imagery? a. The patient's facial expressions are stoic during the procedure. b. The patient rates pain during the dressing change as a 6 on a scale of 0 to 10. c. The patient's need for analgesic medication decreases during the dressing changes. d. The patient asks for pain medication during the dressing changes only once throughout the procedure.

c. The patient's need for analgesic medication decreases during the dressing changes. If the patient needs less pain medication during dressing changes, then guided imagery is helping to manage the patient's pain. The purpose of guided imagery is to allow the patient to alter the perception of pain. Guided imagery works in conjunction with analgesic medications, potentiating their effects. A rating of 6 on a 0 to 10 scale indicates that the patient is having moderate pain and shows that this patient is not experiencing pain relief at this time. A person who is stoic is not showing feelings, which makes it difficult to know whether or not the patient is experiencing pain. Having to ask for pain medication during the dressing changes indicates the guided imagery is not effective.

A patient who has had type 2 diabetes for 26 years is beginning to experience peripheral neuropathy in the feet and lower leg. The nurse is providing education to the patient to prevent injury to the feet by wearing shoes or slippers when walking. Which statement made by the nurse best explains the rationale for this instruction? a. "Wearing shoes blocks pain perception and helps you adapt to pain, which ends up protecting your feet." b. "Shoes provide nonpharmacological pain relief to people with diabetes and peripheral neuropathy." c. "The neurological gates open when wearing shoes, which protects your feet." d. "If you step on something without shoes, you might not feel it; this could possibly cause injury to your foot."

d. "If you step on something without shoes, you might not feel it; this could possibly cause injury to your foot." Any factor that interrupts or influences normal pain reception or perception (e.g., spinal cord injury, peripheral neuropathy, or neurological disease) affects a patient's awareness of and response to pain. The patient will no longer have protective reflexes to prevent injury to the feet. Wearing shoes prevents the patient from injuring the feet because they protect the feet. Shoes do not block pain perception, and they do not help people adapt to pain. Shoes are not a form of nonpharmacological pain relief. Wearing shoes will not have an effect on opening or closing the pain gates.

The nurse is caring for a patient who suddenly experiences chest pain. What is the nurse's first priority? a. Call the rapid response team. b. Start an intravenous (IV) line. c. Administer pain-relief medications. d. Ask the patient to rate and describe the pain.

d. Ask the patient to rate and describe the pain. The nurse's ability to establish a nursing diagnosis, plan and implement care, and evaluate the effectiveness of care depends on an accurate and timely assessment. The other responses are all interventions; the nurse cannot know which intervention is appropriate until the nurse completes the assessment.

A nurse is providing medication education to a patient who just started taking ibuprofen. Which information will the nurse include in the teaching session? a. Ibuprofen helps to depress the central nervous system to decrease pain perception. b. Ibuprofen reduces anxiety, which will help you cope with your pain. c. Ibuprofen binds with opiate receptors to reduce your pain. d. Ibuprofen inhibits the production of prostaglandins.

d. Ibuprofen inhibits the production of prostaglandins. NSAIDs like ibuprofen likely work by inhibiting the synthesis of prostaglandins to inhibit cellular responses to inflammation. Ibuprofen does not depress the central nervous system, nor does it enhance coping with pain. Opioids bind with opiate receptors to modify perceptions of pain.

A woman is in labor and refuses to receive any sort of anesthesia medication. Which alternative treatment is best for this patient? a. Transcutaneous electrical nerve stimulation (TENS) b. Herbal supplements with analgesic effects c. Pudendal block (regional anesthesia) d. Relaxation and guided imagery

d. Relaxation and guided imagery In the case of a patient in labor, relaxation with guided imagery is often an effective supplement for pain management because it provides women with a sense of control over their pain. Relaxation and guided imagery can be used during any phase of health or illness. TENS units are typically used to manage post surgical and procedural pain. Herbal supplements need to be evaluated for safety during pregnancy. Additionally, some patients consider herbal supplements to be another form of medication, and they are not typically used to control acute pain. A pudendal block is a type of regional anesthesia (injection or infusion of local anesthetics to block a group of sensory nerve fibers); use of it does not respect the patient's wishes for nonpharmacological pain control.

27. The nurse is administering pain medication for several patients. Which patient does the nurse administer medication to first? a. The patient who needs to be premedicated before walking b. The patient who has a PCA running that needs the syringe replaced c. The patient who needs to take a scheduled dose of maintenance pain medication d. The patient who is experiencing 8/10 pain and has an immediate order for pain medication

d. The patient who is experiencing 8/10 pain and has an immediate order for pain medication Immediate (STAT) medications need to be given as soon as possible. In addition, this patient is the priority because of the report of severe pain. The other patients need pain medication, but their situations are not as high a priority as that of the patient with the STAT medication order.

A nurse is assessing a patient who started to have severe pain 3 days ago. When the nurse asks the patient to describe the pain, the patient states, "The pain feels like it is in my stomach. It is a burning pain, and it spreads out in a circle around the spot where it hurts the most." Which type of pain does the nurse document the patient is having at this time? a. Superficial pain b. Idiopathic pain c. Chronic pain d. Visceral pain

d. Visceral pain Visceral pain arises from visceral organs, such as those from the gastrointestinal tract. Visceral pain is diffuse and radiates in several directions and can have a burning quality. Superficial pain has a short duration and is usually a sharp pain arising from the skin. Pain of an unknown cause is called idiopathic pain. Chronic pain lasts longer than 6 months.

A client reports taking acetaminophen (Tylenol) to control osteoarthritis. Which instruction should the nurse give the patient requiring long-term acetaminophen use? 1)Caution the patient against combining acetaminophen with alcohol. 2)Explain that acetaminophen increases the risk for bleeding. 3)Advise taking acetaminophen with meals to prevent gastric irritation. 4)Explain that physical dependence may occur with long-term oral use.

1 Even in recommended doses, acetaminophen can cause hepatotoxicity in those who consume alcohol. Therefore, the nurse should caution the patient against combining acetaminophen with alcohol. Aspirin, not acetaminophen, increases the risk for bleeding because it inhibits platelet aggregation. Nonsteroidal anti-inflammatory drugs (NSAIDs), not acetaminophen, cause gastric irritation and should be taken with meals. Opioid analgesics, not acetaminophen, can cause physical dependence.

Which action should the nurse take first when the patient has a score of -4 on the sedation rating scale? 1)Stimulate the patient. 2)Prepare to administer naloxone (Narcan). 3)Administer a dose of pain medication. 4)Notify the physician immediately.

1 If the patients score on the sedation rating scale is equal to or greater than 4, the nurse should first stimulate the patient. He should next notify the physician. The nurse should consider administering naloxone, as prescribed, if the patients respiratory rate is less than 8 breaths/minute; if respirations are shallow with marginal or falling oxygen saturation; or if the patient is unresponsive to stimulation.

The nurse plays music for a child with leukemia who is experiencing pain. Which pain management technique is this nurse using? 1)Distraction 2)Guided imagery 3)Sequential muscle relaxation 4)Hypnosis

1 Music is a form of distraction Guided imagery uses auditory and imaginary processes to help the patient to relax. In sequential muscle relaxation, the patient sits and tenses muscles for 15 seconds and then relaxes the muscles while breathing out. This relaxation technique has also been effective for relieving pain. Hypnosis involves the induction of a deeply relaxed state.

A patient with a history of mitral valve replacement, hypertension, and type 2 diabetes mellitus undergoes emergency surgery to remove an embolus in the right leg. Which factor contraindicates the use of epidural analgesia in this patient? 1)Anticoagulant therapy 2)Diabetes mellitus 3)Hypertension 4)Embolectomy

1 Patients who undergo mitral valve replacement typically require long-term anticoagulant therapy. Anticoagulant therapy is a contraindication for epidural analgesia use because of the risk for spinal hematoma and uncontrolled bleeding. Diabetes and hypertension are not contraindications for epidural analgesia. Epidural analgesia is commonly used after embolectomy because certain anesthetic agents, such as bupivacaine, help prevent vasospasm.

Which drug might the primary care provider prescribe to help facilitate pain management in a client with chronic pain? 1)Selective serotonin reuptake inhibitor 2)Selective norepinephrine reuptake inhibitor 3)Narcotic analgesic 4)Anti-emetic

1 The control of depression greatly facilitates pain management, especially for patients experiencing chronic pain. Therefore, the physician may prescribe a selective serotonin uptake inhibitor (antidepressant), such as paroxetine (Paxil), as part of the treatment plan. Selective norepinephrine reuptake inhibitors, such as Atomoxetine (Strattera), are commonly used for attention deficit-hyperactivity disorder. If a narcotic, such as oxycodone (OxyContin), is used for a long time, it may become habit forming (causing mental or physical dependence). Physical dependence may lead to withdrawal side effects when you stop taking the medicine. This is not the first-line therapy for chronic pain. An anti-emetic, such as ondansetron (Zofran), is used to control for nausea and vomiting, which can occur with some analgesic medication. However, the prescriber would more likely change the medication to something the patient tolerates better rather than order an anti-emetic to control the side effect.

When should the nurse assess pain? 1)Whenever a full set of vital signs is taken 2)During the admission interview 3)Every 4 hours for the first 2 days after surgery 4)Only when the patient complains of pain

1 The nurse should assess pain whenever a full set of vital signs is checked. Moreover, the nurse should assess pain on admission of a patient to the facility, even when pain is not the chief complaint. Patients may have chronic pain that has no association with their reason for seeking care. Pain should be assessed more frequently than every 4 hours in the immediate postoperative period. Pain should be reassessed after any treatment is given to evaluate effectiveness of the treatment. Some patients may not complain of pain unless they are specifically asked whether they are in pain. Pain rating scales help to quantify the intensity of pain for the nurse providing analgesia.

A patient is prescribed morphine sulfate 4 mg intravenously for postoperative pain. Which action should the nurse take before administering the medication? 1)Monitor the patient's respiratory status. 2)Auscultate the patient's heart sounds. 3)Check blood pressure in supine and sitting positions. 4)Monitor the patient for psychological drug dependence.

1 The nurse should assess the patients respiratory status and level of alertness before administering the medication because respiratory depression can be a life-threatening effect. It is not necessary to auscultate heart sounds or to check blood pressure while the patient lies down (supine position) and sits up. Psychological dependence occurs rarely even after long-term prescribed use of morphine. Therefore, it is not necessary to routinely monitor a patient who is receiving morphine for acute postoperative pain for psychological drug dependence.

What is typically the most reliable indicator of pain? 1)Patient's self-report 2)Past medical history 3)Description by caregiver(s) 4)Behavioral cues

1 The patients self-report is the most reliable indicator of pain. A patients facial expression, vocalization, posture or position, or other behaviors do not always accurately indicate the intensity or quality of a patients experience of pain. The patient might be trying to hide signs of pain in order to be brave or strong. Sociocultural factors can influence a patients nonverbal expression of pain. Caregivers might not appreciate the extent of pain because pain is an individualized experience. Perception of pain might be heightened if other medical conditions coexist, although this perception is also influenced by other factors, such as past experience with pain and the success or failure of the treatment to produce relief. Emotions, cognitive impairment, developmental stage, communication skills, and mental health disorders, such as depression or anxiety, can influence the perception of pain.

The nurse is assessing an intubated patient who returned from coronary artery bypass surgery 3 hours ago. Which assessment finding might indicate that this patient is experiencing pain? 1)Blood pressure 160/82 mm Hg 2)Temperature 100.6°F 3)Heart rate 80 beats/min 4)Oxygen saturation 95%

1 This patient has an elevation in blood pressure which is a physiological finding associated with pain. The patient has a mild temperature elevation, which is a common response to surgery. Heart rate and oxygen saturation are within normal limits.

A patient develops a respiratory rate of 6 breaths/minute after receiving IV hydromorphone (Dilaudid) 2 mg. Which medication should the nurse anticipate administering to this patient after notifying the prescriber of this side effect? 1)Physostigmine (Antilirium) 2)Flumazenil (Romazicon) 3)Naloxone (Narcan) 4)Protamine sulfate

3 The nurse should anticipate administering naloxone to reverse the respiratory depression associated with opioid use. Flumazenil reverses the central nervous system depressant effects of benzodiazepines. Physostigmine reverses the effects of anticholinergic drugs. Protamine sulfate is the antidote for heparin.

The nurse is teaching a client who sustained an ankle injury about cold application. Which instruction should the nurse include in the teaching plan? 1)Place the cold pack directly on the skin over the ankle. 2)Apply the cold pack to the ankle for 30 minutes at a time. 3)Check the skin frequently for extreme redness. 4)Keep the cold pack in place for at least 24 hours.

3 The nurse should instruct the patient to cover the cold pack with a washcloth, towel, or fitted sheet before applying it to the ankle to prevent tissue damage. A cold pack should be applied intermittently for the first 24 hours, leaving it in place for no longer than 15 minutes at a time. The patient should check the skin frequently and discontinue the treatment immediately if redness or other signs of tissue irritation occur.

The nurse uses his hands to direct energy fields surrounding the patient's body. After this intervention, the patient states that his pain has lessened. How should the nurse document the intervention? 1)Tactile distraction was performed and appeared effective in reducing pain. 2)Guided imagery was effective to relax the patient and reduce the pain. 3)Therapeutic touch was performed; patient verbalized lessening of pain after treatment. 4)Sequential muscle relaxation was performed; patient states pain is less.

3 Therapeutic touch focuses on the use of hands to direct energy fields surrounding the body. The nurse should document use of therapeutic touch and its effectiveness in the progress notes after performing the procedure. Tactile distraction involves activities such as massage, hugging a favorite toy, holding a loved one, or stroking a pet. Guided imagery uses auditory and imaginary processes to help the patient to relax. In sequential muscle relaxation, the patient sits and tenses muscles for 15 seconds and then relaxes the muscle while breathing out. This relaxation technique is often effective for relieving pain.

4. A patient who sustained a leg laceration in an industrial accident is brought to the emergency department. The area around the laceration is red, swollen, and tender. Which substance is responsible for causing this response? 1)Histamine 2)Prostaglandin 3)Bradykinin 4)Serotonin

3 Tissue damage causes the release of the substances histamine, bradykinin, and prostaglandin. Bradykinin triggers the release of inflammatory chemicals that cause the injured area to become red, swollen, and tender.

The nurse is caring for a patient who is recovering from thoracotomy surgery and notes that the patient's pain is rated 9/10 and is unable to focus on anything. Which intervention by the nurse is the highest priority? a. Administer prescribed IV pain medication and evaluate impact in 30 minutes. b. Ask the patient to describe prior pain experiences and methods used to manage pain. c. Explain that comfort is a priority goal of nursing care in the postoperative period. d. Assist the patient to minimize the effects of pain on interpersonal relationships with family members.

ANS: A A The highest priority intervention for a patient in acute pain is to provide pain relief. The other interventions do not address acute pain relief.

The nurse knows which is the best pain medication option for a patient to manage severe long-term cancer pain at home? a. Fentanyl (Duragesic) 50 mcg transdermal patch q 72 hours b. Meperidine (Demerol) 50 mg IM q 6 hours c. Hydromorphone (Dilaudid) 0.2 mg q 10 minutes IV via PCA pump d. Hydromorphone (Dilaudid) 0.08 mg/hour infusion through epidural catheter

ANS: A An opioid transdermal patch is the best pain management option for home use with patients who have long-term, severe cancer pain as no injections are required and the opioid is slowly released. Epidurals and PCA pumps are intended for hospital use.

The nurse is caring for a cancer patient with ongoing pain from widespread metastasis to the bones. The nurse notes that the patient's morphine dosage had to be increased to sufficiently manage the discomfort. What is the nurse's interpretation of this assessment finding? a. The patient became tolerant to the previous morphine dosage. b. The patient is becoming addicted to the pain medication. c. The patient has been abusing the prescribed pain medications. d. The patient may be seeking to end life with an overdose of morphine.

ANS: A Drug tolerance is an adaptation to the medication, which eventually leads to less effective pain relief. The patient is requiring higher doses of narcotic pain medication because of this tolerance. This is common when patients require long-term pain medication. Since the patient is taking morphine to control ongoing pain, the patient is not addicted to it. Need for increased morphine dosage is not indicative of drug abuse or a wish to die.

The nurse is caring for a patient who will be using a hydromorphone (Dilaudid) PCA analgesia pump following surgery. Which intervention is the highest priority for the nurse to include in the patient's care plan related to this pump? a. Assess the patient's respiratory status frequently after PCA pump started. b. Review patient's medication profile to check for interactions with hydromorphone. c. Teach the patient how to use PCA pump when the pain level is still tolerable. d. Keep naloxone (Narcan) available at the bedside in case of respiratory depression.

ANS: A For patient safety, the nurse would check the patient's respirations frequently after the pump has been initiated due to possible respiratory depression. Reviewing the medication profile would occur prior to initiating the pump. Teaching the patient how to use the pump is important, but not the priority. Naloxone should be close by to treat respiratory depression but monitoring the respirations frequently would hopefully prevent depression.

The nurse is caring for a patient who has been taking ibuprofen (Motrin) 800 mg TID for the last several months to relieve knee pain from arthritis. Which assessment finding must be reported by the nurse to the provider promptly? a. The patient has abdominal pain and pale skin. b. The patient has constipation and takes stool softeners daily. c. The patient enjoys a glass of wine every Friday and Saturday evening. d. The patient has gained 15 lb in the last 3 months.

ANS: A Ibuprofen (Motrin) is an NSAID and NSAIDs have significant side effects, including possible gastrointestinal upset and bleeding and cardiac and renal complications. Abdominal pain with pale skin in this patient may be indicative of a bleeding ulcer and should be reported to the provider promptly

Which assessment question helps the nurse determine the character of the patient's pain? a. "What does the pain feel like?" b. "When did the pain first start?" c. "What interventions make the pain better?" d. "Is there any pattern to when the pain occurs?"

ANS: A Pain character should be assessed using questions to learn more about what the pain feels like. Examples like stabbing, aching, burning may be used so that patients can understand what the nurse is requesting. Onset is determined by asking when the pain started. Exacerbating/relieving factors are determined by asking which interventions make the pain worse or better. Time course is determined by asking if there is a pattern to when the pain occurs.

The nurse is caring for a patient who just underwent laparoscopic appendectomy. The patient complains of severe postoperative pain between the shoulder blades. Which term best describes the pain that this patient is having? a. Referred pain b. Phantom pain c. Neuropathic pain d. Psychogenic pain

ANS: A Referred pain is pain that occurs when discomfort is felt in a different area than the source of the pain. Phantom pain occurs in amputees when pain is felt in the missing limb. Neuropathic pain occurs in the nervous system and often feels like burning or tingling. Psychogenic pain is discomfort felt by the patient that has no physical cause.

The nurse administered 100 mcg sublingual fentanyl spray (Subsys) at 10:00 a.m. to a patient experiencing severe breakthrough pain. At what time will the nurse ask the patient if pain relief was obtained? a. 10:30 a.m. b. 11:00 a.m. c. 11:30 a.m. d. 12:00 noon

ANS: A Sublingual pain medications should be working well 15 to 30 minutes after administration, so the nurse should reassess the patient's pain at 10:30 a.m.

The nurse is caring for a patient who only speaks a foreign language. What is the best method for the nurse to assess the patient's pain level? a. Perform a pain assessment using a translator. b. Check the patient's vital signs and pulse oximetry. c. Check the patient's respiratory rate, depth, and rhythm. d. Look to see if the patient appears to be resting comfortably.

ANS: A The best method to determine pain in a patient who speaks only a foreign language is to use an interpreter. Noncognitive pain assessment tools such as the Wong-Baker FACES Pain Rating Scale may be used to assess pain levels.

What is the priority nursing assessment for a patient who is receiving postoperative epidural analgesia with hydromorphone (Dilaudid)? a. Respiratory rate, depth, and pattern b. Skin underneath the epidural dressing c. Bladder scanning to check for urinary retention d. Itching on the trunk and/or extremities

ANS: A The respiratory system is the priority nursing assessment for patients receiving narcotic pain medication via any route. This is because narcotics can cause respiratory suppression. The other assessments are a lower priority and may be done after a respiratory assessment is completed.

The nurse is caring for a patient who has pain following abdominal surgery. Which actions are independent nursing interventions that can be used to make the patient more comfortable? (Select all that apply.) a. Encourage the patient to relax and imagine resting on a tropical beach. b. Provide headphones so that the patient can listen to favorite music. c. Increase pain medication dosage if prescribed regimen is ineffective to manage pain. d. Teach the patient to take pain medication before discomfort becomes severe. e. Switch the patient from IV to oral pain medication when bowel sounds return. f. Demonstrate the use of relaxation breathing before painful procedures.

ANS: A, B, D, F Independent nursing interventions may be carried out without an order from the provider. Changing medication orders must be done by the provider; increasing pain medication dosage and switching the patient to PO pain medications are not independent nursing interventions.

The nurse is caring for a patient who just had knee replacement surgery. Which factors will affect how the patient experiences pain after this surgery? (Select all that apply.) a. The patient has had rheumatoid arthritis for the last 16 years. b. The patient is allergic to aspirin and strawberries. c. The patient owns a business and is self-insured. d. The patient has been a vegetarian for the last 8 years. e. The patient had the other knee replaced 2 years ago. f. The patient was a marathon runner in high school and college.

ANS: A, E, F Through their life experiences, individuals learn to concept of pain. Current pain is influenced by an individual's previous experiences with pain. Having had an injury or surgery previously, a patient has a preconceived idea about what the pain will feel like and what methods are effective for pain relief. The patient's history of rheumatoid arthritis, previous knee replacement surgery, and marathon running indicate that the patient has had significant experience dealing with pain, which will affect how he or she experiences pain after this surgery.

The nurse is caring for a patient recovering from knee replacement surgery. The patient complains of severe pain in the knee after receiving hydrocodone with acetaminophen (Vicodin) 2 hours previously. What is the nurse's best action? a. Administer another dose of the medication. b. Apply ice packs to the knee. c. Apply heat packs to the knee. d. Perform gentle range of motion

ANS: B Application of cold decreases swelling and pain, produces local analgesia, and slows nerve conduction, which improves functioning. Examples of cold therapy are ice bags and cold compresses. The nurse should not administer another dose of medication without an order from the provider. Heat will increase blood flow to the area rather than reduce swelling. Gentle ROM will increase pain if done at this time.

The nurse is caring for a trauma patient with the nursing diagnosis of acute pain r/t fracture and muscle spasms. Which is an appropriate goal for this Nursing diagnosis? a. The patient will experience less pain when participating in physical therapy. b. The patient will describe meditation techniques that can be used to cope with pain. c. Nursing staff will explain the ordered pain management approach to the patient. d. The patient will feel less pain each day when range-of-motion therapy is performed.

ANS: B Goals must be measurable and objective so that nursing staff can determine when each of the goals has been met. Having the patient describe meditation techniques is measurable because the nursing staff can determine whether he can actually describe them. The nursing staff cannot accurately measure whether the patient is experiencing or feeling less pain. The goal statements "The patient will report less pain ... or state that he has less pain ..." are not measurable and appropriate.

The nurse is caring for a patient who has a PCA pump following total hysterectomy surgery. The nurse sees the visitor push the PCA button while the patient is sleeping quietly. What is the best response of the nurse? a. "Thank you for pushing the button for her to help keep her comfortable after surgery." b. "Please do not push the button for the patient—she could receive more medication than she needs." c. "You can push the button for her now, but please have her do it herself when she awakens." d. "PCA pumps are great because she doesn't have to wait for me to administer her pain medication."

ANS: B PCA by proxy is unauthorized activation of the PCA pump by someone other than the patient. The nurse needs to ensure that only the patient operates the PCA pump. Family members should never activate the pump for the patient because too much medication could be delivered, resulting in overdose and respiratory suppression.

The nurse identifies which patient to be best suited for PCA analgesia? a. A patient who is confused after a head injury. b. A patient recovering from total hysterectomy surgery. c. A patient who has severe psychogenic pain. d. A patient with arthritis who is unable to push the nurse call button

ANS: B Patients recuperating from surgery are often good candidates for PCA analgesia. Confusion, inability to push the PCA button, and psychogenic pain are all contraindications for PCA analgesia.

The nurse is caring for a patient who has severe burning pain in the right arm caused by a compressed nerve in the neck. Which medications can be used along with a narcotic pain reliever to relieve the patient's pain until surgery can be performed to release the nerve? (Select all that apply.) a. Diphenhydramine (Benadryl) 50 mg PO daily b. Amitriptyline (Elavil) 50 mg PO BID c. Ondansetron (Zofran) 8 mg PO q 4 hours PRN d. Gabapentin (Neurontin) 400 mg PO BID e. Senna (Senokot) 8.6 mg PO daily f. Naloxone (Narcan) 0.4 mg IV now, may repeat in 1 hour PRN

ANS: B, D Tricyclic antidepressants like amitriptyline and anticonvulsants like gabapentin are often used to treat neuropathic pain because they work directly on the nervous system. They may be given along with narcotic pain medication to make the patient comfortable. Senna will relieve constipation and diphenhydramine will relieve itching. Ondansetron is used to relieve nausea and vomiting, whereas naloxone will reverse narcotic-induced respiratory suppression.

The nurse is caring for a 6-month-old infant who has just undergone surgery. The infant's facial muscles are tight with a furrowed brow and the infant's respirations are shallow and irregular. The infant is mildly fussy and softly crying without muscular rigidity in the arms and legs. What score will the nurse give to the infant on the Neonatal Infant Pain Scale? a. 2 b. 3 c. 4 d. 5

ANS: C Tight muscles and furrowed brow = 1 point. Softly crying = 1 point. Shallow, irregular respirations = 1 point. Relaxed arms and legs = 0 points. Mild fussiness = 1 point. Total = 4 points

The nurse is caring for a diabetic patient who has painful foot neuropathy. The patient asks why the nurse is administering gabapentin (Neurontin) when there is no history of seizure disorder. What is the nurse's best response? a. "Gabapentin will help you sleep at night so you can deal with the pain more effectively." b. "Long-term diabetes can put patients at risk for certain type of seizures." c. "This medication can help relieve your anxiety from being admitted to the hospital." d. "Gabapentin works on the nervous system to help relieve the burning pain in your feet."

ANS: D Anticonvulsant medication like gabapentin and tricyclic antidepressants are often used to relieve neuropathic pain as they work directly on the nervous system. The other statements do not correctly indicate why the patient is receiving this medication.

The nurse is caring for a patient with rheumatoid arthritis who is in constant severe pain. Which nursing diagnosis is the highest priority for this patient? a. Impaired mobility r/t patient's need to use a cane or walker with ambulation. b. Impaired health maintenance r/t sedentary lifestyle and poor physical condition. c. Anxiety r/t mistrust of health care personnel. d. Chronic pain r/t ongoing inflammatory tissue damage and joint destruction

ANS: D Chronic pain is the highest priority diagnosis for this patient because it is severe. The other diagnoses may be addressed once the patient's pain is controlled.

A nurse teaches the patient about the gate control theory. Which statement made by a patient reflects a correct understanding about the relationship between the gate control theory of pain and the use of meditation to relieve pain? a. "Meditation controls pain by blocking pain impulses from coming through the gate." b. "Meditation alters the chemical composition of pain neuroregulators, which closes the gate." c. "Meditation will help me sleep through the pain because it opens the gate." d. "Meditation stops the occurrence of pain stimuli."

a. "Meditation controls pain by blocking pain impulses from coming through the gate." According to this theory, gating mechanisms located along the central nervous system regulate or block pain impulses. Pain impulses pass through when a gate is open and are blocked when a gate is closed. Nonpharmacologic pain-relief measures, such as meditation, work by closing the gates, which keeps pain impulses from coming through. Meditation does not open pain gates or stop pain from occurring. Meditation also does not have an effect on pain neuroregulators.

The nurse is teaching a student nurse about pain assessment scales. Which statement by the student indicates effective teaching? a. "You cannot use a pain scale to compare the pain of my patient with the pain of your patient." b. "When patients say they don't need pain medication, they aren't in pain." c. "A patient's behavior is more reliable than the patient's report of pain." d. "Pain assessment scales determine the quality of a patient's pain."

a. "You cannot use a pain scale to compare the pain of my patient with the pain of your patient." Do not use a pain scale to compare the pain of one patient to that of another. Pain is subjective and cannot be compared to the pain of another patient. Some patients do not express their pain (stoic) or do not wish to take medications to relieve the pain. This does not mean they aren't in pain. A patient's behavior is not more reliable than the patient's report of pain. Pain scales help determine severity or intensity, not quality.

A nurse is providing discharge teaching for a patient with a fractured humerus. The patient is going home with hydrocodone. Which important patient education does the nurse provide? a. "You need to drink plenty of fluids and eat a diet high in fiber." b. "Narcotics can be addictive, so do not take them unless you are in severe pain." c. "Be sure to eat a meal high in fat before taking the medication, to avoid a stomach ulcer." d. "As your pain severity lessens, you will begin to give yourself once-daily intramuscular injections."

a. "You need to drink plenty of fluids and eat a diet high in fiber." A common side effect of opioid analgesics is constipation. Therefore, the nurse encourages the patient to drink fluids and eat fiber to prevent constipation. Although medications can be irritating to the stomach, eating a diet high in fat does not prevent gastric ulcers. To best manage pain, the patient needs to take pain medication before painful procedures or activities or before pain becomes severe. As the patient's pain gets better, the strength of the medications will decrease. IM, IV, and topical analgesics are used for more severe and chronic pain.

The nurse is caring for a group of patients. Which task may the nurse delegate to the nursing assistive personnel (NAP)? a. Administer a back massage to a patient with pain. b. Assessment of pain for a patient reporting abdominal pain. c. Administer patient-controlled analgesia for a postoperative patient. d. Assessment of vital signs in a patient receiving epidural analgesia.

a. Administer a back massage to a patient with pain. A massage may be delegated to an NAP. Pain assessment is a nursing function and cannot be delegated to an NAP. Administration of patient-controlled analgesia (PCA) cannot be delegated to an NAP. Assessment of vital signs is a licensed nursing function; the NAP can take vital signs for a patient receiving epidural analgesia.

A nurse is caring for a patient with chronic pain from arthritis. Which action is best for the nurse to take? a. Give pain medications around the clock. b. Administer pain medication before any activity. c. Give pain medication after the pain is a 7/10 on the pain scale. d. Administer pain medication only when nonpharmacological measures have failed.

a. Give pain medications around the clock. When a patient with arthritis has chronic pain, the best way to manage pain is to take medication regularly throughout the day to maintain constant pain relief. "Before any activity" is nonspecific, and the medication may not have time to work before activity. If the patient waits until having pain (7/10) to take the medication, pain relief takes longer. Nonpharmacological measures are used in conjunction with medications unless requested otherwise by the patient.

The nurse is administering ibuprofen (Advil) to an older patient. Which assessment data causes the nurse to hold the medication? (Select all that apply.) a. Patient states allergy to aspirin. b. Patient states joint pain is 2/10 and intermittent. c. Patient reports past medical history of gastric ulcer. d. Patient reports last bowel movement was 4 days ago. e. Patient experiences respiratory depression after administration of an opioid medication.

a. Patient states allergy to aspirin. c. Patient reports past medical history of gastric ulcer. NSAIDs can cause bleeding, especially in the gastrointestinal (GI) tract; therefore, NSAIDs are most likely contraindicated in this patient. Patients with an allergy to aspirin or have asthma are sometimes also allergic to other NSAIDs. The nurse needs to verify that the health care provider is aware of the history of GI bleeding and of allergy to aspirin before administering ibuprofen. NSAIDs do not interfere with bowel function and are used for the treatment of mild to moderate acute intermittent pain. NSAIDs also do not suppress the central nervous system by causing respiratory depression.

The nurse is assessing a patient for opioid tolerance. Which finding supports the nurse's assessment? a. The patient needed a substantial dose of naloxone (Narcan). b. The patient needs increasingly higher doses of opioid to control pain. c. The patient no longer experiences sedation from the usual dose of opioid. d. The patient asks for pain medication close to the time it is due around the clock.

b. The patient needs increasingly higher doses of opioid to control pain. Opioid tolerance occurs when a patient needs higher doses of an opioid to control pain. Naloxone (Narcan) is an opioid antagonist that is given to reverse the effects of opioid overdose. Taking pain medications regularly around the clock is an effective way to control pain. The pain medication for this patient is most likely effectively managing the patient's pain because the patient is not asking for the medication before it is due. A patient no longer experiencing a side effect (sedation) of an opioid does not indicate opioid tolerance.

A nurse is caring for a patient who is experiencing pain following abdominal surgery. Which information is important for the nurse to share with the patient when providing patient education about effective pain management? a. "To prevent overdose, you need to wait to ask for pain medication until you begin to experience pain." b. "You should take your medication after you walk to make sure you do not fall while you are walking." c. "We should work together to create a schedule to provide regular dosing of medication." d. "When you experience severe pain, you will need to take oral pain medications."

c. "We should work together to create a schedule to provide regular dosing of medication." One way to maximize pain relief while potentially decreasing opioid use is to administer analgesics around the clock (ATC) rather than on a prn basis. This approach ensures a more constant therapeutic blood level of an analgesic. Working with the patient to design a schedule allows the patient to be a full partner in the care provided. The nurse should not wait until pain is experienced because it takes medications 10-30 minutes to begin to relieve pain. The nurse administers pain medications before painful activities, such as walking, and administers intravenous medications when a patient is having severe pain.

The nurse has brought a patient the scheduled pain medication. The patient asks the nurse to wait to give pain medication until the time for the dressing change, which is 2 hours away. Which response by the nurse is most therapeutic? a. "This medication will still be providing you relief at the time of your dressing change." b. "OK, swallow this pain pill, and I will return in a minute to change your dressing." c. "Would you like medication to be given for dressing changes in addition to your regularly scheduled medication?" d. "Your medication is scheduled for this time, and I can't adjust the time for you. I'm sorry, but you must take the pill right now."

c. "Would you like medication to be given for dressing changes in addition to your regularly scheduled medication?" Additional doses of medication can be given to patients in certain circumstances, as with an extensive dressing change, when the health care provider is notified that more medication is needed. It is the nurse's responsibility to communicate with the provider and with the patient about a pain- control plan that works for both. By asking to hold off on the dose, the patient is indicating that the dressing changes are extremely painful. The regularly scheduled dose might not be as effective for the patient 2 hours later when the dressing change is scheduled. Oral medications take 30 to 60 minutes to take effect. If the nurse began the dressing change right then, the medication would not have been absorbed yet. The patient has the right to refuse to take a medication.

.A nurse receives an order from a health care provider to administer hydrocodone and acetaminophen (Vicodin ES 7.5/750), to a patient who is experiencing 8/10 postsurgical pain. The order is to give 2 tablets every 6 hours by mouth as needed for pain. What is the nurse's next best action? a. Give the Vicodin ES to the patient immediately because the patient is experiencing severe pain. b. Ask the health care provider for a nonsteroidal anti-inflammatory drug (NSAID) order. c. Ask the health care provider to verify the dosage and frequency of the medication. d. Give the Vicodin ES in addition to playing soothing music for the patient.

c. Ask the health care provider to verify the dosage and frequency of the medication. The maximum 24-hour dosage for acetaminophen is 4 grams. If the patient took 2 tablets of Vicodin ES every 6 hours, the patient would take in 6 grams of acetaminophen in 24 hours (2 tablets = 750 + 750 = 1500 4 [could have 4 doses in 24 hours every 6 hours] = 6000 mg = 6 g). This exceeds the safe dosage of acetaminophen, so the best action is to question this order. Giving the medication as ordered would possibly result in the patient's taking more acetaminophen than is considered a safe dose. Acetaminophen overdose can result in liver failure. NSAIDs are used to treat mild to moderate pain. At this moment, the patient is experiencing severe pain. Implementing music therapy is a nursing intervention and is an independent nursing action that can be instituted with painmedication, but the possible acetaminophen dose is the priority.