Pain

A nurse is creating a plan of care for range-of-motion exercises for a client with rheumatoid arthritis who has severe pain and swelling of the joints in both hands. What should the plan include?

Applying heat or cold before the exercises

An obese client had an adjustable gastric banding procedure performed to reduce weight. At a follow-up visit the client reports episodes of abdominal pain and vomiting after eating. What should the nurse encourage the client to do?

Chew food thoroughly before swallowing.

A client who had a prostatectomy complains of painful bladder spasms. To limit the spasms the nurse should:

Encourage the client to avoid contracting muscles as if the client were voiding

The nurse is caring for a client with deep partial-thickness burns who is receiving a low dosage of an opioid for pain management. The preferred mode of medication administration for this client is:

Intravenous

On the third postoperative day after a subtotal gastrectomy, a client complains of severe abdominal pain. The nurse palpates the client's abdomen and identifies rigidity. What action should the nurse take?

Obtain the client's vital signs

An expectant couple asks the nurse about the cause of low back pain during labor. The nurse replies that this pain occurs most often when the fetus is positioned:

Occiput posterior

A client is brought to the emergency department with moderate substernal chest pain radiating to the inner aspect of the left arm, unrelieved by rest and nitroglycerin. The pain is associated with slight nausea and anxiety. What is the priority nursing intervention for this client?

Provide pain medication

A client in a hospice home care program is experiencing severe pain. Morphine (MS Contin) has been prescribed for pain management. Which information should the nurse plan to explain to the client in preparation for this pain management regimen?

Dosages of the drug will be given automatically at regular intervals around the clock

An older client experiences urinary frequency and nocturia. While ambulating, the client develops severe back pain and is found to have a vertebral compression fracture. The nurse recalls that this type of fracture is described as:

Collapse of vertebral bodies

A client is admitted after incurring electrical burns to both hands while playing golf during a lightning storm. When assessing the entrance and exit wounds, the nurse considers that electrical injury:

Causes severe nervous tissue destruction along a path of least resistance

A client who has been breastfeeding her newborn every 3 hours experiences sore nipples. What should the nurse teach her about easing nipple soreness?

Change the baby's breastfeeding position for each feeding.

A client with a urinary retention catheter reports discomfort in the bladder and urethra. What should the nurse do first?

Check the patency of the catheter.

A client with a history of food intolerance has abdominal pain, abdominal distention, and a feeling of fullness. The client is admitted to the hospital for diagnostic testing. What specific information should the nurse collect when performing the nursing admission history and physical?

Detailed characteristics of the pain

A client who had abdominal surgery is receiving patient-controlled analgesia (PCA) intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is experiencing pain still. What should the nurse do first ?

Determine the integrity of the intravenous delivery system.

A client complains of foot pain and is diagnosed with arterial insufficiency. The nurse provides teaching about what the client can do to increase arterial dilation and to decrease foot pain. The nurse concludes that further teaching is needed when the client states, "I will:

Elevate my foot

A client who has been experiencing chest pain and vomiting for several hours is admitted to the hospital with a diagnosis of myocardial infarction. The client is transferred immediately to the cardiac intensive care unit. The client's potassium level is below the expected range. Considering the laboratory result, the nurse should monitor the client's electrocardiogram (ECG) for:

Elevated U and flattened T waves

On the third postpartum day after a cesarean birth a client tells the nurse that her breasts feel warm, firm, and tender. The skin is shiny and taut. What does the nurse suspect as the cause of the client's breast discomfort?

Extended vascular and lymphatic circulation in the breasts

A hospice client who has severe pain asks for another dose of oxycodone (OxyContin). The nurse's primary consideration when responding to the client's request is to:

Help reduce the client's pain immediately

How can a nurse best soothe a hospitalized infant who appears to be in pain?

Holding the infant

A nurse is assessing clients on the postpartum unit for pain. The client who will have more severe afterbirth pains is one who:

Is a grand multipara

A client who had a laparoscopic cholecystectomy reports pain in the shoulder. In what position should the nurse place the client?

Left Sims

A client receiving morphine is being monitored by the nurse for signs and symptoms of overdose. Which clinical findings support a conclusion of overdose? Select all that apply .

Lethargy Bradycardia Slow respirations

A client comes to the fertility clinic for a hysterosalpingography using radiopaque contrast material to determine whether her fallopian tubes are patent. When preparing for the test, the nurse explains to the client that she:

May have some persistent shoulder pain for 14 hours after the test

After a lateral crushing chest injury, obvious right-sided paradoxical motion of a client's chest demonstrates multiple rib fractures, resulting in a flail chest. For which complication, associated with this injury, should the nurse assess this client?

Mediastinal shift

A client arrives in the emergency department with complaints of epigastric pain and prolonged vomiting. Assessment findings include rapid and shallow respirations, dry and flushed skin, weakness, and lethargy. Based on the client's database, the primary nursing concern is:

Metabolic alkalosis

The nurse is caring for an Asian client who had a laparoscopic cholecystectomy six hours ago. When asked whether there is pain, the client smiles and says, "No." What should the nurse do?

Monitor for nonverbal cues of pain.

A client returns to the surgical unit after a liver biopsy. The nurse identifies a moderately large amount of bile-colored drainage on the dressing. The client also complains of right upper quadrant pain. The nurse should:

Notify the primary health care provider of the client's status immediately

A client is suspected of having a gastric peptic ulcer. When obtaining a history from this client, the nurse expects the reported pain to have what characteristics?

Occurs one to three hours after meals

What should the nurse monitor to evaluate the effectiveness of carbamazepine (Tegretol) in the management of a client's trigeminal neuralgia?

Pain intensity

What are the desired outcomes that the nurse expects when administering a nonsteroidal antiinflammatory drug (NSAID)? Select all that apply.

Pain relief Antipyresis Reduced inflammation

A client with rheumatoid arthritis is in the convalescent stage of an exacerbation. The client states, "The only time I am without pain is when I lie perfectly still." Considering the client's statement, the nurse should encourage the client to:

Participate in active joint flexion and extension exercises

The mother of a 5-year-old child recovering from varicella (chickenpox) calls the nurse in the pediatric clinic, asking how the child's itching can be relieved. What is the best response by the nurse?

Pat the lesions while applying the prescribed calamine lotion.

A client admitted to the hospital for chest pain is diagnosed with angina. The nurse should teach the client that the most common characteristic of anginal pain is that it is:

Relieved by rest

Morphine via an epidural catheter is prescribed for a client after abdominal surgery. The client asks the nurse why this medicine is necessary. What primary rationale does the nurse give for the administration of an opioid analgesic after abdominal surgery?

Relieves abdominal pain

A 12-year-old child with sickle cell anemia is admitted during a vaso-occlusive crisis. What is the priority of care for this child?

Relieving pain

A client had a cesarean birth 4 hours ago. What is the major nursing intervention at this time?

Relieving postoperative pain

A client is shot in the chest during a holdup and is transported to the hospital via ambulance. In the emergency department chest tubes are inserted, one in the second intercostal space and one at the base of the lung. What does the nurse expect the tube in the second intercostal space to accomplish?

Remove the air that is present in the intrapleural space

After orthopedic surgery a 15-year-old adolescent reports pain and rates it a 5 on a scale of 0 to 10. A nurse administers the prescribed 5 mg of oxycodone every 3 hours as needed. Two hours after having been given this medication, the adolescent reports pain and rates it a 10 of 10. What action should the nurse take next?

Request that the health care provider evaluate the need for additional medication.

One month after abdominal surgery a client is readmitted to the hospital with recurrent abdominal pain and fever. The medical diagnosis is fistula formation with peritonitis. The nurse should maintain the client in what position?

Semi-Fowler

A client is admitted for repair of bilateral inguinal hernias. Before surgery the nurse assesses the client for signs that strangulation of the intestine may have occurred. What is an early sign of strangulation?

Sharp abdominal pain

A 14-year-old girl in whom scoliosis has been diagnosed undergoes spinal fusion. On the first postoperative day her face is red, she is rigid, and she is crying because she is in pain. She has prescriptions for morphine sulfate for severe pain and an acetaminophen-codeine compound for moderate pain. What information should influence the nurse's choice of analgesic?

Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic.

During administration of an enema, a client reports having intestinal cramps. What should the nurse do?

Stop the fluid until the cramps subside

After a subtotal gastrectomy, a client begins to eat more food in varied forms. After meals the client experiences a cramping discomfort and a rapid pulse with waves of weakness, which often are followed by nausea and vomiting. The nurse concludes that the client is experiencing dumping syndrome, which is caused by:

Sudden passage of a hyperosmolar food solution into the small intestine

What position should a nurse teach a client to avoid when the client is experiencing back pain during labor?

Supine

A nurse is teaching a childbirth preparation class about the discomfort of labor. What is the greatest influence on the perception of pain for a woman in labor?

Tension of the client

A client who has a long leg cast for a fractured bone is to be discharged from the emergency department. When discussing pain management, the nurse should advise the client to take the prescribed as needed oxycodone and acetaminophen (Percocet):

When the discomfort begins

A client with arthritis states that the prescribed aspirin (ASA) causes stomach irritation even when taken with food. The nurse should instruct the client to take the aspirin:

With a full glass of water

While receiving an adrenergic beta 2 agonist drug for asthma, the client complains of palpitations, chest pain, and a throbbing headache. What is the most appropriate nursing action?

Withhold the drug until additional prescriptions are obtained.

A nurse is teaching an older adult client about managing chronic pain with acetaminophen (Tylenol). Which client statement indicates that the teaching is effective?

"I have to be careful about which over-the-counter cold preparations I take when I have a cold."

The nurse is providing preoperative teaching to a client that is scheduled for an electromyography of the leg. What should the nurse include in the education?

A needle will be inserted into the muscle being tested

A client receives a prescription for nitroglycerin (Nitrostat) sublingual as needed for anginal pain. What should the nurse include in the teaching about this medication?

Place the tablet under the tongue or between the cheek and gum

A nurse is planning care for a client admitted to the hospital with abdominal spasms and pain associated with severe diarrhea. What primary serum blood level should the nurse monitor?

Potassium

What should the nurse identify as the primary cause of the pain experienced by a client with a coronary occlusion?

Heart muscle ischemia

A client undergoes a cesarean birth because of cephalopelvic disproportion. What care is needed for this client in addition to the routine nursing care given to all postpartum clients during the first 24 hours?

Administering the prescribed pain medication

The nurse assesses for which major complication in a client that has had a gastroscopy?

Abdominal distention with pain

A nurse is caring for an older adult who is taking acetaminophen (Tylenol) for the relief of chronic pain. Which substance is most important for the nurse to determine if the client is taking because it intensifies the most serious adverse effect of acetaminophen?

Alcohol

A nurse explains to a client with trigeminal neuralgia that a treatment that is effective on a temporary (6 to 18 months) basis is:

An alcohol injection of the peripheral branch of the fifth cranial nerve

A client comes to the ambulatory surgery unit on the morning of an elective surgical procedure. The client reports shortness of breath, dizziness, and palpitations. The nurse observes profuse diaphoresis and is concerned that the client may be having either a panic attack or a myocardial infarction. Which assessments support the conclusion that the client may be experiencing a myocardial infarction? Select all that apply .

Anxiety Chest pain Irregular pulse

After head and neck surgery for cancer, the client reports that the neck dressing is tight. What action should the nurse take?

Assess for signs of constriction

A client newly diagnosed with rheumatoid arthritis is admitted to the hospital with bilateral painful knee and wrist joints. The nurse identifies impaired physical mobility related to painful, swollen joints. What should the nurse teach the client to do during the acute phase of the disease?

Avoid exercises to the involved joints

The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. The nurse concludes that the teaching is understood when the client states, "I should:

Avoid using a sleeping mask at night."

Which nursing action is specific to the plan of care for a client with trigeminal neuralgia?

Be alert to prevent dehydration or starvation.

A client who is admitted for surgery for a ruptured tubal pregnancy tells the nurse that she has shoulder pain. The nurse concludes that the pain is caused by:

Blood accumulation under the diaphragm

A client and her partner are working together during the woman's labor. The client's cervix is now dilated to 7 cm, and the presenting part is low in the midpelvis. What should the nurse instruct the partner to do that will alleviate the client's discomfort during contractions?

Deep-breathe slowly.

When a client who had an above-the-knee amputation (AKA) complains of phantom limb sensations, the nursing staff should:

Describe the neurological mechanisms in language that the client understands

A client with a coronary occlusion is experiencing chest pain and distress. The nurse administers oxygen to:

Increase oxygen concentration to heart cells.

A client describes abdominal discomfort following ingestion of milk. Which enzyme, as a result of a genetic deficiency, should the nurse consider to be the cause of the client's discomfort?

Lactase

A client who is 5 feet, 8 inches tall and weighs 220 pounds is admitted to the hospital with ureteral colic, blood in the urine, and a blood pressure of 150/90. The immediate objective of nursing care for this client is to decrease:

Pain

A nurse is about to perform a wound irrigation on a client who had a left hemispheric stroke one year ago. What assessment is most important for the nurse to perform before beginning the irrigation?

Pain

The nurse should monitor for which involuntary physiological response in a client who is experiencing pain?

Perspiring

After surgery a 5-year-old child experiences intense pain and an analgesic is prescribed. What should the nurse consider when administering the analgesic?

Even though children do not like medicines, analgesics will make them more comfortable

A client is admitted to the hospital with severe back and abdominal pain, nausea and occasional vomiting, and an oral temperature of 101°F. The client reports drinking six to eight beers a day. A diagnosis of acute pancreatitis is made. Based on the data presented, the primary nursing concern for this client is:

Acute pain

A 78-year-old client who had a right above the knee amputation (AKA) 2 days ago is complaining of crushing pain in the right foot. How should the nurse respond to this?

Administer prescribed pain medication

A client who has just begun breastfeeding complains that her nipples feel very sore. What should the nurse encourage the mother to do? Select all that apply.

Apply cool packs to her breasts to reduce the discomfort. Take the analgesic medication prescribed to limit the discomfort. Assume a different position when breastfeeding to adjust the infant's sucking.

A pregnant woman is admitted in active labor. What should the nurse instruct her coach to do when the client complains of back pain?

Apply pressure to the sacrum during contractions

A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. The nurse expects that the client's initial treatment will include which medication?

Aspirin

A client being treated for uncontrolled hypertension and chest pain calls out to the nurse and reports he or she is having a nose bleed. Upon entry to the client's room, the nurse immediately applies pressure. Which action should the nurse take next?

Auscultate the client's blood pressure

A client is admitted to the hospital after two days of painful abdominal spasms and severe diarrhea. The nurse uses an appropriate sequence to examine the client's abdomen, starting with "inspection" followed by:

Auscultation, percussion, palpation

After a prostatectomy the client complains that the urinary catheter tubing is pulling too tightly on the leg. The nurse observes that the indwelling catheter tubing is taut and is taped properly to the thigh. The nurse should respond by:

Explaining that the traction helps control bleeding

A client with a history of heart disease has been receiving a calcium channel blocker and morphine sulfate for pain from abdominal surgery. When getting the client out of bed, the nurse first should have the client sit on the edge of the bed with feet on the floor. What untoward client response can be prevented by this nursing action?

Postural hypotension

A nurse is planning to transfer a client who is experiencing pain when transferring from the bed to a chair. Place the following steps in the order in which they should be implemented.

Verify the client's activity prescription Identify factors that may impact the ability to transfer. Explain the steps of the transfer Ensure that the wheels on the bed are locked. Position the client in functional body alignment before transferring

During a prenatal visit, a client at 37 weeks' gestation tells a nurse that she has painful, irregular contractions. What should the nurse recommend?

Walking around until they subside