327 Chapter 7: Pain Management Q's

Which of the following is a disadvantage of using the transdermal route of opioid administration? A. A delay in effect until the dermal layer is saturated B. Less costly than parenteral route C. Slightly less constipation noted than with oral opioids D. A constant opioid serum level

A. A delay in effect until the dermal layer is saturated A disadvantage of using the transdermal route of administration is that there is a delay in effect when the dermal layer is saturated. Advantages include a consistent opioid serum level, slightly less constipation than with oral opioids, and less cost as compared to the parenteral route.

You are the emergency department (ED) nurse caring for a 9-year-old who was in a motor vehicle accident. The mother arrives at the ED, and you explain that the child is in pain from a broken arm, which will need surgical intervention to set the bones. You ask the mother to comfort the child. What type of pain are you dealing with in this patient? A. Acute B. Chronic C. Phantom D. Intermittent

A. Acute Acute pain is usually of recent onset and commonly associated with a specific injury. Acute pain indicates that damage or injury has occurred. Chronic pain is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributed to a specific cause or injury. Phantom pain occurs when the body experiences a loss, such as an amputation, and still feels pain in the missing part.

Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain? A. Do not administer if respirations are less than 12 breaths per minute B. Avoid caffeine or other stimulants, such as decongestants C. Monitor weight, vital signs, and serum glucose concentration D. Monitor blood counts and liver function tests

A. Do not administer if respirations are less than 12 breaths per minute The nurse should not administer the prescribed opiate therapy if respirations are less than 12 breaths per minute. The nurse should instruct a client who is prescribed psychostimulants to avoid caffeine or other stimulants, such as decongestants. The nurse should monitor weight, vital signs, and serum glucose concentration when administering corticosteroids. When administering anticonvulsants, the nurse should also monitor blood counts and liver function tests.

The nurse is aware that there are approximate dose equivalents for oral and parenteral opioid analgesics. Select the accurate equivalent value from the following choices. A. OxyContin: 30 mg (oral); 15 mg (parenteral) B. Morphine: 30 mg (oral); 20 mg (parenteral) C. Dilaudid: 8 mg (oral); 4 mg (parenteral) D. Codeine: 200 mg (oral); 50 mg (parenteral)

A. OxyContin: 30 mg (oral); 15 mg (parenteral) The parenteral doses of codeine and OxyContin are half that of the oral doses. Morphine is one-third of the oral dose and Dilaudid is one-quarter of the oral dose. Refer to Table 7-3 in the text.

Which phase of pain transmission occurs when the one is made aware of pain? A. Perception B. Transmission C. Modulation D. Transduction

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

For which reasons are nonpharmacologic pain management techniques used? Select all that apply. A. They allow clients to match the technique to their own individual and cultural preferences. B. They help decrease the distress a client experiences as a result of pain. C. They can successfully replace pain medications for severe pain. D. They lower the risk of clients becoming addicted to pain medications. E. They help decrease the sensation of pain.

A. They allow clients to match the technique to their own individual and cultural preferences. B. They help decrease the distress a client experiences as a result of pain. E. They help decrease the sensation of pain. Nonpharmacologic pain management techniques are usually used in conjunction with medications and help to decrease the sensation of pain and the distress the client experiences as a result of pain. Nonpharmacologic methods are used to complement, not replace, pharmacologic methods in cases of severe pain. Many clients find that the use of nonpharmacologic methods helps them cope better with their pain and feel they have greater control over the pain. Nonpharmacologic methods do not have any relation to a client's risk of becoming addicted to pain medications. A variety of techniques allows clients to match the technique to their own individual and cultural preferences.

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

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

Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission? A. A surgeon making an incision to perform surgery B. A child quickly removing a hand when touching a hot object C. A mother in labor utilizing imagery to reduce pain D. A patient taking tramadol to enhance pain management

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

Nursing interventions for pain management in an elderly patient must take into consideration which of the following facts about the assessment of pain? The elderly: A. Have a decreased risk for drug toxicity. B. Experience reduced sensory perception. C. Have a decreased pain threshold. D. Are expected to experience chronic pain.

B. Experience reduced sensory perception. The elderly are susceptible to nervous system depression and reduced sensory perception. Refer to Table 7-1 in the text.

A 20-year-old man has presented to the emergency department with a 24-hour history of abdominal pain. The nurse who is admitting the patient notes that he is diaphoretic, wincing, and guarding the lower right quadrant of his abdomen. The nurse asks the patient to rate his pain on a scale of 1 to 10, to which the patient responds, "One or two." How should the nurse best respond to this patient's statement? A. Reassess the patient's pain in 30 to 45 minutes. B. Explain the 0-to-10 pain scale in greater detail. C. Document the fact that the patient has slight pain. D. Administer ibuprofen or acetaminophen rather than an opioid.

B. Explain the 0-to-10 pain scale in greater detail. While it is important to accept a patient's self-report of pain, this does not mean that further education about pain scales is not sometimes necessary. This is especially the case when there is a clear inconsistency between patient's subjective pain report and the nurse's assessment findings. Thus, further teaching should take place prior to choosing an intervention or documenting the patient's pain as "slight."

The physician has ordered a mu opioid analgesic for a patient with pain. What drug does the nurse anticipate administering? A. Stadol B. Fentanyl C. Nubain D. Buprenex

B. Fentanyl Opioid analgesic agents are divided into two major groups: (1) mu agonist opioids (also called morphine-like drugs) and (2) agonist-antagonist opioids. The mu agonist opioids comprise the larger of the two groups and include morphine, hydromorphone, hydrocodone, fentanyl, oxycodone, and methadone, among others. The agonist-antagonist opioids include buprenorphine (Buprenex, Butrans), nalbuphine (Nubain), and butorphanol (Stadol).

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

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

Consider the following four statements that are in the Pain Care Bill of Rights. Select the primary right that must be addressed before the others. A person with pain has the right to: A. Participate in decisions about pain management. B. Have his or her report of pain taken seriously and be treated with dignity and respect. C. Have pain thoroughly assessed and treated. D. Receive clear and prompt answers to questions.

B. Have his or her report of pain taken seriously and be treated with dignity and respect. The first principle of pain is that it is "whatever the person says it is, existing whenever the person says it does." It is the first and primary right of a person in pain.

A nurse who provides care for a diverse patient population on a busy medical unit has had significant success with the use of ice and heat in the management of patients' pain. The nurse should exercise particular caution when applying cold therapy or heat therapy to a patient who: A. Consistently rates his or her pain at 8 out of 10 or higher B. Is unable to communicate or has a cognitive or sensory deficit C. Has pain unrelated to observable tissue damage D. Is simultaneously using a patient-controlled analgesic (PCA) pump

B. Is unable to communicate or has a cognitive or sensory deficit To avoid potential injury, ice and heat are not normally applied to patients who lack sensation or the ability to clearly communicate discomfort. Ice and heat have effective analgesic applications but carry a risk of skin damage. It is unnecessary to avoid their use among patients who have a PCA, highly rated pain, or who have not experienced tissue damage.

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

B. Older people experience reduced sensory perception. Pain affects individuals of every age, sex, race, and socioeconomic class

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

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

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

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

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

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

A patient has been admitted to the surgical unit from postanesthetic recovery and begun on a morphine patient-controlled analgesic (PCA) pump. What teaching point should the nurse who is performing this action provide to the patient? A. "Please ring your call bell to check with your nurse before you push your PCA button so you can be assessed first." B. "Try to use the deep-breathing techniques that you were taught before you resort to using your PCA." C. "Don't hesitate to use you PCA when you first feel mild pain or when you anticipate you're going to have pain." D. "It's important that you not push the button twice in rapid succession, so that you avoid giving yourself a double dose."

C. "Don't hesitate to use you PCA when you first feel mild pain or when you anticipate you're going to have pain." Patients should be encouraged to use their PCA preventively and when they experience slight pain. They should be taught not to wait until pain is severe, and should be reassured that the PCA settings preclude overdosing. It is normally unnecessary for a patient to ask the nurse's permission before using his or her PCA.

A teenage client is undergoing a dressing change to burns on the thigh. The client refuses pain medication and states, "I do not hurt, and I don't need it." He is withdrawn, grimaces, and turns away during the dressing change. He was last medicated 8 hours ago. What is the best statement by the nurse? A. "You are so brave to not take your pain medication when the dressing change will hurt." B. "If you need pain relief, I can give you some medication when I have completed the dressing change." C. "I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication." D. "You are so right to not take your pain medication. You can become dependent on the medication."

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

You are an obstetrical nurse who is providing care for a woman who gave birth by cesarean section a few hours ago. Knowing that the woman is likely to experience pain, you are providing patient education about pain. Which of the following statements should you include when teaching this patient about pain and about pain management? A. "When your pain crosses the line between being bearable and unbearable, I'll be able to give you some medication for it." B. "I'll teach you some techniques that you can use so that you'll be able to avoid using drugs to manage your pain." C. "I'll be checking with you often, but please let me know as soon as you're starting to feel pain." D. "When you feel like you're not able to manage your pain on your own, ring your call bell, and I can get you something for pain."

C. "I'll be checking with you often, but please let me know as soon as you're starting to feel pain." The patient should be informed that pain should be reported in the early stages. As well, the nurse should address the patient's pain well before it becomes unbearable. It is unrealistic to expect nonpharmacologic interventions to wholly replace drugs.

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

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

The nurse has assessed a client's pain subsequent to a broken ankle. How would the nurse categorize and document the client's pain? A. Intermittent B. Visceral C. Acute D. Chronic

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

A client with appendicitis has had an appendectomy. After surgery, what type of pain does the nurse anticipate the client will have? A. Referred pain B. Neuropathic pain C. Acute pain D. Chronic pain

C. Acute pain Acute pain is a discomfort that has a short duration (from a few seconds to less than 6 months). It is associated with tissue trauma, including surgery, or some other recent identifiable etiology. The characteristics of chronic pain, discomfort that lasts longer than 6 months, are almost totally opposite from those of acute pain. An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Referred pain is a term used to describe discomfort that is perceived in a general area of the body, but not in the exact site where an organ is anatomically located.

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

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

A client who is watching television with a visitor reports severe pain and wants pain medication. Which action will the nurse take? A. Wait until the visitor leaves before providing pain medication. B. Encourage client to use distraction techniques to manage pain. C. Prepare a dose of pain medication as prescribed. D. Watch the client's actions to determine pain level.

C. Prepare a dose of pain medication as prescribed. The client's report of pain is the undisputed standard of pain assessment. Since the client reported severe pain, a dose of pain medication should be prepared. Watching the client's actions to determine pain level is inappropriate, as personal and cultural differences yield different demonstrations of pain levels and behaviors are not as reliable of indicators as the client's report of pain. Encouraging the client to use distraction techniques to manage their pain would not be indicated in this scenario, as the client is already using these techniques and still reporting severe pain, indicating the need for medication. There is no reason to wait for the visitor to leave before providing the client with the pain medication.

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

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

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

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

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

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

The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting: A. Anticipated harmful effects of the pain experience B. Medical interventions for pain management C. Severity of the pain as judged by the patient D. Anticipated duration of the pain

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

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

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

A nurse is preparing to apply an ice pack to the client's knee after surgery to assist with pain control. When using this therapy, the nurse would apply the ice for: A. 60 minutes. B. 30 minutes. C. 45 minutes. D. 20 minutes.

D. 20 minutes Ice should be applied to an area for no longer than 15 to 20 minutes at a time and should be avoided in clients with compromised circulation (Arthritis Foundation, 2015). Prolonged applications of ice may result in frostbite or nerve injury.

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

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

The nurse is caring for a client in the hospital who has been taking an analgesic for pain related to a chronic illness and has developed a tolerance to the medication. What is the most appropriate action by the nurse? A. Inform the client that you will ask the physician to order a non-narcotic analgesic. B. Suggest a consultation with a psychiatrist to treat the client's addiction. C. Inform the client that he will not be able to receive more medication than the physician has ordered. D. Consult with the prescriber regarding the need for an increased dose of the drug and not to reduce the frequency of administration.

D. Consult with the prescriber regarding the need for an increased dose of the drug and not to reduce the frequency of administration. The most appropriate action by the nurse would be to consult with the physician regarding the need for an increased dose of the drug and not to reduce its frequency of administration. As a rule of thumb, an ineffective dose should be increased by 25% to 50%. Informing the client that he will not be able to receive more medication is not acting as a client advocate nor acting in the best interest of the client. Suggesting a psychiatrist consultation would not be an appropriate action because the client has a chronic illness that requires medication. Taking a non-narcotic analgesic would not provide the client with the pain relief that he has.

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

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

A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client A. About activities that would distract him from pain B. That the nurse will notify the surgeon of his fear C. How anxiety could increase his pain perception D. That medication will be prescribed for pain relief

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