Chapter 34, Comfort and Pain Management

Of the following individuals, who can best determine the experience of pain? A) The person who has the pain B) The person's immediate family C) The nurse caring for the client D) The physician diagnosing the cause

Ans: A Feedback: According to McCaffery, an expert on pain, "Pain is whatever the experiencing person says it is, existing whenever he (or she) says it does." The only one who can be a real authority on whether and how a person experiences pain is that individual.

The nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. The nurse notes that the client's respiratory rate is 10 breaths per minute. The client is somnolent, with minimal response to physical stimulation. The nurse should prepare to administer which of the following medications? A) Intravenous naloxone (Narcan) B) Intravenous flumazenil (Romazicon) C) Oral modafinil (Provigil) D) Nebulized albuterol (Proventil)

Ans: A Feedback: Albuterol is a bronchodilator and not appropriate for this clinical situation.

Which client would be most likely to have decreased anxiety about, and response to, pain as a result of past experiences? A) One who had pain but got adequate relief B) One who had pain but did not get relief C) One who has had chronic pain for years D) One who has had multiple pain experiences

Ans: A Feedback: An individual's experience of pain in the past, and the qualities of that experience, profoundly affect new pain experiences. Some clients have experienced severe acute or chronic pain in the past but received immediate and adequate pain relief. These clients are generally unafraid of pain and initiate appropriate requests for assistance.

Which statement accurately describes pain experienced by the older adult? A) Boredom and depression may affect an older person's perception of pain. B) Residents in long-term care facilities have a minimal level of pain. C) The older client has decreased sensitivity to pain. D) A heightened pain tolerance occurs in the older adult.

Ans: A Feedback: Boredom, loneliness, and depression may affect an older person's perception and report of pain. One myth held by many to be true is that older clients have a decreased sensitivity to pain and therefore a heightened pain tolerance. Numerous older adult clients residing in long-term care facilities have significant pain that negatively affects their quality of life.

Which of the following clients would be classified as having chronic pain? A) A client with rheumatoid arthritis B) A client with pneumonia C) A client with controlled hypertension D) A client with the flu

Ans: A Feedback: Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Acute pain is generally rapid in onset and varies in intensity from mild to severe. After its underlying cause is resolved, acute pain disappears. It should end once healing occurs.

Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique? A) Tactile kinesthetic distraction B) Visual distraction C) Auditory distraction D) Project distraction

Ans: A Feedback: Examples of tactile kinesthetic distraction include holding or stroking a loved one, pet, or toy; rocking; and slow rhythmic breathing. Project distraction includes playing a challenging game or performing meaningful work. Visual distraction can be accomplished through reading or watching television. Auditory distraction may occur when one listens to music.

A client has an order for a narcotic analgesic every three to four hours and he received his last dose three hours earlier. Which of the following actions is most appropriate for the nurse to take in response to the client's request for pain medication on his first postoperative day? A) Provide the client with pain medication B) Tell the client that the pain cannot be severe C) Document and ask the client to wait one hour D) Contact the physician for a change in medication

Ans: A Feedback: Inadequate or poor pain assessment is a leading factor in poor pain control, because the health care professional may not know a client has pain. The nurse must provide the next dose of pain medication.

Which misconception is common in clients in pain? A) "I will get addicted to pain medications." B) "I need to ask for pain medications." C) "The nurses are here to help relieve the pain." D) "I do not have to fight the pain without help."

Ans: A Feedback: Many misconceptions interfere with the client's ability to communicate pain. A common misconception is that "if I ask for something for pain, I may become addicted to the medication."

Why is acute pain said to be protective in nature? A) It warns an individual of tissue damage or disease. B) It enables the person to increase personal strength. C) As a subjective experience, it serves no purpose. D) As an objective experience, it aids diagnosis.

Ans: A Feedback: Pain is a subjective experience. Acute pain, lasting from a few minutes to less than six months, warns an individual of tissue damage or organic disease. After its underlying cause is resolved, acute pain disappears.

A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his left leg, and the pain is worse with ambulation. The nurse will document this type of pain as which of the following? A) Somatic pain B) Cutaneous pain C) Visceral pain D) Phantom pain

Ans: A Feedback: Somatic pain is diffuse or scattered pain, and it originates in tendons, ligaments, bones, blood vessels, and nerves. Cutaneous pain usually involves the skin or subcutaneous tissues. Visceral pain is poorly localized and originates in body organs. Phantom pain occurs in an amputated leg for which receptors and nerves are clearly absent, but the pain is a real experience for the client.

A nurse implements a back massage as an intervention to relieve pain. What theory is the motivation for this intervention? A) Gate control theory B) Neuromodulation C) Large/small fiber theory D) Prostaglandin stimulation

Ans: A Feedback: The gate control theory of pain describes the transmission of painful stimuli. Nursing interventions, such as massage or a warm compress to a painful lower back, stimulate large nerve fibers to close the gate, thus blocking nerve impulses from that area.

A nurse is assessing a mentally challenged, adult client who is in pain after a fall. Which of the following scales should the nurse use to assess the client's pain? A) Pain Assessment in Advanced Dementia (PAINAD) B) Wong-Baker Faces scale C) Linear Scale D) Numeric Scale

Ans: A Feedback: The nurse should use the Pain Assessment in Advanced Dementia (PAINAD) scale, which was developed for cognitively impaired clients. The Wong-Baker FACES scale is best for children and clients who are culturally diverse. Nurses generally use a numeric scale, a word scale, or a linear scale to quantify the pain intensity of adult clients who can express their pain intensity in words, numbers, or linear fashion with the help of the respective scales.

The nurse has just completed programming of a patient-controlled analgesia (PCA) pump using prescribed parameters. Which of the following actions should you take next? A) Verify the settings with another nurse. B) Document implementation of the PCA on the client's chart. C) Attach the PCA pump tubing to the client's intravenous access device. D) Check the pump's electrical cords for cracks, splits, or fraying.

Ans: A Feedback: This action should be performed before programming is initiated.

The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which of the following responses is most appropriate? A) "The mild electrical impulses block the pain signal before it can reach the brain." B) "The electrode patches generate heat and decrease muscle tension." C) "The machine tricks the mind into believing the pain does not exist." D) "The electricity produces numbness and alters tissue sensitivity."

Ans: A Feedback: This statement explains the use of cold therapy for pain.

The Joint Commission supports the client's right to pain management, and published standards for assessment and management of pain in hospitals, ambulatory care settings, and home care settings (Joint Commission, 2008b). Which of the following are recommended guidelines for pain management? Select all that apply. A) Teach all clients to use a pain rating scale. B) Determine a pain-rating goal with each client. C) Use pharmacologic pain relief measures first. D) Manipulate factors that affect the pain experience. E) Keep the primary care provider in charge of all pain relief measures.

Ans: A, B, D Feedback: The Joint Commission recommendations include teaching all clients to use a pain-rating scale and determining a painrating goal with each client. Nursing interventions to achieve this goal include establishing a trusting nurse-patient relationship; manipulating factors that affect the pain experience; initiating nonpharmacologic pain relief measures; managing pharmacologic interventions; reviewing additional pain control measures; ensuring ethical and legal responsibility to relieve pain; and educating the client about pain.

A nurse is assessing the vital signs of a client who is moaning due to the acute onset of pain. What would be the expected objective findings? A) Decreased pulse and respirations B) Increased pulse and blood pressure C) Increased temperature D) No change from client's norms

Ans: B Feedback: A client who is in acute pain will most often also have an increased pulse and blood pressure.

Which client would benefit from a p.r.n. drug regimen? A) One who had thoracic surgery 12 hours ago B) One who had thoracic surgery four days ago C) One who has intractable pain D) One who has chronic pain

Ans: B Feedback: A p.r.n. drug regimen has not proven effective for people experiencing acute pain, such as in the early postoperative period. It is not adequate for clients with intractable or chronic pain. However, later in the postoperative period, it may be acceptable to relieve occasional pain episodes.

A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and become chronic. What is a characteristic of chronic pain? A) Chronic pain will lead to psychological imbalance. B) Chronic pain has far-reaching effects on the client. C) Chronic pain can be severe in its initial stages. D) Chronic pain eases with healing and eventually disappears.

Ans: B Feedback: Chronic pain has far-reaching effects on the client because the discomfort lasts longer than six months. Chronic pain is not as severe in the initial stage as acute pain, but does not disappear eventually with pain medication. Chronic pain need not always lead to psychological imbalance.

Besides controlling pain of the post-abdominal surgery client with narcotics, the nurse suggests to the client that he ... A) focus on pain relief B) use distraction C) describe the pain D) think about the next dose

Ans: B Feedback: Distraction is useful when clients are undergoing brief periods of sharp, intense pain, such as dressing changes, wound débridement, biopsy, or incident pain from shifting positions.

A client in the emergency department is diagnosed with a myocardial infarction (heart attack). The client describes pain in his left arm and shoulder. What name is given to this type of pain? A) Cutaneous pain B) Referred pain C) Allodynia D) Nociceptive

Ans: B Feedback: Referred pain is pain that is perceived in an area distant from the point of origin. Pain associated with a myocardial infarction is frequently referred to the neck, shoulder, or arm.

A client with cancer pain is taking morphine for pain relief. Knowing constipation is a common side effect, what would the nurse recommend to the client? A) "Only take morphine when you have the most severe pain." B) "Increase fluids and high-fiber foods, and use a mild laxative." C) "Administer an enema to yourself every third day." D) "Constipation is nothing to worry about; take your medicine."

Ans: B Feedback: The most common side effects associated with opioids (e.g., morphine) are sedation, nausea, and constipation. If constipation persists, it usually responds to treatment with increased fluids and fiber, and use of a mild laxative.

A middle-age client is complaining of acute joint pain to a nurse who is assessing the client's pain in a clinic. Which of the following questions related to pain assessment should the nurse ask the client? A) Does your diet include red meat and poultry products? B) Does your pain level change after taking medications? C) Are your family members aware of your pain? D) Have you thought of the effects of your condition on your family?

Ans: B Feedback: The nurse should ask direct and specific questions about the nature of the pain and whether it changes with medication, as this helps the nurse to quickly gather objective data about the client's pain. The nurse should avoid asking irrelevant and closed-ended questions, such as whether the client's diet includes red meat and poultry products, or whether the client has thought about the effects of his condition on his family. These types of questions do not add any value to pain assessment, but could make the client feel more depressed and uncomfortable.

A nurse is ordered to apply a transcutaneous electrical nerve stimulation (TENS) unit to a client recovering from abdominal surgery. Which of the following is a consideration when using this device? A) TENS is an invasive technique for providing pain relief. B) TENS involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers. C) TENS is most beneficial when used to treat pain that is generalized. D) A TENS unit is applied intermittently throughout the day and should not be worn for extended periods of time.

Ans: B Feedback: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive technique for providing pain relief that involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers. It is most beneficial when the pain is localized and the unit can be worn for extended periods of time.

A client tells the nurse that she is experiencing stabbing pain in her mouth, gums, teeth, and chin following brushing her teeth. These are symptoms of which of the following pain syndromes? A) Complex regional pain syndrome B) Postherpetic neuralgia C) Trigeminal neuralgia D) Diabetic neuropathy

Ans: C Feedback: A symptom of trigeminal neuralgia is paroxysms of lightning-like stabs of in tense pain in the distribution of one or more divisions of the trigeminal nerve, the fifth cranial nerve. Pain is usually experienced in the mouth, gums, lips, nose, cheek, chin, and surface of the head and may be triggered by everyday activities like talking, eating, shaving, or brushing one's teeth.

What is the term used to describe a pharmaceutical agent that relieves pain? A) Antacid B) Antihistamine C) Analgesic D) Antibiotic

Ans: C Feedback: An analgesic is a pharmaceutical agent that relieves pain. Analgesics reduce the perception of pain and alter responses to discomfort.

A mother calls the nurse practitioner to say, "I don't know what is wrong with my baby. He cried all night and kept pulling at his ear." How would the nurse respond? A) "Oh, he probably was just hungry and wet. Did you feed him?" B) "Babies at that age cry at night. Think nothing of it." C) "That means his ear hurt. Bring him in to be checked." D) "That probably means he had a tummy ache. How is he now?"

Ans: C Feedback: Pain is frustrating for children because they are unable to understand the concept and cause of pain, and may have difficulty describing it. Crying and touching/grabbing the painful body part are observations that may indicate pain in a child.

A nurse is assessing a client with arthritis. Which of the following should the nurse consider in the initial assessment of the client? A) Blood group B) Anxiety level C) Pain level D) Glucose level

Ans: C Feedback: The nurse should first assess the client's pain level since the client has arthritis. Anxiety level, blood group, and glucose level are not vital signs which will help the nurse assess the client's pain during the initial assessment.

A nurse is teaching an alert client how to use a PCA system in the home. How will she explain to the client what he must do to self-manage pain? A) "You don't have to do anything. The machine does it all." B) "I will teach your family what they need to do." C) "When you push the button, you will get the medicine." D) "The medicine is going into your body all the time."

Ans: C Feedback: When the sensation of pain occurs, the client pushes a button that activates the PCA device to deliver a small preset bolus dose of the analgesic. A lockout interval (usually 5 to 10 minutes) prevents reactivation of the pump and administration of another dose during that period of time. Other safeguards also limit the possibility of overmedication.

The nurse is caring for a client with terminal bone cancer. The client states, My pain is getting worse and worse, and the morphine doesn't help anymore. The nurse determines the client's pain is which of the following? A) Acute B) Chronic malignant C) Diffuse D) Intractable

Ans: D Feedback: Chronic malignant pain is acute pain episodes, persistent chronic pain, or both, associated with a progressive malignanttype process.

A client who has breast cancer is said to be in remission. What does this term signify? A) The client is experiencing symptoms of the disease. B) The client has end-stage cancer. C) The client is experiencing unremitting pain. D) The disease is present but the client is not experiencing symptoms.

Ans: D Feedback: Commonly, people with chronic pain experience periods of remission (when the disease is present but the person does not experience symptoms) or exacerbation (the symptoms reappear).

How may a nurse demonstrate cultural competence when responding to clients in pain? A) Treat every client exactly the same, regardless of culture. B) Be knowledgeable and skilled in medication administration. C) Know the action and side effects of all pain medications. D) Avoid stereotyping responses to pain by clients.

Ans: D Feedback: Culture influences an individual's response to pain. It is particularly important to avoid stereotyping responses to pain because the nurse frequently encounters clients who are in pain or anticipating it will develop. A form of pain expression that is frowned upon in one culture may be desirable in another cultural group.

A client has been taught relaxation exercises before beginning a painful procedure. What chemicals are believed to be released in the body during relaxation to relieve pain? A) Narcotics B) Sedatives C) A-delta fibers D) Endorphins

Ans: D Feedback: Endorphins, which are opioid neuromodulators, are produced at neural synapses at various points in the CNS pathway. They have prolonged analgesic effects and produce euphoria. It is suggested that they may be released when measures such as skin stimulation and relaxation techniques are used.

A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain? A) Six hours after administering a prescribed analgesic B) After the client is discharged from the health care facility C) Once per day when the pain is a potential problem D) Whenever the vital signs are measured and documented

Ans: D Feedback: The nurse should assess the client's pain whenever the nurse measures and documents vital signs. When administering a prescribed analgesic, the nurse should assess pain before implementing a pain-management intervention, and again 30 minutes later. The nurse should assess the client's pain when the client is admitted to, not discharged from, the health care facility. Similarly, the nurse should assess pain once per shift when pain is an actual or potential problem.

A client has a severe abdominal injury with damage to the liver and colon from a motorcycle crash. What type of pain will predominate? A) Psychogenic pain B) Neuropathic pain C) Cutaneous pain D) Visceral pain

Ans: D Feedback: Visceral pain is poorly localized and originates in body organs in the thorax, cranium, and abdomen. The pain occurs as organs stretch abnormally and become distended, ischemic, or inflamed.

A nurse asks a client to rate his pain on a scale of 0 to 10, with 0 being no pain and 10 being worst pain. What characteristic of pain is the nurse assessing? A) Duration B) Location C) Chronology D) Intensity

Ans: D Feedback: When a nurse asks a client to rate his pain on a scale of 0 to 10, the intensity of the pain is being assessed. Duration is how long the pain has lasted, and location is the site of the pain.