Comfort & Pain Management
A nurse observes that a client who underwent knee surgery 2 weeks ago needs progressively larger doses of analgesics to get relief from pain. The nurse interprets this as: (a) addiction (b) tolerance (c) dependence (d) sedation
b
A client has been prescribed patient-controlled analgesia and the nurse is setting up the system and educating the client about safe and effective use of PCA. Which teaching point should the nurse provide to the client? (a) "If you feel severe pain, either push the button yourself or ask one of your family members to push the button." (b) "I'll have the unit's care aide come check on you every few minutes after I set up the system." (c) "We'll be monitoring your use of the system closely, to ensure you don't develop an addiction to your pain medication." (d) "The pump is programmed so that it's not possible for you to overdose on your pain medication."
d
A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a p.r.n. drug regimen as an effective method of pain control would be the client: (a) experiencing acute pain. (b) in the early postoperative period. (c) experiencing chronic pain. (d) in the postoperative stage with occasional pain.
d
The nurse is visiting a client at home who is recovering from a bowel resection. The client reports constant pain and discomfort and displays signs of depression. When assessing this client for pain, what should be the nurse's focal point? (a) judging whether the client is in pain or is just depressed (b) beginning pain medications before the pain is too severe (c) administering a placebo and performing a reassessment of the pain (d) reviewing and revising the pain management treatment plan
d
Two hours after receiving a pain medication, the client reports still suffering from pain. Which question is most appropriate to ask the client? (a) "Do you need your pain medication now?" (b) "Have you ever had pain like this before?" (c) "Tell me where your pain is located." (d) "Tell me more about your pain."
d
The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opiod anesthesia, the nurse observes the client's respiratory rate decrease to 8 breaths per minute. What is the priority action by the nurse? (a) Administer a lower dose of the analgesic for the next dose (b) Begin CPR (c) Place the client in the supine position (d) Administration of 0.4 mg of naloxone
d--The client is experiencing impending respiratory arrest due to the effect of the medication and this should be reversed immediately prior to arrest. This is the priority action and will correct the respiratory depression immediately. CPR is not indicated at this time, because the client is not in full arrest. Placing the client in the supine position may decrease respirations further.
A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system? (a) The dose that is delivered when the client activates the machine is preset. (b) Thorough client education is necessary to prevent overdoses. (c) Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression. (d) An antidote is automatically delivered if the client exceeds the recommended dose.
a
A client has required frequent scheduled and breakthrough doses of opioid analgesics in the 6 days since admission to the hospital. The client's medication regimen may necessitate which intervention? (a) stool softeners and increased fluid intake (b) supplementary oxygen and chest physiotherapy (c) calorie restriction and dietary supplements (d) frequent turns and application of skin emollients
a
A client in pain believes that the pain is a punishment from God, and feels angry and resentful. Which is the most appropriate action by the nurse? (a) Encourage client to confer with a spiritual advisor. (b) Consult a psychiatric nurse practitioner. (c) Encourage the client to pray for oneself. (d) Encourage visitors to pray for the client.
a
A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. Which opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort? (a) Endorphins (b) Serotonin (c) Melatonin (d) Dopamine
a
A nurse is caring for a client who complains of an aching pain in the abdomen. The nurse also noted that the client is guarding the area. The client is experiencing: (a) visceral pain. (b) cutaneous pain. (c) somatic pain. (d) neuropathic pain.
a
The nurse has completed a preoperative teaching session with a client who will receive morphine via a patient-controlled analgesia (PCA) pump after surgery. Which statement by the client indicates the need for further teaching? (a) "I will remind my family member to push the PCA pump button for me if I doze off during the day." (b) "I will let my nurse know if the pain medication is not effective enough to help me move after surgery." (c) "I can push the button whenever I feel pain." (d) "I will use the PCA pump until oral pain medication controls my pain."
a
The nurse is assessing a client for the chronology of the pain she is experiencing. Which interview question is considered appropriate to obtain this data? (a) How does the pain develop and progress? (b) How would you describe your pain? (c) How would you rate the pain on a scale of 0 to 10? (d) What do you do to alleviate your pain and how well does it work?
a
Which assessment finding is consistent with the presence of pain? (a) restlessness (b) decreased blood pressure (c) decreased pulse (d) euphoria
a
The nurse is developing a plan of care for a client in acute pain. Which nursing interventions should be included? (Select all that apply.) (a) Encourage deep breathing. (b) Play the client's favorite music. (c) Promote a restful environment. (d) Encourage increased protein. (e) Encourage the use of a sitter.
a,b,c
The young female client had emergency surgery for appendicitis. She is a cigarette smoker, is breast-feeding her infant, and expressed a desire to continue to breast-feed when discharged from the hospital. The surgeon has prescribed acetaminophen/oxycodone for pain relief at home. What instructions would the nurse include when providing discharge teaching? Select all that apply. (a) Do not drive a vehicle while taking this medication. (b) Client is allowed to have one drink of alcohol each day. (c) You may smoke cigarettes during the day but not at night. (d) You must check with your primary care provider before breast-feeding your infant. (e) For better absorption, take your pain medication on an empty stomach. (f) Keep a diary to record level of pain and time medication is taken.
a,d,f
The nurse is preparing to initiate PCA therapy for a client with sleep apnea. What is the correct action by the nurse? (a) Contact the physician. (b) Initiate the therapy. (c) Increase the lock out time. (d) Decrease the loading dose.
a--The nurse should contact the physician, as PCA therapy for pain management is contraindicated for clients with sleep apnea
A client comes to the emergency department complaining of a shooting pain in his chest. When assessing the client's pain, which behavioral response would the nurse expect to find? (a) Decreased heart rate (b) Guarding of the chest area (c) Increased respiratory rate (d) High blood pressure
b
A client reports pain and requests the prescribed pain medication. When entering the client's room, the client is laughing with visitors and does not appear to be in pain. What is the appropriate action by the nurse? (a) Hold the pain medication. (b) Administer the pain medication. (c) Reassess the client's pain in 30 minutes. (d) Contact the client's health care provider.
b
A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a client being discharged. What process is involved in this pain relief measure? (a) Biofeedback mechanism (b) Cutaneous stimulation (c) Patient-controlled analgesia (PCA) (d) Guided imagery
b
A nurse is caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain? (a) referred pain (b) phantom pain (c) visceral pain (d) cutaneous pain
b
A nurse is taking care of a client who requests acetaminophen to help with a headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours for pain. What type of order is this considered? (a) standing order (b) p.r.n. order (c) one-time order (d) stat order
b
A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the nurse's best intervention in this situation? (a) Ignore the boy's pain if he is not complaining about it. (b) Ask the boy to draw a cartoon about the color or shape of his pain. (c) Medicate the boy with analgesics to reduce the anxiety of experiencing pain. (d) Distract the boy so he does not notice his pain.
b
After the nurse has instructed a client with low-back pain about the use of a transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what? (a) "One advantage of the TENS unit is it increases blood flow." (b) "I could use the TENS unit if I feel pain somewhere else on my body." (c) "I may need fewer pain medications with the TENS unit in place." (d) "Wearing the TENS unit should not interfere with my daily activities."
b
The nurse is teaching a client how to manage postoperative pain through a patient controlled analgesia (PCA) pump. The nurse determines that additional teaching is needed when the client make which statement? (a) "This will allow me to control my own pain medication." (b) "I should only take medication when my pain is intense." (c) "I give myself the pain medication by pushing the button." (d) "The pump is programmed to limit the chance of overmedicating."
b
The nurse manager hears a nurse and a nurse aide talking about a female client who reports pain of 8 out of 10 on a 1-10 scale after a Caesarean birth to deliver twins. The nurse states, "I don't believe this client has any pain at all. I'm sure she is just drug seeking." What is the appropriate nurse manager action? (a) Continue listening to the conversation before intervening. (b) Ask the nurse to speak privately for a moment, and educate about bias in pain treatment. (c) Enter the conversation and tell the nurse and UAP that this type of discussion will not be tolerated. (d) Write the nurse up for disciplinary action.
b
A client describes pain in the lower leg and has been diagnosed with a herniated lumbar disk. The pain in the leg is what type of pain? (a) acute pain (b) chronic pain (c) referred pain (d) limited pain
c
A nurse giving a client a massage notes the presence of a nonblanching reddened area on the client's sacrum. What is the nurse's best action? (a) Gently massage the region, document the finding, and verbally report it to the health care provider. (b) Avoid massaging the area and apply a thin layer of a topical antibiotic ointment. (c) Avoid massaging this area and report the finding to the health care provider. (d) Massage the area in an attempt to restore adequate circulation.
c
What is the most reliable method for assessing pain? (a) asking significant others (b) asking the primary care provider (c) asking the client (d) observing the client
c