Jensen Ch. 6
A nursing instructor is teaching students how to assess a patient's pain. The instructor emphasizes that there are many misconceptions about pain. The instructor realizes that a student needs further direction when the student states: a) "Patients with chronic illnessess can have chronic pain." b) "Nurses are the best authority on pain." c) "Acute pain can be as intense as chronic pain." d) "Chronic pain can be referred to as persistent pain."
"Nurses are the best authority on pain."
The nurse is assessing a client's pain. Which question would be most appropriate to ask the client when the goal is to identify precipitating factors that might have exacerbated the pain? a) "Is the pain continuous or intermittent?" b) "When did the pain start?" c) "What were you doing when the pain first stated?" d) "Do concurrent symptoms accompany the pain?"
"What were you doing when the pain first stated?"
As a nurse is adjusting a client's hospital bed, the nurse accidently pinches a finger between the bed and the wall. Which of the following components is involved in the transduction of the pain the nurse feels? a) A-delta fibers b) C-fibers c) L-beta fibers d) K-fibers
A-delta fibers *Nociceptors are located at the peripheral ends of both myelinated nerve endings of type A fibers and unmyelinated type C fibers, and there are three types that are stimulated by different stimuli: mechanosensitive nociceptors (of A-delta fibers), sensitive to intense mechanical stimulation (e.g., pliers pinching skin); temperature-sensitive (thermosensitive) nociceptors (of A-delta fibers), sensitive to intense heat and cold; and polymodal nociceptors (of C fibers), sensitive to noxious stimuli of a mechanical, thermal, or chemical nature. There are no "K-fibers" or "L-beta fibers."
A client presents to the ED with pain in the upper right quadrant that worsens after eating. The client describes the pain as sharp, stabbing, and at times very intense. This is a description of which type of pain? a) Acute b) Cutaneous c) Phantom d) Chronic
Acute
A client presents to the health care clinic with reports of 20day history of sore throat pain, ear pressure, fever, and stiff neck. The client states they have taken Tylenol and lozenges without relief. Which nursing diagnosis can be confirmed by this data? a) Acute Pain related to sore throat b) Anxiety related to prolonged pain c) Impaired Mobility related stiff neck d) Risk for Fluid Volume Deficit related to fever
Acute Pain related to sore throat
A client presents to the health care clinic with reports of a 2-day history of sore throat, ear pressure, fever, and stiff neck. The client states she has taken Tylenol and lozenges without relief. Which nursing diagnosis can be confirmed by this data? a) Acute pain related to sore throat b) Risk for deficient fluid volume related to fever c) Impaired physical mobility related stiff neck d) Anxiety related to prolonged pain
Acute pain related to sore throat *The client describes pain of 2 days' duration, which is within the definition for acute pain. The client did not describe or display any major defining characteristics of anxiety such as restlessness, concern about lifestyle changes, or sleep disturbances. The stiff neck was not confirmed by objective data collected by the nurse. No evidence exists for the client to have risk for deficient fluid volume.
Which of the dimensions of pain listed is being assessed by the question "How does the pain treatment you are getting affect your overall mood?" a) Behavioral. b) Physical. c) Affective. d) Cognitive.
Affective.
The nurse is caring for a patient who is experiencing visceral pain. What is this patient's most likely diagnosis? a) Myocardial infarction b) Shingles c) Appendicitis d) Bone fracture
Appendicitis
The community health nurse is caring for an older patient who states that she has not been taking the postoperative pain medication that she was prescribed. What question is most likely to be relevant? a) Are you able to afford the prescribed medication? b) Is confusion causing you to refuse your pain medications? c) Will you take the medication if you are ordered to do so? d) Are you too busy to take your prescribed pain medication?
Are you able to afford the prescribed medication?
A nurse is admitting a client to the postsurgical unit from the postanesthetic care unit. The nurse has transferred the client from the stretcher to a bed and asked the client if he is experiencing pain. The client acknowledges that he is in pain. What should be the nurse's next action? a) Assess the client's self-management skills. b) Assess the client's pain by gathering subjective data from the client. c) Assess the client's pain by obtaining a set of vital signs. d) Ask the client to briefly explain his cultural background.
Assess the client's pain by gathering subjective data from the client.
A patient is reporting pain and informs the nurse that it has become unbearable. The first thing the nurse should do is what? a) Check the physician's orders to see what pain medication to administer. b) Call the physician. c) Check the patient's record for allergies. d) Assess the site and intensity of the pain.
Assess the site and intensity of the pain.
How may a nurse demonstrate cultural competence when responding to patients in pain? a) Know the action and side effects of all pain medications. b) Avoid stereotyping responses to pain by patients. c) Treat every patient exactly the same, regardless of culture. d) Be knowledgeable and skilled in medication administration.
Avoid stereotyping responses to pain by patients.
The nursing class is learning about pain assessment. Which of the following is a manifestation of pain? a) Bracing b) Confusion c) Pressured speech d) Apathy
Bracing *Six pain behaviors indicate pain in patients who cannot verbalize: (1) vocalizations, (2) facial grimacing, (3) bracing, (4) rubbing painful areas, (5) restlessness, and (6) vocal complaints.
The nurse should assess for which pain complaints from a client diagnosed with Type II Diabetes Mellitus? a) Pain only on movement b) Burning, tingling c) Aching, gnawing d) Sharp, stabbing
Burning Tingling
The nurse is caring for a post-operative patient with an order for morphine sulfate 2 mg IV push every 4 hours. The patient's pain is unrelieved 30 minutes following administration of the morphine sulfate with the pain rating increasing from 7 to 10. Which action should the nurse take? a) Call the prescribing physician see about changing the pain medication. b) Administer another dose of the morphine sulfate immediately. c) Instruct the patient that it is too soon for another dose of morphine. d) Wait and medicate the patient when the next dose of morphine is due.
Call the prescribing physician see about changing the pain medication.
In preparing a care plan for a patient receiving opioid analgesics, the nurse selects which of the following as an applicable nursing diagnosis associated with side effects of opioid use? a) Impaired urinary elimination b) Diarrhea c) Constipation d) Bowel incontinence
Constipation
A male client with a history of a back injury 2 months ago has been taking daily doses of narcotic pain medication. He is currently hospitalized with a leg fracture after falling down the stairs. He complains of 10/10 pain in his back and leg after taking pain medication one hour ago. What is the nurse's best action? a) Inform the client that the next dose of medication is due in one more hour. b) Request a psychiatric evaluation for drug seeking behavior. c) Tell the client to take his own prescription medication. d) Consult with the healthcare provider about increasing the dose of medication.
Consult with the healthcare provider about increasing the dose of medication.
The nurse is working on a pediatric unit caring for a 4-year-old who is recovering from the surgical repair of the pelvis. When assessing the patient's pain, what is the most appropriate pain assessment tool for the nurse to use? a) Numeric Pain Intensity Scale b) Visual Analog Scale c) FACES Pain Scale d) Face, Legs, Activity, Cry, Consolability Scale
FACES Pain Scale
The nurse is caring for a 4-year old patient with abdominal pain. The most appropriate pain assessment tool would be the: a) Visual Analog Scale b) Numeric Pain Intensity Scale c) Combined Thermometer Scale d) FACES Pain Scale
FACES Pain Scale *The FACES Pain Scale is appropriate for children age 3 and older, using six faces ranging from happy with a wide smile to sad with tears on the face. The other three scales are appropriate for use with older children and adults. The Numeric Pain Intensity Scale is a one-dimensional pain scale using an 11-poing Likert-type scale ranging from 0 to 10, where 0 means "no pain" and 10 means "worst possible pain." The Combined Thermometer Scale looks like a thermometer and has both numbers that increase from the bottom up and descriptor words to measure pain intensity. The Visual Analog Scale is a 100-mm line with "no pain" at one end and "worst possible pain" at the other.
A nurse is assessing a mentally challenged adult client who is in pain after a fall from a staircase. Which of the following scales should the nurse use to assess the client's pain? a) Numeric scale b) Linear scale c) Word scale d) FACES scale
FACES scale
A nurse is caring for a 4-year-old patient who is crying and appears to be in pain. The nurse begins to assess the pain by showing pictures on a chart and asking the patient to point to the one that best represents the pain he is experiencing. This is an example of which of the following: a) VISUAL analog scale b) Numeric scale c) FLACC scale d) FACES scale
FACES scale
The nurse is caring for a 4-week-old postoperative patient. The most appropriate pain assessment tool would be the: a) Numeric Pain Intensity Scale b) Combined Thermometer Scale c) Face, Legs, Activity, Cry, Consolability Scale d) FACES Pain Scale
Face, Legs, Activity, Cry, Consolability Scale
The nurse is caring for a 4-week-old postoperative patient. The most appropriate pain assessment tool would be the: a) Numeric Pain Intensity Scale b) FACES Pain Scale c) Combined Thermometer Scale d) Face, Legs, Activity, Cry, Consolability Scale
Face, Legs, Activity, Cry, Consolability Scale *The Face, Legs, Activity, Cry, Consolability Scale is the appropriate pain assessment tool for a 4-week-old postoperative patient. This tool measures pain using observable behaviors as pain indicators.
The nursing student asks the nurse what would be an example of visceral pain. What would be the correct response by the nurse? a) Gallbladder pain b) Cardiac pain c) Arthritic pain d) Burn pain
Gallbladder Pain
A client on a medical-surgical unit reports pain of 10 on a scale of 0 to 10 and wants more pain medication. The nurse does not think the pain is as bad as the client says. The physician left orders for prn morphine for breakthrough pain. What is the priority nursing action? a) Hold the medication and wait 30 minutes b) Give the prn morphine c) Call the physician to check the order d) Document the client's pain rating on a scale of 0 to 10
Give the prn morphine
A nurse is assessing the effect of a client's chronic back pain on his affective dimension. Which question should the nurse ask for this assessment? a) Where is the pain located? b) What is the highest level of education you've completed? c) What medical conditions do you have? d) How does the pain influence your overall mood?
How does the pain influence your overall mood?
A client complains of pain in several areas of the body. How should the nurse assess this client's pain? a) Have the client rate each location separately. b) If pain does not radiate, there is no need to rate that area. c) Ask the client to rate the area with the highest pain level. d) Mark each site on the client's body with a marker.
Have the client rate each location separately.
The nurse collects vital signs on a client with pain. Which of the following would indicate to the nurse that the client is experiencing pain? a) Respiratory rate of 18 breaths/min b) Temperature of 99.1°F c) Heart rate of 110 bpm d) Blood pressure of 120/70 mmHg
Heart rate of 110 bpm
A hospital's protocols for assessment have been modified in light of standards established by the Joint Commission. What change would bring practice into alignment with these standards? a) Identifying pain as the fifth vital sign and assessing clients accordingly b) Triaging clients according to the type of pain that they are experiencing c) Assessing clients' pain objectively rather than subjectively d) Teaching all new clients about the basic pathophysiology of pain
Identifying pain as the fifth vital sign and assessing clients accordingly
A patient who was in an automobile accident a week ago is at home recovering from her injuries. She contacts her primary care provider's office to report that she still has severe pain in her back, resulting from an injury to that region, that has not been lessened by two different pain relievers that the physician had prescribed for her. The nurse recognizes this as which type of pain? a) Intractable b) Referred c) Visceral d) Chronic
Intractable
The U.S. government has created guidelines for health care providers caring for clients in pain. Which of the following reflect these guidelines? a) American Cancer Society Guidelines for Pain Management. b) Joint Commission Standards for Pain Management. c) National Institutes of Health Standards for Pain Treatment. d) American Pain Society Guidelines for Pain Management.
Joint Commission Standards for Pain Management.
A nurse is using the FLACC (Face, Legs, Activity, Cry, Consolability) scale for pediatric pain assessment to assess for pain in a 6-month-old client. Which of the following findings on this assessment tool would indicate the strongest pain in the client? a) Kicking b) Lying quietly c) Whimpering d) Occasional grimace or frown
Kicking
A nurse is using the FLACC (Face, Legs, Activity, Cry, Consolability) scale for pediatric pain assessment to assess for pain in a 6-month-old client. Which of the following findings on this assessment tool would indicate the strongest pain in the client? a) Lying quietly b) Whimpering c) Occasional grimace or frown d) Kicking
Kicking
The nurse is using a multidimensional pain assessment tool that combines indices measuring pain intensity, mood, pain location (via body diagram), and verbal descriptors, and which includes questions about medication efficacy. Which of these tools is a multidimensional pain assessment tool? a) Visual Analog Scale b) McGill Pain Questionnaire c) Numeric Pain Intensity Scale d) Combined Thermometer Scale
McGill Pain Questionnaire
A construction worker in his mid-40s suffered a severe laceration on his leg while on the job site. Soon after he arrives at the emergency room, a nurse assesses his pain. The client states that pain, although severe, has lessened since the accident first occurred. The nurse knows that the pain message likely has been inhibited by release of endorphins and other neurotransmitters. Which physiological process does this represent? a) Transduction b) Transmission c) Modulation d) Perception
Modulation *Modulation is the physiological process whereby brain stem neurons release endogenous neurotransmitters (e.g., endorphins, enkephalins, and serotonin), which inhibit the transmission of pain. Transduction is the process whereby injured tissue releases chemicals that affect nociceptors, sending the pain message up the sensory neuron. Transmission is the process whereby the pain impulse from the nociceptors relays the pain from the spinal cord to the brain. Perception is the process whereby pain is perceived in the brain.
A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing? a) Chronic pain b) Visceral pain c) Cutaneous pain d) Neuropathic pain
Neuropathic pain
After describing the pathophysiology of pain, an instructor determines that the students have understood the teaching when they identify which of the following as being responsible for transmitting the sensations to the central nervous system? a) Nociceptors b) Modulation c) Transduction d) Cytokines
Nociceptors
Which of the following principles should the nurse integrate into the pain assessment and pain management of pediatric patients? a) Pharmacologic pain relief should be used only as an intervention of last resort. b) Pain assessment may require multiple methods in order to ensure accurate pain data. c) The developing neurological system children transmits less pain than in older patients. d) A numeric scale should be used to assess pain if the child is older than 5 years of age.
Pain assessment may require multiple methods in order to ensure accurate pain data.
A nurse is caring for an elderly client who is unable to walk without a support due to knee pain. During his initial assessment, however, the client does not mention pain. Which of the following beliefs common in elderly clients may cause them to underreport their pain? a) Pain is harmless b) Pain is a normal part of aging c) Pain will draw their families closer to them d) Pain can be eliminated with medication
Pain is a normal part of aging
A nurse is working with an elderly Jewish man who is experiencing excruciating pain from a severe burn that he suffered earlier in the day. Given his cultural background, which expression of pain should the nurse most expect to find in this client? a) Pain is expressed openly, with much complaining b) Pain is a challenge to be fought; it is inevitable and is to be endured c) Pain is natural and honorable and should be dealt with by using mind over body d) Pain must be endured as part of preparing for the next life in the cycle of reincarnation
Pain is expressed openly, with much complaining
When performing a pain assessment the client should be asked to provide all the following information except: a) Treatment expectations b) Effectiveness of treatment c) Effects of pain on activities of daily living d) Physiological classification
Physiological classification
The nurse is assessing hospitalized post-operative pain and has asked the client to rate his pain, describe it, state the location and onset of when it started. What other question should the nurse include in this pain assessment? a) Financial resources to obtain medication b) Provoking and alleviating factors c) Availability of medication d) Medications taken in the past
Provoking and alleviating factors
The patient comes to the emergency department reporting indigestion and left arm pain. The physician orders an EKG along with drawing of cardiac enzymes. When the results are back, the patient is informed of the diagnosis of heart attack. The indigestion and arm pain are examples of which of the following? a) Referred pain b) Cutaneous pain c) Visceral pain d) Somatic pain
Referred pain
A nursing instructor is teaching students about the pain experience. The instructor informs the students that a patient experiencing pain will have a stress repsonse. The students are aware that this stress repsonse causes the following: a) Decrease in muscle tension and stress b) Decrease in oxygen and energy consumption c) Release of epinephrine, cortisol, and norepinephrine d) Decrease in blood glucose and lactate levels
Release of epinephrine, cortisol, and norepinephrine *The nurse must assess objective data as well as subjective data when assessing the patient for pain. Pain will induce a stress response that causes the release of epinephrine, cortisol, and norepinephrine. These hormones will have a metabolic and neuroendocrine response. Some of these effects are increased oxygen demand and consumption, as well as increased blood glucose and lactate levels and ketones. Muscle tension may also increase from the stress response.
The patient with a cognitive impairment sometimes cannot rate pain on a scale of 0 to 10. In such a case, the nurse is aware of other cues to assess the patient's pain. Which of the following is correct? a) Showing signs of having a difficult personality and yelling b) Restlessness, guarding c) Loss of appetite and decreased urine output d) Decreased blood pressure and pulse rate
Restlessness, guarding
The nurse is assessing the client's perception of pain and its intensity and quality. Which dimension is the nurse evaluating? a) Cognitive b) Sensory c) Physical d) Behavioral
Sensory
The nurse enters an older client's room to assess for pain and discovers the client is hard of hearing. What is the nurse's best action? a) Suggest client purchase a hearing aid. b) Utilize the FLACC scale. c) Ask client to numerically rate pain in a high-pitched voice. d) Speak to the client face to face.
Speak to the client face to face.
The nurse recognizes that a barrier to successful pain management for the patient with opioid tolerance is: a) Appropriate pain assessment tools are unavailable for this type of patient. b) The patient does not experience pain relief with usual doses of opioids. c) The patient has the normal physiologic response to painful stimuli. d) The repeated use of opioids causes their bodies to become less sensitive to pain.
The patient does not experience pain relief with usual doses of opioids.
The nurse is evaluating the effectiveness of the patient's pain medication and notes the patient is hard to arouse. The nurse interprets this as: a) The patient may be over-sedated. b) The patient is having an allergic reaction. c) The patient is getting much needed sleep. d) The patient is exhibiting expected behavior.
The patient may be over-sedated.
A patient reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator may be responsible for this increased level of comfort? a) The release of melatonin b) The release of insulin c) The release of dopamine d) The release of endorphins
The release of endorphins
A nurse is providing care to a client who has been in a motor vehicle accident and who has facial lacerations and a pelvic fracture. How can the nurse best determine the reliability and accuracy of data obtained during a pain assessment? a) Compare the findings to the client's preinjury level of health. b) Ask the primary care provider to validate the assessment data. c) Validate the assessment data with the client. d) Compare the findings to the most recent previous pain assessment.
Validate the assessment data with the client. *It is important to validate pain assessment data that are collected with the client. Comparisons to previous assessments and consultation with other members of the care team do not determine the reliability and accuracy of data obtained during a pain assessment.
The nurse is caring for a patient following an open reduction, internal fixation of the right hip. The nurse observes the patient moans when being repositioned. What type of pain indicator is moaning? a) Verbalization b) Behavioral c) Emotional d) Vocalization
Vocalization
When assessing the client for pain, the nurse should a) believe the client when he or she claims to be in pain. b) assess for the presence of physiologic indicators (such as diaphoresis, tachycardia, etc.), then believe the client. c) doubt the client when he or she describes the pain. d) assess for underlying causes of pain, then believe the client.
believe the client when he or she claims to be in pain.
One of the body's normal physiologic responses to pain is a) hypoglycemia. b) diaphoresis. c) hypotension. d) pulse rate below 50 beats/minute.
diaphoresis. *Diaphoresis is associated with acute pain.
A nurse is collecting subjective data from a client with acute appendicitis. Which interventions should the nurse use for this task? Select all that apply. a) Suggest words to help describe the pain if the client is unable to express self b) Maintain the client's privacy and ensure confidentiality c) Observe the client's posture d) Maintain a quiet environment when interviewing e) Listen carefully to the client's description of problem
• Listen carefully to the client's description of problem • Maintain a quiet environment when interviewing • Maintain the client's privacy and ensure confidentiality
Which would the nurse recognize as an example of visceral pain? Select all that apply. a) Burn pain b) Muscular pain c) Pancreatic pain d) Liver pain e) Gallbladder pain
• Pancreatic pain • Liver pain • Gallbladder pain *Examples of visceral pain include pain associated with the liver, gallbladder, and pancreas. Pain associated with a burn is an example of cutaneous pain. Muscular pain is a type of somatic pain.
When explaining the basis of pain, which of the following would the nurse include? Select all that apply. a) Cutaneous b) Psychological c) Visceral d) Somatic e) Physiologic
• Physiologic • Psychological
A client enters the emergency department moaning and complaining of severe pain in his lower back. Which of the following clinical manifestations should the nurse expect to see in this client as a physiologic response to pain? Select all that apply. a) Hypoglycemia b) Sleeplessness c) Increased heart rate d) Increased intestinal motility e) Perspiration
• Sleeplessness • Increased heart rate • Perspiration