PAIN PRACTICE QUESTIONS

Nurses working with clients in pain need to recognize and avoid common misconceptions and myths about pain. In regard to the pain experience, which of the following is correct? 1. THE CLIENT IS THE BEST AUTHORITY ON THE PAIN EXPERIENCE 2. CHRONIC PAIN IS MOSTLY PSYCHOSOCIAL IN NATURE 3. REGULAR USE OF ANALGESICS LEADS TO DRUG ADDICTION 4. THE AMOUNT OF TISSUE DAMAGE IS ACCURATELY REFLECTED IN THE DEGREE OF PAIN PERCEIVED

ANS: 1 A clients self-report of pain is the single most reliable indicator of the existence and intensity of pain and any related discomfort. Pain is individualistic. A misconception about pain is that chronic pain is psychological. The belief that administering analgesics regularly will lead to drug addiction is a misconception. Another misconception about pain is that the amount of tissue damage is accurately reflected in the degree of pain perceived.

A client who had knee replacement surgery the previous day refuses to take any pain medication, even though he rates his pain as an 8 on a 0 to 10 scale. Upon questioning the client the nurse learns that the reason for refusing pain medication is because he is concerned about injuring the knee and not feeling it. The best information that the nurse can provide this client is to explain that: 1. THE PAIN MEDICATION WILL HELP SPEED HIS RECOVERY TIME 2. HE NEED NOT WORRY ABOUT BECOMING ADDICTED TO THE PAIN MEDICATION 3. HE WILL NOT BE PERCEIVED AS WEAK FOR TAKING THE PAIN MEDICATION 4. HE IS BEING DIFFICULT CLIENT AND NEEDS TO COMPLY WITH THE HEALTH CARE PROVIDER ORDERS

ANS: 1 Acute pain seriously threatens a clients recovery by resulting in prolonged hospitalization, increased risks of complications from immobility, and delayed rehabilitation. Physical or psychological progress is delayed as long as acute pain persists, because the client focuses all www.testbanktank.com energy on pain relief. Thus a primary nursing goal is to provide pain relief that allows clients to participate in their recovery.

A client with chronic pain states, I just want to be pain-free. Do something to make that happen. The most therapeutic response is: 1. TOGETHER WE WILL ALL WORK AT MAKING YOUR PAIN TOLERABLE 2. I WILL DO EVERYTHING I CAN TO MANAGE YOUR PAIN; I PROMISE 3. ARE YOU FEELING DEPRESSED OR ANXIOUS BECAUSE OF YOUR PAIN? 4. YOU SOUND ANXIOUS. WOULD YOU LIKE SOMETHING FOR YOUR NERVES?

ANS: 1 Complete pain relief is not always achievable, but reducing pain to a tolerable level is realistic. The remaining options either address issues other than pain or make promises that may be difficult or impossible to keep.

A 44-year-old client shares with the admitting nurse that the client is having epigastric pain that the client identifies as a 7 on a 0 to 10 scale. In order to plan for the pain management of this client, which is the most appropriate response from the nurse? 1. WHAT WOULD BE A SATISFACTORY LEVEL OF PAIN CONTROL FOR US TO ACHIEVE? 2. YOU DO NOT LOOK LIKE YOU ARE IN THAT MUCH PAIN 3. YOU WILL BE PAIN FREE FOLLOWING YOUR SURGERY 4. IVE CARED FOR A CLIENT WITH A NAIL IN HIS HEAD WHO ONLY RATED HIS PAIN AS A 5; ARE YOU SURE YOUR PAIN IS A 7?

ANS: 1 Complete pain relief is not always achievable, but reducing pain to a tolerable level is realistic. Thus a primary nursing goal is to provide pain relief that allows clients to participate in their recovery. Successful pain management does not necessarily mean pain elimination, but rather attainment of a mutually agreed-upon pain-relief goal that allows clients to control their pain instead of the pain controlling them. A person in pain feels distress or suffering and seeks relief. However, you as the nurse cannot see or feel the clients pain. It is realistic that the client will most likely experience postoperative pain. The nurse should not use a pain scale to compare the pain of one client to that of another client.

Which one of the following nursing interventions for a client in pain is based on the gate- control theory? 1. GIVING THE CLIENT A BACK RUB 2. CHANGING THE CLIENTS POSITION IN BED 3. GIVING THE CLIENTS A PAIN MEDICATION 4. LIMITING THE NUMBER OF VISITORS

ANS: 1 The gate-control theory suggests that cutaneous stimulation activates larger, faster-transmitting A-beta sensory nerve fibers. This decreases pain transmission through small-diameter A-delta and C fibers. A back massage is a nursing intervention based on the gate-control theory. Changing the clients position in bed is not a form of cutaneous stimulation used to relieve pain. Giving the client a pain medication is a pharmacological approach to relieving pain. Limiting the number of visitors may provide a quiet environment conducive to relaxation, but it is not based on the gate-control theory

The daughter of an 88-year-old female client tells the nurse that her mother has recently quit going on walks in the neighborhood because of pain in her legs. Which of the following is the best response from the nurse? 1. I WOULD LIKE TO SPEAK WITH YOUR MOTHER TO GET MORE INFORMATION 2. OLDER PEOPLE FREQUENTLY SUFFER FROM ARTHRITIS THAT CAN CAUSE LEG PAIN 3. YOUR MOTHER PROBABLY HAS POOR CIRCULATION IN HER LEGS, WHICH IS CAUSING THE PAIN 4. SHE IS LUCKY TO BE AS HEALTHY AS SHE IS AT HER AGE

ANS: 1 The presence of pain in an older adult requires aggressive assessment, diagnosis, and management. Pain is not an inevitable part of aging.

The management on a postoperative care unit is assessing the quality of the clients pain/ In order to obtain this specific information about the pain experience from the client, the nurse should ask: 1. WHAT DOES YOUR DISCOMFORT FEEL LIKE? 2. WHAT ACTIVITIES MAKE THE PAIN WORSE? 3. HOW MUCH DOES IT HURT ON A SCALE FROM 0 TO 10? 4. HOW MUCH DISCOMFORT ARE YOU ABLE TO TOLERATE?

ANS: 1 To determine the quality of the clients pain the nurse might say, What does your discomfort feel like? It is more accurate to have clients describe the pain in their own words whenever possible. Inquiring about what activities make the pain worse is a type of question directed at determining the pain pattern. Having the client rate his or her pain on a pain scale is a method of measuring the intensity of pain. To determine the clients expectations, the nurse may ask the client, How much discomfort are you able to tolerate?

When a client's husband questions how a patient-controlled analgesia (PCA) pump works, the nurse explains that the client: 1. HAS CONTROL OVER THE FREQUENCY OF THE INTRAVENOUS (IV) ANALGESIA 2. CAN CHOOSE THE DOSAGE OF THE DRUG RECEIVED 3. MAY REQUEST THE TYPE OF MEDICATION RECEIVED 4. CONTROLS THE ROUTE FOR ADMINISTERING THE MEDICATION

ANS: 1 With a PCA system the client controls medication delivery. The PCA system is designed to deliver no more than a specified number of doses. The client does not choose the dosage. The health care provider prescribes the type of medication to be used. The advantage for the client is that he or she may self-administer opioids with minimal risk for overdose. The client does not control the route for administration. Systemic PCA typically involves IV drug administration but can also be given subcutaneously.

The greatest barrier to a 3-year-old clients ability to self-assess her pain is: 1. A LIMITED VOCABULARY 2. INCREASED SEPARATION ANXIETY 3. RELUCTANCE TO TALK TO STRANGERS 4. INABILITY TO GRASP THE CONCEPT OF PAIN

ANS: 1 Young children who have not developed full vocabularies have difficulty verbally describing and expressing pain to parents or caregivers. Toddlers and preschoolers are unable to recall explanations about pain or associate pain with experiences that occur in various situations. The remaining options may have an effect on self-assessment of pain, but only to a limited degree.

The home care nurse notes that a 67-year-old female diabetic clients blood glucose level has been elevated since she strained her back the previous week. The client states that she cannot understand why her blood glucose level is elevated. The nurse suspects the most likely cause for the elevated blood sugar is: 1. THE DECREASED ACTIVITY LEVEL OF THE CLIENT SINCE THE INJURY 2. PARASYMPATHETIC STIMULATION FROM THE BODY'S NORMAL RESPONSE TO PAIN 3. THE CLIENT IS CONSUMING MORE FOOD AS A COMFORT MEASURE 4. THE CLIENT MAY NOT BE TAKING HER MEDICATION AS ORDERED

ANS: 2 An increased blood glucose level is the body's physiological response to pain, which is triggered by the parasympathetic nervous system in order to provide additional glucose for additional energy.

The nurse knows that a PCA pump would be most appropriate for the client who: 1. HAS PSYCHOGENIC DISCOMFORT 2. IS RECOVERING AFTER A TOTAL HIP REPLACEMENT 3. EXPERIENCES RENAL DYSFUNCTION 4. RECENTLY EXPERIENCED A CEREBROVASCULAR ACCIDENT (STROKE)

ANS: 2 Patient-controlled analgesia is a safe method for postoperative pain management, such as the client recovering from total hip replacement surgery. PCA would not be the mode of choice for treating psychogenic pain or for the client with renal dysfunction. The client with renal impairment would be at increased risk for drug toxicity because of decreased drug excretion. Clients must be able to understand the use of the equipment and be physically able to locate and press the button to deliver the dose. The client who recently experienced a cerebrovascular accident may have difficulty managing the PCA system.

A non-pharmacological approach that the nurse may implement for clients experiencing pain that focuses on promoting pleasurable and meaningful stimuli is: 1. ACUPRESSURE 2. DISTRACTION 3. BIOFEEDBACK 4. HYPNOSIS

ANS: 2 Pleasurable stimuli cause the release of endorphins. The nurse assesses activities enjoyed by the client that may act as distractions. Distraction directs a clients attention to something else and thus can reduce the awareness of pain and even increase tolerance. Acupressure does not focus on promoting pleasurable and meaningful stimuli. Acupressure is finger pressure applied therapeutically at selected points on the body. Biofeedback focuses on an individuals physiological responses (e.g., blood pressure or tension) and ways to exercise voluntary control over those responses. Hypnosis does not focus on promoting pleasurable and meaningful stimuli. Hypnosis is a condition resembling sleep in which the mind is susceptible to suggestions.

The nurse recognizes that the most likely reason a runner who has injured his ankle during a race is not aware of it until after he crosses the finish line is that: 1. THE EMOTIONAL EXHILARATION OF RUNNING THE RACE MASKED THE PAIN OF THE INJURY 2. HIS ENDORPHIN LEVELS WERE HIGH AS A RESULT OF PHYSICAL STRESSORS OF THE RACE 3. HE WAS MENTALLY DISTRACTED BY THE NEED TO CONCENTRATE ON THE EVER-CHANGING NATURE OF THE RACE 4. THE PHYSICAL EFFECTS OF THE INJURY SLOWLY INCREASED DURING THE RACE AND REACHED PAIN-PRODUCING CAPACITY ONLY AFTER THE RACE

ANS: 2 Stress, exercise, and other factors increase the release of endorphins, raising an individuals pain threshold (the point at which a person feels pain). Because the amount of circulating substances varies with each individual, the response to pain will be different. Although the other options may have affected his pain perception, they did not exert as much influence as the answer.

Which of the following statements made by a nurse requires follow-up with additional instruction regarding the personal nature of pain? 1. I HAVE EXPERIENCED PAIN BEFORE, AND SO I HAVE GREAT COMPASSION FOR ANYONE DEALING WITH PAIN 2. MY POST-SURGICAL CLIENTS GET THE PRESCRIBED PAIN MEDICATIONS ON SCHEDULE WITH NO DIVERSION FROM THAT SCHEDULE 3. IF I WERE EXPERIENCING SEVERE PAIN, I CERTAINLY WOULD WANT SOMEONE TO DEVOTE THEIR TIME TO MANAGING FOR ME 4. CLIENTS DON'T ALWAYS REQUEST PAIN MEDICATION, AND SO I ALWAYS ASK THEM IF THEY WANT IT ACCORDING TO THE SCHEDULE

ANS: 2 The nurse cannot see or feel the clients pain. Pain is purely subjective; no two persons experience pain in the same way, and no two painful events create identical responses or feelings www.testbanktank.com in a person. Flexibility is a necessary component in pain management. The remaining options do not require follow-up because they do not express any attitudes that are not compatible with good nursing care of the client in pain.

The client is experiencing breakthrough pain while receiving opioids. An order is written for the client to receive a trans-mucosal fentanyl unit. In teaching about this medication, the nurse should instruct the client to: 1. SWAB THE UNIT OVER THE CHEEKS 2. DO NOT CHEW THE UNIT AFTER ADMINISTRATION 3. TAKE NO MORE THAN TWO UNITS PER EPISODE OF DISCOMFORT 4. ALLOW THE UNIT TO DISSOLVE SLOWLY IN THE MOUT OVER 15 MINUTES OR MORE

ANS: 2 The unit needs to be left intact and not chewed. The unit is placed in the clients mouth and swabbed over the inside of the cheeks and lower gums. No more than two units should be used per breakthrough pain episode. The unit needs to be allowed to dissolve and absorb over a 15- minute period.

A client with chronic back pain has an order for a transcutaneous electrical nerve stimulation (TENS) unit for pain control. The nurse should instruct the client to: 1. KEEP THE UNIT ON HIGH 2. USE THE UNIT WHEN PAIN IS PERCEIVED 3. REMOVE THE ELECTRODES AT BEDTIME 4. USE THE THERAPY WITHOUT MEDICATIONS

ANS: 2 When a client feels pain, the TENS unit is turned on and a buzzing or tingling sensation is created. The tingling sensation can be applied until pain relief occurs. The client may adjust the intensity of skin stimulation. It does not have to remain on high. The electrodes do not have to be removed at bedtime. Medication can be administered with a TENS unit.

An older client with mild musculoskeletal pain is being seen by the primary care provider. The nurse anticipates that treatment of this clients level of discomfort will include: 1. FENTANYL 2. DIAZEPAM 3. ACETAMINOPHEN 4. MEPERIDINE HYDROCHLORIDE

ANS: 3 A non-opioid analgesic, such as acetaminophen, is used to effectively treat mild musculoskeletal pain. Fentanyl is about 100 times more potent than morphine. It is typically used for cancer pain, not mild musculoskeletal pain. Diazepam is given as an anti-anxiety agent. Meperidine hydrochloride is an opioid analgesic used to treat moderate to severe acute pain, not mild pain.

Which of the following symptoms would the nurse expect with a client who is experiencing acute pain? 1. BRADYCARDIA 2. BRADYPNEA 3. DIAPHORESIS 4. DECREASED MUSCLE TENSION

ANS: 3 An expected assessment finding of a client experiencing acute pain would be diaphoresis resulting from sympathetic nerve stimulation. Additional assessment findings of a client experiencing acute pain would be an increased heart rate, respiratory rate, and muscle tension.

A client with a history of chronic back pain is questioning the need to keep asking for pain medication, fearing that he will be viewed as being weak by his family. The most therapeutic nursing response to this client would be: 1. CHRONIC BACK PAIN IS VERY DIFFICULT TO DEAL WITH; UTILIZE THE PAIN MEDICATION BECAUSE THATS WHAT ITS THERE FOR 2. YOUR FAMILY WONT THINK YOU ARE WEAK; THEY WANT YOU TO BE COMFORTABLE, AND THE MEDICATION WILL HELP 3. TAKING THE MEDICATION AS PRESCRIBED WILL HELP YOU TO BE MORE ACTIVE; YOUR FAMILY WILL BE HAPPY YOU CAN DO THINGS WITH THEM AGAIN 4. ITS IMPORTANT THAT YOU MANAGE YOUR PAIN AS EFFECTIVELY AS POSSIBLE; IT REALLY DOESN'T MATTER WHAT OTHER PEOPLE THINK ABOUT YOU

ANS: 3 As a nurse, you encourage clients to accept pain-relieving measures so that they remain active. Clients who have a low pain tolerance (level of pain a person is willing to put up with) are sometimes inaccurately perceived as whiners or weak. The client needs to learn that effective, appropriate pain management is essential to his physical and emotional well-being. Although the remaining options are not incorrect, they do not display the degree of understanding the answer does.

A client who is scheduled for the second in a series of painful dressing changes asks for my pain medication now so its working when the dressing is changed is most likely expressing: 1. A GREAT FEAR OF THE EXPECTED PAIN 2. A NEED TO BE IN CONTROL OF HIS PAIN 3. AN UNDERSTANDING THAT IT IS EASIER TO PREVENT THE PAIN THAN TO STOP THE PAIN 4. AN ACCEPTANCE OF THE PAIN THAT THE DRESSING CHANGE WILL OBVIOUSLY CAUSE THEM

ANS: 3 Clients often seek relief before pain occurs, having learned that pain is easier to prevent than to treat. Although the other options may not be incorrect, the likelihood is greater for the answer.

The nurse should describe pain that is causing the client a burning sensation in the epigastric region as: 1. REFERRED 2. RADIATING 3. DEEP OR VISCERAL 4. SUPERFICIAL OR CUTANEOUS

ANS: 3 Deep or visceral pain is diffuse and may radiate in several directions. Visceral pain may be described as a burning sensation. Referred pain is felt in a part of the body separate from the source of pain, such as with a myocardial infarction, in which pain may be referred to the jaw, left arm, and left shoulder. Radiating pain feels as though it travels down or along a body part, such as low back pain that is accompanied by pain radiating down the leg from sciatic nerve irritation. Superficial or cutaneous pain is of short duration and is localized as in a small cut.

Which of the following is most appropriate when the nurse assess the intensity of the clients pain? 1. ASK ABOUT WHAT PARTICIPATES THE PAIN 2. QUESTIONS THE CLIENT ABOUT THE LOCATION OF THE PAIN 3. OFFER THE CLIENT A PAIN SCALE TO OBJECTIFY THE INFORMATION 4. USE OPEN-ENDED QUESTIONS TO FIND ABOUT THE SENSATION

ANS: 3 Descriptive scales are a more objective means of measuring pain intensity. Asking the client what precipitates the pain does not assess intensity, but rather it is an assessment of the pain pattern. Asking the client about the location of pain does not assess the intensity of the clients pain. To determine the quality of the clients pain, the nurse may ask open-ended questions to find out about the sensation experienced.

Before inserting a Foley catheter, the nurse explains that the client may feel some discomfort. This is an example of: 1. DISTRACTION 2. REDUCING PAIN PERCEPTION 3. ANTICIPATORY RESPONSE 4. SELF-CARE MAINTENANCE

ANS: 3 Pain can be prevented by anticipating painful events. Before performing procedures, the nurse considers the clients condition, aspects of the procedure that may be uncomfortable, and techniques to avoid causing pain. The nurse who tells the client that the urinary catheter insertion may feel uncomfortable is an example of anticipatory response. Distraction directs a clients attention to something else and thus can reduce the awareness of pain and even increase tolerance. Reducing pain perception means to remove stimuli that are uncomfortable or to prevent stimuli that are painful, such as changing wet linens, or preventing constipation with fluids, diet, and exercise. Self-care maintenance implies the client is able to carry out necessary activities to care for himself or herself. This may include pain management measures.

The nurse caring for a terminally ill client with liver cancer understands which of the following goals would be most appropriate? 1. INCREASINGLY ADMINISTER NARCOTICS TO OVER-SEDATE THE CLIENT AND THEREBY DECREASE THE PAIN 2. CONTINUE TO CHANGE THE ANALGESICS UNTIL THE RIGHT NARCOTIC IS FOUND THAT COMPLETELY ALLEVIATES THE PAIN 3. ADAPT THE ANALGESICS AS THE NURSING ASSESSMENT REVEALS THE NEED FOR SPECIFIC MEDICATIONS 4. WITHHOLD ANALGESICS BECAUSE THEY ARE NOT BEING EFFECTIVE IN RELIEVING DISCOMFORT

ANS: 3 The best choice of treatment often changes as the clients condition and the characteristics of pain change. It is realistic to expect that a terminally ill clients need for pain medication will change over time with disease progression. The goal is not to over-sedate the client but to provide pain control without excessive sedation. It would be unrealistic to expect that the pain of terminal cancer will be completely alleviated. Analgesics should not be withheld, because this would only increase the clients level of pain. The medication regimen may need to be adapted to meet the clients needs.

A client who ruptured his spleen in a motor vehicle accident rates his postoperative pain as a level 8 on a 0 to 10 pain scale. After administering pain medication, the nurse discusses the use of complementary therapies with the client to explore ways to reduce the pain. The client would like to try a massage. The nurse delegates this task to the assistive personnel (AP). Which of the following instructions is most important for the nurse to share with the AP? 1. YOU NEED TO WARM THE BOTTLE OF LOTION BEFORE USING IT 2. REPORT ANY CHANGES IN THE CLIENTS SKIN CONDITION TO ME IMMEDIATELY 3. DO NOT MASSAGE THE CLIENTS LEGS 4. MASSAGE EACH BODY PART AT LEAST 10 MINUTES

ANS: 3 The nurse should instruct the AP not to massage the clients legs or calf muscles, because there is a risk for dislodging a vascular clot. The nurse needs to know about changes in the condition of the clients skin, but this can be obtained after the clients massage it is not as critical as the AP's knowing not to massage the clients legs before beginning the massage.

A client with chronic pain presents in the emergency department of the local hospital stating I just cant take this anymore. On questioning the client, the nurse discovers that the client have experienced chronic pain since being involved in an accident 2 years previously. The client states that he has been labeled a drug seeker because he is looking for relief for the pain and feels hopeless, angry, and powerless to do anything about the situation. The nurse understands that this client is at risk for: 1. CRIMINAL ACTIVITY 2. OPIOID ABUSE 3. SUICIDE 4. DRUG ADDICTION

ANS: 3 The possible unknown cause of non-cancer pain, combined with the unrelenting pain and uncertainty of its duration, frustrates the client, frequently leading to psychological depression and perhaps suicide. There is no evidence to demonstrate a relationship between chronic pain and criminal activity. Health care workers are usually less willing to treat chronic noncancer pain with opioids, although a recent policy statement supports the use of opioids for noncancer pain. In addition, the American Society of Anesthesiologists developed the Practice Guidelines for Chronic Pain Management, which includes the use of opioids. Many health care providers and clients fear addiction when long-term opioid use is prescribed to manage pain, although this fear is often inappropriate. Because of this concern, health care providers require opioid agreements and random urine testing in clients who require long-term opioid therapy. The effectiveness of agreements is lacking, and there are ethical concerns about using them for all clients who require long-term opioid therapy. This raises the question as to whether agreements protect clients or health care providers.

When caring for a client who is experiencing continuous severe pain, the nurse should expect that the pain management plan would include: 1. FOCUSING ON INTRAMUSCULAR ADMINISTRATION OF ANALGESICS 2. WAITING FOR PAIN TO BECOME MORE INTENSE BEFORE ADMINISTERING OPIOIDS 3. ADMINISTERING OPIOIDS WITH NON-OPIOID ANALGESICS FOR SEVERE PAIN EXERCISES 4. ADMINISTERING LARGE DOSES OF OPIOIDS INITIALLY TO CLIENTS WHO HAVE NOT TAKEN THE MEDICATIONS BEFORE

ANS: 3 To treat a client who is experiencing continuous severe pain, the nurse should expect the client to receive opioid and non-opioid analgesics for severe pain experiences. Intramuscular administration of analgesics is not expected because the injection itself is painful, and there may be inconsistent erratic absorption of the drug. The nurse should administer opioids before the clients pain becomes intense. It is easier to maintain pain control than it is to get intense pain under control. Large doses of opioids are not given initially to clients who have not taken the medications before because they may cause respiratory depression. The expectation is to begin with lower doses and titrate upward.

A client is having severe, continuous discomfort from kidney stones. Based on the clients experience, the nurse anticipates which of the following findings in the clients assessment? 1. TACHYCARDIA 2. DIAPHORESIS 3. PUPIL DILATION 4. NAUSEA AND VOMITING

ANS: 4 Acute severe or deep pain, as with kidney stones, will cause a parasympathetic response. The client would likely exhibit nausea and vomiting. Tachycardia is a response of sympathetic stimulation, commonly seen with pain of low to moderate intensity and superficial pain. Diaphoresis is a response of sympathetic stimulation, commonly seen with pain of low to moderate intensity and superficial pain. Pupil dilation is a response of sympathetic stimulation, commonly seen with pain of low to moderate intensity and superficial pain.

Taking into consideration the hospice clients chronic pain from bone cancer, the most appropriate person to collaborate with regarding management of pain is: 1. OCCUPATIONAL THERAPIST TO DEVISE A SPLINT FOR THE CLIENTS LEG 2. PHYSICAL THERAPIST DETERMINE EXERCISES TO STRENGTHEN THE LEG MUSCLES 3. ART THERAPIST TO PROVIDE CREATIVE THERAPY AS A DIVERSION 4. AN ONCOLOGY NURSE

ANS: 4 An oncology nurse specialist is very familiar with pharmacological and non-pharmacological interventions that are most effective for chronic/persistent pain. The client is terminally ill, and although occupational therapy, physical therapy, and art therapy are all important therapies to consider, in this case the most appropriate discipline is the nurse who cares for this type of client and is familiar with the interventions that would be most appropriate

Which of the following statements is the most appropriate response to a clients statement, I thought you could tell I was in pain? 1. HOW DO YOU EXPRESS A NEED FOR PAIN MEDICATION IF NOT BY ASKING? 2. IM SO VERY SORRY; MAY I GET YOU YOUR PAIN MEDICATION RIGHT AWAY 3. I DO NOT THINK IT IS WISE TO ASSUME I CAN EFFECTIVELY READY YOUR MIND REGARDING THE NEED FOR PAIN MEDICATIONS 4. I WILL MAKE A POINT OF ASKING YOU TO RATE YOUR PAIN AT LEAST EVERY 2 HOURS, SO THIS MISCOMMUNICATION WONT HAPPEN AGAIN

ANS: 4 Be sensitive to variations in communication styles. Some cultures feel nonverbal expression of pain is sufficient to describe the pain experience, whereas others assume that if pain medication is appropriate, the nurse will bring it; thus asking is inappropriate. The remaining options are not as effective at addressing the root of the problem or providing a possible solution.

The nurse is caring for a cognitively impaired client who has experienced a painful procedure. The nurse is most effective in determining the clients pain medication needs when using which of the following assessment methods? 1. MEDICATING THE CLIENT WITH THE AS-NEEDED (PRN) ANALGESIC AS OFTEN AS ORDERED 2. UTILIZING THE PAIN FACE SCALE TO ASSESS THE CLIENTS PAIN EXPERIENCE 3. ASKING THE CLIENT TO RATE HIS OR HER PAIN ON A SCALE 1-10, WITH 10 BEING THE MOST SEVERE PAIN 4. OBSERVING THE CLIENTS BODY MOVEMENTS AND FACIAL EXPRESSIONS FOR TYPICAL PAIN BEHAVIORS

ANS: 4 Body movements and facial expressions that indicate pain include clenching the teeth, holding the painful part, bent posture, and grimaces. Some clients cry or moan, are restless, or make frequent requests of a nurse. You will soon learn to recognize patterns of behavior that reflect pain. This becomes especially important in clients who are unable to report their pain, such as the cognitively impaired. However, lack of pain expression does not necessarily mean that the client is not experiencing pain. The remaining options are not always as effective for the cognitively impaired or reflect inappropriate use of analgesics.

A 38-year-old client presents to the pain clinic with complaints of phantom pain. The client was involved in a farming accident 3 years previously that resulted in a below-the-elbow amputation of his right arm. The nurse knows that phantom pain is categorized as: 1. PAINFUL POLYNEUROPOTHY 2. SOMATIC PAIN 3. SYMPATHETICALLY MAINTAINED PAIN 4. DEAFFERENTATION PAIN

ANS: 4 Deafferentation pain comes from injury to either the peripheral or central nervous system. Phantom pain reflects injury to the peripheral nervous system. In painful polyneuropathy the client feels pain along the distribution of many peripheral nerves; examples include diabetic neuropathy, alcohol-nutritional neuropathy, and Guillain-Barr syndrome. Somatic pain comes from bone, joint, muscle, skin, or connective tissue. It is usually aching or throbbing in quality and is well localized. Sympathetically maintained pain is associated with dysregulation of the autonomic nervous system; examples include pain associated with reflex sympathetic dystrophy/ causalgia (complex regional pain syndrome, type I, type II).

The nurse is attempting to ambulate a postoperative client who continues to rate his pain as a 7 on a scale of 0 to 10, with 10 being the most severe. The client is reluctant to walk and consents to move only to the chair, reporting that it hurts too much to walk. The nurses primary concern regarding the clients recovery related to his pain experience is that: 1. HIS PAIN MEDICATIONS ARE NOT EFFECTIVELY MANAGING HIS PAIN 2. HE DOES NOT FULLY UNDERSTAND THE IMPORTANCE OF AMBULATION 3. HE IS EXPENDING TOO MUCH OF HIS ENERGY DEALING WITH PAIN 4. HE IS NOT READY TO PARTICIPATE IN THE ACTIVITIES NEEDED TO RECOVER QUICKLY

ANS: 4 Efforts aimed at teaching and motivating the client toward self-care are often hampered until the pain is successfully managed. Thus a primary nursing goal is to provide pain relief that allows clients to participate in their recovery. Although the remaining options are not inappropriate, they do not express the major concern regarding his recovery.

The nurse is discussing the effects of pain with an older adult client diagnosed with osteoarthritis. The most therapeutic response to the clients comment of, I wonder whether it would hurt if I took a nap in the afternoon? would be: 1. AS LONG AS IT DID NOT INTERFERE WITH YOUR GETTING A GOOD NIGHTS SLEEP 2. ID SUGGEST TAKING YOUR NAP RIGHT AFTER YOU TAKE YOUR PAIN MEDICATION 3. IF IT HELPS YOU COPE BETTER WITH THE PAIN, I DON'T SEE ANY HARM IN TAKING A NAP 4. I THINK A NAP IS A GOOD IDEA BECAUSE WE SEEM TO FEEL PAIN MORE WHEN WE ARE TIRED

ANS: 4 Fatigue heightens the perception of pain and decreases coping abilities. If fatigue occurs along with sleeplessness, the perception of pain is even greater. Pain is often experienced less after a restful sleep than at the end of a long day. The other options are not inappropriate but are not as informative regarding the benefit of rest on the perception or effects of pain.

In creating the plan of care for a newly diagnosed breast cancer client, the nurse is concerned about pain control. The client has expressed an interest in relaxation therapy as a complementary pain therapy. The nurse knows that the best time to teach the client is: 1. IMMEDIATELY FOLLOWING THE CLIENTS MASTECTOMY 2. BEFORE GIVING PAIN MEDICATION TO EVALUATE IF THE COMPLEMENTARY THERAPY WORKS 3. IMMEDIATELY PRECEDING SURGERY 4. WHEN THE CLIENT IS COMFORTABLE

ANS: 4 For effective relaxation, teach techniques only when the client is not distracted by acute discomfort. The nurse would want to teach the client before the surgery so that the client could practice the technique before experiencing post-surgical pain.

Which of the following statements made by the nurse regarding the clients self-assessment of pain requires immediate follow-up regarding the personal nature of pain? 1. THE MEDICATION SHOULD BE PROVIDING ENOUGH RELIEF, TRY TO AMBULATE HER 2. IVE NEVER KNOWN ANYONE TO HAVE SUCH PAIN AFTER THAT PROCEDURE 3. HE SHOULD BE ABLE TO AMBULATE WITH ONLY MINIMAL PAIN BY NOW 4. SHE SAYS SHES IN PAIN, BUT SHE DOESN'T ACT LIKE SHE IS IN PAIN

ANS: 4 It is not the responsibility of clients to prove that they are in pain; it is the nurses responsibility to accept clients report of pain. Although the other options appear to be insensitive to the clients pain, they are not as overtly critical

The nurse inquires of a postoperative client as to the need for pain medication. The client denies the need then but 30 minutes later reports, I am really in a lot of pain. Can you bring me my pain pill now? The nurse recognizes that the most immediate need for client education is related to explaining that: 1. HIS ORAL MEDICATION WILL TAKE APPROXIMATELY 30 MINUTES TO AFFECT HIS PAIN 2. THERE MAY BE A NEED TO ADMINISTER HIS PAIN MEDICATION VIA THE INTRAVENOUS ROUTE 3. PAIN MEDICATION IS MORE EFFECTIVE IF BLOOD LEVELS ARE MAINTAINED AT A CONSTANT LEVEL 4. HIS PAIN WILL BE MORE EFFECTIVELY MANAGED IF HE REPORTS A NEED FOR PAIN MEDICATION WHILE THE PAIN IN STILL TOLERABLE

ANS: 4 Teach clients the importance of reporting their pain sooner rather than later because the pain is better managed while it is still tolerable. Medication routes do affect the amount of time it will take to feel relief, and blood levels are a factor in pain management as well. The answer addresses the most general and immediate educational need.

Which of the following statements made by a nurse shows the greatest understanding of the personal nature of the pain experience? 1. I HAVE EXPERIENCED PAIN BEFORE, AND SO I HAVE GREAT COMPASSION FOR ANYONE DEALING WITH PAIN 2. PEOPLE HANDLE PAIN DIFFERENTLY, BUT EVERYONE IN PAIN IS ONLY INTERESTED IN HAVING THE PAIN STOP 3. MANAGING A CLIENTS PAIN IS THE SINGLE MOST IMPORTANT THING A NURSE CAN DO FOR A CLIENT EXPERIENCING PAIN 4. I CAN ONLY ACCEPT WHAT THE CLIENT REPORTS CONCERNING THE PAIN BEING FELT AND ATTEMPT TO INTERVENE SUCCESSFULLY IN ITS MANAGEMENT

ANS: 4 The nurse cannot see or feel the clients pain. Pain is purely subjective; no two persons experience pain in the same way, and no two painful events create identical responses or feelings in a person. A nursing responsibility requires that the nurse make good faith attempts to help minimize the pain and to advocate for the client to this end. The remaining options, while not inappropriate, do not express the most therapeutic attitude toward the nursing role regarding client pain.

The nurse is attempting to ambulate an older adult client who recently experienced a fall at the assisted living facility where he resides. The client is reluctant to walk and consents to move only to the chair, reporting that it hurts too much to walk. Which of the following nursing interventions is most therapeutic regarding this client? 1. ALLOW THE CLIENT TO REMAIN IN BED IN ORDER TO CONSERVE HIS ENERGY 2. TRANSFER HIM TO THE CHAIR, REALIZING SOME ACTIVITY IS PREFERABLE TO NONE 3. CALL HIS HEALTH CARE PROVIDER TO DISCUSS THE APPARENT INEFFECTIVENESS OF HIS PAIN MEDICATIONS 4. ASSESS THE CLIENT FOR OTHER FACTORS THAT MAY BE AFFECTING HIS ABILITY AND MOTIVATION TO AMBULATE

ANS: 4 The perception of pain is affected by both physical and emotional factors. The client may be expressing concern over his ability or desire to return to the assisted living facility and so perceives the pain as a barrier to ambulating. Thus physical pain can cause psychological pain and vice versa. The other options are either not therapeutic or not the initial action to be taken.

A priority nursing intervention when caring for a client who is receiving an epidural infusion for pain relief is to: 1. USE ASEPTIC TECHNIQUE 2. LABEL THE PORT AS AN EPIDURAL CATHETER 3. MONITOR VITAL SIGNS EVERY 15 MINUTES 4. AVOID SUPPLEMENTAL DOSES OF SEDATIVES

ANS:3 When clients are receiving epidural analgesia, monitoring occurs as often as every 15 minutes, including assessment of respiratory rate, respiratory effort, and skin color. Complications of epidural opioid use include nausea and vomiting, urinary retention, constipation, respiratory depression, and pruritus. A common complication of epidural anesthesia is hypotension. Assessing vital signs is the priority nursing intervention. Because of the catheter location, strict surgical asepsis is needed to prevent a serious and potentially fatal infection. To reduce the risk for accidental epidural injection of drugs intended for IV use, the catheter should be clearly labeled epidural catheter. Supplemental doses of opioids or sedative/hypnotics are avoided because of possible additive central nervous system adverse effects.

Which of the following statements by the nurse reflects a need for immediate follow-up regarding the physical effects of chronic pain on body function? 1. HIS PULSE AND BLOOD PRESSURE ARE WITHIN HIS NORMAL BASELINE LIMITS, SO IM SURE THE PAIN MEDICATION IS WORKING 2. PLEASE TAKE HIS PULSE AND BLOOD PRESSURE, AND LET ME KNOW IF THEY ARE ELEVATED ABOVE HIS NORMAL BASELINES 3. IF HIS PULSE AND BLOOD PRESSURE ARE ABOVE HIS NORMAL BASELINE, LET ME KNOW, AND I WILL MEDICATE HIM FOR PAIN 4. UNMANAGED PAIN USUALLY MANIFESTS ITSELF IN BOTH AN ELEVATED PULSE AND BLOOD PRESSURE

ANS: 1 Except in cases of severe traumatic pain, which sends a person into shock, most people reach a level of adaptation in which physical signs return to normal. Thus clients in pain will not always have changes in their vital signs. Changes in vital signs are more often indicative of problems other than pain. Although the remaining options recognize the phenomena, they are not assuming that no elevation of vital signs means the absence of pain.

The nursery nurse is explaining post-circumcision care to a new mother. Which of the following statements by the new mother indicates that additional teaching needs to occur? 1. BABIES DO NOT EXPERIENCE PAIN, SO I DO NOT NEED TO WORRY ABOUT HURTING HIM WHEN I TOUCH THE PENIS 2. I NEED TO BE CAREFUL NOT TO PUT HIS DIAPER ON TOO TIGHT TO AVOID DISCOMFORT 3. I CAN COMFORT MY BABY FOLLOWING THE PROCEDURE BY HOLDING HIM 4. THE HEALTH CARE PROVIDER WILL NUMB THE AREA BEFORE PERFORMING THE PROCEDURE

ANS: 1 Term neonates have the same sensitivity to pain as older infants and children. Preterm neonates have a greater sensitivity to pain than term neonates or older children.

Which of the following statements made by a client reporting severe pain expresses the most insight into how pain impacts a clients energy reserves? 1. I CANT SLEEP IF I DON'T GET SOMETHING FOR THIS PAIN 2. IF ONLY I COULD GET AN HOUR WHEN I WAS FREE OF THIS PAIN 3. IM EXHAUSTED PHYSICALLY AND EMOTIONALLY TRYING TO LIVE WITH THIS PAIN 4. I DON'T SEE HOW I CAN CONTINUE TO COPE WITH THIS PAIN; I NEED SOME RELIEF

ANS: 3 Pain is exhausting and demands a persons energy. The remaining options do express this fact but not as directly as the answer.

Which of the following is the most appropriate nursing intervention for a client who is receiving epidural analgesia? 1. CHANGE THE TUBING EVERY 48 TO 72 HOURS 2. CHANGE THE DRESSING EVERY SHIFT 3. SECURE THE CATHETER TO THE OUTSIDE SKIN 4. USE A BULKY OCCLUSIVE DRESSING OVER THE SITE

ANS: 3 To prevent catheter displacement, the catheter should be secured carefully to the outside skin. The infusion tubing should be changed every 24 hours to prevent infection. To prevent infection, the dressing should not be routinely changed over the site. A transparent dressing should be used over the site to secure the catheter and aid inspection.

Which of the following statements made by a nurse caring for a client reporting severe pain expresses the most insight into how pain impacts a clients energy reserves? 1. IF I CAN'T GET HIS PAIN UNDER CONTROL, HIS RECOVERY WILL TAKE A LOT LONGER 2. PAIN CERTAINLY INTERFERES WITH THE CLIENTS ABILITY TO REST AND RECUPERATE 3. IM GOING TO CALL FOR ANOTHER PAIN PRESCRIPTION SO HE CAN GET SOME REST 4. TRYING TO COPE WITH PAIN IS USING UP THE ENERGY THAT HIS RECOVERY REQUIRES

ANS: 4 Pain is exhausting and demands a persons energy. The remaining options do express this fact but not as directly as the answer.