Ch 35 - Comfort and Pain Management

The client is a new admission who reports lower right quadrant abdominal pain. The client is scheduled for an emergency appendectomy. What question(s) will the nurse ask the client in relation to the pain? Select all that apply. A. How do you rate your pain on a scale of 0 to 10? B. Does anything make the pain worse? C. How would you describe the pain? D. When did your pain begin? E. What medication have you taken to relieve the pain?

A, B, C, D, E - all answers correct. All of these questions are appropriate for a pain assessment. They are part of a comprehensive pain assessment, which is to be performed on the client's admission to a clinical facility. The nurse wants to quantify the client's pain as well as wants to qualify the client's pain by asking for a description of the pain in the client's own words. The nurse asks about the onset, which is when the pain began. It is important to know what medications the client has taken for pain relief. For this client, it is extremely important, because the client is going for emergency surgery. These medications could affect the client's outcome for the surgery.

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: Encourage deep breathing; Play the client's favorite music; Promote a restful environment. Anxiety, lack of sleep, and muscle tension may all increase the client's perceived intensity of pain. Therefore, the client's plan of care should include measures to promote sleep and decrease anxiety and muscle tension. These include relaxation techniques, such as deep breathing, favorite music, and restful environment. Use of a sitter, someone to be paid to stay with the client in the room at all times, is not indicated and may cause the client's anxiety level to increase. Encouraging increased protein does not aid in the client's perceived intensity of pain.

The three types of responses to pain are physiologic, behavioral, and affective. Which are examples of behavioral responses to pain? Select all that apply. A. A patient cradles a wrist that was injured in a car accident B. A child is moaning and crying due to a stomachache C. A patient's pulse is increased following a myocardial infarction D. A patient in pain strikes out at a nurse who attempts to provide a bath E. A patient who has chronic cancer pain is depressed and withdrawn F. A child pulls away from a nurse trying to give an injection

A, B, F: A patient cradles a wrist that was injured in a car accident; A child is moaning and crying due to a stomachache; A child pulls away from a nurse trying to give an injection Protecting or guarding a painful area, moaning and crying, and moving away from painful stimuli are behavioral responses. Examples of a physiologic or involuntary response would be increased blood pressure or dilation of the pupils. Affective responses, such as anger, withdrawal, and depression, are psychological in nature.

A nurse is monitoring patients in a hospital setting for acute and chronic pain. Which patients would most likely receive analgesics for chronic pain from the nurse? Select all that apply. A. A patient is receiving chemotherapy for bladder cancer B. An adolescent is admitted to the hospital for an appendectomy C. A patient is experiencing a ruptured aneurysm D. A patient who has fibromyalgia requests pain medication E. A patient has back pain related to an accident that occurred last year F. A patient is experiencing pain from second-degree burns

A, D, E: A patient is receiving chemotherapy for bladder cancer; A patient who has fibromyalgia requests pain medication; A patient has back pain related to an accident that occurred last year Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Examples are cancer pain, fibromyalgia pain, and back pain. Acute pain is generally rapid in onset and varies in intensity from mild to severe, as occurs with an emergency appendectomy, a ruptured aneurysm, and pain from burns.

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: Do not drive a vehicle while taking this medication; You must check with your primary care provider before breast-feeding your infant; Keep a diary to record level of pain and time medication is taken. The nurse will provide instructions about the medication prescribed for pain relief. This medication is an opioid, and extra precautions are required. The client is not to drive a vehicle while taking an opioid due to slowed reflexes and decreased cognitive thinking. The client is not to breast-feed her infant without checking with her primary care provider. The opioid may be absorbed into the breast milk and fed to the infant, which may adversely affect the infant. The client is to keep a diary about her pain experiences, which includes level of pain and time the medication was taken. This provides a more accurate documentation of the pain experience and prevents overdosage from taking the medication too frequently. The client is not to drink alcohol. Alcohol will depress the central nervous system when taken with an opioid and may lead to respiratory failure. The client may smoke, but someone will need to be present (for safety reasons) since the client may fall asleep due to the opioid. It does not matter whether it is day or night. The medication is not better absorbed when taken on an empty stomach. The client takes the pain medication with food, since nausea is a frequent side effect when the opioid is taken on an empty stomach.

How should the nurse position the head of the bed for a client receiving epidural opioids? A. Elevated 30 degrees B. Flat C. Reverse Trendelenburg D. Trendelenburg

A. Elevated 30 degrees The nurse should position the head of the bed so that it is elevated 30 degrees unless contraindicated. Elevation of the client's head minimizes upward migration of the opioid in the spinal cord, thereby decreasing the risk for respiratory depression. The Trendelenburg position is when the feet are higher than the head. Reverse Trendelenburg position or supine position is when the head is higher than the feet.

A nurse is conducting discharge teaching for a postoperative client prescribed oral pain medication. The client states that pain medications always causes nausea. What is the appropriate response by the nurse? A. "Do you take the medication on an empty stomach?" B. "Do not take the pain medication." C. "Take the pain medication with an antacid." D. "Does the nausea go away after a while?"

A. "Do you take the medication on an empty stomach?" The nurse should ask the client whether the pain medication is taken on an empty stomach, as this can be the reason for the nausea. Clients should be taught to avoid taking pain medication on an empty stomach. The nurse should not encourage the client to not take the medication if it is helping with the pain. Taking the medication with an antacid is not warranted because the antacid will neutralize acid, not stop the overproduction of the acid. Asking the client if the nausea goes away is not the right question to determine the cause of the nausea.

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. "I will remind my family member to push the PCA pump button for me if I doze off during the day." Sedation occurs before clinically significant respiratory depression. Thus, if the client is too sleepy to push the button (or ask that it be pushed), the button should not be pushed. The other answers are all correct.

A client receiving epidural analgesia asks the nurse to put the head of the bed all the way down to sleep better. What is the correct response by the nurse? A. "It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to minimize the risk of respiratory depression." B. "It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to decrease the risk of severe migraine headaches." C. "It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to increase the effectiveness of the spinal analgesia." D. "It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to prevent accidental dislodgement of the catheter."

A. "It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to minimize the risk of respiratory depression." The rationale for keeping the head of the bed elevated 30 degrees is that this position helps to minimize the upward migration of the opioid in the spinal cord, thereby minimizing the risk of respiratory depression. The nurse does not keep the head of the bed elevated to decrease the risk of migraines as migraines are not a common problem with epidural analgesia. Positioning of the client does not increase the effectiveness of the medication. Positioning also does not prevent accidental dislodgement of the catheter; this is accomplished by a secure dressing and taping the tubing so that it is not pulled.

The nurse is caring for a client who has a long history of using opioid pain medication. Which action will the nurse take to further assess the client's pain and provide pain relief? A. Acknowledge the pain as the client reports it and administer pain medication as prescribed. B. Observe the client's behavior when the nurse is not with the client. C. Take the client's vital signs often to observe for changes that may indicate pain. D. Report the client to the health care provider for seeking drugs.

A. Acknowledge the pain as the client reports it and administer pain medication as prescribed. Pain is subjective and the nurse must acknowledge pain as the client reports it. Observing the client's behavior is not an appropriate nursing intervention, as pain is a self-reported finding. Taking the client's vital signs would help in administering pain medications, as pain medicine can lower a client's blood pressure and heart rate. The nurse will not report the client to the health care provider; this is making assumptions about the client.

When the nurse assists a patient recovering from abdominal surgery to walk, the nurse observes that the patient grimaces, moves stiffly, and becomes pale. The nurse is aware that the patient has consistently refused pain medication. What would be a priority nursing diagnosis for this patient? A. Acute Pain related to fear of taking prescribed postoperative medications B. Impaired Physical Mobility related to surgical procedure C. Anxiety related to outcome of surgery D. Risk for Infection related to surgical incision

A. Acute Pain related to fear of taking prescribed postoperative medications The patient's immediate problem is the pain that is unrelieved because the patient refuses to take pain medication for an unknown reason. The other nursing diagnoses are plausible, but not a priority in this situation.

A nurse is caring for patients in a hospital setting. Which patient would the nurse place at risk for pain related to the mechanical activation of pain receptors? A. An older adult on bedrest following cervical spine surgery B. A patient with a severe sunburn being treated for dehydration C. An industrial worker who has burns caused by a caustic acid D. A patient experiencing cardiac disturbances from an electrical shock

A. An older adult on bedrest following cervical spine surgery Receptors in the skin and superficial organs may be stimulated by mechanical, thermal, chemical, and electrical agents. Friction from bed linens causing pressure sores is a mechanical stimulant. Sunburn is a thermal stimulant. An acid burn is the result of a chemical stimulant. An electrical shock is an electrical stimulant.

A client prescribed pain medication around the clock experiences pain 1 hour before the next dose of the pain medication is due. Which is the most appropriate action by the nurse? A. Assess for medication prescription for breakthrough pain. B. Tell the client he or she will have to wait for 1 hour. C. Administer the next dose of the pain medication. D. Assess the client for signs of opioid addiction.

A. Assess for medication prescription for breakthrough pain. Breakthrough pain is a temporary flare-up of moderate to severe pain that occurs even when the client is taking pain medication around the clock. It can occur before the next dose of analgesic is due (end of dose pain). It is treated most effectively with supplemental doses of a short-acting opioid taken on an "as needed basis." Therefore, the nurse should check for a prescription for breakthrough pain medication. Telling the client that he or she has to wait is not a therapeutic action by the nurse. Administering the next dose of pain medication is a violation of nursing practice and does not follow the standard of care. The nurse needs to assess for the therapeutic effects of the pain medication and not opioid addiction.

The nurse is assessing the pain of a neonate who is admitted to the NICU with a heart defect. Which pain assessment scale would be the best tool to use with this patient? A. CRIES scale B. COMFORT scale C. FLACC scale D. FACES scale

A. CRIES scale The CRIES Pain Scale is a tool intended for use with neonates and infants from 0 to 6 months. The COMFORT Scale, used to assess pain and distress in critically ill pediatric patients, relies on six behavioral and two physiologic factors that determine the level of analgesia needed to adequately relieve pain in these children. The FLACC Scale (F-Faces, L-Legs, A-Activity, C-Cry, C-Consolability) was designed for infants and children from age 2 months to 7 years who are unable to validate the presence or severity of pain. The FACES Scale is used for children who can compare their pain to the faces depicted on the scale.

While providing a back massage, the nurse observes a reddened area on the client's sacral area. Which action by the nurse is appropriate? A. Document the finding. B. Apply a warm compress to the area. C. Massage the area using lotion. D. Stop the back massage immediately.

A. Document the finding. The nurse should document this finding after completion of the back massage and client care and report it to the health care provider. The nurse would also position the client to remove any pressure from that area. The nurse should not apply a warm compress or massage the reddened area.

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. Endorphins Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals, which have prolonged analgesic effects and produce euphoria. It is thought that certain measures, such as skin stimulation and relaxation techniques, release endorphins. Serotonin is an important chemical and neurotransmitter in the human body. It is believed that serotonin helps regulate mood and social behavior, appetite and digestion, sleep, memory, and sexual desire and function. Melatonin is a hormone that is produced by the pineal gland in humans and animals and regulates sleep and wakefulness. Dopamine is a neurotransmitter that helps control the brain's reward and pleasure centers.

Which of the following is considered to be the most potent neuromodulators? A. Endorphins B. Enkephalins C. Efferent D. Afferent

A. Endorphins Endorphins and enkephalins are opioid neuromodulators. Endorphins are powerful pain blocking chemicals with prolonged analgesic effects. Enkephalins are considered less potent. There are no neuromodulators called efferent or afferent.

The spouse of a client with cancer asks why the client's breakthrough doses of morphine have recently needed to be higher and more frequent for the client to achieve pain relief? Which response by the nurse is appropriate? A. Higher doses are needed because the client has developed a tolerance to the morphine. B. The client is now addicted to the morphine and requires higher doses. C. The higher dose is due to the client's physical dependence on the morphine. D. The morphine is having more drug interactions with the client's other medications, requiring a higher dose.

A. Higher doses are needed because the client has developed a tolerance to the morphine. This client is likely developing drug tolerance, which occurs when the body becomes accustomed to the opioid and needs a larger dose each time for pain relief. This is not a pathologic finding and does not necessarily indicate physical dependence. Addiction is the fact or condition of being addicted to a particular substance, thing, or activity. Tolerance does not indicate addiction or a heightened risk for addiction. A drug interaction is a reaction between two (or more) drugs or between a drug and a food or beverage.

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. How does the pain develop and progress? When assessing the chronology of the client's pain, the nurse could ask the client how the pain develops and progresses. To assess the quality of the client's pain, the nurse could ask for the client to describe the pain. To assess the quantity of the pain, the client could be asked to rate the pain on a scale of 0 to 10. To assess the alleviating factor of the pain, the nurse could ask what the client does to alleviate the pain and how well it works.

A 77-year-old woman is on the nurse's unit s/p left knee replacement. The client typically stools every morning but has not had a bowel movement in 3 days. The nurse knows that which medication places the client at increased risk for constipation? A. Hydromorphone B. Psyllium C. Acetaminophen D. Furosemide

A. Hydromorphone Hydromorphone is an opioid agent which is often constipating in older adults. Psyllium helps promote regular bowel elimination. Acetaminophen is not linked to constipation. Furosemide is used as a diuretic. It does not cause constipation.

The nurse preparing to admit a client receiving epidural opioids should make sure that which of the following medications is readily available on the unit? A. Naloxone B. Furosemide C. Lisinopril D. Digoxin

A. Naloxone The nurse should ensure that naloxone is readily available on the unit, as it can reverse the respiratory depressant effects of opioids. Naloxone is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. Furosemide is a loop diuretic and used to treat hypertension (high blood pressure) and edema. Lisinopril is an angiotensin converting enzyme (ACE) inhibitor used for treating high blood pressure, heart failure and for preventing kidney failure due to high blood pressure and diabetes. Digoxin is used to treat congestive heart failure.

Which principle should the nurse integrate into the pain assessment and pain management of pediatric clients? A. Pain assessment may require multiple methods in order to ensure accurate pain data. B. The developing neurologic system of children transmits less pain than in older clients. C. Pharmacologic pain relief should be used only as an intervention of last resort. D. A numeric scale should be used to assess pain if the child is older than 5 years of age.

A. Pain assessment may require multiple methods in order to ensure accurate pain data. It is often necessary to use more than one technique for pain assessment in children. Though their neurologic system is indeed developing, children feel pain acutely, and it is inappropriate to withhold analgesics until they are a "last resort." It is simplistic to specify a numeric pain scale for all clients above a certain age; the assessment tool should reflect the client's specific circumstances, abilities, and development.

The nurse is preparing a care plan for a client receiving opioid analgesics. Which factors associated with opioid analgesic use will the nurse include in the plan of care? A. Preventing constipation B. Observing for diarrhea C. Assessing for impaired urinary elimination D. Observing for bowel incontinence

A. Preventing constipation The most common side effects associated with opioid use are sedation, nausea, and constipation. Respiratory depression is also a commonly feared side effect of opioid use. Urinary elimination and bowel incontinence are not affected by opioid use.

Which is the priority assessment for a nurse caring for a client with a Patient Controlled Analgesia (PCA) pump? A. Respiratory B. Cardiovascular C. Peripheral Vascular D. Neuromuscular

A. Respiratory The priority assessment for the nurse caring for a client with a PCA pump is respiratory, with particular attention to the respiratory rate and pattern. Too much opioid or a displaced catheter may allow the medication to have a depressant effect on the brainstem center, causing life-threatening respiratory depression. The cardiac system can be affect by a opioid PCA by decreasing the blood pressure and heart rate as the pain decreases. It is expected but not the priority. The neuromuscular and peripheral vascular system are not affected by the PCA.

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. The dose that is delivered when the client activates the machine is preset. PCAs are designed to make it impossible for the client to exceed the client-specific dosing parameters programmed into the machine. PCAs do not administer antidotes, and they are almost always used to deliver opioid analgesics. The client does not need to be educated about overdoses.

The nurse is providing education to a client about the role of endogenous opioids in the transmission of pain. Which information about the release of endogenous opioids is most accurate? A. They bind to opioid receptor sites throughout the CNS. B. They react with acetylcholine and serotonin. C. They occupy cell receptors for neurotransmitters. D. They block glutamate receptors and peptides.

A. They bind to opioid receptor sites throughout the CNS. When endogenous opioids are released, they are believed to produce their analgesic effects by binding to specific opioid receptor sites throughout the central nervous system (CNS), blocking the release or production of pain-transmitting substances.

The nurse is employing gate theory in the care of a client with pain in the lower back. What actions by the nurse may assist in pain relief for the client? A. Use massage and heat application to the lower back B. Administer opioid analgesics C. Have the client perform active exercises to stretch the back muscles D. Encourage the client to have an epidural steroid injection

A. Use massage and heat application to the lower back The gate theory appears to explain why mechanical and electrical interventions or heat and pressure may provide effective pain relief. Nursing measures, such as massage or a warm compress to a painful lower back area, stimulate large nerve fibers to close the gate, thus blocking pain impulses from that area. Teaching self-management techniques that activate closing the gate may also minimize the experience of pain. Pain medication and epidural anesthesia are not a part of gate theory interventions. Stretches and active exercises may cause further injury to the client.

You are a new nurse in an ambulatory care setting. You know that the Joint Commission requires that pain be addressed at each visit. When is the most appropriate time to do so? A. When obtaining client vital signs B. Before the client is discharged C. The first question you ask the client D. At several points throughout your history-taking

A. When obtaining client vital signs Pain should be addressed during your first encounter with the client. However, you will probably want to start a professional conversation prior to addressing pain. Vital signs are often collected in the beginning of the client visit. This would be the most appropriate time to address pain.

When performing an assessment on a client with chronic pain, the nurse notes that the client frequently shifts conversational topics. What does the nurse determine this may indicate? A. anxiety B. depression C. boredom D. moodiness

A. anxiety Clients in pain may experience anxiety, and the anxiety may also increase the perception of pain. Signs of anxiety include decreased attention span or ability to follow directions, asking frequent questions, shifting topics of conversation, and avoidance of discussion of feelings. Depression can elicit symptoms of insomnia or sleepiness. Boredom is a verbal expression of feeling unsatisfied by an activity or being uninterested in it. Moodiness describes minor daily mood changes that can elicit emotions of happiness and then sadness or vice versa.

A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as: A. biofeedback. B. transcutaneous electrical nerve stimulation (TENS). C. hypnosis. D. Therapeutic Touch (TT).

A. biofeedback. Biofeedback is a technique that uses a machine to monitor physiologic responses through electrode sensors on the client's skin. The unit transforms the data into a visual display, and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. Transcutaneous electrical nerve stimulation (TENS) is a noninvasive alternative technique that involves electrical stimulation of large-diameter fibers to inhibit transmission of painful stimuli carried over small-diameter fibers. Hypnosis is an alteration in a person's state of consciousness so that pain is not perceived as it normally would be. Therapeutic Touch involves using one's hands to direct an energy exchange consciously from the practitioner to the client in order to facilitate healing or pain relief.

A nurse is caring for a client who was administered an opioid. The client reports constipation. What is another potential side effect of opioid use? A. sedation B. anxiety C. diarrhea D. insomnia

A. sedation Opioids and opiates can cause sedation, nausea, and constipation. They also can cause respiratory depression, which is the main side effect to watch for with opioid use. Opioids and opiates do not lead to anxiety, diarrhea, or insomnia in clients.

A male college student age 20 years has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is the client most likely experiencing? A. visceral pain B. referred pain C. cutaneous pain D. somatic pain

A. visceral pain Visceral pain occurs when organs stretch abnormally and become distended, ischemic, or inflamed. Appendicitis is characterized by inflammation of the vermiform appendix. Cutaneous pain is superficial. Somatic pain is more commonly associated with tendons, ligaments, and bones. Referred pain is perceived distant from its point of origin, but this client's pain is sensed near the location of his appendix.

A nurse instructor is teaching a class of student nurses about the nature of pain. Which statements accurately describe this phenomenon? Select all that apply. A. Pain is whatever the health care provider treating the pain says it is B. Pain exists whenever the person experiencing it says it exists C. Pain is an emotional and sensory reaction to tissue damage D. Pain is a simple, universal, and easy-to-describe phenomenon E. Pain that occurs without a known cause is psychological in nature F. Pain is classified by duration, location, source, transmission, and etiology

B, C, F: Pain exists whenever the person experiencing it says it exists; Pain is an emotional and sensory reaction to tissue damage; Pain is classified by duration, location, source, transmission, and etiology Margo McCaffery offers the classic definition of pain that is probably of greatest benefit to nurses and their patients, "Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does." The International Association for the Study of Pain further defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is an elusive and complex phenomenon, and despite its universality, its exact nature remains a mystery. Pain is present whenever a person says it is, even when no specific cause of the pain can be found. Pain may be classified according to its duration, its location or source, its mode of transmission, or its etiology.

The nurse is caring for a client who reports muscular and joint pain after an ankle sprain when playing soccer last week. How will the nurse document this type of pain? Select all that apply. A. cutaneous B. somatic C. visceral D. referred E. acute

B, E: somatic; acute Based on the information about the client, the nurse documents the pain as somatic, acute pain. Somatic pain develops from injury to structures such as muscles, tendons, and joints. Cutaneous, visceral, referred, chronic, and neuropathic pain are not reflected in this scenario.

A postoperative vaginal hysterectomy client complains of pain that is more intense than this morning. This factor should be explained to the client as A. "Your present pain is worse because you had your packing removed." B. "Acute pain tends to increase during the day and is called a routine pain response" C. "I will call your doctor because you may have loosened sutures when walking." D. "You will need more pain medication as the days progress."

B. "Acute pain tends to increase during the day and is called a routine pain response" Acute pain occurs abruptly after an injury or disease and persists until healing occurs. Acute pain also may be associated with anxiety and fear. Acute pain consistently increases at night and during wound care, ambulation, coughing, and deep breathing.

The nurse is taking a history for a pregnant client who has been seen for chronic headaches for 2 years. Today, the client reports a headache that feels different than the normal headaches she has experienced in the past. Which assessment question helps the nurse assess quality of pain? A. "When did your pain begin?" B. "Can you describe the type of pain you are having?" C. "Could you please rate your pain on a 1-10 scale?" D. "How long have you experienced this pain?"

B. "Can you describe the type of pain you are having?" Asking the client to describe the pain establishes quality. Asking the client to rate pain on a 1-10 scale reflects intensity. Asking how long the pain has existed reflects duration. Asking when the pain began reflects onset.

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. "I could use the TENS unit if I feel pain somewhere else on my body." The client needs further instruction when they say they can use the TENS unit on other areas of the body. Such a statement would indicate that the client does not understand that the unit should be used as prescribed by the physician in the location defined by the physician. The TENS unit will decrease the amount of the pain medication used by the client as it increases the blood supply to the injured area and will not interfere with the activities of daily living.

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. "I should only take medication when my pain is intense." PCA pumps allow the client to control the amount and timing of pain medication by pushing a button when the sensation of pain occurs versus waiting until the pain becomes intense. The pump is programmed with a lockout period that limits the chance of clients overmedicating themselves.

The nurse is performing assessments for clients admitted in the emergency department. Which client is most likely experiencing somatic pain? A. A client suspected to have a perforated peptic ulcer B. A client who has a sprained ankle C. A client with chest pain who is having a myocardial infarction D. A client who has appendicitis

B. A client who has a sprained ankle Somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep somatic pain. Visceral pain, or splanchnic pain, is poorly localized and originates in body organs in the thorax, cranium, and abdomen. Visceral pain is one of the most common types of pain produced by disease, and occurs as organs stretch abnormally and become distended, ischemic, or inflamed such as with a ruptured peptic ulcer or appendicitis. A client having a myocardial infarction with chest pain is experiencing referred pain.

Which medical client is most likely to be experiencing diffuse pain? A. A client who is undergoing diagnostic testing for appendicitis B. A client with shingles affecting her entire torso C. A client who has presented to the emergency department with a stab wound D. A client who has been prescribed antibiotics for the treatment of strep throat

B. A client with shingles affecting her entire torso Diffuse pain is pain that covers a large area and, usually, the client is unable to point to a specific area without moving the hand over a large surface, such as the client's entire torso. Pain related to appendicitis, a stab wound, or strep throat is more likely to be localized and sharp.

A nurse is assessing a patient receiving a continuous opioid infusion. For which related condition would the nurse immediately notify the primary care provider? A. A respiratory rate of 10/min with normal depth B. A sedation level of 4 C. Mild confusion D. Reported constipation

B. A sedation level of 4 Sedation level is more indicative of respiratory depression because a drop in level usually precedes it. A sedation level of 4 calls for immediate action because the patient has minimal or no response to stimuli. A respiratory level of 10 with normal depth of breathing is usually not a cause for alarm. Mild confusion may be evident with the initial dose and then disappear; additional observation is necessary. Constipation should be reported to the health care provider, but is not the priority in this situation.

A client is prescribed pain medication every 4 to 6 hours as needed. When the nurse enters the client's room to administer the medication, the client is laughing with visitors. The client's pulse rate is 64, respirations 16, and blood pressure 120/80. The client reports pain and wants the medication. What is the most appropriate action by the nurse? A. Hold the pain medication at this time. B. Administer the pain medication. C. Reassess the need for pain medication in 30 minutes. D. Encourage the client to use alternative pain relief measures.

B. Administer the pain medication. Pain is present whenever the client perceives being in pain. The client is prescribed the medication, the client's vital signs are within acceptable range, and the client reports being in pain. Therefore, the nurse should administer the pain medication as prescribed. Holding the pain medication is an inappropriate action. The nurse should reassess the pain in 30 after giving the pain medication. The client can use alternative pain relieve measures to assist with the effects of the pain medication.

Applying the gate control theory of pain, what would be an effective nursing intervention for a patient with lower back pain? A. Encouraging regular use of analgesics B. Applying a moist heating pad to the area at prescribed intervals C. Reviewing the pain experience with the patient D. Ambulating the patient after administering medication

B. Applying a moist heating pad to the area at prescribed intervals Nursing measures such as applying warmth to the lower back stimulate the large nerve fibers to close the gate and block the pain. The other choices do not involve attempts to stimulate large nerve fibers that interfere with pain transmission as explained by the gate control theory.

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. Ask the boy to draw a cartoon about the color or shape of his pain. Asking the boy to draw a cartoon about the color or shape of his pain is an excellent intervention by the nurse. The child could be in pain and not complaining, so ignoring the boy's pain is not correct. Distracting the boy so he does not notice his pain would not be appropriate. Medicating the boy with analgesics to reduce the anxiety of experiencing the pain is not correct. Addressing the anxiety does not address the pain.

A neonatal nurse is caring for a 2-day-old infant who experienced shoulder subluxation during delivery. What pain assessment scale should the nurse use to assess this client's pain? A. Wong-Baker B. CRIES Pain Scale C. FLACC Scale D. PAINAD Scale

B. CRIES Pain Scale The CRIES scale is appropriate for neonates (0 to 6 months). The Wong-Baker Faces Pain Rating scale requires children to be at least 3 years old. The FLACC scale is used for infants and children (2 months to 7 years) unable to validate the presence of or quantify pain severity; and the PAINAD scale is specific to the needs of clients with dementia.

The nurse is preparing to administer an NSAID to a client for pain relief. The nurse notices that the client is diagnosed with a bleeding disorder. What should the nurse do? A. Administer the medication. B. Contact the health care provider. C. Ask the client if the medication is desired. D. Administer the medication with food.

B. Contact the health care provider. The nurse should contact the health care provider regarding the diagnosis of a bleeding disorder and the prescription for the NSAID. NSAIDs are contraindicated in clients with bleeding disorders, because the action of the NSAID can interfere with the client's platelet function. Administering the medication is not warranted because the nurse has identified a problem that can affect the safety of the client. Asking the client if the medication is desired will not change the risk. Administering the medication with food can affect the safety of the client.

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. Cutaneous stimulation Cutaneous stimulation techniques include acupressure, massage, application of heat and cold, and transcutaneous electrical nerve stimulation (TENS).

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. Guarding of the chest area A person's behavioral response to pain can be demonstrated by protecting or guarding the painful area, grimacing, crying, or moaning. Increased blood pressure and respiratory rate are typical physiologic (sympathetic) responses to moderate pain. Decreased heart rate is a typical physiologic (parasympathetic) response to severe pain.

When assessing pain in a child, the nurse needs to be aware of what considerations? A. Immature neurologic development results in reduced sensation of pain B. Inadequate or inconsistent relief of pain is widespread C. Reliable assessment tools are currently unavailable D. Narcotic analgesic use should be avoided

B. Inadequate or inconsistent relief of pain is widespread Health care personnel are only now becoming aware of pain relief as a priority for children in pain. The evidence supports the fact that children do indeed feel pain and reliable assessment tools are available specifically for the use with children. Opioid analgesics may be safely used with children as long as they are carefully monitored.

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 as needed for pain. What type of order is this considered? A. standing order B. PRN order C. one-time order D. stat order

B. PRN order A PRN order is one that is given to a client on an "as needed" basis.

A client who is living with chronic pain has received a health care provider's order for TENS. When applying the device to the client's skin, the nurse should do what action? A. Turn on the unit shortly before applying the electrodes to the client's skin. B. Start with the lowest intensity and gradually increase it to the appropriate level. C. Disinfect with chlorhexidine the areas where the electrodes will be applied D. Administer analgesia 30 minutes before beginning a TENS session.

B. Start with the lowest intensity and gradually increase it to the appropriate level. After applying the electrodes, the nurse should turn on the unit and adjust the intensity setting to the lowest intensity and determine if the client can feel a tingling, burning, or buzzing sensation. The nurse should then adjust the intensity to the prescribed amount or the setting most comfortable for the client. Skin should be clean before applying the electrodes, but it is unnecessary to use disinfectant. Analgesia may or may not be necessary before a TENS session.

The nurse is caring for a client whose pain is being treated with epidural analgesia. Which nursing action is most appropriate? A. If the client develops a headache, an opioid analgesic may be administered along with the epidural analgesia. B. The anesthesiologist/pain management team should be notified immediately if the client's respiratory rate is below 10 breaths/min. C. If a client is experiencing adverse effects, a peripheral IV line should be inserted to allow immediate administration of emergency drugs, if warranted. D. The nurse should expect slight resistance during the removal of the epidural catheter.

B. The anesthesiologist/pain management team should be notified immediately if the client's respiratory rate is below 10 breaths/min. The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min or has unmanaged pain, leakage at the insertion site, fever, inability to void, paresthesia, itching, or headache. No other medications should be administered; a peripheral IV line should already be in place. Resistance should not be felt when removing an epidural catheter.

A cancer client's care plan includes the use of a transcutaneous electrical nerve stimulation (TENS) unit. Which action should be included in the plan? A. Unlicensed assistive personnel (UAP) may apply the device, if necessary. B. The unit should be turned off whenever repositioning the electrodes. C. TENS should not be used if the client is being treated with opioid analgesics. D. Water should be kept far from the client to reduce the risk of electrocution.

B. The unit should be turned off whenever repositioning the electrodes. The unit should be turned off to remove or reposition electrodes. Application of TENS is not delegated to UAP. Opioids do not contraindicate the use of TENS and there is no associated risk of electrocution.

A patient reports abdominal pain that is difficult to localize. The nurse documents this as which type of pain? A. Cutaneous B. Visceral C. Superficial D. Somatic

B. Visceral The patient's pain would be categorized as visceral pain, which is poorly localized and can originate in body organs in the abdomen. Cutaneous pain (superficial pain) usually involves the skin or subcutaneous tissue. A paper cut that produces sharp pain with a burning sensation is an example of cutaneous pain. Deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep somatic pain.

The nurse is caring for a client newly diagnosed with chronic pain. When preparing to educate the client regarding chronic pain and management they ask who should be involved in the teaching. Which response is best? A. "Your spouse or caregiver." B. "Your best friend." C. "Anyone you think needs to know." D. "One of your neighbors will do."

C. "Anyone you think needs to know." Teaching about pain should include anyone the client identifies as needing the information so that they understand the concept of pain and are able to help the person in pain. Designated people can be family members, caregivers, friends, or neighbors; therefore, the correct answer is whomever the client identifies as needing the information.

The nurse is caring for a client utilizing a Patient Controlled Analgesia (PCA) pump that is programmed to allow a bolus dose every 10 minutes. The client is sleeping with visitors at the bedside. Which of the following instructions should the nurse give the client's visitors? A. "Push the button on the pump every 10 minutes." B. "Push the pump button when you think the client is in pain." C. "Only the client should push the pump button." D. "Remind the client to push the button more often than every 10 minutes."

C. "Only the client should push the pump button." The nurse should instruct the visitors that only the client should push the button on the pump to administer the bolus pain medication. Unauthorized family members or caregivers (instead of the client) who administer PCA by pushing the dosage button can cause serious analgesic overdoses resulting in oversedation, respiratory depression, and death. The client should push the pump's button only when feeling the sensation of pain.

A client is postoperative day 1 and the nurse's assessment reveals signs of pain, such as grimacing and guarding. Which is the most reliable method for assessing the client's pain? A. Assess and document the client's behaviors over a period of hours. B. Compare the client's presentation to expected outcomes at this point in recovery. C. Ask the client to describe and rate their pain. D. Correlate the client's vital signs with their symptoms.

C. Ask the client to describe and rate their pain. Pain is whatever the experiencing person says it is, existing whenever the person says it does. This definition rests on the belief that the only one who can be a real authority on whether a person is experiencing pain is that individual. Because pain is subjective, self-report is generally considered the most reliable way to assess pain and should be used whenever possible. It is superior to objective assessments, even though these may inform the nurse's decision-making.

The client had orthopedic surgery 2 days ago. Physical therapy is scheduled in 1 hour. During the nurse's rounds, the client reports postoperative pain as mild and denies needing the prescribed oral pain medication. Which nursing action will best aid in mobilizing the client? A. Praise the client for experiencing mild pain and not needing pain medication. B. Do not administer the oral pain medication per the client's request. C. Encourage the client to take a dose of the pain medication now. D. Plan to administer the pain medication in 1 hour.

C. Encourage the client to take a dose of the pain medication now. It is appropriate to administer pain medication prior to an activity that would produce an increase in pain. If the client takes the pain medication now, there is adequate time for the medication to be absorbed and metabolized. The client will then be better able to participate in the physical therapy exercises. Delaying administration for 1 hour will not allow the client to participate fully in physical therapy. Praising the client and not administering the medication does not aid in the mobility of the client. It will actually hinder the client because the client will limit activity due to pain.

A nurse uses a whirlpool to relax a patient following intense physical therapy to restore movement in the patient's legs. What is a potent pain-blocking neuromodulator, released through relaxation techniques? A. Prostaglandins B. Substance P C. Endorphins D. Serotonin

C. Endorphins Endorphins are produced at neural synapses at various points along the CNS pathway. They are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that endorphins are released through pain relief measures, such as relaxation techniques. Prostaglandins, substance P, and serotonin (a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and produce vasoconstriction) are neurotransmitters or substances that either excite or inhibit target nerve cells.

The nurse recognizes which statement is true of chronic pain? A. It can be easily described by the client. B. It is always present and intense. C. It may cause depression in clients. D. It disappears with treatment.

C. It may cause depression in clients. Chronic pain may lead to withdrawal, depression, anger, frustration, and dependency. Clients have difficulty describing chronic pain because it may be poorly localized. Moreover, health care personnel have difficulty assessing it accurately because of the unique responses of individual clients to persistent pain. Chronic pain is commonly characterized by periods of remission and exacerbation.

A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client? A. NSAIDs B. Corticosteroids C. Opioid analgesics D. Nonopioid analgesics

C. Opioid analgesics The nurse would expect to administer opioid analgesics to a client with severe pain following a mastectomy. Nonopioid analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), are usually the drugs of choice for both acute and persistent moderate chronic pain. Corticosteroids would be used to address inflammation and swelling.

A nurse has attended a pain control workshop and learned about the psychological and physiological basis of placebos. What principle should guide the use of placebos in the treatment of pain? A. Placebos can effectively treat pain while avoiding unpleasant side effects of opioids. B. Placebos may be used in the treatment of pain in clients who have allergies or addictions. C. Placebos involve the use of deception and are considered unethical in most circumstances. D. Placebos should be used if the client provides written consent for their use.

C. Placebos involve the use of deception and are considered unethical in most circumstances. Placebos have been shown to have some efficacy in the control of pain. However, because they involve deception they are usually considered unethical. In most circumstances, this fact overrides their possible efficacy. When a client is informed that a pill is a placebo, it loses the essential characteristic of a placebo.

The nurse implements cutaneous stimulation for a client as part of a strategy for pain relief. Which nursing action exemplifies the use of this technique? A. The nurse plays soft music in the client's room. B. The nurse assists the client to focus on something pleasant rather than on pain. C. The nurse gives the client a massage before bed. D. The nurse teaches the client deep-breathing techniques for relaxation.

C. The nurse gives the client a massage before bed. Some forms of cutaneous stimulation include massage, application of heat or cold (or both intermittently), acupressure, and transcutaneous electrical nerve stimulation (TENS). All the options listed are examples of complementary and alternative relief measures, but only massage is an example of cutaneous stimulation.

When developing the care plan for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain not related to cancer or palliative/end-of-life care is most effectively relieved through which method? A. Using the highest effective dose of an opioid on a PRN (as needed) basis B. Using nonopioid drugs conservatively C. Using consistent nonpharmacologic and nonopioid pharmacologic therapies D. Administering a continuous intravenous infusion on a regular basis

C. Using consistent nonpharmacologic and nonopioid pharmacologic therapies Nonpharmacologic and nonopioid pharmacologic therapies are the preferred choices for chronic pain that is not related to active cancer, palliative care, or end-of-life care. If progression to opioids becomes necessary, the lowest effective dose of an immediate-release opioid should be initiated first. Ongoing assessment and careful monitoring should guide the prescription of opioids for the management of chronic pain. A PRN (as needeD) drug regimen has not been proven effective for people experiencing chronic or acute pain. In the early postoperative period, when pain is expected, this protocol may result in an intense pain experience for the patient. Later, however, in the postoperative course, a PRN schedule may be acceptable to relieve occasional pain episodes.

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. referred pain Pain from the abdominal, pelvic, or back region may be referred to areas far distant from the site of tissue damage. Acute pain is distinct from chronic pain and is relatively more sharp and severe and lasts from 3 to 6 months. Chronic pain is often defined as any pain lasting more than 12 weeks. Limited pain is not usually a term used.

The nurse is performing an assessment for a client related to pain. To determine the need for pain medication, on what primary source will the nurse base the decision? A. generalized increase in metabolism B. increased respiratory rate C. verbal report D. nonverbal clues

C. verbal report Verbal reports of pain, although subjective, are the most dependable indicators of pain in people who are able to communicate verbally. Therefore, the nurse should use them as the primary source of data, even if they vary from other objective information. The nurse also collects objective data. Pain often increases respiratory and heart rates, as well as blood pressure. Pain often sets off a generalized increase in metabolism, such as an increase in oxygen consumption, blood glucose, free fatty acids, blood lactate, and ketones. Nonverbal cues, such as grimacing and increased muscle tension, may also be used.

Two hours after receiving a pain medication, the client reports still suffering from pain. Which response is most appropriate? 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. "Tell me more about your pain." Pain intensity indicates the magnitude or amount of pain perceived. Terms used to describe pain intensity include none, mild, slight, moderate, severe, and excruciating. Pain intensity also may be described on a numeric scale. The most appropriate assessment is one which allows for all information and is broad.

The nurse is assessing a client who is experiencing pain. The nurse notes the client is experiencing acute rather than chronic pain when the client makes which statement? A. "No amount of medication seems to relieve the pain completely." B. "I am experiencing a very low mood right now." C. "I cannot recall when this pain started." D. "The pain is really sharp in this one spot."

D. "The pain is really sharp in this one spot." Acute pain can be differentiated from chronic pain because it is specific and localized, whereas chronic pain tends to be nonspecific and generalized. Clients experiencing acute pain will indicate a recent onset whereas chronic pain has a remote onset. Acute pain is associated with sympathetic nervous system responses such as hypertension, tachycardia, restlessness, and anxiety, whereas chronic pain features the absence of autonomic nervous system responses and manifests with depression and irritability. Acute pain responds favorably when pain medication is administered. Chronic pain requires more frequent and higher doses of pain medication to elicit a positive response due to the threshold people build to the efficacy over time.

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 with safeguards to limit the possibility overmedication."

D. "The pump is programmed with safeguards to limit the possibility overmedication." The parameters programmed into the PCA pump prevent accidental overdose. Addiction is not a realistic risk for most clients. Care related to a PCA is not delegated to unlicensed care providers. The button should be pushed only by the client.

A patient is postoperative following an emergency cesarean section birth. The patient asks the nurse about the use of pain medications following surgery. What would be a correct response by the nurse? A. "It's not a good idea to ask for pain medication regularly as it can be addictive." B. "It is better to wait until the pain is severe before asking for pain medication." C. "It's natural to have to put up with pain after surgery and it will lessen in intensity in a few days." D. "Your doctor has prescribed pain medications for you, which you should request when you have pain."

D. "Your doctor has prescribed pain medications for you, which you should request when you have pain." Many pain medications are ordered on a PRN (as needed) basis. Therefore, nurses must be diligent to assess patients for pain and administer medications as needed. A patient should not be afraid to request these medications and should not wait until the pain is unbearable. Few people become addicted to the medications if used for a short period of time. Pain following surgery can be controlled and should be considered a natural part of the experience that will lessen in time.

Charles is an 86-year-old man with chronic lower back pain. He asks you what some appropriate treatments might be for his back pain. Which would you not expect to be ordered as first-line therapy? A. Physical therapy referral B. A walking aid C. Acupuncture D. A chronic opioid therapy plan

D. A chronic opioid therapy plan Opioids are not contraindicated in older adults but are rarely used in chronic pain prior to nonpharmacologic measures.

A patient who is having a myocardial infarction reports pain that is situated in the neck. The nurse documents this as what type of pain? A. Transient pain B. Superficial pain C. Phantom pain D. Referred pain

D. Referred pain Referred pain is perceived in an area distant from its point of origin, whereas transient pain is brief and passes quickly. Superficial pain originates in the skin or subcutaneous tissue. Phantom pain may occur in a person who has had a body part amputated, either surgically or traumatically.

A pregnant woman is receiving an epidural analgesic prior to delivery. The nurse provides vigilant monitoring of this patient to prevent the occurrence of what side effect? A. Pruritus B. Urinary retention C. Vomiting D. Respiratory depression

D. Respiratory depression Too much of an opioid drug given by way of an epidural catheter or a displaced catheter may result in the occurrence of respiratory depression. Pruritus, urinary retention, and vomiting may occur but are not life threatening.

A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse caring for the client explains the functioning of PCA. What is the main advantage of PCA? A. The client obtains pain relief slowly and steadily. B. The client requires less nursing care. C. The client is able to have long hours of rest. D. The client is actively involved in pain management.

D. The client is actively involved in pain management. Patient-controlled analgesia (PCA) gives the client the advantage of playing an active role in pain management, as the client is allowed to self-administer medication. Pain relief is rapid, not slow and steady, because the drug is delivered intravenously. PCA does not replace nursing care or reduce the amount of care that the client requires.

When the male client on his first postoperative day after chest surgery appears stoic and does not ask for any pain medication, the nurse should: A. document the client's lack of medication. B. assume the client does not need medication. C. ask the client's family if he ever uses pain medicines. D. actively solicit information about the client's pain level.

D. actively solicit information about the client's pain level. Some cultures see pain tolerance as a virtue; often men are expected to tolerate pain more stoically than women do. Health care providers need to recognize the client's cultural beliefs and not impose their own judgments.

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. reviewing and revising the pain management treatment plan The nurse's focal point should be on reviewing and revising the pain management treatment plan presently in place. The client is status-post bowel resection, so administering a placebo is not the correction option, and could be ethically wrong. The nurse would possibly do a depression assessment, but if the client is reporting constant pain, the pain management plan must be reviewed and revised. The question does not address if the client is taking pain medications, so the option addressing beginning pain medications before the pain is too severe is not correct.

A nurse is caring for a client with cancer who is experiencing pain. What would be the most appropriate assessment of the client's pain? A. the client's recent responses to pain and to pain medication B. nonverbal cues of the client C. the nurse's impression of the client's pain D. the client's pain based on a pain rating

D. the client's pain based on a pain rating The client's assessment of pain, based on a pain rating, is the most appropriate assessment data. The pain is rated on a 0 to 10 scale and nursing actions are then implemented to reduce the pain. The nurse's impression of pain and nonverbal clues are subjective data which should be considered, but which are not more important than the pain rating. Pain relief after nursing intervention is appropriate, but is a part of evaluation.