Ch 9 - Assessing Pain
Which would the nurse recognize as an example of visceral pain? Select all that apply. A. Liver pain B. Gallbladder pain C. Pancreatic pain D. Burn pain E. Muscular pain
A, B, C: Liver pain; Gallbladder pain; Pancreatic pain Examples of visceral pain include pain associated with the liver, gallbladder, and pancreas. Pain associated with a burn is an example of cutaneous pain. Muscular pain is a type of somatic pain.
A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator may be responsible for this increased level of comfort? A. The release of endorphins B. The release of insulin C. The release of melatonin D. The release of dopamine
A. The release of endorphins Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals and have prolonged analgesic effects and produce euphoria. It is thought that certain measures such as skin stimulation and relaxation techniques release endorphins.
In preparing a care plan for a client receiving opioid analgesics, the nurse selects which of the following as an applicable nursing diagnosis associated with side effects of opioid use? A. Constipation B. Diarrhea C. Impaired urinary elimination D. Bowel incontinence
A. 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.
When assessing the client for pain, the nurse should A. doubt the client when he or she describes the pain. B. assess for underlying causes of pain, then believe the client. C. believe the client when he or she claims to be in pain. D. assess for the presence of physiologic indicators (such as diaphoresis, tachycardia, etc.), then believe the client.
C. believe the client when he or she claims to be in pain. "Pain is whatever the person says it is." It is important to remember this definition when assessing and treating pain.
A nurse asks a client to rate his pain on a scale of 0 to 10, with 0 being no pain and 10 being worst pain. What characteristic of pain is the nurse assessing? A. Duration B. Location C. Chronology D. Intensity
D. Intensity When a nurse asks a client to rate his pain on a scale of 0 to 10, the intensity of the pain is being assessed. Duration is how long the pain has lasted, and location is the site of the pain.
A client presents to the ED with pain in the upper right quadrant that worsens after eating. The client describes the pain as sharp, stabbing, and at times very intense. This is a description of which type of pain? A. Acute B. Chronic C. Phantom D. Cutaneous
A. Acute Acute pain results from tissue damage, whether through injury or surgery. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. Phantom pain is pain in an extremity or body part that is no longer there. Cutaneous pain and phantom pain are not described as above. Chronic pain, also known as persistent pain, is a description of a pain that is present for more than 6 months, and can be described in many different terms, not just as above.
A post-operative client is observed breathing 24 breaths/minute while complaining of 10/10 abdominal pain. The client's oxygen saturation is 90% on 2 liters nasal cannula. What is the nurse's priority action? A. Administer prescribed analgesia as ordered. B. Teach and encourage incentive spirometry use. C. Explain why deep breathing and coughing is important. D. Manually ventilate client with ambu bag at bedside.
A. Administer prescribed analgesia as ordered. The client is complaining of the highest level of pain at 10/10. Therefore, the increased respirations and low oxygen saturation are likely a result of hypoventilation due to pain. Acute pain that is not adequately treated can impair pulmonary function. When the client is suffering from an intense amount of pain, the client may not be very receptive to teaching and explanations. The client may have the desire to cough and deep breathe but is unable to due to the intensity of pain. The client can still breathe on his/her own, so an ambu bag is not needed.
During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is which of the following? A. Analgesics B. Surgery C. Relaxation techniques D. Cutaneous stimulation
A. Analgesics Analgesics are most often the primary treatment measure for pain, although a growing trend involves the integration of complementary, nonpharmacologic measures with conventional medicine.
A male client with a history of a back injury 2 months ago has been taking daily doses of narcotic pain medication. He is currently hospitalized with a leg fracture after falling down the stairs. He complains of 10/10 pain in his back and leg after taking pain medication one hour ago. What is the nurse's best action? A. Consult with the healthcare provider about increasing the dose of medication. B. Inform the client that the next dose of medication is due in one more hour. C. Request a psychiatric evaluation for drug seeking behavior. D. Tell the client to take his own prescription medication.
A. Consult with the healthcare provider about increasing the dose of medication. Clients with a history of opioid tolerance pose difficult challenges for pain assessment. They have an altered physiologic response to the pain stimulus, and the repeated use of opioids causes their bodies to become more sensitive to pain. The sensitivity is called opioid hyperalgesia and can occur as soon as 1 month after opioid use begins. Not only are clients with opioid tolerance more sensitive to pain, they face a high level of bias from health care providers. Because these clients are more sensitive to pain, they often report high levels of pain with little relief from usual doses of opioids. They are often labeled as drug seeking.
The nurse is caring for a 4-week-old postoperative client. The most appropriate pain assessment tool would be the: A. Face, Legs, Activity, Cry, Consolability Scale B. FACES Pain Scale C. Numeric Pain Intensity Scale D. Combined Thermometer Scale
A. Face, Legs, Activity, Cry, Consolability Scale The Face, Legs, Activity, Cry, Consolability Scale is the appropriate pain assessment tool for a 4-week-old postoperative client. This tool measures pain using observable behaviors as pain indicators. The FACES Pain Scale is appropriate for children age 3 and older, using six faces ranging from happy with a wide smile to sad with tears on the face. The other two scales are appropriate for use with older children and adults. The Numeric Pain Intensity Scale is a one-dimensional pain scale using an 11-point Likert-type scale ranging from 0 to 10, where 0 means "no pain" and 10 means "worst possible pain." The Combined Thermometer Scale looks like a thermometer and has both numbers that increase from the bottom up and descriptor words to measure pain intensity.
A student nurse learns that especially in the very young and very old pain can be inadequately treated. What else would the student learn about inadequate pain treatment in the very young? A. It can lead to neurodevelopmental problems B. It can lead to higher client compliance with medication C. It can lead to nutritional deficiencies from lack of appetite D. It can lead to an increase in hormonal disorders
A. It can lead to neurodevelopmental problems Inadequate pain treatment can lead to a delay in healing and behavioral consequences, such as learning disabilities, psychiatric disorders, and neurodevelopmental problems. It does not increase hormonal disorders, nutritional deficiencies, or client compliance with medication.
The U.S. government has created guidelines for health care providers caring for clients in pain. Which of the following reflect these guidelines? A. Joint Commission Standards for Pain Management. B. National Institutes of Health Standards for Pain Treatment. C. American Cancer Society Guidelines for Pain Management. D. American Pain Society Guidelines for Pain Management.
A. Joint Commission Standards for Pain Management. Joint Commission Standards for Pain Management were revised and published in 2000-2001. The standards require health care providers and organizations to improve pain assessment and management for all clients.
A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his left leg, and the pain is worse with ambulation. The nurse will document this type of pain as which of the following? A. Somatic pain B. Cutaneous pain C. Visceral pain D. Phantom pain
A. Somatic pain Somatic pain is diffuse or scattered pain, and it originates in tendons, ligaments, bones, blood vessels, and nerves. Cutaneous pain usually involves the skin or subcutaneous tissues. Visceral pain is poorly localized and originates in body organs. Phantom pain occurs in an amputated leg for which receptors and nerves are clearly absent, but the pain is a real experience for the client.
A nurse is caring for a client with dull ache in her abdomen. On the way to the health care facility, the client vomits and shows symptoms of pallor. What kind of pain is the client experiencing? A. Visceral pain B. Cutaneous pain C. Somatic pain D. Neuropathic pain
A. Visceral pain The client is experiencing visceral pain, which is associated with disease or injury. It is sometimes referred or poorly localized as it is not experienced in the exact site where an organ is located. In cutaneous pain, the discomfort originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma. Somatic pain develops from an injury to structures such as muscles, tendons, and joints. Neuropathic pain is experienced days, weeks, or even months after the source of the pain has been treated and resolved.
Mark is a 20-year-old college student who 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 Mark 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 and 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 is interviewing a 65-year-old client with a history of atrial fibrillation, type 2 diabetes, obesity, and congestive heart failure. The nurse determines the client is experiencing chronic neuropathic pain when the client makes which of the following statements? A. "My shoulder has been hurting off and on for the year." B. "The burning sensation in my feet has gotten worse over the past year." C. "I have had this aching pain in the right side of my stomach for a few months now." D. "I have been so depressed since my husband died that I ache all over."
B. "The burning sensation in my feet has gotten worse over the past year." Neuropathic pain results from damage or dysfunction of any level of the nervous system, including peripheral nerves. This client has a long history of type 2 diabetes, which can cause peripheral neuropathy (burning, tingling sensation). The client has been experiencing the pain for longer than a year. Constant pain lasting more than 6 months is classified as chronic. Shoulder pain that comes and goes would be classified as nociceptic pain. Pain in the abdomen that has been ongoing for a few months would be acute visceral pain. The client statement about being depressed and aching all over indicates psychogenic pain, which occurs when psychological pain becomes physical.
The nurse is working in the post anesthesia care unit and assessing pain in a 6 month old infant. Which method should the nurse use to assess the infant's pain? A. Measure heart rate. B. FLACC scale. C. Count respirations. D. BPIQ tool.
B. FLACC scale. The FLACC (Face, Legs, Activity, Cry, Consolability) scale was originally designed to measure acute postoperative pain in children 2 months to 7 years old. Heart rate and respirations are part of an infant pain assessment; however the FLACC scale is the most comprehensive tool. The BPIQ (brief pain impact questionnaire) is used mainly to assess chronic pain in adults.
Beliefs of health care providers can serve as barriers to an accurate assessment of a client's pain. Which of the following beliefs will not be likely to impair the assessment of pain? A. Old people have more pain which is to be expected. B. Infants can feel pain and may respond with crying or agitation. C. A sleeping person feels no pain. D. Persons asking for pain medication but who are showing no other evidence of pain are just addicted to the medication.
B. Infants can feel pain and may respond with crying or agitation. It is hard to evaluate pain in neonates and infants. Behaviors that indicate pain are used to assess their pain. Crying and not being able to be consoled indicate pain in this population.
A client recovering from a stroke complains of pain. The nurse suspects this client is most likely experiencing which type of pain? A. Nociceptive B. Neuropathic C. Somatic D. Idiopathic
B. Neuropathic Neuropathic pain can occur from central nervous system brain injury caused by a stroke. Nociceptive pain is caused by tissue damage. Somatic pain is another term used for nociceptive pain. Idiopathic pain does not have an identified cause.
Mr. Garcia comes to the office for a rash on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. On examination, the nurse notes a rash with small blisters (vesicles) on a background of reddened skin. The rash overlies an entire rib on his right side. What type of pain is this? A. Idiopathic B. Neuropathic C. Nociceptive or somatic D. Psychogenic
B. Neuropathic This vignette is consistent with a diagnosis of herpes zoster or shingles. This is caused by re-emergence of dormant varicella (chicken pox) viruses from Mr. Garcia's nerve root. The characteristic burning quality without a history of an actual burn makes one think of neuropathic pain. It will most likely remain for months after the rash has resolved. There is no evidence of physical injury, and this distribution is peculiar, making nociceptive pain less likely. There is no evidence o f a psychogenic etiology, and the presence of a rash makes this possibility less likely as well. The pain is not idiopathic.
When clients report pain, it is important to find the source. When clients describe pain as "burning, painful numbness, or tingling," the source is more than likely: A. Visceral B. Neuropathic C. Somatic D. Referred
B. Neuropathic Visceral pain originates from abdominal organs and is often described as crampy or gnawing. Somatic pain originates from the skin, muscles, bones, and joints. Referred pain originates from a specific site, but the client experiencing the pain feels it at another site along the innervating spinal nerve. Neuropathic pain is described as burning, painful numbness, or tingling.
A nurse is caring for an elderly client who is unable to walk without a support due to knee pain. During his initial assessment, however, the client does not mention pain. Which of the following beliefs common in elderly clients may cause them to underreport their pain? A. Pain is harmless B. Pain is a normal part of aging C. Pain can be eliminated with medication D. Pain will draw their families closer to them
B. Pain is a normal part of aging When assessing elderly clients, the nurse should remember that they often underreport pain. Many elderly people believe that pain is a normal part of aging, may be a punishment for past actions, may result in a loss of independence, and may indicate that death is near. Elderly clients usually do not believe that pain is harmless, that medicine will eliminate pain, or that pain will draw the family closer to the elderly client.
A client who recently had his lower leg amputated due to a complication associated with diabetes complains of feeling pain in the area of the foot that was amputated. The nurse recognizes this pain as which of the following? A. Referred B. Phantom C. Radiating D. Deep somatic
B. Phantom Phantom pain can be perceived in nerves left by a missing, amputated, or paralyzed body part. Radiating pain is perceived both at the source and extending to other tissues, and referred pain is perceived in body areas away from the pain source. Deep somatic pain is felt in the ligaments, tendons, bones, blood vessels, or nerves.
The client comes to the emergency department reporting indigestion and left arm pain. The physician orders an EKG along with drawing of cardiac enzymes. When the results are back, the client is informed of the diagnosis of heart attack. The indigestion and arm pain are examples of which of the following? A. Visceral pain B. Referred pain C. Cutaneous pain D. Somatic pain
B. Referred pain Referred pain originates from a specific site, but the person feels the pain at another site along the innervated spinal nerve. An example is cardiac pain that the person experiences as arm pain and indigestion. Visceral pain originates from abdominal organs. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. Somatic pain originates from skin, muscles, bones, and joints.
A client who suffers from arthritis complains of sharp pain in her knees and elbows. The nurse recognizes this is what type of pain? A. Visceral B. Somatic C. Cutaneous D. Referred
B. Somatic Pain nociception has various locations. Visceral pain originates from abdominal organs; clients often describe this pain as crampy or gnawing. Somatic pain originates from skin, muscles, bones, and joints; clients usually describe somatic pain as sharp. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. It is often burning or sharp, such as with a partial-thickness burn. Referred pain originates from a specific site, but the person experiencing it feels the pain at another site along the innervating spinal nerve.
The Joint Commission mandates that nurses assess and reassess a client's pain level. A nurse's healthcare facility mandates pain reassessment at 30 minutes for any drug given intravenously. This mandate is based on what? A. The research supporting intravenous medications given for pain take half as long to work as oral medications B. The time it takes a pain medication to decrease pain intensity C. The time it takes a pain medication to block pain in a client D. The median half-life of an intravenous pain medication
B. The time it takes a pain medication to decrease pain intensity Most healthcare facilities have a standard time frame for reassessment, such as 1 hour for oral medication and 30 minutes for pain medication given intravenously. Standards are based on the time it takes a pain medication to provide a noticeable decrease in pain intensity. The mandate from the Joint Commission does not look at the half-life of the pain medication, because the half-life would differ from drug to drug, and no drug is listed in the question. The pain medication does not block pain, but decreases the pain intensity. Research does not support that intravenous medication takes half as long to work as oral medication, because this information depends on the individual drug and the chemical makeup of the drug.
A client reports pain in the knee. The knee is warm, swollen, and red and the client describes the pain as aching and gnawing. The nurse determines the client is experiencing which of the following types of nociceptive pain? A. neuropathic B. somatic C. referred D. phantom
B. somatic The client is experiencing somatic pain, pain that occurs when stimuli in the tissues (skin, muscles, joints, skeleton, connective tissue) are activated. Neuropathic pain results when there is damage or dysfunction to the nervous system. Referred pain occurs when pain is in a body region that is distant from the actual source of the painful stimulus, such as pain in the jaw and shoulder when a person is experiencing a myocardial infarction. Phantom pain occurs when there is pain in a part of the body that has been removed, such as when a client reports pain in the right foot after a right above-the-knee amputation.
A nurse enters a client's room to conduct an assessment. The client is crying and states they have so much pain. What is the best response of the nurse? A. "When did it start?" B. "I am sorry to hear that." C. "Could you tell me more about your pain?" D. "Do you want some pain medication?"
C. "Could you tell me more about your pain?" The nurse will elicit more information about the pain with an open-ended question. Asking when the pain started will not provide enough information. The nurse telling the client that they are sorry to hear about the pain will not elicit information about the pain. The nurse needs to perform a full pain assessment prior to administering pain medications.
The nurse should assess for which pain complaints from a client diagnosed with Type II Diabetes Mellitus? A. Sharp, stabbing B. Aching, gnawing C. Burning, tingling D. Pain only on movement
C. Burning, tingling The nurse should assess for neuropathic pain associated with diabetic neuropath. Neuropathic pain: Pain that results from damage to nerves in the peripheral or central nervous system. Examples of neuropathic pain include diabetic peripheral neuropathy, post herpetic neuralgia, and postmastectomy pain. You should also be alert for the common terms that clients use to report neuropathic pain, such as burning, painful tingling, pins and needles, and painful numbness.
A middle aged female client presents to the emergency department complaining of indigestion and left arm pain. What is the nurse's best action? A. Alert the healthcare provider to the client's somatic pain complaints. B. Administer an antacid and apply a topical anesthetic for the arm pain. C. Check the client's vital signs and connect her to a cardiac monitor. D. Request a strong narcotic analgesic for the client's visceral pain complaints.
C. Check the client's vital signs and connect her to a cardiac monitor. Pain nociception has various locations. Visceral pain originates from abdominal organs; clients often describe this pain as crampy or gnawing. Somatic pain originates from the skin, muscles, bones, and joints; clients usually describe somatic pain as sharp. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. It is often burning or sharp, such as with partial-thickness burn. Referred pain originates from a specific site, but the person experiencing it feels the pain at another site along the innervating spinal nerve. An example is cardiac pain that a person experiences as indigestion, neck pain, or arm pain. Phantom pain is pain in an extremity or body part that is no longer there (e.g., a client who experiences pain in a leg with an amputation). The client is presenting with atypical chest pain and should be assessed for pain of a cardiac origin.
A female client with bone cancer is experiencing pain that has become more severe over the past several days. When modifying the client's plan of care, the nurse identifies a need to assess the affective dimension of the client's pain. How can the nurse best accomplish this goal? A. Document the ways that the client's pain affects activities of daily living. B. Determine whether the client is able to independently treat the pain. C. Closely monitor the effects of the pain on the client's emotions. D. Ask the client to rate the pain during every physiological assessment.
C. Closely monitor the effects of the pain on the client's emotions. The affective dimension of pain concerns feelings, sentiments, and emotions related to the experience. This dimension does not directly related to ADLs, independence in treatment, or frequent pain rating.
A nurse assesses a cognitively impaired adult client who grimaces and points to the right knee following a motor vehicle accident. Which pain scale would be most appropriate for the nurse to use to assess the client's pain? A. Verbal Descriptor Scale B. Numeric Rating Scale C. Faces Pain Scale D. Visual Analog Scale
C. Faces Pain Scale The nurse should use the Faces Pain Scale (FPS) to rate the pain felt by the client. The FPS shows different facial expressions; the client is asked to choose the face that best describes the intensity or level of pain being experienced. This tool is best suited for cognitively impaired adults. A Verbal Descriptor Scale (VDS) ranges pain on a scale between mild, moderate, and severe. The Numeric Rating Scale (NRS) rates pain on a scale from 0 to 10: 0 reflects no pain and 10 reflects pain at its worst. It has been shown to be best for older adults with no cognitive impairment. The Visual Analog Scale (VAS) rates pain on a 10-cm continuum numbered from 0 to 10: 0 reflects no pain and 10 reflects pain at its worst. These scales would require verbal communication between the client and the nurse.
Which of the following statements most accurately conveys an aspect of the gate-control theory? A. The transmission and sensation of pain exist completely within the spinal cord. B. Substances such as endorphins are noted to increase pain sensation. C. Specialized cells can decrease pain transmission by exciting inhibitory neurons. D. Pain transmission and emotional state exist independently of each other.
C. Specialized cells can decrease pain transmission by exciting inhibitory neurons. According to the gate-control theory, the excitation of inhibitory interneurons can inhibit pain. Peripheral receptors, the spinal cord, and the brain are all involved in the process, and endorphins can decrease pain. The gate-control theory identifies the way that pain and emotional state affect each other.
A client reports pressure in the chest but describes pain in the jaw and right arm. Based on these findings, the nurse determines that the client may be experiencing which of the following types of pain? A. phantom B. radicular C. referred D. inflammatory
C. referred Referred pain occurs when the sensation of pain is distant from the actual source of the pain; a client having a myocardial infarction may feel pressure int he chest but the actual pain radiates to the jaw and arm. Radicular pain is generated by stimuli at the nerve root at its connection to the spinal nerves, such as pain that radiates from the back or hip into the legs. Inflammatory pain occurs during inflammation of joints and tissues; rheumatoid arthritis or osteoarthritis and back pain are examples. Phantom pain occurs when there is pain in a part of the body that has been removed.
A client is admitted with right lower abdominal pain with rebound tenderness. The nurse suspects appendicitis and documents this type of pain as which of the following? A. phantom B. somatic C. visceral D. referred
C. visceral Because the pain is due to inflammation of the appendix (an organ), it would be documented as visceral pain. Phantom pain occurs when a client reports pain from a removed body part. Somatic pain occurs when stimuli in the tissues (skin, muscles, joints, skeleton, connective tissue) are activated. Referred pain is the sensation of pain in a body region distant from the actual source of the painful stimulus.
Recently, lung cancer has metastasized to the bones of a 68-year-old client, precipitating a sudden increase in his pain. The client's wife and daughter are concerned about the consequent increase in the amount of hydromorphone the client requires, citing the risk of addiction. How can the nurse best respond to the family's concern? A. "Even when he becomes addicted, we can take comfort knowing that his pain is controlled." B. "It's actually a myth that clients can become addicted to hospital narcotics." C. "If he ends up needing higher doses to resolve the pain, we will discontinue the drug." D. "There's a very minimal risk of addiction, and controlling his pain is our first concern."
D. "There's a very minimal risk of addiction, and controlling his pain is our first concern." Concerns about addiction are normally unfounded. Nonetheless, it is inaccurate to characterize the possibility of addiction as a myth, on one hand, or a very real risk, on the other. Tolerance would not necessitate discontinuation.
A client presents to the health care clinic with reports of a 2-day history of sore throat, ear pressure, fever, and stiff neck. The client states she has taken Tylenol and lozenges without relief. Which nursing diagnosis can be confirmed by this data? A. Anxiety related to prolonged pain B. Impaired physical mobility related stiff neck C. Risk for deficient fluid volume related to fever D. Acute pain related to sore throat
D. Acute pain related to sore throat The client describes pain of 2 days' duration, which is within the definition of acute pain. The client did not describe or display any major defining characteristics of anxiety such as restlessness, concern about lifestyle changes, or sleep disturbances. The stiff neck was not confirmed by objective data collected by the nurse. No evidence exists for the client to have risk for deficient fluid volume.
How may a nurse demonstrate cultural competence when responding to clients in pain? A. Treat every client exactly the same, regardless of culture. B. Be knowledgeable and skilled in medication administration. C. Know the action and side effects of all pain medications. D. Avoid stereotyping responses to pain by clients.
D. Avoid stereotyping responses to pain by clients. Culture influences an individual's response to pain. It is particularly important to avoid stereotyping responses to pain because the nurse frequently encounters clients who are in pain or anticipating it will develop. A form of pain expression that is frowned on in one culture may be desirable in another cultural group.
A client complains of pain in several areas of the body. How should the nurse assess this client's pain? A. Ask the client to rate the area with the highest pain level. B. Mark each site on the client's body with a marker. C. If pain does not radiate, there is no need to rate that area. D. Have the client rate each location separately.
D. Have the client rate each location separately. When assessing pain location, ask the client to point to the painful area. If more than one area is painful, have the client rate each one separately, and note which area is the most painful. Marking each site is not necessary practice for assessing pain. Pain is a subjective sensation for the client. Radiating pain is notable, because such radiation may affect treatment choices.
A nurse is assessing the effect of a client's chronic back pain on his affective dimension. Which question should the nurse ask for this assessment? A. What medical conditions do you have? B. Where is the pain located? C. What is the highest level of education you've completed? D. How does the pain influence your overall mood?
D. How does the pain influence your overall mood? The question regarding the influence of the pain on mood would address the client's affective dimension, which includes feelings and emotions that result from the pain. The question regarding medical conditions would help assess the client's physical dimension. The question regarding the location of the pain would address the client's sensory dimension. The question regarding the client's education would address his cognitive dimension.
A client experiences pain regardless of the type or amount of medication provided. How should the nurse classify this client's pain? A. Acute B. Cancer C. Chronic D. Intractable
D. Intractable Intractable pain is defined by a high resistance to pain relief. Acute pain is usually associated with a recent injury. Cancer pain is often due to the compression of peripheral nerves or meninges or from damage to these structures after surgery, chemotherapy, radiation, or tumor growth and infiltration. Chronic pain is usually associated with a specific cause or injury and is described as a constant pain that persists for more than 6 months.
A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing? A. Cutaneous pain B. Visceral pain C. Chronic pain D. Neuropathic pain
D. Neuropathic pain The client is experiencing neuropathic pain or functional pain. Neuropathic pain is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. The client is not experiencing cutaneous, visceral, or chronic pain. In cutaneous pain, the discomfort originates at the skin level. In visceral pain, the discomfort arises from internal organs caused from a disease or injury. In chronic pain the discomfort lasts longer than 6 months.
An elderly farmer has sustained severe injuries after a serious accident involving a combine harvester. At the hospital, he tells the nurse that he thinks the pain he is feeling now is "payback" for living a "mean, selfish life." The nurse recognizes that this response by the man indicates which dimension of pain? A. Cognitive dimension B. Sociocultural dimension C. Affective dimension D. Spiritual dimension
D. Spiritual dimension The spiritual dimension refers to the meaning and purpose that the person "attributes to the pain, self, others, and the divine." In this case, it seems that the man is interpreting his accident and subsequent pain as divine retribution for his past wrongdoings. The cognitive dimension concerns "beliefs, attitudes, intentions, and motivations related to the pain and its management." The sociocultural dimension concerns the influences of the client's social context and cultural background on the client's pain experience. The affective dimension concerns feelings, sentiments, and emotions related to the pain experience.
A nurse performs a focused assessment on a client reporting back pain after helping someone move into a new home. The nurse uses COLDSPA to further assess the client's pain. Character: sharp; onset: yesterday; location: lower back; duration: persistent since yesterday; severity: 8 out of 10 (on a scale 0-10, 10 being the worst); pattern: continuous; associated factors: movement. The nurse determines the client is experiencing which of the following classifications of pain? A. chronic neuropathic pain B. acute psychological pain C. chronic psychogenic pain D. acute inflammatory pain
D. acute inflammatory pain The pain the client is experiencing is acute (started less than 6 months ago) because it started within the last 24 hours. Chronic pain is pain that has been persistent for 6 months or longer. The pain appears to be caused by inflammation due to a recent injury. There is no indication the pain is psychological (emotional or mental), psychogenic (when psychological pain becomes physical), or neuropathic (pain resulting from damage or dysfunction of any level of the nervous system, for example, neuropathies).
A client describes pain in the soles of both feet as constantly burning. Which type of pain should the nurse suspect this client is experiencing? A. somatic B. referred C. visceral D. neuropathic
D. neuropathic Pain resulting from direct injury to the peripheral or central nervous system is termed neuropathic. Over time, neuropathic pain may become independent of the inciting injury and be described as burning. Somatic pain originates from the skin, muscles, bones, and joints and is usually described as sharp. Referred pain is pain felt in a body area, away from the pain source. Visceral pain originates from abdominal organs and is usually described as cramping or gnawing.
