Ch. 9 Study Guide

The nurse is caring for a young adult client with a diagnosis of cerebral palsy who has been admitted for the relief of painful contractures in the lower extremities. When creating a nursing care plan for this client, what variables should the nurse consider? Select all that apply. A. Client's gender B. Client's comorbid conditions C. Type of procedure to be performed D. Changes in neurologic function that may result from the procedure E. Prior effectiveness in relieving the pain

- Client's comorbid conditions - Type of procedure to be performed - Changes in neurologic function that may result from the procedure - Prior effectiveness in relieving the pain

The nurse is caring for a client admitted to the medical-surgical unit after an injury. The client states, "I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse." When planning the client's care, which variables should the nurse consider? Select all that apply. A. How the presence of pain affects clients and families B. Resources that can assist the client with pain management C. The influence of the client's cognition on their pain D. The advantages and disadvantages of available pain relief strategies E. The difference between acute and intermittent pain

- How the presence of pain affects clients and families - Resources that can assist the client with pain management - The advantages and disadvantages of available pain relief strategies

A client receiving an intravenous (IV) opioid following surgery is being switched to an oral form of the drug. To provide safe care for the client, which concept of equianalgesia should the nurse follow? Select all that apply. A. There is a difference in potency between oral and IV doses of morphine. B. Equianalgesic conversion prevents giving the client an opioid overdose. C. Equianalgesic conversion is only for opioid-tolerant clients. D. Oral analgesics do not control pain as well as IV analgesic administration. E. The dose and frequency of the opioid conversion is guided by the client's individual response to the drug.

- There is a difference in potency between oral and IV doses of morphine. - Equianalgesic conversion prevents giving the client an opioid overdose. - The dose and frequency of the opioid conversion is guided by the client's individual response to the drug.

The emergency department nurse is caring for an adult client who was in a motor vehicle accident. Radiography reveals an ulnar fracture. Which type of pain is the nurse addressing with this client? A. Chronic B. Acute C. Intermittent D. Osteopenic

Acute

A client who had abdominal surgery reports extreme pain when the bed sheet touches the abdomen. Which concept does the nurse use to explain this phenomenon to the client? A. Hyperalgesia B. Nociceptive pain C. Phantom pain D. Allodynia

Allodynia

The nurse is admitting a client with an abdominal tumor who is experiencing increasing unrelieved pain over the last three days despite taking opioids, as prescribed. Which sign—a manifestation of unrelieved pain—should the nurse expect to assess in this client? A. Hyperglycemia B. Bradycardia C. Hyperactive bowel sounds D. Poor skin turgor

Hyperglycemia

A client is receiving postoperative morphine through a client-controlled analgesia (PCA) pump and the client's prescriptions specify an initial bolus dose. What is the nurse's priority assessment? A. Assessment for decreased level of consciousness (LOC) B. Assessment for respiratory depression C. Assessment for fluid overload D. Assessment for paradoxical increase in pain

Assessment for respiratory depression

The nurse is caring for a client with dementia who has a fractured femur secondary to a fall. Which approach should the nurse take in regard to pain management with this client? A. Assume that a client with dementia does not feel pain. B. Document that the client is not in pain if the client is sleeping. C. Assess vital signs to determine if the client is in pain. D. Assume that a fracture is painful and the client is in pain.

Assume that a fracture is painful and the client is in pain.

The nurse caring for an older adult client with osteoarthritis is reviewing the client's chart. This client is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this client? A. Depression B. Chronic illness C. Inadequate pain control D. Drug interactions

Drug interactions

A client's spouse is concerned because the client is requiring increasingly high doses of analgesia. The spouse reports that the client, "was in pain long before the cancer diagnosis because of a broken back about 20 years ago. For that problem, though, the pain medicine wasn't just raised and raised." What would be the nurse's best response? A. "I did not know that. I will speak to the health care provider about your husband's pain control." B. "Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the client relief." C. "Cancer is a chronic kind of pain, so the more it hurts the client, the more medicine we give the client until it no longer hurts." D. "Does the increasing medication dosage concern you?"

"Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the client relief."

The nurse is caring for a client with metastatic bone cancer. The client asks the nurse, "Why am I getting larger doses of this pain medication? It does not seem to be affecting me." What is the nurse's best response? A. "Over time you become more tolerant of the drug." B. "You may have become immune to the effects of the drug." C. "You may be developing a mild addiction to the drug." D. "Your body absorbs less of the drug due to the cancer."

"Over time you become more tolerant of the drug."

An unlicensed assistive personnel (UAP) reports to the nurse that a postsurgical client has pain rated as 8 on a 0-to-10-point scale. The UAP tells the nurse that the client is exaggerating and does not need pain medication. What is the nurse's best response? A. "Since pain often comes and goes with postsurgical clients, reassess the client's pain in 30 minutes." B. "We need to provide pain medications because it is the law, and we must always follow the law." C. "Unless there is strong evidence to the contrary, we should take the client's report at face value." D. "It's not unusual for clients to misreport pain to get our attention when we are busy."

"Unless there is strong evidence to the contrary, we should take the client's report at face value."

The home health nurse is developing a plan of care for a client who will be managing chronic pain at home with NSAID analgesics. Which pain management interventions should the nurse teach the client? Select all that apply. A. Use a pain assessment tool to monitor pain levels and response to interventions. B. Monitor for adverse analgesic effects and notify the health care provider if they occur. C. Take an analgesic when the pain reaches an intolerable level. D. Discuss signs and symptoms and risk of addiction. E. Discuss the use of nonpharmacologic measures of pain control.

- Use a pain assessment tool to monitor pain levels and response to interventions. - Monitor for adverse analgesic effects and notify the health care provider if they occur. - Discuss the use of nonpharmacologic measures of pain control.

The nurse is assuming the care of an adult client who has been experiencing severe and intractable pain. When reviewing the client's medication administration record, the nurse notes the presence of gabapentin. The nurse is justified in suspecting which phenomenon in the etiology of the client's pain? A. Neuroplasticity B. Misperception C. Psychosomatic processes D. Neuropathy

Neuropathy

Two clients have recently returned to the postsurgical unit after knee arthroplasty. One client is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other client is reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most plausible rationale for understanding the clients' different perceptions of pain? A. Awareness and emotions affect the perception of pain. B. One of the clients is exaggerating the sense of pain. C. The clients are likely experiencing a variance in vasoconstriction. D. One of the clients may be experiencing opioid tolerance.

Awareness and emotions affect the perception of pain.

The nurse is assessing an 86-year-old postoperative client who has an unexpressive, stoic demeanor. The client is curled into the fetal position and diaphoretic, and the vital signs are elevated. On a 10-point scale, the client indicates a pain level of "3 or so." How should the nurse treat this client's pain? A. Treat the client on the basis of objective signs of pain and reassess frequently. B. Call the health care provider for new prescriptions because it is apparent that the pain medicine is not working. C. Believe what the client says, reinforce education, and reassess often. D. Ask the family what they think and treat the client accordingly.

Believe what the client says, reinforce education, and reassess often.

A client is receiving care on the oncology unit for breast cancer that has metastasized to the lungs and liver. When addressing the client's pain in the plan of nursing care, the nurse should consider which characteristic of cancer pain? A. Cancer pain is often related to the stress of the client knowing they have cancer and requires relatively low doses of pain medications along with a high dose of anti-anxiety medications. B. Cancer pain is always chronic and challenging to treat, so distraction is often the best intervention. C. Cancer pain can be acute or chronic and typically requires comparatively high doses of pain medications. D. Cancer pain is often misreported by clients because of confusion related to their disease process.

Cancer pain can be acute or chronic and typically requires comparatively high doses of pain medications.

A client with osteoarthritis of the hip for a number of years reports a dull, aching pain with ambulation and pain shooting down the leg at night while sleeping. The nurse recognizes that the client is experiencing which type of pain? A. Acute pain B. Breakthrough pain C. Chronic pain D. Neuropathic pain

Chronic pain

The nurse on a rehabilitation unit receives a report about a new client who has fibromyalgia and has difficulty with ADLs. The off-going nurse also reports that the client is withdrawn, refusing visitors, and has been vacillating between tears and anger all afternoon. What aspect of chronic pain syndromes could account for this client's behavior? A. Fibromyalgia is not a chronic pain syndrome, so further assessment is necessary. B. The client is likely frustrated about having to be in the hospital. C. The client likely has an underlying psychiatric disorder. D. Chronic pain can cause intense emotional responses.

Chronic pain can cause intense emotional responses.

A medical nurse is appraising the effectiveness of a client's current pain control regimen. The nurse is aware that if an intervention is deemed ineffective, goals need to be reassessed and other measures need to be considered. What is the role of the nurse in obtaining additional pain relief for the client? A. Primary caregiver B. Client advocate C. Team leader D. Case manager

Client advocate

A client was diagnosed with rheumatoid arthritis 1 year ago, but has achieved adequate symptom control with celecoxib, a COX-2 selective NSAID. The nurse should recognize that this drug, like other NSAIDs, influences what aspect of the pathophysiology of nociceptive pain? A. Distorting the action potential that is transmitted along the A-delta ( ) and C fibers B. Diverting noxious information from passing through the dorsal root ganglia and synapses in the dorsal horn of the spinal cord C. Blocking modulation by limiting the reuptake of serotonin and norepinephrine D. Inhibiting transduction by blocking the formation of prostaglandins in the periphery

Inhibiting transduction by blocking the formation of prostaglandins in the periphery

The nurse is admitting a client to the rehabilitation unit who has a diagnosis of persistent, severe pain. According to the client's history, the client's pain has not responded to conventional approaches to pain management. What treatment should the nurse expect will be tried with this client? A. Intravenous analgesia B. Long-term intrathecal or epidural catheter C. Oral analgesia D. Intramuscular analgesia

Long-term intrathecal or epidural catheter

The nurse, who is a member of the palliative care team, is assessing a client. The client reports saving client-controlled analgesics (PCA) until the pain is intense because pain control has been inadequate. What client education should the nurse give this client? A. Medication should be taken when pain levels are low so the pain is easier to reduce. B. Pain medication can be increased when the pain becomes intense. C. It is difficult to control chronic pain, so this is an inevitable part of the disease process. D. The client will likely benefit more from distraction than pharmacologic interventions.

Medication should be taken when pain levels are low so the pain is easier to reduce.

The nurse is caring for a 71-year-old client who experienced a humeral fracture in a fall. The client is receiving an opioid for pain control. Which principle of pain management for an older adult should the nurse apply? A. Monitor for signs of drug toxicity. B. Assess for an increase in absorption of the drug. C. Monitor for a paradoxical increase in pain. D. Administer higher doses of opioids to relieve pain.

Monitor for signs of drug toxicity.

A client's intractable neuropathic pain is being treated using a multimodal approach to analgesia. After administering a recently increased dose of IV morphine to the client, the nurse has returned to assess the client and finds the client unresponsive to verbal and physical stimulation with a respiratory rate of five breaths per minute. The nurse has called a code blue and should anticipate the administration of what drug? A. Acetylcysteine B. Naloxone C. Celecoxib D. Acetylsalicylic acid

Naloxone

A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical clients' pain. What principle should guide the nurse's use of placebos in pain management? A. Placebos require a higher level of informed consent than conventional care. B. Placebos are an acceptable, but unconventional, form of nonpharmacologic pain management. C. Placebos are never recommended in the treatment of pain. D. Placebos require the active participation of the client's family.

Placebos are never recommended in the treatment of pain.

The home health nurse is caring for a homebound client who is terminally ill and is delivering a client-controlled analgesia (PCA) pump at today's visit. The family members will be taking care of the client. What would the nurse's priority interventions be for this visit? A. Teach the family the theory of pain management and the use of alternative therapies. B. Provide psychosocial family support during this emotional experience. C. Provide client and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication. D. Provide family teaching regarding use of morphine, recognizing morphine overdose, and offering spiritual guidance.

Provide client and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.

The nurse is caring for a client whose diagnosis of bone cancer is causing severe and increasing pain. Before introducing nonpharmacologic pain control interventions into the client's plan of care, the nurse should teach the client which of the following? A. Nonpharmacologic interventions must be provided by individuals other than members of the health care team. B. These interventions will not directly reduce pain, but will refocus the client on positive stimuli. C. These interventions carry similar risks of adverse effects as analgesics. D. Reducing the use of analgesics is not the purpose of these interventions.

Reducing the use of analgesics is not the purpose of these interventions.

The nurse is assessing a client's pain while the client awaits a cholecystectomy. The client is tearful, hesitant to move, and grimacing, but reports feeling pain as a 2 at this time on a 0-to-10 pain scale. How should the nurse best respond to this assessment finding? A. Remind the client that they are indeed experiencing pain. B. Reinforce education about the pain scale number system. C. Reassess the client's pain in 30 minutes. D. Administer an analgesic and then reassess.

Reinforce education about the pain scale number system.

A client has just returned from the postanesthesia care unit (PACU) following left tibia open reduction internal fixation. The client is reporting pain, and the nurse is preparing to administer intravenous hydromorphone. Prior to administering the drug, the nurse should prioritize which assessment? A. Electrolyte levels B. Heart rate C. Respiratory status D. Hydration

Respiratory Status

A 75-year-old client has been admitted to the rehabilitation facility after falling and fracturing the left hip. The client has not regained functional ability and may have to be readmitted to an acute-care facility. When planning this client's care, what should the nurse know about the negative effects of the stress associated with pain? A. Stress is less pronounced in older adults because they generally have more sophisticated coping skills than younger adults. B. Stress is particularly harmful in older adults who have been injured or who are ill. C. It affects only those clients who are already debilitated prior to experiencing pain. D. It has no inherent negative effects; it just alerts the person/health care team of an underlying disease process.

Stress is particularly harmful in older adults who have been injured or who are ill.

The nurse in a pain clinic is caring for a client who has long-term, intractable pain. The pain team feels that first-line pharmacologic methods of pain relief have been ineffective. Which recommendation should guide this client's subsequent care? A. The client may benefit from new alternative pain management options that are available in other countries. B. The client may benefit from a multimodal approach to pain management. C. The client may need to increase exercise and activity levels significantly to create distractions. D. The client may need to relocate to long-term care to have activities of daily living needs met.

The client may benefit from a multimodal approach to pain management.

The nurse is caring for a client with a fractured pelvis and a ruptured bladder resulting from a motor vehicle accident. The nurse's aide (NA) reports concern to the nurse because the client's resting heart rate is 110 beats per minute, respirations are 24 breaths per minute, temperature is 37.3°C (99.1°F) axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as the nurse assesses this client's physiologic status? A. The client's understanding of pain physiology B. The client's serum glucose level C. The client's white blood cell count D. The client's rating of their pain

The client's rating of their pain

The nurse is creating a nursing care plan for a client with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of clients who live with chronic pain should be integrated into care planning? A. They are typically more comfortable with underlying pain than clients without chronic pain. B. They often have a lower pain threshold than clients without chronic pain. C. They often have an increased tolerance of pain. D. They can experience acute pain in addition to chronic pain.

They can experience acute pain in addition to chronic pain.

A client is asking for a breakthrough dose of analgesia. The pain-medication prescriptions are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner? A. To prevent respiratory depression B. To eliminate the need for additional medication during the night C. To achieve better pain control than with one medication alone D. To eliminate the potentially adverse effects of the opioid

To achieve better pain control than with one medication alone

A client with cancer expresses concern to the nurse that increasingly higher doses of opioids are needed to control pain and the client is concerned about opioid overdose and addiction. Which concept of pain management should guide the nurse's response to this client? A. Addiction occurs when higher doses are needed to control pain. B. The need for increasing doses of opioids to control pain is a sign of substance use disorder (SUD). C. Opioid-induced hyperalgesia results in the need for increasing doses of opioids. D. Tolerance develops when higher doses are needed to control pain.

Tolerance develops when higher doses are needed to control pain.

A client is experiencing severe pain after suffering an electrical burn in a workplace accident. The nurse is applying knowledge of the pathophysiology of pain when planning this client's nursing care. What is the physiologic process by which noxious stimuli, such as burns, activate nociceptors? A. Transduction B. Transmission C. Perception D. Modulation

Transduction

The nurse is caring for a postsurgical client who minimally speaks the dominant language. How should the nurse most accurately assess this client's pain? A. Use a chart with the dominant language on one side of the page and the client's native language on the other so the client can rate their pain. B. Ask the client to write down a number according to the 0-to-10-point pain scale. C. Use the Visual Analog Scale (VAS). D. Use the services of a translator each time when assessing the client to document the client's pain rating.

Use a chart with the dominant language on one side of the page and the client's native language on the other so the client can rate their pain.

The nurse is caring for a client with back pain. The nurse reviews the medications and sees that an NSAID (ibuprofen) is prescribed every 6 hours as needed. How should the nurse best implement preventive pain measures? A. Let the client know ibuprofen is available every 6 hours, if needed. B. Administer ibuprofen if the client's pain rating is 5 or higher, on a 0 to 10 scale. C. Use a pain scale to assess client's pain and offer ibuprofen every 6 hours. D. Assume the client is not in pain if the client does not request pain medication.

Use a pain scale to assess client's pain and offer ibuprofen every 6 hours.

The nurse is caring for a client with sickle cell disease who lives in the community. Over the years, there has been joint damage, and the client is in chronic pain. The client has developed a tolerance to the usual pain medication. When does the tolerance to pain medication become the most significant problem? A. When it results in inadequate relief from pain B. When dealing with withdrawal symptoms resulting from the tolerance C. When having to report the client's addiction to the client's health care provider D. When the family becomes concerned about increasing dosage

When it results in inadequate relief from pain