Chapter 34: Comfort and Pain Management

A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain? A) Amitriptyline (Elavil) B) Corticosteroids C) Methylphenidate (Ritalin) D) Lorazepam (Ativan)

A) Amitriptyline (Elavil) Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract sedation if the client is on opioids. Lorazepam is an anxiolytic (used to reduce anxiety.) NSAID: Nonsteroidal anti-inflammatory drugs are a drug class that reduce pain, decrease fever, prevent blood clots and, in higher doses, decrease inflammation. Side effects depend on the specific drug, but largely include an increased risk of gastrointestinal ulcers and bleeds, heart attack and kidney disease. Wikipedia

Of the following individuals, who can best determine the experience of pain? A) The person who has the pain B) The person's immediate family C) The nurse caring for the client D) The physician diagnosing the cause

Ans: A Feedback: According to McCaffery, an expert on pain, "Pain is whatever the experiencing person says it is, existing whenever he (or she) says it does." The only one who can be a real authority on whether and how a person experiences pain is that individual.

The nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. The nurse notes that the client's respiratory rate is 10 breaths per minute. The client is somnolent, with minimal response to physical stimulation. The nurse should prepare to administer which of the following medications? A) Intravenous naloxone (Narcan) B) Intravenous flumazenil (Romazicon) C) Oral modafinil (Provigil) D) Nebulized albuterol (Proventil)

Ans: A Feedback: Albuterol is a bronchodilator and not appropriate for this clinical situation.

Which client would be most likely to have decreased anxiety about, and response to, pain as a result of past experiences? A) One who had pain but got adequate relief B) One who had pain but did not get relief C) One who has had chronic pain for years D) One who has had multiple pain experiences

Ans: A Feedback: An individual's experience of pain in the past, and the qualities of that experience, profoundly affect new pain experiences. Some clients have experienced severe acute or chronic pain in the past but received immediate and adequate pain relief. These clients are generally unafraid of pain and initiate appropriate requests for assistance.

Which statement accurately describes pain experienced by the older adult? A) Boredom and depression may affect an older person's perception of pain. B) Residents in long-term care facilities have a minimal level of pain. C) The older client has decreased sensitivity to pain. D) A heightened pain tolerance occurs in the older adult.

Ans: A Feedback: Boredom, loneliness, and depression may affect an older person's perception and report of pain. One myth held by many to be true is that older clients have a decreased sensitivity to pain and therefore a heightened pain tolerance. Numerous older adult clients residing in long-term care facilities have significant pain that negatively affects their quality of life.

Which of the following clients would be classified as having chronic pain? A) A client with rheumatoid arthritis B) A client with pneumonia C) A client with controlled hypertension D) A client with the flu

Ans: A Feedback: Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Acute pain is generally rapid in onset and varies in intensity from mild to severe. After its underlying cause is resolved, acute pain disappears. It should end once healing occurs.

Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique? A) Tactile kinesthetic distraction B) Visual distraction C) Auditory distraction D) Project distraction

Ans: A Feedback: Examples of tactile kinesthetic distraction include holding or stroking a loved one, pet, or toy; rocking; and slow rhythmic breathing. Project distraction includes playing a challenging game or performing meaningful work. Visual distraction can be accomplished through reading or watching television. Auditory distraction may occur when one listens to music.

A client has an order for a narcotic analgesic every three to four hours and he received his last dose three hours earlier. Which of the following actions is most appropriate for the nurse to take in response to the client's request for pain medication on his first postoperative day? A) Provide the client with pain medication B) Tell the client that the pain cannot be severe C) Document and ask the client to wait one hour D) Contact the physician for a change in medication

Ans: A Feedback: Inadequate or poor pain assessment is a leading factor in poor pain control, because the health care professional may not know a client has pain. The nurse must provide the next dose of pain medication.

Which misconception is common in clients in pain? A) "I will get addicted to pain medications." B) "I need to ask for pain medications." C) "The nurses are here to help relieve the pain." D) "I do not have to fight the pain without help."

Ans: A Feedback: Many misconceptions interfere with the client's ability to communicate pain. A common misconception is that "if I ask for something for pain, I may become addicted to the medication."

Why is acute pain said to be protective in nature? A) It warns an individual of tissue damage or disease. B) It enables the person to increase personal strength. C) As a subjective experience, it serves no purpose. D) As an objective experience, it aids diagnosis.

Ans: A Feedback: Pain is a subjective experience. Acute pain, lasting from a few minutes to less than six months, warns an individual of tissue damage or organic disease. After its underlying cause is resolved, acute pain disappears.

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

Ans: A Feedback: 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 implements a back massage as an intervention to relieve pain. What theory is the motivation for this intervention? A) Gate control theory B) Neuromodulation C) Large/small fiber theory D) Prostaglandin stimulation

Ans: A Feedback: The gate control theory of pain describes the transmission of painful stimuli. Nursing interventions, such as massage or a warm compress to a painful lower back, stimulate large nerve fibers to close the gate, thus blocking nerve impulses from that area.

The nurse has just completed programming of a patient-controlled analgesia (PCA) pump using prescribed parameters. Which of the following actions should you take next? A) Verify the settings with another nurse. B) Document implementation of the PCA on the client's chart. C) Attach the PCA pump tubing to the client's intravenous access device. D) Check the pump's electrical cords for cracks, splits, or fraying.

Ans: A Feedback: This action should be performed before programming is initiated.

The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which of the following responses is most appropriate? A) "The mild electrical impulses block the pain signal before it can reach the brain." B) "The electrode patches generate heat and decrease muscle tension." C) "The machine tricks the mind into believing the pain does not exist." D) "The electricity produces numbness and alters tissue sensitivity."

Ans: A Feedback: This statement explains the use of cold therapy for pain.

The Joint Commission supports the client's right to pain management, and published standards for assessment and management of pain in hospitals, ambulatory care settings, and home care settings (Joint Commission, 2008b). Which of the following are recommended guidelines for pain management? Select all that apply. A) Teach all clients to use a pain rating scale. B) Determine a pain-rating goal with each client. C) Use pharmacologic pain relief measures first. D) Manipulate factors that affect the pain experience. E) Keep the primary care provider in charge of all pain relief measures.

Ans: A, B, D Feedback: The Joint Commission recommendations include teaching all clients to use a pain-rating scale and determining a pain-rating goal with each client. Nursing interventions to achieve this goal include -establishing a trusting nurse-patient relationship -manipulating factors that affect the pain experience -initiating nonpharmacologic pain relief measures -managing pharmacologic interventions -reviewing additional pain control measures -ensuring ethical and legal responsibility to relieve pain -educating the client about pain.

A nurse is assessing the vital signs of a client who is moaning due to the acute onset of pain. What would be the expected objective findings? A) Decreased pulse and respirations B) Increased pulse and blood pressure C) Increased temperature D) No change from client's norms

Ans: B Feedback: A client who is in acute pain will most often also have an increased pulse and blood pressure.

Which client would benefit from a p.r.n. drug regimen? A) One who had thoracic surgery 12 hours ago B) One who had thoracic surgery four days ago C) One who has intractable pain D) One who has chronic pain

Ans: B Feedback: A p.r.n. drug regimen has not proven effective for people experiencing acute pain, such as in the early postoperative period. It is not adequate for clients with intractable or chronic pain. However, later in the postoperative period, it may be acceptable to relieve occasional pain episodes.

A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and become chronic. What is a characteristic of chronic pain? A) Chronic pain will lead to psychological imbalance. B) Chronic pain has far-reaching effects on the client. C) Chronic pain can be severe in its initial stages. D) Chronic pain eases with healing and eventually disappears.

Ans: B Feedback: Chronic pain has far-reaching effects on the client because the discomfort lasts longer than six months. Chronic pain is not as severe in the initial stage as acute pain, but does not disappear eventually with pain medication. Chronic pain need not always lead to psychological imbalance.

Besides controlling pain of the post-abdominal surgery client with narcotics, the nurse suggests to the client that he ... A) focus on pain relief B) use distraction C) describe the pain D) think about the next dose

Ans: B Feedback: Distraction is useful when clients are undergoing brief periods of sharp, intense pain, such as dressing changes, wound débridement, biopsy, or incident pain from shifting positions.

A client in the emergency department is diagnosed with a myocardial infarction (heart attack). The client describes pain in his left arm and shoulder. What name is given to this type of pain? A) Cutaneous pain B) Referred pain C) Allodynia D) Nociceptive

Ans: B Feedback: Referred pain is pain that is perceived in an area distant from the point of origin. Pain associated with a myocardial infarction is frequently referred to the neck, shoulder, or arm. Nociceptive pain is the normal process that results in noxious stimuli being perceived as painful. This is transmitted through the peripheral nerve fibers that are transmitting pain from the somatic and visceral sites.

A client with cancer pain is taking morphine for pain relief. Knowing constipation is a common side effect, what would the nurse recommend to the client? A) "Only take morphine when you have the most severe pain." B) "Increase fluids and high-fiber foods, and use a mild laxative." C) "Administer an enema to yourself every third day." D) "Constipation is nothing to worry about; take your medicine."

Ans: B Feedback: The most common side effects associated with opioids (e.g., morphine) are sedation, nausea, and constipation. If constipation persists, it usually responds to treatment with increased fluids and fiber, and use of a mild laxative.

A middle-age client is complaining of acute joint pain to a nurse who is assessing the client's pain in a clinic. Which of the following questions related to pain assessment should the nurse ask the client? A) Does your diet include red meat and poultry products? B) Does your pain level change after taking medications? C) Are your family members aware of your pain? D) Have you thought of the effects of your condition on your family?

Ans: B Feedback: The nurse should ask direct and specific questions about the nature of the pain and whether it changes with medication, as this helps the nurse to quickly gather objective data about the client's pain. The nurse should avoid asking irrelevant and closed-ended questions, such as whether the client's diet includes red meat and poultry products, or whether the client has thought about the effects of his condition on his family. These types of questions do not add any value to pain assessment, but could make the client feel more depressed and uncomfortable.

A nurse is ordered to apply a transcutaneous electrical nerve stimulation (TENS) unit to a client recovering from abdominal surgery. Which of the following is a consideration when using this device? A) TENS is an invasive technique for providing pain relief. B) TENS involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers. C) TENS is most beneficial when used to treat pain that is generalized. D) A TENS unit is applied intermittently throughout the day and should not be worn for extended periods of time.

Ans: B Feedback: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive technique for providing pain relief that involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers. It is most beneficial when the pain is localized and the unit can be worn for extended periods of time.

A client tells the nurse that she is experiencing stabbing pain in her mouth, gums, teeth, and chin following brushing her teeth. These are symptoms of which of the following pain syndromes? A) Complex regional pain syndrome B) Postherpetic neuralgia C) Trigeminal neuralgia D) Diabetic neuropathy

Ans: C Feedback: A symptom of trigeminal neuralgia is paroxysms of lightning-like stabs of in tense pain in the distribution of one or more divisions of the trigeminal nerve, the fifth cranial nerve. Pain is usually experienced in the mouth, gums, lips, nose, cheek, chin, and surface of the head and may be triggered by everyday activities like talking, eating, shaving, or brushing one's teeth.

What is the term used to describe a pharmaceutical agent that relieves pain? A) Antacid B) Antihistamine C) Analgesic D) Antibiotic

Ans: C Feedback: An analgesic is a pharmaceutical agent that relieves pain. Analgesics reduce the perception of pain and alter responses to discomfort.

A nurse is assessing a client with arthritis. Which of the following should the nurse consider in the initial assessment of the client? A) Blood group B) Anxiety level C) Pain level D) Glucose level

Ans: C Feedback: The nurse should first assess the client's pain level since the client has arthritis. Anxiety level, blood group, and glucose level are not vital signs which will help the nurse assess the client's pain during the initial assessment.

A nurse is teaching an alert client how to use a PCA system in the home. How will she explain to the client what he must do to self-manage pain? A) "You don't have to do anything. The machine does it all." B) "I will teach your family what they need to do." C) "When you push the button, you will get the medicine." D) "The medicine is going into your body all the time."

Ans: C Feedback: When the sensation of pain occurs, the client pushes a button that activates the PCA device to deliver a small preset bolus dose of the analgesic. A lockout interval (usually 5 to 10 minutes) prevents reactivation of the pump and administration of another dose during that period of time. Other safeguards also limit the possibility of overmedication.

A client who has breast cancer is said to be in remission. What does this term signify? A) The client is experiencing symptoms of the disease. B) The client has end-stage cancer. C) The client is experiencing unremitting pain. D) The disease is present but the client is not experiencing symptoms.

Ans: D Feedback: Commonly, people with chronic pain experience periods of remission (when the disease is present but the person does not experience symptoms) or exacerbation (the symptoms reappear).

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.

Ans: D Feedback: 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 upon in one culture may be desirable in another cultural group.

A client has been taught relaxation exercises before beginning a painful procedure. What chemicals are believed to be released in the body during relaxation to relieve pain? A) Narcotics B) Sedatives C) A-delta fibers D) Endorphins

Ans: D Feedback: Endorphins, which are opioid neuromodulators, are produced at neural synapses at various points in the CNS pathway. They have prolonged analgesic effects and produce euphoria. It is suggested that they may be released when measures such as skin stimulation and relaxation techniques are used.

A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain? A) Six hours after administering a prescribed analgesic B) After the client is discharged from the health care facility C) Once per day when the pain is a potential problem D) Whenever the vital signs are measured and documented

Ans: D Feedback: The nurse should assess the client's pain whenever the nurse measures and documents vital signs. When administering a prescribed analgesic, the nurse should assess pain before implementing a pain-management intervention, and again 30 minutes later. The nurse should assess the client's pain when the client is admitted to, not discharged from, the health care facility. Similarly, the nurse should assess pain once per shift when pain is an actual or potential problem.

A client has a severe abdominal injury with damage to the liver and colon from a motorcycle crash. What type of pain will predominate? A) Psychogenic pain B) Neuropathic pain C) Cutaneous pain D) Visceral pain

Ans: D Feedback: Visceral pain is poorly localized and originates in body organs in the thorax, cranium, and abdomen. The pain occurs as organs stretch abnormally and become distended, ischemic, or inflamed. Psychogenic pain is when a physical cause for the pain can not be identified. (usually pain has both and not just one)

The three types of responses to pain are physiologic, behavioral, and affective. Which are examples of affective responses to pain? Select all that apply. a) Increase in blood pressure b) A patient is anxious because they are afraid of upcoming surgery c) A patient's pulse is increased following a myocardial infarction. d) A patient is pallor and has increased glucose. e) A patient who has chronic cancer pain is depressed and withdrawn. f) A child pulls away from a nurse trying to give him an injection.

B, E,

Which client is most likely to receive opioids for extended periods of time? A) A client with fibromyalgia B) A client with phantom limb pain C) A client with progressive pancreatic cancer D) A client with trigeminal neuralgia

C) A client with progressive pancreatic cancer Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioid and adjuvant medications. Trigeminal neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.

Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b. NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine A) B, A, C B) C, A, B C) B, C, A D) A, B, C

C) B, C, A Step 1 includes non-opioids and adjuvant drugs. Step 2 includes opioids for mild pain plus Step 1 drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain (replacing Step 2 opioids) and continuing Step 1 drugs and adjuvant drugs as needed. Opioid analgesics: (controlled substances for moderate to severe pain)- Morphine, codeine, oxycodone, hydromorphone, methadone : Sedation, nausea, constipation, respiratory depression Nonopioid analgesics (used for acute and persistent moderate chronic pain) Acetaminophen-hepatotoxicity NSAIDS-Bleeding Adjuvant Analgesics: Anticonvulsants, antidepressants, corticosteroids (used to enhance effect of opioids by providing additional pain relief/lesson anxiety

In caring for a young child with pain, which assessment tool is the most useful? A) Simple description pain intensity scale B) 0-10 numeric pain scale C) Faces pain-rating scale D) McGill-Melzack pain questionnaire

C) Faces pain-rating scale The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is appropriate for young children who may have difficulty describing pain or understanding the correlation of pain to numerical or verbal descriptors. The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary.

Family members are encouraging your client to "tough it out" rather than run the risk of becoming addicted to narcotics. The client is stoically abiding by the family's wishes. Priority nursing interventions for this client should target which dimension of pain? A) Sensory B) Affective C) Sociocultural D) Behavioral E) Cognitive

C) Sociocultural The family is part of the sociocultural dimension of pain. They are influencing the client and should be included in the teaching sessions about the appropriate use of narcotics and about the adverse effects of pain on the healing process. The other dimensions should be included to help the client/family understand overall treatment plan and pain mechanism

The three types of responses to pain are physiologic, behavioral, and affective. Which are examples of physiologic 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 is experiencing extreme muscle tension e) A patient who has chronic cancer pain is depressed and withdrawn. f) A patient has an increase respiratory rate due to pleural rub

C, D, F

Which client is at greater risk for respiratory depression while receiving opioids for analgesia? A) An elderly chronic pain client with a hip fracture B) A client with a heroin addiction and back pain C) A young female client with advanced multiple myeloma D) A child with an arm fracture and cystic fibrosis

D) A child with an arm fracture and cystic fibrosis (cystic fibrosis is a chronic disease which affects the function of the lungs and causes consistent coughing-due to mucous build up) at greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors.

As the charge nurse, you are reviewing the charts of clients who were assigned to a newly graduated RN. The RN has correctly charted dose and time of medication, but there is no documentation regarding non-pharmaceutical measures. What action should you take first? A) Make a note in the nurse's file and continue to observe clinical performance B) Refer the new nurse to the in-service education department. C) Quiz the nurse about knowledge of pain management D) Give praise for the correct dose and time and discuss the deficits in charting.

D) Give praise for the correct dose and time and discuss the deficits in charting.

A client with chronic pain reports to you, the charge nurse, that the nurse have not been responding to requests for pain medication. What is your initial action? A) Check the MARs and nurses' notes for the past several days. B) Ask the nurse educator to give an in-service about pain management. C) Perform a complete pain assessment and history on the client. D) Have a conference with the nurses responsible for the care of this client

D) Have a conference with the nurses responsible for the care of this client As charge nurse, you must assess for the performance and attitude of the staff in relation to this client. After gathering data from the nurses, additional information from the records and the client can be obtained as necessary. The educator may be of assistance if knowledge deficit or need for performance improvement is the problem.

Mr. Wright is recovering from abdominal surgery. When the nurse assists him to walk, she observes that he grimaces, moves stiffly, and becomes pale. She is aware that he has consistently refused his 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 Mr. Wright's immediate problem is his pain that is unrelieved because he refuses to take his pain medication for an unknown reason. The other nursing diagnoses are plausible, but not a priority in this situation.

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.

How should the nurse position the head of the bed for a client receiving epidural opioids? a) Elevated 30 degrees b) Reverse trendelenberg c) Flat d) Trendelenberg

a) Elevated 30 degrees

In providing care to a client with chronic pain, which of the following characteristics or client responses should the nurse expect? a) Heart rate, blood pressure, and pulse rate may be normal while the client is experiencing pain. b) Opioid-based analgesics may have little if any effect on reducing the quality of chronic pain. c) The client may have adapted so successfully to the presence of chronic pain that measures for relief are unnecessary. d) The actual intensity of chronic pain is difficult to assess because the client may complain constantly

a) Heart rate, blood pressure, and pulse rate may be normal while the client is experiencing pain. Adaptation to the presence of chronic pain is physiologic. Thus, the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain.

The nurse is teaching a novice nurse about the therapeutic effects of laughter. Which example correctly identifies one of these effects? a) It activates the immune system. b) It causes shallow breathing. c) It increases the level of epinephrine. d) It decreases heart rate.

a) It activates the immune system.

An elderly patient is confined to bedrest following cervical spine surgery to treat nerve pinching. The nurse is vigilant about turning the patient and assessing the patient regularly to prevent the formation of pressure ulcers. What type of agent is the stimulus for pressure ulcers? a) Mechanical b) Thermal c) Chemical d) Electrical

a) Mechanical Receptors in the skin and superficial organs may be stimulated by mechanical, thermal, chemical, and electrical agents. Friction from bed linens causing pressure sores and pressure from a cast are mechanical stimulants. Sunburn is a thermal stimulant. An acid burn is the result of a chemical stimulant. The jolt from a lightening bolt is an electrical stimulant.

A postoperative client who has been receiving morphine for pain management is exhibiting a depressed respiratory rate and is not responsive to stimuli. Which drug has the potential to reverse the respiratory-depressant effect of an opioid? a) Naloxone b) Epinephrine c) Diphenhydramine d) Atropine

a) Naloxone

The nurse caring for a client receiving opioid therapy notes that the client's respirations are 7. What is the first action by the nurse? a) Physically stimulate client. b) Take the client's blood pressure. c) Begin cardiac compressions. d) Administer Narcan.

a) Physically stimulate client. The first action by the nurse is to physically stimulate the client by shaking the client or using a loud sound, followed by reminders every few minutes to breathe deeply. If this is ineffective, Narcan can be used to reverse the respiratory depressant effect of the opioid.

Which circumstance may preclude the use of cutaneous stimulation to relieve a client's pain? a) The client has difficulty localizing his pain. b) The client has a history of heart disease. c) The client is receiving both scheduled and breakthrough analgesia. d) The client's pain is chronic rather than acute.

a) The client has difficulty localizing his pain.

A nurse is caring for a client who complains of an aching pain in the abdomen. The nurse also noted that the client is guarding the area. What kind of pain is the client experiencing? a) Visceral pain b) Somatic pain c) Cutaneous pain d) Neuropathic pain

a) Visceral pain

Based on your knowledge of pain and the body's response, when assessing a client in pain, you would anticipate which objective findings. a. Increased blood pressure b. Diaphoresis c. Decreased pulse d. Increased pulse e. Increased respiratory rate f. Decreased respiratory rate g. Dilated pupils h. Constricted pupils i. Decreased blood pressure

a, b, d, e, g objective symptoms: increased blood pressure, increased pulse, increased respiratory rate, dilated pupils, and diaphoresis.

A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from the dosage of pain medication with around the clock dosing. Select all that apply a) experiencing chronic pain. b) in the postoperative stage with occasional pain. c) experiencing acute pain. d) in the early postoperative period.

a, d, c

One of the most common distinctions of pain is whether it is acute or chronic. Which examples describe chronic pain? 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 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.

When assessing a patient receiving a continuous opioid infusion, the nurse immediately notifies the physician when the patient has: 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 physician, but is not the priority in this situation.

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. In the Gate Control Theory, pain messages travel from the periphery of the body through nerve "gates" in the spinal cord and up to the brain. The theory uses the concept of "gates" in the central nervous system to describe how some pain messages are allowed get through and reach the brain, while others are blocked.

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) Medicate the boy with analgesics to reduce the anxiety of experiencing pain. b) Ask the boy to draw a cartoon about the color or shape of his pain. c) Ignore the boy's pain if he is not complaining about it. 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.

The nurse is preparing to initiate PCA therapy for a client with sleep apnea. What is the correct action by the nurse? a) Increase the lock out time. b) Contact the physician. c) Initiate the therapy. d) Decrease the loading dose.

b) Contact the physician. The nurse should contact the physician, as PCA therapy for pain management is contraindicated for clients with sleep apnea. This is due to the fact that oversedation in clients with sleep apnea poses a significant health risk. PCA therapy is also contraindicated in confused clients, infants and very young children, cognitively impaired clients, and clients with asthma.

A client is experiencing acute pain following the amputation of a limb. What nursing interventions would be most appropriate when treating this client? a) Increase and decrease the serum level of the analgesic as needed. b) Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. c) Treat the pain only as it occurs to prevent drug addiction. d) Do not provide analgesia if there is any doubt about the likelihood of pain occurring.

b) Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. The client would benefit from the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. The phantom pain is real pain and should be treated as such. The nurse would not increase and decrease the serum level of the analgesic as needed. The nurse would not doubt the client's report of pain and would not withhold analgesia if she doubted the likelihood of the pain occurring.

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 use with children. Opioid analgesics may be safely used with children as long as they are carefully monitored.

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) Lasix b) Narcan c) Digoxin d) Lopressor

b) Narcan

A postoperative client has not voided for 8 hours (since surgery). He is restless and reports abdominal pain. How and what would the nurse assess before administering pain medications? a) Check database for last bowel movement. b) Palpate abdomen for distended bladder. c) Percuss abdomen for sounds of tympany. d) Auscultate abdomen for bowel sounds.

b) Palpate abdomen for distended bladder. Nurses can provide interventions to alter or relieve pain. A client who has not voided for 8 hours after surgery, is restless, and is having abdominal pain probably has pain from a distended bladder and needs to be catheterized.

Which of the following is the priority assessment for a nurse caring for a client with a Patient Controlled Analgesia (PCA) pump? a) Cardiovascular b) Respiratory c) Peripheral Vascular d) Nueromuscular

b) Respiratory

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) Thorough client education is necessary to prevent overdoses. b) The dose that is delivered when the client activates the machine is preset. c) An antidote is automatically delivered if the client exceeds the recommended dose. d) Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression.

b) The dose that is delivered when the client activates the machine is preset. Explanation: PCAs are designed to make it impossible for the client to exceed the patient-specific dosing parameters programmed into the machine. PCAs do not administer antidotes, and they are almost always used to deliver opioid analgesics.1138

A patient complains of 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 (sticking in nature) with a burning sensation is an example of cutaneous pain. Deep somatic pain is diffuse (covers a large area) 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.

Which clients would be the best candidate to receive epidural analgesia for pain management? a) a client who is experiencing chest pains b) a child undergoing hip surgery c) a cliient with a strained back d) a client with an inoperable brain tumor

b) a child undergoing hip surgery Epidural analgesia is being used more commonly to provide pain relief during the immediate postoperative phase and for chronic pain situations. Epidural pain management is also being used in children with terminal cancer and children undergoing hip, spinal, or lower extremity surgery.

A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a p.r.n. drug regimen as an effective method of pain control would be the client: a) experiencing chronic pain. b) in the postoperative stage with occasional pain. c) experiencing acute pain. d) in the early postoperative period.

b) in the postoperative stage with occasional pain. A p.r.n. (as needed) medication would be most appropriate for a client in the postoperative stage with occasional pain. A client in the early postoperative period would benefit from the dosage of pain medication with around the clock dosing. A client experiencing chronic pain would benefit from the dosage of pain medication with around the clock dosing. A client experiencing acute pain would benefit from the dosage of pain medication with around the clock dosing.

A nurse is performing pain assessments on clients in a physician's office. Which clients would the nurse document as having acute pain? Select all that apply. a) A client who has diabetic neuropathy b) A client who fell and broke an ankle c) a client who is having a myocardial infarction d) A client who presents with the signs and symptoms of appendicitis e) A client who has bladder cancer f) A client who has rheumatoid arthritis

b, c, d

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 physician 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 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 he (or she) says it does." The International Association for the Study of Pain (IASP) further defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (IASP, 1994). 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 instructs the client taking ibuprofen that the drug is effective for pain relief because it acts to a- slow painful stimuli through type A-delta pain fibers. b- reduce inflammation and block prostaglandins. c- interrupt the transmission of pain impulses. d- interfere with the relay of pain information through the dorsal horn.

b- reduce inflammation and block prostaglandins. The site of action of nonsteroidal anti-inflammatory drugs (NSAIDs) is primarily the periphery at the receptor site, where NSAIDs serve an anti-inflammatory function and prevent the production of prostaglandins.

After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client? a) 2 b) 1 c) 3 d) 4

c) 3 The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: 1 = awake and alert; no action necessary 2 = occasionally drowsy but easy to arouse; requires no action 3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose 4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

When developing the plan of care for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain is most effectively relieved when analgesics are administered in what matter? a) On a PRN (as needed) basis b) Conservatively c) Around the clock (ATC) d) Intramuscularly

c) Around the clock (ATC) The PRN protocol is totally inadequate for patients experiencing chronic pain. ATC doses of analgesics are more effective, whereas conservative pain management for whatever reason may also prove ineffective. Intramuscular administration is not practical on a long-range basis for a patient with chronic pain.

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) Transcutaneous electrical nerve stimulation c) Cutaneous stimulation d) Client-controlled analgesia

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

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 does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort? a) Melatonin b) Dopamine c) Endorphins d) Serotonin

c) 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.

A nurse uses a whirlpool to relax a patient following intense physical therapy to restore movement in her 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.

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) High blood pressure c) Guarding of the chest area d) Increased respiratory rate

c) Guarding of the chest area

The nurse recognizes which of the following statements is true of chronic pain? a) It can be easily described by the client. b) It disappears with treatment. c) It may cause depression in clients. d) It is always present and intense.

c) It may cause depression in clients.

Three days after surgery, a patient continues to have moderate to severe incisional pain. Based on the gate control theory, what action should the nurse take? a) Decrease external stimuli in the room during painful episodes. b) Advise the patient to try to sleep following administration of pain medication. c) Reposition the patient and gently massage the patient's back. d) Administer pain medications in smaller doses but more frequently.

c) Reposition the patient and gently massage the patient's back. The nurse would reposition the client and gently massage the client's back using the gate control theory of pain. The gate control theory provides the most practical model regarding the concept of pain. It describes the transmission of painful stimuli and recognizes a relation between pain and emotions. 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.

A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0 to 10 scale) and requests "something for pain that will work quickly." The nurse will document this as a) somatic pain. b) referred pain. c) breakthrough pain. d) neuropathic pain.

c) breakthrough pain. Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.

Endogenous opioids such as endorphins: a) release neurotensin. b) excite neural pathways. c) contribute to analgesia. d) cause muscle spasms.

c) contribute to analgesia. The opioid receptors, important for the inhibition of pain perception, are sites where endogenous opioids and exogenous opioids bind. Three groups of endogenous opioids relieve pain: enkephalins, endorphins, and dynorphins.

Which physiologic or behavioral manifestation is more commonly associated with acute pain rather than chronic pain? a- Reduced tendency to touch or move the affected area b- Psychosocial withdrawal c- Inability to concentrate d-Dry skin and moist oral mucous membranes

c- Inability to concentrate The characteristic most common to chronic pain is psychosocial withdrawal. Dry skin and moist mucous membranes indicate an absence of or physiologic adaptation to the stress response associated with chronic pain. Clients experiencing either acute or chronic pain tend to protect the painful area. The inability to concentrate is associated much more with acute pain before any physiologic or behavioral adaptation has occurred.

A postoperative client that recently returned from surgery has a morphine PCA pump. The basal rate is ordered to be 1 mg/hour and the patient can have a 1-mg bolus every 15 minutes. When the nurse assesses the client, the nurse finds the client stuporous, hard to arouse, with a respiratory rate of 6 breaths/minute. After successfully treating the client, which action by the nurse takes priority? The nurse should a- request the physician order different basal and bolus rates. b- question the client about how he/she has been using the button on the pump. c- check the IV pump to ensure the basal rate is set correctly. d- Ask the physician to discontinue the PCA pump and revert to prn opioids for pain.

c- check the IV pump to ensure the basal rate is set correctly. The patient exhibited manifestations of opioid toxicity. The ordered dose was well within a safe range for a postoperative client. On a PCA pump, the demand feature has a lock-out device limiting the amount of opioid the client can administer. This could have been set incorrectly, allowing the client to overdose him/herself; however, a sleepy postoperative client often cannot use the demand feature without reminders. This leaves the basal rate as the most likely source of error and the nurse should check to see that it was set correctly. Giving prn pain medications often results in undertreatment of pain and should not be used on a postoperative client. If the pump was set incorrectly, there is no need to adjust the rates. Questioning the client and re-educating him/her if needed are always appropriate, but it is not the priority since the pump most likely was set incorrectly.

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) "I may need fewer pain medications with the TENS unit in place." b) "Wearing the TENS unit should not interfere with my daily activities." c) "One advantage of the TENS unit is it increases blood flow." d) "I could use the TENS unit if I feel pain somewhere else on my body."

d) "I could use the TENS unit if I feel pain somewhere else on my body." The client needs further instruction when she says she 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.

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 gets unbearable 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 ordered pain medications for you, which you should not be afraid to request any time you have pain."

d) "Your doctor has ordered pain medications for you, which you should not be afraid to request any time 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 not be considered a natural part of the experience that will lessen in time.

A middle-age client tells the nurse that her neck pain reduced considerably after she underwent a treatment in which thin needles were inserted into her skin. What kind of pain relief treatment did the client undergo? a) Transcutaneous electrical nerve stimulation b) Biofeedback c) Rhizotomy d) Acupuncture

d) Acupuncture

Which of the following means of pain control is based on the gate control theory? a) Distraction b) Hypnosis c) Biofeedback d) Acupuncture

d) Acupuncture Acupuncture is a means of pain control that is based on the gate control theory. Biofeedback, distraction, and hypnosis are alternative and complementary therapies that are nonpharmacological means of pain control. They are not based on the gate control theory.

A client states that he is pain and requests the ordered pain medication. When entering the client's room, the client is laughing with visitors and does not appear to be in pain. What is the appropriate action by the nurse? a) Reassess the client's pain in 30 minutes. b) Contact the client's physician. c) Hold the pain medication. d) Administer the pain medication.

d) Administer the pain medication.

When performing an assessment on a client with chronic pain, the nurse notes that the client frequently shifts conversational topics. The nurse determines that this may be an indicator for which of the following? a) Boredom b) Depression c) Moodiness d) Anxiety

d) 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.

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) Ask the client if they want the medication. c) Administer the medication with food. d) Contact the physician.

d) Contact the physician. The nurse should contact the physician regarding the diagnosis of a bleeding disorder and the order for the NSAID. NSAIDs are contraindicated in clients with bleeding disorders, as the action of the NSAID can interfere with the client's platelet function.

While assessing an infant, the nurse notes that the infant displays an occasional grimace and is withdrawn; legs are kicking, body is arched, and the infant is moaning during sleep. When awakened, the infant is inconsolable. What scale should the nurse use while assessing pain in this infant? a) BRADEN SCALE b) APGAR SCORE c) FACES SCALE d) FLACC SCALE

d) FLACC SCALE 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. 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.

Which medication would the nurse most likely see on the medication administration record (MAR) of a client with diabetic neuropathy? a) Lorazepam b) Hydromorphone c) Morphine d) Gabapentin

d) Gabapentin Gabapentin is used to treat nerve pain.

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) Visceral pain b) Chronic pain c) Cutaneous pain d) Neuropathic pain

d) Neuropathic pain

Which guideline regarding pain should be included in the nurse's education plan for a group of parents with infants and toddlers? a) Toddlers often try to be brave and not cry. b) Toddlers are often reluctant to express pain. c) Infants cannot express pain until 8 months of age. d) Pain can be a source of fear and threat to the toddler's security.

d) Pain can be a source of fear and threat to the toddler's security.

Based on your knowledge of pain and the body's response, when assessing a client in pain, you would anticipate the a) Pulse rate is decreased b) Blood pressure is normal c) Respirations are shallow d) Pupils are dilated

d) Pupils are dilated Acute pain stimulates the sympathetic nervous system and produces the following objective symptoms: increased blood pressure, increased pulse, increased respiratory rate, dilated pupils, and diaphoresis.

A female patient who is having a myocardial infarction complains of pain that is situated in her jaw. 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: 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 client has required frequent scheduled and breakthrough doses of opioid analgesics in the 6 days since admission to the hospital. The client's medication regimen may necessitate which intervention? a) Supplementary oxygen and chest physiotherapy b) Calorie restriction and dietary supplements c) Frequent turns and application of skin emollients d) Stool softeners and increased fluid intake

d) Stool softeners and increased fluid intake The most common side effect of opioid use is constipation. Consequently, stool softeners and increased fluid intake may be indicated. Opioids may cause respiratory depression, but this fact in and of itself does not create a need for oxygen supplementation or chest physiotherapy. The use of opioids does not create a need for calorie restriction, supplements, frequent turns, or the use of skin emollients.

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 block glutamate receptors and peptides. b) They occupy cell receptors for neurotransmitters. c) They react with acetylcholine and serotonin. d) They bind to opioid receptor sites throughout the CNS.

d) They bind to opioid receptor sites throughout the CNS.

A client asks the nurse which vitamins should be taken daily for feelings of fatigue, anxiety, and depression 1 week before menses. Which of the following is the correct response by the nurse? a) Vitamin D b) Vitamin A c) Vitamin C d) Vitamin B6

d) Vitamin B6