Chapter 9 Pain Management

When taking a client history, the nurse notes that the client is taking herbal remedies in addition to acetaminophen. Which herb, when taken in conjunction with acetaminophen, enhances the risk of bleeding? Ginkgo Kava Echinacea Willow

Ginkgo

A nurse is caring for a client with pain. What should the nurse monitor for when administering intravenous acetaminophen? hepatotoxicity gastrointestinal effects bleeding renal toxicity

Hepatotoxicity

The nurse is to administer meperidine 75 mg intramuscularly to a client. The medication is supplied in an ampule of 50 mg/mL. How many milliliters should the nurse administer to the client? Enter the correct number ONLY.

1.5 mL

The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply. "How long have you experienced this pain?" "You've never had this pain before, have you?" "What aggravates your chest pain?" "Please point to where you are experiencing pain." "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain."

"How long have you experienced this pain?" "Please point to where you are experiencing pain." "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." "What aggravates your chest pain?"

A clinic nurse assesses a client with diabetes who reports taking naproxen (Aleve) and the herb bilberry for osteoarthritis. To assess for an adverse reaction between naproxen and bilberry, the nurse asks the client "Has your blood sugar been elevated more than usual?" "Have you noticed an increase in your pain levels?" "Do you bleed easily?" "Have you been constipated?"

"Do you bleed easily?"

A teenage client is undergoing a dressing change to burns on the thigh. The client refuses pain medication and states, "I do not hurt, and I don't need it." He is withdrawn, grimaces, and turns away during the dressing change. He was last medicated 8 hours ago. What is the best statement by the nurse? "You are so brave to not take your pain medication when the dressing change will hurt." "If you need pain relief, I can give you some medication when I have completed the dressing change." "I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication." "You are so right to not take your pain medication. You can become dependent on the medication."

"I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication."

A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies "A nausea medication has been prescribed that I will give you." "I will notify your physician." "What do you mean by the word sick?" "A lot of people have a similar problem with this medication."

"What do you mean by the word sick?"

A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain? Provide patient-controlled analgesia. Administer oral opioids as needed. Administer pain medication through a transdermal patch. Administer analgesics around the clock.

Administer analgesics around the clock

How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client? Administering the analgesics on a regular basis Administering analgesics with increased dosage Administering the analgesics intravenously Administering the analgesics on an as-needed per client request

Administering the analgesics on a regular basis

A 75-year-old client had surgery for a hip fracture yesterday. The client is under stress because of the pain, the medications, sleep deprivation, and hospital surroundings. Which nursing intervention to treat the client's pain should the nurse question when ordered by the doctor? Morphine rather than Advil for pain management Advil for pain management Acetaminophen for pain management Use of transcutaneous electrical nerve stimulator (TENS)

Advil for pain management

Regarding tolerance and addiction, the nurse understands that the nurse must be primarily concerned about the development of addiction by a client in pain. tolerance to opioids is uncommon. although clients may need increasing levels of opioids, they are not addicted. addiction to opioids often develops.

Although clients may need increasing levels of opioids, they are not addicted

A client with a terminal illness grimaces and begins to cry when being turned and repositioned in bed. Which action will the nurse take at this time? Stay with the client until pain from activity eases. Coach the client with guided imagery. Ask the client to rate the pain. Support the body area that is painful.

Ask the client to rate the pain

The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for? Asystole Hypertension Bradypnea Tachycardia

Bradypnea

When a nurse asks a patient to describe the quality of the pain, what type of descriptive term does the nurse expect the patient to use? Burning Chronic Intermittent Severe

Burning

When using transdermal Fentanyl, the nurse and patient should be aware of which sign or symptom of Fentanyl overdose? Insomnia Confusion Hyperventilation Hyperalertness

Confusion

The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain? Hypotension Bradycardia Diaphoresis Decreased respiratory rate

Diaphoresis

The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to Plan to use medication and nonpharmacologic interventions. Notify the surgeon of the client's goal of "0." Ensure the client is prescribed large doses of opioids postoperatively. Educate the client that this goal may not be achievable.

Educate the client that this goal may not be achievable

Which substance reduces the transmission of pain? Acetylcholine Endorphins Serotonin Substance P

Endorphins

The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe? Hydromorphone Gabapentin Ketamine Tramadol

Gabapentin

When evaluating a patient's response to acute pain, the nurse assesses for the presence of physiologic responses associated with the pain experience. Select all that apply: Hyperglycemia Lowered production of cortisol Increased cardiac output Increased metabolic rate Bradycardia and hypotension Decreased urinary output

Increased metabolic rate Hyperglycemia Decreased urinary output Increased cardiac output

A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends increasing the amount of bran and fresh fruits and vegetables using milk of magnesia 30 mL every day ingesting up to 6 glasses of fluids per day inserting a bisacodyl (Dulcolax) rectal suppository every morning

Increasing the amount of bran and fresh fruits and vegetables

When drafting a nursing care plan for a patient in pain, it is important for the nurse to determine if the pain is acute or chronic. Choose the best example of chronic pain. Angina Appendicitis Intervertebral disk herniation A migraine headache

Intervertebral disk herniation

A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing? Neuropathic pain Visceral pain Breakthrough pain Referred pain

Neuropathic pain

The nurse is administering an analgesic to an older adult patient. Why is it important for the nurse to assess the patient carefully? Older people are more sensitive to drugs. Older people have lower ratios of body fat and muscle mass. Older people have increased hepatic, renal, and gastrointestinal function. Older people metabolize drugs more rapidly.

Older people are more sensitive to drugs

The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient? Older people have a decreased pain threshold. Older people are expected to experience chronic pain. Older people experience reduced sensory perception. Older people have increased sensory perception.

Older people experience reduced sensory perception.

The nurse has given an older adult an oral opioid for postoperative pain. What should the nurse do first to make the pain medication more effective? Provide the client with a fresh gown. Position the client for comfort. Encourage the client to eat crackers. Consult with the health care prescriber to include hydroxyzine with the opioid.

Position the client for comfort

The nurse has given an older adult an oral opioid for postoperative pain. What should the nurse do first to make the pain medication more effective? Position the client for comfort. Consult with the health care prescriber to include hydroxyzine with the opioid. Encourage the client to eat crackers. Provide the client with a fresh gown.

Position the client for comfort.

A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be: Prolonged in duration. Rapidly occurring and subsiding with treatment. Attributed to a specific cause. Separate from any central or peripheral pathology.

Prolonged in duration

An elderly client has a fractured hip and is in Buck's traction. The client is disoriented and cannot express herself. At 0730 the client was calm. Now, at 0930, the client is restless and agitated. The nurse reviews the medication administration record. The last dose of opioid was at 0330. The nurse assesses the client's agitation may be from Increased uptake of opioids Effects of the opioid medication Diminished pain perception Recurring pain

Recurring pain

Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy? Risk for impaired gas exchange Risk for injury Altered mobility Diarrhea

Risk for impaired gas exchange

The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting: Severity of the pain as judged by the patient Anticipated harmful effects of the pain experience Medical interventions for pain management Anticipated duration of the pain

Severity of the pain as judged by the patient

A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client That medication will be prescribed for pain relief About activities that would distract him from pain How anxiety could increase his pain perception That the nurse will notify the surgeon of his fear

That medication will be prescribed for pain relief

Which of the following is the only reliable source for quantifying pain? The client The pain assessment tool The health care provider The nurse

The client

The nurse informs the patient that a preventive approach for pain relief will be used, involving nonsteroidal anti-inflammatory drugs. What will this mean for the patient? The pain medication will be administered when the level of pain tolerance has been exceeded. The pain medication will be administered before the pain is experienced. The pain medication will be administered before the pain becomes severe. The pain medication will be administered when the pain is at its peak.

The pain medication will be administered before the pain is experienced

A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing?

Visceral

A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing? visceral deeper somatic neuropathic chronic

Visceral

A client has been taking opioid analgesics for more than 2 weeks to control post-surgical pain. Although pleased with the client's progress, the surgeon decides to change the analgesic to a non-opioid drug. The surgeon prescribes a gradually lower opioid dose and increasingly larger non-opioid doses. The surgeon is changing medications in this manner to avoid: respiratory depression. tolerance. addiction. withdrawal symptoms.

Withdrawal symptoms

A client informs the nurse of having taken ibuprofen every 6 hours for 3 weeks to help alleviate the pain of arthritis. The client has a history of a gastric ulcer and is taking a proton pump inhibitor for the treatment of this disorder. What should the nurse instruct the client about the use of the ibuprofen? "It would be best to contact the health care provider before taking any over-the-counter medications." "Don't you know that you can cause bleeding when you take that medication so often?" "You should never take ibuprofen; it can cause considerable problems." "Ibuprofen is contraindicated when taking a proton pump inhibitor."

"It would be best to contact the health care provider before taking any over-the-counter medications."