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 Explanation: Ginkgo, when taken with acetaminophen, enhances the risk of bleeding. Echinacea, willow, and kava, when taken with acetaminophen, increase the potential for hepatotoxicity and nephrotoxicity

A client sustained second- and third-degree burns to the chest and neck 4 days ago and is now refusing analgesics stating, "I don't want to become addicted to pain medication." What is the best response by the nurse?

"Although misusing the medication may cause addiction, there is little evidence that those who require narcotics for legitimate pain become addicted." Explanation: The American Society for Pain Management Nursing describes addiction as a chronic, relapsing, treatable disease—characterized by craving, dysfunctional behaviors, inability to control impulses regarding consumption of a substance, and compulsive use despite harmful consequences (Oliver et al., 2012). Although opioid drugs can result in addiction, there is very little evidence that those who require narcotics for legitimate pain actually become addicted. The other options are nontherapeutic responses to the client's concern about addiction.

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 He is withdrawn, grimaces, and turns away during the dressing change.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?

"I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication." Explanation: The nurse needs to explore the reason a client denies pain when pain is expected during a treatment, as with a dressing change to burns, and when the client grimaces during the dressing change. The nurse needs to educate clients about effects of pain on recovery. The nurse also cannot ignore that pain relief will hasten recovery. The nurse should not allow the client to associate pain with his dressing changes.

The nurse applies a transdermal patch of fentanyl for a client with pain due to cancer of the pancreas. The client puts the call light on 1 hour later and tells the nurse that it has not helped. What is the best response by the nurse?

"It will take approximately 12 to 18 hours for the medication to begin to work, so I will give you something else now to relieve the pain." Explanation: Its lipophilicity makes fentanyl ideal for drug delivery by transdermal patch (Duragesic) for long-term opioid administration and by the oral transmucosal (Actiq) and buccal (Fentora) routes for BTP treatment in patients who are opioid tolerant. Following application of the transdermal patch, a subcutaneous depot of fentanyl is established in the skin near the patch. After absorption from the depot into the systemic circulation, the drug distributes to fat and muscle. When the first patch is applied, 12 to 18 hours are required for clinically significant analgesia to be obtained; attention must be paid to providing adequate supplemental analgesia during that time.

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." Explanation: Clients should not use an over-the-counter analgesic agent, such as aspirin, ibuprofen, or acetaminophen, consistently to treat chronic pain without first consulting a physician. Ibuprofen is not contraindicated when taking a proton pump inhibitor. Asking "Don't you know that you can cause bleeding when you take that medication so often?" implies accusation and is not a therapeutic response.

A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client

"Only you are to push the button for medication." Explanation: With a PCA machine, clients control the administration of their pain medication within prescribed parameters. Family members or other visitors should not push the button on the PCA machine for the client; doing so overrides the safety features of the machine. Clients may become frustrated if pushing the button frequently does not result in pain relief. The nurse needs to instruct the client about time limits. Other instructions include not waiting until the pain is severe before pushing the button and that the PCA machine is used to control pain.

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?" -"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?" Explanation: The nurse needs to assess pain as to intensity, timing, location, and aggravating factors. Assessing frequency is important, but the statement "You've never had this pain before, have you" is leading and nontherapeutic

The nurse caring for a 79-year-old client who has just returned to the medical-surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that the client has been agitated in the past following opioid administration. What principle(s) should guide the nurse's management of the client's pain? Select all that apply.

-Older adults may require lower doses of medication to minimize side effects. -Older adults are at risk for confusion when introduced to new medications.

The nurse plans nonpharmacologic interventions for a client who is approaching discharge after a left knee arthroplasty to address the client's pain. For each intervention, click to specify if the therapy indicates a physical modality, cognitive and behavioral method, or movement therapy for the treatment of pain.

-application of heat or cold= Physical Modality -relaxation breathing= Cognitive & Behavioral Method -yoga=Movement Therapy -aquatic therapy= Physical Modality -distraction= Cognitive & Behavioral Method -Thai Chi= Movement therapy -proper body alignment= Physical Modality -imagery= Cognitive & Behavioral Method

Which of the following assessment tools will be most effective when assessing for pain in a four-year-old client?

A FACES scale Explanation: FACES scales are best for assessing pain in very young clients because these scales use pictures and short descriptive phrases. Although a numeric scale, a word scale, or a linear scale may be used, a child may find them difficult to understand.

A client with appendicitis has had an appendectomy. After surgery, what type of pain does the nurse anticipate the client will have?

Acute pain Explanation: Acute pain is a discomfort that has a short duration (from a few seconds to less than 6 months). It is associated with tissue trauma, including surgery, or some other recent identifiable etiology. The characteristics of chronic pain, discomfort that lasts longer than 6 months, are almost totally opposite from those of acute pain. An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Referred pain is a term used to describe discomfort that is perceived in a general area of the body, but not in the exact site where an organ is anatomically located.

A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect?

Addiction Explanation: Addiction is a behavioral pattern of substance use characterized by a compulsion to take the substance primarily to experience its psychic effects. Placebo effect is analgesia that results from the expectation that a substance will work, not from the actual substance itself. Dependence occurs when a client who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued. Tolerance occurs when a client who has been taking opioids becomes less sensitive to their analgesic properties

The nurse is obtaining data regarding medications the client is taking on a regular basis. The client states he is taking duloxetine, an antidepressant for the treatment of neuropathic pain. What type of therapy does the nurse understand the client is receiving?

Adjuvant drug therapy Explanation: Adjuvant drugs are medications that are ordinarily administered for reasons other than treating pain. Duloxetine is used to treat depression but is being used for neuropathic pain for this client.

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?

Administer analgesics around the clock. Explanation: Because assessing pain medication needs in a client with end-stage dementia is difficult, analgesics should be administered around the clock. Clients at this stage of dementia typically can't request oral pain medications when needed. They're also unable to use patient-controlled analgesia devices. Transdermal patches are used to manage chronic pain; not postoperative pain.

The nurse understands that which statement is true about tolerance and addiction?

Although clients may need increasing levels of opioids, they are not addicted. Explanation: Physical tolerance usually occurs in the absence of addiction. Tolerance to opioids is common. Addiction to opioids is rare and should never be the primary concern for a client in pain.

When caring for a patient who is deaf, which of the following should be used to elicit information regarding the patient's level of pain?

An outside interpreter should be used. Explanation: For people who are deaf of hard of hearing, outside interpreters (i.e., not family members) should be used. For people with disabilities that result in communication impairment, computer-generated speech may be useful. For people who are blind and who know how to read Braille, pain assessment instruments can be obtained in Braille. The patient is deaf, so verbally asking to rate the pain on a scale would be inappropriate.

The nurse is assessing a client's level of pain. How is the pain best described?

An unpleasant sensation of physical hurt or discomfort that can be caused by disease, injury, or surgery. Explanation: Pain is a privately experienced, unpleasant sensation usually associated with disease, injury, or surgery. Although pain can have an emotional component, referred to as suffering, this is not the source of all pain. Although pain can be the result of disease, it can also be caused by injury, surgery, emotional or mental conditions, or other causes. Pain is a normal aspect of nervous system functioning. Neuropathic pain is pain that is processed abnormally by the nervous system.

A client who fell at home is hospitalized for a hip fracture. The client is in Buck's traction, anticipating surgery, and reports pain as "2" on a pain intensity scale of 0 to 10. The client also exhibits moderate anxiety and moves restlessly in the bed. The best nursing intervention to address the client's anxiety is to

Assess the reason for the client's anxiety. Explanation: Following the steps of the nursing process, the nurse needs to assess the reason for the client's anxiety. The client could be anxious about impending surgery, an unattended pet, a sick family member, etc. Then, the nurse intervenes appropriately by obtaining the assistance the client may need or administering anti-anxiety medication. The question is asking about treatment for anxiety. Pain medication should not be administered for anxiety. The nurse will not assist the client to a chair, because the client is on bedrest and in Buck's traction.

When administering a fentanyl patch, the last dose of sustained-release morphine should be administered at what point?

At the same time the first patch is applied Explanation: Because it takes 12 to 18 hours for the fentanyl concentrations to increase gradually from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied. The skin must be clean and dry before applying the patch; no shower is required. Respiratory assessment must be conducted before applying the fentanyl patch.

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?

Bradypnea Explanation: Most patients experience sedation at the beginning of opioid therapy and whenever the opioid dose is increased significantly. If left untreated, excessive sedation can progress to clinically significant respiratory depression (bradypnea, or reduced breathing rate)

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 Explanation: When asking the patient to describe how the pain feels, the nurse should suggest to the patient descriptors such as "sharp," "shooting," or "burning," which may help identify the presence of neuropathic pain.

Which of the following nursing interventions contributes to achieving a client's pain relief?

Collaborate with the client about the goal of a level of pain relief. Explanation: The nurse should collaborate with each client about the goal of a level of pain relief; this helps implement interventions for achieving the goal. The client's description of pain or need for pain relief should never doubted or minimized. The client need not refrain from self-administering analgesics; providing a client with equipment to self-administer analgesics promotes a more consistent level of pain relief. The nurse should also inform the client of available pain management techniques and incorporate any preferences or objections to interventions for pain management that the client may have when establishing a plan of care; using all forms of available pain management techniques is not necessary.

The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain?

Diaphoresis Explanation: Observe behavioral signs, e.g., facial expressions, crying, restlessness, diaphoresis (sweating), and changes in activity. A pain behavior in one patient may not be in another. Try to identify pain behaviors that are unique to the patient ("pain signature"). Increased heart rate, blood pressure, and respiratory rate would be more likely to be associated with pain rather than decreased levels of these measures

Which of the following is the appropriate intervention to avoid physical withdrawal on drugs in a client?

Discontinue drugs gradually. Explanation: To avoid withdrawal symptoms, drugs that are known to cause physical dependence are discontinued gradually. The most appropriate nursing action to avoid tolerance is to consult with the physician for an increased dosage of the drug. Subtherapeutic dosages and adjuvant drugs are not needed to avoid physical dependence of drugs in a client

Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain?

Do not administer if respirations are less than 12 breaths per minute Explanation: The nurse should not administer the prescribed opiate therapy if respirations are less than 12 breaths per minute. The nurse should instruct a client who is prescribed psychostimulants to avoid caffeine or other stimulants, such as decongestants. The nurse should monitor weight, vital signs, and serum glucose concentration when administering corticosteroids. When administering anticonvulsants, the nurse should also monitor blood counts and liver function tests

Which substance reduces the transmission of pain?

Endorphins Explanation: Chemicals that reduce or inhibit the transmission of perception of pain include endorphins and enkephalin, which are morphinelike endogenous neurotransmitters . Acetylcholine, serotonin, and substance P are chemicals that increase the transmission of pain

The nurse is administering a narcotic analgesic for the control of a newly postoperative client's pain. What medication will the nurse administer to this client?

Fentanyl Explanation: Opioid and opiate analgesics such as morphine and fentanyl are controlled substances referred to as narcotics. The other medications are not opioid analgesics and should not be given for a newly postoperative client.

An older adult is being treated with opioids for pain relief. Which of the following should the nurse strongly recommend to this client?

Follow a bowel regimen. Explanation: The nurse should ensure that a bowel regimen to prevent constipation is started when any older adult is treated with opioids. A high-fiber diet along with increased fluids should be encouraged. The client should not reduce fiber intake because this increases the risk for constipation. The client need not exercise regularly or avoid harsh sunlight because these have no effects on the drug therapy.

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?

Gabapentin Explanation: The anticonvulsant gabapentin is a first-line analgesic agent for neuropathic pain. Tramadol is designated as a second-line analgesic agent for the treatment of neuropathic pain. Ketamine is used as a third-line analgesic agent for refractory acute pain. Hydromorphone is a first-line opioid not used as an analgesic agent for neuropathic pain.

Which route of administration of medication is preferred in the most acute care situations?

Intravenous Explanation: The intravenous route is the preferred parenteral route in most acute care situations because it is much more comfortable for the client and peak serum concentrations and pain relief occur more rapidly and reliably. Epidural administration is used to control postoperative and chronic pain. Subcutaneous administration results in slow absorption of medication. Medication administered intramuscularly is absorbed more slowly than intravenously administered medication.

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 Explanation: An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Chronic pain sufferers may have periods of acute pain, which is referred to as breakthrough pain. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is a term used to describe discomfort that is perceived in a general area of the body but not in the exact site where an organ is anatomically located.

A client is reporting her pain as "8" on a 0-to-10 pain intensity scale. Then, the client states the pain is "3." Before the nurse leaves the room, the client states her pain is "6." The best action of the nurse is to

Obtain a pain scale with faces for the client to measure her pain. Explanation: Various scales are helpful to clients trying to describe pain intensity. If the client cannot use one scale, such as the numeric pain intensity scale, the nurse uses another pain intensity scale that the client finds easy to understand and use. The nurse does not average the numbers, medicate based on the highest number, nor record each of the numbers the client stated.

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. Explanation: Older adults are often sensitive to the effects of the adjuvant analgesic agents that produce sedation and other CNS effects, such as antidepressants and anticonvulsants. Therapy should be initiated with low doses, and titration should proceed slowly with systematic assessment of patient response.

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 experience reduced sensory perception. Explanation: Pain affects individuals of every age, sex, race, and socioeconomic class, and everyone should be assessed for pain. Additionally, older adults tend to experience reduced sensory perception.

Which phase of pain transmission occurs when the one is made aware of pain?

Perception Explanation: Perception is the pain process where one becomes aware of the pain as a result of neural activity. Modulation involves the response to noxious stimuli. Transduction refers to the processes by which noxious stimuli activate primary afferent neurons called nociceptors. Transmission describes the action potential that is created by transduction being transmitted along fibers.

Which is a true statement regarding placebos?

Placebos should never be used to test a client's truthfulness about pain. Explanation: Many pain guidelines, position papers, nurse practice acts, and hospital policies nationwide agree that placebos should not be used to assess or manage pain in any client, regardless of age or diagnosis. Perception of pain is highly individualized. A placebo effect is a true physiologic response. A placebo should never be used as a first line of treatment. Reduction in pain as a response to placebo should never be interpreted as an indication that the person's pain is not real.

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. Explanation: A major distinguishing characteristic between acute and chronic pain is its duration. Chronic is always prolonged.

The nurse's major area of assessment for a patient receiving patient-controlled analgesia is assessment of what system?

Respiratory Explanation: Essential to the safe use of a basal rate with PCA is close monitoring by nurses of sedation and respiratory status and prompt decreases in opioid dose (e.g., discontinue basal rate) if increased sedation is detected (Pasero, Quinn et al., 2011).

Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy?

Risk for impaired gas exchange Explanation: Problems that may develop with opioid and opiate therapy include risk for impaired gas exchange related to respiratory depression, constipation related to slowed peristalsis, and risk for injury related to drowsiness and unsteady gait.

Which condition is a heightened response that occurs after exposure to a noxious stimulus?

Sensitization Explanation: Sensitization is a heightened response that occurs after exposure to a noxious stimulus. Pain tolerance is the maximum intensity or duration of pain that a person is willing to endure. Pain threshold is the point at which a stimulus is perceived as painful. Dependence occurs when a client who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued.

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 Explanation: The patient's perception of pain severity should always be the primary consideration. It forms the baseline for all management

Which of the following is a disadvantage to using the IV route of administration for analgesics?

Short duration Explanation: Disadvantages of using the IV route for analgesic administration include short duration, the occurrence of possible respiratory depression, and that careful dosage calculations are needed. Intramuscular analgesics have a slower entry into the bloodstream.

Which of the following is a true statement with regards to the preventative approach to the use of analgesics?

Smaller doses of medication are needed. Explanation: Smaller doses of medication are needed with the preventative approach, because the pain does not escalate to a level of severe intensity. A preventative approach may result in the administration of less medication over a 24-hour period, helping prevent tolerance to analgesic agents and decreasing the severity of side effects. The preventative approach reduces the peaks and troughs in the serum level and provides more pain relief with fewer side effects.

The nurse asks the client about a reddened area on the left arm. The client reports having been bitten by an insect, and the bite area burned briefly. What type of pain does the nurse document this as?

Superficial somatic pain Explanation: Superficial somatic pain, also known as cutaneous pain (such as that from an insect bite or a paper cut), is perceived as sharp or burning discomfort. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Causes for visceral pain are varied and include ischemia, compression of an organ, intestinal distention with gas, or contraction as occurs with gallbladder or kidney stones. Deeper somatic pain is caused by trauma and produces localized sensations that are sharp, throbbing, and intense. Neuropathic pain is processed abnormally by the nervous system and results from damage to either the pain pathways in peripheral nerves or pain-processing centers in the brain.

A client reports abdominal pain as "8" on a pain intensity scale of 0-10 thirty minutes after receiving an opioid intravenously. Her past medical history includes partial-thickness burns to approximately 60% of her body several years ago. The nurse assesses

That the client's past experiences with pain may influence her perception of current pain Explanation: Clients who have had previous experiences with pain are usually more frightened about subsequent painful events, as in the client who experienced partial-thickness burns to more than 60% of her body. The clients in these situations are less able to tolerate pain. Insufficient data in the stem support that the client is dependent on drugs or that this current pain is related to the client's previous burn injuries.

Which of the following is a reliable source for quantifying pain?

The client's description of the pain Explanation: The client's description of the pain is the only reliable source for quantifying pain. Physiologic data such as vital signs or the extent or nature of the injury do not indicate the amount of pain.

Which type of pain arises from an internal organ, such as the kidneys?

Visceral Explanation: Visceral pain arises from internal organs, such as the heart, kidneys, and intestines, that are diseased or injured. Neuropathic pain is pain that is processed abnormally by the nervous system. Nociceptive pain is the noxious stimuli that are transmitted from the point of cellular injury over peripheral sensory nerves to pathways between the spinal cord and thalamus, and eventually from the thalamus to the cerebral cortex of the brain.

The nurse is caring for a client with kidney stones who reports severe pain. What type of pain does the nurse understand this client is experiencing?

Visceral pain Explanation: Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Somatic pain is caused by mechanical, chemical, thermal, or electrical injuries or disorders affecting bones, joints, muscles, skin, or other structures composed of connective tissue. Neuropathic pain is pain that is processed abnormally by the nervous system. Chronic pain is discomfort that lasts longer than 6 months and is almost totally opposite from those of acute pain.

Regarding tolerance and addiction, the nurse understands that

although clients may need increasing levels of opioids, they are not addicted. Explanation: Physical tolerance usually occurs in the absence of addiction. Tolerance to opioids is common. Addiction to opioids is rare and should never be the primary concern for a client in pain.

A client reports having joint pain that has gotten worse over the last year despite gradually increasing doses of an OTC pain reliever. Which type of pain will the nurse document as the chief complaint?

chronic pain Explanation: This client is experiencing chronic pain, which is pain or discomfort that lasts for a period longer than 6 months. Pain or discomfort with a short duration is acute pain. It is associated with trauma, injury, or surgery. Referred pain is pain felt in the body in a location that is different from the actual source of the pain. Breakthrough pain is a period of acute pain experienced by those suffering from chronic pain.

A nurse is caring for a client with pain. What should the nurse monitor for when administering intravenous acetaminophen?

hepatotoxicity Explanation: The nurse will need to monitor the client receiving acetaminophen for hepatotoxicity. Intravenous acetaminophen should not cause renal toxicity, bleeding, and gastrointestinal effects.

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 Explanation: Constipation is a common problem with the use of opioid medications, such as methadone. Activities to prevent constipation include increasing bran and fresh fruits and vegetables in the diet. The client should ingest 8 to 10 glasses of fluids per day. Milk of magnesia may be used if no bowel movement is produced in 3 days. Milk of magnesia is not to be used daily. A glycerin suppository, not bisacodyl, may be used to make the bowel movement less painful.

A client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. The client is without breakthrough pain at this point in time. How would this client's pain be classified?

neuropathic and chronic Explanation: When classified according to its source, pain can be categorized as nociceptive or neuropathic. When classified according to its onset, intensity, and duration, pain can be categorized as either acute or chronic. Because the client is without breakthrough pain at this time, he has no acute pain. Nociceptive pain is transmitted from a point of cellular injury to the brain. This is not the type of pain related to long-term diabetes mellitus. Neuropathic pain sustained by injury or dysfunction of the peripheral or central nervous systems. This type of pain is related to long-term diabetes mellitus. Acute pain is pain or discomfort of short duration: from a few seconds to less than 6 months. This is not the type of pain related to long-term diabetes mellitus.

A client is on a second round of radiation therapy for an inoperable tumor, and asks the nurse for medication to help with pain. The nurse suspects that the client's pain is the result of nerve damage from the radiation. Which type of pain is the client likely experiencing?

neuropathic pain Explanation: Neuropathic pain can affect cancer patients due to nerve damage from chemotherapy or radiation therapy. Somatic pain is caused by damage or disorders that affect bones, joints, muscles, skin, or other structures. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is pain felt in the body in a location that is different from the actual source of the pain.

The nurse sees an order for a lidocaine 5% patch. What use is approved for by the US Food and Drug Administration for this patch?

postherpetic neuralgia Explanation: A lidocaine 5% patch has been shown to be effective in postherpetic neuralgia. Lidocaine 5% patch has not been approved for epidural anesthesia, general anesthesia, or diabetic neuropathy.

A client has been given a patient-controlled analgesia (PCA) device to control postoperative pain. The client expresses concern about administering too much of the analgesic and accidentally overdosing. What topic should the nurse teach the client about?

the limits on dose and frequency that are programmed into the PCA Explanation: Patient-controlled analgesia (PCA) devices allow clients to self-administer their own narcotic analgesic using an intravenous pump system and pressing a handheld button. The dose and time intervals between doses are programmed into the device to prevent accidental overdose. Dosing may or may not be more than twice per hour. Naloxone treats overdoses, but this will not likely alleviate the client's concerns about overdosing in the first place. The client may benefit from non-pharmacologic pain measures, but should not be encouraged to minimize the use of the PCA or to endure pain.

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 Explanation: Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Visceral pain usually is diffuse, poorly localized, and accompanied by autonomic nervous system symptoms such as nausea, vomiting, pallor, hypotension, and sweating. Neuropathic pain is pain that is processed abnormally by the nervous system. Deeper somatic pain such as that caused by trauma produces localized sensations that are sharp, throbbing, and intense. Chronic pain has a duration longer than 6 months