EAQ PAIN

Which action would the nurse take to understand the nature of a clients pain?

- Observe where the client locates the pain. -Note whether the pain radiates to any other part of the body.

After undergoing minor surgery, a postoperative child has recovered from anesthesia. Which observations alert the nurse the child may be ready for discharge? SATA.

- Vital signs are stable. -Pain rate is at baseline. -The child is alert and priented.

When can oral morphine be administered?

60 minutes before.

In which time frame would the nurse advise a client with a long leg cast for a fractured bone to take the prescribed as needed oxycodone?

When the discomfort begins.

Which response by the nurse asked "How will they 'knock me out' for this colonoscopy?" described the route of administration for conscious sedation?

You will receive medication through an intravenous (IV) catheter.

What is a Transdermal medication?

applied to the skin, usually as part of an adhesive patch, for absorption into the bloodstream.

Which group of clients who were in a bus accident and admitting to the emergency department with injuries is considered urgent according to the three-tier triage system?

severe abdominal pain

Which mode of medication administration is preferred for a client with deep partial-thickness burns who is receiving an opioid for pain management?

Intravenous

Which route would a nurse expect to administer morphine sulfate prescribed for pain in a client admitted to the emergency department with burns to the anterior trunk, entire right arm, and anterior left arm?

Intravenously. The intravenous route is preferred route for medication for a client impaired peripheral circulation.

What is Diazepam used for?

Is a muscle relaxant that may be used for its sedative effect.

What is Oxycodone used for?

Is an orally administered analgesic;an analgesic that is administered via the intravenous, not the oral, route provides more immediate pain relief.

A student athlete reports muscle pain after a practice session. Which product of muscle metabolism would the nurse explain as being a cause of pain?

Lactic acid

When providing comfort to a client during the last hours of life, which would the nurses primary concern?SATA.

-pain. -respiratory status.

Which is the MOST reliable indicator of a 2.5 year old Childs pain?

Changes in behavior

When naloxone has been administered to a client with an opiate overdose, which action is MOST important for the nurse to take?

Observe respiratory rate and depth.

Which factor would the nurse recognize as a cause of neck pain in the client?

Poor posture

Which nonpharmacological nursing intervention is effective in helping relieve postoperative pain?

Repositioning

Which factors would the nurse consider when administering opioids to a child with severe pain? SATA.

-Dosing calculations. -Appropriate dosage form. -Presence of other symptoms.

Which action would the nurse take when caring for a client using a patient controlled analgesia pump who identifies attempts to self administer the analgesic 10 times because the client is still experiencing pain?

Determine the integrity of the intravenous delivery sysem.

According to the nursing process, which action would the nurse take after administering pain medication to a postoperative client?

Determine whether the pain medicine relieved the clients pain.

Which client would the nurse assess FIRST?

65 year old who reports tearing abdominal pain and has a history of uncontrolled hypertnesion.

The nursing team is collaborating in the care of a client with chronic pain. Which task must be performed by the registered nurse?

Developing a treatment plan for the client's pain.

The nursing is planning the discharge of a 9 year old child who has undergone tonsillectomy. In addition to the prescribed analgesic, which would the nurse recommend the parent use to ease their childs pain?

Light-colored ice pops

Which action would be taken by a nurse when caring for a client prescribed transdermal fentanyl 25 mcg/h every 72 hours during the first 24 hours after starting the fentanyl?

Manage pain with analgesic by a different route.

When caring intervention helps provide comfort, dignity, respect, and peace to a client?

Relieving pain and suffering

A school age child with end stage cancer has a continuous infusion of morphine to manage their pain. Breakthrough pain occurs and a fentanyl "lollipop" is prescribed. Which instruction would the nurse give the child regarding the use of the lollipop when pain occurs?

"Hold it in your cheek only until the pain is relieved."

Which pain relief medication would the nurse expect to find in the plan of care of a client with myocardial infarction admitted to the cardiac intensive care unit?

Morphine

Which action is the nurses responsibility when administering prescribed opioid analgesics? SATA.

-Count the clients respirations. -Document the intensity of the clients pain. -Verify the number of doses in the lock cabinet before administering the prescribed dose.

A client is admitted to the hospital with severe back and abdominal pain, nausea and occasional vomiting, an oral temperature of 101 F (38.3C). The client reports drinking six to eight beers a day. A diagnosis of acute pancreatitis is made. Based on the date presented, which clinical finding is a primary nursing concern for this client?

Acute pain

A client with terminal cancer is to receive 2mg of hydromorphone intravenously (IV) every 4 hours as needed for severe breakthrough pain. It is supplied at 10 mg/mL/ When the client complains of severe pain, how many milliliters of hydromorphone will the nurse administer? Record your answer using one decimal place. Include a leading zero is applicable.

0.2 prescribed dose= 2mg IV. available concentration is 10 mg/mL

Six hours after major abdominal surgery, a client reports severe abdominal pain and faintness. The nurse identifies a thready, rapid pulse. The nurse checks the medication administration record MAR and determines that the client can receive another injection of pain medication in an hour. Which action would the nurse take?

Notify the health care provider about the clients symptoms.

Which therapeutic outcome is expected after administering ibuprofen? SATA.

-Pain relief. -Temperature reduction. -Reduced infammation.

Which method qualify as alternative therapies for pain?SATA.

-Prayer -Hypnosis -Aromatherapy -Guided imagery

A child is administered fentanyl during outpatient surgery. The nurse understands which criteria must be met before the child can be discharged? SATA.

-The child is alert and active. -The childs pain is at baseline levels. -The childs vital signs have remained stable.

A 3.5 year old child begins to scream and kick when a laboratory technician arrives to draw blood. Which developmental milestone would the nurse recognize as likely contributing to this reaction?

Terror of intrusive procedure.

For a client who had knee replacement surgery, which assessment findings gathered by the nurse is an example of subjective data?

The clients pain is 7 on a scale of 1 to 10.

Which conclusion would the nurse make regarding the clients response to pain medication when a client using a pain scale of 1 to 10 rates the pain as an 8 before receiving analgesic and a 7 after being medicated?

The medication is not adequately effective.

Which outcome would be a PRIORITY for the nurse to incorporate into the plan of care for a client with a migraine?

To decrease pain.

Which response would the nurse give to a client newly diagnosed with multiple sclerosis who asks the nurse, "Will I experience pain?"

"Pain is not a characteristics symptom of this condition."

A client presents to the health care facility with abdominal pain. Which question would the nurse ask the client to obtain information about concomitant symptoms?

"What other discomfort do you experience?"

Which nursing concerns is a PRIORITY when a 6 year old child with sickle cell disease is admitted with a vasoocclusive crisis(pain episode) SATA.

-Hydration. -Pain management. -Oxygen supplementation.

Which action would the nurse take FIRST for a postsurgical client who is still intubated but becoming restless, with an increased pulse rate and blood pressure, when it has been 4 hours since the last dose of pain medication?

Administer the prescribed pain medication.

Which physiological response will occur if a client being treated for myocardial infraction experiences the intended therapeutic effect of morphine?

Decreased workload of the heart.

Which property would the nurse understands that the medication is being used PRIMARILY for when aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis?

Anti-inflammatory

The nurse applies a cold pack to relieve musculoskeletal pain. Which rationale explains the analgesic properties of cold therapy?

Causes local vasoconstriction, preventing edema and muscle spasms

Which action would the nurse take while giving an injection to a preschooler?

Distract the child with conversation.

Which intervention would the nurse incorporate into the plan of care of the older adult experiencing chronic pain?

Exercise

Which assessment would the nurse complete o promote safety before administering pain medication to an older adult?

Other prescribed medications

A client with a known history of Opioid addiction has a surgical repair of multiple stab wounds to the abdomen. After surgery, the client's pain is not relieved by the prescribed morphine injections. Which phenomenon is the client experiencing when they fail to achieve pain relief?

Tolerance

The primary nurse, leaving the unit for lunch, provides a verbal report for the covering nurse. The report included one client's prescription for morphine: 2mg intravenously (IV) every 3 hours for abdominal pain secondary to major abdominal surgery that morning. During the primary nurses lunch, the client complains of pain at a level 8 out of 10 on the pain scale. Which action would the nurse perform FIRST?

Verify that the written prescription matches initially to relieve the pain.

Twenty four hours after receiving spinal anesthesia during childbirth, a client tells the nurse she has a headache. Which statements indicate to the nurse that the headache is a reaction to the anesthesia? SATA.

- "My ears are ringing." -"it gets better when I lie down." -"Bright lights really bother my eyes." -"My head hurts more when I'm sitting watching television."

Which action would the nurse take when a client reports pain and burning at a peripheral intravenous (IV) site after the nurse has flushed the saline lock with normal saline?

Remove the IV catheter and restart the saline lock in another site.

The nurse must restart a peripheral intravenous (IV) infusion on a child. Which would the nurse do to promote the childs sense of security?

Take the child to the treatment room for the procedure.

Which assessment findings of a client with chronic pain who has been prescribed Opioid treatment indicates the need for a PRIORITY nursing intervention?

-Level 3 sedation. -Respiratory rate of 8 bpm

When obtaining a health history from the newly admitted client who has chronic pain in the right knee, which pain assessment date would the nurse include? SATA.

-Pain history, including location, intensity and quality of pain. -Pain, pattern, including precipitating and alleviating factors.

When assessing a client after abdominal surgery, which cue would the nurse use to form a data cluster?

-The client reports pain with movement. -The client has pain over the surgical area. -The client rates the pain as 8 on a scale of 0 to 10.

Which recommendation would the nurse give to the client with trigeminal neuralgia?

Chew on the unaffected side.

Which scale is used to measure the intensity of pain in preschoolers?

FACES scale

The registered nurse (RN) is caring for a client who has severe abdominal pain. The Rn plans to work with the assistance of an unlicensed assistive personnel (UAP). The RN starts the client. Which tasks would the RN take into consideration when initiating the process of active delegation? SATA.

- Assessing the level of the clients abdominal pain. -Directing the UAP to assist the client while toileting. -Ensuring the UAP is accountable for successful completion of the task.

An adolescent is admitted with partial and full thickness burns of the arms and upper torso. Which are the primary purposes of administering pain medication via the intravenous route, rather than the intramuscular route? SATA.

- It decreases the risk of tissue irritation. -Severe pain is reduced more effectively. -Impaired peripheral circulation is bypassed.

After interacting with a client, the nurse thinks the client is in the prodromal phase of a migraine. Which statements made by the client led the nurse to reach this conclusion? SATA.

-"I feel drowsy all the time." -"I feel confused at this point in time." -"I feel weakness in the left side of my body."

Which information would the nurse include in the client's medication teaching on the administration of aspirin 650mg every 6 hours as needed for arthritic pain? SATA.

-"Report persistent abdominal pain." -"Do not chew enteric-coated tablets." -"Take the aspirin with meals or a snack."

The nurse is questioning a client who reports pain. Which questions ask by the nurse are correct. SATA.

-"Where does it hurt?" -"What makes the pain worse?" -"How long have you noticed it?" -"How severe is your pain on a scale of 0 to 10?"

Which strategies would the nurse implement to reduce a childs pain and anxiety concerning vaccines?SATA.

-Applying a topical anesthetic. -Using microneedles or needle-free devices. -Injecting intramuscular vaccines quickly and without aspiration.

Which nursing interventions would the nurse implement for a child undergoing treatment with opioid analgesics?

-Assessing the childs level of pain. -Administering oral medications with meals or snacks. -Assessing the child's verbal and nonverbal behaviors. -Documenting the child's age, weight, and height before treatment.

Which benefit would be provided by administering patient-controlled analgesia (PCA) to a client after surgery? SATA.

-Client is able to self-administer pain-relieving medications as necessary. -Decreases client dependency. -Increases client sense of autonomy.

Which action would the nurse take before administering each dose in a client who takes oxycodone every 3 hours for pain after surgery? SATA.

-Count the client's respiratory rate. -Ask the client to rate the level of pain. -Assess the client's level of consciousness.

For which involuntary physiologic response would the nurse monitor development in a client experiencing pain?

Perspiring

Which intervention is the PRIORITY nursing care for a client in the coronary care unit who develops "viselike" chest pain radiating to the neck with a blood pressure of 124/64 mm Hg, an irregular apical pulse of 64 beats per minute, and diaphoresis who is prescribed morphine sulfate 4mg intravenous (IV) push stat and cardiac monitoring?

Relief of pain.

After orthopedic surgery, an adolescent reports pain and rates it a 5 on a scale of 0 to 10 the nurse administers the prescribed 5mg of oxycodone every 3 hours as needed. Two hours after having been given this medication, the adolescent reports pain and rates it a 10 of 10. Which action would the nurse take?

Request that the primary health provider evaluate the need for additional medication.

An adolescent client has orders for morphine sulfate for sever pain and acetaminophen-codeine compound for moderate pain after a spinal fusion. The pain assessment reveals the client is rigid and crying in pain. Which information would influence the nurses choice of analgesic?

Spinal fusion causes considerable pain during the early postoperative days, and morphine is more effective analgesic.

What is concomitant symptoms?

Symptoms that accompany the primary symptom of the illness and worsen the health conidition.

At which time would the nurse plan to administer morphine 2mg by mouth every 2 hours as needed to a client who has burns on 55% of the body surface and requires dressing changes?

60 minutes before the dressing change

Which pain description would the nurse expect a client to report when describing pain associated with suspected duodenal peptic ulcer?

A gnawing sensation in the epigastric area.

A client with an inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit, which nursing action is appropriate?

Adjust the dial on the unit until the client states that the pain is relieved.

The day after undergoing abdominal appendectomy, a school aged child is prepared for ambulation. Which nursing action would be MOST effective before the start of ambulation?

Administering the prescribed pain medication.

The registered nurse is reviewing the clinical status of four clients. Which clients care can be delegated to the licensed practical nurse (LPN)?

Condition- Dental pain. Medication- Non steroidal anti-inflammatory drugs.

A cient has been receiving oxycodone for moderate pain associated with multiple injuries sustained in a motor vehicle collision. Which assessment finding, in addition to the clients slurred speech, leads the nurse to suspect opioid intoxication?

Constricted pupils

The nurse is caring for a client who has developed dysphagia and is unable to swallow. The client is receiving around the clock opioid pain medications for cancer, and hospice has recently begun to care for the client. Which is the BEST nursing intervention in preparing for the clients discharge?

Contact the clients health care provide to discuss use of transdermal

A client who has severe facial scarring from burns tells the nurse, "I've saved some oxycodone, and when I get home, I'm going to take all of them. Dont tell anyone. "Which response is best?

Are you planning to kill yourself?

When, during the first 24 hours postoperatively, will analgesics be administered to a client who undergoes an abdominal cholecystectomy for gangrene of the gallbladder?

As prescribed by the health care provider.

A 20 year old carpenter with a history of substance abuse falls from a roof and sustains fractures of the right femur and left tibia. Which intervention is the MOST important?

Assessing for amount and time of last substance use.

The nurse is caring for a child with an exacerbation of leukemia. The nurse would plan to administer the prescribed analgesic for bone pain at which time?

At scheduled intervals.

Which interview technique would the nurse use to ask a client to rate their pain on a scale from 0 to 10?

Closed-ended questioning

Which intervention is useful in promoting comfort for the client experiencing a headache?

Cold therapy

Which situation would the nurse address FIRST according to Masclows hierarchy?

Complains of sleeplessness due to pain postsurgery.

An adolescent client with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis) and has a patient-controlled analgesia (PCA) pump. The current pain rating is 5 on a scale of 1 to 10 at the right elbow. The nurse observes that the pump is "locked out" for another 10 minutes. Which action would the nurse implement?

Placing the prescribed as-needed warm, wet compress on the elbow.

Which nursing action is beneficial for the client who has pain due to muscle spasm?

Providing heat compresses at the site.

Assessment findings of a client who is admitted to the emergency department including cramping pain in the left lower quadrant, weakness, bloating, malaise, and a low grade fever. The nurse suspects which condition?

Diverticulitis

A child is experiencing pain after abdominal surgery and is given an opioid analgesic. Which statement is correct regarding children in pain and their response to opioid analgesics when they are prescribed?

Even though children do not like taking medicines, analgesics will make them more comfortable.

The nurse understands which anesthetic medication is commonly used for short procedures on pediatric clients?

Fentanyl

The nurse provides care for a Chinese client who is experiencing leg pain. The client states, "I dont want to take any medications that i may get addicted to." Which is the correct nursing intervention in this situation?

Give ibuprofen to the client with hot tea.

After obtaining vital sign data of blood pressure 90/60 mm Hg, pulse 96 beats/minute, and respiratory rate 10 breaths/minute for a postoperative client receiving hydromorphone by a patient-controlled analgesia (PCA) pump, which PRIORITY action would the nurse take?

Give naloxone intravenously per protocol.

Which strategy would the nurse use to assess a 4 year old child who is guarding the abdomen,crying, and not allowing any physical contact with the staff after a fall onto the handlebars of a tricycle?

Having the child guide the examiners hand to the area that hurts.

What is Midazolam used for?

Hypnotic that may be used to reduce fear and reslessness.

A client with a history of Osteoporosis and Vertebral compression has been coming to the clinic more frequently for prescription refills of hydrocodone/acetaminophen. Which inference will the nurse make?

Higher doses are needed to achieve pain relief.

After an amputation of a limb, a client reports extreme discomfort in the area where the limb once was. Which goal would the nurse plan to focus interventions?

Identifying actions to decrease pain in the lost limb.

A client who had thoracic surgery reports pain at the incision site when coughing and deep breathing. Which action would the nurse take?

Instruct the client to splint the wound with a pillow when coughing.

The nurse is caring for an Asian client who had a laparoscopic cholecystectomy 6 hours ago, When asked whether there is pain, the client smiles and says, "No." Which action should the nurse take?

Monitor for nonverbal cues of pain

Which consideration is the nurses concern when responding to the request of a hospice client who has severe pain and asks for another dose of oxycodone?

Reduce the clients pain.