Health Assessment Prep-U Chapter 9 Pain
A client was administered PO pain medications at 1530. By what time should the nurse re-assess and document the effects of the pain medication?
1630
In chronic pain
the discomfort lasts longer than 6 months
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?
somatic pain
The charge nurse on a geriatric unit should further educate a new staff nurse who makes which statement? Older adults tend to be undertreated for pain. or Pain sensation is diminished in older adults. or There is little information about the effects of increased age on pain. or Transmission of pain along A-delta and C fibers may be altered in older adults.
Pain sensation is diminished in older adults.
When documenting assessment data, the nurse should avoid which phrases because of their lack of description? Select all that apply. "Client looks pale and fatigued." "Client appears to be in no apparent physical distress." "Client presented as well developed." "Client is alert with appropriate eye contact." "Client is of average height and well nourished."
"Client appears to be in no apparent physical distress." "Client presented as well developed." "Client is of average height and well nourished."
A middle-aged 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? "Are your family members aware of your pain?" "Does your pain level change after taking medications?" "Have you thought of the effects of your condition on your family?" "Does your diet include red meat and poultry products?"
"Does your pain level change after taking medications?"
The nursing instructor is teaching a class about how to assess pain in older adults. The teachers tells the students that problems can arise in certain circumstances. The instructor realizes the need for more teaching about pain in the elderly when one of the students replies: "Patients may fear that uncontrolled pain will affect their independence." "Older patients may worry that reporting pain will lead to costly tests." "Patients are reluctant to report pain because they want to be condsidered as 'good' patients." "Pain is a natural part of aging."
"Pain is a natural part of aging."
Recently, lung cancer has metastasized to the bones of a 68-year-old client, precipitating a sudden increase in his pain. The client's wife and daughter are concerned about the consequent increase in the amount of hydromorphone the client requires, citing the risk of addiction. How can the nurse best respond to the family's concern?
"There's a very minimal risk of addiction, and controlling his pain is our first concern."
The cognitive dimension concerns
"beliefs, attitudes, intentions, and motivations related to the pain and its management."
The nurse enters an older client's room to assess for pain and discovers the client is hard of hearing. What is the nurse's best action? A. Speak to the client face to face. B. Ask client to numerically rate pain in a high-pitched voice. C. Suggest client purchase a hearing aid. D. Utilize the FLACC scale.
A. Speak to the client face to face.
How may a nurse demonstrate cultural competence when responding to patients in pain? Be knowledgeable and skilled in medication administration. or Know the action and side effects of all pain medications. or Avoid stereotyping responses to pain by patients. or Treat every patient exactly the same, regardless of culture.
ANSWER: Avoid stereotyping responses to pain by patients.
A nurse is assessing the effect of a client's chronic back pain on his affective dimension. Which question should the nurse ask for this assessment? A. Where is the pain located? B. What is the highest level of education you've completed? C. What medical conditions do you have? D. How does the pain influence your overall mood?
ANSWER: D. How does the pain influence your overall mood?
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? Neuropathic pain or Cutaneous pain or Visceral pain or Chronic pain
ANSWER: Neuropathic pain The client is experiencing neuropathic pain or functional pain.
The patient arrives to the emergency room reporting severe abdominal pain that started 3 hours ago. He rates the pain as an 8 on a scale of 1 to 10. After tests are performed, the patient is diagnosed with appendicitis. This is an example of which of the following types of pain? Acute or Chronic or Neuropathic or Cutaneous
Acute
A client presents to the health care clinic with reports of a 2-day history of sore throat, ear pressure, fever, and stiff neck. The client states she has taken Tylenol and lozenges without relief. Which nursing diagnosis can be confirmed by this data? Risk for deficient fluid volume related to fever or Acute pain related to sore throat or Impaired physical mobility related stiff or Anxiety related to prolonged pain
Acute pain related to sore throat
A post-operative client is observed breathing 24 breaths/minute while complaining of 10/10 abdominal pain. The client's oxygen saturation is 90% on 2 liters nasal cannula. What is the nurse's priority action? Explain why deep breathing and coughing is important. OR Teach and encourage incentive spirometry use. OR Administer prescribed analgesia as ordered. OR Manually ventilate client with ambu bag at bedside.
Administer prescribed analgesia as ordered The client is complaining of a the highest level of pain at 10/10. Therefore, the increased respirations & low oxygen saturation are likely a result of hypoventilation due to pain. Acute pain that is is not adequatley treated can impair pulmonary function. When the client is suffering for an intense amount of time, the client may not be very receptive to teaching and explanations. The client may have the desire to cough and deep breathe but is unable to due to the intensity of pain. The client can still breathe on his/her own, so an ambu bag is not needed.
What is the term used to describe a pharmaceutical agent that relieves pain?
Analgesic
During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is which of the following?
Analgesics
A patient recovering from abdominal surgery is complaining of pain. The nurse realizes that the patient is most likely experiencing which type of pain? Idiopathic or Somatic or Psychogenic or Neuropathic
Answer Somatic
A patient in the Emergency Department is diagnosed with a myocardial infarction (heart attack). The patient describes pain in his left arm and shoulder. What name is given to this type of pain? Allodynia or Nociceptive or Referred pain or Cutaneous pain
Answer: 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.
As a nurse is adjusting a client's hospital bed, the nurse accidently pinches a finger between the bed and the wall. Which of the following components is involved in the transduction of the pain the nurse feels? A-delta fibers L-beta fibers K-fibers C-fibers
Answer: A-delta fibers Nociceptors are located at the peripheral ends of both myelinated nerve endings of type A fibers and unmyelinated type C fibers. There are 3 types that are stimulated by different stimuli: Mechanosensitive nociceptors (of A-delta fibers) are sensitive to intense mechanical stimulation (e.g., pliers pinching skin); Temperature-sensitive (thermosensitive) nociceptors (of A-delta fibers) are sensitive to intense heat and cold; & Polymodal nociceptors (of C fibers) are sensitive to noxious stimuli of: a mechanical, thermal, or chemical nature. There are no "K-fibers" or "L-beta fibers."
A nurse is working with an elderly Jewish man who is experiencing excruciating pain from a severe burn that he suffered earlier in the day. Given his cultural background, which expression of pain should the nurse most expect to find in this client? Pain is natural and honorable and should be dealt with by using mind over body Pain must be endured as part of preparing for the next life in the cycle of reincarnation Pain is a challenge to be fought; it is inevitable and is to be endured Pain is expressed openly, with much complaining
Answer: Pain is expressed openly, with much complaining
The patient comes to the ED reporting indigestion and left arm pain. The physician orders an EKG along w/drawing of cardiac enzymes. When the results are back, the patient is informed of the diagnosis of heart attack. The indigestion and arm pain are examples of which of the following? Somatic pain or Visceral pain or Cutaneous pain or Referred pain
Answer: Referred pain
An elderly farmer has sustained severe injuries after a serious accident involving a combine harvester. At the hospital, he tells the nurse that he thinks the pain he is feeling now is "payback" for living a "mean, selfish life." The nurse recognizes that this response by the man indicates which dimension of pain? Cognitive dimension or Affective dimension or Sociocultural dimension or Spiritual dimension
Answer: Spiritual dimension refers to the meaning & purpose that the person "attributes to the pain, self, others, and the divine."
The nurse is caring for a patient who is experiencing visceral pain. What is this patient's most likely diagnosis? Myocardial infarction or Appendicitis or Shingles or Bone fracture
Appendicitis
Which of the following cultural expressions of pain would be likely to be found in a person of Hispanic culture? A. Pain is honorable and should be endured. B. Pain must be endured to perform gender role duties, but response to it is very expressive. C. Pain may be caused by past transgressions and helps to atone and achieve higher spirituality. D. Pain is part of the preparation for the next life in the cycle of reincarnation.
B. Pain must be endured to perform gender role duties, but response to it is very expressive.
What is the main issue that a nurse should consider when choosing a pain assessment tool to collect objective data? A. Include a laundry list of terms to describe the pain B. Produce accurate results each time it is used C. Be useful with a wide range of populations D. Applicable with many types of pain
B. Produce accurate results each time it is used
The nurse is assessing hospitalized post-operative pain and has asked the client to rate his pain, describe it, state the location and onset of when it started. What other question should the nurse include in this pain assessment? A. Financial resources to obtain medication B. Provoking and alleviating factors C. Medications taken in the past D. Availability of medication
B. Provoking and alleviating factors
A nurse assesses a cognitively impaired adult client who grimaces and points to the right knee following a motor vehicle accident. Which pain scale would be most appropriate for the nurse to use to assess the client's pain? Visual Analog Scale or Faces Pain Scale or Numeric Rating Scale or Verbal Descriptor Scale
Faces Pain Scale
A nurse is assessing a client for pain who was in a car accident. Which Joint Commission standards should the nurse follow in this case? Select all that apply. Wrong Watch client's facial expressions, grimaces, and body movements Correct Recognize the right of patients to appropriate assessment and management of pain Correct Screen for the existence of pain Wrong Record pain assessment whenever pain increases in the body Correct Assess the nature and intensity of pain in the client
Correct response: Recognize the right of patients to appropriate assessment and management of pain Screen for the existence of pain Assess the nature and intensity of pain in the client
A client on a medical-surgical unit reports pain of 10 on a scale of 0 to 10 and wants more pain medication. The nurse does not think the pain is as bad as the client says. The physician left orders for prn morphine for breakthrough pain. What is the priority nursing action? A. Hold the medication and wait 30 minutes B. Document the client's pain rating on a scale of 0 to 10 C. Call the physician to check the order D. Give the prn morphine
D. Give the prn morphine
The nurse is working on a pediatric unit caring for a 4-year-old who is recovering from the surgical repair of the pelvis. When assessing the patient's pain, what is the most appropriate pain assessment tool for the nurse to use?
FACES Pain Scale
A nurse is caring for a 4-year-old patient who is crying and appears to be in pain. The nurse begins to assess the pain by showing pictures on a chart and asking the patient to point to the one that best represents the pain he is experiencing. This is an example of which of the following:
FACES scale
Visceral pain
From abdominal organs; patients often describe this pain as crampy or gnawing. In visceral pain, the discomfort arises from internal organs caused from a disease or injury.
A client complains of pain in several areas of the body. How should the nurse assess this client's pain?
Have the client rate each location separately.
The U.S. government has created guidelines for health care providers caring for clients in pain. Which of the following reflect these guidelines? American Pain Society Guidelines for Pain Management. OR Joint Commission Standards for Pain Management. OR American Cancer Society Guidelines for Pain Management. OR National Institutes of Health Standards for Pain Treatment.
Joint Commission Standards for Pain Management The standards require health care providers and organizations to improve pain assessment and management for all patients.
A nurse is using the FLACC (Face, Legs, Activity, Cry, Consolability) scale for pediatric pain assessment to assess for pain in a 6-month-old client. Which of the following findings on this assessment tool would indicate the strongest pain in the client? Occasional grimace or frown or Whimpering or Kicking or Lying quietly
Kicking or the legs being drawn up is a strong sign indicating pain, as it would receive a 2. An occasional grimace or frown and whimpering are weaker signs of pain, as they would each warrant only a 1. Lying quietly is a normal activity and indicates the absence of pain; thus, it would receive a 0.
Neuropathic pain
Neuropathic pain is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. Neuropathic pain results from direct injury to the peripheral or central nervous system.
Which of the following principles should the nurse integrate into the pain assessment and pain management of pediatric patients?
Pain assessment may require multiple methods in order to ensure accurate pain data.
Enters the emergency department moaning and complaining of severe pain in his lower back. Which of the following clinical manifestations should the nurse expect to see in this client as a physiologic response to pain? Select all that apply. Sleeplessness Perspiration Hypoglycemia Increased intestinal motility Increased heart rate
Sleeplessness Perspiration Increased heart rate
A patient reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator may be responsible for this increased level of comfort? The release of dopamine or The release of insulin or The release of melatonin or The release of endorphins
The release of endorphins Explanation: Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that certain measures such as skin stimulation and relaxation techniques release endorphins
FLACC scale
To assess pain in children ages (4weeks) 2 months to 7 years This scale uses which of the following indicators Facial expression Leg movements Activity Cry Consolability
A nurse is caring for a client with dull ache in her abdomen. On the way to the health care facility, the client vomits and shows symptoms of pallor. What kind of pain is the client experiencing?
Visceral pain
Polymodal nociceptors (of C fibers) are sensitive to noxious stimuli of:
a mechanical, thermal, or chemical nature.
A middle aged female client presents to the emergency department complaining of indigestion and left arm pain. What is the nurse's best action? a) Check the client's vital signs and connect her to a cardiac monitor. b) Administer an antacid and apply a topical anesthetic for the arm pain. c) Request a strong narcotic analgesic for the client's visceral pain complaints. d) Alert the healthcare provider to the client's somatic pain complaints.
a) Check the client's vital signs and connect her to a cardiac monitor.
Example of cardiac pain
arm pain and indigeston.
Neuropathic pain
can occur from central nervous system brain injury caused by a stroke. Pain that results from damage to nerves in the peripheral or central nervous system Examples of neuropathic pain include: diabetic peripheral neuropathy, post herpetic neuralgia, and postmastectomy pain. You should also be alert for the common terms that patients use to report neuropathic pain, such as: burning, painful tingling, pins and needles, & painful numbness
The sociocultural dimension
concerns the influences of the patient's social context and cultural background on the patient's pain experience.
In cutaneous pain
discomfort originates at the skin level. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues.
Idiopathic pain
does not have an identified cause.
The affective dimension concerns
feelings, sentiments, and emotions related to the pain experience.
Temperature-sensitive (thermosensitive) nociceptors (of A-delta fibers) are sensitive to
intense heat and cold
Mechanosensitive nociceptors (of A-delta fibers) are sensitive to
intense mechanical stimulation (e.g., pliers pinching skin)
Somatic pain
is caused by tissue damage, which would occur after abdominal surgery. Somatic pain originates from skin, muscles, bones, and joints. Is usually described as sharp.
Nociceptive pain (Somatic pain)
is caused by tissue damage. Somatic pain is another term used for nociceptive pain Somatic pain originates from skin, muscles, bones, and joints.
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.
Allodynia
is the experience of pain from a non-painful stimulation of the skin, such as light touch.
Describes pain in the soles of both feet as constantly burning. Which type of pain should the nurse suspect this client is experiencing?
neuropathic Pain resulting from direct injury to the peripheral or central nervous system is termed neuropathic. Over time, neuropathic pain may become independent of the inciting injury and be described as burning.
Referred pain
originates from a specific site, but the person feels the pain at another site site along the innervated spinal nerve. Referred pain is pain felt in a body area, away from the pain source
Psychogenic pain
relates to factors that influence the patient's report of pain such as anxiety and depression.
