PAIN EXAM 6

The nurse is discussing pain management with a student who is caring for a 1-day postoperative abdominal surgery client who is a known opioid substance abuser. What comment by the student indicates a need for further education? 1. Opioid substance abusers are less tolerant to opioids and require decreased doses. 2.These clients should be allowed to choose their pain medications and dosing regimen. 3.Non-opioid therapies such as cutaneous stimulation are generally effective if used alone. 4.These clients are at an increased risk for abrupt physiological withdrawal when opioid agonists are abruptly withdrawn.

#1 Opioid substance abusers have developed a tolerance to opioids and require higher, not decreased, doses for a therapeutic effect. The other statements are appropriate comments.

The nurse is instructing a client about receiving patient-controlled analgesia to control postoperative pain. What comment by the client indicates that further instruction is needed? 1."That's great that overdosing can't happen." 2."It will keep my pain at a pretty consistent level." 3."I feel a lot less nervous because I can control my own pain." 4."I'm glad I can give myself some medication and not have to wait for the nurse to give me something."

1 Because human error is always a possibility, overdosing can happen.

A staff nurse is precepting a new graduate nurse and the new graduate is assigned to care for a client with chronic pain. Which statement, if made by the new graduate nurse, indicates the need for further teaching regarding pain management? 1."I will be sure to ask my client what his pain level is on a scale of 0 to 10." 2."I know that I should follow up after giving medication to make sure it is effective." 3."I know that pain in the older client might manifest as sleep disturbances or depression." 4."I will be sure to cue in to any indicators that the client may be exaggerating their pain."

4 Pain is a highly individual experience, and the new graduate nurse should not assume that the client is exaggerating his pain

A child is seen in the school nurse's office with complaints of pain in his right forearm. In reviewing the child's record the nurse notes that he has a history of being physically abused by the mother. Which should be the initial intervention with this child? 1.Assess the child's physical status. 2.Ask the child how the injury occurred. 3.Report the case as suspected child abuse. 4.Observe the interactions between the child and his friends.

1 The initial intervention is to assess the child's physical status. The child should be initially assessed for injury to the right arm and for bruises, burns, scars, and any other signs of abuse.

The nursing instructor is discussing the topic of pain with a student nurse who is assessing the status of pain in a cognitively impaired older adult. What comment by the student implies that further education is needed? 1.Older adults tend to report pain less often than do younger adults. 2.Clients in this age group are less sensitive to pain and have a greater pain tolerance. 3.Mental images of pain are a less effective means to assess pain in this group than visual representations. 4.Pain in the cognitively impaired older adult may require more frequent assessments than in clients who are not impaired.

2 Cognitive impairment in the older adult acts as a barrier to pain assessment, and pain may be more accurately reported at the moment when it occurs than when prompted by the nurse. Clients in this age group are not less sensitive to pain and do not necessarily have a greater pain tolerance.

The nurse is making initial rounds on the nursing unit to check the condition of assigned clients. The client complains of discomfort at the intravenous (IV) site, and the nurse notes that the site is cool, pale, and swollen and that the solution is infusing slowly. What action should the nurse take first? 1.Stop the IV infusion. 2.Apply ice to the catheter site. 3.Contact the health care provider. 4.Readjust the rate of IV administration.

1 The IV must be stopped immediately because it has infiltrated.

The nurse is assessing the status of pain in an alert elderly client who was recently admitted to the hospital with a diagnosis of ruptured lumbar disc. What are some of the beliefs and concerns older adults have about pain? Select all that apply. 1.Pain is something that must be lived with. 2.Nurses are too busy to listen to reports of pain. 3.Pain signifies a serious illness or impending death. 4.Reporting pain will result in being labeled as a "bad" client. 5.Expressing pain is only done by people who want attention. 6.Nurses and other caregivers often give too much medication to older clients.

1, 2, 3, 4 Some beliefs and concerns of older adults about pain include the following: pain is something that must be lived with, nurses are too busy to listen to reports of pain, pain signifies a serious illness or impending death, and reporting pain will result in being labeled as a "bad" client.

The nurse is caring for a client who takes ibuprofen for pain. The nurse is gathering information on the client's medication history, and determines it is necessary to contact the health care provider (HCP) if the client is also taking which medications, that are contraindicated for use with ibuprofen? Select all that apply. 1.Warfarin 2.Glimepiride 3.Amlodipine 4.Simvastatin 5.Hydrochlorothiazide

1,2,3

A client who had abdominal surgery is receiving epidural analgesia. The nurse monitors the client closely, knowing that which is a potential complication of this therapy? 1.Constipation because of the location of the epidural catheter 2.Dislodgment of the epidural catheter because the catheter is not sutured in place 3.Permanent lower motor weakness because of the proximity of the catheter to the sciatic nerve 4.Chronic addiction to the epidural medication because epidural analgesia is a more powerful means of pain relief than patient-controlled analgesia therapy

2 Epidural catheters are not sutured in position and must be taped in place to help prevent dislodgment.

The nurse is caring for a postoperative client who is receiving demand-dose hydromorphone via a patient-controlled analgesia (PCA) pump for pain control. The nurse enters the client's room and finds the client drowsy and records the following vital signs: temperature 97.2°F (36.2°C) orally, pulse 52 beats per minute, blood pressure 101/58 mm Hg, respiratory rate 11 breaths per minute, and SpO2 of 93% on 3 liters of oxygen via nasal cannula. Which action should the nurse take next? 1.Document the findings. 2.Attempt to arouse the client. 3.Contact the health care provider (HCP) immediately. 4.Check the medication administration history on the PCA pump.

2 The primary concern with opioid analgesics is respiratory depression and hypotension. Based on the assessment findings, the nurse should suspect opioid overdose. The nurse should first attempt to arouse the client and then reassess the vital signs.