Theories and Concepts: Pain and Comfort

A mother calls the nurse practitioner to say, "I don't know what is wrong with my baby. He cried all night and kept pulling at his ear." How would the nurse respond?

"That means his ear hurt. Bring him in to be checked."

A patient with cancer pain is talking morphine for pain relief. Knowing constipation is a common side effect, what would the nurse recommend to the patient?

"Increase fluids and high-fiber foods, and use a mild laxative"

A patient who has had a recent below-knee amputation tells the nurse that he feels as though his toes are cramping. What would the nurse say in return?

"That is called phantom pain and it is not unusual

An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the patient is exaggerating and does not need pain medication. What is the nurse's best response?

"Unless there is strong evidence to the contrary, we should take the patient's report at face value."

A nurse is teaching an alert patient how to use a PCA system in the home. How will she explain to the patient what he must do to self-manage pain?

"When you push the button, you will get the medicine."

Which of the following misconceptions is common in patients in pain?

"I will get addicted to pain medications"

What is the maximum dose of tylenol in 24 hours

3000 mg

What is the term used to describe a pharmaceutical agent that relieves pain?

Analgesic

A nurse assesses a patient who is being given an opioid analgesic and finds the patient unresponsive to shaking or other stimuli. What drug might be ordered to reverse this state?

Naloxone

Your patient is 12-hours post ORIF right ankle. The patient is asking for a breakthrough dose of analgesia. The pain-medication orders are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner?

To achieve better pain control than with one medication alone

A physician orders a placebo for a patient. What is a placebo?

an inactive substance given in place of a drug

which of the following patients would benefit from a p.r.n. drug regimen?

one who had thoracic surgery 4 days ago

A nurse on an oncology unit has arranged for an individual to lead meditation exercises for patients who are interested in this non-pharmacological method of pain control. The nurse should recognize the use of what category of non-pharmacological intervention?

A mind-body method

You are assessing an 86-year-old postoperative patient who has an unexpressive, stoic demeanor. When you enter the room, the patient is curled into the fetal position and your assessment reveals that his vital signs are elevated and he is diaphoretic. You ask the patient what his pain level is on a 0-to-10 scale that you explained to the patient prior to surgery. The patient indicates a pain level of "three or so." You review your pain-management orders and find that all medications are ordered PRN. How would you treat this patient's pain?

Believe what the patient says, reinforce education, and reassess often

You are frequently assessing an 84-year-old woman's pain after she suffered a humeral fracture in a fall. When applying the nursing process in pain management for a patient of this age, what principle should you best apply? A) Monitor for signs of drug toxicity due to a decrease in metabolism. B) Monitor for an increase in absorption of the drug due to age-related changes. C) Monitor for a paradoxical increase in pain with opioid administration. D) Administer analgesics every 4 to 6 hours as ordered to control pain.

C. monitor for signs of drug toxicity due to a decrease in metabolism

Which of the following patients would be classified as having chronic pain?

a patient with rheumatoid arthritis

Your patient is receiving postoperative morphine through a patient-controlled analgesic (PCA) pump and the patient's orders specify an initial bolus dose. What is your priority assessment?

assessment for respiratory depression

What is the reversal agent for opioids?

Narcan

Which of the following statements is true of chronic pain?

It interferes with normal functioning

The nurse is assessing a patient's pain while the patient awaits a cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at this time using a 0-to-10 pain scale. How should the nurse best respond to this assessment finding?

reinforce teaching about the pain scale number system

A 60-year-old patient who has diabetes had a below-knee amputation 1 week ago. The patient asks "why does it still feel like my leg is attached, and why does it still hurt?" The nurse explains neuropathic pain in terms that are accessible to the patient. The nurse should describe what pathophysiologic process?

the abnormal reorganization of the nervous system

You are admitting a patient to your rehabilitation unit who has a diagnosis of persistent, severe pain. According to the patient's history, the patient's pain has not responded to conventional approaches to pain management. What treatment would you expect might be tried with this patient?

Long-term intrathecal or epidural catheter

A child with a leg cast tells the nurse that he has pain inside his cast. What type of pain is this most likely to be?

Mechanical

You are the nurse coming on shift in a rehabilitation unit. You receive information in report about a new patient who has fibromyalgia and has difficulty with her ADLs. The off-going nurse also reports that the patient is withdrawn, refusing visitors, and has been vacillating between tears and anger all afternoon. What do you know about chronic pain syndromes that could account for your new patient's behavior?

Chronic pain can cause intense emotional responses

The nurse who is a member of the palliative care team is assessing a patient. The patient indicates that he has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate. What teaching should the nurse do with this patient?

Medication should be taken when pain levels are low so the pain is easier to reduce

A medical nurse is appraising the effectiveness of a patient's current pain control regimen. The nurse is aware that if an intervention is deemed ineffective, goals need to be reassessed and other measures need to be considered. What is the role of the nurse in obtaining additional pain relief for the patient?

Patient advocate

You are the home health nurse caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will be taking care of the patient. What would your priority nursing interventions be for this visit?

Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication

You are the nurse in a pain clinic caring for an 88-year-old man who is suffering from long-term, intractable pain. At this point, the pain team feels that first-line pharmacological and nonpharmacological methods of pain relief have been ineffective. What recommendation should guide this patient's subsequent care?

The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options.

You are the nurse caring for the 25-year-old victim of a motor vehicle accident with a fractured pelvis and a ruptured bladder. The nurse's aide (NA) tells you that she is concerned because the patient's resting heart rate is 110 beats per minute, her respirations are 24 breaths per minute, temperature is 99.1°F axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as you assess this patient's physiologic status?

The patient's rating of her pain.

The mother of a cancer patient comes to the nurse concerned with her daughter's safety. She states that her daughter's morphine dose that she needs to control her pain is getting "higher and higher". As a result, the mother is afraid that her daughter will overdose. The nurse educates the mother about what aspect of her pain management?

There is not absolute maximum opioid dose and her daughter is becoming more tolerant to the drug

A patient tells the nurse that she is experiencing stabbing pain in her mouth, gums, teeth, and chin following brushing her teeth. These are symptoms of which of the following pain syndromes?

Trigeminal neuralgia

You are caring for a patient with sickle cell disease in her home. Over the years, there has been joint damage, and the patient is in chronic pain. The patient has developed a tolerance to her usual pain medication. When does the tolerance to pain medication become the most significant problem?

When it results in inadequate relief from pain

How may a nurse demonstrate cultural competence when responding to patients in pain?

avoid stereotyping responses to pain by patients

A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical patients' pain. What principle should guide the nurse's use of placebos in pain management? A) Placebos require a higher level of informed consent than conventional care. B) Placebos are an acceptable, but unconventional, form of nonpharmacological pain management. C) Placebos are never recommended in the treatment of pain. D) Placebos require the active participation of the patient's family.

placebos are never recommended in the treatment of pain

You are caring for a 20-year-old patient with a diagnosis of cerebral palsy who has been admitted for the relief of painful contractures in his lower extremities. When creating a nursing care plan for this patient, what variables should the nurse consider? Select all that apply

prior effectiveness in relieving the pain patient's comorbid conditions changes in neurologic function due to the procedure type of procedure be performed

The nurse is caring for a 51-year-old female patient whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem?

depression

The nurse caring for a 91-year -old patient with osteoarthritis is reviewing the patient's chart. This patient is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this patient?

drug interactions

A nurse implements a back massage as an intervention to relieve pain. What theory is the motivation for this intervention?

gate control theory

A nurse asks a patient to rate his pain on a scale of 0 to 10, with 0 being no pain and 10 being worst pain. What characteristic of pain is the nurse assessing?

intensity

You are part of the health care team caring for an 87-year-old woman who has been admitted to you rehabilitation facility after falling and fracturing her left hip. The patient appears to be failing to regain functional ability and may have to be readmitted to an acute-care facility. When planning this patient's care, what do you know about the negative effects of the stress associated with pain?

it is particularly harmful in the elderly who have been injured or who are ill

A postoperative patient has not voided for 8 hours (since surgery(. He is restless and complains of abdominal pain. How and what would the nurse assess before administering pain medications?

palpate abdomen for distended bladder