Ch5 Pain

A postoperative client is requesting medication for pain every 4 hours. In planning effective pain management, what assessment question does the nurse ask the client before administering the medication?

"Is your pain controlled between doses?" Asking the client about the frequency of pain and how the pain is being controlled helps in formulating an effective pain management plan.

When assessing a client for pain, acute or chronic, what question does the nurse ask the client to obtain the most data?

"When does it hurt?" This response helps determine precipitating factors to identify the source of pain. It is an open-ended question that requires a descriptive response.

A client with chronic arthritis pain tells the nurse, "I take 2 arthritis strength Tylenol (650 mg) every 8 hours." How does the nurse respond?

"You will need to have routine liver and renal function laboratory tests." Clients taking Tylenol, especially high doses of it, should be reminded to have routine liver and renal function laboratory testing done. Hepatotoxicity and nephrotoxicity are adverse effects associated with long-term use.

A client reports increasing pain during dressing changes. Which interventions does the nurse recommend for the client? Select all that apply.

- Distraction - Music therapy - Premedication - Distraction stimulates efferent nerve fibers and reduces the client's perception of painful experiences. - Music therapy provides a distraction and can reduce the client's pain perception. Efferent nerve fibers are stimulated. - Premedication before painful client treatments is a good method of controlling pain during treatment.

A nurse is planning a dressing change on a postoperative mastectomy client. The client is receiving acetaminophen and oxycodone (Percocet) orally for pain every 4 hours and is due to receive them at 4 PM. When does the nurse change the dressing?

4:30 PM About 30 minutes after an analgesic is received is an optimal time to perform a procedure on a client. The opioid has had time to take effect and provide relief for the client.

Which client does the RN arriving for duty assess first?

A 56-year-old with acute pancreatitis who complains of increasing abdominal pain Because acute pain is a biologic warning signal, the nurse should assess the client with pancreatitis for complications such as bleeding or perforation that may be causing the client's increasing pain.

A postoperative client reports, "I have pain from a mild headache." Which PRN medication does the nurse administer?

Acetaminophen (Tylenol) Non-opioid analgesics such as Tylenol are the first line of therapy for mild to moderate pain.

A client with chronic pain feels no relief with high-dose opioids and says, "I just can't manage living right now." What intervention does the nurse anticipate the health care provider will order for this client?

Adding sertraline (Zoloft) as adjuvant therapy Both tricyclic and other antidepressants such as sertraline (Zoloft) help treat the depression that can accompany chronic pain. They also stimulate the activity of endogenous opiates (endorphins and enkephalins) by increasing levels of the neurotransmitter serotonin. Perhaps the greatest advantage of this group of drugs is their sedative effect.

A cancer client is receiving low-dose oral morphine but is reporting both "breakthrough" pain and constipation. What intervention does the nurse implement?

Administers ordered docusate sodium (Colace) and gabapentin (Neurontin) Docusate is a stool softener, and gabapentin is an adjuvant for breakthrough pain.

In the role of client advocate, what does the nurse do first for a client who reports pain?

Believes the client's report of pain The nurse's primary role in pain management is to advocate for the client by believing reports of pain.

Which activity does the RN team leader on a large medical-surgical unit assign to the LPN/LVN?

Complex dressing changes for a sacral wound for a client with type 2 diabetes who was given prescriptions for pain medication before wound care LPN/LVN education and scope of practice include working within practice parameters to administer pain medication and to perform dressing changes.

A postoperative client is receiving epidural analgesia and reports itching. What does the nurse do next?

Gives a small amount of naloxone (Narcan) Pruritus (itching) is a common side effect of epidural opioids and is first treated with a small amount of naloxone (Narcan).

A nurse is caring for a client who had a fractured ankle repaired. Twenty minutes after receiving 1.5 mg of hydromorphone (Dilaudid) IV push, the client is slow to respond and has constricted pupils and a respiratory rate of 6 breaths/min. What action does the nurse take initially?

Gives the client a dose of naloxone (Narcan) 0.4 mg IV In an unresponsive client, the nurse should administer Narcan 0.4 mg (diluted in 10 mL) over a 2-minute time period to reverse the action of the opioid analgesic.

A postoperative client is vomiting and states, "I am having a lot of pain-about a 7 on a scale of 1 to 10." Which route of administration does the nurse choose to administer an analgesic to the client?

Intravenous The intravenous route is the best choice for fast relief of nausea and pain.

A nurse is preparing a client for home care pain management following discharge. Which intervention does the nurse implement?

Offers flexibility in home management of the client's current regimen Flexibility will be necessary to adapt to the client's needs and allow for uninterrupted control of the client's pain issues.

Which statement is true about assessing pain in the older adult client?

Older adults are at great risk for undertreated pain. Older adults are at great risk for undertreated pain because of outdated beliefs by some health care providers about older adults' pain sensitivity, tolerance, and ability to take opioids.

A client with extensive burn injuries is to be weaned from long-term opioid use. What type of opioid dependence does the nurse expect this client to have?

Physical dependence Physical dependence occurs in everyone who takes opioids over a period of time. When it is necessary to discontinue opioid analgesia for the client who is opioid dependent, slow tapering (weaning) of the drug dosage lessens or alleviates physical withdrawal symptoms.

The nurse manager for an oncology unit is evaluating a newly hired staff nurse. Which action by the nurse is of greatest concern to the nurse manager?

Preparing to administer a placebo to a client with chronic back pain Current national guidelines from regulatory agencies and nursing organizations indicate that placebos should never be used for clients who are experiencing pain.

During change-of-shift report, the day shift staff learns that a client with back surgery has been complaining of increasing lower back pain during the night. It is most appropriate for which day staff member to assess the client's pain?

RN team leader who is responsible for updating the care plan for the client The RN team leader should assess this client's level of pain and the need for a change in the plan of care.

A newly admitted client who was in an automobile accident has a concussion and is complaining of pain from a fractured femur and broken fingers. Which staff member does the charge nurse on the orthopedic unit assign to care for this client?

The neurology unit RN who has floated to the orthopedic unit The neurology RN will have the skills and experience needed to assess the neurologic and orthopedic status of this client, as well as the client's pain status.

The nurse manager on a surgical unit is making assignments for the day. Who is assigned to check and program the patient-controlled analgesia (PCA) pumps on the unit?

Two registered nurses (RNs) To prevent drug errors, it is recommended that two nurses program the dosing parameters into the PCA delivery device.

A nurse is establishing a plan of care for a hospitalized client with chronic pain caused by fibromyalgia. Which nursing action does the nurse delegate to a nursing assistant?

Use of conversation about the client's family to distract the client Distraction techniques such as conversation, music, and television may be implemented by unlicensed nursing staff members.

A client had surgery two (2) days ago and reports having a moderate amount of pain, stating that it is "a 7 on a 1 to 10 scale" of intensity. What intervention has the highest priority in the client's nursing care plan?

Using preemptive analgesia Use of preemptive analgesia is a technique designed to decrease pain in the postoperative period, decrease the requirements for a postoperative analgesic, prevent morbidity, and decrease the hospital stay.

The family of a client with chronic cancer pain says to the nurse, "Can you please reduce Dad's pain medication so that we can spend more quality time with him?" How does the nurse respond?

"Let's ask your father about your request." The client's desires about analgesia are the most important consideration in this scenario. He should be consulted initially about his family's request. This open-ended type of question acknowledges the family, while keeping the client as the major decision maker.

A client who is using patient-controlled analgesia (PCA) is asleep. The nurse observes a family member pushing the PCA button for the sleeping client. What does the nurse say to the visitor?

"Please allow the client to push the button when needed." The "PC" in "PCA" means "patient-controlled," so having someone else push the button and administer analgesia defeats the purpose. More important, this action could cause oversedation and possible serious safety issues.

A client being discharged after hip replacement says, "I am going to use hypnosis instead of medication to manage my pain. I believe in mind over body." How does the nurse respond?

"That sounds like a great plan; can you tell me more about it?" Complementary and alternative therapies should supplement, not replace, medication management. The nurse needs to obtain more data about the client's plan.

A client with cancer who is taking pain medication states, "I am still having pain." During the assessment, the client does not exhibit any physical manifestations of pain. What does the nurse do next?

Gives the pain medication as requested Both types of chronic pain (chronic cancer pain and chronic non-cancer pain) do not cause sympathetic reactions. Therefore, some clients do not appear to be in pain, even when they are. Clients with cancer tend to know what medication works for them. The nurse needs to follow the protocol for the client regardless of the client's responses when it is chronic cancer pain.