Chapter 12: Pain Management

The client has suffered an injury to his right leg and is reporting pain at the level of "5" on a scale of 0 to 10. The client has a history of peripheral arterial disease. The client requests nonpharmacologic interventions. The nurse does all of the following applies ice to the injured site on the leg turns on the television to a show the client asks to watch consults with the healthcare provider about a macrobiotic diet teaches the client to perform slow, rhythmic breathing massages the client's back and shoulders

massages the client's back and shoulders teaches the client to perform slow, rhythmic breathing turns on the television to a show the client asks to watch

A clinic nurse assesses a client with diabetes who reports taking naproxen (Aleve) and the herb bilberry for osteoarthtitis. To assess for an adverse reaction between naproxen and bilberry, the nurse asks the client "Has your blood sugar been elevated more than usual?" "Have you noticed an increase in your pain levels?" "Have you been constipated?" "Do you bleed easily?"

"Do you bleed easily?" Naproxen, a nonsteroidal anti-inflammatory drug, with the herb bilberry may enhance a client's risk for bleeding.

The client experienced abdominal surgery the previous day and has just received an opioid medication for report of pain. The client is sitting in a chair next to the bed. An additional activity that the nurse uses to relieve pain is have the client deep breathe and hold assist the client to ambulate on the nursing unit apply ice to the incision site for 30 minutes encourage the client to watch television

encourage the client to watch television

Which of the following is a physiologic response to pain? Hypotension Dry skin Bradycardia Pallor

pallor

A client has been given a patient-controlled analgesia (PCA) device to control postoperative pain. The client expresses concern about administering too much of the analgesic and accidentally overdosing. What topic should the nurse teach the client about? the use of non-pharmacologic pain interventions to minimize use of the PCA the limits on dose and frequency that are programmed into the PCA the importance of limiting the use of the PCA to no more than twice per hour the fact that naloxone will be kept readily available at all times

the limits on dose and frequency that are programmed into the PCA Patient-controlled analgesia (PCA) devices allow clients to self-administer their own narcotic analgesic using an intravenous pump system and pressing a handheld button. The dose and time intervals between doses are programmed into the device to prevent accidental overdose.

The nurse understands the definition of pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Which of the following comments by a client confirm the client's understanding of the fundamental concepts of pain? Select all that apply. "I will depend on you and your experience to treat my pain, as you feel appropriate." "I feel good in knowing that my doctor will determine when and how I get pain medication." "I would love to go to church, but my back pain is too uncomfortable to make it through the service." "I used to walk every day for exercise; pain in my knee made me stop walking." "I am tired of living with this nagging pain; I'm not sure how much longer I can go on."

"I am tired of living with this nagging pain; I'm not sure how much longer I can go on." "I would love to go to church, but my back pain is too uncomfortable to make it through the service." "I used to walk every day for exercise; pain in my knee made me stop walking."

Which of the following is the appropriate intervention to avoid physical dependence on drugs in a client? Administer adjuvant drugs along with the prescribed drug. Increase dosage of the drug. Administer subtherapeutic doses. Discontinue drugs gradually.

Discontinue drugs gradually.

The nurse applies a transdermal patch of fentanyl for a client with pain due to cancer of the pancreas. The client puts the call light on 1 hour later and tells the nurse that it has not helped. What is the best response by the nurse? "It should have begun working 30 minutes ago. I will call the doctor and let the doctor know you need something stronger." "It will take about 24 hours for the medication to work. I can't give you anything else or you will overdose." "It will take approximately 12 to 18 hours for the medication to begin to work, so I will give you something else now to relieve the pain." "You have probably developed a tolerance to the medication."

"It will take approximately 12 to 18 hours for the medication to begin to work, so I will give you something else now to relieve the pain." Following application of the transdermal patch, a subcutaneous depot of fentanyl is established in the skin near the patch. After absorption from the depot into the systemic circulation, the drug distributes to fat and muscle. When the first patch is applied, 12 to 18 hours are required for clinically significant analgesia to be obtained; attention must be paid to providing adequate supplemental analgesia during that time.

A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies "A lot of people have a similar problem with this medication." "What do you mean by the word sick?" "A nausea medication has been prescribed that I will give you." "I will notify your physician."

"What do you mean by the word sick?" Nausea may occur with opiod use; however, before taking any other action, the nurse needs to clarify that this is what the client means by the word "sick."

Mrs. Laird is a 56-year-old postsurgical patient who has an unremarkable social and medical history. Her surgeon has ordered fentanyl patient-controlled analgesia (PCA) but Mrs. Laird admits to you that she is very reluctant to use it for fear of becoming addicted. How should you best respond to Mrs. Laird's concerns? "I will make a note for your health care provider to see if you can receive non-narcotic medications for your pain." "Your risks of becoming addicted to this drug are very, very low." "These days, there are very effective measures that we can use to address addiction." "People who do not have a history of drug abuse almost never develop a tolerance or addiction to narcotics in the hospital."

"Your risks of becoming addicted to this drug are very, very low." Addiction after therapeutic opioid administration is so negligible that it should not be a consideration when caring for patients in pain. Tolerance, however, is a common phenomenon. This patient demonstrates a need for health education rather than a change to nonopioid analgesics.

The nurse is assessing a client who has been taking up to 4 grams of acetaminophen (Tylenol) every day for undiagnosed pain. Upon questioning, the client reports he also takes kava-kava for pain. To check for a reaction due to ingestion of acetaminophen and kava-kava, the nurse asks the client about Abrupt onset of rash and pruritus Shortness of breath Excessive clotting of blood Sensitivity to hot and cold temperatures

Abrupt onset of rash and pruritus The use of acetaminophen and kava-kava increases the risk of hepatotoxicity. Initial signs and symptoms of a drug-induced hepatitis include an abrupt onset of a rash and pruritus.

The nurse assessed a patient's pain subsequent to a broken ankle. The nurse documented that the patient's pain was categorized as: Intermittent Chronic Acute Constant

Acute

The nurse is obtaining data regarding the medication that the client is taking on a regular basis. The client states he is taking duloxetine (Cymbalta), an antidepressant for the treatment of neuropathic pain. What type of therapy does the nurse understand the client is receiving? Alternate drug therapy Withdrawal therapy Replacement drug therapy Adjuvant drug therapy

Adjuvant drug therapy Adjuvant drugs are medications that are ordinarily administered for reasons other than treating pain. Cymbalta is used to treat depression but is being used for neuropathic pain for this client.

A client is receiving morphine sulfate intravenously (IV) every 4 hours as needed for the relief of pain related to a surgical procedure the client had 3 days previously. The physician is discontinuing the IV and will be starting the client on oral pain medication. What would provide the client with optimal pain relief when discontinuing the IV dose? The client should be ordered the medication to be administered intramuscularly (IM) instead of by mouth. Administer a lower dose so the client does not get addicted to the medication. Administer an equianalgesic dose. Administer a higher dose of the medication by mouth.

Administer an equianalgesic dose.

A client who is prescribed morphine for undiagnosed abdominal pain reports that he is allergic to morphine. The nurse questions the client about his allergic reaction; the client responds that when he took it in the past, he experienced itching. The nurse plans to Administer prescribed diphenhydramine (Benadryl). Obtain an order for a skin cream to minimize itching. Notify the physician that the client is allergic to morphine. Refuse to administer the morphine.

Administer prescribed diphenhydramine (Benadryl). Pruritus or itching is a frequent side effect of morphine. It does not mean the client is allergic to morphine.

Carbamazepine (Tegretol) is an example of which medication classification used in analgesia? Psychostimulant Anticonvulsant Opioid Corticosteroid

Anticonvulsant

Prior to starting a peripheral intravenous line on a patient, what intervention can the nurse provide to decrease the pain from the needle puncture? Give an oral opioid analgesic 30 minutes before the procedure. Inject lidocaine 2% with epinephrine locally around the potential procedure site. Apply eutectic mixture of local anesthetic cream 30 minutes prior to the procedure. Apply diclofenac gel over the site 1 hour before the procedure.

Apply eutectic mixture of local anesthetic cream 30 minutes prior to the procedure.

A home health nurse is visiting a client who has been taking the same dose of acetaminophen/hydrocodone for 2 months. To monitor for the presence of expected side effects of this medication, what should the nurse include in the assessment of the client? Take the client's blood pressure. Observe respiratory rate and depth. Assess level of consciousness. Ask about the client's bowel pattern.

Ask about the client's bowel pattern.

The client is prescribed 2 mg of intravenous morphine every 2 hours as needed for pain. The nurse administers the medication. Thirty minutes later, the client reports the pain level remains at a "6" on a pain intensity scale of 0 to 10. The nurse first States that "You received the full dose. I can give you no more." Contacts the physician to report the ineffectiveness of the medication Assesses the client's mental status and vital signs Teaches the client about guided imagery and distraction

Assesses the client's mental status and vital signs The nurse is to reassess the client after administration of a medication for pain. Reassessment includes a pain rating scale, mental status, and vital signs. If the reassessment of the client demonstrates the client is alert, has satisfactory vital signs, and reports unrelieved pain, the nurse then consults with the physician

The client takes naproxen (Aleve) for arthritic pain and is now prescribed warfarin (Coumadin) for persistent atrial fibrillation. Due to the interactions of the medications, the nurse Informs the client to decrease alcohol to one glass each day Administers both medications with food to increase absorption Assesses the client's stool for color Teaches the client to ingest foods high in vitamin K

Assesses the client's stool for color

When administering a fentanyl patch, the last dose of sustained-release morphine should be administered at what point? At the same time the first patch is applied Before respiratory assessment There are no administration requirements Immediately after the morning shower

At the same time the first patch is applied Because it takes 12 to 18 hours for the fentanyl concentrations to increase gradually from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied. The skin must be clean and dry before applying the patch; no shower is required. Respiratory assessment must be conducted before applying the fentanyl patch.

A patient who has bone cancer has a new order for a Fentanyl patch. She has previously been receiving morphine for pain. When administering a Fentanyl patch, the last dose of sustained-release morphine should be administered: 1 hour prior At the same time the first patch is applied There are no administration requirements 1 hour after

At the same time the first patch is applied Because it takes 12 to 24 hours for the Fentanyl levels to gradually increase from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied.

Which action by the nurse indicates understanding of one basic principle of providing effective pain management? Administering pain medications on a PRN (as needed) basis Awakening a new postoperative client to take pain medication Administering a dose of an analgesic agent via client-controlled analgesia (PCA) during rounds Continuing to provide around-the-clock pain medications 72 hours after a surgical procedure

Awakening a new postoperative client to take pain medication Awakening postoperative clients with moderate to severe pain to take pain medication is especially important during the first 24 to 48 hours after surgery to keep pain under control.

The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for? Tachycardia Asystole Bradypnea Hypertension

Bradypnea

When the nurse is performing an assessment and finds no physical cause for a patient's pain, what should the nurse do when the patient continues to complain of pain? Believe a patient when he or she states that pain is present. Assume that the patient may be a drug seeker and should be given other methods for pain control. Doubt that pain exists when no physical origin can be identified. Realize that patients frequently imagine and state that they have pain without actually feeling painful sensations.

Believe a patient when he or she states that pain is present.

When a nurse asks a patient to describe the quality of the pain, what type of descriptive term does the nurse expect the patient to use? Intermittent Severe Chronic Burning

Burning When asking the patient to describe how the pain feels, the nurse should suggest to the patient descriptors such as "sharp," "shooting," or "burning," which may help identify the presence of neuropathic pain.

The client, newly admitted to the hospital, is unsure of home medications and is wearing a transdermal fentanyl patch. What is most important for the nurse to do first? Teach about adverse reactions Ask about constipation Check the dose Remove the old patch

Check the dose The dosage of any medication should be checked for correctness. This is basic medication administration to prevent error. The nurse will also perform the other options listed.

Which of the following is a misconception about pain and analgesia? No evidence exists that stress causes pain. The stress of managing the chronic pain may lead to depression. Chronic pain is due to a psychological disturbance. It is rare for chronic pain patients to misrepresent their symptoms.

Chronic pain is due to a psychological disturbance.

Which substance reduces the transmission of pain? Acetylcholine Substance P Serotonin Endorphins

Endorphins Chemicals that reduce or inhibit the transmission of perception of pain include endorphins and enkephalin, which are morphinelike endogenous neurotransmitters . Acetylcholine, serotonin, and substance P are chemicals that increase the transmission of pain.

A client being treated for rheumatoid arthritis has been prescribed a glucocorticosteroid. How should the nurse best ensure this client's safety during treatment? Ensure the client knows to taper down the dose if it is discontinued by the care provider. Educate the client about the need to avoid grapefruit and grapefruit juice during treatment. Teach the client the signs and symptoms of gastrointestinal bleeding. Educate the client about the difference between tolerance and dependence.

Ensure the client knows to taper down the dose if it is discontinued by the care provider.

A client has been prescribed a fentanyl patch for pain control. The nurse understands that this patch should be replaced how often? Every 36-60 hours Every 12-24 hours Every 48-72 hours Every 24-36 hours

Every 48-72 hours

When taking a client history, the nurse notes that the client is taking herbal remedies in addition to acetaminophen. Which herb, when taken in conjunction with acetaminophen, enhances the risk of bleeding? Echinacea Gingko Kava Willow

Gingko Gingko, when taken with acetaminophen, enhances the risk of bleeding. Echinacea, willow, and kava, when taken with acetaminophen, increase the potential for hepatotoxicity and nephrotoxicity.

The client is taking oxycodone (Oxycontin) for chronic back pain and reports decreased pain relief when he began taking a herb to improve his physical stamina. The nurse asks if the herb is ginseng kava-kava chamomile valerian

Ginseng Ginseng may inhibit the analgesic effects of an opioid, such as oxycodone. The other herbs listed (valerian, kava-kava, and chamomile) may increase central nervous system depression.

Prostaglandins are chemical substances with what property? Increase the sensitivity of pain receptors Reduce the perception of pain Inhibit the transmission of pain Inhibit the transmission of noxious stimuli

Increase the sensitivity of pain receptors Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin. Endorphins and enkephalins reduce or inhibit transmission or perception of pain. Morphine and other opioid medications inhibit the transmission of noxious stimuli by mimicking enkephalin and endorphin.

When drafting a nursing care plan for a patient in pain, it is important for the nurse to determine if the pain is acute or chronic. Choose an example of chronic pain. Angina A migraine headache Appendicitis Intervertebral disk herniation

Intervertebral disk herniation

A patient is complaining of a headache during epidural administration of an anesthetic agent. Which of the following nursing interventions should be completed? Keep the head of the bed flat. Place patient in semi-Fowler's position. Maintain a dehydrated state. No intervention is necessary.

Keep the head of the bed flat. If a headache develops, the patient should remain flat in bed, should be given large amounts of fluids (provided the medication condition allows), and the physician should be notified.

A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing? Neuropathic pain Referred pain Visceral pain Breakthrough pain

Neuropathic pain

A client is reporting her pain as "8" on a 0-to-10 pain intensity scale. Then, the client states the pain is "3." Before the nurse leaves the room, the client states her pain is "6." The best action of the nurse is to Obtain a pain scale with faces for the client to measure her pain. Average the numbers and report that number as the client's level of pain. Medicate the client for pain based on the highest number of "8." Record each of the numbers the client stated for her pain.

Obtain a pain scale with faces for the client to measure her pain.

The nurse is administering an analgesic to an older adult patient. Why is it important for the nurse to assess the patient carefully? Older people are more sensitive to drugs. Older people metabolize drugs more rapidly. Older people have lower ratios of body fat and muscle mass. Older people have increased hepatic, renal, and gastrointestinal function.

Older people are more sensitive to drugs.

The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient? Older people experience reduced sensory perception. Older people are expected to experience chronic pain. Older people have increased sensory perception. Older people have a decreased pain threshold.

Older people experience reduced sensory perception.

When caring for a patient who is deaf, which of the following should be used to elicit information regarding the patient's level of pain? Use of Braille An outside interpreter should be used. Computer-generated speech Verbally asking the rate of pain

Outside interpereter

Which condition, approved by the U.S. Food and Drug Administration, is the only use for the lidocaine 5% patch? General anesthesia Postherpetic neuralgia Epidural anesthesia Diabetic neuropathy

Postherpetic neuralgia

The nurse is caring for a patient who has been hospitalized on several occasions for lower abdominal pain related to Crohn's disease. How may this chronic pain be described? Attributable to a specific cause Separate from any central or peripheral pathology Prolonged in duration Rapidly occurring and subsiding with treatment

Prolonged in duration

A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be: Rapidly occurring and subsiding with treatment. Separate from any central or peripheral pathology. Attributed to a specific cause. Prolonged in duration.

Prolonged in duration.

Which route of medication administration should the nurse consider first after IV removal in a postoperative client with an NPO (nothing by mouth) order? Rectal Intrathecal Subcutaneous Topical

Rectal

Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy? Risk for injury Diarrhea Altered mobility Risk for impaired gas exchange

Risk for impaired gas exchange

Which condition is a heightened response that occurs after exposure to a noxious stimulus? Pain tolerance Sensitization Dependence Pain threshold

Sensitization Sensitization is a heightened response that occurs after exposure to a noxious stimulus. Pain tolerance is the maximum intensity or duration of pain that a person is willing to endure. Pain threshold is the point at which a stimulus is perceived as painful

The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting: Medical interventions for pain management Anticipated duration of the pain Anticipated harmful effects of the pain experience Severity of the pain as judged by the patient

Severity of the pain as judged by the patient

Which of the following is a reliable source for quantifying pain? The client's vital signs The extent of the client's injury The nature of the client's injury or condition The client's description of the pain

The client's description of the pain The client's description of the pain is the only reliable source for quantifying pain. Physiologic data such as vital signs or the extent or nature of the injury do not indicate the amount of pain.

The nurse caring for a 74-year-old man who has just returned to the surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment, in which the patient stated that he has "gotten confused" in the past when he takes pain medications. The nurse should recognize which of the following principles of pain management among older adults? The elderly may be confused following surgery, a fact that is related to normal aging and unrelated to the medication. The elderly may have altered absorption and metabolism, which prohibits the use of opioids. The elderly may require lower doses of medication and are easily confused with new medications. The elderly may require a higher initial dose of pain medication followed by a tapered dose.

The elderly may require lower doses of medication and are easily confused with new medications. The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and therefore the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion. Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors, like environment. The elderly may have altered absorption and metabolism, but the use of lower-dose opiates is encouraged for pain. Confusion following surgery is never normal. With the elderly, give medication at a low dose and slowly increase the dose until the pain is managed.

A 19-year-old woman had a mandibular osteotomy (jaw surgery) performed early this morning and is being assessed by the nurse after being transferred from the PACU. The nurse has asked the patient about her pain, to which the patient has responded, "I'm not really having any pain, but I've got a dull ache all around my jaw that's really bad." How should the nurse best interpret this patient's statement? The patient is currently free of pain but is likely to experience pain in the near future. The patient is experiencing pain but is describing it in different terms. The patient is not experiencing pain but likely requires interventions for her discomfort. The patient is misinterpreting her body's pain response.

The patient is experiencing pain but is describing it in different terms. It is reasonable to conclude that this patient is experiencing pain but is using different terms to describe the sensation. It would be erroneous for the nurse to conclude that this patient is pain free and to reject interventions. This patient is not "misinterpreting" her sensation but is rather characterizing it in a different way from the nurse.

Which of the following is a true statement with regards to the nursing process of pain control? Formulate treatment plans based on behaviors. Nonverbal expressions of pain are reliable indicators of the quality of pain. The use of physiologic signs to indicate pain is unreliable. Usually all patients exhibit the same pain behaviors.

The use of physiologic signs to indicate pain is unreliable.

An adult with severe cognitive impairment has had a surgical procedure, and the nurse is having a difficult time assessing the level of pain the client is having postoperatively. What method can the nurse use to obtain data about the client's pain? Ask the client to point to a pain level between 0 and 10 on a chart. Use behavioral comparison of the client's current and previous behavior patterns. Have the client point to a smiley face or a frown. Ask the client loudly if he is having any pain and what level it is.

Use behavioral comparison of the client's current and previous behavior patterns.

A client who speaks Korean only had emergency surgery. No pain scale was established prior to surgery. To assess the client's pain postoperatively, the nurse Asks a family member to interpret Obtains a visual analogues scale Uses a language translation phone line Uses a 0 to 10 numeric pain intensity scale

Uses a language translation phone line

The nurse is assessing a client's level of pain. Pain is best described as: an unpleasant sensation created by emotional states such as fear, frustration, anger, or depression. an unpleasant sensation of physical hurt or discomfort that can be caused by disease, injury, or surgery. an unpleasant sensation that occurs due to malfunctioning of the nervous system. a chronic, unpleasant sensation that occurs due to disease affecting one or more body systems.

an unpleasant sensation of physical hurt or discomfort that can be caused by disease, injury, or surgery.

Regarding tolerance and addiction, the nurse understands that tolerance to opioids is uncommon. although clients may need increasing levels of opioids, they are not addicted. addiction to opioids often develops. the nurse must be primarily concerned about the development of addiction by a client in pain.

although clients may need increasing levels of opioids, they are not addicted.

A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends inserting a bisacodyl (Dulcolax) rectal suppository every morning increasing the amount of bran and fresh fruits and vegetables using milk of magnesia 30 mL every day ingesting up to 6 glasses of fluids per day

increasing the amount of bran and fresh fruits and vegetables

The nurse administered an analgesic to a client who was reporting pain. The medication is ordered as needed every 3 hours. Forty minutes later the client states he has had little relief. The nurse does all of the following: plans to place the client in a position of comfort when pain is relieved states, "I can administer the medication to you in about 2 hours" consults with the healthcare provider about the client's report evaluates the pain level using the established pain scale assesses respirations, pulse, and blood pressure

evaluates the pain level using the established pain scale assesses respirations, pulse, and blood pressure consults with the healthcare provider about the client's report

A client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. The initial surgeries occurred more than 2 months ago, and the nurse is concerned about the repeated requests. What does the nurse suspect to be the cause of the client's frequent appeals for pain medication? tolerance drug allergy addiction poor quality control by the drug manufacturer

tolerance

A client has been taking opioid analgesics for more than 2 weeks to control post-surgical pain. Although pleased with the client's progress, the surgeon decides to change the analgesic to a non-opioid drug. The surgeon prescribes a gradually lower opioid dose and increasingly larger non-opioid doses. The surgeon is changing medications in this manner to avoid: withdrawal symptoms. addiction. tolerance. respiratory depression.

withdrawal symptoms.