Chapter 35: Comfort and Pain Management Part 1

A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain? A) Amitriptyline (Elavil) B) Corticosteroids C) Methylphenidate (Ritalin) D) Lorazepam (Ativan)

A) Amitriptyline (Elavil) Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract sedation if the client is on opioids. Lorazepam is an anxiolytic.

What type of nonpharmacologic pain relief measure uses electrical stimulation to inhibit transmission of painful impulses? A) TENS B) acupressure C) acupuncture D) hypnosis

A) TENS

A physician orders a placebo for a patient. What is a placebo? A) an inactive substance given in place of a drug B) a smaller than usual dose of an analgesic C) an analgesic with no known side effects D) an intravenous form of a potent analgesic

A) an inactive substance given in place of a drug

A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a patient being discharged. What process is involved in this pain relief measure? A) biofeedback B) cutaneous stimulation C) patient controlled analgesia D) percutaneous electrical nerve stimulation

A) biofeedback

Which of the following is the drug of choice to treat chronic pain in the home? A) oral morphine B) intravenous morphine C) NSAIDs D) antidepressants

A) oral morphine

When titrating an analgesic to manage pain, what is the priority goal? A. administer smallest dose that provides relief with the fewest side effects B. titrate upward until the client is pain free C. tirate downwards to prevent toxicity D. ensure that the drug is adequate to meet the clients subjective needs

A. administer smallest does that provides relief with the fewest side effects the goal is to control pain while minimizing side effects. For severe pain, the medication can be titrated upward until pain is controlled. Downward titration occurs when the pain begins to subside. Adequate dosing is important; however, the concept of controlled dosing applies more to potent vasoactive drugs.

In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant? A. assist the client with preparation of a sits bath B. monitor the client for signs of discomfort while ambulating C. coach the client to deep breathing during painful procedures D. evaluate relief after applying a cold application

A. assist the client with preparation of aa sits bath The nursing assistant is able to assist the client with hygiene issues and knows the principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and evaluating outcomes are nursing responsibilities.

A client appears upset and tearful, but denies pain and refuses pain medication, because "my sibling is a drug addict and has ruined our lives." what is the priority intervention for this client? A. encourage expression of fears on past experiences B. provide accurate information about use of pain meds C. explain that addiction is unlikely among acute care clients D. Seek family assistance

A. encourage expression of fears on past experiences This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.

Which patient would be expected to experience acute pain? a. A patient who had abdominal surgery 8 hours ago b. A patient who has cancer and has been receiving treatment for 4 months c. A patient who states that he or she has lived with severe pain for many years d. A patient who has been treated unsuccessfully over the past year for back pain

ANS: A Feedback A Acute pain has a recent onset and results from tissue damage; is usually self-limiting; and ends when the tissue heals. B Acute pain has a recent onset and results from tissue damage; is usually self-limiting; and ends when the tissue heals. C This patient has experienced chronic pain for years. Acute pain has a recent onset and results from tissue damage; is usually self-limiting; and ends when the tissue heals. D This patient has experienced chronic pain for one year. Acute pain has a recent onset and results from tissue damage; is usually self-limiting; and ends when the tissue heals.

A patient admitted to the emergency department with "excruciating chest pain, above the rating of 10," has a heart rate of 55, rapid, irregular respirations, complains of nausea, and is too weak to move to the stretcher without aid. The nurse recognizes that this response to severe pain is due to the response of the _____ nervous system. a. Parasympathetic b. Sympathetic c. Central d. Peripheral

ANS: A Feedback A During severe or deep pain the parasympathetic nervous system may cause pallor; rapid, irregular breathing; nausea; and vomiting. B The sympathetic nervous system responds to acute pain by increasing heart rate, increasing blood pressure, causing diaphoresis, increasing respiratory rate, increasing muscle tension, dilating pupils, and decreasing gastrointestinal motility. C The central nervous system includes the brain and spinal cord. The manifestations described in the case are due to parasympathetic nervous system stimulation. D The manifestations described in the case are due to parasympathetic nervous system stimulation.

In the labor and delivery department, the nurse notices that two women who are in labor are responding differently to their contractions. The first woman, who is having her first baby, has rated her pain as a "7," seems agitated, and has asked for pain medication. The second woman, who is having her third baby, has also rated her pain as a "7," but is calmer and says she does not need anything for pain at this time. What explains the differences in the outward responses to pain between these women? a. Pain tolerance b. Pain threshold c. Nociception d. Physiologic stress

ANS: A Feedback A Pain tolerance is the duration or intensity of pain a person will endure before outwardly responding. A person's culture, pain experience, expectations, role behaviors, and physical and emotional health influence pain tolerance. The second woman had experienced the birth process before and had different expectations than the first woman, who was having her first baby. B Pain threshold is the point at which a stimulus is perceived as pain. This threshold does not vary significantly among people or in the same person over time. C Nociception is the process of pain perception and involves transduction, transmission, perception, and modulation. D Physiologic stress stimulates the sympathetic nervous system causing tachycardia, increased respiratory rate, and dilated pupils, but does not necessarily affect pain response.

How do nurses assess pain of neonates or of adults with dementia or decreased level of consciousness? Select all that apply. a. Ask family or caregivers what indicators they think may indicate the patient's pain. b. Review results of blood tests for signs of pain. c. Administer the ordered analgesic to the patient. d. Identify any physiologic signs of pain. e. Examine the patient for possible causes of pain.

ANS: A, C, D, E Correct: These four answers are the clinical practice recommendations of Herr and colleagues. Incorrect: Pain cannot be detected with laboratory tests.

A nurse is assessing a patient who complains of "awful" abdominal pain and rates it as a 9 on a scale of 0 to 10. Which of the following physiologic signs may accompany acute pain? Select all that apply. a. Tachycardia b. Irritability c. Increased blood pressure d. Depression e. Insomnia f. Sweating

ANS: A, C, F Correct: The sympathetic nervous system responds to acute pain by increasing heart rate, increasing blood pressure, causing diaphoresis, increasing respiratory rate, increasing muscle tension, dilating pupils, and decreasing gastrointestinal motility. Incorrect: Irritability, depression, and insomnia are manifestations of chronic rather than acute pain.

A patient with gout is complaining of severe, throbbing pain in the great toe. What type of pain is this patient experiencing? a. Neuropathic pain b. Somatic pain c. Referred pain d. Visceral pain

ANS: B Feedback A Neuropathic pain is caused by abnormal processing of sensory input from the peripheral nervous system. B Somatic pain arises from bone, joint, muscle, skin, or connective tissues and is usually aching or throbbing in quality and well located. C Referred pain is pain felt at a site different from that of an injured or diseased organ. D Visceral pain occurs with obstruction of a hollow organ and causes intermittent cramping pain.

A patient has had chronic back pain for several years. On assessment, the nurse notes that the patient sits quietly in a chair, reads a book, talks with a companion, and does not appear to be in pain. When questioned, the patient rates the pain as a 6 on a scale of 0 to 10. How does the nurse interpret these data? a. Many patients cannot be believed when they complain of severe pain lasting many months. b. Patients may not have the same objective responses to chronic pain because of compensation over time. c. The patient probably has already taken a very effective pain medication. d. This patient is probably not having as much pain as reported initially, and more assessment is required.

ANS: B Feedback A Pain is whatever the patient says it is. Patients with chronic pain adapt to the pain and have more subtle manifestations than patients with acute pain. B Clinical manifestations of chronic pain are not those of physiologic stress because the patient adapts to the pain. C Patients with chronic pain adapt to the pain and have more subtle manifestations than patients with acute pain despite the effects of pain medication. D Pain is whatever the patient says it is. Patients with chronic pain adapt to the pain and have more subtle manifestations than patients with acute pain.

Which patient has pain caused by abnormal processing of sensory input from the peripheral nervous system? a. The patient who has aching pain from muscle strain b. The patient who has burning pain along the sciatic nerve c. The patient who has cramping pain from a tumor in the colon d. The patient who has throbbing pain from arthritis

ANS: B Feedback A The patient who has aching pain from muscle strain has nociceptor, somatic pain. B The patient who has burning pain along the sciatic nerve has neuropathic pain. C The patient who has cramping pain from a tumor in the colon has nociceptor, visceral pain. D The patient who has throbbing pain from arthritis has nociceptor, somatic pain.

A patient who had an amputation of his lower leg comes to the clinic with a complaint of pain. He asks, "How I can be feeling pain in my foot—my foot is gone!" What is the appropriate response from the nurse? a. "After your amputation, pain perception increases." b. "Amputating your leg caused abnormal processing of sensory input by the peripheral nervous system." c. "Stimulation of nerves from your leg sends impulses to the brain so that you feel pain even though your leg is no longer there." d. "When sensory nerves enter the spinal cord, they stimulate nerves from unaffected organs in the same spinal cord segment as those neurons in areas where injury or disease is located."

ANS: C Feedback A "After your amputation, pain perception increases" is a definition of pain threshold. B "Amputating your leg caused abnormal processing of sensory input by the peripheral nervous system" is a definition of neuropathic pain. C "Stimulation of nerves from your leg sends impulses to the brain so that you feel pain even though your leg is no longer there" is a definition of phantom pain. D "When sensory nerves enter the spinal cord, they stimulate nerves from unaffected organs in the same spinal cord segment as those neurons in areas where injury or disease is located" is a definition of referred pain.

A patient who had extensive surgery asks the nurse for pain medication for a pain of 9 on a scale of 0 to 10. The nurse completes an assessment of this patient's pain and agrees to give pain medication. When the nurse returns to the patient with the ordered intravenous pain medication, she notices the patient's eyes are closed and he appears to be sleeping. What is the nurse's appropriate action at this time? a. Lock up the medication in a safe location until the patient awakens. b. Arouse the patient to confirm he still wants the medication. c. Give the medication as ordered and agreed to. d. Consult a colleague about what action to take.

ANS: C Feedback A The patient needs to receive the ordered pain medication now. B There is no reason to confirm the need for pain medication requested earlier. C Sleep is not synonymous with pain relief. When the patient reports a pain of 9 and asks for medication for which there is an order, he needs to receive the medication. D There is no reason to ask a colleague about giving the pain medication requested earlier.

The nurse notes in the patient's history that the patient has persistent, malignant pain. What is the meaning of this type of pain? a. The pain has been present for at least 2 weeks. b. The pain began after recent surgery and is associated with healing incisions. c. The pain has been present for 6 or more months. d. The pain has been present since surgery to remove cancer.

ANS: C Feedback A This time frame is too short. Chronic pain may be intermittent or continuous pain lasting more than 6 months. B This is a description of acute pain rather than chronic. C This is the definition of persistent or chronic pain. D Surgery to remove malignant tissue does not necessarily equate to malignant pain.

A patient reports "right shoulder pain that comes and goes" as the chief complaint. During the physical examination, the patient asks why the upper right abdomen is being examined for shoulder pain. What is the appropriate response from the nurse? a. "A comprehensive examination is required to determine the cause of your pain." b. "There may be associated problems that have not produced any symptoms yet that we want to identify." c. "Yes, this can be confusing, but if you will be patient I'm sure we can find something to help you." d. "It does seem odd, but the gallbladder doesn't have pain receptors of its own, so the pain shows up in the shoulder."

ANS: D Feedback A A focused examination is indicated at this time, not a comprehensive examination. B This patient's pain is due to referred pain, not to associated problems that have not produced any symptoms of pain. C This response reflects concern for the patient's pain, but does not address the patient's questions about examining the abdomen. D Referred pain is pain felt at a site different from that of an injured or diseased organ. It commonly occurs during visceral pain because many organs have no pain receptors; thus, when afferent nerves enter the spinal cord, they stimulate sensory nerves from unaffected organs in the same spinal cord segment as those neurons in areas where injury or disease is located.

A patient with a partial small bowel obstruction describes the pain as "cramping, off-and-on pain that spreads over my stomach." What type of pain is this patient experiencing? a. Referred pain b. Phantom pain c. Somatic pain d. Visceral pain

ANS: D Feedback A Referred pain is felt at a site different from that of an injured or diseased organ. B Phantom pain is associated with amputations. C Somatic pain arises from bone, joint, muscle, skin, or connective tissues and is usually aching or throbbing in quality and well located. D Visceral pain occurs with obstruction of a hollow organ and causes intermittent cramping pain.

Of the following individuals, who can best determine the experience of pain? A) The person who has the pain B) The person's immediate family C) The nurse caring for the client D) The physician diagnosing the cause

Ans: A Feedback: According to McCaffery, an expert on pain, "Pain is whatever the experiencing person says it is, existing whenever he (or she) says it does." The only one who can be a real authority on whether and how a person experiences pain is that individual.

The nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. The nurse notes that the client's respiratory rate is 10 breaths per minute. The client is somnolent, with minimal response to physical stimulation. The nurse should prepare to administer which of the following medications? A) Intravenous naloxone (Narcan) B) Intravenous flumazenil (Romazicon) C) Oral modafinil (Provigil) D) Nebulized albuterol (Proventil)

Ans: A Feedback: Albuterol is a bronchodilator and not appropriate for this clinical situation.

Which client would be most likely to have decreased anxiety about, and response to, pain as a result of past experiences? A) One who had pain but got adequate relief B) One who had pain but did not get relief C) One who has had chronic pain for years D) One who has had multiple pain experiences

Ans: A Feedback: An individual's experience of pain in the past, and the qualities of that experience, profoundly affect new pain experiences. Some clients have experienced severe acute or chronic pain in the past but received immediate and adequate pain relief. These clients are generally unafraid of pain and initiate appropriate requests for assistance.

Which statement accurately describes pain experienced by the older adult? A) Boredom and depression may affect an older person's perception of pain. B) Residents in long-term care facilities have a minimal level of pain. C) The older client has decreased sensitivity to pain. D) A heightened pain tolerance occurs in the older adult.

Ans: A Feedback: Boredom, loneliness, and depression may affect an older person's perception and report of pain. One myth held by many to be true is that older clients have a decreased sensitivity to pain and therefore a heightened pain tolerance. Numerous older adult clients residing in long-term care facilities have significant pain that negatively affects their quality of life.

A nurse is assessing the vital signs of a client who is moaning due to the acute onset of pain. What would be the expected objective findings? A) Decreased pulse and respirations B) Increased pulse and blood pressure C) Increased temperature D) No change from client's norms

Ans: B Feedback: A client who is in acute pain will most often also have an increased pulse and blood pressure.

Which of the following clients would be classified as having chronic pain? A) A client with rheumatoid arthritis B) A client with pneumonia C) A client with controlled hypertension D) A client with the flu

Ans: A Feedback: Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Acute pain is generally rapid in onset and varies in intensity from mild to severe. After its underlying cause is resolved, acute pain disappears. It should end once healing occurs.

Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique? A) Tactile kinesthetic distraction B) Visual distraction C) Auditory distraction D) Project distraction

Ans: A Feedback: Examples of tactile kinesthetic distraction include holding or stroking a loved one, pet, or toy; rocking; and slow rhythmic breathing. Project distraction includes playing a challenging game or performing meaningful work. Visual distraction can be accomplished through reading or watching television. Auditory distraction may occur when one listens to music.

A client has an order for a narcotic analgesic every three to four hours and he received his last dose three hours earlier. Which of the following actions is most appropriate for the nurse to take in response to the client's request for pain medication on his first postoperative day? A) Provide the client with pain medication B) Tell the client that the pain cannot be severe C) Document and ask the client to wait one hour D) Contact the physician for a change in medication

Ans: A Feedback: Inadequate or poor pain assessment is a leading factor in poor pain control, because the health care professional may not know a client has pain. The nurse must provide the next dose of pain medication.

Which misconception is common in clients in pain? A) "I will get addicted to pain medications." B) "I need to ask for pain medications." C) "The nurses are here to help relieve the pain." D) "I do not have to fight the pain without help."

Ans: A Feedback: Many misconceptions interfere with the client's ability to communicate pain. A common misconception is that "if I ask for something for pain, I may become addicted to the medication."

Why is acute pain said to be protective in nature? A) It warns an individual of tissue damage or disease. B) It enables the person to increase personal strength. C) As a subjective experience, it serves no purpose. D) As an objective experience, it aids diagnosis.

Ans: A Feedback: Pain is a subjective experience. Acute pain, lasting from a few minutes to less than six months, warns an individual of tissue damage or organic disease. After its underlying cause is resolved, acute pain disappears.

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? A) Somatic pain B) Cutaneous pain C) Visceral pain D) Phantom pain

Ans: A Feedback: Somatic pain is diffuse or scattered pain, and it originates in tendons, ligaments, bones, blood vessels, and nerves. Cutaneous pain usually involves the skin or subcutaneous tissues. Visceral pain is poorly localized and originates in body organs. Phantom pain occurs in an amputated leg for which receptors and nerves are clearly absent, but the pain is a real experience for the client.

A nurse implements a back massage as an intervention to relieve pain. What theory is the motivation for this intervention? A) Gate control theory B) Neuromodulation C) Large/small fiber theory D) Prostaglandin stimulation

Ans: A Feedback: The gate control theory of pain describes the transmission of painful stimuli. Nursing interventions, such as massage or a warm compress to a painful lower back, stimulate large nerve fibers to close the gate, thus blocking nerve impulses from that area.

A nurse is assessing a mentally challenged, adult client who is in pain after a fall. Which of the following scales should the nurse use to assess the client's pain? A) Pain Assessment in Advanced Dementia (PAINAD) B) Wong-Baker Faces scale C) Linear Scale D) Numeric Scale

Ans: A Feedback: The nurse should use the Pain Assessment in Advanced Dementia (PAINAD) scale, which was developed for cognitively impaired clients. The Wong-Baker FACES scale is best for children and clients who are culturally diverse. Nurses generally use a numeric scale, a word scale, or a linear scale to quantify the pain intensity of adult clients who can express their pain intensity in words, numbers, or linear fashion with the help of the respective scales.

The nurse has just completed programming of a patient-controlled analgesia (PCA) pump using prescribed parameters. Which of the following actions should you take next? A) Verify the settings with another nurse. B) Document implementation of the PCA on the client's chart. C) Attach the PCA pump tubing to the client's intravenous access device. D) Check the pump's electrical cords for cracks, splits, or fraying.

Ans: A Feedback: This action should be performed before programming is initiated.

The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which of the following responses is most appropriate? A) "The mild electrical impulses block the pain signal before it can reach the brain." B) "The electrode patches generate heat and decrease muscle tension." C) "The machine tricks the mind into believing the pain does not exist." D) "The electricity produces numbness and alters tissue sensitivity."

Ans: A Feedback: This statement explains the use of cold therapy for pain.

The Joint Commission supports the client's right to pain management, and published standards for assessment and management of pain in hospitals, ambulatory care settings, and home care settings (Joint Commission, 2008b). Which of the following are recommended guidelines for pain management? Select all that apply. A) Teach all clients to use a pain rating scale. B) Determine a pain-rating goal with each client. C) Use pharmacologic pain relief measures first. D) Manipulate factors that affect the pain experience. E) Keep the primary care provider in charge of all pain relief measures. F) Ensure the ethical and legal responsibility to relieve pain.

Ans: A, B, D, F Feedback: The Joint Commission recommendations include teaching all clients to use a pain-rating scale and determining a painrating goal with each client. Nursing interventions to achieve this goal include establishing a trusting nurse-patient relationship; manipulating factors that affect the pain experience; initiating nonpharmacologic pain relief measures; managing pharmacologic interventions; reviewing additional pain control measures; ensuring ethical and legal responsibility to relieve pain; and educating the client about pain.

Which client would benefit from a p.r.n. drug regimen? A) One who had thoracic surgery 12 hours ago B) One who had thoracic surgery four days ago C) One who has intractable pain D) One who has chronic pain

Ans: B Feedback: A p.r.n. drug regimen has not proven effective for people experiencing acute pain, such as in the early postoperative period. It is not adequate for clients with intractable or chronic pain. However, later in the postoperative period, it may be acceptable to relieve occasional pain episodes.

A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and become chronic. What is a characteristic of chronic pain? A) Chronic pain will lead to psychological imbalance. B) Chronic pain has far-reaching effects on the client. C) Chronic pain can be severe in its initial stages. D) Chronic pain eases with healing and eventually disappears.

Ans: B Feedback: Chronic pain has far-reaching effects on the client because the discomfort lasts longer than six months. Chronic pain is not as severe in the initial stage as acute pain, but does not disappear eventually with pain medication. Chronic pain need not always lead to psychological imbalance.

Besides controlling pain of the post-abdominal surgery client with narcotics, the nurse suggests to the client that he ... A) focus on pain relief B) use distraction C) describe the pain D) think about the next dose

Ans: B Feedback: Distraction is useful when clients are undergoing brief periods of sharp, intense pain, such as dressing changes, wound débridement, biopsy, or incident pain from shifting positions.

A client in the emergency department is diagnosed with a myocardial infarction (heart attack). The client describes pain in his left arm and shoulder. What name is given to this type of pain? A) Cutaneous pain B) Referred pain C) Allodynia D) Nociceptive

Ans: B Feedback: Referred pain is perceived in an area distant from its point of origin, whereas transient pain is brief and passes quickly. Superficial pain originates in the skin or subcutaneous tissue. Phantom pain may occur in a person who has had a body part amputated, either surgically or traumatically.

A client with cancer pain is taking morphine for pain relief. Knowing constipation is a common side effect, what would the nurse recommend to the client? A) "Only take morphine when you have the most severe pain." B) "Increase fluids and high-fiber foods, and use a mild laxative." C) "Administer an enema to yourself every third day." D) "Constipation is nothing to worry about; take your medicine."

Ans: B Feedback: The most common side effects associated with opioids (e.g., morphine) are sedation, nausea, and constipation. If constipation persists, it usually responds to treatment with increased fluids and fiber, and use of a mild laxative.

A middle-age 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? A) Does your diet include red meat and poultry products? B) Does your pain level change after taking medications? C) Are your family members aware of your pain? D) Have you thought of the effects of your condition on your family?

Ans: B Feedback: The nurse should ask direct and specific questions about the nature of the pain and whether it changes with medication, as this helps the nurse to quickly gather objective data about the client's pain. The nurse should avoid asking irrelevant and closed-ended questions, such as whether the client's diet includes red meat and poultry products, or whether the client has thought about the effects of his condition on his family. These types of questions do not add any value to pain assessment, but could make the client feel more depressed and uncomfortable.

A nurse is ordered to apply a transcutaneous electrical nerve stimulation (TENS) unit to a client recovering from abdominal surgery. Which of the following is a consideration when using this device? A) TENS is an invasive technique for providing pain relief. B) TENS involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers. C) TENS is most beneficial when used to treat pain that is generalized. D) A TENS unit is applied intermittently throughout the day and should not be worn for extended periods of time.

Ans: B Feedback: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive technique for providing pain relief that involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers. It is most beneficial when the pain is localized and the unit can be worn for extended periods of time.

A client 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? A) Complex regional pain syndrome B) Postherpetic neuralgia C) Trigeminal neuralgia D) Diabetic neuropathy

Ans: C Feedback: A symptom of trigeminal neuralgia is paroxysms of lightning-like stabs of in tense pain in the distribution of one or more divisions of the trigeminal nerve, the fifth cranial nerve. Pain is usually experienced in the mouth, gums, lips, nose, cheek, chin, and surface of the head and may be triggered by everyday activities like talking, eating, shaving, or brushing one's teeth.

What is the term used to describe a pharmaceutical agent that relieves pain? A) Antacid B) Antihistamine C) Analgesic D) Antibiotic

Ans: C Feedback: An analgesic is a pharmaceutical agent that relieves pain. Analgesics reduce the perception of pain and alter responses to discomfort.

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? A) "Oh, he probably was just hungry and wet. Did you feed him?" B) "Babies at that age cry at night. Think nothing of it." C) "That means his ear hurt. Bring him in to be checked." D) "That probably means he had a tummy ache. How is he now?"

Ans: C Feedback: Pain is frustrating for children because they are unable to understand the concept and cause of pain, and may have difficulty describing it. Crying and touching/grabbing the painful body part are observations that may indicate pain in a child.

A nurse is assessing a client with arthritis. Which of the following should the nurse consider in the initial assessment of the client? A) Blood group B) Anxiety level C) Pain level D) Glucose level

Ans: C Feedback: The nurse should first assess the client's pain level since the client has arthritis. Anxiety level, blood group, and glucose level are not vital signs which will help the nurse assess the client's pain during the initial assessment.

A nurse is teaching an alert client how to use a PCA system in the home. How will she explain to the client what he must do to self-manage pain? A) "You don't have to do anything. The machine does it all." B) "I will teach your family what they need to do." C) "When you push the button, you will get the medicine." D) "The medicine is going into your body all the time."

Ans: C Feedback: When the sensation of pain occurs, the client pushes a button that activates the PCA device to deliver a small preset bolus dose of the analgesic. A lockout interval (usually 5 to 10 minutes) prevents reactivation of the pump and administration of another dose during that period of time. Other safeguards also limit the possibility of overmedication.

The nurse is caring for a client with terminal bone cancer. The client states, My pain is getting worse and worse, and the morphine doesn't help anymore. The nurse determines the client's pain is which of the following? A) Acute B) Chronic malignant C) Diffuse D) Intractable

Ans: D Feedback: Chronic malignant pain is acute pain episodes, persistent chronic pain, or both, associated with a progressive malignanttype process.

A client who has breast cancer is said to be in remission. What does this term signify? A) The client is experiencing symptoms of the disease. B) The client has end-stage cancer. C) The client is experiencing unremitting pain. D) The disease is present but the client is not experiencing symptoms.

Ans: D Feedback: Commonly, people with chronic pain experience periods of remission (when the disease is present but the person does not experience symptoms) or exacerbation (the symptoms reappear).

How may a nurse demonstrate cultural competence when responding to clients in pain? A) Treat every client exactly the same, regardless of culture. B) Be knowledgeable and skilled in medication administration. C) Know the action and side effects of all pain medications. D) Avoid stereotyping responses to pain by clients.

Ans: D Feedback: Culture influences an individual's response to pain. It is particularly important to avoid stereotyping responses to pain because the nurse frequently encounters clients who are in pain or anticipating it will develop. A form of pain expression that is frowned upon in one culture may be desirable in another cultural group.

A client has been taught relaxation exercises before beginning a painful procedure. What chemicals are believed to be released in the body during relaxation to relieve pain? A) Narcotics B) Sedatives C) A-delta fibers D) Endorphins

Ans: D Feedback: Endorphins, which are opioid neuromodulators, are produced at neural synapses at various points in the CNS pathway. They have prolonged analgesic effects and produce euphoria. It is suggested that they may be released when measures such as skin stimulation and relaxation techniques are used.

A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain? A) Six hours after administering a prescribed analgesic B) After the client is discharged from the health care facility C) Once per day when the pain is a potential problem D) Whenever the vital signs are measured and documented

Ans: D Feedback: The nurse should assess the client's pain whenever the nurse measures and documents vital signs. When administering a prescribed analgesic, the nurse should assess pain before implementing a pain-management intervention, and again 30 minutes later. The nurse should assess the client's pain when the client is admitted to, not discharged from, the health care facility. Similarly, the nurse should assess pain once per shift when pain is an actual or potential problem.

A client has a severe abdominal injury with damage to the liver and colon from a motorcycle crash. What type of pain will predominate? A) Psychogenic pain B) Neuropathic pain C) Cutaneous pain D) Visceral pain

Ans: D Feedback: Visceral pain is poorly localized and originates in body organs in the thorax, cranium, and abdomen. The pain occurs as organs stretch abnormally and become distended, ischemic, or inflamed.

A nurse asks a client 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? A) Duration B) Location C) Chronology D) Intensity

Ans: D Feedback: When a nurse asks a client to rate his pain on a scale of 0 to 10, the intensity of the pain is being assessed. Duration is how long the pain has lasted, and location is the site of the pain.

A first day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take? A. Deliver the bolus dose per standing order. B. Contact the physician to increase the dose. C. Try non-pharmacological comfort measures. D. Assess the pain for location, quality, and intensity

Assess the pain for location, quality, and intensity Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps.

Which of the following nonpharmacologic pain relief measures has been found to be effective for soothing agitated newborns and comatose patients? A) distraction B) music C) humor D) imagery

B) music

Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? Choose all that apply. A. An anxious, chronic pain client who frequently uses the call button B. A client second day post-op who needs pain medication prior to dressing changes C. A client with HIV who reports headache and abdominal and pleuritic chest pain D. A client who is being discharged with a surgically implanted catheter

B. A client second day post-op who needs pain medication prior to dressing changes A second day postoperative client who needs medication prior to dressing changes has predictable and routine care that a new nurse can manage. Although clients with chronic pain can be relatively stable, the interaction with this client will be time consuming and may cause the new nurse to fall behind. The client with HIV has complex complaints that require expert assessment skills. The client pending discharge will need special and detailed instructions.

Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.) A. A client who needs pre-op teaching for use of a PCA pump B. A client with a leg cast who needs neurologic checks and PRN hydrocodone C. A client post-op toe amputation with diabetic neuropathic pain D. A client with terminal cancer and severe pain who is refusing medication

B. A client with a leg cast who needs neurologic checks and PRN hydrocodone C. A client post-op toe amputation with diabetic neuropathic pain The clients with the cast and the toe amputation are stable clients and need ongoing assessment and pain management that are within the scope of practice for an LPN/LVN under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and the terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication.

Which client is at greater risk for respiratory depression while receiving opioids for analgesia? A) An elderly chronic pain client with a hip fracture B) A client with a heroin addiction and back pain C) A young female client with advanced multiple myeloma D) A child with an arm fracture and cystic fibrosis

D) A child with an arm fracture and cystic fibrosis at greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors.

For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take? A. Closely assess for nonverbal signs such as grimacing or rocking. B. Obtain baseline behavioral indicators from family members. C. Look at the MAR and chart, to note the time of the last dose and response. D.Give the maximum PRS dose within the minimum time frame for relief

B. Obtain baseline behavioral indicators from family members. Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.

In educating clients about non-pharmaceutical alternatives, which topic could you delegate to an experienced LPN/LVN, who will function under your continued support and supervision? A. therapeutic touch B. use of heat and cold applications C. meditation D. transcutaneous electrical nerve stimulation (TENS)

B. use of heat and cold applications Use of heat and cold applications is a standard therapy with guidelines for safe use and predictable outcomes, and an LPN/LVN will be implementing this therapy in the hospital, under the supervision of an RN. Therapeutic touch requires additional training and practice. Meditation is not acceptable to all clients and an assessment of spiritual beliefs should be conducted. Transcutaneous electrical stimulation is usually applied by a physical therapist.

which route of administration is preferable for administration of daily analgesics? A. IV B. IM or subcutaneous C. Oral D. Transdermal E. PCA

C oral If the gastrointestinal system is function, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms.

Which client is most likely to receive opioids for extended periods of time? A) A client with fibromyalgia B) A client with phantom limb pain C) A client with progressive pancreatic cancer D) A client with trigeminal neuralgia

C) A client with progressive pancreatic cancer Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioid and adjuvant medications. Trigeminal neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.

Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b. NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine A) B, A, C B) C, A, B C) B, C, A D) A, B, C

C) B, C, A Step 1 includes non-opioids and adjuvant drugs. Step 2 includes opioids for mild pain plus Step 1 drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain (replacing Step 2 opioids) and continuing Step 1 drugs and adjuvant drugs as needed.

In caring for a young child with pain, which assessment tool is the most useful? A) Simple description pain intensity scale B) 0-10 numeric pain scale C) Faces pain-rating scale D) McGill-Melzack pain questionnaire

C) Faces pain-rating scale The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is appropriate for young children who may have difficulty describing pain or understanding the correlation of pain to numerical or verbal descriptors. The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary.

Family members are encouraging your client to "tough it out" rather than run the risk of becoming addicted to narcotics. The client is stoically abiding by the family's wishes. Priority nursing interventions for this client should target which dimension of pain? A) Sensory B) Affective C) Sociocultural D) Behavioral E) Cognitive

C) Sociocultural The family is part of the sociocultural dimension of pain. They are influencing the client and should be included in the teaching sessions about the appropriate use of narcotics and about the adverse effects of pain on the healing process. The other dimensions should be included to help the client/family understand overall treatment plan and pain mechanism

A family member asks you, "Why can't you give more medicine? He is still having a lot of pain." What is your best response? A. "The doctor ordered the medicine to be given every 4 hours." B. "If the medication is given too frequently he could suffer ill effects." C. "Please tell him that I will be right there to check of him." D. "Let's wait about 30-40 minutes. If there is no relief I'll call the doctor."

C. "Please tell him that I will be right there to check of him." directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next.

A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal? A. fever B. nausea C. diaphoresis D. abdominal cramps

C. diaphoresis Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.

Which route of administration is preferred if immediate analgesia and rapid titration are necessary A. intraspinal B.patient-controlled analgesia (PCA) C. intravenous D. sublingual

C. intravenous the IV route is preferred as the fastest and most amenable to titration. A PCA bolus can be delivered; however, the pump will limit the dosage that can be delivered unless the parameters are changed. Intraspinal administration requires special catheter placement and there are more potential complications with this route. Sublingual is reasonably fast, but not a good route for titration, medication variety in this form is limited.

In applying the principles of pain treatment, what is the first consideration? A.treatment is based on client goals B. a multidisciplinary approach is needed C. the client must be believed about perceptions of own pain D. drug side effects must be prevented and managed

C. the client must be believed about perceptions of own pain The client must be believed and his or her experience of pain must be acknowledged as valid. The data gathered via client reports can then be applied to other options in developing the treatment plan.

A client is receiving opioid analgesia for pain control. The nurse is assessing the client for possible respiratory depression. Which method would be most reliable for the nurse to use to identify impending respiratory depression?

Capnography End tidal CO2 is considered a highly reliable measure of the quality of ventilation and, unlike pulse oximetry, is an early indicator of impending respiratory depression. Although respiratory rate and lungs sounds help evaluate the client's respiratory status, they are not reliable indicators of impending respiratory depression.

As the charge nurse, you are reviewing the charts of clients who were assigned to a newly graduated RN. The RN has correctly charted dose and time of medication, but there is no documentation regarding non-pharmaceutical measures. What action should you take first? A) Make a note in the nurse's file and continue to observe clinical performance B) Refer the new nurse to the in-service education department. C) Quiz the nurse about knowledge of pain management D) Give praise for the correct dose and time and discuss the deficits in charting.

D) Give praise for the correct dose and time and discuss the deficits in charting. In supervising the new RN, good performance should be reinforced first and then areas of improvement can be addressed. Asking the nurse about knowledge of pain management is also an option; however, it would be a more indirect and time-consuming approach. Making a note and watching do not help the nurse to correct the immediate problem. In-service might be considered if the problem persists. as the charge nurse, you are reviewing the charts of clients who were assigned to a newly graduated RN. The Rn correctly charted dose and time of medication, but there is no documentation regarding non-pharmaceutical measures. what action should you take first?A. make a note in the nurse's file and continue to observe clinical performanceB. refer the new nurse to the in-service education departmentC. quiz the nurse about knowledge of pain managementD. give praise for the correct dose and time and discuss the deficits in charting

A client with chronic pain reports to you, the charge nurse, that the nurse have not been responding to requests for pain medication. What is your initial action? A) Check the MARs and nurses' notes for the past several days. B) Ask the nurse educator to give an in-service about pain management. C) Perform a complete pain assessment and history on the client. D) Have a conference with the nurses responsible for the care of this client

D) Have a conference with the nurses responsible for the care of this client As charge nurse, you must assess for the performance and attitude of the staff in relation to this client. After gathering data from the nurses, additional information from the records and the client can be obtained as necessary. The educator may be of assistance if knowledge deficit or need for performance improvement is the problem.

The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take? A. prepare the medication and hand it to the physician B. check the hospital policy regarding use of the placebo C. follow a personal code of ethics and refuse to give it D. contact the charge nurse for advice

D. contact the charge nurse for advice the charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following one's own ethical code is correct, you must ensure that the client is not abandoned and that care continues.

A 54-year-old man is recovering from an outbreak of Herpes zoster on his left chest. He tells the nurse that even his shirt touching him causes a horrible pain on the left side of the chest. What term would best describe the client's pain? Nociceptive pain Chronic pain Hyperalgesia Somatic pain

Hyperalgesia - increased sensitivity to pain

For a client who is taking aspirin, which laboratory value should be reported to the physician? A. Potassium 3.6 mEq/L B. Hematocrit 41% C.PT 14 seconds D. BUN 20 mg/dL

PT 14 seconds When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%, female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).

A nurse has attended a pain control workshop and learned about the psychological and physiological basis of placebos. What principle should guide the use of placebos in the treatment of pain? Placebos can effectively treat pain while avoiding unpleasant side effects of opioids. Placebos may be used in the treatment of pain in clients who have allergies or addictions. Placebos involve the use of deception and are considered unethical in most circumstances. Placebos should be used if the client provides written consent for their use.

Placebos involve the use of deception and are considered unethical in most circumstances.

The nurse instructs the client taking ibuprofen that the drug is effective for pain relief because it acts to a- slow painful stimuli through type A-delta pain fibers. b- reduce inflammation and block prostaglandins. c- interrupt the transmission of pain impulses. d- interfere with the relay of pain information through the dorsal horn.

b- reduce inflammation and block prostaglandins. The site of action of nonsteroidal anti-inflammatory drugs (NSAIDs) is primarily the periphery at the receptor site, where NSAIDs serve an anti-inflammatory function and prevent the production of prostaglandins.

The nurse is caring for a client whose pain is being treated with epidural analgesia. Which nursing action is most appropriate? The nurse should expect slight resistance during the removal of the epidural catheter. If a client is experiencing adverse effects, a peripheral IV line should be inserted to allow immediate administration of emergency drugs, if warranted. The anesthesiologist/pain management team should be notified immediately if the client's respiratory rate is below 10 breaths/min. If the client develops a headache, an opioid analgesic may be administered along with the epidural analgesia.

The anesthesiologist/pain management team should be notified immediately if the patient exhibits a respiratory rate below 10 breaths/minute. Explanation: The anesthesiologist/pain management team should be notified immediately if the patient exhibits a respiratory rate below 10 breaths/minute or has unmanaged pain, leakage at the insertion site, fever, inability to void, paresthesia, itching, or headache. No other medications should be administered; a peripheral IV line should already be in place. Resistance should not be felt when removing an epidural catheter. 1140

In providing care to a client with chronic pain, which of the following characteristics or client responses should the nurse expect? a) Heart rate, blood pressure, and pulse rate may be normal while the client is experiencing pain. b) Opioid-based analgesics may have little if any effect on reducing the quality of chronic pain. c) The client may have adapted so successfully to the presence of chronic pain that measures for relief are unnecessary. d) The actual intensity of chronic pain is difficult to assess because the client may complain constantly

a) Heart rate, blood pressure, and pulse rate may be normal while the client is experiencing pain. Adaptation to the presence of chronic pain is physiologic. Thus, the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain.

The nurse is teaching a novice nurse about the therapeutic effects of laughter. Which example correctly identifies one of these effects? a) It activates the immune system. b) It causes shallow breathing. c) It increases the level of epinephrine. d) It decreases heart rate.

a) It activates the immune system.

An elderly patient is confined to bedrest following cervical spine surgery to treat nerve pinching. The nurse is vigilant about turning the patient and assessing the patient regularly to prevent the formation of pressure ulcers. What type of agent is the stimulus for pressure ulcers? a) Mechanical b) Thermal c) Chemical d) Electrical

a) Mechanical Receptors in the skin and superficial organs may be stimulated by mechanical, thermal, chemical, and electrical agents. Friction from bed linens causing pressure sores and pressure from a cast are mechanical stimulants. Sunburn is a thermal stimulant. An acid burn is the result of a chemical stimulant. The jolt from a lightening bolt is an electrical stimulant.

A middle-age client tells the nurse that her neck pain reduced considerably after she underwent a treatment in which thin needles were inserted into her skin. What kind of pain relief treatment did the client undergo? a) Transcutaneous electrical nerve stimulation b) Biofeedback c) Rhizotomy d) Acupuncture

d) Acupuncture

One of the most common distinctions of pain is whether it is acute or chronic. Which examples describe chronic pain? Select all that apply. a. A patient is receiving chemotherapy for bladder cancer. b. An adolescent is admitted to the hospital for an appendectomy. c. A patient is experiencing a ruptured aneurysm. d. A patient who has fibromyalgia requests pain medication. e. A patient has back pain related to an accident that occurred last year. f. A patient is experiencing pain from second-degree burns.

a. A patient is receiving chemotherapy for bladder cancer. d. A patient who has fibromyalgia requests pain medication. e. A patient has back pain related to an accident that occurred last year. RATIONALEChronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Examples are cancer pain, fibromyalgia pain, and back pain. Acute pain is generally rapid in onset and varies in intensity from mild to severe, as occurs with an emergency appendectomy, a ruptured aneurysm, and pain from burns.

A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. The nurse's reply is based on the information that these strategies a. impact the cognitive and affective components of pain. b. increase the modulating effect of the efferent pathways. c. prevent transmission of nociceptive stimuli to the cortex. d. slow the release of transmitter chemicals in the dorsal horn.

a. impact the cognitive and affective components of pain. Cognitive therapies impact on the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.

When doing a pain assessment for a patient who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the patient's pain? a. "How long have you had this pain?" b. "How would you describe your pain?" c. "How much medication do you take for the pain?" d."How many times a day do you medicate for pain?"

b. "How would you describe your pain?" Because pain is a multidimensional experience, asking a question that addresses the patient's experience with the pain is likely to elicit more information than the more specific information asked in the other three responses. All of these questions are appropriate, but the response beginning "How would you describe your pain?" is the best initial question.

The health care provider plans to titrate a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time (select all that apply)? a. Assessing for signs that the patient is becoming addicted to the opioid b. Monitoring for therapeutic and adverse effects of opioid administration c. Emphasizing that the risk of some opioid side effects increases over time d. Educating the patient about how analgesics improve postoperative activity level e. Teaching about the need to decrease opioid doses by the second postoperative day

b. Monitoring for therapeutic and adverse effects of opioid administration d. Educating the patient about how analgesics improve postoperative activity level Monitoring for pain relief and teaching the patient about how opioid use will improve postoperative outcomes are appropriate actions when administering opioids for acute pain. Although postoperative patients usually need decreasing amount of opioids by the second postoperative day, each patient's response is individual. Tolerance may occur, but addiction to opioids will not develop in the acute postoperative period. The patient should use the opioids to achieve adequate pain control, and so the nurse should not emphasize the adverse effects.

When developing the plan of care for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain is most effectively relieved when analgesics are administered in what matter? a) On a PRN (as needed) basis b) Conservatively c) Around the clock (ATC) d) Intramuscularly

c) Around the clock (ATC) The PRN protocol is totally inadequate for patients experiencing chronic pain. ATC doses of analgesics are more effective, whereas conservative pain management for whatever reason may also prove ineffective. Intramuscular administration is not practical on a long-range basis for a patient with chronic pain.

A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0 to 10 scale) and requests "something for pain that will work quickly." The nurse will document this as a) somatic pain. b) referred pain. c) breakthrough pain. d) neuropathic pain.

c) breakthrough pain. Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.

Which physiologic or behavioral manifestation is more commonly associated with acute pain rather than chronic pain? a- Reduced tendency to touch or move the affected area b- Psychosocial withdrawal c- Inability to concentrate d-Dry skin and moist oral mucous membranes

c- Inability to concentrate The characteristic most common to chronic pain is psychosocial withdrawal. Dry skin and moist mucous membranes indicate an absence of or physiologic adaptation to the stress response associated with chronic pain. Clients experiencing either acute or chronic pain tend to protect the painful area. The inability to concentrate is associated much more with acute pain before any physiologic or behavioral adaptation has occurred.

A postoperative client that recently returned from surgery has a morphine PCA pump. The basal rate is ordered to be 1 mg/hour and the patient can have a 1-mg bolus every 15 minutes. When the nurse assesses the client, the nurse finds the client stuporous, hard to arouse, with a respiratory rate of 6 breaths/minute. After successfully treating the client, which action by the nurse takes priority? The nurse should a- request the physician order different basal and bolus rates. b- question the client about how he/she has been using the button on the pump. c- check the IV pump to ensure the basal rate is set correctly. d- Ask the physician to discontinue the PCA pump and revert to prn opioids for pain.

c- check the IV pump to ensure the basal rate is set correctly. The patient exhibited manifestations of opioid toxicity. The ordered dose was well within a safe range for a postoperative client. On a PCA pump, the demand feature has a lock-out device limiting the amount of opioid the client can administer. This could have been set incorrectly, allowing the client to overdose him/herself; however, a sleepy postoperative client often cannot use the demand feature without reminders. This leaves the basal rate as the most likely source of error and the nurse should check to see that it was set correctly. Giving prn pain medications often results in undertreatment of pain and should not be used on a postoperative client. If the pump was set incorrectly, there is no need to adjust the rates. Questioning the client and re-educating him/her if needed are always appropriate, but it is not the priority since the pump most likely was set incorrectly.

A postoperative patient asks the nurse how the prescribed ibuprofen (Motrin) will control the incisional pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing the a. modulating effect of descending nerves. b. sensitivity of the brain to painful stimuli. c. production of pain-sensitizing chemicals. d. spinal cord transmission of pain impulses.

c. production of pain-sensitizing chemicals. Nonsteroidal anti-inflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by the NSAIDs.

A patient is postoperative following an emergency cesarean section birth. The patient asks the nurse about the use of pain medications following surgery. What would be a correct response by the nurse? a) "It's not a good idea to ask for pain medication regularly as it can be addictive." b) "It is better to wait until the pain gets unbearable before asking for pain medication." c) "It's natural to have to put up with pain after surgery and it will lessen in intensity in a few days." d) "Your doctor has ordered pain medications for you, which you should not be afraid to request any time you have pain."

d) "Your doctor has ordered pain medications for you, which you should not be afraid to request any time you have pain." Many pain medications are ordered on a PRN (as needed) basis. Therefore, nurses must be diligent to assess patients for pain and administer medications as needed. A patient should not be afraid to request these medications and should not wait until the pain is unbearable. Few people become addicted to the medications if used for a short period of time. Pain following surgery can be controlled and should not be considered a natural part of the experience that will lessen in time.

When performing an assessment on a client with chronic pain, the nurse notes that the client frequently shifts conversational topics. The nurse determines that this may be an indicator for which of the following? a) Boredom b) Depression c) Moodiness d) Anxiety

d) Anxiety Clients in pain may experience anxiety, and the anxiety may also increase the perception of pain. Signs of anxiety include decreased attention span or ability to follow directions, asking frequent questions, shifting topics of conversation, and avoidance of discussion of feelings.

A patient with chronic back pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask? a. "Can you describe the quality of your pain?" b. "Has there been a change in the pain location?" c. "How would you rate your pain on a 0 to 10 scale?" d. "Does the pain keep you from doing things you enjoy?"

d. "Does the pain keep you from doing things you enjoy?" The goal for the treatment of chronic pain usually is to enhance function and quality of life. The other questions also are appropriate to ask, but information about patient function is more useful in evaluating effectiveness.

A patient with chronic cancer pain is receiving imipramine (Tofranil) in addition to long-acting morphine for pain control. Which information is the best indicator that the imipramine is effective? a. The patient sleeps 8 hours every night. b. The patient has no symptoms of anxiety. c. The patient states, "I feel much less depressed since I've been taking the imipramine." d. The patient states, "The pain is manageable, and I can accomplish my desired activities.

d. The patient states, "The pain is manageable, and I can accomplish my desired activities. Imipramine is being used in this patient to manage chronic pain and improve functional ability. Although the medication also is prescribed for patients with depression, insomnia, and anxiety, the evaluation for this patient is based on improved pain control and activity level.

A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which of these prescribed medications will be best for the nurse to administer? a. lorazepam (Ativan) 1 mg orally b. amitriptyline (Elavil) 10 mg orally c. ibuprofen (Motrin) 400 to 800 mg orally d. immediate-release morphine 30 mg orally

d. immediate-release morphine 30 mg orally The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid, such as the immediate-release morphine. The Motrin and Elavil may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of anti-anxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.

Which non-pharmacological measure is particularly useful for a client with acute pancreatitis A. Diversional therapy, such as playing cards or board games B. Massage of back and neck with warmed lotion C. Side-lying position with knees to chest and pillow against abdomen D. Transcutaneous electrical nerve stimulation (TENS)

side lying position with knees to chest and pillow against abdomen The side-lying, knee-chest position opens retroperitoneal space and provides relief. The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain, especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain. The additional stimulation of massage may be distressing to the client.