Chapter 7 Care of Patients with Pain EAQ
The nurse observes that a patient is distressed as a result of severe pain. Which statement by the nurse would help reduce anxiety in the patient? 1 "I will call your family members; they will surely help you." 2 "I will assist you in whatever way I can to reduce your pain." 3 "I believe that you are in pain. Do not worry; it will reduce in time." 4 "I will inform the primary health care provider; please wait for some time."
"I will assist you in whatever way I can to reduce your pain." The nurse is responsible for providing suitable interventions to relieve the patient's anxiety. The nurse should therefore tell the patient that the nurse believes the patient and will assist the patient with reducing the pain. The patient need not rely on his or her family members to relieve pain and anxiety. The family members may provide psychological support, but they cannot provide active interventions to reduce the patient's anxiety. The nurse should not judge the pain perceived by the patient. The patient may be in severe pain and may require painkillers to reduce pain. If the nurse says, "please wait for some time," this may increase the patient's anxiety. The nurse should take pain relief measures for the patient. If those do not work, the nurse should inform the primary health care provider.
A postoperative patient is to receive patient-controlled analgesia (PCA). The LPN/LVN explains the process to the patient. Which of these statements, if made by the patient, indicates a need for further instruction? 1 "I will be able to tell when I need medication by how I feel." 2 "I will have set times at which I can get certain quantities of medications." 3 "I will be able to give myself medication at any time within certain parameters." 4 "I will be able to control the amount of medication I give myself within certain parameters."
"I will have set times at which I can get certain quantities of medications." PCA allows patients to self-administer pain medication based their needs, within preset parameters. There are usually no set times for medication administration using PCA.
A patient tells the LPN/LVN that using a mentholated rub, which is bought as an over-the-counter product, helps with muscle pain. Which of these instructions should the nurse give the patient? 1 "Take a shower right after you apply the rub." 2 "Try not to breathe in the menthol from the rub." 3 "Wash your hands well after applying the menthol rub." 4 "Be sure to lie down for at least 30 minutes after applying the rub."
"Wash your hands well after applying the menthol rub." Menthol should not be placed near or in the eyes or on mucous membranes; therefore, handwashing after applying the product is important. Showering immediately after application would not allow the menthol to penetrate the skin. Breathing the menthol from the application should not disturb the patient. Lying down is not necessary.
What are some examples of acute pain? Select all that apply. 1 Bee sting 2 Kidney stone pain 3 Osteoarthritis pain 4 Postoperative pain 5 Diabetic neuropathic pain
1 Bee sting 2 Kidney stone pain 3 Osteoarthritis pain 4 Postoperative pain Acute pain's duration is less than 6 months, it is of recent onset, and it has a good prognosis. It may resolve spontaneously or in response to analgesic therapy. The cause of acute pain is relatively easy to identify. Acute pain may temporarily disrupt normal activities or routine, but often there are transient to no lasting effects. Medication for acute pain is usually beneficial, and surgery is often helpful. Bee sting, kidney stone pain, and postoperative pain are examples of acute pain. Chronic pain's duration is months to years. The prognosis for relief is poor unless complicating factors are removed, and spontaneous relief is unusual. Sometimes the cause is known, but diagnosis may be complex or undetermined. Chronic pain can affect the patient's ability to earn a living, enjoy social activities, and maintain self-esteem. For chronic pain, medications may be helpful, but the patient may become dependent on them. Osteoarthritis pain and diabetic neuropathic pain are examples of chronic pain.
The nurse is assisting with data collection for a patient who has a suspected myocardial infarction. In addition to the substernal area, the patient could also experience pain in which other area(s)? Select all that apply. 1 Jaw 2 Arm 3 Groin 4 Flank 5 Right back
1 Jaw 2 Arm Referred pain is pain that is felt in a different part of the body from where it actually originates. Usual referred pain sites for the heart are the arm, the jaw, the left chest, and between the scapulae. Groin pain sometimes occurs with kidney stones for males. Flank pain is usually associated with kidney or kidney stone pain. Right back pain is associated with referred pain from the liver.
A nurse is caring for a patient who is receiving an adjuvant medication to assist with pain control. Which medications may be used as an adjuvant? Select all that apply. 1 Phenytoin 2 Amitriptyline 3 Meperidine 4 Gabapentin 5 Carisoprodol 6 Hydromorphone
1 Phenytoin 2 Amitriptyline 4 Gabapentin 5 Carisoprodol Meperidine and hydromorphone are both opioid analgesics and are not used as adjuvants. Amitriptyline is an antidepressant that may be used as a supplement for various types of chronic pain. Phenytoin and gabapentin are anticonvulsants that may be used for neuropathic or nerve pain. Carisoprodol is a muscle relaxant that may be used for muscle spasms.
The LPN/LVN is teaching a patient about managing pain in the early postoperative period. Which patient statement indicates a need for further teaching? 1 "If I feel like moaning and groaning a bit, it's okay." 2 "At this time, I should try to maintain my usual dislike of using analgesics." 3 "If I take a pain medication, I'm likely to have fewer complications from immobility." 4 "I can expect the methods used to relieve my pain to help me from getting fatigued."
2 "At this time, I should try to maintain my usual dislike of using analgesics." Avoiding the use of analgesics will hamper the patient's ability to recover from the surgery in a timely manner. The nurse should offer further teaching if the patient is considering avoiding analgesics. The patient would be correct in saying that it is okay to moan and groan a bit, that pain medication generally leads to fewer complications from immobility, and that pain relief methods also improve fatigue.
The nurse is caring for a patient who has severe postoperative pain and who has been prescribed fentanyl citrate (Actiq) and psyllium (Metamucil). What instructions should the nurse give the patient to enhance the effectiveness of psyllium (Metamucil)? Select all that apply. 1 Meditate. 2 Rest more. 3 Drink more water. 4 Exercise regularly. 5 Eat a fiber-rich diet.
3 Drink more water. 4 Exercise regularly. 5 Eat a fiber-rich diet. Fentanyl citrate (Actiq) is an opioid drug used for analgesia. Constipation is the most common side effect of opioids. Therefore, the primary health care provider prescribed psyllium (Metamucil) to facilitate bowel moment. These laxatives alone will not be sufficient to prevent constipation. The nurse should instruct the patient to drink more water, eat a proper fiber-rich diet, and exercise regularly. These strategies would further assist with bowel movement. Meditation is usually performed to relieve stress. Excessive rest would further aggravate constipation.
When reviewing medical records, the nurse notes that the patient has chronic back pain. Which characteristics of chronic pain is this patient likely to exhibit? Select all that apply. 1 Surgery is often helpful 2 Duration is hours to days 3 Medication usually beneficial 4 Spontaneous relief is unusual 5 Can affect ability to earn a living 6 Cause is relatively easy to identify
3 Medication usually beneficial 4 Spontaneous relief is unusual 5 Can affect ability to earn a living Chronic pain's duration is months to years. The prognosis for relief is poor unless complicating factors are removed, and spontaneous relief is unusual. Sometimes the cause is known, but diagnosis may be complex or undetermined. Chronic pain can affect the patient's ability to earn a living, enjoy social activities, and maintain self-esteem. For chronic pain, medications may be helpful, but the patient may become dependent. A multiple-medication regimen may be used to treat chronic pain. Surgery may help, but it may also worse the problem. Acute pain's duration is less than 6 months and of recent onset, and it has a good prognosis. It may resolve spontaneously or in response to analgesic therapy. The cause in acute pain is relatively easy to identify. Acute pain may temporarily disrupt normal activities or routine, but often there are transient to no lasting effects. Medication for acute pain is usually beneficial, and surgery is often helpful.
Which is an understanding the LPN/LVN should have concerning pain? 1 If pain is present, there is a demonstrable cause. 2 A patient with low pain tolerance has no self-control. 3 A patient with high pain tolerance is emotionally mature. 4 The person who has pain is the one to decide if the pain is tolerable.
4 The person who has pain is the one to decide if the pain is tolerable. The nurse should understand that there does not have to be an obvious reason for the patient to experience pain. Pain tolerance is very individualized and may even vary within an individual at different times. The person experiencing pain is the only one who may ultimately decide if the pain is tolerable.
The nurse has administered an opioid analgesic medication to a patient who had an abdominal hysterectomy 12 hours ago. Which best indicates effective pain relief? 1 The patient's respiration rate is 10 breaths/min. 2 The patient's pupils are no longer dilated to 7 mm. 3 The patient is not responding to any verbal stimulation. 4 The patient states, "I'd say that my pain has gone down to 4/10."
4 The patient states, "I'd say that my pain has gone down to 4/10. The patient's statement about pain reduction is the best indicator of effective pain relief. The patient should be responding to verbal stimulation. Pupil dilation is not the best indicator of effective pain relief. A respiratory rate of 10 breaths/min indicates respiratory depression, which is a potentially life-threatening adverse effect that requires immediate intervention
What are some serious interactions or contraindications that should be taught to patients related to the use of over-the-counter (OTC) analgesics? Select all that apply. 1 Aspirin is used solely for pain control. 2 Aspirin can cause the blood to clot too quickly. 3 Acetaminophen in high doses is toxic to the liver. 4 OTC analgesics are always safe to use with prescription medications. 5 Following dosing requirements is essential for patients using OTC medications.
Acetaminophen in high doses is toxic to the liver. Following dosing requirements is essential for patients using OTC medications. Following dosage requirements is essential for patients. Acetaminophen in high doses is toxic to the liver. Aspirin is used for pain, but it is a powerful anticoagulant, so it will cause the blood to clot more slowly (not more quickly). Many OTC analgesics have serious interactions with prescription medications.
What assessment tools are used to assess a patient's pain? Select all that apply. 1 Activity 2 Behavior 3 Vital signs 4 Appearance 5 Diagnostic tests
Activity 2 Behavior 3 Vital signs 4 Appearance Appearance, behavior, activity level, verbalization, and physiologic cues (such a vital signs) are used in combination to assess a patient's pain. Diagnostic tests cannot assess the level of pain of a patient.
A new patient is admitted to the hospital with a diagnosis of rheumatoid arthritis. The patient reports having had difficulty with leg pain for the last 2 years. This is an example of what type of pain? 1 Acute pain 2 Chronic pain 3 Referred pain 4 Fight-or-flight response
Chronic pain Chronic pain is generally characterized as pain that lasts longer than 6 months; it can be continuous or intermittent and as intense as acute pain. Acute pain is intense and of short duration, usually lasting less than 6 months. Referred pain is felt at a site other than the injured or diseased organ or part of the body. The fight-or-flight response is a flooding of the body with epinephrine; this is an autonomic response created by acute pain as a warning of actual or potential tissue damage.
The nurse is applying cold therapy for a patient who was diagnosed with a sprained ankle. Which statement about the application of cold is correct? 1 Cold applications should be limited to 30 minutes per session. 2 Cold is helpful to reduce swelling through vasoconstriction. 3 The continuous application of cold is more effective than intermittent therapy. 4 Abdominal cramping and muscle and joint pain are relieved with applications of cold.
Cold is helpful to reduce swelling through vasoconstriction. Cold therapy is helpful to reduce swelling through vasoconstriction. Cold applications should be limited to 15 minutes at a time to prevent tissue injury. Intermittent applications of cold are more effective than continuous applications. Abdominal cramping and muscle and joint pain respond better to heat therapy than to cold.
A patient is receiving fentanyl (Duragesic) transdermal patches to relieve chronic pain associated with cancer. This patient is experiencing multiple side effects of the medication. Which of the side effects listed will continue while the patient is taking this medication? 1 Nausea 2 Sedation 3 Vomiting 4 Constipation
Constipation Opioid analgesics have specific side effects. Constipation is one side effect that is very common and for which tolerance does not develop. Tolerance of nausea with or without vomiting may eventually develop, but it may initially need to be treated with antiemetics. Sedation usually subsides within a few days.
Opioids are commonly given to patients for pain control. Constipation is the most common side effect of opioid use. Which intervention will help reduce the risk of constipation? 1 Maintain bed rest. 2 Decrease fluid intake. 3 Minimize intake of fiber. 4 Consult with the prescriber regarding a stool softener.
Consult with the prescriber regarding a stool softener. Adding stool softeners to the medication list will help to promote regularity to prevent constipation. The amount of activity should also be increased; patients should not be sedentary unless specified by the primary health care provider. Increasing the amount of fiber and fluid intake promotes regularity.
The nurse administered oral pain medication 1 hour ago to a patient who had an appendectomy yesterday, but the patient has not experienced any relief. What should be the nurse's next action? 1 Give the patient another dose of pain medication. 2 Give the patient one-half of the dosage due in 3 hours. 3 Inform the patient that she must have developed a tolerance. 4 Contact the health care provider regarding the lack of effectiveness.
Contact the health care provider regarding the lack of effectiveness. The nurse should contact the health care provider when measures to relieve pain are not effective. Giving the patient another dose or one-half of another dose could be dangerous. It is unlikely that the patient has developed drug tolerance since the surgery only occurred the day before.
Which questions should be included when assisting with data collection regarding a patient's pain? Select all that apply. 1 "Does anything make your pain better?" 2 "Where is your pain located on your body?" 3 "Have you ever considered psychiatric care? 4 "Can you describe the modulation or transduction of your pain?" 5 "What words would describe the pain that you are experiencing?"
Does anything make your pain better?" 2 "Where is your pain located on your body?" 5 "What words would describe the pain that you are experiencing?" When interviewing and assessing a patient's pain, questions such as "Where is your pain?," "Can you point to your pain?," "Does anything make your pain better?," and "What words would describe the pain that you are experiencing" are questions that help obtain subjective information from the patient. Asking a patient who is in pain "Have you ever considered psychiatric care?" is inappropriate and potentially offensive. "Can you describe the modulation or transduction of your pain?" is a question that is not appropriate. The patient may not understand these terms.
A patient falls and hurts her ankle. The nurse recognizes this as acute pain. What criteria describe acute pain? Select all that apply. 1 Duration is less than 6 months 2 Cause is relatively easy to identify 3 Often resolves spontaneously or with analgesia 4 May temporarily disrupt normal activities or routine 5 Cause is sometimes unknown and diagnosis may be complex
Duration is less than 6 months 2 Cause is relatively easy to identify 3 Often resolves spontaneously or with analgesia 4 May temporarily disrupt normal activities or routine Acute pain's duration is less than 6 months, it is of recent onset, and it has a good prognosis. It may resolve spontaneously or in response to analgesic therapy. The cause of acute pain is relatively easy to identify. Acute pain may temporarily disrupt normal activities or routine, but often there are transient to no lasting effects. Medication for acute pain is usually beneficial, and surgery is often helpful. Chronic pain's duration is months to years. The prognosis for relief is poor unless complicating factors are removed, and spontaneous relief is unusual. Sometimes the cause is known, but diagnosis may be complex or undetermined. Chronic pain can affect the patient's ability to earn a living, enjoy social activities, and maintain self-esteem.
When assessing a patient who is experiencing acute pain and comparing the findings with the patient's baseline, what can the LPN/LVN expect to find? 1 Loss of muscle tension 2 Increase in blood pressure 3 Decrease in pulse pressure 4 Decrease in respiratory rate
Increase in blood pressure The patient experiencing acute pain may have physiologic symptoms such as increased pulse and respiratory rates, increased blood pressure, diaphoresis, and increased muscle tension.
The nurse is assessing the patient's pain level. Which physiologic sign would indicate the patient is experiencing pain? 1 Anxiety 2 Increased temperature 3 Increased respiratory rate 4 Blood pressure within normal limits (WNL) for patient
Increased respiratory rate Rapid breathing may indicate the patient is sensing discomfort or pain. Anxiety may increase the intensity of perceived pain, but it does not cause pain. Blood pressure changes are a common physiologic response to pain. Body temperature does not correlate with pain sensation.
The nurse is caring for a patient receiving a strong narcotic for pain control. During the assessment the nurse notes the patient's respiratory rate to be 8 respirations per minute. Which medication may be necessary for this patient? 1 Ipecac 2 Naloxone 3 Sodium chloride 4 Potassium sulfate
Naloxone Naloxone is a narcotic antagonist medication that is given to combat respiratory depression caused by narcotics. It may be given intramuscularly (IM) or intravenously (IV). Ipecac, sodium chloride, and potassium sulfate are inappropriate medications for narcotic overdose.
The LPN is assisting the RN with assessing the pain status of a postoperative patient who is receiving morphine for pain control. Vital signs are as follows: pulse 62, blood pressure 100/58, and respiratory rate 6. The patient is difficult to arouse. The nurse may expect to administer which medication? 1 Naloxone (Narcan) 2 Phenytoin (Dilantin) 3 Methylphenidate (Ritalin) 4 Promethazine (Phenergan)
Naloxone (Narcan) Naloxone (Narcan) is a medication that will reverse the sedative effects of morphine. The other three medications will not be effective. Promethazine (Phenergan) is an antiemetic, methylphenidate (Ritalin) is a stimulant, and phenytoin (Dilantin) is an anticonvulsant.
A patient has just returned to the unit from surgery. The patient's skin color is pink. The dressing is intact with no drainage noted to be coming through, but the patient is moaning, restless, and showing facial grimacing. Which vital sign will the nurse assess related to these findings? 1 Pain 2 Pulse 3 Respirations 4 Blood pressure
Pain Pain is considered the fifth vital sign, and it should be assessed along with the other vital signs. Because the patient's wound and skin color are normal, the nurse would need to address the moaning and restlessness.
The nurse is documenting a patient's complaints of pain experienced with a migraine headache. Which nursing documentation is most appropriate? 1 Patient complains of a headache and nausea but not blurred vision. 2 Patient states, "I'd rate my pain as 8 out of 10, and it's on my right forehead." 3 The patient is asking for pain medication but has received two doses already today. 4 The patient's husband says he wants her to have more pain and nausea medication.
Patient states, "I'd rate my pain as 8 out of 10, and it's on my right forehead." Nursing documentation should include the patient's own words. The other options do not include these words.
Two days after surgery, a 64-year-old patient with insulin-dependent diabetes who has had a left below-the-knee amputation reports feeling pain from the left great toe. What kind of pain is the patient experiencing? 1 Referred 2 Phantom 3 Radiating 4 Psychogenic
Phantom Phantom limb sensation is a commonly occurring phenomenon following amputation and should be evaluated as acute pain. It may spontaneously resolve or persist for several months. Referred pain originates in an area anatomically distant from the area in which it is perceived; this is caused by the types and distribution of pain fibers in body areas. Radiating pain spreads out from the source of the pain. Psychogenic pain is thought to be of psychological origin.
A patient asks the nurse how endorphins work. The LPN/LVN explains to the patient that endorphins aid in which way? 1 Inducing unpleasant sensations 2 Preventing pain and discomfort 3 Reducing anxiety and relieving pain 4 Producing depression and an "I don't care" attitude
Reducing anxiety and relieving pain Endorphins (endogenous morphine) attach to pain receptors and block pain and reduce anxiety. They do not induce unpleasant sensations, prevent pain or discomfort, or produce depression and an "I don't care" attitude.
A nurse is caring for a patient who is reporting an aching, cramping-type pain located around the umbilicus that began 1 hour ago. Subsequently, this patient was diagnosed with appendicitis by the primary care physician. The nurse knows that the pain experienced by the patient is known as which type of pain? 1 Mild pain 2 Chronic pain 3 Referred pain 4 Intractable pain
Referred pain Referred pain is experienced in a location different from its source. The appendix is located in the lower-right abdominal quadrant, and this example has the patient experiencing pain in the umbilical area. Mild pain is a subjective term and not the best way to describe pain. The patient described the pain as beginning 1 hour ago; therefore, it is acute pain rather than chronic pain. Intractable pain is a term that refers to pain that cannot be relieved and that has no effective treatment.
What is the overall nursing goal for a patient in pain, if possible? 1 Relief of pain 2 Referred pain 3 Managing pain 4 Evaluation of pain
Relief of pain If possible, the overall nursing goal for a patient in pain is the relief of that pain. Otherwise, controlling or managing pain is the next alternative. >Referred pain is pain that is felt in a different part of the body from where it actually originates. Evaluating pain is an important action of the nurse, but it is not the ultimate desired outcome or goal.
The nurse adds warm blankets to the postoperative patient, provides cutaneous stimulation, and helps the patient to conjure mental images of a pleasant place. As she leaves the hospital room, she closes the door quietly so as to not disturb the patient. Which specific nonpharmacologic approaches were used to help control this patient's pain? Select all that apply. 1 Rest 2 Heat 3 Massage 4 Biofeedback 5 Guided Imagery
Rest 2 Heat 3 Massage 5 Guided Imagery Adequate sleep and rest are being safeguarded as the nurse quietly closes the door so as to not disturb the patient. The warm blankets added to the patient are providing gentle heat to help provide pain relief. Cutaneous stimulation is massage that stimulates circulation, relaxes muscles, and increases a general sense of well-being. Helping the patient to think of mental images of a pleasant place is guided imagery; this helps to provide a feeling of comfort and peace, which reduces pain. Biofeedback involves the use of a machine that uses electrodes attached to the skin to measure the degree of muscular tension. As the patient is presented with visual and auditory confirmation of self-induced relaxation, the machine indicates the successful achievement of relaxation.
The nurse has assisted with data collection for a patient with a compound fracture of the femur. The nurse correctly identifies which behaviors as those demonstrated by a person in acute pain? Select all that apply. 1 Tears 2 Pallor 3 Constricted pupils 4 Ignoring the painful site 5 A talkative person becoming quiet
Tears 2 Pallor 5 A talkative person becoming quiet Tears, pallor, and a talkative person becoming quiet are behaviors often demonstrated by a person in pain. Physiologic clues include dilated pupils, not constricted pupils. A behavior often exhibited by a person in pain is guarding, not ignoring, the painful site. All physiologic changes must be fully assessed to determine their cause.
A patient is brought to the emergency department after experiencing excruciating pain for the past 36 hours. The patient says the pain is still intense. The patient is to have an examination, has not had any medications, and falls asleep while waiting for the primary health care provider. Which of these interpretations of the patient's behavior is most accurate? 1 The patient is no longer in pain. 2 The patient is attempting to get drugs. 3 The patient's pain was an attention-getting device. 4 The patient may have become exhausted by the pain.
The patient may have become exhausted by the pain. Intense pain, especially over an extended period of time, is very exhausting and may have led to the patient falling asleep. The nurse should not assume that the patient was seeking attention or drugs, or that the patient is no longer in pain.
An 84-year-old patient is admitted to the hospital because of kidney stones. The patient is in acute pain. Which statement about administering analgesics to the older adult is accurate? 1 The patient can easily become addicted to narcotics. 2 The patient will require careful monitoring for side effects. 3 The patient should not be given drugs that have respiratory effects. 4 The patient may require larger doses of medication to achieve relief.
The patient will require careful monitoring for side effects. When administering analgesics to older adult patients, the nurse must carefully monitor for side effects. The older adult patient may have reduced tolerance to analgesics for a number of reasons, including slower metabolism of medications. The patient becoming addicted to narcotics is not the issue here. Drugs that have respiratory effects are not an issue in this case. Older adult patients often require a lower dosage of pain medication.