Chapter 9 Pain

A nursing instructor is teaching students how to assess a patient's pain. The instructor emphasizes that there are many misconceptions about pain. The instructor realizes that a student needs further direction when the student states: a) "Acute pain can be as intense as chronic pain." b) "Patients with chronic illnessess can have chronic pain." c) "Chronic pain can be referred to as persistent pain." d) "Nurses are the best authority on pain."

"Nurses are the best authority on pain." Explanation: Pain is what the patient says it is, and it exists whenever the patient says it does. The patient is the best authority on pain, and self-report is the gold standard. Therefore, nurses are not authorities on pain. It is true that patients with chronic illnesses can and often do have chronic pain. It also is true that acute pain can be intense. Chronic pain is sometimes known as persistent pain

The nurse administers pain medication to a client at 1600. At what time should the nurse return to reassess the client's pain level? a) 2000 b) 2030 c) 1730 d) 1630

1630 Explanation: Pain should be assessed every 4 hours; reassessments after interventions should be done in 30 minutes after intervention

A carpenter has been admitted to the hospital after suffering a heart attack. He explains to the nurse that he felt chest pains for the past 3 days while working, but did not want to go to the doctor because he was afraid that the other workers would tease him about it. The nurse recognizes that which of the following was most likely a barrier to pain assessment in this client? a) A belief that pain is a punishment for past mistakes b) A belief that old people just have more pain c) A belief that pain medications are addictive and cause awful side effects d) A belief that acknowledging pain is a sign of weakness

A belief that acknowledging pain is a sign of weakness Explanation: The client in this situation appears to believe that acknowledging his pain would be a sign of weakness and thus a reason for his coworkers to tease him. There is no evidence to support the idea that this man's primary barrier to pain assessment is any of the other answers.

Which of the dimensions of pain listed is being assessed by the question "How does the pain treatment you are getting affect your overall mood?" a) Behavioral. b) Affective. c) Physical. d) Cognitive.

Affective. Explanation: The affective dimension concerns feelings, sentiments, and emotions related to the pain experience. The pain can affect the emotions and the emotions can affect the perception of pain

During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is which of the following? a) Surgery b) Relaxation techniques c) Cutaneous stimulation d) Analgesics

Analgesics Explanation: Analgesics are most often the primary treatment measure for pain, although a growing trend involves the integration of complementary, nonpharmacologic measures with conventional medicine

The nurse is caring for a patient who is experiencing visceral pain. What is this patient's most likely diagnosis? a) Bone fracture b) Myocardial infarction c) Shingles d) Appendicitis

Appendicitis Explanation: Visceral pain originates from abdominal organs; patients often describe this pain as crampy or gnawing.

In preparing a care plan for a patient receiving opioid analgesics, the nurse selects which of the following as an applicable nursing diagnosis associated with side effects of opioid use? a) Constipation b) Impaired urinary elimination c) Bowel incontinence d) Diarrhea

Constipation Explanation: The most common side effects associated with opioid use are sedation, nausea, and constipation. Respiratory depression is also a commonly feared side effect of opioid use.

What is the most commonly accepted theory of pain? a) Pain transmission theory b) Gatekeeper theory c) Pain stimulus theory d) Gate control theory

Currently, the theory of pain with the widest acceptance is the gate control theory. The other three options are distractors only. The terms do not represent a theory of pain

Which of the following is not released during the stress response? a) Dopamine b) Epinephrine c) Cortisol d) Norepinephrine

Dopamine Explanation: The stress response causes the release of epinephrine, norepinephrine, and cortisol.

A patient 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) Endorphins b) Sedatives c) A-delta fibers d) Narcotics

Endorphins Explanation: 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

The nurse is working on a pediatric unit caring for a 4-year-old who is recovering from the surgical repair of the pelvis. When assessing the patient's pain, what is the most appropriate pain assessment tool for the nurse to use? a) Numeric Pain Intensity Scale b) Visual Analog Scale c) FACES Pain Scale d) Face, Legs, Activity, Cry, Consolability Scale

FACES Pain Scale Explanation: Children 2 years and older can identify pain and point to its location. You can use a facial expression scale for children starting at approximately 3 years. The FACES scale uses six faces ranging from happy with a wide smile to sad with tears on the face

A nurse is assessing the effect of a client's chronic back pain on his affective dimension. Which question should the nurse ask for this assessment? a) How does the pain influence your overall mood? b) What medical conditions do you have? c) What is the highest level of education you've completed? d) Where is the pain located?

How does the pain influence your overall mood? Explanation: The question regarding the influence of the pain on mood would address the client's affective dimension, which includes feelings and emotions that result from the pain. The question regarding medical conditions would help assess the client's physical dimension. The question regarding the location of the pain would address the client's sensory dimension. The question regarding the client's education would address his cognitive dimension.

A 12-year-old boy has reported to the emergency department after having fallen off his bicycle and sustained what appear to be minor injuries. The nurse is assessing him for pain. Which of the following objective findings would most tend to indicate pain? a) Maintaining a consistent position and posture b) Upright posture while sitting c) Sustained eye contact with the nurse d) Nodding up and down in response to questions

Nodding up and down in response to questions Explanation: Nodding up and down or saying, "yeah, yeah," may not indicate a client's positive response to questions, but rather may indicate just listening or not wanting to be negative, as responding verbally or in detail would require too much effort while the client is in pain. The other findings listed would all tend to indicate a lack of pain: upright posture, sustained eye contact, and maintaining a consistent position and posture

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

Pain level Explanation: 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 caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain? a) Visceral pain b) Cutaneous pain c) Phantom pain d) Referred pain

Phantom pain Correct Explanation: The nurse should document the pain as phantom pain, a type of neuropathic pain that is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. The client perceives that the amputated limb still exists and feels burning, itching, and deep pain in tissues that have been surgically removed. The client is not experiencing referred pain, visceral pain, or cutaneous pain. Visceral pain is associated with disease or injury. Referred pain is not experienced in the exact site where an organ is located. Cutaneous pain originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma

In addition to pain intensity, what is another basic element of a pain assessment? a) Quality b) Focused goal c) History d) Preferred assessment tool

Quality Explanation: Some prefer to use mnemonics to remember the elements of pain assessment. One of these is PQRST: O: Onset; P: Provocative or palliative; Q: Quality; R: Region and radiation; S: Severity; T: Timing.

The patient comes to the emergency department reporting indigestion and left arm pain. The physician orders an EKG along with drawing of cardiac enzymes. When the results are back, the patient is informed of the diagnosis of heart attack. The indigestion and arm pain are examples of which of the following? a) Cutaneous pain b) Visceral pain c) Referred pain d) Somatic pain

Referred pain Explanation: Referred pain originates from a specific site, but the person feels the pain at another site site along the innervated spinal nerve. An example is cardiac pain that the person experiences as arm pain and indigeston. Visceral pain originates from abdominal organs. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. Somatic pain originates from skin, muscles, bones, and joints.

The nurse enters an older client's room to assess for pain and discovers the client is hard of hearing. What is the nurse's best action? a) Utilize the FLACC scale. b) Suggest client purchase a hearing aid. c) Speak to the client face to face. d) Ask client to numerically rate pain in a high-pitched voice.

Speak to the client face to face. Explanation: When assessing the older patient for pain, determine whether the patient has any auditory impairment. If so, position your face in the patient's view, speak in a slow, normal tone of voice, reduce extraneous noises, and provide written instructions. The FLACC scale is used primarily for infants. Hearing aids are expensive and suggesting to purchased one does not aid in the pain assessment at present

A patient reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator may be responsible for this increased level of comfort? a) The release of dopamine b) The release of melatonin c) The release of endorphins d) The release of insulin

The release of endorphins Explanation: Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that certain measures such as skin stimulation and relaxation techniques release endorphins

A popular pain assessment scale for children is: a) Memorial Pain Assessment Card. b) FLACC Pain Assessment Scale. c) Visual Analog Scale. d) Descriptive Pain Intensity Scale.

Visual Analog Scale. Explanation: The visual analog scale is appropriate to assess pain in children. Reference: Weber, J. R., & Kelley, J. H. (2014). Health Assessment in Nursing, 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 9: Assessing Pain: The 5th Vital Sign, p. 150.

When assessing the client for pain, the nurse should a) doubt the client when he or she describes the pain. b) assess for underlying causes of pain, then believe the client. c) assess for the presence of physiologic indicators (such as diaphoresis, tachycardia, etc.), then believe the client. d) believe the client when he or she claims to be in pain.

believe the client when he or she claims to be in pain. Explanation: "Pain is whatever the person says it is." It is important to remember this definition when assessing and treating pain.

Which would the nurse recognize as an example of visceral pain? Select all that apply. a) Gallbladder pain b) Burn pain c) Muscular pain d) Pancreatic pain e) Liver pain

• Liver pain • Pancreatic pain • Gallbladder pain Explanation: Examples of visceral pain include pain associated with the liver, gallbladder, and pancreas. Pain associated with a burn is an example of cutaneous pain. Muscular pain is a type of somatic pain.

A client presents to the ED with pain in the upper right quadrant that worsens after eating. The client describes the pain as sharp, stabbing, and at times very intense. This is a description of which type of pain? a) Chronic b) Acute c) Phantom d) Cutaneous

Acute Explanation: Acute pain results from tissue damage, whether through injury or surgery. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. Phantom pain is pain in an extremity or body part that is no longer there. Cutaneous pain and phantom pain are not described as above. Chronic pain, also known as persistent pain, is a description of a pain that is present for more than six months, and can be described in many different terms, not just as above.

A client presents to the emergency department after falling off a ladder and reports pain in the right shoulder. He says that he has not taken anything for the pain yet. The nurse recognizes this as what type of pain? a) Chronic b) Visceral c) Acute d) Intractable

Acute Explanation: Acute pain is pain associated with an injury with a recent onset and duration of less than 6 months. Intractable pain is pain that is highly resistant to pain relief. Because no pain relief has yet been attempted with this client, there is not enough evidence to know whether the pain is intractable. Chronic pain is pain that persists longer than 6 months. Visceral pain is pain experienced in a deep organ, typically in the abdominal cavity, thorax, or cranium.

A pathophysiology instructor is discussing pain and its treatment across cultures. The instructor points out that patients from racial and ethnic minorities often receive less pain medication compared to Caucasians for what specific conditions? a) Broken limbs b) Chronic pain from fibromyalgia c) Head injuries d) Acute pain in the ED

Acute pain in the ED Explanation: African Americans, Hispanic Americans, and other patients of racial and ethnic minority heritage receive less pain medication compared to Caucasians across a range of conditions, including cancer pain, acute postoperative pain, chest pain, acute pain presenting in the ED, and chronic low back pain. This disparity may be the result of patient variables such as nociceptive differences, communication processes, or pain behaviors.

A client presents to the Emergency Department after falling off a ladder and reports pain in the right shoulder. The nurse recognizes this as what type of pain? a) Transient b) Iatrogenic c) Chronic d) Acute

Acute pain is pain associated with an injury with a recent onset and duration of less than 6 months. Iatrogenic pain is a result of an intervention. Chronic pain is pain that persists longer than 6 months. Transient pain is intermittent in nature. (less)

The nurse is attempting to assess pain in a nonverbal, very lethargic client. The client just arrived back to his room after an MRI scan and appears restless. There are no visitors in the room with the client. What is the nurse's best action? a) Assess pain using the FACES scale. b) Use the FLACC scale to assess pain. c) Administer a trial dose of analgesia. d) Complete the Brief Pain Inventory.

Administer a trial dose of analgesia. Explanation: Patients Unable to Report Pain The JCAHO instituted pain management guidelines in 2001 that mandated the assessment of pain for all patients (Joint Commission on Accreditation of Healthcare Organizations, 2001). Self-report is the most reliable indicator of pain, but many patients cannot communicate verbally. The development of behavioral tools for assessing pain in nonverbal patients is the newest area of pain assessment and a developing science. When attempting to perform a pain assessment on a patient who cannot self-report pain, do the following: • Attempt a self-report of pain. • Try to identify any potential causes for pain. • Observe patient behaviors. • Ask the family or other caregivers if they have noticed any changes in behavior. • Attempt an analgesic trial (Herr, Bjoro, and Decker, 2006b). The FACES scale is used in children 2 months to 7 years old. The FLACC scale was originally designed to measure acute postoperative pain in children 2 months to 7 years old. A limitation of the Brief Pain Inventory (BPI) is that the patient must be able to correlate the questions to his or her individual pain experience using the various scales

A middle aged female client presents to the emergency department complaining of indigestion and left arm pain. What is the nurse's best action? a) Check the client's vital signs and connect her to a cardiac monitor. b) Administer an antacid and apply a topical anesthetic for the arm pain. c) Request a strong narcotic analgesic for the client's visceral pain complaints. d) Alert the healthcare provider to the client's somatic pain complaints.

Check the client's vital signs and connect her to a cardiac monitor. Explanation: Pain nociception has various locations. Visceral pain originates from abdominal organs; patients often describe this pain as crampy or gnawing. Somatic pain originates from skin, muscles, bones, and joints; patients usually describe somatic pain as sharp (D'Arcy, 2014). Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. It is often burning or sharp, such as with a partial-thickness burn. Referred pain originates from a specifi c site, but the person experiencing it feels the pain at another site along the innervating spinal nerve (Fig. 6.3). An example is cardiac pain that a person experiences as indigestion, neck pain, or arm pain. Phantom pain is pain in an extremity or body part that is no longer there (e.g., a patient who experiences pain in a leg with an amputation). The client is presenting with atypical chest pain and should be assessed for pain of a cardiac origin

A male client with a history of a back injury 2 months ago has been taking daily doses of narcotic pain medication. He is currently hospitalized with a leg fracture after falling down the stairs. He complains of 10/10 pain in his back and leg after taking pain medication one hour ago. What is the nurse's best action? a) Request a psychiatric evaluation for drug seeking behavior. b) Consult with the healthcare provider about increasing the dose of medication. c) Inform the client that the next dose of medication is due in one more hour. d) Tell the client to take his own prescription medication.

Consult with the healthcare provider about increasing the dose of medication. Explanation: Clients with a history of opioid tolerance pose diffi cult challenges for pain assessment (D'Arcy, 2014). They have an altered physiologic response to the pain stimulus, and the repeated use of opioids causes their bodies to become more sensitive to pain. This sensitivity is called opioid hyperalgesia and can occur as soon as 1 month after opioid use begins. Not only are clients with opioid tolerance more sensitive to pain, they face a high level of bias from health care providers. Because these clients are more sensitive to pain, they often report high levels of pain with little relief from usual doses of opioids. They are often labeled as drug seeking.

A male client with a history of a back injury 2 months ago has been taking daily doses of narcotic pain medication. He is currently hospitalized with a leg fracture after falling down the stairs. He complains of 10/10 pain in his back and leg after taking pain medication one hour ago. What is the nurse's best action? a) Inform the client that the next dose of medication is due in one more hour. b) Request a psychiatric evaluation for drug seeking behavior. c) Consult with the healthcare provider about increasing the dose of medication. d) Tell the client to take his own prescription medication.

Consult with the healthcare provider about increasing the dose of medication. Explanation: Clients with a history of opioid tolerance pose diffi cult challenges for pain assessment (D'Arcy, 2014). They have an altered physiologic response to the pain stimulus, and the repeated use of opioids causes their bodies to become more sensitive to pain. This sensitivity is called opioid hyperalgesia and can occur as soon as 1 month after opioid use begins. Not only are clients with opioid tolerance more sensitive to pain, they face a high level of bias from health care providers. Because these clients are more sensitive to pain, they often report high levels of pain with little relief from usual doses of opioids. They are often labeled as drug seeking.

A client on a medical-surgical unit reports pain of 10 on a scale of 0 to 10 and wants more pain medication. The nurse does not think the pain is as bad as the client says. The physician left orders for prn morphine for breakthrough pain. What is the priority nursing action? a) Give the prn morphine b) Hold the medication and wait 30 minutes c) Call the physician to check the order d) Document the client's pain rating on a scale of 0 to 10

Give the prn morphine Explanation: Pain is what the client says it is, and it exists whenever the client says it does. It would not be appropriate to hold the medication for 30 minutes, call the physician to check the order, or just document the client's pain.

A nurse is assessing the vital signs of a patient who is moaning with pain. What would be the expected findings? a) Decreased pulse and respirations b) Increased temperature c) Increased pulse and blood pressure d) No change from usual result

Increased pulse and blood pressure Explanation: A patient who is in pain will most often also have an increased pulse and blood pressure. Reference: Weber, J., & Kelley, J. H. (2014). Health Assessment in Nursing, 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 9: Assessing Pain: The 5th Vital Sign, p. 145.

A patient who was in an automobile accident a week ago is at home recovering from her injuries. She contacts her primary care provider's office to report that she still has severe pain in her back, resulting from an injury to that region, that has not been lessened by two different pain relievers that the physician had prescribed for her. The nurse recognizes this as which type of pain? a) Referred b) Chronic c) Intractable d) Visceral

Intractable Explanation: Intractable pain is pain that is highly resistant to pain relief, which appears to be the case in this situation. Referred pain is perceived in body areas away from the pain source; because the pain this client is experiencing is due to an injury to the back, this does not seem to be referred pain. Chronic pain is pain that persists longer than 6 months. Visceral pain is pain experienced in a deep organ, typically in the abdominal cavity, thorax, or cranium.

Which of the following principles should the nurse integrate into the pain assessment and pain management of pediatric patients? a) Pain assessment may require multiple methods in order to ensure accurate pain data. b) The developing neurological system children transmits less pain than in older patients. c) A numeric scale should be used to assess pain if the child is older than 5 years of age. d) Pharmacologic pain relief should be used only as an intervention of last resort.

Pain assessment may require multiple methods in order to ensure accurate pain data. Explanation: It is often necessary to use more than one technique for pain assessment in children. Though their neurological system is indeed developing, children feel pain acutely, and it is inappropriate to withhold analgesics until they are a "last resort." It is simplistic to specify a numeric pain scale for all patients above a certain age; the assessment tool should reflect the patient's specific circumstances, abilities, and development

Which of the following principles should the nurse integrate into the pain assessment and pain management of pediatric patients? a) The developing neurological system children transmits less pain than in older patients. b) Pharmacologic pain relief should be used only as an intervention of last resort. c) A numeric scale should be used to assess pain if the child is older than 5 years of age. d) Pain assessment may require multiple methods in order to ensure accurate pain data.

Pain assessment may require multiple methods in order to ensure accurate pain data. Explanation: It is often necessary to use more than one technique for pain assessment in children. Though their neurological system is indeed developing, children feel pain acutely, and it is inappropriate to withhold analgesics until they are a "last resort." It is simplistic to specify a numeric pain scale for all patients above a certain age; the assessment tool should reflect the patient's specific circumstances, abilities, and development

A nurse is caring for an elderly client who is unable to walk without a support due to knee pain. During his initial assessment, however, the client does not mention pain. Which of the following beliefs common in elderly clients may cause them to underreport their pain? a) Pain will draw their families closer to them b) Pain is a normal part of aging c) Pain can be eliminated with medication d) Pain is harmless

Pain is a normal part of aging Explanation: When assessing elderly clients, the nurse should remember that they often underreport pain. Many elderly people believe that pain is a normal part of aging, may be a punishment for past actions, may result in a loss of independence, and may indicate that death is near. Elderly clients usually do not believe that pain is harmless, that medicine will eliminate pain, or that pain will draw the family closer to the elderly client.

A patient recovering from abdominal surgery is complaining of pain. The nurse realizes that the patient is most likely experiencing which type of pain? a) Neuropathic b) Somatic c) Psychogenic d) Idiopathic

Somatic Explanation: Somatic pain is caused by tissue damage, which would occur after abdominal surgery. Psychogenic pain relates to factors that influence the patient's report of pain such as anxiety and depression. Idiopathic pain does not have an identified cause. Neuropathic pain results from direct injury to the peripheral or central nervous system.

The nursing instructor is teaching a class about how to assess pain in older adults. The teachers tells the students that problems can arise in certain circumstances. The instructor realizes the need for more teaching about pain in the elderly when one of the students replies: a) "Pain is a natural part of aging." b) "Patients are reluctant to report pain because they want to be condsidered as 'good' patients." c) "Older patients may worry that reporting pain will lead to costly tests." d) "Patients may fear that uncontrolled pain will affect their independence." Submit your answer

"Pain is a natural part of aging." Explanation: Pain is prevalent in older adults; however, some of them mistakenly believe pain to be a normal part of aging. Older patients may be afraid to report pain for many different reasons. They may not want pain to interfere with their independence. They may worry that medical attention to their pain will lead to costly tests. They also may fear that healthcare providers will not see them as "good" patients if they mention pain, and so they try to mask it.

A client was administered PO pain medications at 1530. By what time should the nurse re-assess and document the effects of the pain medication? a) 1630. b) By end of shift. c) 2130. d) 1930.

1630. Explanation: The JCAHO has set a standard that states that nurses must assess and reassess pain regularly. Most hospitals have a standard timeframe for reassessment, such as 1 hour for oral medication and 30 minutes for pain medication given intravenously. They base these timeframes on the time it takes a pain medication to provide a noticeable decrease in pain intensity

As a nurse is adjusting a client's hospital bed, the nurse accidently pinches a finger between the bed and the wall. Which of the following components is involved in the transduction of the pain the nurse feels? a) K-fibers b) L-beta fibers c) A-delta fibers d) C-fibers

A-delta fibers Explanation: Nociceptors are located at the peripheral ends of both myelinated nerve endings of type A fibers and unmyelinated type C fibers, and there are three types that are stimulated by different stimuli: mechanosensitive nociceptors (of A-delta fibers), sensitive to intense mechanical stimulation (e.g., pliers pinching skin); temperature-sensitive (thermosensitive) nociceptors (of A-delta fibers), sensitive to intense heat and cold; and polymodal nociceptors (of C fibers), sensitive to noxious stimuli of a mechanical, thermal, or chemical nature. There are no "K-fibers" or "L-beta fibers."

A client presents to the health care clinic with reports of a 2-day history of sore throat, ear pressure, fever, and stiff neck. The client states she has taken Tylenol and lozenges without relief. Which nursing diagnosis can be confirmed by this data? a) Anxiety related to prolonged pain b) Acute pain related to sore throat c) Risk for deficient fluid volume related to fever d) Impaired physical mobility related stiff neck

Acute pain related to sore throat Explanation: The client describes pain of 2 days' duration, which is within the definition for acute pain. The client did not describe or display any major defining characteristics of anxiety such as restlessness, concern about lifestyle changes, or sleep disturbances. The stiff neck was not confirmed by objective data collected by the nurse. No evidence exists for the client to have risk for deficient fluid volume.

A patient reports pain and rates it as a 9 on a scale of 0 to 10. The nurse administers medication as ordered and returns 20 minutes later to assess the severity of the patient's pain. To assess the severity, the nurse would: a) Ask the patient to rate the pain on a scale of 0 to 10. b) Ask the patient if he or she needs anything. c) Ask about the location of the pain. d) Ask the patient what makes the pain worse.

Ask the patient to rate the pain on a scale of 0 to 10. Explanation: When assessing a patient's pain, the nurse should ask about location, duration, intensity, quality, alleviating/aggrevating factors, management goal, and functional goal. To assess severity or intersity, the nurse should ask the patient to rate the pain on a scale of 0 to 10 or 1 to 10.

How may a nurse demonstrate cultural competence when responding to patients in pain? a) Be knowledgeable and skilled in medication administration. b) Avoid stereotyping responses to pain by patients. c) Treat every patient exactly the same, regardless of culture. d) Know the action and side effects of all pain medications.

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

The nurse should assess for which pain complaints from a client diagnosed with Type II Diabetes Mellitus? a) Sharp, stabbing b) Aching, gnawing c) Pain only on movement d) Burning, tingling

Burning, tingling Explanation: The nurse should assess for neuropathic pain associated with diabetic neuropath. Neuropathic pain: Pain that results from damage to nerves in the peripheral or central nervous system (Staats, et al., 2004). Examples of neuropathic pain include diabetic peripheral neuropathy, post herpetic neuralgia, and postmastectomy pain. You should also be alert for the common terms that patients use to report neuropathic pain, such as burning, painful tingling, pins and needles, and painful numbness

The nurse is caring for a 4-week-old postoperative patient. The most appropriate pain assessment tool would be the: a) Numeric Pain Intensity Scale b) FACES Pain Scale c) Combined Thermometer Scale d) Face, Legs, Activity, Cry, Consolability Scale

Face, Legs, Activity, Cry, Consolability Scale Explanation: The Face, Legs, Activity, Cry, Consolability Scale is the appropriate pain assessment tool for a 4-week-old postoperative patient. This tool measures pain using observable behaviors as pain indicators. The FACES Pain Scale is appropriate for children age 3 and older, using six faces ranging from happy with a wide smile to sad with tears on the face. The other two scales are appropriate for use with older children and adults. The Numeric Pain Intensity Scale is a one-dimensional pain scale using an 11-poing Likert-type scale ranging from 0 to 10, where 0 means "no pain" and 10 means "worst possible pain." The Combined Thermometer Scale looks like a thermometer and has both numbers that increase from the bottom up and descriptor words to measure pain intensity.

The nursing student asks the nurse what would be an example of visceral pain. What would be the correct response by the nurse? a) Cardiac pain b) Gallbladder pain c) Burn pain d) Arthritic pain

Gallbladder pain Explanation: Visceral pain originates from abdominal organs, such as the gallbladder. Burns cause cutaneous pain, which is derived from the dermis, epidermis, and subcutaneous tissues. Referred pain originates from a specific site, but is experienced in another site along the innervating spinal nerve, such as occurs with cardiac pain. Somatic pain originates from skin, muscles, bones, and joints, such as arthritic pain.

When reviewing a client's medication administration record, the nurse should plan to administer a medication containing which substance that blocks pain sensations? a) Bradykinin b) Glutamate c) Gamma-aminobutyric acid d) Substance P

Gamma-aminobutyric acid Correct Explanation: BOX 6.1 Substances with a Role in Pain Pain-facilitating substances • Substance P • Bradykinin • Glutamate Pain-blocking substances • Serotonin • Opioids (both natural and synthetic) • Gamma-aminobutyric acid: gabapentin (Neurontin) and pregabalin

A client complains of pain in several areas of the body. How should the nurse assess this client's pain? a) Mark each site on the client's body with a marker. b) If pain does not radiate, there is no need to rate that area. c) Ask the client to rate the area with the highest pain level. d) Have the client rate each location separately.

Have the client rate each location separately. Explanation: When assessing pain location, ask the patient to point to the painful area. If more than one area is painful, have the patient rate each one separately, and note which area is the most painful. Marking each site is not necessary practice for assessing pain. Pain is a subjective sensation for the client. Radiating pain is notable, because such radation may affect treatment choices

A nurse is assessing the effect of a client's chronic back pain on his affective dimension. Which question should the nurse ask for this assessment? a) How does the pain influence your overall mood? b) What is the highest level of education you've completed? c) What medical conditions do you have? d) Where is the pain located?

How does the pain influence your overall mood? Explanation: The question regarding the influence of the pain on mood would address the client's affective dimension, which includes feelings and emotions that result from the pain. The question regarding medical conditions would help assess the client's physical dimension. The question regarding the location of the pain would address the client's sensory dimension. The question regarding the client's education would address his cognitive dimension.

A client enters the emergency department moaning and complaining of severe pain in his lower back. Which of the following clinical manifestations should the nurse expect to see in this client as a physiologic response to pain? Select all that apply. a) Hypoglycemia b) Perspiration c) Increased heart rate d) Sleeplessness e) Increased intestinal motility

Increased heart rate • Sleeplessness • Perspiration Explanation: Sleeplessness, perspiration, and increased heart rate are physiologic responses to pain. Pain elicits a stress response in the human body that triggers the sympathetic nervous system. Hyperglycemia, not hypoglycemia, and decreased, not increased, intestinal motility are physiologic responses to pain

A student nurse learns that especially in the very young and very old pain can be inadequately treated. What else would the student learn about inadequate pain treatment in the very young? a) It can lead to higher patient compliance with medication b) It can lead to neurodevelopmental problems c) It can lead to an increase in hormonal disorders d) It can lead to nutritional deficiencies from lack of appetite

It can lead to neurodevelopmental problems Explanation: Inadequate pain treatment can lead to a delay in healing and behavioral consequences, such as learning disabilities, psychiatric disorders, and neurodevelopmental problems. It does not increase hormonal disorders, nutritional deficiencies, or patient compliance with medication.

The U.S. government has created guidelines for health care providers caring for clients in pain. Which of the following reflect these guidelines? a) National Institutes of Health Standards for Pain Treatment. b) American Pain Society Guidelines for Pain Management. c) American Cancer Society Guidelines for Pain Management. d) Joint Commission Standards for Pain Management.

Joint Commission Standards for Pain Management. Explanation: Joint Commission Standards for Pain Management were revised and published in 2000-2001. The standards require health care providers and organizations to improve pain assessment and management for all patients

A nurse is using the FLACC (Face, Legs, Activity, Cry, Consolability) scale for pediatric pain assessment to assess for pain in a 6-month-old client. Which of the following findings on this assessment tool would indicate the strongest pain in the client? a) Lying quietly b) Kicking c) Whimpering d) Occasional grimace or frown

Kicking Explanation: According to the FLACC scale for pediatric pain assessment, kicking or the legs being drawn up is a strong sign indicating pain, as it would receive a 2. An occasional grimace or frown and whimpering are weaker signs of pain, as they would each warrant only a 1. Lying quietly is a normal activity and indicates the absence of pain; thus, it would receive a 0.

Which of the following best describes neuropathic pain? a) Described as sharp, or dull and aching b) Labelled as musculoskeletal pain c) May be labelled as central pain d) Associated with organs in the thorax, abdomen, and pelvis

May be labelled as central pain Explanation: Neuropathic pain is described as burning, tingling, numbness, stabbing, shooting, or electric, and if the problem is in the central nervous system, the pain may be labelled as central pain. Visceral pain is associated with the organs, and somatic nociceptive pain is labeled as musculoskeletal. Nociceptive pain is more often described as sharp, or dull or aching.

A construction worker in his mid-40s suffered a severe laceration on his leg while on the job site. Soon after he arrives at the emergency room, a nurse assesses his pain. The client states that pain, although severe, has lessened since the accident first occurred. The nurse knows that the pain message likely has been inhibited by release of endorphins and other neurotransmitters. Which physiological process does this represent? a) Transmission b) Modulation c) Perception d) Transduction

Modulation Explanation: Modulation is the physiological process whereby brain stem neurons release endogenous neurotransmitters (e.g., endorphins, enkephalins, and serotonin), which inhibit the transmission of pain. Transduction is the process whereby injured tissue releases chemicals that affect nociceptors, sending the pain message up the sensory neuron. Transmission is the process whereby the pain impulse from the nociceptors relays the pain from the spinal cord to the brain. Perception is the process whereby pain is perceived in the brain.

Mr. Garcia comes to the office for a rash on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. On examination, the nurse notes a rash with small blisters (vesicles) on a background of reddened skin. The rash overlies an entire rib on his right side. What type of pain is this? a) Idiopathic b) Neuropathic c) Psychogenic d) Nociceptive or somatic

Neuropathic Explanation: This vignette is consistent with a diagnosis of herpes zoster or shingles. This is caused by re-emergence of dormant varicella (chicken pox) viruses from Mr. Garcia's nerve root. The characteristic burning quality without a history of an actual burn makes one think of neuropathic pain. It will most likely remain for months after the rash has resolved. There is no evidence of physical injury, and this distribution is peculiar, making nociceptive pain less likely. There is no evidence of a psychogenic etiology, and the presence of a rash makes this possibility less likely as well. The pain is not idiopathic

A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing? a) Chronic pain b) Neuropathic pain c) Visceral pain d) Cutaneous pain

Neuropathic pain Explanation: The client is experiencing neuropathic pain or functional pain. Neuropathic pain is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. The client is not experiencing cutaneous, visceral, or chronic pain. In cutaneous pain, the discomfort originates at the skin level. In visceral pain, the discomfort arises from internal organs caused from a disease or injury. In chronic pain the discomfort lasts longer than 6 months

Question: Identify the steps in nociception. (Number 1 is the first step and number 4 is the last step.) The neuronal signal moves from the periphery to the spinal cord and up to the brain. Noxious stimuli cause a nerve impulse perceived by free nerve endings. The impulses being transmitted to the higher areas of the brain are identified as pain. Inhibitory and facilitating input from the brain influences the sensory transmission at the level of the spinal cord.

Noxious stimuli cause a nerve impulse perceived by free nerve endings. The neuronal signal moves from the periphery to the spinal cord and up to the brain. The impulses being transmitted to the higher areas of the brain are identified as pain. Inhibitory and facilitating input from the brain influences the sensory transmission at the level of the spinal cord. Explanation: Noxious stimuli cause a nerve impulse perceived by free nerve endings.The neuronal signal moves from the periphery to the spinal cord and up to the brain. The impulses being transmitted to the higher areas of the brain are identified as pain. Inhibitory and facilitating input from the brain influences the sensory transmission at the level of the spinal cord

A nurse is working with an elderly Jewish man who is experiencing excruciating pain from a severe burn that he suffered earlier in the day. Given his cultural background, which expression of pain should the nurse most expect to find in this client? a) Pain must be endured as part of preparing for the next life in the cycle of reincarnation b) Pain is a challenge to be fought; it is inevitable and is to be endured c) Pain is natural and honorable and should be dealt with by using mind over body d) Pain is expressed openly, with much complaining

Pain is expressed openly, with much complaining Explanation: Those of a Jewish background tend to believe that pain should be expressed openly, with much complaining. Asians and Asian Americans tend to think of pain as being natural and honorable and that it should be dealt with by using mind over body and positive thinking. African Americans tend to think of pain as a challenge to be fought, as inevitable, and to be endured. Hindus tend to believe that pain must be endured as part of preparing for the next life in the cycle of reincarnation

Which of the following cultural expressions of pain would be likely to be found in a person of Hispanic culture? a) Pain is honorable and should be endured. b) Pain is part of the preparation for the next life in the cycle of reincarnation. c) Pain must be endured to perform gender role duties, but response to it is very expressive. d) Pain may be caused by past transgressions and helps to atone and achieve higher spirituality.

Pain must be endured to perform gender role duties, but response to it is very expressive. Explanation: In the Hispanic culture pain response is often very expressive, though pain must be endured to perform gender role duties.

The charge nurse on a geriatric unit should further educate a new staff nurse who makes which statement? a) There is little information about the effects of increased age on pain. b) Pain sensation is diminished in older adults. c) Older adults tend to be undertreated for pain. d) Transmission of pain along A-delta and C fibers may be altered in older adults.

Pain sensation is diminished in older adults. Explanation: Little is known about the effect of increased age on pain perception. No evidence suggests that pain sensation is diminished in older adults, which is a common misperception. Transmission along the A-delta and C fibers may become altered with aging, but it is not clear how this change affects the pain experience. Studies of sensitivity and pain tolerance have indicated that changes in pain perception are probably not clinically significant (American Geriatric Society, 2002; Reyes-Gibby, Aday, Todd, et al., 2007). Because older people are likely to experience more adverse effects from analgesia, especially from opiates, health care providers may undertreat pain in older adults.

The nurse is assessing hospitalized post-operative pain and has asked the client to rate his pain, describe it, state the location and onset of when it started. What other question should the nurse include in this pain assessment? a) Medications taken in the past b) Provoking and alleviating factors c) Availability of medication d) Financial resources to obtain medication

Provoking and alleviating factors The nurse is conducting a focused pain assessment of a hospitalized client. Some burses prefer to use mnemonics to remember the elements of pain assessment. One of these is OPQRST : O: Onset P: Provocative or palliative Q: Quality R: Region and radiation S: Severity T: Timing The availiability of medication, past medications, and client's financial resources are not the most pertinent questions to include at this time.

The nursing instructor is discussing the different types of pain with the nursing class. What type of pain would the instructor explain originates from a specific site, yet the client feels the pain at another site? a) Chronic pain b) Somatic pain c) Cutaneous pain d) Referred pain

Referred pain Explanation: Referred pain originates from a specific site, but the person experiencing it feels the pain at another site along the innervating spinal nerve. Chronic pain is pain referred to as persistent. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues and is felt at its origination. Somatic pain originates from skin, muscles, bones, and joints and is felt at its origination

Which assessment finding is consistent with the presence of pain? a) Euphoria b) Decreased pulse c) Decreased blood pressure d) Restlessness

Restlessness Explanation: Common assessment findings that are present when a patient is in pain include restlessness, grimacing, crying, clenching fists, guarding of the painful area, increased blood pressure and pulse, and reported pain

The nurse is assessing the pain of an older adult client who is recovering from a right hip open reduction procedure. What element would the nurse know it is important to review to best understand the patient's pain? a) Genetic history b) Family history c) Sleep patterns d) Elimination pattern

Sleep patterns Explanation: When assessing pain in older adults, the nurse should be sure to also review the effects of pain on diet, sleep, and mood. Unrelieved pain may lead to insomnia or depression and seriously affect the client's quality of life. It would not be necessary to assess the family history, genetic history, or elimination pattern to gain insight into the client's pain level.

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) Cutaneous pain b) Phantom pain c) Visceral pain d) Somatic pain

Somatic pain Explanation: 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 patient.

An elderly farmer has sustained severe injuries after a serious accident involving a combine harvester. At the hospital, he tells the nurse that he thinks the pain he is feeling now is "payback" for living a "mean, selfish life." The nurse recognizes that this response by the man indicates which dimension of pain? a) Affective dimension b) Cognitive dimension c) Spiritual dimension d) Sociocultural dimension

Spiritual dimension Explanation: The spiritual dimension refers to the meaning and purpose that the person "attributes to the pain, self, others, and the divine." In this case, it seems that the man is interpreting his accident and subsequent pain as divine retribution for his past wrongdoings. The cognitive dimension concerns "beliefs, attitudes, intentions, and motivations related to the pain and its management." The sociocultural dimension concerns the influences of the patient's social context and cultural background on the patient's pain experience. The affective dimension concerns feelings, sentiments, and emotions related to the pain experience.

A nurse is caring for a 4-year-old patient who is crying and appears to be in pain. The nurse begins to assess the pain by showing pictures on a chart and asking the patient to point to the one that best represents the pain he is experiencing. This is an example of which of the following: a) FLACC scale b) VISUAL analog scale c) FACES scale d) Numeric scale

The FACES scale is used for children who are 3 years or older. This tool allows the patient to point to the picture of the face that best represents the pain he or she is feeling. The FLACC scale uses face, legs, activity, cry, and consolability to assess the pain. The visual analog scale uses a 100-mm line with "no pain" at one end and "worst pain" at the other. The numeric scale is the most commonly used scale--an example is an 11-point Likert scale with 0 meaning no pain and 10 meaning the worst pain ever.

The nurse is explaining the difference between acute pain and chronic pain to the patient. Which should the nurse include in the explanation? a) Acute pain lasts longer than 3 to 6 months. b) The duration of chronic pain is short. c) Chronic pain is caused by damage to nerves. d) The cause of acute pain can be identified.

The cause of acute pain can be identified. Explanation: Acute pain is of short duration and has an identifiable cause. Chronic pain lasts beyond the normal healing period of 3 to 6 months. Neuropathic pain results from damage to nerves in the peripheral or central nervous system.

Recently, lung cancer has metastasized to the bones of a 68-year-old client, precipitating a sudden increase in his pain. The client's wife and daughter are concerned about the consequent increase in the amount of hydromorphone the client requires, citing the risk of addiction. How can the nurse best respond to the family's concern? a) "It's actually a myth that clients can become addicted to hospital narcotics." b) "If he ends up needing higher doses to resolve the pain, we will discontinue the drug." c) "Even when he becomes addicted, we can take comfort knowing that his pain is controlled." d) "There's a very minimal risk of addiction, and controlling his pain is our first concern."

There's a very minimal risk of addiction, and controlling his pain is our first concern." Explanation: Concerns about addiction are normally unfounded. Nonetheless, it is inaccurate to characterize the possibility of addiction as a myth, on one hand, or a very real risk, on the other. Tolerance would not necessitate discontinuation.

Pain is frequently a motivator for people to seek health care and is considered the fifth vital sign. a) True b) False

True

Which interventions should a nurse use to collect the subjective data from a client? Select all that apply. a) Listen carefully to the client's description of problem b) Use the numeric rating scale to determine the client's pain c) Provide help if the client is unable to express him- or herself d) Maintain a quiet environment when interviewing e) Maintain the client's privacy and ensure confidentiality

• Listen carefully to the client's description of problem • Maintain a quiet environment when interviewing • Maintain the client's privacy and ensure confidentiality Explanation: The nurse should listen carefully to the client's description of the problem. The nurse should maintain a quiet environment when interviewing to collect subjective data from the client. The nurse should also maintain the client's privacy and ensure confidentiality when collecting subjective data. The nurse should never help the client verbally by adding words or putting words in the client's mouth if the client is unable to explain the problem. When collecting objective data, the nurse may use the numeric rating scale to determine the client's pain.

Which of the following are elements of a pain assessment? (Select all that apply.) a) Aggravating/alleviating factors b) Duration c) Intensity d) Location e) Quality

• Location • Duration • Intensity • Aggravating/alleviating factors • Quality Explanation: In addition to pain intensity, other basic elements of a pain assessment are location, duration, intensity, quality, and aggravating/alleviating factors.

A nurse attempts to assess a client's pain but finds the client is having difficulty describing the pain. Which interventions by the nurse may help with the collection of subjective data about the client's pain? Select all that apply. a) Give a laundry list of terms to help the client choose b) Maintain a quiet and calm environment c) Ask the client yes/no questions d) Assure the client's privacy e) Document the terms used by the client

• Maintain a quiet and calm environment • Assure the client's privacy • Document the terms used by the client Explanation: To help the client describe the pain, the nurse should maintain a quiet and clam environment, maintain the client's privacy, ask questions in an open format, listen carefully to the client's verbal descriptions, watch for facial grimaces, and do not put words in to the client's mouth.

A nurse is assessing a young woman for injuries who appears to be a victim of domestic violence. The nurse observes from the client's health record that her baseline vital signs are within normal limits. Which of the following objective findings would most tend to indicate pain? Select all that apply. a) Blood pressure of 140/90 mm Hg b) Respiratory rate of 20 breaths per minute c) Edema at the elbow joint d) Slumped shoulders e) Heart rate of 90 beats per minute

• Slumped shoulders • Blood pressure of 140/90 mm Hg • Edema at the elbow joint Explanation: Slumped shoulders, an elevated blood pressure (<120/80 mm Hg is normal), and edema at the elbow point are all indicators of pain. A heart rate of 90 beats per minute (60 to 100 is normal) and a respiratory rate of 20 breaths per minute (12-20 is normal) are not indicators of pain.

A nurse is meeting for the first time a 42-year-old client whose visit to the clinic has been prompted by her chief complaint of ongoing lower back pain. Which of the following approaches to pain assessment should the nurse use when assessing the client's pain? a) The nurse should use a pain assessment tool that is simple but still addresses the major parameters of pain. b) The nurse should allow the client to guide the direction and character of assessment to identify her priorities. c) The nurse should prioritize objective data to quantify and validate the client's pain. d) The nurse should implement a pain assessment tool that is as detailed as possible.

The nurse should use a pain assessment tool that is simple but still addresses the major parameters of pain. Explanation: Pain assessment requires an instrument that is easy to use, clinically valid, and easy to evaluate. An instrument that is too detailed is a liability; while the nurse should be responsive to the client's priorities and identified needs, it would inappropriate to wholly delegate the character and direction of assessment to the client. Pain assessment is highly dependent on subjective data, and these findings would not be minimized or discounted. (less)

The nurse understands the importance of performing an accurate pain assessment. In addition to having the patient rate the pain on a pain scale, other things to assess are the following: (Check all that apply.) a) Diet and allergies b) Urine output and pulse oximetry value c) Quality and description d) Location and duration e) Alleviating and aggravating factor

• Alleviating and aggravating factors • Location and duration • Quality and description Correct Explanation: In a pain assessment. the nurse asks the patient to use a pain scale to rate the intensity of the pain. Other areas to assess are location and duration, quality and description, and any alleviating or aggravating factors. Although the nurse would want to assess the patient's allergies before giving pain medications, diet is not included, nor is urinary output or oxygenation.

The nurse is assessing a female client diagnosed with fibromyalgia. The nurse should assess for which physiological indicators of pain? (Select all that apply.) a) Heart rate 115 beats/minute. b) Increased appetite. c) Blood pressure 180/75. d) Elevated estrogen level. e) Respiratory rate 18 breaths/minute.

• Heart rate 115 beats/minute. • Blood pressure 180/75. Explanation: All patients show an increased physiological response to pain including heart rate and blood pressure increase. Conditions such as menstrual migraine have demonstrated the estrogenic effect of pain (Brandes, 2006). Although considerable attention has been devoted to biological variables such as hormonal infl uences and genetics, psychological and social factors might also account for gender differences in reporting pain. It is unknown whether fundamental, gender-specific differences in basic pain mechanisms exist. Estrogen increase is known to cause a menstrual migraine. 18 breaths/minute is within expected range for adults. Increased appetite is not a commonly well-known physiological response to pain

A client who reports severe pain in his extremities after suffering third-degree burns has been admitted to the hospital. Which of the following responses to pain should the nurse expect to see in this client? Select all that apply. a) Cries and moans b) Decreased epinephrine c) Constricted pupils d) Decrease in cognitive function e) Thoughts of suicide

• Thoughts of suicide • Cries and moans • Decrease in cognitive function Explanation: Thoughts of suicide, cries and moans, and decrease in cognitive function are all expected responses to pain. Increased, not decreased, epinephrine and dilated, not constricted, pupils are other signs of pain