Chapter 9 - Pain (The 5th Vital Sign)
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?
FACES Pain Scale
The nurse is working in the post anesthesia care unit and assessing pain in a 6 month old infant. Which method should the nurse use to assess the infant's pain?
FLACC scale.
A patient is reporting pain and rates it as 7 on a scale of 1 to 10. When the nurse asks him to decribe the pain, he states, "It feels like a knife is stabbing or cutting me." The nurse knows that this type of pain is conducted by which fibers?
A-delta fibers
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-delta fibers
A nurse assesses a non-English-speaking client who grimaces and points to the right knee following a motor vehicle accident. Which pain scale would be most appropriate for the nurse to use to assess the client's pain?
Wong-Baker Faces
A middle-aged 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?
"Does your pain level change after taking medications?"
A nursing instructor is teaching about the gate control theory of pain. The instructor realizes that a student needs more information when the student states:
"In the limbic system the stimulus is identified as pain and a reponse is created."
A patient who has had a recent below-knee amputation tells the nurse that he feels as though his toes are cramping. What would the nurse say in return?
"That is called phantom pain, and it is not unusual."
Which of the following is not released during the stress response?
Dopamine
Of the following individuals, who can best determine the experience of pain?
The person who has the pain
A client describes pain in the soles of both feet as constantly burning. Which type of pain should the nurse suspect this client is experiencing?
neuropathic
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?"
Affective
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?
Analgesics
The nurse is caring for a patient who is experiencing visceral pain. What is this patient's most likely diagnosis?
Appendicitis
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:
Ask the patient to rate the pain on a scale of 0 to 10.
How may a nurse demonstrate cultural competence when responding to patients in pain?
Avoid stereotyping responses to pain by patients.
The nurse is caring for a 22-year-old man with a crush injury. The nurse would be alert for what pain descriptions that would indicate neuropathic pain?
Burning Painful numbness
Which JCAHO standards should a nurse follow when assessing a client who experiences pain? Select all that apply. Screen for pain; assess the nature and intensity of pain in the client Record pain assessment whenever pain increases in the body Follow established policies that support appropriate prescribing of medications Watch client's facial expressions, grimaces, and body movements Ensure that the pain does not interfere with the client's rehabilitation
Follow established policies that support appropriate prescribing of medications Screen for pain; assess the nature and intensity of pain in the client Ensure that the pain does not interfere with the client's rehabilitation
When reviewing a client's medication administration record, the nurse should plan to administer a medication containing which substance that blocks pain sensations?
Gamma-aminobutyric acid
What is the most commonly accepted theory of pain?
Gate control theory Specialized cells can decrease pain transmission by exciting inhibitory neurons.
Pain is whatever the patient says it is. Self-report is the gold standard for assessing pain; however, nurses learn when assessing pain to assess the following as well: (Check all that apply.)
Grimacing Rocking Increased heart rate Increased blood pressure
A client complains of aching all over her body. The client's health record indicates that she is otherwise healthy, with her baseline vital signs all well within normal limits. The nurse is assessing her for pain. Which of the following objective findings would most tend to indicate pain?
Heart rate of 110 beats per minute
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?
It can lead to neurodevelopmental problems
The U.S. government has created guidelines for health care providers caring for clients in pain. Which of the following reflect these guidelines?
Joint Commission Standards for Pain Management.
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?
Kicking
Which of the following best describes neuropathic pain?
May be labelled as central pain
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?
Modulation
A patient recovering from a stroke complains of pain. The nurse suspects this patient is most likely experiencing which type of pain?
Neuropathic
A client with spinal nerve compression says the pain is uncomfortable. When the nurse provides the following scale, where would the nurse expect the client to identify the pain level to be?
On the Pain Distress Intensity Scale, uncomfortable is rated as a 4 or moderate pain. No pain is a 0. Annoying is mild pain or a 2. Dreadful is severe pain or a 6. Horrible is very severe pain or an 8. And agonizing is the worst possible pain or a 10.
A client is admitted for treatment of pneumonia. When conducting a pain assessment, which area on the diagram provided should the nurse expect the client to experience referred pain because of this health problem?
Pain generating from the lung and diaphragm is referred to the left side of the neck.
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.
Perspiration Increased heart rate Sleeplessness
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?
Phantom pain
Why is it important for a nurse to gather information about a client's past experiences with pain?
Provides insight into positive or negative expectations for relief
Which assessment finding is consistent with the presence of pain?
Restlessness
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?
Sleep patterns
Which of these clinical manifestations are physiologic responses to pain? Select all that apply.
Sleeplessness Perspiration Increased heart rate
A client who suffers from arthritis complains of sharp pain in her knees and elbows. The nurse recognizes this is what type of pain?
Somatic
The nurse is explaining the difference between acute pain and chronic pain to the patient. Which should the nurse include in the explanation?
The cause of acute pain can be identified.
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.
Thoughts of suicide Cries and moans Decrease in cognitive function
A nurse is caring for a client whose injured cells are releasing chemicals such as substance P, prostaglandins, bradykinin, histamine, and glutamate. Which phase of pain is the client experiencing?
Transduction
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:
"Pain is a natural part of aging."
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?
"There's a very minimal risk of addiction, and controlling his pain is our first concern."
A client presents to the health care clinic with reports of two-day history of sore throat pain, ear pressure, fever, and stiff neck. The client states they have taken Tylenol and lozenges without relief. Which nursing diagnosis can be confirmed by this data?
Acute Pain related to sore throat
The nurse should assess for which pain complaints from a client diagnosed with Type II Diabetes Mellitus?
Burning, tingling
A nurse assesses a cognitively impaired adult client who grimaces and points to the right knee following a motor vehicle accident. Which pain scale would be most appropriate for the nurse to use to assess the client's pain?
Faces Pain Scale The nurse should use the Faces Pain Scale (FPS) to rate the pain felt by the client. The FPS shows different facial expressions; the client is asked to choose the face that best describes the intensity or level of pain being experienced. This tool is best suited for cognitively impaired adults. A Verbal Descriptor Scale (VDS) ranges pain on a scale between mild, moderate, and severe. The Numeric Rating Scale (NRS) rates pain on a scale from 0 to 10: 0 reflects no pain and 10 reflects pain at its worst. It has been shown to be best for older adults with no cognitive impairment. The Visual Analog Scale (VAS) rates pain on a 10-cm continuum numbered from 0 to 10: 0 reflects no pain and 10 reflects pain at its worst. These scales would require verbal communication between the client and the nurse.
A nurse is administering prescribed medicine to a client who experienced acute pain in the lower back after a motor vehicle accident. The client tells the nurse that compared to the previous week, his pain had reduced considerably. Which phase of pain is the client experiencing?
Modulation
When providing information to a client concerning the client's osteoarthritic, nociceptive pain, the nurse should include which statements about this type of pain? Select all that apply.
Neurotransmitters like endorphins and histamines regulate this pain. The pain is associated with the inflammatory process. This form of pain can be either chronic or acute in nature.
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?
Nodding up and down in response to questions
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?
Pain is a normal part of aging
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?
Pain is expressed openly, with much complaining
Which of the following cultural expressions of pain would be likely to be found in a person of Hispanic culture?
Pain must be endured to perform gender role duties, but response to it is very expressive.
The charge nurse on a geriatric unit should further educate a new staff nurse who makes which statement?
Pain sensation is diminished in older adults.
Pain that is felt in a part of the body that has been removed is called:
Phantom pain.
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?
The release of endorphins
The Joint Commission mandates that nurses assess and reassess a client's pain level. A nurse's healthcare facility mandates pain reassessment at 30 minutes for any drug given intravenously. This mandate is based on what?
The time it takes a pain medication to decrease pain intensity
A nursing instructor is teaching the class about different theories of pain. The instructor informs the students that the most common clinical interpretation of pain transmission is called "nociception." The instructor includes the following components in nociception: (Check all that apply.)
Transduction Modulation Perception Transmission
Below are the four physiological processes involved in pain perception. Put them in the correct order. Perception Transduction Transmission Modulation
Transduction Transmission Perception Modulation
Pain is frequently a motivator for people to seek health care and is considered the fifth vital sign. True False
True
A nurse begins to assess pain in a client admitted to the hospital for new onset of severe nausea and vomiting. What question should the nurse ask the client to assess the pattern of pain?
"How often do you experience the pain?"
A nursing instructor is teaching about the gate control theory of pain. The instructor realizes that a student needs more information when the student states:
"In the limbic system the stimulus is identified as pain and a reponse is created." *It is in the cerebral cortex, not the limbic system, that the stimulus is identified as pain and a repsonse is created. Once generated, the response passes down the efferent pathways where the reaction to the pain is created.
A client who is cringing says that the pain is the worse that it has ever been. If using the numeric pain intensity scale, which number is the client describing?
10
The nurse administers pain medication to a client at 1600. At what time should the nurse return to reassess the client's pain level?
1630
A client recovering from total knee replacement is experiencing severe pain. Where should the nurse expect the client to rate this pain on the following scale?
7-10
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 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?
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?
Administer a trial dose of analgesia. 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 post-operative client is observed breathing 24 breaths/minute while complaining of 10/10 abdominal pain. The client's oxygen saturation is 90% on 2 liters nasal cannula. What is the nurse's priority action?
Administer prescribed analgesia as ordered.
A middle aged female client presents to the emergency department complaining of indigestion and left arm pain. What is the nurse's best action?
Check the client's vital signs and connect her to a cardiac monitor.
A nurse assesses a client with acute small-bowel obstruction who reports intermittent pain. He only noticed symptoms of this condition earlier today. Which questions are appropriate for the nurse to ask when assessing the client's pain? Select all that apply.
Describe the pain. Where is the pain located? When did the pain start?
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?
Endorphins
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:
FACES scale
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?
How does the pain influence your overall mood?
Beliefs of health care providers can serve as barriers to an accurate assessment of a client's pain. Which of the following beliefs will not be likely to impair the assessment of pain?
Infants can feel pain and may respond with crying or agitation.
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?
Intractable
When patients report pain, it is important to find the source. When patients describe pain as "burning, painful numbness, or tingling," the source is more than likely:
Neuropathic
Identify the steps in nociception. (Number 1 is the first step and number 4 is the last step.) Noxious stimuli cause a nerve impulse perceived by free nerve endings. Inhibitory and facilitating input from the brain influences the sensory transmission at the level of the spinal cord. 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.
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 patient rates the current pain level as being a 5 on the Numeric Rating Scale. How should the nurse document this pain assessment?
Patient rated pain level as being a 5 using the rating scale.
In addition to pain intensity, what is another basic element of a pain assessment?
Quality
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?
Referred pain
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?
Referred pain
A patient recovering from abdominal surgery is complaining of pain. The nurse realizes that the patient is most likely experiencing which type of pain?
Somatic
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?
Speak to the client face to face.
Which of the following statements most accurately conveys an aspect of the gate-control theory?
Specialized cells can decrease pain transmission by exciting inhibitory neurons.
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?
Spiritual dimension
A nurse is caring for an athlete who was injured during a practice session. There is visible skin impairment, and the client complains of throbbing pain in the leg. What level of pain does the nurse document for this client?
Subcutaneous level
The Joint Commission supports the patient'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.
Teach all patients to use a pain rating scale Determine a pain-rating goal with each patient Manipulate factors that affect the pain experience Ensure the ethical and legal responsibility to relieve pain
The nurse is assessing a client with a history of drug addiction. What will be helpful in determining interventions that will be most beneficial for providing adequate pain relief to this client?
Using in-depth questions to collect significant data about the client's pain
A nurse is caring for a client with dull ache in her abdomen. On the way to the health care facility, the client vomits and shows symptoms of pallor. What kind of pain is the client experiencing?
Visceral pain
When assessing the client for pain, the nurse should
believe the client when he or she claims to be in pain.
When the nurse is considering the client outcomes associated with pain management, what factors should the nurse consider? Select all that apply.
if the medication has lessened the client's pain if the client's pain affects the ability for self care if the client is experiencing any adverse reactions associated with the medication if the client is demonstrating any atypical behaviors since beginning the medication
