Faoundation of Nursing Chapter 35 : Pain Management

While caring for a client with chronic pain, the nurse talks with a family member. Which family member statement does the nurse identify as consistent with caregiver role strain? a. "I feel badly because my loved one is in pain all of the time." b. "Sometimes it seems like I can never get a moment to myself." c. "Even when I do extra tasks around the house, I'm glad to help my loved one." d. "Our insurance company finally found a way to cover my loved one's care."

"Sometimes it seems like I can never get a moment to myself." Explanation: Caregiver role strain may be exhibited by statements of exhaustion, frustration, or seeming overwhelmed. If the client states that time to themselves is rare, he or she may be feeling consumed with care for the client with chronic pain. Feeling badly regarding a loved one's pain, discussing insurance coverage, and helping the loved one by doing household tasks do not indicate caregiver role strain.

The nurse is preparing to apply a transcutaneous electrical nerve stimulation (TENS) unit. Arrange the following steps in the correct order. 1 Apply electrodes to the prescribed location. 2 Plug electrodes into the TENS unit. 3 Turn on the TENS unit. 4 Assure that client can feel the tingling sensation. 5 Adjust intensity to prescribed setting. 6 Secure unit to the client.

1.Apply electrodes to the prescribed location. 2. Plug electrodes into the TENS unit. 3. Turn on the TENS unit. 4. Assure that client can feel the tingling sensation. 5. Adjust intensity to prescribed setting. 6. Secure unit to the client.

A nurse attempts to relieve the pain of a client by using cutaneous stimulation. Which of the following describes usage of this technique? a. A nurse guides a client to use imagery. b. A nurse uses deep-breathing exercises to distract a client from his pain. c. A nurse applies intermittent heat and cold to a client's leg. d. A nurse distracts the client by playing his favorite music.

A nurse applies intermittent heat and cold to a client's leg. Explanation: Cutaneous stimulation is the intermittent application of heat or cold, or both. Heat accelerates the inflammatory response to promote healing, reduces muscle tension to promote relaxation, and helps to relieve muscle spasms and joint stiffness. Cold reduces muscle spasm, alters tissue sensitivity, and promotes comfort by slowing the transmission of pain stimuli. Distraction such as playing a client's favorite music, deep breathing exercises, and imagery are diversional activities that assist coping with the pain.

The nurse manager hears a nurse and a nurse aide talking about a female client who reports pain of 8 out of 10 on a 1-10 scale after a Caesarean birth to deliver twins. The nurse states, "I don't believe this client has any pain at all. I'm sure she is just drug seeking." What is the appropriate nurse manager action? a. Continue listening to the conversation before intervening. b. Ask the nurse to speak privately for a moment, and educate about bias in pain treatment. c. Enter the conversation and tell the nurse and UAP that this type of discussion will not be tolerated. d. Write the nurse up for disciplinary action.

Ask the nurse to speak privately for a moment, and educate about bias in pain treatment. Explanation: Research has shown that treatment bias may delay pain-relieving measures. The nurse manager should privately and professionally educate the nurse, and then subsequently educate the nurse aide. Addressing the concern quickly is important so the client can receive appropriate care and pain management. Entering the conversation is not the best action to educate the nurse and disciplinary action doesn't help to immediately address the current situation.

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

Avoid stereotypical responses to pain in clients. Explanation: Culture influences an individual's response to pain. It is particularly important for nurses to avoid stereotypical responses to pain because they frequently encounter clients who are in pain or who anticipate that it will develop. A form of pain expression that is frowned upon in one culture may be desirable in another cultural group. Nurses should treat every client exactly the same but be aware of cultural influence in providing care. Medication knowledge is essential, but nurses should understand the cultural influence of pain and use of medication.

A nurse is assessing a mentally challenged adult client who is in pain after a fall from a staircase. Which scale should the nurse use to assess the client's pain? a. numeric scale b. word scale c. linear scale d. FACES scale

FACES scale Explanation: The nurse should use the Wong-Baker FACES scale, which is best for children and clients who are culturally diverse or mentally challenged. Nurses generally use a numeric scale, a word scale, or a linear scale to quantify the pain intensity of adult clients who can express their pain intensity in words, numbers, or linear fashion.

When asking an older adult client about abdominal pain, the client reports, "I don't want to be a bother because nothing hurts too much." The nurse notes that the client grimaces and splints the abdomen when moving. What is the appropriate nursing action? a. Document the client's statement, and do nothing further. b. Remind the client that pain can be tolerated instead of using addictive pain medication. c. Gently mention that the client appears to be experiencing pain that can be treated. d. Confirm that age is the reason for many types of pain.

Gently mention that the client appears to be experiencing pain that can be treated. Explanation: Pain is underdetected and poorly managed among older adults, because they often do not want to be perceived as a complainer, or they feel that pain is part of growing older. The nurse should gently mention that the client appears to be experiencing pain that can be treated, and then continue the conversation by reassuring that the client is not a bother. Documenting without addressing the client's report, confirming age as a reason for pain, and reminding that pain can be tolerated are inappropriate nursing actions.

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

It warns an individual of tissue damage or disease. Explanation: Acute pain, lasting from a few minutes to less than 6 months, warns an individual of tissue damage or organic disease. After its underlying cause is resolved, acute pain disappears. Pain is a subjective experience and does assist in the coping and psychological strength of a person.

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

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 neurologic 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 clients above a certain age; the assessment tool should reflect the client's specific circumstances, abilities, and development.

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

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

Which statement accurately represents a consideration when using an epidural analgesia for client pain management? a. If the client develops a headache, a mild analgesic may be administered along with the epidural. b. The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min. c. If a client is experiencing adverse effects, a peripheral IV line should be installed to allow immediate administration of emergency drugs, if warranted. d.Slight resistance should be felt during the removal of an epidural catheter.

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

A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system? a. The dose that is delivered when the client activates the machine is preset. b. Thorough client education is necessary to prevent overdoses. c. Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression. d. An antidote is automatically delivered if the client exceeds the recommended dose.

The dose that is delivered when the client activates the machine is preset. Explanation: PCAs are designed to make it impossible for the client to exceed the client-specific dosing parameters programmed into the machine. PCAs do not administer antidotes, and they are almost always used to deliver opioid analgesics. The client does not need to be educated about overdoses.

A nurse implements cutaneous stimulation for a client as part of a strategy for pain relief. Which nursing action exemplifies the use of this technique? a. The nurse plays soft music in the client's room. d. The nurse assists the client to focus on something pleasant rather than on pain. c. The nurse gives the client a massage before bed. d. The nurse teaches the client deep breathing techniques for relaxation.

The nurse gives the client a massage before bed. Explanation: Some forms of cutaneous stimulation include the following: massage, application of heat or cold (or both intermittently), acupressure, transcutaneous electrical nerve stimulation (TENS). All the options listed are examples of complementary and alternative relief measures, but only massage is an example of cutaneous stimulation.

Epidural analgesia is appropriate for postoperative analgesia and can be administered via continuous infusion pump, or by a patient-controlled epidural analgesia pump (PCEA). a. True b. False

True

A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as: a. biofeedback. b. transcutaneous electrical nerve stimulation (TENS). c. hypnosis. d. Therapeutic Touch (TT).

biofeedback. Explanation: Biofeedback is a technique that uses a machine to monitor physiologic responses through electrode sensors on the client's skin. The unit transforms the data into a visual display, and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. Transcutaneous electrical nerve stimulation (TENS) is a noninvasive alternative technique that involves electrical stimulation of large-diameter fibers to inhibit transmission of painful stimuli carried over small-diameter fibers. Hypnosis is an alteration in a person's state of consciousness so that pain is not perceived as it normally would be. Therapeutic Touch involves using one's hands to direct an energy exchange consciously from the practitioner to the client in order to facilitate healing or pain relief.

A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a p.r.n. drug regimen as an effective method of pain control would be the client: a. experiencing acute pain. b. in the early postoperative period. c. experiencing chronic pain. d. in the postoperative stage with occasional pain.

in the postoperative stage with occasional pain. Explanation: A p.r.n. (as needed) medication would be most appropriate for a client in the postoperative stage with occasional pain. A client in the early postoperative period would benefit from the dosage of pain medication with around the clock dosing. A client experiencing chronic pain would benefit from the dosage of pain medication with around the clock dosing. A client experiencing acute pain would benefit from the dosage of pain medication with around the clock dosing.

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. cutaneous pain b. visceral pain c. chronic pain d. neuropathic 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. 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.

A client has required frequent scheduled and breakthrough doses of opioid analgesics in the 6 days since admission to the hospital. The client's medication regimen may necessitate which intervention? a. stool softeners and increased fluid intake b.supplementary oxygen and chest physiotherapy c. calorie restriction and dietary supplements d. frequent turns and application of skin emollients

stool softeners and increased fluid intake Explanation: The most common side effect of opioid use is constipation. Consequently, stool softeners and increased fluid intake may be indicated. Opioids may cause respiratory depression, but this fact in and of itself does not create a need for oxygen supplementation or chest physiotherapy. The use of opioids does not create a need for calorie restriction, supplements, frequent turns, or the use of skin emollients.

The wife of a client with cancer is concerned that her husband's breakthrough doses of morphine have recently needed to be larger and more frequent in order for him to achieve pain relief. The nurse would recognize that the client is likely showing the effects of: a. tolerance. b. addiction. c. physical dependence. d. drug interactions.

tolerance. Explanation: This client is likely developing drug tolerance, which occurs when the body becomes accustomed to the opioid and needs a larger dose each time for pain relief. This is not a pathologic finding and does not necessarily indicate physical dependence. Addiction is the fact or condition of being addicted to a particular substance, thing, or activity. A drug interaction is a reaction between two (or more) drugs or between a drug and a food or beverage. Tolerance does not indicate addiction or a heightened risk of addiction.

The nurse is caring for a client who reports having "kidney pain from a urinary tract infection" for 3 days. How will the nurse describe this pain when reporting off via SBAR? Select all that apply. cutaneous somatic visceral referred neuropathic acute chronic

visceral acute Explanation: Visceral pain (discomfort arising from internal organs) is associated with disease or injury. It is sometimes referred or poorly localized. Acute pain (discomfort that has a short duration) lasts for a few seconds to less than 6 months. Other answers are incorrect.