med/surg chapter 5

Which statement made by a nurse represents the need for further education regarding pain management in older adult clients?

"Older clients have a different pain mechanism and do not feel it as much."

The nurse is caring for four clients. Which client assessment is the most indicative of having pain?

Heart rate of 105 beats/min and restlessness

The nurse is caring for four clients who are reporting pain. Based on the following assessments and histories, which client's pain is most likely chronic in nature?

History of fibromyalgia with a blood pressure of 110/70 mm Hg

Which assessment finding is cause for concern in a client who has taken 4 grams of acetaminophen (Tylenol) to relieve back pain?

Increased liver function tests

A client is admitted to the hospital with a history of oxycodone (Percodan) abuse. For which clinical manifestations does the nurse observe the client?

Muscle twitching and profuse perspiration

Which client does the nurse assess first for pain control?

Quiet client with pancreatic cancer curled up in bed

The nurse is caring for a client who was medicated for pain 1 hour ago. The client states that the medication is not working and the pain is still present. What is the first action that the nurse will take?

Believe the client's report of pain.

A client with colon cancer is discharged to home with morphine for pain management. He is having episodes of nausea and vomiting. Which route of morphine administration would be most advantageous to use?

Rectal

The client is taking an oxycodone-acetaminophen combination (Tylox) at home daily for chronic pain management. What instruction does the nurse give this client?

"Drink plenty of water and eat foods high in fiber."

A client who is at the end of life is being given morphine for pain management. The family expresses concern that the morphine may cause the client to stop breathing and die. What is the nurse's best response?

"His respirations are not affected by the morphine."

Which instruction is the most accurate for the nurse to give a client who has a patient-controlled analgesia device (PCA) after abdominal surgery?

"Push the button when you first feel pain instead of waiting until pain is severe."

A client with cholecystitis has pain in the right shoulder area and asks, "What is happening to me? What did I do to my shoulder?" What is the nurse's best response?

"Sometimes pain from a certain organ is referred elsewhere in the body."

A home care client who is currently on hydromorphone (Dilaudid) for pain management presents to the hospital reporting abdominal cramping, nausea, and sweating. When taking the client's history, the nurse asks which question first?

"When did you take your last dose of Dilaudid?"

During preoperative assessment, the client tells the nurse about taking NSAIDs for years. What question is most important for the nurse to ask?

"When was the last time you took your NSAID?

What instruction should the nurse include in the discharge teaching plan of a client who has a transcutaneous electrical nerve stimulation (TENS) unit?

"You can perceive a pins and needles sensation."

A client has a history of alcohol abuse. Which pain relief regimen does the nurse anticipate if morphine (MS Contin) is given for pain?

A higher dose of opioids will be needed to provide effective pain relief.

A home care client who is taking morphine for pain management abruptly stops taking the medication. Which symptom would indicate physical dependence?

Abdominal cramping

The nurse accidentally administers 10 mg of morphine intravenously to a client who had been given another dose of morphine, 5 mg IV, about 30 minutes earlier. What action must the nurse be prepared to take?

Administer naloxone (Narcan).

The client was given 15 mg of morphine IM for postsurgical pain. When the nurse checks the client for pain relief 1 hour later, the client is sleeping and has a respiratory rate of 10 breaths/min. What is the nurse's first action?

Arousing the client by calling his or her name

When assessing a client who is taking long-term ibuprofen (Motrin) for pain, the nurse finds numerous areas of bruising. What is the nurse's first action?

Assess for gastric discomfort.

A client is postoperative day one and has a patient-controlled analgesia (PCA) pump with a continuous basal dose for pain control. Currently, the client is stating that the operative pain is escalating. What is the first action of the nurse?

Assess the client's pain according to PQRST.

A client is stating that he has the sensation of burning, aching, and dullness. Which afferent nerve fibers should be transmitting the pain?

C fibers

The nurse assesses several postoperative clients receiving patient-controlled epidural analgesia (PCEA). Which client does the nurse prioritize to assess first?

Client receiving bupivacaine (Marcaine) describing "inability to move legs"

Which client would the nurse suggest should try subcutaneous opioid analgesia for pain management?

Client with cancer who is nauseous

The nurse is assigned to care for the following four clients who have the potential for having pain. Which client is most likely not to be treated adequately for this problem?

Client with expressive aphasia

The physician orders a dose of medication that does not resolve the client's chronic pain. When the nurse questions the order, the physician explains that he or she fears the client will develop an addiction with higher drug dosages. What is the nurse's best response?

Consult with the pain control specialist.

The nurse is assessing a client with a long-term history of arthritic pain. Assessment reveals a heart rate of 115 beats/min and blood pressure of 170/80 mm Hg. Which intervention will the nurse carry out first?

Continue to assess for possible causes of elevated vital signs.

When a client is assessed, which behavior best indicates that he or she is experiencing changes associated with acute pain?

Inability to concentrate

A client has epidural analgesia with bupivacaine (Marcaine) for pain relief. For which condition should the nurse assess this client?

Inability to raise legs off the bed

A client with chronic pain is being discharged from the hospital. When planning the client's pain relief regimen for home, it is most important for the nurse to communicate with which member of the health care team?

Home health care nurse

Before surgery, the nurse observes the client listening to music on the radio. Based on this observation, the nurse may try which nonpharmacologic intervention for pain relief in the postoperative setting?

Imagery

A client with arthritic pain is considering taking an herbal supplement to relieve arthritic pain. What teaching is most important for the nurse to carry out with this client?

Inform any health care providers about the use of this supplement.

An older client just returned from surgery and is rating pain as "8" on a 0 to 10 scale. Which medications are unsafe choices for treatment of severe pain in this older adult?

Meperidine (Demerol), Methadone (Dolophine), Propoxyphene (Darvocet), Codeine

Which is most indicative of pain in an older client who is confused? (Select all that apply.)

Screaming, Facial grimace, Restlessness, Crying

When is the nurse correct in decreasing the dose of pain medication in a client with end-stage cancer?

The client wants to remain alert during the visit of a long-time friend.

Why does the nurse always ask the client his or her pain level after taking routine vital signs?

To ensure that pain assessment occurs on a regular basis

A client who has been taking oxycodone (OxyContin) for an extended period of time comes to the clinic reporting that the drug is no longer relieving his pain. Which category would be given to the client's complaint?

Tolerance

The nurse anticipates that the client who rates pain as 10 on a scale of 1 to 10 has undergone which surgical procedure?

Upper abdominal surgery