PAIN

The nurse is preparing to assess pain in a patient with peripheral vascular disease. Which open-ended question is appropriate for this assessment?

"How does your pain affect your job?"

Which question is most effective for assessing the psychosocial impact of chronic pain?

"How has chronic pain affected your professional life?"

A postoperative patient is requesting medication for pain every 4 hours. In planning effective pain management, what assessment question does the nurse ask the patient before administering the medication?

"Is your pain controlled between doses?"

The nurse is performing a comprehensive pain assessment. Which statement by the nurse will be most useful in helping to differentiate between nociceptive and neuropathic pain?

"Please describe what your pain feels like."

The nurse preceptor is educating the novice nurse about the use of McCaffery and Pasero's Hierarchy of Pain Measures. Which statement by the nurse preceptor accurately describes this tool?

"The Hierarchy of Pain Measures includes behavioral pain assessment.

A patient with metastasized breast cancer reports pain in the back. What statements by the patient best describe it as a chronic pain? Select all that apply.

"The pain does not allow me to get out of bed. ""The pain began gradually and has become persistent."" The pain tires me and makes me feel sad and depressed."

Which patients are at greatest risk for under treatment of pain? Select all that apply.

A patient who is sedated following general anesthesia A patient who is intubated after a motor vehicle collision A patient who is unresponsive after sustaining a head injury A cognitively impaired patient who is diagnosed with bronchitis

The nurse is performing a pain assessment on an alert, mechanically ventilated patient. Which patient behavior has the potential to provide the most useful assessment data for determining pain intensity?

Blinking Rationale Self-reports are the most accurate measures of pain. For patients who are unable to verbally or manually rate the intensity of their pain, alternative methods of communication may include blinking. During a pain assessment, behavioral signs are secondary in value to self-reporting. Behavioral signs include facial expressions, such as smiling and grimacing. Vocalizations such as crying or groaning are also behavioral signs, which are secondary in value compared to self-reports.

Pain duration may be described using which term?

Brief Rationale "Brief" is a descriptor that is used to describe pain duration. Descriptors such as "beating," "penetrating," and "hot" are used to describe pain quality.

Which objectives are accomplished by conducting an analgesic trial for a cognitively impaired patient? Select all that apply.

Confirming the presence of pain Establishing a basis for a pain treatment plan

Which term is used to describe pain quality?

Cramping Rationale Cramping is a descriptor that is used to describe pain quality. Descriptors such as "steady," "intermittent," and "periodic" are used to describe pain duration.

Which condition places the patient at highest risk for undertreatment of pain?

Delirium

A patient reports sharp, shock-like, burning, shooting pain in the feet and legs that is associated with numbness. The nurse suspects that the patient is experiencing what condition?

Diabetic neuropathy

A patient is brought to the hospital in a state of delirium. Which indicators on the Checklist of Nonverbal Pain Indicators (CNPI) does the nurse use to assess this patient's level of pain? Select all that apply.

Facial expression Mental status changes Changes in interpersonal interactions Rationale The patient is in a state of delirium; therefore, the nurse uses the Checklist of Nonverbal Pain Indicators (CNPI). Facial expression, mental status changes, and changes in interpersonal interactions are all groups of behavioral indicators of pain as included under CNPI. Breathing is an indicator used on the Pain Assessment in Advanced Dementia (PAINAD) scale, not the CNPI. Lying in bed resting is not an indicator of pain in the CNPI.

Which strategy represents correct use of behavioral signs as part of pain assessment?

Identifying specific pain behaviors that are unique to the patient Rationale When performing a behavioral pain assessment, the nurse should try to identify pain behaviors that are unique to the patient ("pain signature"). Pain does not produce identical behaviors in all patients; a pain behavior in one patient may not be exhibited by another. The patient's use of a numeric scale to rate pain is part of self-reporting, not behavioral pain assessment. A behavioral score is not the same as a pain intensity score.

The registered nurse is working with a student nurse who is trying to help gauge the level of pain in a patient who is unable to use other tools of communication. Which action by the student nurse needs correction?

Misinterpreting lip-reading by eye contact

Which statement is true about assessing pain in an older adult patient?

Older adults are at great risk for undertreated pain. Rationale Older adults are at great risk for undertreated pain because of outdated beliefs by some health care providers about older adults' pain sensitivity, tolerance, and ability to take opioids. The nurse should assess only for present pain. Older adults often believe that expressing pain is unacceptable. Pain usually signifies a major illness.

Effective pain assessment requires the nurse to understand which principles related to pain perception among older adults? Select all that apply.

Older adults may be reluctant to report pain.The incidence of pain is higher in older adults.

Which term describes pain produced by inflammation of the trigeminal nerve (trigeminal neuralgia) that is diffuse in nature, extending across the various nerves that innervate the face?

Projected

Use of the term "scalding" applies to which component of pain assessment?

Quality Rationale Descriptors such as "scalding" are used to describe pain quality, which refers to the patient's sensory perception of the pain. Intensity refers to severity of pain. Onset refers to when the pain started. Duration addresses whether the pain is constant or intermittent.

Which component of pain assessment is addressed by the patient describing his pain as "searing"?

Quality Rationale Descriptors such as "searing" are used to describe pain quality, which refers to the patient's sensory perception of the pain. Intensity refers to severity of pain. Onset refers to when the pain started. Duration addresses whether the pain is constant or intermittent.

Which component of a comprehensive pain assessment is most helpful for differentiating between nociceptive and neuropathic pain?

Quality Rationale Quality refers to the patient's sensory perception of the pain. Descriptions of the quality of pain (such as "sharp," "shooting," or "burning") may help identify the presence of neuropathic pain. Intensity (severity of pain), onset (when the pain started) and duration (whether the pain is constant or intermittent) may be similar for nociceptive and neuropathic pain.

Which term describes pain that originates at the site of a herniated cervical disk and extends into the arm, hand, and fingers?

Radiating Rationale Pain that originates at the site of a herniated cervical disk and extends into arm, hand, and fingers is an example of radiating pain, which is a sensation that is felt along a specific nerve or nerves. Referred pain is felt in an area distant from the site of painful stimuli. Localized pain is confined to the site of origin. Projected pain is diffuse around the site of origin and is not well localized.

Which term describes back pain caused by pancreatitis?

Referred Rationale Back pain that is caused by pancreatitis is an example of referred pain, which is felt in an area distant from the site of painful stimuli. Localized pain is confined to the site of origin. Projected pain is diffuse around the site of origin and is not well localized. Radiating pain is felt along a specific nerve or nerves.

Which term describes right shoulder pain caused by gallstones?

Referred Rationale Right shoulder pain related to gallstones is an example of referred pain, which is felt in an area distant from the site of painful stimuli. Localized pain is confined to the site of origin. Projected pain is diffuse around the site of origin and is not well localized. Radiating pain is felt along a specific nerve or nerves.

Which pain rating scale requires the patient to select the phrase that best corresponds with the pain intensity?

The Verbal Descriptor Scale (VDS) The Verbal Descriptor Scale (VDS) uses different words or phrases to describe the intensity of pain, such as "no pain, mild pain, moderate pain, severe pain very severe pain, and worst possible pain." The patient is asked to select the phrase that best describes the pain intensity. The Wong-Baker FACES® Pain Rating Scale consists of 6 cartoon faces with word descriptors, ranging from a smiling face on the left for "no pain (or hurt)" to a frowning, tearful face on the right for "worst pain (or hurt)." The faces are most commonly numbered 0 to 10. Patients are asked to choose the face that best describes their pain. It is important to appreciate that faces scales are self-report tools; clinicians should not attempt to match a face shown on a scale to the patient's facial expression to determine pain intensity. The Faces Pain Scale-Revised (FPS-R) has 7 faces to make it consistent with other scales using the 0 to 10 metric. The faces range from a neutral facial expression to one of intense pain. As with the Wong-Baker FACES® scale, patients are asked to choose the face that best reflects their pain. The Numeric Rating Scale (NRS) is usually presented as a horizontal 0- to 10-point scale, with word anchors of "no pain" at one end of the scale, "moderate pain" in the middle of the scale, and "worst possible pain" at the end of the scale.

A patient rates their pain at a 2 or 3 on a pain rating scale on a calibrated 0-to-10. How does the nurse interpret this finding?

The patient has mild pain. Rationale On a pain rating scale, 2 or 3 would indicate mild pain. A pain rating of 0 means no pain. At 7 or higher, severe pain is implied; and moderate pain is at the middle of the scale, denoted by 5.

Which term is used to describe pain duration?

Transient Rationale "Transient" is a descriptor that is used to describe pain duration. Descriptors such as "pulling," "tugging," and "pressing" are used to describe pain quality.

Which strategy is most useful for pain assessment in the alert patient who is mechanically ventilated?

Using a communication board

The nurse is attending to an Asian-American patient who cannot communicate in English. What tool does the nurse use when assessing the pain of the patient?

Wong-Baker FACES Pain Rating Scale Rationale When assessing the pain of a patient who does not understand English, the nurse should use the Wong-Baker Faces Pain Rating Scale. This scale is also useful for children, older adults, and developmentally disabled patients. The Percent Relief Scale, Simple Descriptive Pain Distress Scale, and 0-10 Numeric Pain Distress Scale are used most commonly in clinical practices for adults who are able to communicate well in English.