Skills-Prep u Chapter 20
Which misconception is common in clients in pain?
"I will get addicted to pain medications."
The nurses who provide care on a postsurgical unit have integrated the Joint Commission Pain Assessment and Management Standards into their practice. As a result, the nurses should apply which principle to the care that they provide?
Every client will have their pain assessed accurately and regularly.
The nurse will assess the child's pain using either:
FLACC behavioral scale or COMFORT behavior scale
Two hours after receiving a pain medication, the client reports still suffering from pain. Which response is most appropriate?
"Tell me more about your pain."
Who is the authority on the presence and extent of pain experienced by a client?
The client
A health care provider orders a placebo for a client. What is a placebo?
an inactive substance given in place of a drug
The nurse is taking a history for a pregnant client who has been seen for chronic headaches for 2 years. Today, the client reports a headache that feels different than the normal headaches she has experienced in the past. Which assessment question helps the nurse assess quality of pain?
"Can you describe the type of pain you are having?"
The nurse is taking a history for a client who is being seen for chronic unrelieved back pain. Which assessment question helps the nurse assess duration of pain?
"How long have you experienced this pain?"
A client with traumatic injuries from a motor vehicle accident has been prescribed opioids for several days and has now been encouraged to introduce NSAIDs. What statement by the client demonstrates that they understand this change in their medication regimen?
"I can likely decrease my opioid doses as I introduce NSAIDs."'
After the nurse has instructed a client with low-back pain about the use of a transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what?
"I could use the TENS unit if I feel pain somewhere else on my body."
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?
The dose that is delivered when the client activates the machine is preset.
A client comes to the emergency department reporting a shooting pain in his chest. When assessing the client's behavioral responses, what would the nurse expect to find?
Frowning and grimacing
A 70-year-old woman has experienced a decline in her quality of life because of mobility limitations caused by rheumatoid arthritis (RA). The nurse is aware that the symptoms of RA are primarily caused by joint inflammation. What drug class is particularly effective at treating pain caused by inflammation?
Nonsteroidal anti-inflammatory drugs (NSAIDs)
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
Which of the following nonpharmacologic pain relief measures has been found to be effective for soothing agitated newborns and comatose clients?
music
The nurse is preparing a care plan for a client receiving opioid analgesics. Which factors associated with opioid analgesic use will the nurse include in the plan of care?
preventing constipation
The nurse is performing an assessment of a client that is experiencing pain after a surgical procedure. What symptoms does the nurse assess based on the pain response?
pupils are dilated
A client in the emergency department is diagnosed with a myocardial infarction (heart attack). The client describes pain in the left arm and shoulder. What name is given to this type of pain?
referred
A client describes pain in the lower leg and has been diagnosed with a herniated lumbar disk. The pain in the leg is what type of pain?
referred pain
A cyclist reports to the nurse that they are experiencing pain in the tendons and ligaments of the left leg, and the pain is worse with ambulation. The nurse will document this type of pain as:
somatic pain
A client who has been harassed at her place of work tells the nurse, "Every time I think of my job, I get a debilitating headache and have to go lie down to make the pain go away." Which nursing intervention will the nurse perform to practice according to the Neuromatrix Theory?
teaching client to remove items from home that remind them of work
A client has a severe abdominal injury with damage to the liver and colon from a motorcycle crash. What type of pain will predominate?
visceral pain
The nurse has completed a preoperative teaching session with a client who will receive morphine via a patient-controlled analgesia (PCA) pump after surgery. Which statement by the client indicates the need for further teaching?
"I will remind my family member to push the PCA pump button for me if I doze off during the day."
The nurse witnesses a caregiver interacting with a client with chronic pain. When helping the client get dressed, the caregiver appears hurried and frustrated, and speaks to the client angrily. What is the appropriate nursing response?
"Let me help you dress the client while we talk about home health resources that can assist when the client goes home."
A client who had a recent amputation below the knee tells the nurse about feeling as though the toes are cramping in the missing leg. Which statement will the nurse use to educate the client?
"That is called phantom pain, and it is not unusual."
The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which response is most appropriate?
"The mild electrical impulses block the pain signal before it can reach the brain."
The nurse is assessing a client who is experiencing pain. The nurse notes the client is experiencing acute rather than chronic pain when the client makes which statement?
"The pain is really sharp in this one spot."
The nurse is caring for a client who lives with chronic pain. The client states, "I have heard meditation can help me relieve my pain. Is that true?" How should the nurse respond?
"This is true. It can help with reducing high blood pressure associated with pain."
A nurse is teaching an alert client how to use a patient-controlled analgesia (PCA) system at home. Which important information will the nurse include in the plan of care for self-management of pain at home?
"When you push the button, you will get a small dose of medicine."
The nurse is providing care to a hospitalized client who has a history of hypertension and underlying chronic pain. While taking morning medications, the client points to the fluoxetine and asks the nurse, "I do not understand why I have been prescribed this medication, I already take celecoxib for my pain." How should the nurse respond?
"Your health care provider has prescribed it because it makes your pain medication work better."
The client experiences intractable chronic pain from cancer. The nurse is developing a care plan to provide the client adequate pain relief. What principle(s) will guide the treatment plan? Select all that apply.
- Administer pain medications around the clock. - Give oral medications for pain relief. - Assess the client's pain experience at every visit. - Contact the health care provider if the client reports unrelieved pain.
The nurse is providing a massage to a client who has been experiencing muscular pain as a result of overreaching. What actions would the nurse perform to provide comfort for the client? Select all that apply.
-Assist the client to the prone position. -Begin the massage with light, gliding strokes to shoulders, back and sacral area. -End the massage with strokes that are lighter in pressure.
A nurse who works on the pain management team is preparing a presentation for a group of new nurses about various pain management strategies. When describing cognitive and behavioral strategies to the group, what would the nurse likely include? Select all that apply.
-Biofeedback -imagery -Distraction
The nurse is preparing to administer opioid analgesics to an older adult client having acute joint pain. The nurse is aware that the client has a history of impaired drug excretion and should do which of the following? Select all that apply.
-Monitor the client for seizure activity. -Assess the client orientation before and after administration. -Monitor the client for signs of psychosis.
When asking an older adult client about abdominal pain, the client reports, "I do not 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?
Gently mention that the client appears to be experiencing pain that can be treated.
A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA) by a health care provider. What is an advantage that PCA offers?
Pain can be kept within a consistently tolerable level.
A nurse attempts to relieve the pain of a client by using cutaneous stimulation. Which of the following describes usage of this technique?
A nurse applies intermittent heat and cold to a client's leg.
The nurse is caring for a client on their first postoperative day after chest surgery. The client appears stoic and does not request analgesia, The nurse should perform what action?
Actively solicit information about the client's pain level
The nurse is caring for a client who reports throbbing pain at the site of a recent laceration from a pocketknife. How will the nurse document this type of pain? Select all that apply.
Acute cutaneous
The nurse is caring for a client with chronic back pain due to inoperable spinal stenosis. Which strategies, suggested by the nurse, may help to decrease the client's back pain?
Adding the use of hot or cold packs for pain control
What is the term used to describe a pharmaceutical agent that relieves pain?
Analgesic
A client has been experiencing persistent back pain despite the regular use of opioids and NSAIDs. The nurse should encourage the client to speak with their care provider about the use of what adjuvant medication for pain control?
Antidepressant
The nurse is caring for an older client with chronic pain due to osteoarthritis, hypertension, and mild dementia. The client reports blurred vision, and the spouse states, "I'm worried. Today I noticed that there was blood in the stool, and there is more confusion than usual." What is the priority nursing action?
Ask the client and caregiver for a medication history.
The nurse is caring for a client who frequently comes to the emergency department (ED) reporting a headache that is an 8 or 9 on a pain scale of 1 to 10. The client is noted to be laughing while on the phone and chatting with staff after reporting a headache that is a 10. Which action will the nurse perform prior to initiating treatment?
Assess for nonverbal cues to pain
How may a nurse demonstrate cultural competence when responding to clients in pain?
Avoid stereotyping responses to pain by clients.
A nurse is assessing the vital signs of a client who is moaning with pain. Which vital sign assessment warrants reporting to the health care provider?
Blood pressure of 165/93 mm Hg
Which statement accurately describes pain experienced by the older adult?
Boredom and depression may affect an older person's perception of pain.
The nurse is caring for a client who has had back pain for 2 years, following a fall from a ladder. How does the nurse going off-shift report this kind of pain to the oncoming nurse? Select all that apply.
Chronic Somatic
The health care provider has ordered a patient controlled analgesia (PCA) pump for a client. Which assessment finding would cause the nurse to question the order?
Client is disoriented to time and place
A postsurgical client and family have differing opinions about the level of pain that the client is experiencing. Which is the best way to educate the client and family about pain and pain relief?
Discuss with the family that the client is the best person to describe its level.
The spouse of a client with cancer asks why the client's breakthrough doses of morphine have recently needed to be higher and more frequent for the client to achieve pain relief? Which response by the nurse is appropriate?
Higher doses are needed because the client has developed a tolerance to the morphine.
The nurse likes to use humor to help clients deal with pain. What guidelines should the nurse follow when using humor to foster pain relief?
Humor should take into account the client's personality and circumstances.
A postoperative client's incisional Mapain is being treated with opioids. In addition to providing pharmacological interventions, the nurse will perform what action?
Implement distraction techniques
Which statement is true of chronic pain?
It interferes with normal functioning.
Why is acute pain said to be protective in nature?
It warns an individual of tissue damage or disease.
A client is experiencing pain at a surgical incision site. During transmission of the pain signal, what event will occur?
Movement of ions propels the pain signal along a nerve fiber
A nurse is caring for a client who is undergoing thermal therapy for relieving pain. Which nursing intervention should the nurse implement during a thermal application?
Protect the skin with cloth or a towel before applying the hot or cold pack.
A client who underwent surgery yesterday has a prescription for an opioid analgesic every 3 to 4 hours and received the last dose 3 hours earlier. Which action is most appropriate for the nurse to take in response to the client's request for pain medication?
Provide the client with pain medication
The client has had chronic and continuous back pain which has not been managed. A pain management plan has been prescribed for the client (above). What information will the nurse review with the client to help manage the pain?
Schedule taking the naproxen at the same times daily.
A nurse is caring for a client who is receiving morphine via a patient controlled analgesia (PCA) pump. When assessing the client, the nurse notes that the client's respiratory rate is 6 breaths per minute. What should the nurse do first?
Stop the PCA pump.
Which statement accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain?
The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval.
At 1930 the client reports experiencing neuropathic pain in the legs. The client has a history of neuropathic pain following chemotherapy. The client describes the pain as burning and rates the pain as a 7 on the pain scale of 1 to 10. Based on the client's medication orders (above), which medication would the nurse administer to the client for a report of pain?
acetaminophen/codeine 1 tablet
During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is:
analgesics
A client is prescribed oxycodone for pain relief. After teaching the client about the medication and common side effects, the nurse determines that the education was successful when the client identifies which side effect as most common?
constipation
Before inserting a urinary catheter, a nurse discusses the procedure with the client. When inserting the catheter, the nurse distracts the client by talking to him about his work. The nurse is attempting to relieve the client's procedural pain through:
focusing on another stimuli in the environment.
A nurse is assessing a nonverbal client's pain. Which assessment finding will the nurse interpret as potentially indicating acute pain?
increased blood pressure
A male college student age 20 years has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is the client most likely experiencing?
visceral pain
