ATI Engage Fundamentals (Physiologic Concepts for Nursing Practice): Pain

A nurse is discussing the FLACC scale with a newly licensed nurse. Which of the following categories should the nurse include? (Select all that apply.)

- Face is correct. Face is one of the categories included in the FLACC pain assessment. The nurse should observe the client's facial expression and determine a score. - Legs is correct. Legs is one of the categories included in the FLACC pain assessment. The nurse should observe the client's position, tone, and extremities and determine a score. - Alert is incorrect. Alert is not a category included in the FLACC pain assessment. Activity is one of the categories included in the FLACC pain assessment. The nurse should observe the client's activity level and determine a score. - Circulation is incorrect. Circulation is not a category included in the FLACC pain assessment. Cry is one of the categories included in the FLACC pain assessment. The nurse should observe the client to determine if they are crying and assign a score. - Consolability is correct. Consolability is a category included in the FLACC pain assessment. The nurse should observe the client to determine if they are consolable and assign a score.

A nurse is caring for a client who has kidney stones. Which of the following manifestations is an objective indicator of pain?

- The client is diaphoretic. MY ANSWERThe nurse should identify that sweating is an objective manifestation of pain. Objective data is information the nurse can gather by using their five senses. Sweating can be visually noticed by the nurse. - The client is experiencing stabbing pain. This is a characteristic of pain, but the nurse would not be able to observe or measure this type of pain. Anything the client reports to the nurse and cannot be measured or noted using the five senses is a subjective finding. - The client is nauseated. The nurse would not be able to measure nausea. The client would need to tell the nurse they are feeling nauseated. Therefore, this is a subjective finding of pain. - The client states feeling dizzy. The nurse could not measure dizziness. Anything the client reports to the nurse and cannot be measured or noted using the five senses is a subjective finding.

A nurse is teaching staff about the ethical principle of justice and how it relates to pain management for clients. Which of the following statements should the nurse make?

- "Justice allows the client the freedom of choice."Autonomy allows the client the freedom to make an informed decision about their pain management. "Justice allows the client the opportunity to be treated fairly." Justice requires that all clients be treated fairly in regard to their pain management regardless of age, ethnicity, or history, such as substance use disorder or limited social and economic resources. Pain relief should be available to all clients. - "Justice is causing no harm to the client." Nonmaleficence is working to do no harm. By providing the client with effective pain management, the nurse is meeting this ethical principle. - "Justice is doing good for the client." Beneficence is doing good and acting in the best interest of the client by proving pain management.

A nurse is monitoring a client who is 2 hr postoperative and is receiving morphine via PCA pump. Which of the following findings should the nurse plan to monitor to detect Opioid-Induced Ventilatory Impairment (OIVI)? (Select all that apply.)

- Bowel sounds is incorrect. While opioid medications can affect bowel sounds, bowel sounds do not provide information about OIVI. - Deep tendon reflexes is incorrect. Deep tendon reflexes are an indicator of neurologic function and do not provide information about OIVI. - Respiratory rate is correct. The nurse should plan to monitor the respiratory rate frequently. A finding below the expected reference range could indicate OIVI. - Capnography is correct. The nurse should recognize that capnography (measuring carbon dioxide) can assist with identifying OIVI. - Oxygen saturation is correct. The nurse should plan to monitor the client's oxygen saturation frequently or continuously, depending on policy. A finding below the expected reference range could indicate OIVI.

A nurse is caring for a client who has a prescription for heat therapy for knee pain. The nurse should apply heat therapy to the client's knee for how long?

- 60 min Applying heat therapy for 60 min is too long without a break and might cause skin or tissue damage. The nurse should to apply heat therapy for no more than 20 min at a time with at least a 20-min break after usage. - 20 min The nurse should apply heat therapy for no more 20 min at a time with at least a 20-min break after usage. - 30 min Applying heat therapy for 30 min is too long without a break and might cause skin or tissue damage. The nurse should instruct the client to apply heat therapies for no more 20 min at a time with at least a 20-min break after usage. - 45 min Applying heat therapy for 45 min is too long without a break and might cause skin or tissue damage. The nurse should apply heat therapy for no more 20 min at a time with at least a 20-min break after usage.

A nurse is assisting with a staff in-service regarding pain control. Which of the following statements by a staff member indicates an understanding of the information? (Select all that apply.)

- "A client's religious beliefs might affect the way they respond to pain" is correct. The nurse should be aware of factors that could inhibit communication with the client and prevent pain control, such as differences in ethnic backgrounds or religious beliefs. - "Herbal therapies are not permitted for a client receiving prescription pain medication" is incorrect. If a client chooses to use herbal medications, the nurse should advocate for the client to be able to continue using them. The nurse should consult with the provider and pharmacist to ensure there are no interactions or special precautions needed in order to protect the client. - "The client's past pain experiences are not related to their current pain and pain management" is correct. The client's past pain experiences are not related to their current pain and pain management. - "If a client can rate their pain using a numeric pain scale, there is no need to note nonverbal findings" is incorrect. The nurse should document client verbalizations regarding pain and any physical findings as part of a complete pain assessment. - "Pain control might be harder to achieve if the nurse and client speak different primary languages" is correct. The nurse should be aware of factors that could inhibit communication with the client and prevent pain control, such as language barriers or educational differences.

A nurse is evaluating a client's pain level using the PQRST mnemonic. Which of the following questions should the nurse ask to evaluate the letter "R"?

- "Can you rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine?" The nurse should use the PQRST mnemonic to obtain more information about the client's pain. This question evaluates the severity of the client's pain. - "Can you point to where you are having your pain?" The nurse should use the PQRST mnemonic to obtain more information about the client's pain. This question evaluates the region of the client's pain. - "What does your pain feel like?" The nurse should use the PQRST mnemonic to obtain more information about the client's pain. This question obtains information about the quality of the client's pain. - "What were you doing when your pain started?" The nurse should use the PQRST mnemonic to obtain more information about the client's pain. This question obtains information about the precipitating cause of the client's pain.

A nurse is reviewing discharge instructions for a client who has a prescription for morphine oral solution 10 to 20 mg every 4 hr PRN. Which of the following statements by the client indicates an understanding of the instructions?

- "I can use the morphine as needed as long as I don't take it more than six times a day. "The nurse should clarify this statement with the client, as it indicates that the client might not understand that the morphine should be taken no more frequently than every 4 hr. - "I will use my household teaspoon to measure the correct amount of morphine. "The client will not receive an accurate dose of the oral solution when using a household teaspoon. The pharmacy should provide the client with a metered medicine cup or oral syringe that will precisely measure the amount of solution for an appropriate dose. - "I will monitor for high blood pressure while taking the morphine. "There is no need to monitor for high blood pressure. Opioid medications can cause orthostatic hypotension. The client should slowly change positions from lying to sitting and from sitting to standing. - "I will keep the morphine bottle in a locked cabinet in my kitchen." Morphine is a medication that carries significant risks to others, including children, and should only be accessible and used by the client for whom it is prescribed. Storing the medication in a high cabinet prevents accidental access to the morphine by others.

A nurse is discussing transcutaneous electrical nerve stimulation (TENS) treatment with a client who has chronic lower back pain. Which of the following statements should the nurse include? (Select all that apply.)

- "You can be taught how to use TENS therapy at home" is correct. TENS therapy can be provided by the nurse or the client can be taught to use the TENS unit and self-administer in the home setting. - "We will insert very small sterile needles into your skin to block your pain" is incorrect. This statement describes the procedure used for acupuncture. TENS therapy is a noninvasive therapy and uses electrodes applied to the skin to deliver the low-voltage electrical impulses. - "This therapy may result in you having some temporary bruising at the site of application" is incorrect. Localized bruising, swelling, pain, or numbness to the area of application are adverse effects of extracorporeal shock-wave lithotripsy (ESWL). No adverse effects of TENS are expected. The skin electrodes used to deliver the low-voltage impulses can produce an allergic reaction in some clients. - "The TENS therapy delivers low-voltage electrical impulses to the skin over the painful areas" is correct. These low-voltage electrical impulses reduce the nervous system's ability to transmit pain from the area of application to the brain. In addition, these impulses stimulate the body to produce endorphins, which also assist in relieving pain. - "We will adjust the intensity, pulse rate, and duration of the electrical pulses during your therapy" is correct. The intensity, pulse rate, and duration of each pulse of treatment with TENS therapy can be adjusted by the nurse or the client.

A nurse is reviewing a new prescription with a client who reports difficulty managing their chronic pain. Which of the following statements should the nurse include?

- "You should write down the pain interventions you use and your pain rating before and after." Keeping a pain diary or a pain log can be helpful for the client to determine if medications or treatments are helping over time. - "You should understand that it is impossible to fix everyone's pain." This statement is nontherapeutic for the client. The nurse should show empathy and offer solutions to the client to help them achieve an optimal level of pain control. - "Your provider is best at determining whether your pain treatments are effective." The nurse should identify that pain is individualized and should believe the client's report of pain. Therefore, the client should be the one to determine whether their pain is effectively managed. The provider can assist the client in evaluating their pain treatments. - "Your care partner should manage your pain control because you are unable." The nurse should ensure that the client has the opportunity to make choices about their own treatment plan. Unless the client is unable to cognitively make choices for themselves, the client should make their own informed decisions.

A nurse is providing end-of-life care for a client who is unresponsive and near death. The client's family asks the nurse about managing the client's pain. Which of the following statements should the nurse make to the client's family?

- "Your family member will not require pain medication." According to the American Society for Pain Management Nursing and the Hospice and Palliative Nurses Association position statement, end-of-life effective pain management is a basic human right. Clients who are receiving end-of-life care should receive special consideration for pain management. - "Your family member can inform the provider about their decision for pain management." The client is unresponsive and near death and will not be able to communicate their desires to the provider. If the client were alert and responsive, they would be legally able to give verbal consent and make decisions about pain management. - "Your family member has the right to receive effective pain management." According to the American Society for Pain Management Nursing and the Hospice and Palliative Nurses Association position statement, end-of-life effective pain management is a basic human right. Clients who are receiving end-of-life care should receive special consideration for pain management. - "Your family member will not be able to tolerate the effects of pain medications." According to the American Society for Pain Management Nursing and the Hospice and Palliative Nurses Association position statement, end-of-life effective pain management is a basic human right. Clients who are receiving end-of-life care should receive special consideration for pain management, and dosing will be based on the individual.

A nurse is caring for a group of clients on the pediatric unit. For which of the following clients should the nurse use the FLACC Pain Scale to determine their pain level? (Select all that apply.)

- A 12-year-old client who has had an appendectomy is incorrect. A 12 year old would be able to cognitively report their pain level using a Numeric Rating Scale (NRS) or a Visual Analog Scale (VAS). The FLACC Pain Scale is recommended for children from 2 months to 7 years and for cognitively disabled children. - A 3-year-old toddler who has a fractured femur is correct. The FLACC Pain Scale is recommended for children from 2 months to 7 years. A 3 year old might not be able to accurately report their pain using a NRS or VAS due to their cognitive development at this age. - A 6-day-old infant who had a surgical repair of a heart defect is incorrect. The FLACC Pain Scale is recommended for children from 2 months to 7 years and for cognitively disabled children. The Crying, Requires Oxygen, Increased Vital Signs, Expression, Sleeplessness (CRIES) Scale is more appropriate for the age of this client. - A 14-year-old client who has severe cognitive and developmental delays is correct. Even though this client is of an age greater that than the ages recommended for use of the FLACC, this client has cognitive and developmental delays and might not be able to appropriately rate their pain using a NRS or VAS. The FLACC Pain Scale is recommended for children who are cognitively disabled. - A 5-year-old preschooler who is experiencing pain during a sickle cell crisis is correct. A 5-year-old child might not be able to accurately report their level of pain using other pain scales. The FLACC Pain Scale is recommended for children from 2 months to 7 years.

A nurse is reviewing information for several clients on the unit. The nurse should recognize that which of the following clients is at greatest risk for respiratory depression?

- A client who has chronic pain and recently started taking paroxetine Any client could experience respiratory difficulties; however, paroxetine is not known to directly cause respiratory depression. Therefore, there is another client the nurse should identify as having the greatest risk. - A client who has cancer and has taken oxycodone PRN for several months Any client could experience respiratory difficulties; however, a client who has been taking an opioid medication long term has a significantly lower risk of respiratory depression than a client who is newly taking the medication. Therefore, there is another client the nurse should identify as having the greatest risk. -A client who has been accidentally taking twice the amount of prednisone as prescribed Any client could experience respiratory difficulties; however, prednisone is not known to directly cause respiratory depression. Therefore, there is another client the nurse should identify as having the greatest risk. - A client who had surgery 3 hr ago and is receiving IV hydromorphone PRN Use of an opioid medication can decrease the respiratory rate, and the first 4 hr postoperative are when the client is at highest risk for surgical complications. Therefore, the nurse should identify that the client who had surgery 3 hr ago and is receiving IV hydromorphone is at greatest risk for respiratory depression.

A nurse is evaluating a group of clients who are experiencing pain. Which of the following clients should the nurse identify as experiencing neuropathic pain?

- A client who has osteoarthritis and reports difficulty ambulating for the past 6 months Chronic pain is pain that has been present usually for 3 to 6 months or longer after the injury or damage has healed. Examples of chronic pain are arthritis pain or pain from a back injury. Chronic pain can physically and emotionally debilitate a client. - A client who had surgery to repair a fractured tibia and reports incisional pain Acute pain is related to a recent injury, surgery, or damage to the body and lasts for a limited amount of time. Once the injury or damage has healed, the pain should subside. - A client who has diabetes mellitus and reports bilateral burning foot pain without signs of injury. Neuropathic pain is often referred to as nerve pain and arises from the somatosensory system. Neuropathic pain includes diabetic neuropathy, phantom limb pain, and pain associated with a spinal cord injury. Neuropathic pain is frequently described as intense, shooting, or burning. - A hospice client who has prostate cancer and reports pelvic pain Several types of pain might arise in clients who have cancer, such as tumor pain, bone pain, and treatment-associated pain, such as chronic postsurgical pain (CPSP).

A nurse is planning to teach coworkers about the legal and ethical principles used with pain management. Which of the following examples should the nurse include as an example of autonomy?

- A nurse allows a client to wait longer for their pain medication than other clients. This is an example of a violation of justice. Justice means that the client should be treated equally and that fair and adequate pain relief should be provided regardless of age, ethnicity, or history, such as substance use disorder or limited social and economic resources. - A nurse does not properly clean a vial of pain medication prior to withdrawing medication from the vial, which results in the client contracting an infection. This is an example of negligence, which means that the nurse should have cared for the client in a way that any other reasonable person would have. Properly cleaning the medication vial prior to use is a basic skill that the nurse should perform to prevent infection to the client. - A nurse administers scheduled pain medication and provides therapeutic distraction techniques for a client in pain. This is an example of beneficence, which is doing good or acting in the best interest of the client. - A nurse provides a client with the opportunity to take an intramuscular injection or oral medication for pain relief. This is an example of autonomy. The nurse is providing the client their right of self-determination by permitting the client an ability to make an informed decision.

A nurse is caring for a client who has a prescription for hydromorphone 1 to 2 mg IM every 4 hr as needed for a pain rating of 4 to 6 on a 0 to 10 scale. The client has never taken hydromorphone before. Which of the following actions should the nurse plan to take?

- Administer 1 mg IM. When a client has a prescription that includes a range, and the client has never taken the medication previously, the nurse should administer the lowest dose to the client. If the dose is ineffective, the nurse can increase the dosage up to the maximum amount in the range prescribed by the provider. - Request a prescription to give the medication IV instead. The nurse should recognize that administering the medication IV will make the effects of the medication have a more rapid and intense onset, which could potentially harm the client. - Request a prescription for a different medication. The nurse should administer the medication prescribed by the provider unless a contraindication is noted. If the medication is ineffective or the client is unable to tolerate it, the nurse can request a prescription change. - Administer 2 mg IM. The nurse should recognize that administering the highest dose to a client who has never taken hydromorphone could increase the risk of adverse effects.

A nurse is caring for a client who has a prescription for oxycodone 5 to 10 mg PO every 4 to 6 hr as needed for pain rating 7 to 10 on a 0 to 10 scale. Fifteen minutes after receiving the dose, the client reports to the nurse their pain is still a 7 and has not changed. Which of the following actions should the nurse take?

- Administer another 5-mg dose of the oral opioid now. The nurse should not administer additional oxycodone now because the previous dose of the oral oxycodone would not have reached its peak in 15 min. Repeating the dose now would violate the provider's prescription and could cause toxicity during the peak effects of the medication. - Administer 10 mg of oxycodone every 2 hr. The nurse should not administer 10 mg of oxycodone every 2 hr because the decision to administer the medication early requires prescriptive authority, which is outside the nurse's scope of practice. This would equate to 20 mg every 4 hr, which exceeds the prescription. Splitting the medication dose in this manner might cause medication toxicity if the medication half-life is overlapped. - Inform the provider that the client's pain medication is not effective. Fifteen minutes after administration of an oral opioid medication, the nurse should not expect the client's pain to be alleviated. The oral oxycodone would not have had time to peak after 15 min. - Offer to assist the client with nonpharmacological relief strategies. The oxycodone would not have had time to peak and to be effective after 15 min. The nurse should offer to assist the client with nonpharmacological pain relief strategies until the medication has had time to work. Oral oxycodone peak effects should be noted 60 to 90 min after administration.

A nurse is caring for a client who reports muscle pain to the lower back that has persisted for over a year after a motor-vehicle crash. In which way should the nurse categorize this client's pain?

- Cancer pain Several types of pain might arise in clients who have cancer, such as tumor pain, bone pain, and treatment-associated pain, such as chronic postsurgical pain (CPSP). - Acute pain Acute pain is a result of a recent injury, surgery, or damage to the body and lasts for a limited amount of time. Once the injury or damage has healed, the pain should subside. - Chronic pain Chronic pain is pain that has been present usually for 3 to 6 months or longer after the injury or damage has healed. Examples of chronic pain are arthritis pain or pain from a back injury. Chronic pain can physically and emotionally debilitate a client. -Neuropathic pain Neuropathic pain is often referred to as nerve pain because it originates due to damage of the somatosensory system. Pain that is nociceptive in nature originates from actual or potential non-neural tissue damage and the somatosensory system is intact.

A nurse is reviewing the plan of care for several clients who are receiving treatment for pain. Which of the following actions should the nurse plan to take to evaluate the clients' pain control? (Select all that apply.)

- Consider each client's cultural preferences is correct. The nurse must consider client factors that can affect their perception, response to, and report of pain, such as culture and socioeconomic status. - Determine the effectiveness of nonpharmacological strategies is correct. The nurse should evaluate the effectiveness of each individual pain strategy, including both pharmacological and nonpharmacological. This helps determine which strategies are ineffective so that more effective strategies can be used consistently. - Record the clients' subjective reports rather than the nurse's objective observations is incorrect. The nurse should document both observed or measured information as well as client-reported information regarding the client's pain in the medical record. - Recognize that older adult clients over-report their pain level is incorrect. The nurse should identify that older adult clients tend to underreport pain. The nurse should encourage clients to report their pain and use a variety of measures to determine the clients' level of comfort. - Use a pain scale specific to each client's cognitive abilities is correct. The nurse should ensure that the pain scale used to measure a client's pain level is appropriate to their abilities, whether performing an initial pain assessment or evaluating pain effectiveness.

A nurse is discussing end-of-life pain management with a group of coworkers. Which of the following should the nurse include as barriers to end-of life pain management? (Select all that apply.)

- Fear of addiction is correct. Barriers to end-of-life pain management from a client or their family include fear of addiction. This leads to pain being undertreated or not treated at all. Every client has the right to effective pain management as they near the end of life. - Belief that pain is an expected part of their illness is correct. Barriers to end-of-life pain management from a client or their family include the belief that pain is an expected part of their illness. This leads to pain being undertreated or not treated at all. Every client has the right to effective pain management as they near the end of life. - Inability to sleep is incorrect. The inability to sleep is not a barrier to end-of-life pain management. The inability to sleep might be due to pain or other physical or psychosocial issues, and the nurse should determine what factors are contributing to the client's inability to sleep. - Lack of support is incorrect. Lack of support is not a barrier to end-of-life pain management. The nurse should consider this factor while planning effective end-of-life pain management for this client. - Inadequate pain assessment is correct. The client's pain assessment can be inadequate due to several factors, such as the client's denial of pain, the client being unable to verbally express their level of pain due to unconsciousness or aphasia, or the client's or nurse's fear of causing adverse effects from the prescribed medications.

A nurse is assessing a client who is nonverbal for the presence of pain. Which of the following findings indicate an increased level of discomfort? (Select all that apply.)

- Grimacing is correct. Clients who have cognitive impairment or communication challenges (e.g., expressive aphasia) require careful nursing assessment. The client might not report pain effectively, and the nurse should look for behaviors that suggest pain is present such as guarding, grimacing, restlessness, and other behavioral changes. - Restlessness is correct. Clients who have cognitive impairment or communication challenges (e.g., expressive aphasia) require careful nursing assessment. The client might not report pain effectively, and the nurse should look for behaviors that suggest pain is present such as guarding, grimacing, restlessness, and other behavioral changes. - Elevated temperature is incorrect. An elevated temperature is not an indication of an increased pain level. Physiologic indicators of pain include changes to vital signs such as an elevated blood pressure or pulse. - Increased diaphoresis is correct. Objective indicators of pain include crying, sweating, restlessness, grimacing, or guarding by the client. Objective indicators are manifestations that can be observed by the nurse using their senses of sight, hearing, smell, and touch. - Bradycardia is incorrect. Bradycardia is not an indication of an increased pain level. An increase in the resting heart rate of greater than 20/min can be a physiologic indicator of the presence of pain.

A nurse is caring for a client who has severe pain and repeatedly asks for pain medication. The nurse is busy and forgets to assess the client's pain and administer prescribed pain medication. Which of the following can the nurse be charged with?

- Malpractice Malpractice is a negligent act performed by a professional or trained personnel that can occur by not adhering to the standard of care for pain management. - Negligence Negligence means failure to perform in a manner that a reasonable person would have. By failing to assess the client's pain and administer the client's pain medication, the nurse was negligent. - Nonmaleficence Nonmaleficence is an ethical term used to describe causing no harm to clients. This nurse's negligence caused harm to the client from prolonged suffering with pain. - Beneficence Beneficence is an ethical term used to describe doing good for clients. This nurse would have demonstrated beneficence for the client by medicating them for their pain and reducing the amount of pain.

A nurse is discussing the use of heat therapy with a newly licensed nurse. The nurse should include that heat therapy is effective for which of the following conditions? (Select all that apply.)

- Muscular pain is correct. The nurse should discuss the fact that heat therapy, in the form of a heating pad or hot water bottle, is typically used for muscular pain relief, such as back pain or menstrual pain. - Active bleeding is incorrect. Active bleeding is not a condition where heat therapy is effective. It is contraindicated for active bleeding because heat causes vasodilation and increases bleeding. - Backache is correct. The nurse should discuss the fact that heat therapy, in the form of a heating pad or hot water bottle, is typically used for muscular pain relief, such as back pain or menstrual pain. - Menstrual discomfort is correct. The nurse should discuss the fact that heat therapy, in the form of a heating pad or hot water bottle, is typically used for muscular pain relief, such as back pain or menstrual pain. - Swollen extremity is incorrect. The use of heat is contraindicated for a swollen extremity. The nurse should apply an ice pack to decrease swelling.

A nurse is caring for a client who is postoperative following abdominal surgery and has a morphine PCA pump. Which of the following medications should the nurse ensure is available in case the client develops respiratory depression?

- Naloxone Naloxone is a reversal agent for respiratory depression caused by opioids. It works quickly to reverse the effects of opioids on the client's respiratory system. - Lidocaine Lidocaine is not a reversal agent for opioid-induced respiratory depression. It is a local anesthetic. - Prednisone Prednisone is not a reversal agent for opioid-induced respiratory depression. It is a corticosteroid that is used as an adjuvant medication to assist with pain relief. - Amitriptyline Amitriptyline is not a reversal agent for opioid-induced respiratory depression. It is a tricyclic antidepressant that can be used as an adjuvant medication to assist with pain relief.

A charge nurse is reviewing factors that can affect a client's perception of pain with a newly licensed nurse. Which of the following should the charge nurse include? (Select all that apply.)

- Stress is correct. Stress levels are psychological factors that can affect a client's experience with pain. Other psychological factors include mood/affect, catastrophizing (assuming the worst), and coping. - Dietary practices is incorrect. Factors that can affect a client's experience with pain include biological, psychological, and social factors. Dietary practices do not affect pain perception. - Culture is correct. A client's identified culture is a social factor that can affect a client's experience with pain. Social factors also include economic factors, the social environment, and social support. - Social support is correct. The availability of support from family and or friends is a social factor that can affect a client's experience of pain. Social factors also include cultural and economic factors and the social environment. - Disease severity is correct. The severity of a client's disease is a biological factor that can affect a client's experience of pain. Biological factors also include nociception, inflammation, and brain function.

A nurse is discussing cutaneous stimulation with a client who has back pain. Which of the following methods should the nurse include? (Select all that apply.)

- Transcutaneous electronic stimulating unit (TENS unit) is correct. The nurse should include transcutaneous electronic stimulating unit (TENS unit) as a method of cutaneous stimulation. This nonpharmacological cutaneous stimulation can be effective for the relief of back pain. - Distraction techniques is incorrect. Distraction techniques are a nonpharmacological pain intervention that use cognitive strategies such as relaxation, imagery, mindfulness, meditation, and music therapy. These strategies do not involve stimulation of the skin nor the need to touch the client. Cognitive strategies have been effective in the treatment of acute and chronic pain. - Massage is correct. The nurse should include massage as a method of cutaneous stimulation. This nonpharmacological cutaneous stimulation can be effective for the relief of back pain. - Acupuncture is correct. The nurse should include acupuncture as a method of cutaneous stimulation. This nonpharmacological cutaneous stimulation can be effective for the relief of back pain. - Cold therapy is correct. The nurse should include the application of cold therapy as a method of cutaneous stimulation. This nonpharmacological cutaneous stimulation can be effective for the relief of back pain.

A nurse is caring for an older adult client who has a cognitive impairment and is postoperative. Which of the following actions should the nurse take?

- Use the Crying, Requires Oxygen, Increases Vital Signs, Expression, Sleeplessness (CRIES) pain scale. The CRIES pain scale is used to assess pain in infants born at 38 weeks of gestation or greater. It would not be an appropriate scale for an older adult client. A client who has a cognitive impairment should be observed for the presence of nonverbal signs such as guarding, grimacing, restlessness, and other behavioral changes. - Reassure family members that older adult clients have a decreased ability to sense pain. As age increases, pain seems to increase for neuropathic conditions and for joint and lower extremity conditions. Research suggests that pain tolerance does not change significantly as a person ages. - Evaluate the client for pain by observing their behavior. Clients who have cognitive impairment might be unable to appropriately report their pain. The nurse should observe for behaviors that suggest pain is present such as guarding, grimacing, restlessness, and other behavioral changes. - Assign a pain scale number based on the FACES pain scale. The FACES pain scale is appropriate to use in children ages 3 and up. The scale is intended for clients to rate their own pain, not for others to rate the pain of the client.