Ch. 34: Comfort and Pain Management PrepU

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? a) "One advantage of the TENS unit is it increases blood flow." b) "I may need fewer pain medications with the TENS unit in place." c) "Wearing the TENS unit should not interfere with my daily activities." d) "I could use the TENS unit if I feel pain somewhere else on my body."

"I could use the TENS unit if I feel pain somewhere else on my body." Explanation: The client needs further instruction when she says she can use the TENS unit on other areas of the body. Such a statement would indicate that the client does not understand that the unit should be used as prescribed by the physician in the location defined by the physician

What type of nonpharmacologic pain relief measure uses electrical stimulation to inhibit transmission of painful impulses? a) hypnosis b) TENS c) acupuncture d) acupressure

TENS Explanation: TENS (transcutaneous electrical nerve stimulator) is a noninvasive alternative technique that involves electrical stimulation to inhibit transmission of painful impulses.

The nurse is teaching a client how to manage their post-operative pain through a Patient Controlled Analgesia (PCA) pump. The nurse determines that additional teaching is needed when the client states which of the following? a) "I give myself the pain medication by pushing the button." b) "This will allow me to control my own pain medication." c) "I should only take medication when my pain is intense." d) "The pump is programmed to limit the chance of over-medicating."

"I should only take medication when my pain is intense." Explanation: PCA pumps allow the client to control the amount and timing of pain medication by pushing a button when the sensation of pain occurs versus waiting until the pain becomes intense. The pump is programmed with a lockout period that limits the chance of clients over-medicating themselves.

Which of the following client statements would indicate to the nurse that the client needs additional teaching regarding prn pain medication and management? (Select all that apply.) a) "The nurse will know when my medication is due and will give it to me automatically." b) "If I ask for pain medication, I may become addicted." c) "I should wait until my pain gets worse before asking for pain medications." d) "I should ask for my pain medication when I am feeling pain." e) "It's better to put up with the pain than deal with side effects of medication."

"I should wait until my pain gets worse before asking for pain medications." • "It's better to put up with the pain than deal with side effects of medication." • "If I ask for pain medication, I may become addicted." • "The nurse will know when my medication is due and will give it to me automatically." Explanation: The nurse should determine that the additional teaching is needed relating to prn pain medication and management when they state any of the following: "I should wait until my pain gets worse before asking for pain medications"; "It's better to put up with the pain than deal with the side effects of medication"; "If I ask for pain medication, I may become addicted".

After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client? a) 1 b) 2 c) 3 d) 4

3 Explanation: The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: 1 = awake and alert; no action necessary 2 = occasionally drowsy but easy to arouse; requires no action 3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose 4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

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 uses deep-breathing exercises to distract a client from his pain. b) A nurse distracts the client by playing his favorite music. c) A nurse applies intermittent heat and cold to a client's leg. d) A nurse guides a client to use imagery.

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.

Who is the authority on the presence and extent of pain experienced by a client? a) The client b) A nurse c) An anesthesiologist d) A surgeon

The client Explanation: The only one who can be a real authority on whether, and how, an individual is experiencing pain is that individual.

A client states that he is pain and requests the ordered pain medication. When entering the client's room, the client is laughing with visitors and does not appear to be in pain. What is the appropriate action by the nurse? a) Contact the client's physician. b) Administer the pain medication. c) Hold the pain medication. d) Reassess the client's pain in 30 minutes.

Administer the pain medication. Explanation: Pain is considered to be present whenever the client states it is. Therefore, the nurse should administer the client's pain medication. It would be inappropriate to delay administration or to hold the medication. There is no indication that the client's physician needs to be notified at this time.

A nurse is caring for a client who received Narcan to reverse respiratory depression due to opioid therapy. The client is now complaining of pain and wishes to receive the newly prescribed pain medication. What is the correct action by the nurse? a) Administer the medication when the client's blood pressure is > 140/90. b) Administer the medication when the client's heart rate is < 90. c) Administer the medication if respiratory rate is > 9. d) Administer the medication when the client's heart rate is > 80.

Administer the medication if respiratory rate is > 9. Explanation: The nurse can safely administer the new pain medication when the client's respiratory rate is greater than 9.

A client is ordered pain medication every 4 to 6 hours as needed. When the nurse enters the client's room to administer the medication, the client is laughing with visitors. The client's pulse rate is 64, respirations 16, and blood pressure 120/80. The client states that they are in pain and wants the medication. What is the most appropriate action by the nurse? a) Encourage the client to use alternative pain relief measures. b) Hold the pain medication at this time. c) Reassess the need for pain medication in 30 minutes. d) Administer the pain medication.

Administer the pain medication. Explanation: Pain is present whenever the client perceives that they are in pain. The client is ordered the medication, the client's vital signs are within acceptable range, and the client states that they are in pain. Therefore, the nurse should administer the pain medication as ordered.

A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the nurse's best intervention in this situation? a) Distract the boy so he does not notice his pain. b) Medicate the boy with analgesics to reduce the anxiety of experiencing pain. c) Ask the boy to draw a cartoon about the color or shape of his pain. d) Ignore the boy's pain if he is not complaining about it.

Ask the boy to draw a cartoon about the color or shape of his pain. Explanation: Asking the boy to draw a cartoon about the color or shape of his pain is an excellent intervention by the nurse. The child could be in pain and not complaining, so ignoring the boy's pain is not correct. Distracting the boy so he does not notice his pain would not be appropriate. Medicating the boy with analgesics to reduce the anxiety of experiencing the pain is not correct. Addressing the anxiety does not address the pain.

A client prescribed pain medication around the clock experiences pain one hour before the next dose of the pain medication is due. Which is the most appropriate action by the nurse? a) Administer the next dose of the pain medication. b) Assess the client for signs of narcotic addiction. c) Assess for medication order for breakthrough pain. d) Tell the client he has to wait for one hour.

Assess for medication order for breakthrough pain. Explanation: Breakthrough pain is a temporary flare-up of moderate to severe pain that occurs even when the client is taking pain medication around the clock. It can occur before the next dose of analgesic is due (end of dose pain). It is treated most effectively with supplemental doses of a short-acting opioid taken on an "as needed basis." Therefore, the client should check the orders for breakthrough pain medication.

The nurse is preparing to administer an NSAID to a client for pain relief. The nurse notices that the client is diagnosed with a bleeding disorder. What should the nurse do? a) Administer the medication with food. b) Administer the medication. c) Contact the physician. d) Ask the client if they want the medication.

Contact the physician. Explanation: The nurse should contact the physician regarding the diagnosis of a bleeding disorder and the order for the NSAID. NSAIDs are contraindicated in clients with bleeding disorders, as the action of the NSAID can interfere with the client's platelet function.

Which circumstance may preclude the use of cutaneous stimulation to relieve a client's pain? a) The client has difficulty localizing his pain. b) The client's pain is chronic rather than acute. c) The client is receiving both scheduled and breakthrough analgesia. d) The client has a history of heart disease.

The client has difficulty localizing his pain. Explanation: Cutaneous stimulation requires that the client be able to localize his pain. It may be used on both chronic and acute pain, and neither analgesics nor heart problems contraindicate the use of cutaneous stimulation.

A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort? a) Serotonin b) Dopamine c) Melatonin d) Endorphins

Endorphins Explanation: Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals, which have prolonged analgesic effects and produce euphoria. It is thought that certain measures, such as skin stimulation and relaxation techniques, release endorphins.

Which of the following is considered to be the most potent neuromodulators? a) Efferent b) Endorphins c) Enkephalins d) Efferent

Endorphins Explanation: Endorphins and enkephalins are opioid neuromodulators. Endorphins are powerful pain blocking chemicals with prolonged analgesic effects. Enkephalins are considered less potent. There are no neuromodulators called efferent or afferent.

A client comes to the emergency department complaining of a shooting pain in his chest. When assessing the client's pain, which behavioral response would the nurse expect to find? a) Guarding of the chest area b) Decreased heart rate c) High blood pressure d) Increased respiratory rate

Guarding of the chest area Explanation: A person's behavioral response to pain can be demonstrated by protecting or guarding the painful area, grimacing, crying, or moaning. Increased blood pressure and respiratory rate are typical physiologic (sympathetic) responses to moderate pain. Decreased heart rate is a typical physiologic (parasympathetic) response to severe pain.

The nurse is assessing a patient for the chronology of the pain she is experiencing. Which is an example of an appropriate interview question to obtain this data? a) How would you rate the pain on a scale of one to ten? b) What do you do to alleviate your pain and how well does it work? c) How does the pain develop and progress? d) How would you describe your pain?

How does the pain develop and progress? Explanation: When assessing the chronology of the client's pain, the nurse could ask the client how does the pain develop and progress.

A nurse is assessing a client's pain. The nurse notes which database finding that is indicative of acute pain? a) Pupil constriction b) Decreased pulse rate c) Increased blood pressure d) Decreased respiratory rate

Increased blood pressure Explanation: The increase in blood pressure that may accompany acute pain is believed to be due to overactivity of the sympathetic nervous system.

The nurse is teaching a novice nurse about the therapeutic effects of laughter. Which example correctly identifies one of these effects? a) It increases the level of epinephrine. b) It causes shallow breathing. c) It decreases heart rate. d) It activates the immune system

It activates the immune system. Explanation: Therapeutic effects of laughter include activating the immune system. Therapeutic effects of laughter do not increase the level of epinephrine, decrease the heart rate, or cause shallow bre

Which of the following nonpharmacologic pain relief measures has been found to be effective for soothing agitated newborns and comatose clients? a) Distraction b) Humor c) Imagery d) Music

Music Explanation: Listening to music can relax, soothe, decrease pain, and provide distraction. It has proven effective for soothing agitated newborns and comatose clients.

A nurse assesses a client who is being given an opioid analgesic and finds the client unresponsive to shaking or other stimuli. What drug might be ordered to reverse this state? a) Naloxone b) Aspirin c) Cortisone d) Penicillin

Naloxone Explanation: Naloxone is an opioid antagonist that reverses the respiratory-depressant effects of opioids. If stimulation is ineffective in arousing a client using opioids, naloxone can be used. When the client is alert and the respiratory rate is greater than 9 breaths/min, the opioids may be resumed.

The nurse preparing to admit a client receiving epidural opioids should make sure that which of the following medications is readily available on the unit? a) Lopressor b) Lasix c) Narcan d) Digoxin

Narcan Explanation: The nurse should ensure that Narcan is readily available on the unit, as it can reverse the respiratory depressant effects of opioids.

The nurse is administering oxycodone to a client. To which category of analgesics does this belong? a) Adjuvant b) Multipurpose c) Nonsteroidal anti-inflammatory d) Opioid

Opioid Explanation: Opioids analgesics were formerly called narcotic analgesics and are used to manage moderate to severe pain. These include morphine, codeine, oxycodone, meperidine, hydromorphone, and methadone.

A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client? a) Corticosteroids b) Nonopioid analgesics c) NSAIDs d) Opioid analgesics

Opioid analgesics Explanation: The nurse would expect to administer opioid analgesics to a client with severe pain following a mastectomy. Nonopioid analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), are usually the drugs of choice for both acute and persistent moderate chronic pain. Corticosteroids would be used to address inflammation and swelling.

While assessing a client on PCA therapy, the nurse finds the client to be somnolent, with minimal response to physical stimulation, scoring a 4 on the sedation scale. What is the best nursing action to take in this situation? a) Increase frequency of monitoring the client to every 15 minutes. b) Sit the client up in high-Fowler position and encourage deep breathing. c) Stop the PCA infusion and check the medication level. d) Stop the PCA infusion immediately and prepare to administer naloxone.

Stop the PCA infusion immediately and prepare to administer naloxone. Explanation: If a client receiving a PCA infusion becomes somnolent, with a sedation score of 4, the best nursing action is to stop the medication infusion immediately and notify the primary care provider. The nurse should prepare to administer oxygen and a narcotic antagonist, such as naloxone (Narcan).

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

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.

Which guideline regarding pain should be included in the nurse's education plan for a group of parents with infants and toddlers? a) Infants cannot express pain until 8 months of age. b) Toddlers are often reluctant to express pain. c) Toddlers often try to be brave and not cry. d) Pain can be a source of fear and threat to the toddler's security.

Pain can be a source of fear and threat to the toddler's security. Explanation: During the toddler and preschool years, children are achieving a sense of autonomy. Because pain can be a source of fear and threat to security, children respond with crying, anger, physical resistance, or withdrawal.

A nurse is caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain? a) Phantom pain b) Cutaneous pain c) Referred pain d) Visceral pain

Phantom pain Explanation: The nurse should document the pain as phantom pain, a type of neuropathic pain that is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. The client perceives that the amputated limb still exists and feels burning, itching, and deep pain in tissues that have been surgically removed.

The nurse caring for a client receiving opioid therapy notes that the client's respirations are 7. What is the first action by the nurse? a) Take the client's blood pressure. b) Begin cardiac compressions. c) Physically stimulate client. d) Administer Narcan

Physically stimulate client. Explanation: The first action by the nurse is to physically stimulate the client by shaking the client or using a loud sound, followed by reminders every few minutes to breathe deeply. If this is ineffective, Narcan can be used to reverse the respiratory depressant effect of the opioid.

Three days after surgery, a patient continues to have moderate to severe incisional pain. Based on the gate control theory, what action should the nurse take? a) Administer pain medications in smaller doses but more frequently. b) Decrease external stimuli in the room during painful episodes. c) Advise the patient to try to sleep following administration of pain medication. d) Reposition the patient and gently massage the patient's back.

Reposition the patient and gently massage the patient's back. Explanation: The nurse would reposition the client and gently massage the client's back using the gate control theory of pain. The gate control theory provides the most practical model regarding the concept of pain. It describes the transmission of painful stimuli and recognizes a relation between pain and emotions. Nursing measures, such as massage or a warm compress to a painful lower back area, stimulate large nerve fibers to close the gate, thus blocking pain impulses from that area.

Which of the following is the priority assessment for a nurse caring for a client with a Patient Controlled Analgesia (PCA) pump? a) Cardiovascular b) Nueromuscular c) Peripheral Vascular d) Respiratory

Respiratory Explanation: The priority assessment for the nurse caring for a client with a PCA pump is respiratory, with particular attention to the respiratory rate and pattern. Too much narcotic or a displaced catheter may allow the medication to have a depressant effect on the brainstem center, causing life-threatening respiratory depression.

Which assessment finding is consistent with the presence of pain? a) Decreased blood pressure b) Decreased pulse c) Restlessness d) Euphoria

Restlessness Explanation: Common assessment findings that are present when a client is in pain include restlessness, grimacing, crying, clenching fists, guarding of the painful area, increased blood pressure and pulse, and reported pain.

A nurse is caring for a client who was administered opioid narcotics. The client reports constipation. What is another potential side effect of opioid narcotics? a) Insomnia b) Diarrhea c) Anxiety d) Sedation

Sedation Explanation: Opioids and opiates can cause sedation, nausea, and constipation. They also can cause respiratory depression, which is the main side effect to watch for with narcotics. Opioids and opiates do not lead to anxiety, diarrhea, or insomnia in clients.

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) Supplementary oxygen and chest physiotherapy b) Calorie restriction and dietary supplements c) Frequent turns and application of skin emollients d) Stool softeners and increased fluid intake

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.

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) An antidote is automatically delivered if the client exceeds the recommended dose. 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) The dose that is delivered when the client activates the machine is preset.

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.

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 assists the client to focus on something pleasant rather than on pain. b) The nurse teaches the client deep breathing techniques for relaxation. c) The nurse gives the client a massage before bed. d) The nurse plays soft music in the client's room.

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).

Which statements accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain? a) A PCA pump must be used and monitored in a health care facility. b) The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. c) This approach can only be used with oral analgesics. d) The PCA pump is not effective for chronic pain.

The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. Explanation: The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. This approach can be used with oral analgesic agents as well as with infusions of opioid analgesic agents by intravenous, subcutaneous, epidural, and perineural routes. This drug delivery system may be used to manage acute and chronic pain in a health care facility or the home.

The nurse is providing education to a client about the role of endogenous opioids in the transmission of pain. Which information about the release of endogenous opioids is most accurate? a) They block glutamate receptors and peptides. b) They bind to opioid receptor sites throughout the CNS. c) They occupy cell receptors for neurotransmitters. d) They react with acetylcholine and serotonin.

They bind to opioid receptor sites throughout the CNS. Explanation: When endogenous opioids are released, they are believed to produce their analgesic effects by binding to specific opioid receptor sites throughout the central nervous system (CNS), blocking the release or production of pain-transmitting substances.

A nurse is caring for a client who complains of an aching pain in the abdomen. The nurse also noted that the client is guarding the area. What kind of pain is the client experiencing? a) Somatic pain b) Cutaneous pain c) Visceral pain d) Neuropathic pain

Visceral pain Explanation: The client is experiencing visceral pain, which is poorly localized and originates in body organs in the thorax, cranium, and abdomen. A reflex contraction or spasm of the abdominal wall, called guarding, may occur as a protective mechanism to prevent additional trauma to underlying structures. In cutaneous pain, the discomfort originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma.

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? a) Somatic pain b) Visceral pain c) Cutaneous pain d) Referred pain

Visceral pain Explanation: Visceral pain occurs when organs stretch abnormally and become distended, ischemic, or inflamed. Appendicitis is characterized by inflammation of the vermiform appendix. Cutaneous pain is superficial. Somatic pain is more commonly associated with tendons, ligaments, and bones. Referred pain is perceived distant from its point of origin, but this client's pain is sensed near the location of his appendix.

A client asks the nurse which vitamins should be taken daily for feelings of fatigue, anxiety, and depression 1 week before menses. Which of the following is the correct response by the nurse? a) Vitamin A b) Vitamin C c) Vitamin B6 d) Vitamin D

Vitamin B6 Explanation: The nurse should encourage taking Vitamin B6 daily, as it may be effective at relieving symptoms of irritability, fatigue, and depression related to the premenstrual period.

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) transcutaneous electrical nerve stimulation (TENS). b) hypnosis. c) Therapeutic Touch (TT). d) biofeedback.

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.

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) in the early postoperative period. b) experiencing chronic pain. c) in the postoperative stage with occasional pain. d) experiencing acute 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 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? a) acute pain b) referred pain c) limited pain d) chronic pain

referred pain Explanation: Pain from the abdominal, pelvic, or back region may be referred to areas far distant from the site of tissue damage.

The nurse is visiting a client at home who is recovering from a bowel resection. The client reports constant pain and discomfort and displays signs of depression. When assessing this client for pain, what should be the nurse's focal point? a) reviewing and revising the pain management treatment plan b) administering a placebo and performing a reassessment of the pain c) beginning pain medications before the pain is too severe d) judging whether the client is in pain or is just depressed

reviewing and revising the pain management treatment plan Explanation: The nurse's focal point should be on reviewing and revising the pain management treatment plan presently in place. The client is status-post bowel resection

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) drug interactions. b) tolerance. c) addiction. d) physical dependence.

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. Tolerance does not indicate addiction or a heightened risk of addiction. The phenomenon noted is not indicative of a drug interaction.

What are examples of the use of guided imagery to promote client comfort? Select all that apply. a) A nurse asks a client to focus on tightening and relaxing a particular muscle group. b) A nurse asks a client to concentrate on the details of a pleasant image. c) A nurse asks a client to imagine sitting on the beach on a sunny day. d) A nurse instructs a client how to breathe properly for relaxation. e) A nurse reads a book to a client who is postcataract surgery. f) A nurse plays a client's favorite music in the background.

• A nurse asks a client to imagine sitting on the beach on a sunny day. • A nurse asks a client to concentrate on the details of a pleasant image. Explanation: Guided imagery helps the client to become gradually less aware of the discomfort or pain. Positive emotions evoked by the image help reduce the pain experience.

The nurse that ascribes to the gate control theory of pain would be most likely to prescribe which of the following for the relief of pain? (Select all that apply.) a) Cold b) Massage c) Heat d) Percocet e) Tylenol

• Cold • Massage • Heat Explanation: The gate theory supports that the signals at the gate in the spinal cord determine which impulses eventually reach the brain. A limited amount of sensory information can be processed by the nervous system at any given moment. When there is too much information sent through, certain cells in the spinal column interrupt the signal as if closing a gate. The theory appears to explain why mechanical and electrical interventions such as heat, cold, pressure, and massage provide effective pain relief.

The nurse desiring to use laughter as a therapeutic modality for pain should assess for which of the following therapeutic effects? a) Increased pain threshold b) Decreased heart rate c) Decreased levels of epinephrine d) Increased ability to face difficult procedure e) Shallow respirations

• Decreased levels of epinephrine • Increased pain threshold • Increased ability to face difficult procedure Explanation: When evaluating the therapeutic effects of laughter, the nurse should assess for decreased levels of epinephrine, increased pain threshold, and increased ability to help one face difficult procedures. Additional therapeutic effects include activation of immune system, promote spiritual and psychological coping, create positive atmosphere, increased heart rate, deepened respirations, and contraction of the muscles.