Chapter 12 Pain Management
A client comes to the clinic and informs the nurse that he needs more analgesics for chronic pain. The client states that the medication is not as strong, and he requires more than the prescribed dose. What does the nurse suspect is occurring with the client? A.) Addiction B.) Tolerance C.) Physical dependence D.) Withdrawal symptoms
Answer: B.) Tolerance
Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission? A.) A child quickly removing a hand when touching a hot object B.) A surgeon making an incision to perform surgery C.) A mother in labor utilizing imagery to reduce pain D.) A patient taking tramadol to enhance pain management
Answer: A.) A child quickly removing a hand when touching a hot object Rationale: Transduction, the first process involved in nociception, refers to the processes by which a noxious stimulus, such as a burn, releases of a number of excitatory compounds, which move pain along the pain pathway. Transmission, the second process involved in nociception, is responsible for a rapid reflex withdrawal from painful stimulus. The third process involved in nociception is perception. Imagery is based on the belief that the brain processes can strongly influence pain perception. A dual-mechanism analgesic agent, such as tramadol, involves many different neurochemicals as in the process of modulation.
The nurse is obtaining data regarding medications the client is taking on a regular basis. The client states he is taking duloxetine, an antidepressant for the treatment of neuropathic pain. What type of therapy does the nurse understand the client is receiving? A.) Adjuvant drug therapy B.) Replacement drug therapy C.) Alternate drug therapy D.) Withdrawal therapy
Answer: A.) Adjuvant drug therapy Rationale: Adjuvant drugs are medications that are ordinarily administered for reasons other than treating pain. Duloxetine is used to treat depression but is being used for neuropathic pain for this client.
The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain? A.) Diaphoresis B.) Bradycardia C.) Hypotension D.) Decreased respiratory rate
Answer: A.) Diaphoresis Rationale: Observe behavioral signs, e.g., facial expressions, crying, restlessness, diaphoresis (sweating), and changes in activity. A pain behavior in one patient may not be in another. Try to identify pain behaviors that are unique to the patient ("pain signature"). Increased heart rate, blood pressure, and respiratory rate would be more likely to be associated with pain rather than decreased levels of these measures.
The nurse understands that which of the following physiologic changes that influence the pain response occur in the gerontologic population? A.) Increased sensitivity to medications B.) Lower blood levels of medications C.) Faster metabolism of medications D.) Decreased use of prescription and over-the-counter (OTC) medications
Answer: A.) Increased sensitivity to medications
A new surgical patient has been prescribed an opioid analgesic intravenously for pain control. The nurse should be aware of which most serious adverse effect of this medication? A.) Respiratory depression B.) Nausea and vomiting C.) Constipation D.) Pruritus
Answer: A.) Respiratory depression
When completing a teaching plan for a client receiving patient-controlled analgesia (PCA), which component would be important for the nurse to stress? A.) The pump will deliver a preset amount of medication. B.) The client should wait until the pain is severe to push the button to prevent overdose. C.) Teach the client to avoid pushing the button multiple times because additional doses will be given. D.) Chance of sedation is rare when using a PCA pump.
Answer: A.) The pump will deliver a preset amount of medication.
A client reports having joint pain that has gotten worse over the last year despite gradually increasing doses of an OTC pain reliever. Which type of pain will the nurse document as the chief complaint? A.) chronic pain B.) acute pain C.) referred pain D.) breakthrough pain
Answer: A.) chronic pain
According to The Joint Commission's pain assessment and management standards, which of the following are essential components of a comprehensive pain assessment? A.) location, onset, alleviating factors, and aggravating factors B.) quality, location, intensity, and family history C.) nutritional deficiencies, onset, duration, and effects of pain D.) intensity, variations, range of motion, and the client's goal for pain control
Answer: A.) location, onset, alleviating factors, and aggravating factors
A client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. The client is without breakthrough pain at this point in time. How would this client's pain be classified? A.) neuropathic and chronic B.) nociceptive and chronic C.) nociceptive and acute D.) neuropathic and acute
Answer: A.) neuropathic and chronic Rationale: When classified according to its source, pain can be categorized as nociceptive or neuropathic. When classified according to its onset, intensity, and duration, pain can be categorized as either acute or chronic. Because the client is without breakthrough pain at this time, he has no acute pain. Nociceptive pain is transmitted from a point of cellular injury to the brain. This is not the type of pain related to long-term diabetes mellitus. Neuropathic pain sustained by injury or dysfunction of the peripheral or central nervous systems. This type of pain is related to long-term diabetes mellitus. Acute pain is pain or discomfort of short duration: from a few seconds to less than 6 months. This is not the type of pain related to long-term diabetes mellitus.
The client is taking continuous-release oxycodone for chronic pain and now reports constipation. What should be the first question the nurse asks the client? A.) "What do you usually take for constipation?" B.) "When was your last bowel movement?" C.) "Can you take bisacodyl?" D.) "Are you able to increase fluids and fiber in your diet?"
Answer: B.) "When was your last bowel movement?"
Which is a true statement regarding placebos? A.) A placebo effect is an indication that the client does not have pain. B.) A placebo should never be used to test a client's truthfulness about pain. C.) A placebo should be used as the first line of treatment for a client. D.) A positive response to a placebo indicates that the client's pain is not real.
Answer: B.) A placebo should never be used to test a client's truthfulness about pain.
A 75-year-old client had surgery for a hip fracture yesterday. The client is under stress because of the pain, the medications, sleep deprivation, and hospital surroundings. Which nursing intervention to treat the client's pain should the nurse question when ordered by the doctor? A.) Use of transcutaneous electrical nerve stimulator (TENS) B.) Advil for pain management C.) Morphine rather than Advil for pain management D.) Acetaminophen for pain management
Answer: B.) Advil for pain management Rationale: NSAIDs such as Advil increase the risk of gastrointestinal (GI) toxicity in individuals >60 years of age and should be assessed further before administration. Many risk factors exist for opioid-induced respiratory depression in individuals >65 years old; a thorough respiratory assessment is indicated. Acetaminophen should be used for mild pain. Nonpharmacologic methods of pain management, such as TENS, are acceptable in this situation. Society has proposed that opioids are a safer choice than NSAIDs in many older adults because of the increased risk for NSAID-induced adverse GI effects in that population.
The client, newly admitted to the hospital, is unsure of home medications and is wearing a transdermal fentanyl patch. What is most important for the nurse to do first? A.) Remove the old patch B.) Check the dose C.) Teach about adverse reactions D.) Ask about constipation
Answer: B.) Check the dose Rationale: The dosage of any medication should be checked for correctness. This is basic medication administration to prevent error. The nurse will also perform the other options listed.
Which of the following nursing interventions contributes to achieving a client's goal for pain relief? A.) Minimize the client's description of pain or need for pain relief. B.) Collaborate with the client about his or her goal for a level of pain relief. C.) Use all forms of available pain management techniques. D.) Prevent the client from self-administering analgesics.
Answer: B.) Collaborate with the client about his or her goal for a level of pain relief.
A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing? A.) Breakthrough pain B.) Neuropathic pain C.) Visceral pain D.) Referred pain
Answer: B.) Neuropathic pain
A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be: A.) Attributed to a specific cause. B.) Prolonged in duration. C.) Rapidly occurring and subsiding with treatment. D.) Separate from any central or peripheral pathology.
Answer: B.) Prolonged in duration.
When caring for a patient who is receiving an opioid analgesic agent, the nurse knows to assess for the most serious side effect of: A.) Renal toxicity B.) Respiratory depression C.) Seizures D.) Hypotension
Answer: B.) Respiratory depression
Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy? A.) Risk for injury B.) Risk for impaired gas exchange C.) Diarrhea D.) Altered mobility
Answer: B.) Risk for impaired gas exchange
A client reports abdominal pain as "8" on a pain intensity scale of 0-10 thirty minutes after receiving an opioid intravenously. Her past medical history includes partial-thickness burns to approximately 60% of her body several years ago. The nurse assesses A.) That based on her past experiences the client's perception of pain should be less B.) That the client's past experiences with pain may influence her perception of current pain C.) That the client has become dependent on drugs from her previous experience of burns D.) That the client is experiencing pain relating to the burn injuries from several years ago
Answer: B.) That the client's past experiences with pain may influence her perception of current pain
The nurse informs the patient that a preventive approach for pain relief will be used, involving nonsteroidal anti-inflammatory drugs. What will this mean for the patient? A.) The pain medication will be administered before the pain becomes severe. B.) The pain medication will be administered before the pain is experienced. C.) The pain medication will be administered when the pain is at its peak. D.) The pain medication will be administered when the level of pain tolerance has been exceeded.
Answer: B.) The pain medication will be administered before the pain is experienced.
A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends A.) ingesting up to 6 glasses of fluids per day B.) increasing the amount of bran and fresh fruits and vegetables C.) using milk of magnesia 30 mL every day D.) inserting a bisacodyl (Dulcolax) rectal suppository every morning
Answer: B.) increasing the amount of bran and fresh fruits and vegetables Rationale: Constipation is a common problem with the use of opioid medications, such as methadone. Activities to prevent constipation include increasing bran and fresh fruits and vegetables in the diet. The client should ingest 8 to 10 glasses of fluids per day. Milk of magnesia may be used if no bowel movement is produced in 3 days. Milk of magnesia is not to be used daily. A glycerin suppository, not bisacodyl, may be used to make the bowel movement less painful.
Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain? A.) Avoid caffeine or other stimulants, such as decongestants B.) Monitor weight, vital signs, and serum glucose concentration C.) Do not administer if respirations are less than 12 breaths per minute D.) Monitor blood counts and liver function tests
Answer: C.) Do not administer if respirations are less than 12 breaths per minute
An older adult is being treated with opioids for pain relief. Which of the following should the nurse strongly recommend to this client? A.) Exercise regularly. B.) Avoid harsh sunlight. C.) Follow a bowel regimen. D.) Reduce fiber intake.
Answer: C.) Follow a bowel regimen. Rationale: The nurse should ensure that a bowel regimen to prevent constipation is started when any older adult is treated with opioids. A high-fiber diet along with increased fluids should be encouraged. The client should not reduce fiber intake because this increases the risk for constipation. The client need not exercise regularly or avoid harsh sunlight because these have no effects on the drug therapy.
The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient? A.) Older people are expected to experience chronic pain. B.) Older people have a decreased pain threshold. C.) Older people experience reduced sensory perception. D.) Older people have increased sensory perception.
Answer: C.) Older people experience reduced sensory perception.
The nurse has given an older adult an oral opioid for postoperative pain. What should the nurse do first to make the pain medication more effective? A.) Consult with the health care prescriber to include hydroxyzine with the opioid. B.) Provide the client with a fresh gown. C.) Position the client for comfort. D.) Encourage the client to eat crackers.
Answer: C.) Position the client for comfort.
A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain? A.) Administer oral opioids as needed. B.) Provide patient-controlled analgesia. C.) Administer pain medication through a transdermal patch. D.) Administer analgesics around the clock.
Answer: D.) Administer analgesics around the clock.
A home health nurse is visiting a client who has been taking the same dose of acetaminophen/hydrocodone for 2 months. To monitor for the presence of expected side effects of this medication, what should the nurse include in the assessment of the client? A.) Observe respiratory rate and depth. B.) Assess level of consciousness. C.) Take the client's blood pressure. D.) Ask about the client's bowel pattern.
Answer: D.) Ask about the client's bowel pattern.
When a nurse asks a patient to describe the quality of the pain, what type of descriptive term does the nurse expect the patient to use? A.) Chronic B.) Intermittent C.) Severe D.) Burning
Answer: D.) Burning
The physician has ordered a mu opioid analgesic for a patient with pain. What drug does the nurse anticipate administering? A.) Nubain B.) Stadol C.) Buprenex D.) Fentanyl
Answer: D.) Fentanyl Rationale: Opioid analgesic agents are divided into two major groups: (1) mu agonist opioids (also called morphine-like drugs) and (2) agonist-antagonist opioids. The mu agonist opioids comprise the larger of the two groups and include morphine, hydromorphone, hydrocodone, fentanyl, oxycodone, and methadone, among others. The agonist-antagonist opioids include buprenorphine (Buprenex, Butrans), nalbuphine (Nubain), and butorphanol (Stadol).
A high school football player hurts his foot while playing a game. The client complains of intense pain with muscle spasms and swelling of the toe. Which pain assessment tool will the nurse most likely use to assess the client's pain level? A.) Wong-Baker FACES Pain Rating Scale B.) Verbal Descriptor Scales (VDS) C.) Visual Analog Scale (VAS) D.) Numeric Rating Scale (NRS)
Answer: D.) Numeric Rating Scale (NRS)
Which phase of pain transmission occurs when the brain experiences pain at a conscious level? A.) Transmission B.) Modulation C.) Transduction D.) Perception
Answer: D.) Perception
Which phase of pain transmission occurs when the one is made aware of pain? A.) Transmission B.) Modulation C.) Transduction D.) Perception
Answer: D.) Perception
The nurse is visiting a client at home with intractable cancer pain. The client has a transdermal fentanyl patch on her right chest area. It is most important for the nurse to A.) Instruct the client to note fatigue or extreme sleepiness. B.) Inform the client about use of alcohol with fentanyl. C.) Assess for the date of the client's last bowel movement. D.) Remove the heating pad present on the chest area.
Answer: D.) Remove the heating pad present on the chest area. Rationale: A heating pad over the transdermal patch will increase release of the medication, exposing the client to an overdose. The nurse will also perform the other options listed.
The nurse's major area of assessment for a patient receiving patient-controlled analgesia is assessment of what system? A.) Cardiovascular B.) Integumentary C.) Neurologic D.) Respiratory
Answer: D.) Respiratory
A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client A.) About activities that would distract him from pain B.) That the nurse will notify the surgeon of his fear C.) How anxiety could increase his pain perception D.) That medication will be prescribed for pain relief
Answer: D.) That medication will be prescribed for pain relief
The nurse is monitoring a client who is in the hospital and has a fentanyl patch in place for the control of breakthrough pain for breast cancer. What would be a concern for the nurse when she obtains vital signs for this client? A.) Temperature of 99F B.) Blood pressure 100/60 mm Hg C.) Respiratory rate of 10 breaths/minute D.) Heart rate of 96 beats/minute
Answer: C.) Respiratory rate of 10 breaths/minute
The nurse is to administer meperidine 75 mg intramuscularly to a client. The medication is supplied in an ampule of 50 mg/mL. How many milliliters should the nurse administer to the client? Enter the correct number ONLY.
Answer: 1.5
A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client A.) "Whenever you hurt, push the button." B.) "Only you are to push the button for medication." C.) "Wait until your pain is severe before pushing the button." D.) "This will completely relieve your pain."
Answer: B.) "Only you are to push the button for medication."
