Chapter 20: Pain Management
A postoperative vaginal hysterectomy client complains of pain that is more intense than this morning. This factor should be explained to the client as
"Acute pain tends to increase during the day and is called a routine pain response"
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
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
In preparing a care plan for a client receiving opioid analgesics, the nurse selects which of the following as an applicable nursing diagnosis associated with side effects of opioid use?
Constipation
A mother calls the nurse practitioner to say, "I don't know what is wrong with my baby. He cried all night and kept pulling at his ear." How would the nurse respond?
"That means his ear hurt. Bring him in to be checked."
A client has been reluctant to ask for breakthrough doses of the opioid prescribed, despite showing signs of pain. The client states to the nurse, "I don't want to become addicted to the medication." How should the nurse respond to the client's statement?
"There's only an extremely small chance that you will become addicted to this drug."
A client has just been started on opioid analgesia for pain control. The nurse assesses the client's level of sedation using a sedation scale and notes that the client is awake and alert. The nurse would assign which rating?
1
The nurse is caring for four clients. Which client does the nurse identify as the most likely to have undertreated pain? (Select all that apply.)
29-year old who has a speech impediment 34-year old with schizophrenia 41-year old who is from a different country a) 60-year old with early onset dementia
A client with peripheral neuropathy states, "Sometimes I get the worst pain from just a bedsheet brushing over my foot." What is the nurse's most appropriate action?
Document the client's allodynia.
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.
The nurse is preparing to administer narcotic 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.
Which of the following nonpharmacologic pain relief measures has been found to be effective for soothing agitated newborns and comatose clients?
Music
Whenever possible, the nurse who is treating the pain of older adults should avoid the use of which drug(s)?
NSAIDs
A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing
Neuropathic pain
A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing?
Neuropathic pain
A group of nursing students is reviewing information about the pain process. The students demonstrate understanding of the information when they identify stimulation of which as the first component in the transmission of the pain stimulus?
Nociceptors
Which guideline regarding pain should be included in the nurse's education plan for a group of parents with infants and toddlers?
Pain can be a source of fear and threat to the toddler's security.
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 has an order for a narcotic analgesic every 3 to 4 hours and he received his 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 on his first postoperative day?
Provide the client with pain medication.
A nurse at the health care facility is administering an opioid prescribed by the health care provider to a client with acute abdominal pain. However, the client tells the nurse about developing a sore throat and has difficulty swallowing. What other routes of administration can the nurse use to give the opioid narcotics to the client? Select all that apply.
Rectal route Intramuscular route Transdermal route Parenteral route
What type of nonpharmacologic pain relief measure uses electrical stimulation to inhibit transmission of painful impulses?
TENS
A client who has been harassed at 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 Pattern Theory?
asking if pain is produced by smells or sounds
What is the most reliable method for assessing pain?
asking the client
When implementing the gate-control theory of pain, which intervention will enhance the closing of the gate to the client's pain?
back massage rub
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:
biofeedback.
The nurse identifies the pain described by a client whose back discomfort began after an automobile accident and has persisted for 8 months as:
chronic.
The physician has ordered a patient controlled analgesia (PCA) pump for a client. Which assessment finding would cause the nurse to question the order?
confused to time and place
An emergency department nurse has administered a dose of morphine to a client who has presented with severe chest pain. What effect is this drug likely to have on the client's vital signs?
decreased respiratory rate
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.
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 the vital signs of a client who is moaning with pain. What would be the expected findings?
increased pulse and blood pressure
A nurse asks an adolescent female client to describe her pain using a number between 0 and 10 where 0 means no pain and 10 means severe pain. The nurse is assessing:
intensity of pain.
The nurse is caring for a client who had an above-the-knee amputation of the right leg 6 months ago. Today, the client reports right foot pain. How does the nurse describe this type of pain when talking with the interprofessional healthcare team? (Select all that apply.)
neuropathic acute
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 client tells a nurse, "I have this pounding feeling on the side of my head, like someone is hitting my head with a hammer." The nurse should identify what characteristic of pain assessment?
quality
The nurse is caring for a client who reports chest pain for 30 minutes that radiates down the left arm. How will the nurse document this type of pain? (Select all that apply.)
referred acute
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 client who was a victim of domestic violence for many years states to the nurse, "I know I should not feel this way, but every time I think of my former spouse, I get a debilitating headache and have to go lie down to make the pain go away." Which nursing intervention reflects practice according to the Endogenous Opioid Theory?
requesting healthcare provider to order opioid medication
A neurosurgeon has performed surgery on a client with intractable pain. The surgery involves sectioning a nerve root close to the spinal cord. Which surgical procedure has the physician used to relieve the client from the intractable pain?
rhizotomy
A nurse who provides care at a long-term care home for older adults is careful to ensure that the environmental temperature is kept at a comfortable level. The nurse should be aware that older adults typically prefer:
room temperatures slightly warmer than normal.
A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his 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
The nurse is performing an assessment for a client related to pain. In order to determine the need for pain medication, what should the nurse base the decision on?
temporal pattern.
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 may be responsible for this increased level of comfort?
the release of endorphins
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:
tolerance.
A client with a diagnosis of colorectal cancer has experienced significant growth in the size of the primary tumor, and this has been the cause of increasing pain in recent days. What type of pain is this client most likely experiencing?
visceral
Which assessment findings are associated with chronic pain?
weary, resigned facial expression
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 routinely noted to be laughing while on the phone, and chatting with staff. What is the appropriate nursing action when the client again comes to the ED and states that the headache is now a "10" on a 1-10 scale?
Acknowledge the client's reported pain level.
A physician orders a placebo for a client. What is a placebo?
an inactive substance given in place of a drug
What is the term used to describe a pharmaceutical agent that relieves pain?
analgesic
During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is:
analgesics.
The nurse is administering medications to a client with neuropathic pain. The client asks why he is getting an antidepressant medication since he is not depressed. What is the best response by the nurse?
"Antidepressants have been shown to have pain-relieving qualities in clients with neuropathic pain."
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?"
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."
Which misconception is common in clients in pain?
"I will get addicted to pain medications."
A nurse is evaluating the effectiveness of the preoperative education regarding pain control. Which statement by the client would indicate a need for further education?
"I will have my wife push the PCA button when I'm asleep."
The nurse has completed a preoperative education session with a client who will receive morphine via a patient-controlled analgesia pump (PCA) after surgery. Which statements by the client indicates the need for further education?
"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 fellow staff nurse working with a client who has two broken femurs states to another nurse, "My older adult client is so easy to care for because he says he doesn't have a bit of pain." What is the appropriate response from the other nurse to whom the statement was made?
"Older adults may not report pain so they won't be thought of as a bother."
The nurse is performing assessments for clients admitted in the emergency department. Which client is most likely experiencing somatic pain?
A client who has a sprained ankle
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
A nurse changed a client's wound dressing early in the morning and the client has now illuminated the call light and told the nurse, "I could really use something for pain right about now." What should the nurse's next action be?
Assess the character and severity of the client's pain.
How may a nurse demonstrate cultural competence when responding to clients in pain?
Avoid stereotypical responses to pain in clients.
A client is receiving opioid analgesia for pain control. The nurse is assessing the client for possible respiratory depression. Which method would be most reliable for the nurse to use to identify impending respiratory depression?
Capnography
A client reports throbbing pain caused by a laceration that occurred to the finger while cutting vegetables. Which terminology should the nurse use to document this pain? Select all that apply.
Cutaneous Acute
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.
Cutaneous Acute
A client has been taught relaxation exercises before beginning a painful procedure. What chemicals are believed to be released in the body during relaxation to relieve pain?
Endorphins
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 parents of a preschool child who is experiencing pain from ear surgery inform the nurse that the child is uncharacteristically withdrawn and seems ambivalent. What is the nurse's most appropriate action?
Explain that this is likely a normal, short-term response.
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
When asking an older adult client about abdominal pain, the client reports, "I don't 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.
The nurse is caring for a client with terminal bone cancer. The client states, "My pain is getting worse and worse and the morphine doesn't help anymore." How would the nurse document the type of pain experienced by this client?
Intractable
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 in his right foot. After assessing the client, the nurse suspects that the client may be experiencing neuropathic pain. What would the nurse document to support this suspicion? Select all that apply.
Reports of tingling Pain with normal touching Reports of numbness
Which assessment finding is consistent with the presence of pain?
Restlessness
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?
Stool softeners and increased fluid intake
A nurse is caring for a client who is receiving morphine via a patient controlled analgesia (PCA) pump. When assessing the client, she notes that his respiratory rate is 4. What should the nurse do first?
Stop the PCA pump.
Who is the authority on the presence and extent of pain experienced by a client?
The client
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.
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."
When the male client on his first postoperative day after chest surgery appears stoic and does not ask for any pain medication, the nurse should:
actively solicit information about the client's pain level.
A nursing instructor is preparing a class presentation about the pain process. As part of the class, the instructor will be describing the 4 steps as listed below. Place the steps in the order that the instructor would discuss them from first to last.
Transduction Transmission Perception Modulation
A student nurse is preparing a presentation on pain management. What information regarding nonpharmacologic interventions should he include?
Use cold packs for muscle spasms and surgical site pain. Ice packs should not be left on longer than 20 minutes. Massage can stimulate circulation. Distraction is useful for short pain periods.
Which statements best describes the rationale for using nonpharmacologic methods to help manage pain?
Use of nonpharmacologic methods can diminish the emotional component of pain.
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
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
The triage nurse is assessing a 5-year-old client who has come to the emergency department with a caregiver after falling off of a skateboard. Which pain assessment tool will the nurse choose to use?
Wong-Baker FACES® scale