Chapter 34: Comfort & Pain (Fund.)

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?

Administer the pain medication. 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 postoperative client who has been receiving morphine for pain management is exhibiting a depressed respiratory rate and is not responsive to stimuli. Which drug has the potential to reverse the respiratory-depressant effect of an opioid?

Naloxone

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?

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

Which client populations are at high risk for inadequate pain management? Select all that apply.

Neonates and infants Young children Clients with dementia Older adults with chronic pain Client populations who are not able to communicate pain effectively are at highest risk for inadequate pain management. These clients are the neonates, infants, young children, and patients with dementia. Adults older than age 65 years experience pain more frequently than do younger adults and endure moderate to severe pain for twice as long as younger adults. However, many see pain in the elderly as part of the normal aging process and it is therefore undertreated.

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?

Sedation 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?

Stool softeners and increased fluid intake 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.

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?

Stop the PCA infusion immediately and prepare to administer naloxone. 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).

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. A side effect of morphine is respiratory depression. In this situation, the nurse should first stop the PCA pump and then notify the physician. Naloxone is used to reverse the sedative effects of opioids, but this is not the first step.

What type of nonpharmacologic pain relief measure uses electrical stimulation to inhibit transmission of painful impulses?

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

Which medication would the nurse most likely see on the medication administration record (MAR) of a client with diabetic neuropathy?

Gabapentin Gabapentin is used to treat nerve pain.

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"

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 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."

While caring for a client with chronic pain, the nurse talks with a family member. Which family member statement does the nurse identify as consistent with caregiver role strain?

"Sometimes it seems like I can never get a moment to myself." Caregiver role strain may be exhibited by statements of exhaustion, frustration, or seeming overwhelmed. If the client states that time to themselves is rare, he or she may be feeling consumed with care for the client with chronic pain. Feeling badly regarding a loved one's pain, discussing insurance coverage, and helping the loved one by doing household tasks do not indicate caregiver role strain.

Two hours after receiving a pain medication, the client states he still is suffering from pain. Which question is appropriate to ask the client first?

"Tell me more about your pain."

The nurse is giving a back massage to a client who is having trouble sleeping. Which nursing actions are performed appropriately? Select all that apply.

- The nurse assists the client to a prone position and drapes the client's body as needed with the bath blanket. - The nurse applies warmed lotion to client's shoulders, back, and sacral area. - The nurse places hands at the base of the spine and strokes upward to the shoulder and back down to the buttocks. When giving a massage to the client, the nurse would assist the client to a prone position and drape the client's body as needed with the bath blanket. The nurse would apply warmed lotion to the client's shoulders, back, and sacral area. The nurse would place hands at the base of the spine and stroke upward to the shoulder and back down to the buttocks. The nurse would not use continuous grasping and pinching motions. The nurse would use long, stroking movements, not short ones.

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 -60-year old with early onset dementia Clients who are most likely to have underassessed and undertreated pain include infants; children younger than 7; culturally diverse clients; clients with mental challenges, dementia, hearing, or speech impairment; or those who experience psychological disturbances. The client with a broken ulna and the client with recurrent pancreatitis are not as likely to have undertreated pain.

A nurse is performing pain assessments on clients in a physician's office. Which clients would the nurse document as having acute pain? Select all that apply.

-a client who is having a myocardial infarction -A client who presents with the signs and symptoms of appendicitis -A client who fell and broke an ankle The client having an MI, the client presenting with signs and symptoms of appendicitis, and the client with a broken ankle would be having acute pain. Clients with diabetic neuropathy, rheumatoid arthritis, and bladder cancer would have chronic pain.

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?

3 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 nurse applies intermittent heat and cold to a client's leg. 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.

The nurse is caring for a client who has a long history of using opioid pain medication. When the client reports back pain of "10" on a "1-10" scale, what is the appropriate nursing action?

Acknowledge the pain as the client reports it Nurses must acknowledge pain as the patient reports it, because there is no other way to accurately measure pain. The other answer choices are incorrect nursing actions.

Which of the following means of pain control is based on the gate control theory?

Acupuncture Acupuncture is a means of pain control that is based on the gate control theory. Biofeedback, distraction, and hypnosis are alternative and complementary therapies that are nonpharmacological means of pain control. They are not based on the gate control theory.

What is an accurate step in the procedure for giving a client a back massage?

Apply lotion to the client's shoulders, back, and sacral area using a light, gliding stroke. Lotion should be applied using light, gliding strokes. The massage should begin at the base of the client's spine and work up and down the back using circular stroking motions.

The nurse is conducting an admission assessment, and asks the client what medication is taken for pain. The client responds, "I take a little white pill to control my pain, but I don't know the name of it," and presents the nurse with a plastic baggie full of white pills. What is the priority nursing intervention?

Ask the client if he or she has the bottle the drug was dispensed in from the pharmacy. The priority nursing intervention is to ask the client for the original bottle that the drug was dispensed into from the pharmacy. This will provide the most accurate identification of the medication. Other interventions can subsequently be implemented.

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?

Assess for medication order for breakthrough pain. 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."

When performing a pain assessment on a client, the nurse observes that the client guards his arm, which was fractured in a car accident, and he refuses to move out of his chair. The nurse notes this reaction as what type of pain response?

Behavioral Behavioral (voluntary) responses would include moving away from painful stimuli, grimacing, moaning, crying, restlessness, protecting the painful area, and refusing to move the limb. Physiologic (involuntary) responses would include increased blood pressure, increased pulse and respiratory rates, pupil dilation, muscle tension and rigidity, pallor (due to peripheral vasoconstriction), increased adrenaline output, and increased blood glucose. Psychological responses would include exaggerated weeping and restlessness, withdrawal, stoicism, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, and powerlessness.

For assessment of pain, objective data are used to supplement subjective data. How can a nurse gather objective data about a client's pain? Select all that apply.

By checking the vital signs By observing facial expressions By diagnostic tests and procedures Physical assessment is a mode of gathering objective data about a client's pain perception. It involves assessing the client's vital signs and observing facial expressions of pain. Diagnostic tests and procedures can provide objective data by validating painful events and identifying the source of pain. Eliciting factual information, such as the intensity and type of pain, as well as use of pain assessment questionnaires, are strategies to obtain subjective data about the client's pain perception.

How should the nurse position the head of the bed for a client receiving epidural opioids?

Elevated 30 degrees The nurse should position the head of the bed so that it is eleveated 30 degrees unless contraindicated. Elevation of the client's head minimizes upward migration of the opioid in the spinal cord, thereby decreaseing the risk for respiratory depression.

A client in pain believes that their pain is a punishment from God, and feels angry and resentful. Which of the following is the most appropriate action by the nurse?

Encourage client to confer with a spiritual advisor. The most appropriate action by the nurse would be to encourage the client to confer with a spritual advisor to work through feelings of anger and resentment as it relates to God and their pain experience. Consulting a psychiatric nurse practitioner may help the client work through feelings of anger and resentment, but may not address the underlying feelings/beliefs related to God and the client's experience of pain. Encouraging the client to pray or to have visitors pray for the client may not help the client work through feelings of anger and resentment related to God and their experience of pain.

A client is experiencing acute pain following the amputation of a limb. What nursing interventions would be most appropriate when treating this client?

Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen.

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?

Endorphins

Which of the following is considered to be the most potent neuromodulators?

Endorphins 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.

While assessing an infant, the nurse notes that the infant displays an occasional grimace and is withdrawn; legs are kicking, body is arched, and the infant is moaning during sleep. When awakened, the infant is inconsolable. What scale should the nurse use while assessing pain in this infant?

FLACC SCALE The FLACC Scale (face, legs, activity, cry, and consolability) is used to measure pain for children between the ages of 2 months and 7 years. The Braden scale is used to predict pressure sore risk. The FACES Scale is used to assess pain in older children using a series of faces, ranging from a happy face to a crying face. APGAR score is done at birth to assess how well the baby tolerated the birthing process.

The nurse is assessing the pain of a preschooler. Which of the following pain scales would be appropriate for the nurse to utilize? (Select all that apply.)

FLACC Scale Wong-Baker Faces Scale COMFORT scale When assessing the pain of a preschooler, the nurse could choose from the following pain scales: COMFORT, FLACC, and Wong-Baker Faces. The CRIES pain scale is for neonates, and the 0-10 Numeric scale is for adults and children over 9 years old.

Nurses assess clients who have physiologic responses to pain. Which examples of pain response are physiologic responses? Select all that apply.

Increased blood pressure Muscle tension and rigidity Nausea and vomiting Increased blood pressure, muscle tension and rigidity, and nausea and vomiting are examples of physiologic responses to pain. Exaggerated weeping and restlessness are examples of affective responses to pain. Protecting the painful area, grimacing, and moaning are examples of behavioral responses to pain.

A client comes to the facility reporting acute pain. When assessing the client, the nurse understands that unrelieved acute pain can result in which physiologic responses? Select all that apply.

Gluconeogenesis Increased secretion of cortisol Physiologic responses to unrelieved acute pain include increased secretion of antidiuretic hormone, gluconeogenesis, protein catabolism, increased secretion of cortisol, and increased peripheral vascular resistance.

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?

Guarding of the chest area 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 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.)

Heat Massage Cold 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 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?

How does the pain develop and progress? When assessing the chronology of the client's pain, the nurse could ask the client how does the pain develop and progress. To assess the quality of the client's pain, the nurse could ask for the client to describe the pain. To assess the quantity of the pain, the client could be asked to rate the pain on a scale of one to ten. To assess the alleviating factor of the pain, the nurse could ask what the client does to alleviate the pain and how well does it work.

When a nurse provides a cool glass of water to the client with inflamed throat tissue, the nurse cautions the client not to drink very hot liquids because they can produce

Hyperalgesia

A nurse is assessing a client's pain. The nurse notes which database finding that is indicative of acute pain?

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

The nurse recognizes which of the following statements is true of chronic pain?

It may cause depression in clients. Chronic pain may lead to withdrawal, depression, anger, frustration, and dependency. Clients have difficulty describing chronic pain because it may be poorly localized. Moreover, health care personnel have difficulty assessing it accurately because of the unique responses of individual clients to persistent pain. Chronic pain is commonly characterized by periods of remission and exacerbation.

The emergency room nurse is caring for a boy who will need a lumbar puncture. The physician prescribes EMLA cream to decrease the pain associated with the procedure. When should the nurse administer the EMLA?

One hour prior to the procedure EMLA is a prescription analgesic that must be administered and covered with an occlusive dressing for 1 hour prior to the procedure.

A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client?

Opioid analgesics 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.

Which principle should the nurse integrate into the pain assessment and pain management of pediatric clients?

Pain assessment may require multiple methods in order to ensure accurate pain data. 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.

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.

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?

Reposition the patient and gently massage the patient's backThe nurse is caring for four clients.

Which of the following is the priority assessment for a nurse caring for a client with a Patient Controlled Analgesia (PCA) pump?

Respiratory 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.

An older adult client who is being treated in the hospital was given a hypnotic medication at bedtime. Which of the following possible consequences would indicate a paradoxical effect of this drug?

The client exhibits restless, uncharacteristic behavior after receiving the drug.

A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse caring for the client explains the functioning of PCA. What is the main advantage of PCA?

The client is actively involved in pain management.

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?

They bind to opioid receptor sites throughout the CNS. 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.

Which of the following is the most appropriate cultural accommodation for a Chinese client by the nurse when assessing the client's pain level?

Vertical numeric pain rating scale The most appropriate cultural accommodation for the Chinese client when the nurse is assessing the client's pain level is the use of a vertical numeric pain rating scale, as this is the format in which the Chinese language is read.

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?

Visceral pain 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. Somatic pain develops from injury to structures such as muscles, tendons, and joints. Neuropathic pain is experienced days, weeks, or even months after the source of the pain has been treated and resolved.

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?

Vitamin B6 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.

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. Some cultures see pain tolerance as a virtue; often men are expected to tolerate pain more stoically than women do. Health care providers need to recognize the client's cultural beliefs and not impose their own judgments.

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. 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. Transcutaneous electrical nerve stimulation (TENS) is a noninvasive alternative technique that involves electrical stimulation of large-diameter fibers to inhibit transmission of painful stimuli carried over small-diameter fibers. Hypnosis is an alteration in a person's state of consciousness so that pain is not perceived as it normally would be. Therapeutic Touch involves using one's hands to direct an energy exchange consciously from the practitioner to the client in order to facilitate healing or pain relief.

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

The nurse is preparing to initiate PCA therapy for a client with sleep apnea. What is the correct action by the nurse?

contact the Physician The nurse should contact the physician, as PCA therapy for pain management is contraindicated for clients with sleep apnea. This is due to the fact that oversedation in clients with sleep apnea poses a significant health risk. PCA therapy is also contraindicated in confused clients, infants and very young children, cognitively impaired clients, and clients with asthma.

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 Cutaneous pain originates at the skin level and is commonly experienced as a sensation resulting from some form of trauma. Acute pain lasts for a few seconds to less than 6 months. Therefore, the nurse documents that the client has acute, cutaneous pain. Somatic, visceral, referred, chronic, and neuropathic pain are not demonstrated in this scenario.

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:

in the postoperative stage with occasional pain. A p.r.n. (as needed) medication would be most appropriate for a client in the postoperative stage with occasional pain. A client in the early postoperative period would benefit from the dosage of pain medication with around the clock dosing. A client experiencing chronic pain would benefit from the dosage of pain medication with around the clock dosing. A client experiencing acute pain would benefit from the dosage of pain medication with around the clock dosing.

A child with a leg cast tells the nurse that he has pain inside his cast. Which type of stimulus is most likely causing this pain?

mechanical Receptors in the skin may be stimulated by mechanical, thermal, chemical, and electrical agents. Pressure from a cast is a mechanical agent causing pain. Sunburn is a thermal stimulant. An acid burn is the result of a chemical stimulant. The jolt of a static charge is an electrical stimulant.

Which of the following is an example of a diffuse pain?

pain related to stomach cancer Diffuse pain is pain that covers a large area, and often the client is unable to point to a specific area without moving the hand over a large surface, such as the entire abdomen. Pain related to appendicitis is sharp pain. Pain related to an MI can be sharp and/or shifting. Pain related to a sore throat is usually dull pain.

The nurse is caring for a client who has come to the Emergency Department reporting chest pain rated at 9 on a scale of 1-10, that shoots down the left arm, that started 45 minutes ago. How will the nurse document this pain in the electronic health record? (Select all that apply.)

visceral 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

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?

reviewing and revising the pain management treatment plan

The nurse is caring for a client who has had unrelieved back pain for 3 years. How will the nurse document this type of pain? (Select all that apply.)

somatic chronic Chronic pain is discomfort that lasts longer than 6 months. Somatic pain develops from injury to structures such as muscles, tendons, and joints. Therefore, the nurse appropriate documents this client's pain as somatic and chronic. Cutaneous, visceral, referred, neuropathic, and acute pain are not being depicted in this scenario.

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 Teaching the client to remove items from home that remind them of work is an example of the Neuromatrix Theory. The other actions support other theories.

Who is the authority on the presence and extent of pain experienced by a client?

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

A nurse observes that a client who underwent knee surgery 2 weeks ago needs progressively larger doses of analgesics to get relief from pain. The nurse interprets this as:

tolerance The client is manifesting tolerance, which is characterized by the need for larger doses of analgesics to produce the original effect. The client is not manifesting addiction, dependence, or sedation. Addiction is a psychological condition characterized by a drive to obtain and take substances for other than the prescribed value. Dependence is a physiologic response wherein a person who is dependent on opioids responds to abrupt discontinuation with characteristic withdrawal symptoms. Sedation is an adverse effect of administration of opioid analgesics.

Besides controlling pain of the postabdominal surgery client with narcotics, the nurse suggests to the client that he:

use distraction. Distraction is useful when clients are undergoing brief periods of sharp, intense pain, such as dressing changes, wound débridement, biopsy, or incident pain from shifting positions.

The nurse is caring for a client who reports nausea and vomiting for a week. How will the nurse document this type of pain? (Select all that apply.)

visceral acute