Chapter 35: Comfort and 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"
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."
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 action of ibuprofen is to:
have an anti prostaglandin effect on the CNS
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 post op with occasional pain
Which clients would be the best candidate to receive epidural analgesia for pain management?
a child undergoing hip surgery
A nurse is assessing an adult client with back pain. The client is unable to speak in English. Which pain scale is most appropriate for the nurse to use in assessing the client's pain?
0-10 numeric rating scale
The nurse is administering oxycodone to a client. To which category of analgesics does this belong?
Opioid
The nurse is taking a history for a client who is being seen for chronic unrelieved back pain. Which assessment question helps the nurse assess duration of pain?
"How long have you experienced this pain?"
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."
A nurse is assessing a client with arthritis. Which question will the nurse ask first to establish the client's baseline pain experience?
"On a scale of 1 to 10, what is your pain level?"
The nurse has entered the room of a client who is postoperative day 1 and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of PRN analgesia and, on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. How should the nurse respond to the client's concerns?
"Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery."
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."
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
A nurse attempts to arouse a postoperative client and finds him frequently drowsy and drifting off during conversation; however, he can be aroused. What would be the sedation score for this client?
3
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 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
Which of the following means of pain control is based on the gate control theory?
Acupuncture
The nurse is caring for a client who reports throbbing pain at the site of a laceration that was occurred when placing his hand in his pocket and getting cut by a pocketknife. How will the nurse document this type of pain?
Acute Cutaneous
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?
Administer the medication if the respiratory rate is >9
A client reports pain and requests the prescribed 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.
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
The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opioid anesthesia, the nurse observes the client's respiratory rate decrease to 8 breaths per minute. What is the priority action by the nurse?
Administration of 0.4 mg of naloxone
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
A client is postoperative day 1 and the nurse's assessment reveals signs of pain, such as grimacing and guarding. Which is the most reliable method for assessing the client's pain?
Ask the client to describe and rate his or her pain.
The nurse manager hears a nurse and a nurse aide talking about a female client who reports pain of 8 out of 10 on a 1-10 scale after a Caesarean birth to deliver twins. The nurse states, "I don't believe this client has any pain at all. I'm sure she is just drug seeking." What is the appropriate nurse manager action?
Ask the nurse to speak privately for a moment, and educate about bias in pain treatment.
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.
The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate? Select all that apply.
Assess for pain control 30 minutes after administering an analgesic. Consider cultural implications of the perception of pain. Provide pain medication before activity that may increase pain.
A nurse works with an older adult client who has two broken femurs. The client does not report pain. Which action will the nurse take?
Assess the client for nonverbal cues of pain.
How may a nurse demonstrate cultural competence when responding to clients in pain?
Avoid stereotypical responses to pain in clients.
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
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
The nurse is evaluating pain of several clients who had hip replacement surgery. Which client is most likely to have the greatest perceived pain?
Client who is anxious about discharge
The nurse is evaluating pain of several clients who had hip replacement surgery. Which of the following clients is most likely to have the greatest perceived pain?
Client who is anxious about discharge
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.)
Cold Heat Massage
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?
Contact the health care provider.
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 is developing a discharge teaching plan for clients taking opioid pain medication. Which of the following should the nurse include? (3)
Do not drive while taking pain medication. Do not smoke without someone else present. Avoid alcohol.
How should the nurse position the head of the bed for a client receiving epidural opioids?
Elevated 30 degrees
Which medication would the nurse most likely see on the medication administration record (MAR) of a client with diabetic neuropathy?
Gabapentin
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.
Nurses assess clients who have physiologic responses to pain. Which examples of pain response are physiologic responses? Select all that apply.
Increased BP Muscle tension and rigidity nausea and vomiting
The nurse is caring for client prescribed morphine who is experiencing constipation. Which of the following should the nurse recommend to the client? (Select all that apply.)
Increased Fluids and Fiber Stool softeners
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 nurse is administering prescribed medicine to a client who experienced acute pain in the lower back after a motor vehicle accident. The client tells the nurse that compared to the previous week, his pain had reduced considerably. Which phase of pain is the client experiencing?
Modulation
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?
Naloxone
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 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
A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client?
Opioid analgesics
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 an older adult client who is unable to walk without a support due to knee pain. During the initial assessment, however, the client does not mention pain. Which conversation about pain will the nurse initiate with the client?
Pain is not a normal part of aging.
A postoperative client has not voided for 8 hours (since surgery). He is restless and reports abdominal pain. How and what would the nurse assess before administering pain medications?
Palpate abdomen for distended bladder.
A nurse has attended a pain control workshop and learned about the psychological and physiological basis of placebos. What principle should guide the use of placebos in the treatment of pain?
Placebos involve the use or deception and are considered unethical in most circumstances.
The nurse is preparing a care plan for a client receiving opioid analgesics. Which factors associated with opioid analgesic use will the nurse include in the plan of care?
Preventing constipation
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 back.
Which assessment finding is consistent with the presence of pain?
Restlessness
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?
Stage 3
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.
What type of nonpharmacologic pain relief measure uses electrical stimulation to inhibit transmission of painful impulses?
TENS
A nurse is caring for a client who was administered an opioid. The client reports constipation. What is another potential side effect of opioid use?
sedation
Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique?
Tactile kinesthetic distraction
Which statement accurately represents a consideration when using an epidural analgesia for client pain management?
The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min.
Which circumstance may preclude the use of cutaneous stimulation to relieve a client's pain?
The client has difficulty localizing his pain.
A female client with a long and complex history of chronic pain has begun a program of biofeedback with an advanced practice nurse. Together, the nurse and the client would identify what goal of this program?
The client will learn to alter her physiological response to pain.
A nurse is caring for a client with cancer who is experiencing pain. What would be the most appropriate assessment of the client's pain?
The client's pain based on pain scale rating
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?
The nurse gives the client a massage before bed.
Which statement accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain?
The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval.
A nurse is caring for a client whose injured cells are releasing chemicals such as substance P, prostaglandins, bradykinin, histamine, and glutamate. Which phase of pain is the client experiencing?
Transduction
Epidural analgesia is appropriate for postoperative analgesia and can be administered via continuous infusion pump, or by a patient-controlled epidural analgesia pump (PCEA).
True
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 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
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
At 1930 the client reports experiencing neuropathic pain in the legs. The client has a history of neuropathic pain following chemotherapy. The client describes the pain as burning and rates the pain as a 7 on the pain scale of 1 to 10. Based on the client's medication orders (above), which medication would the nurse administer to the client for a report of pain?
acetaminophen/codeine 1 tablet
A nurse observes a client that had a hysterectomy crying hysterically. What type of pain response is this client experiencing?
affective
A client is receiving patient-controlled epidural analgesia (PCEA) following abdominal surgery. While assessing the client, the client states, "I've started having some back pain." The nurse should:
assess for epidural hematoma.
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.
You are a new nurse in an ambulatory care setting. You know that the Joint Commission requires that pain be addressed at each visit. When is the most appropriate time to do so?
when obtaining vitals
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
Endogenous opioids such as endorphins:
contribute to analgesia
A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a client being discharged. What process is involved in this pain relief measure?
cutaneous stimulation
When implementing the gate-control theory of pain, which intervention will enhance the closing of the gate to the client's pain?
give the client a back rub
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
Which of the following nonpharmacologic pain relief measures has been found to be effective for soothing agitated newborns and comatose clients?
music
Based on your knowledge of pain and the body's response, when assessing a client in pain, you would anticipate the:
pupils are dilated
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 experienced domestic violence for 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 horrible headache and have to go lie down." Which nursing intervention reflects practice according to the Neuromatrix Theory?
removing items from the room that remind client of former spouse
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
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.
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
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
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 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
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 nurse is caring for a client with dull ache in her abdomen. On the way to the health care facility, the client vomits and shows symptoms of pallor. What kind of pain is the client experiencing?
visceral pain