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"
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 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 nurse is caring for a post surgical client whose pain is being treated with the opioid hydromorphone. The nurse's most recent assessment reveals tha the client is drowsy and drifting off during conversation with the nurse; however, the client an be aroused. What is teh nurse's most appropriate action?
Report this finding to the primary care provider and seek a decrease in teh client's opioid dosing
The nurse is taking a history for a client who is being seen for chronic unrelieved back pain. Which assessment question helps teh nurse asses duration of pain?
"How long have you experiences this pain?"
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."
The nurse is teaching a client how to manage postoperative pain through a patient controlled analgesia (PCA) pump. The nurse determines that additional teaching is needed when the client make which statement?
"I should only take medication when my pain is intense."
A client receiving epidural analgesia asks the nurse to put the head of the bed all the way down to sleep better. What is the correct response by the nurse?
"It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to minimize the risk of respiratory depression."
The nurse us assessing a client who is experiencing pain. The nurse notes the client is experiencing acute rather than chronic pain when the client makes which statement?
"The pain is really sharp in this one spot."
A client has just been started on opioid analgesia for pain control. The nurse assesses teh 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. What would be the sedation score for this client?
3
Charles is an 86-year-old man with chronic lower back pain. He asks you what some appropriate treatment might be for his back pain. Which would you not expect to be ordered as first-line therapy?
A chronic opioid therapy plan
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 is caring for four clients. For which client would the nurse request a referral to palliative care?
A client with hypertonic cardiomyopathy and heart failure
Which medical client is most likely to be experiencing diffuse pain?
A client with shingles affecting her entire torso
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 is caring for a client who received naloxone to reverse respiratory depression due to opioid therapy. The client i 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 respiratory rate is >9
A client is prescribed pain medication every 4 to 6 hours as needed. When the nurse enters the client's room to administer the medication, the client is laughing with visitors. The client's pulse rate is 64, respiration 16, and blood pressure 120/80. The client reports pain and wants the medication. What is the most appropriate action by the nurse?
Administer the pain medication
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 hospital client's pain is being treated with epidural analgesia. Which nursing action would pose a threat to the client's safety?
Administering an oral dose of morphine to treat the client's breakthrough pain
The nurse is conducting an admission assessment, and asks the client that 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 if it," and presents the nurse with a plastic baggie full of white pills. What is the priority nursing intervention?
Ask the client of he or she has the bottle the drug was dispensed in from the pharmacy.
A client is posteroperative day 1 and the nurse's assessment reveals signs of pain, such as grimacing and Harding, Which is teh most reliable method for assessing the client's pain?
Ask the client to describe and rate his or her pain
A client prescribed pain medication around the clock experiences pain 1 hour before the next dose of pain medication is due. Which is the most appropriate action by the nurse?
Assess for medication prescription for breakthrough pain.
The nurse us 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 noted to be laughing while on the phone and shutting with staff after reporting a headache that is a 10. Which action will the nurse perform priori to initiating treatment?
Assess for nonverbal cues to pain
A nurse gilding a client a massage notes the presence of a nonblanching reddened area on the client's sacrum. What is the nurse's best action?
Avoid massaging this area and report the finding to the health care provider
The nurse is implementing environmental changes to promote a client's comfort and pain management. Which action is an example of this type of intervention?
Closing the client's room door to reduce unnecessary noises
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
Endogenous opioids such as endorphins:
Contribute to analgesia
What type of pain will the client experience as a result of the intervention being performed?
Cutaneous
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
The young female client had emergency surgery for appendicitis. She is a cigarette smoker, is breastfeeding her infant, and expressed a desire to continue to breastfeed when discharged from the hospital. teh surgeon has prescribed acetaminophen/oxycodone for pain relief at home. What instruction would the nurse include when providing discharge teaching?
Do not drive a vehicle while taking this medication You must check with your primary care provider before breast-feeding you infant Keep a diary to record level of pain and time medication is taken
While providing a back massage, the nurse observes a reddened area on the client's sacral area. Which action by the nurse is appropriate?
Document the finding
A client in pain believes the pain is a punishment from god, and feels angry and resentful. Which is the most appropriate action by the nurse?
Encourage client to confer with a spiritual advisor
The nurse is admitting a dying client wit osteosarcoma. Which nursing action is priority?
Examine the effectiveness of the current pain regimen
A client reports after a back massage that his lower back pain decreased from 8 to 3 on the pain scale. Which opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort?
Endorphins
While assessing an infant, the nurse notes that teh 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. Which scale/score should the nurse use while assessing pain in this infant?
FLACC Scale
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 has provided a hot pack to a client who has been experiencing neck pain. According to the gate control theory of pain transmission, what is this intervention likely to be effective?
Heat stimulates the large-diameter fibers that inhibit pain transmission
The urge is assessing a client for the chronology of teh pain she is experiencing. Which interview question is considered appropriate to obtain this data?
How does the pain develop and progress?
The client is a new admission who reports lower right quadrant abdominal pain. The client is scheduled for an emergency appendectomy. What question(s) will teh nurse ask the client in relation to the pain?
How would you describe the pain? When did your pain begin? What medication have you taken to relieve the pain? Does anything make the pain worse? How do you rate your pain on a scale of 0 to 10?
A 77-year-old woman is on the nurse's unit s/p left knee replacement. The client typically stools every morning has not had a bowel movement in 3 days. The nurse knows that which medication places the client at increased risk for constipation?
Hydromorphone
A nurse administers pain medication to client on a med-surg are. The client that would benefit from a PRN drug regimen as an effective method of pain control would be the client:
In the postoperative stage with occasional pain
The nurse is caring for client prescribed morphine who is experiencing constipation. What intervention should the nurse recommend to the client?
Increased fiber Stool softener Increased fluids
A client comes to the facility reporting acute pain. When assessing the client, teh nurse understands that moderate, superficial acute pain can result in which sympathetic physiologic response(s)?
Increased pulse Increase respiratory rate Increased blood pressure
The nurse recognizes which statement is true of chronic pain ?
It may cause depression in clients.
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
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?
Naloxone
The emergency room nurse is caring for a client who will need a lumbar puncture. The health care provider prescribes lidocaine 2.5% and prilocaine 2.5% cream (EMLA) to decrease the pain associated with the procedure. When should the nurse administer the cream?
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 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.
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?
Pressure Heat Massage
The nurse is preparing a care plan for a client receiving opioid analgesics. WHich factors associates with opiod analgesia use will the nurse include in the plan of care?
Preventing constipation
A nurse is working with a 12-year-old boy who was involved in an MVA. He has several broken bones and contusions. He rates his pain as a 7/10. The nurse plans to administer intravenous hydromorphone to relieve the pain. What side effect is teh nurse most worried about?
Respiratory depression
The nurse is caring for a client during the first 12 hours of receiving epidural analgesia and assesses the client every hour. Along with vital signs, which best describes the priority of the hourly assessment?
Respiratory status, oxygen saturation, pain, and sedation level
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
The nurse is caring for a client who has had back pain for 2 years, following a fall from a ladder. How does the nurse going off-shift report this kind of pain to the oncoming nurse?
Somatic Chronic
A nurse is caring for a client who us 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
When assessing a client on PCA therapy, the nurse finds the client to be drowsy, with minimal or no response to physical stimulation scoring a 4 on the Pasero and McCaffery Sedation Sacle. What is the nurse's best action?
Stop the medication infusion immediately and notify the primary care provider; prepare to administer oxygen and naloxone
The nurse is caring for a client whose pain is being treated with epidural analgesia. Which nursing action is most appropriate?
The anesthesiologist/pain management team should be notified immediately if the client's respiratory rate is below 10 breaths/min.
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 wit 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
A nurse is caring for a client with cancer who is experinecing pain. What would be the most appropriate assessment of the client's pain?
The client's pain based on a pain rating
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.
A client who suffered multiple trauma in a motor vehicle accident is receiving care in an orthopedic trauma unit. The client has a documented history or opioid addiction and the hospital's advanced pain control team has become involved in his pain control plan. Which of the following are aspects of addiction?
The need to use opioids for purposes other than pain relief Compulsive use of a particular drug
The nurse is giving a back massage to a client who is having trouble sleeping. Which nursing actions are performed appropriately?
The nurse assist the client to a prone position and drapes the client's body as needed with the bath blanket The nurse apples warmed lotion to client's shoulders, back, and sacral area The nurse places hands at the base of of the spine and trikes upward to the shoulder and back down to the buttocks
The nurse is providing care to multiple clients. During which client interaction(s) will the nurse ask about the level of pain the client is experiencing?
The nurse is making rounds and taking a client's vital signs at the scheduled time The nurse is completing the admission database with a newly admitted client The nurse is assisting a client to a supine position following a lumbar puncture
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.
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.
The nurse is employing gate theory in teh care of a client with pain in the lower back. What actions by the nurse may assist in pain relief for the client?
Use massage and heat application to the lower back
A 5-year-old client reports abdominal pain. Which action(s) will the nurse tale to assess the pain?
Use the Wong-Baker FACES pain rating scale Observe the client Ask the client to describe the pain
A 5-year-old client reports abdominal pain. Which action(s) will the nurse take to assess teh pain?
Use the Wong-Baker FACES pain rating scale Observe the client Ask the client to describe the pain
The nurse is performing an assessment for a client related to pain. To determine the need for pain medications, on what primary source will the nurse base the decision?
Verbal report
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 to 10. The pain shoots down the left arm and started 45 minutes ago. How will the nurse document this pain in the electronic health record?
Visceral Referred Acute
You are a new nurse in an ambulatory care settings. You know that the joint commission requires that pain be addressed at each visit. When is teh most appropriate time to do so?
When obtaining patient vital signs
