Chapter 35 Pain Prep U
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's focal point should be on reviewing and revising the pain management treatment plan presently in place. The client is status-post bowel resection, so administering a placebo is not the correction option, and could be ethically wrong. The nurse would possibly do a depression assessment, but if the client is reporting constant pain, the pain management plan must be reviewed and revised. The question does not address if the client is taking pain medications, so the option addressing beginning pain medications before the pain is too severe is not correct.
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 Somatic pain is diffuse or scattered pain, and it originates in tendons, ligaments, bones, blood vessels, and nerves. Cutaneous pain usually involves the skin or subcutaneous tissues. Visceral pain is poorly localized and originates in body organs. Phantom pain occurs in an amputated leg for which receptors and nerves are clearly absent, but the pain is a real experience for the client.
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." Physical dependence and tolerance are expected responses to longer-term opioid use, but clients treated with opioids for pain rarely develop addiction. Despite the very low risk of addiction, it would be inappropriate for the nurse to dismiss the client's concerns such as telling them they will become addicted and the hospital has resources or telling the client to focus on controlling your pain or needing more doses to control the pain
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. Narcotic analgesics not excreted readily in older adult clients may lead to confusion, seizures, or psychotic behavior. Thus, initial dosing should be at lower levels and titrated to the most effective dose. Narcotic analgesics if not excreted readily in older adult clients may not necessarily lead to lethargic behavior or insomnia.
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 The sedation score for this client is 3. A score of 1 is given to a client who is awake and alert, 2 is given to a client who is slightly drowsy but easily aroused, and 4 describes a client who is somnolent, with minimal or no response to physical stimulation.
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.
Why is acute pain said to be protective in nature?
Acute pain, lasting from a few minutes to less than 6 months, warns an individual of tissue damage or organic disease. After its underlying cause is resolved, acute pain disappears. Pain is a subjective experience and does assist in the coping and psychological strength of a person.
The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opiod 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 The client is experiencing impending respiratory arrest due to the effect of the medication and this should be reversed immediately prior to arrest. This is the priority action and will correct the respiratory depression immediately. CPR is not indicated at this time, because the client is not in full arrest. Placing the client in the supine position may decrease respirations further.
A client reports a dull, aching pain to his right flank where he was struck during a football game one week ago. What is responsible for the transmission of such pain?
C-fibers Stimulation of C-fibers, which are slow conducting fibers, is responsible for the dull and poorly localized pain persistent after the injury. A-delta fibers give rise to bright, sharp, and well-localized pain that is immediately associated with the injury. The frontal lobe of the brain is not directly involved in the physiology of the pain response. The spinal dorsal complex horn is the site where complex processing of messages occurs.
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. Pain is underdetected and poorly managed among older adults, because they often do not want to be perceived as a complainer, or they feel that pain is part of growing older. The nurse should gently mention that the client appears to be experiencing pain that can be treated, and then continue the conversation by reassuring that the client is not a bother. Documenting without addressing the client's report, confirming age as a reason for pain, and reminding that pain can be tolerated are inappropriate nursing actions
Which statement is true of chronic pain?
It interferes with normal functioning. Chronic pain is pain that may be limited, intermittent, or persistent but that lasts for 6 months or longer and interferes with normal functioning. It is commonly characterized by periods of remission and exacerbation.
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.
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. Patient-controlled analgesia (PCA) gives the client the advantage of playing an active role in pain management, as the client is allowed to self-administer medication. Pain relief is rapid, not slow and steady, because the drug is delivered intravenously. PCA does not replace nursing care or reduce the amount of care that the client requires.
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 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 Children as young as 3 years of age can use the Wong-Baker FACES® scale. A word, numeric, or visual analog scale is more appropriate for adults.
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.
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 health care team? Select all that apply.
neuropathic chronic Neuropathic pain (pain with atypical characteristics) is also called functional pain. This type of pain often is experienced days, weeks, or even months after the source of the pain has been treated and resolved. Acute pain (discomfort that has a short duration) lasts for a few seconds to less than 6 months. Other answers are incorrect.
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 The first step in pain impulse transmission occurs in the periphery at the sight of injury. Energy is converted from one form to another and injured cells release substances that activate or sensitize nearby nociceptors. Nociceptors are located on two types of peripheral nerve cells (A-delta fibers and C-fibers) that are responsible for transmitting pain sensations from the tissues to the central nervous system (CNS). A-delta fibers give rise to bright, sharp, well-localized pain that is immediately associated with the injury. Slow-conducting C-fibers cause a second pain sensation that is dull, poorly localized, and persistent after injury. The spinothalamic tract transmits ascending impulses via secondary afferent neurons toward the brain and thalamus for interpretation.
Whenever possible, the nurse who is treating the pain of older adults should avoid the use of which drug(s)?
nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs: Used effectively in multimodal therapy for the treatment of both acute and persistent pain. Use lowest effective dose over shortest period of time to decrease likelihood of side effects. • Inhibits prostaglandin production, which protects the stomach and kidneys. Also inhibits platelet aggregation. • Side effects include gastrointestinal irritation, renal toxicity, and bleeding. Use with caution in patients with gastrointestinal disorders, kidney disease, and patients with bleeding risk.
A nurse is caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain?
phantom pain The nurse should document the pain as phantom pain, a type of neuropathic pain that is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. The client perceives that the amputated limb still exists and feels burning, itching, and deep pain in tissues that have been surgically removed. The client is not experiencing referred pain, visceral pain, or cutaneous pain. Visceral pain is associated with disease or injury. Referred pain is not experienced in the exact site where an organ is located. Cutaneous pain originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma.
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 a pain rating The client's assessment of pain, based on a pain rating, is the most appropriate assessment data. The pain is rated on a 0 to 10 scale and nursing actions are then implemented to reduce the pain. The nurse's impression of pain and nonverbal clues are subjective data which should be considered, but which are not more important than the pain rating. Pain relief after nursing intervention is appropriate, but is a part of evaluation.
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? You Selected:
the release of endorphins Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that certain measures such as skin stimulation and relaxation techniques release endorphins.
A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain?
whenever the vital signs are measured and documented The nurse should assess the client's pain whenever the nurse measures and documents vital signs. When administering a prescribed analgesic, the nurse should assess pain before implementing a pain-management intervention, and again 30 minutes later. The nurse should assess the client's pain when the client is admitted to, not discharged from, the health care facility. Similarly, the nurse should assess pain once per shift when pain is an actual or potential problem.
