Chapter 4: Pain (Nurs 309)

A client reports severe pain 2 days after surgery. Which INITIAL action should the nurse take after assessing the characteristics of the pain? 1. Encourage rest. 2. Obtain vital signs. 3. Administer PRN analgesic. 4. Document the client's pain response.

2. Obtain vital signs.

A client with an inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit, which nursing action is appropriate? 1. Maintain the settings programmed by the health care provider. 2. Turn the machine on several times a day for ten to twenty minutes. 3. Adjust the dial on the unit until the client states the pain is relieved. 4. Apply color-coded electrodes on the client where they are the most comfortable.

3. Adjust the dial on the unit until the client states the pain is relieved.

A nurse is caring for a client after a total knee replacement who is requesting Vicodin in addition to the patient controlled analgesia. The client reports having taken 2 Vicodin tablets every 4 hours for several weeks before surgery. If each tablet contains 500 mg of acetaminophen , how much acetaminophen had the client been ingesting per day?

6,000 mg

In the care of clients with pain and discomfort, which task is MOST appropriate to delegate to unlicensed assistive personnel (UAP)? 1. Assisting the client with preparation of a sitz bath. 2. Monitoring the client for signs of discomfort while ambulating. 3. Coaching the client to deep breath during painful procedures. 4. Evaluating relief after applying cold compress.

1. Assisting the client with preparation of a sitz bath.

What is a nurse's responsibility when administering prescribed opioid analgesics? SELECT ALL THAT APPLY 1. Count the client's respiration. 2. Document the intensity of the client's pain. 3. Withhold the medication if the client reports pruritus. 4. Verify the number of doses in the locked cabinet before administering the prescribed dose. 5. Discard the medication in the client's toilet before leaving the room if the medication is refused.

1. Count the client's respiration. 2. Document the intensity of the client's pain. 4. Verify the number of doses in the locked cabinet before administering the prescribed dose.

A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal anti-inflammatory drugs. Which medication will the nurse advocate for FIRST? 1. Gabapentin 2. Corticosteroids 3. Hydromorphone 4. Lorazepam

1. Gabapentin

A client with arthritis increases the dose of ibuprofen (Motrin, Advil) to abate joint discomfort. After several weeks, the client becomes week. The health care provider determines that the client is severely anemic and admits the client to the hospital. What clinical indicators does the nurse expect to identify when performing an admission assessment? SELECT ALL THAT APPLY. 1. Melena 2. Tachycardia 3. Constipation 4. Clay-colored stools 5. Painful bowel movements

1. Melena 2. Tachycardia

The nurse is caring for a postoperative client who reports pain. Based on recent evidence-based guidelines, which approach would be BEST? 1. Multimodal strategies 2. Stading orders by protocol 3. Intravenous patient-controlled analgesia 4. Opioid dosage based on valid numerical scale

1. Multimodal strategies

When an analgesic is titrated to manage pain, what is the PRIORITY goal? 1. Titrate to the smallest dose that provides relief with the fewest side effects. 2. Titrate upwards until the client is pain-free or acceptable level of pain is reached. 3. Titrate downward to prevent toxicity, overdose, and adverse effects. 4. Titrate to dosage that is adequate to mee the client's subjective needs.

1. Titrate to the smallest dose that provides relief with the fewest side effects.

A client received as needed (PRN) morphine, lorazepam, and cyclobenzaprine. The unlicensed assistive personnel (UAP) reports that the client has a respiratory rate of 10 breaths/min. What is the PRIORITY action? 1. Call the healthcare provider to obtain an order for naloxone. 2. Assess the client's responsiveness and respiratory status. 3. Obtain a bag-valve mask and deliver breaths at 20 breaths per minute. 4. Double-check prescription to see which drugs were ordered.

2. Assess the client's responsiveness and respiratory status.

The nurse is assessing a client who has been receiving opioid medication via patient-controlled analgesia. What is an EARLY sign that alerts the nurse to a possible adverse opioid reaction? 1. Client reports shortness of breath. 2. Client is more difficult to arouse. 3. Client is more anxious and nervous. 4. Client reports pain is worsening.

2. Client is more difficult to arouse.

A client who had abdominal surgery is receiving patient-controlled analgesia intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client with a lock-out time frame of 10 minutes. The nurse assesses the use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is still experiencing pain. What should the nurse do FIRST? 1. Monitor the client's pain level for another hour. 2. Determine the integrity of the intravenous delivery system. 3. Reprogram the pump to deliver a bolus every 8 minutes. 4. Arrange for the client to be evaluated by the health care provider.

2. Determine the integrity of the intravenous delivery system.

Based on the client's reported pain level, the nurse administers 8 mg of the prescribed morphine. The medication is available in a 10 mg syringe. Wasting of the remaining 2 mg of morphine should be done by the nurse and a witness. It is most appropriate for the nurse to ask which member of the health care team to be the witness? 1. Nursing supervisor 2. Licensed practical nurse (LPN) 3. Client's health care provider 4. Designated nursing assistant

2. Licensed practical nurse (LPN)

In the post anesthesia care unit it is reported that the client received intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as part of the client's INITIAL 24-hour postoperative care? 1. Assessing the client for tachycardia. 2. Monitoring respiratory rate rate hourly. 3. Administering naloxone every 3 to 4 hours. 4. Observing the client for signs of CNS excitement.

2. Monitoring respiratory rate rate hourly.

For a cognitively impaired client who cannot accurately report pain, what is the FIRST action that the nurse should take? 1. Closely assess for nonverbal signs such as grimacing or rocking. 2. Obtain baseline behavioral indicators from family members. 3. Note the time of and client's response to the last dose of analgesic. 4. Give the maximum as needed (PRN) dose within the minimum time frame for relief.

2. Obtain baseline behavioral indicators from family members.

What are the desired outcomes that the nurse expects when administering a nonsteroidal antiinflammatory drug (NSAID)? SELECT ALL THAT APPLY. 1. Diuresis 2. Pain relief 3. Antipyresis 4. Bronchodilation 5. Anticoagulation 6. Reduced inflammation

2. Pain relief 3. Antipyresis 6. Reduced inflammation

A client's family member comes to the nurse's station and says "He needs more pain medicine. He's still having a lot of pain." What is the nurses BEST response? 1. "The healthcare provider ordered the medicine to be given every 4 hours." 2. "If medicine is given to frequently, there are ill effects." 3. "Please tell him I will be right there to check on him." 4. " Let's wait about 40 minutes. If he still hurts, I'll call the health care provider."

3. "Please tell him I will be right there to check on him."

Family members are encouraging the patient to "tough out the pain" rather than risk drug addiction to opioids. The client is stoically abiding. The nurse recognizes the sociocultural dimension of pain is the current priority for the patient. Which question will the nurse ask? 1. "where is the pain located, and does it radiate to other parts of your body?" 2. "How would you describe the pain, and how is it affecting you?" 3. "What do you believe about pain medication and drug addiction?" 4. "How often is the pain affecting your activity level and your ability to function?"

3. "What do you believe about pain medication and drug addiction?"

The health care provider prescribes 7 mg morphine IV as needed (PRN). The nursing student prepares the medication and shows the syringe to the nursing instructor. (Filled to 7 mL and picture shows 10 mg/mL) What should the nursing instructor do FIRST? 1. Tell the student to review the provider's prescription before administering the medication. 2. Waste the medication and tell the student that remediation is required for serious error. 3. Ask the student to demonstrate the calculations and steps required to prepare the dose. 4. Accompany the student to the client's room and observe as the medication is administered.

3. Ask the student to demonstrate the calculations and steps required to prepare the dose.

In application of the principles of pain treatment, what is the FIRST consideration? 1. Treatment based on client goals 2. A multidisciplinary approach is needed 3. Client's perception of pain must be accepted 4. Drug side effects must be prevented and managed

3. Client's perception of pain must be accepted

A client receiving morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate? 1. Nasotracheal suction 2. Mechanical ventilation 3. Naloxone administration 4. Cardiopulmonary resuscitation

3. Naloxone administration

A client who had a total hip replacement asks the nurse about the continuous regional analgesia being used. What information should the nurse include when explaining the benefits of this treatment over conventional methods to control pain? 1. Adjusting the dose is easily done. 2. Neuropathic pain can be relieved. 3. Systemic side effects are minimal. 4. The need for parenteral medication is avoided.

3. Systemic side effects are minimal.

A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. Client's spouse tells the nurse the client is uncomfortable again and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do? 1. Add a placebo to the morphine to appease the spouse. 2. Discuss with the spouse about the risk for morphine addiction. 3.. Assess the client's pain before increasing the dose of morphine. 4. Check the client's heart rate before increasing the morphine to the next level.

3.. Assess the client's pain before increasing the dose of morphine.

A nurse is taking a health history of a client who is to have surgery in 1 week. The nurse identifies that the client is taking ibprofen (Advil) for discomfort associated with osteoarthritis and notifies the health care provider. Which drug does the nurse expect will MOST likely be prescribed instead of Advil? 1. Naproxen (Aleve) 2. Ibuprofen (Motrin) 3. Ketorolac (Toradol) 4. Acetaminophen (Tylenol)

4. Acetaminophen (Tylenol)

What is the BEST way to schedule medication for a client with constant pain? 1. As needed (PRN) at the client's request. 2. Before painful procedures. 3. IV bolus after pain assessment. 4. Around the clock.

4. Around the clock.

On the first day after surgery, a client recieving an analgesic via patient-controlled analgesia pump reports that the pain control is inadequate. What is the FIRST action that the nurse should take? 1. Deliver the bolus dose per standing order. 2. Contact the healthcare provider to increase the dose. 3. Try non-pharmacologic comfort measures. 4. Assess the pain for location, quality, and intensity.

4. Assess the pain for location, quality, and intensity.