CoursePoint+ Chapter 9: Pain Management
A teenage client is undergoing a dressing change to burns on the thigh. The client refuses pain medication and states, "I do not hurt, and I don't need it." He is withdrawn, grimaces, and turns away during the dressing change. He was last medicated 8 hours ago. What is the best statement by the nurse?
"I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication."
The nurse understands that which of the following physiologic changes that influence the pain response occur in the gerontologic population?
Increased sensitivity to medications
The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient?
Older people experience reduced sensory perception.
What term refers to the time the pain began?
Onset
The client takes naproxen for arthritic pain and is now prescribed warfarin for persistent atrial fibrillation. Due to the interactions of the medications, what is the nurse's best response?
Assess the client's stool for color
The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply.
"How long have you experienced this pain?" "Please point to where you are experiencing pain." "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." "What aggravates your chest pain?"
A client informs the nurse of having taken ibuprofen every 6 hours for 3 weeks to help alleviate the pain of arthritis. The client has a history of a gastric ulcer and is taking a proton pump inhibitor for the treatment of this disorder. What should the nurse instruct the client about the use of the ibuprofen
"It would be best to contact the health care provider before taking any over-the-counter medications."
A client informs the nurse of having taken ibuprofen every 6 hours for 3 weeks to help alleviate the pain of arthritis. The client has a history of a gastric ulcer and is taking a proton pump inhibitor for the treatment of this disorder. What should the nurse instruct the client about the use of the ibuprofen?
"It would be best to contact the health care provider before taking any over-the-counter medications."
The nurse is assessing a client who has been taking up to 4 grams of acetaminophen every day for undiagnosed pain. What reaction due to ingestion of acetaminophen will the nurse assess for?
Abrupt onset of rash and pruritus
Which of the following should the nurse recommend to a client with a bruised ankle to initially relieve pain associated with the injury and reduce localized swelling?
Applications of heat and cold
Prior to starting a peripheral intravenous line on a patient, what intervention can the nurse provide to decrease the pain from the needle puncture?
Apply eutectic mixture of local anesthetic cream 30 minutes prior to the procedure.
A home health nurse is visiting a client who has been taking the same dose of acetaminophen/hydrocodone for 2 months. To monitor for the presence of expected side effects of this medication, what should the nurse include in the assessment of the client?
Ask about the client's bowel pattern.
A client with a terminal illness grimaces and begins to cry when being turned and repositioned in bed. Which action will the nurse take at this time?
Ask the client to rate the pain.
A client who fell at home is hospitalized for a hip fracture. The client is in Buck's traction, anticipating surgery, and reports pain as "2" on a pain intensity scale of 0 to 10. The client also exhibits moderate anxiety and moves restlessly in the bed. The best nursing intervention to address the client's anxiety is to
Assess the reason for the client's anxiety.
The client is prescribed 2 mg of intravenous morphine every 2 hours as needed for pain. The nurse administers the medication. Thirty minutes later, the client reports the pain level remains at a "6" on a pain intensity scale of 0 to 10. The nurse first
Assesses the client's mental status and vital signs
A preventative approach to pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) means that the medication is given:
Before pain is experienced.
When a nurse asks a patient to describe the quality of the pain, what type of descriptive term does the nurse expect the patient to use?
Burning
When using transdermal Fentanyl, the nurse and patient should be aware of which sign or symptom of Fentanyl overdose?
Confusion
A client is reporting her pain as "8" on a 0-to-10 pain intensity scale. Then, the client states the pain is "3." Before the nurse leaves the room, the client states her pain is "6." The best action of the nurse is to
Obtain a pain scale with faces for the client to measure her pain
A client arrives in the orthopedic clinic with complaints of twisting the right ankle while playing softball. The nurse collects data including complaints of pain and swelling in the right ankle. What intervention will the nurse provide that will decrease vasodilation and reduce localized swelling?
Ice Bag
When evaluating a patient's response to acute pain, the nurse assesses for the presence of physiologic responses associated with the pain experience. Select all that apply:
Increased cardiac output Increased metabolic rate Hyperglycemia Decreased urinary output
A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing?
Neuropathic pain
Which of the following pain assessment tools is most commonly used in adults?
Numeric scale
Which condition, approved by the U.S. Food and Drug Administration, is the only use for the lidocaine 5% patch?
Postherpetic neuralgia
A client who is watching television with a visitor reports severe pain and wants pain medication. Which action will the nurse take?
Prepare a dose of pain medication as prescribed.
Which of the following is a true statement with regards to the preventative approach to the use of analgesics?
Smaller doses of medication are needed.
The nurse plans nonpharmacologic interventions for a client who is approaching discharge after a left knee arthroplasty to address the client's pain.
application of heart or cold- physical modality relaxation and breathing- cognitive and behavioral method yoga-movement therapy aquatic therapy-physical modality distraction-cognitive and behavioral method thai chi-movement therapy proper body alignment-physical modality imagery- cognitive and behavioral method
Which of the following is a true statement with regards to the nursing process of pain control?
The use of physiologic signs to indicate pain is unreliable.
A 64-year-old client is experiencing joint pain on a regular basis and asks the nurse what the options are beyond heat and the yoga exercises the client has been doing. What does the nurse describe as the cornerstone treatment modality for pain?
drug therapy
The nurse is assessing a client with an epidural catheter. This client is also receiving anti-thrombotic therapy. The nurse notes that the client is experiencing sensory and motor dysfunction of the lower limbs. The nurse should suspect:
epidural hematoma.
A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends
increasing the amount of bran and fresh fruits and vegetables
The nurse sees an order for a lidocaine 5% patch. What use is approved for by the US Food and Drug Administration for this patch?
postherpetic neuralgia
When completing a teaching plan for a client receiving patient-controlled analgesia (PCA), which component would be important for the nurse to stress?
the pump will deliver a preset amount of medication.
A client has been given a patient-controlled analgesia (PCA) device to control postoperative pain. The client expresses concern about administering too much of the analgesic and accidentally overdosing. What topic should the nurse teach the client about?
the limits on dose and frequency that are programmed into the PCA
A client sustained second- and third-degree burns to the chest and neck 4 days ago and is now refusing analgesics stating, "I don't want to become addicted to pain medication." What is the best response by the nurse?
"Although misusing the medication may cause addiction, there is little evidence that those who require narcotics for legitimate pain become addicted."
A physician orders morphine sulfate 1 mg IV stat for chest pain. The drug is available in 2 mg per 1 mL syringe. How many mL does the nurse administer? Enter the correct number ONLY.
0.5
Acute pain can be distinguished from chronic pain by assessing which characteristic?
Acute pain is specific and localized.
A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies
"What do you mean by the word sick?"
A client is receiving morphine sulfate intravenously (IV) every 4 hours as needed for the relief of pain related to a surgical procedure the client had 3 days previously. The physician is discontinuing the IV and will be starting the client on oral pain medication. What would provide the client with optimal pain relief when discontinuing the IV dose?
Administer an equianalgesic dose.
Which of the following is the appropriate intervention to avoid physical dependence on drugs in a client?
Discontinue drugs gradually.
When taking a client history, the nurse notes that the client is taking herbal remedies in addition to acetaminophen. Which herb, when taken in conjunction with acetaminophen, enhances the risk of bleeding?
Ginkgo
The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to
Educate the client that this goal may not be achievable.
Which substance reduces the transmission of pain?
Endorphins
when evaluating a patient's response to acute pain, the nurse assesses for the presence of physiologic responses associated with the pain experience. Select all that apply:
Increased cardiac output Increased metabolic rate Hyperglycemia Decreased urinary output
When drafting a nursing care plan for a patient in pain, it is important for the nurse to determine if the pain is acute or chronic. Choose the best example of chronic pain.
Intervertebral disk herniation
The nurse is caring for a patient who has been hospitalized on several occasions for lower abdominal pain related to Crohn's disease. How may this chronic pain be described?
Prolonged in duration
A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be:
Prolonged in duration.
Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy?
Risk for impaired gas exchange
A client reports having joint pain that has gotten worse over the last year despite gradually increasing doses of an OTC pain reliever. Which type of pain will the nurse document as the chief complaint?
chronic pain
A nurse is caring for a client with pain. What should the nurse monitor for when administering intravenous acetaminophen?
hepatotoxicity
A client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. The initial surgeries occurred more than 2 months ago, and the nurse is concerned about the repeated requests. What does the nurse suspect to be the cause of the client's frequent appeals for pain medication?
tolerance
A client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. The client is without breakthrough pain at this point in time. How would this client's pain be classified?
neuropathic and chronic
The client is taking oxycodone (Oxycontin) for chronic back pain and reports decreased pain relief when he began taking a herb to improve his physical stamina. The nurse asks if the herb is
ginseng
The nurse is caring for a client with kidney stones who reports severe pain. What type of pain does the nurse understand this client is experiencing?
Visceral pain
A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client
"Only you are to push the button for medication."
A client with appendicitis has had an appendectomy. After surgery, what type of pain does the nurse anticipate the client will have?
Acute Pain
The nurse is obtaining data regarding medications the client is taking on a regular basis. The client states he is taking duloxetine, an antidepressant for the treatment of neuropathic pain. What type of therapy does the nurse understand the client is receiving?
Adjuvant drug therapy
A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain?
Administer analgesics around the clock.
How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?
Administering the analgesics every three hours
The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for?
Bradypnea
A client has been prescribed a fentanyl patch for pain control. The nurse understands that this patch should be replaced how often?
Every 48-72 hours
The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting:
Severity of the pain as judged by the patient
The nurse informs the patient that a preventive approach for pain relief will be used, involving nonsteroidal anti-inflammatory drugs. What will this mean for the patient?
The pain medication will be administered before the pain is experienced.
An adult with severe cognitive impairment has had a surgical procedure, and the nurse is having a difficult time assessing the level of pain the client is having postoperatively. What method can the nurse use to obtain data about the client's pain?
Use behavioral comparison of the client's current and previous behavior patterns.
A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing?
visceral
