N504 Ch 11 pain assessment

Which statement made by the student nurse indicates effective learning when differentiating between A and C peripheral nerve fibers? "A fibers are myelinated, and C fibers are unmyelinated." "A fibers are smaller in diameter, and C fibers are larger in diameter." "A fibers transmit signals slowly, and C fibers transmit signals rapidly." "A fibers cause diffuse sensation, and C fibers cause localized sensations."

"A fibers are myelinated, and C fibers are unmyelinated." A fibers are myelinated, whereas C fibers are unmyelinated. A fibers are larger in diameter, whereas C fibers are smaller in diameter. Because A fibers are larger in diameter, they transmit signals more rapidly to the central nervous system (CNS) compared with the smaller C fibers. The sensations caused by the stimulation of A fibers are localized, whereas the sensations caused by the stimulation of C fibers are diffuse. p. 161

Which question by the nurse satisfies the "Timing" criterion of the PQRST method for assessing a patient's pain? "What aggravates the pain?" "Are you ever awakened by pain?" "Do you feel like the pain travels around?" "Does pain interfere with your activities?"

"Are you ever awakened by pain?" The question "Are you ever awakened by pain?" indicates the Timing criterion, because the nurse is assessing the timing of the pain. The question "Do you feel like pain travels around?" indicates the Region/Radiation criterion, because the nurse is assessing radiation of the pain. The question "Does pain interfere with your activities?" indicates the Severity Scale criterion, because the nurse is assessing the severity of the pain. The question "What aggravates it?" indicates the Provocation/Palliation criterion, because the nurse is assessing the trigger for the pain. p. 166

Which statement by the nursing student indicates the need for further teaching about fetal brain development and pain response? "The fetus develops ascending sensory fibers by 20 weeks of gestation." "The fetus responds to pain because of development of a connection to the thalamus." "Pain in the fetus elicits a stress response that should be prevented if possible." "The fetus is sensitive to pain stimuli because of the presence of inhibitory neurotransmitters."

"The fetus is sensitive to pain stimuli because of the presence of inhibitory neurotransmitters." A fetus responds to pain stimuli because of the development of sensory fibers. The presence of inhibiting neurotransmitters helps control pain in the fetus, not cause it. In the 20th week of gestation, the fetus develops ascending sensory fibers. Pain response occurs because of the connection to the thalamus, which occurs around 20 weeks of gestation. Pain stimuli cause a stress response in the fetus, which should be avoided.

Which statement, if made by a nursing student about the transduction phase of nociception, indicates effective teaching? "The patient acknowledges painful sensations during this phase." "The endogenous opioids block the pain impulses during this phase." "The pain impulse moves from the spinal cord to the thalamus during this phase." "The peripheral tissue secretes histamine and prostaglandins during this phase."

"The peripheral tissue secretes histamine and prostaglandins during this phase." In the transduction phase of nociception, the peripheral tissues secrete neurotransmitters such as prostaglandins and histamines at the site of the injury. These neurotransmitters transmit the pain impulses from the sensory nerve fibers to the spinal cord. During the perception phase, the pain stimuli are received and interpreted by the higher cortical structures of the brain and cause the sensory perception of pain. During the transmission phase, endogenous opioids are secreted in the brain and block the pain signals by activating opioid receptors. If the opioid receptor does not block the pain impulse during transmission, then the impulse moves from the spinal cord to the thalamus. p. 161

Which question would the nurse ask the patient with rheumatoid arthritis to evaluate the effectiveness of corticosteroid therapy? "When did your pain start?" "What does this pain mean to you?" "Why do you think you are having pain?" "What makes your pain better or worse?"

"What makes your pain better or worse?" To identify the effectiveness of the treatment, the nurse would ask the patient what makes the pain better or worse. It helps the nurse determine whether the treatment provided to the patient is effective in alleviating pain. The nurse asks the patient when the pain started to identify the onset and duration of the pain, but this does not help evaluate the effectiveness of the treatment. Asking questions like what pain means to the patient and what the patient thinks to be the cause of pain helps the nurse identify the pain myths and misconceptions the patient may believe. p. 164

The postoperative patient reports inadequate pain relief despite analgesic administration. Which questions would the nurse ask to assess the pain in the patient? Select all that apply. "Where do you have pain?" "How do you usually react to pain?" "What does your pain feels like?" "How much pain do you have now?" "Why do you think you are in so much pain?

"Where do you have pain?" "What does your pain feels like?" "How much pain do you have now?" The nurse would assess the pain by asking the patient questions like "Where do you have pain?" These questions help identify the location of pain. The nurse would ask the patient questions like "What does your pain feels like?" because it helps identify the quality of pain. The nurse would also ask the patient "How much pain do you have now?" because it helps assess the intensity of the pain. The primary nursing intervention is to provide pain relief to the postoperative patient. Therefore asking these questions would help the nurse provide better pain management therapies. Asking the patient "How do you usually react to pain?" is appropriate if the patient has chronic pain syndrome and assumes this patient always has pain. Because this patient has pain because of surgery, this question may not be appropriate. Asking the patient "Why do you think you are in so much pain?" isn't helpful because the patient has acute pain related to surgery. p. 165

After abdominal surgery, a 2-year-old child exhibits an occasional grimace, has the legs drawn up, is tense, moans regularly, and has been difficult to console. Using the FLACC Behavioral Pain Scale, the nurse documents which pain score for the patient? Enter your response using a whole number.

7 The FLACC scale is a pain assessment tool that helps evaluate the intensity of pain in infants and children under 3 years of age based on characteristics of the Face, Legs, Activity, Cry, and Consolability. The child who exhibits an occasional grimace (1), has the legs drawn up (2), is tense (1), moans regularly (1), and is difficult to console (2) has a score of 7. It has a score range from 0 to 10. A score of 1 to 3 indicates that the child has mild discomfort. A score of 0 indicates that the child is relaxed and comfortable without any discomfort. A pain score in the range of 4 to 5 indicates that the child has moderate pain. A score range of 7 to 10 indicates that the child has severe discomfort or pain. p. 171

The patient who had an accident several years ago presents to the emergency department complaining of severe arm pain. The nurse gently presses the patient's arm with the blunt end of a tongue depressor and the patient cries out in pain and flinches. Which term would the nurse use to document this finding? Allodynia Hyperalgesia Hyperpathia Hyperstimulation

Allodynia Severe pain in response to a gentle stimulus indicates allodynia, which indicates nerve damage. Hyperalgesia refers to increased pain response to a painful stimulus. Hyperpathia is also an increased response to a painful stimulus, but the pain lingers after the stimulus has been removed. Hyperstimulation is overstimulation of nerve fibers. p. 172

Which condition is associated with deep somatic pain? Tendinitis Stomach and intestinal pain Back pain upon changing positions Coronary syndrome with pain in the neck

Tendinitis Tendinitis is the inflammation of tendons, which causes deep somatic pain. Intestinal pain and severe stomach cramps indicate that the patient has visceral pain. Pain felt by the patient while changing position is an indicator of incident pain. If the patient with coronary disease experiences pain in the neck, then it indicates that the patient has referred pain. p. 162

After an appendectomy, the nurse notes that the patient has pain, hypertension, tachycardia, stoic face, and breathing difficulty. Which type of pain is the patient experiencing? Acute Chronic Malignant Breakthrough

Acute The presence of hypertension, stoic face, and breathing difficulty indicates that the patient has acute pain. If a patient experiences pain for more than 6 months, then it indicates that the patient has chronic pain. Here, the patient is experiencing pain immediately after the surgery, so it does not indicate that the patient has chronic pain. Malignant pain is caused by the presence of a tumor. Increased blood pressure, tachycardia, and stoic face do not indicate that the patient has a tumor. Therefore the patient does not have malignant pain. Reduced effects of opioid analgesic in patients may cause breakthrough pain. Because the patient is not on opioid therapy, the nurse will not infer that the patient has breakthrough pain. p. 168

The nurse is caring for a patient with severe epigastric pain that has occurred within half an hour of eating fatty foods during the past 2 weeks. The pain abates after bringing knees to chest and not moving for about 1 hour. Upon assessment, the nurse finds severe tenderness in the left upper quadrant of the abdomen. The nurse reports which type of pain to the provider? Acute episodic Acute incident Chronic somatic Chronic visceral

Acute episodic The patient states that he or she has episodic pain that usually occurs within half an hour of eating fatty foods and that it lessens after bringing the knees to the chest and not moving for a period of 1 hour. In addition to these statements, severe tenderness in the left upper quadrant of the abdomen indicates acute episodic pain in the patient. Acute incident pain occurs because of body movements. The cause does not involve consumption of fatty or greasy foods. Chronic pain, not episodic pain, continues for 6 months or longer. Therefore the nurse does not assess the pain as chronic somatic or chronic visceral pain. P. 169

A patient with a shoulder injury tells the nurse, "My shirt is chafing my shoulder and causing me pain. Can you get me a sleeveless shirt?" Which term would the nurse use to document the patient's statement? Allodynia Analgesia Incident pain Breakthrough pain

Allodynia An increase in pain because of a slight touch of a cloth or cotton swab indicates that the patient has allodynia, which is damage to the nerve fibers at the injury site. If a patient experiences no pain at the injury site, then it could indicate analgesia. If the patient has pain at a particular site because of movement, then it indicates incident pain. If the patient experiences a transient spike in pain despite taking analgesics to control pain, this is called breakthrough pain. p. 167

Which conditions are associated with visceral pain? Select all that apply. Arthritis Appendicitis Fibromyalgia Cholecystitis Kidney stones

Appendicitis Cholecystitis Visceral pain results from the activation of nociceptors of the visceral organs. Pain associated with appendicitis and cholecystitis is visceral pain. Chronic nonmalignant pain is often associated with musculoskeletal conditions such as arthritis and fibromyalgia. Pain caused by kidney stones is an example of acute pain. p. 162

Patients with which conditions are at risk for chronic nonmalignant pain? Select all that apply. Arthritis Fibromyalgia Low back pain Skin infection Thyroid disorder

Arthritis Fibromyalgia Low back pain Arthritis, fibromyalgia, and low back pain are all musculoskeletal disorders associated with severe nerve and tissue damage, which may result in chronic nonmalignant pain. Skin infection and thyroid disorder are not associated with nerve damage and may not cause chronic nonmalignant pain. Skin infection may result in acute pain because of inflammation and tissue damage. Thyroid disorder is associated with low serum thyroxine levels, resulting in impaired metabolism. p. 163

Which pathologic disorders are associated with nociceptive pain? Select all that apply. Arthritis Mechanical back pain Central poststroke pain Carpal tunnel syndrome Complex regional pain syndrome

Arthritis Mechanical back pain Arthritis and mechanical back pain are the physiologic disorders associated with nociceptive pain. Central poststroke pain, carpal tunnel syndrome, and complex regional pain syndrome are physiologic disorders associated with neuropathic pain. p. 162

Which is an expected finding in a patient with diabetic peripheral neuropathy? Burning pain in feet bilaterally Brittle nails with pale, shiny, dry skin Severe stabbing or piercing pain in face Burning, shooting pain in glove-and-stocking manner

Burning pain in feet bilaterally The diabetic patient with peripheral neuropathy shows symptoms of burning pain in the feet bilaterally, which worsens during the night. The patient with reflexive sympathetic dystrophy has brittle nails, and the skin appears pale, dry, and shiny. Patients with trigeminal neuralgia have severe stabbing or piercing pain in the facial area. Cancer patients who undergo chemotherapy may develop chemotherapy-induced peripheral neuropathy. This symptom manifests as burning, shooting pain in glove-and-stocking manner. p. 172

The patient with trigeminal neuralgia has been experiencing intense facial pain for 1 year that is refractory to analgesics. The nurse assesses the patient for which other symptoms? Select all that apply. Mild anxiety Confusion Depression Hyperventilation Urinary incontinence

Confusion Depression If the patient's pain lasts for more than 6 months and is unresponsive to analgesics, it indicates that the patient has poorly controlled chronic pain; this condition can increase serotonin levels in the brain, resulting in confusion and depression. Anxiety, hypoventilation (not hyperventilation), and urinary incontinence may occur with chronic pain but are more often associated with acute pain. p. 168

Which criteria are assessed using the PAINAD pain assessment scale? Select all that apply. Visual acuity Consolability Facial expression Hearing ability Body language

Consolability Facial expression Body language While using the PAINAD assessment tool, the nurse would monitor five parameters: breathing, vocalization, consolability, facial expression, and body language. Because of the pain, the patient may suffer from hypoxia and hyperventilation. The nurse would check the patient's breathing rate. The patient may make a whimpering sound in response to pain, so the nurse would monitor vocalization. The patient may be confused because of the dementia and may not be open to suggestions. Therefore the nurse would check if the patient is consolable. The patient may exhibit a facial grimace in response to pain and may change the body posture to promote comfort, so the nurse would monitor patient's facial expressions and body language. Pain does not impair visual acuity and does not cause hearing impairment. Therefore the nurse need not monitor the patient's vision and hearing. p. 173

The nurse asks the patient with lower back pain, "How does the pain limit your daily activities?" to determine which aspect of the patient's pain experience? Quality of the pain Degree of impairment Onset and duration of the pain Preconceived notions of pain and medication

Degree of impairment Questions on how pain limits the patient's function or activities help the nurse identify its effect on the quality of life. The question "What does the pain feels like?" helps identify the quality of the pain experienced by the patient. The nurse can identify the pain myths and misconceptions the patient believes by asking questions like "What does this pain mean to you?" Asking a question like "When did your pain start?" helps the nurse determine the onset and duration of the pain. p. 165

Which physiologic change can cause hyperalgesia and allodynia? Depletion of GABAergic interneurons Decrease in prostaglandin and bradykinin levels Increase in opioid receptors along the spinal cord Increase in levels of enkephalins and dynorphins

Depletion of GABAergic interneurons Depletion of GABAergic interneurons causes a decrease in the levels of gamma-aminobutyric acid (GABA), which is an inhibitory neurotransmitter. A decrease in GABA levels increases the sensitivity of the nerves and causes hyperalgesia and allodynia in the patient. A decrease in prostaglandin and bradykinin levels results in decreased pain impulses. It does not cause hyperalgesia and allodynia. An increase in opioid receptors reduces the transmission of pain but does not cause hyperalgesia and allodynia. Enkephalins and dynorphins are endogenous opioids and alleviate pain, but do not cause hyperalgesia and allodynia. p. 162

Which pain assessment tool is appropriate for a 2-year-old patient? FLACC scale CRIES scale PAINAD scale Faces Pain Scale-Revised (FPS-R)

FLACC scale The FLACC scale is a nonverbal pain assessment tool that is used to assess the intensity of pain in infants and children under 3 years of age by observing the facial expression, leg movement, activity level, cry, and consolability in the child; the scale gives a score from 0 to 10. The CRIES scale is a 3-point scale that helps assess postoperative pain in preterm infants and neonates. The PAINAD scale is a pain assessment tool that helps measure pain in patients with dementia. It uses breathing, vocalization, and facial expression as assessment tools. Faces Pain Scale-Revised (FPS-R) is a pain assessment tool that helps assess the intensity of pain through drawings of different facial expressions. p. 168

Which pain assessment tool would the nurse use to evaluate the intensity of pain in a 6-year-old patient? Faces Pain Scale Numeric rating scale Visual Analogue Scale Verbal Descriptor Scale

Faces Pain Scale The Faces Pain Scale is a pain assessment tool that can be used to evaluate the intensity of pain in children and would be selected for a 6-year-old. It consists of drawings of six faces with different facial expressions. Each face depicts a different level of pain intensity, from no pain to a lot of pain. The child is asked to select one picture that matches his or her facial expression while experiencing pain. In the numeric rating scale, the patient is asked to rate the intensity of the pain he or she is experiencing. The Visual Analogue Scale consists of a 10-cm horizontal line with markings for "no pain" to "worst imaginable pain." While using the Verbal Descriptor Scale, the nurse asks the patient to describe the pain. As cognition and communication skills are not well developed in children, the numeric rating scale, Visual Analogue Scale, and Verbal Descriptor Scale are not useful for assessing pain in these patients.

Which pain scale would the nurse use to assess the pain level in a 6-year-old child? Faces pain scale Visual analog scale Numeric rating scale Verbal descriptor scale

Faces pain scale Children over the age of 5 years old can use the faces pain rating scale. The visual analog scale lets the patient make a mark on a 10-cm horizontal line. The numeric rating scale has the patient rate the pain from a "0" having no pain to a "10" the worst pain imaginable. The verbal descriptor scale uses words to describe the patient's meaning of the pain. A 6-year-old child would not be able to use the visual analog scale, the numeric rating scale, and the verbal descriptor scale. p. 169

Which examination visualizes neurochemical changes in the brain caused by nociception? X-ray examination (x-ray film) Computerized axial tomography (CAT) scan Functional magnetic resonance imaging (fMRI) Traditional magnetic resonance imaging (MRI)

Functional magnetic resonance imaging (fMRI) Functional magnetic resonance imaging (fMRI) determines the structural, functional, and neurochemical changes caused in the brain by nociception. The x-ray examination, computerized axial tomography (CAT) scan, or traditional magnetic resonance imaging (MRI) cannot help in determining the neurochemical changes in the brain that lead to pain perception. p. 162

After sustaining a fall, a patient reports severe back pain that shoots down to the legs. Upon assessment, the patient is unable to perform hip flexion or extension. The nurse suspects further testing will reveal which condition? Strained hip flexor muscle Herniated lumbar disc Broken floating rib Subluxation of the hip

Herniated lumbar disc Severe lower back pain that shoots down the legs and is associated with an inability to perform hip flexion or extension points to a herniated lumbar disc. Strained hip flexor muscle, broken floating rib, and subluxation of the hip may all cause pain, but none in the lower back that shoots down the legs. p. 171

Which associated disorders may be found in a patient with neuropathic pain? Select all that apply. Herpes zoster Liver metastasis Postoperative pain Trigeminal neuralgia Distal polyneuropathy

Herpes zoster Trigeminal neuralgia Distal polyneuropathy Herpes zoster, trigeminal neuralgia, and distal polyneuropathy are the disorders that cause neuropathic pain because they cause a primary lesion, called a neuroma, and damage the nervous system. Liver metastasis is visceral damage that results in nociceptive pain. Postoperative pain is somatic damage that causes nociceptive pain. p. 172

Which neurotransmitters are released at the site of injury? Select all that apply. Glutamate Histamine Bradykinin Prostaglandin Gamma-aminobutyric acid

Histamine Bradykinin Prostaglandin Histamine, bradykinin, and prostaglandin are the neurotransmitters that are released at the site of injury. These neurotransmitters send the signal of pain to the spinal cord. Glutamate and gamma-aminobutyric acid are released from the brain and block the transmission of pain impulses. p. 161

Which complications related to poorly controlled pain response would the nurse expect in the patient who reports severe pain after surgery? Select all that apply. Hypoxia Atelectasis Increased cough Hypoventilation Hypotension

Hypoxia Atelectasis Hypotension The patient who has undergone surgery may experience acute and severe pain that leads to hypoxia, atelectasis, and hypoventilation. The hypoventilation is related to the patient taking shallow breaths because of the pain, which leads to hypoxia. The patient avoids coughing because of the pain, which, combined with the decreased minute volume of ventilation, leads to atelectasis. The pain causes a decreased (not increased) cough and hypertension (not hypotension). p. 168

The patient reports severe lower back pain while standing for the past 2 days. The nurse documents which type of pain? Chronic Incident Malignant Breakthrough

Incident Incident pain is a type of acute pain caused by certain body movements. Lower back pain while standing indicates that the patient is having incident pain. If a patient experiences lower back pain for more than 6 months, which is not the case here, then it indicates chronic pain. Breakthrough pain occurs in patients who undergo opioid therapy; the patient experiences sudden pain because of the reduced half-life of the medication. Malignant pain is a type of chronic pain; it is induced by tissue necrosis or by the stretching of an organ by a growing tumor. p. 162

The patient with breast cancer who is on long-acting opioid therapy reports a sudden, frequent pain in the breast. The nurse contacts the provider to discuss which change in management? Increasing the dose of the medication Discontinuing the administration of the medication Administering the medication by the subcutaneous route Increasing the time interval between each dose of the medication

Increasing the dose of the medication The patient who is on a long-acting opioid therapy may experience breakthrough or sudden pain resulting from rapid elimination of the medication from the body. In such conditions, increasing the dose of medication helps maintain the optimum blood levels of the drug and provides pain relief. Discontinuing the medication may cause severe pain. Opioids are either administered by the oral or the intravenous route. Administering the medication by the subcutaneous route may cause slow absorption of the drug and inadequate pain relief. Increasing the time interval between each medication dose will reduce the concentration of the drug in the blood and will not help alleviate the breakthrough pain. p. 163

After assessing pain in a 2-year-old child, the nurse documents the score as 5, using the FLACC scale. Which pain level is this patient experiencing? None Mild Moderate Severe

Moderate The FLACC scale is an objective assessment of pain in children under 3 years of age. The tool assesses five behaviors of pain: facial expression, leg movement, activity level, cry, and consolability. A score range of 4 to 6 indicates that the child has moderate pain. As the documented score falls within this range, the nurse interprets that the patient may have moderate pain. The score of 0 indicates that the child is relaxed and comfortable and is not experiencing any pain. The score range of 1 to 3 indicates that the child has mild pain. The score range of 7 to 10 indicates that the child has severe pain. p. 171

Opioids inhibit which part of nociception? Secretion of glutamate and adenosine triphosphate at the synaptic cleft Secretion of histamine, bradykinin, and prostaglandins at the site of injury Movement of the pain impulse across the synaptic cleft to the dorsal horn neurons Movement of the pain impulses from the spinal cord to the thalamus via the ascending fibers

Movement of the pain impulses from the spinal cord to the thalamus via the ascending fibers Opioid analgesics activate the opioid receptors located in the spinal cord and block the transmission of the pain impulses from the spinal cord to the thalamus; this occurs in the second phase of nociception. The secretion of histamine, bradykinin, prostaglandin, glutamate, and adenosine triphosphate (ATP) takes place during the first phase of nociception. The opioid analgesics do not inhibit the events of the first phase, because they do not block the receptors that secrete histamine, bradykinin, prostaglandin, and glutamate. The transmission of the pain impulses across the synaptic cleft to the dorsal horn neurons takes place because of the secretion of glutamate and ATP. Because the opioid analgesics do not inhibit the secretion of glutamate, they do not hinder the transmission of the impulses across the synaptic cleft to the dorsal horn neurons. p. 161

Which characteristics indicate the patient is experiencing somatic pain? Select all that apply. Nausea Sweating Tachycardia Hypotension Hyperpigmentation

Nausea Sweating Tachycardia Somatic pain is caused by the transmission of pain impulses from ascending nerve fibers to the autonomic nervous system (ANS). This results in increased autonomic functioning. An increase in autonomic functioning triggers the chemoreceptor zone in the brain that causes nausea and vomiting. It also causes sweating and increases heart rate, resulting in tachycardia. Increased autonomic functioning increases blood pressure and causes hypertension, not hypotension. As a result of vasoconstriction, the patient may exhibit pallor, but not hyperpigmentation. p. 162

During a pain assessment, the nurse asks the patient, "What does your pain feel like?" The patient responds, "I have numbness and tingling and occasionally shooting pain." The nurse reports which type of pain to the provider? Neuropathic Breakthrough Nociceptive visceral Nociceptive somatic

Neuropathic The nurse reports that the patient has neuropathic pain because its characteristics including burning, shooting, and tingling. Breakthrough pain occurs beyond the chronic pain that is already being treated by appropriate analgesics. Nociceptive pain originating from visceral sites is described as aching if localized, and as cramping if poorly localized. Nociceptive pain originating from somatic sites is described as aching or throbbing. p. 172

Which type of pain does the nurse document in the medical record for a patient with herpes zoster (shingles) who reports a pain level 10/10? Somatic Visceral Nociceptive Neuropathic

Neuropathic The pain from herpes zoster (shingles) runs along a nerve in the somatosensory nervous system and occurs from injury to the nerve fibers. Somatic pain originates from musculoskeletal tissues. Visceral pain originates from larger internal organs. Nociceptive pain develops when functioning and intact nerve fibers in the periphery and central nervous system are stimulated. p. 164

A patient with carpal tunnel syndrome reports having a tingling and burning sensation in the thumb, middle, and index fingers. Which type of pain would the nurse report to the provider? Referred Cutaneous Nociceptive Neuropathic

Neuropathic The presence of a tingling, burning sensation in the thumb, middle, and index fingers indicates that the patient has neuropathic pain. It is caused by impaired processing of the pain impulses from the site of injury to the nerve fibers. The patient with referred pain has an injury at a particular site, but experiences pain at other sites of the body. Referred pain is caused by damage to a spinal nerve, which sends signals to two different parts of the body. If the patient has pain resulting from skin surface damage, it indicates that the patient has cutaneous pain. Nociceptive pain is associated with aching, throbbing, and a cramping sensation. Because the patient does not report having any aching or throbbing sensation, the nurse would not interpret that the patient has nociceptive pain. p. 172

In which phase of nociception does the drug oxycodone block the signal of pain? Perception Modulation Transduction Transmission

Transmission Oxycodone, an opioid, activates opioid receptors in the spinal cord during the transmission phase to block the signal of pain and inhibit the perception of pain. The opioid receptors are not present in the perception, modulation, and transduction phases. In the perception phase, the patient shows an emotional response to the pain stimulus. In the modulation phase, the release of a third set of neurotransmitters from the brain will show analgesic effects. In the transduction phase, the release of neurotransmitters from the injury site to the spinal cord takes place. p. 161

The nurse is assessing a patient with severe pain, irritation, and inflammation in the lower limbs. The patient is unresponsive to opioid therapy. On reviewing the patient's medical history, the nurse finds that the patient had an accident 5 years ago and sustained a lower limb injury that has completely healed. Which type of pain is this patient experiencing? Referred Nociceptive Neuropathic Breakthrough

Neuropathic The presence of constant irritation and inflammation in the lower limbs indicates that the patient has neuropathic pain, which is chronic pain caused by nerve damage. In this situation, the patient experiences severe pain long after the injury is completely healed. Because of the constant irritation caused by the pain, the opioid receptors are damaged and make the patient unresponsive to opioid therapy. Referred pain is pain that is felt at a particular site but that originates from another location. Nociceptive pain does not cause damage to the opioid receptors and can be alleviated by administering opioid analgesics to the patient. Pain that starts again or escalates before the next scheduled analgesic dose is called breakthrough pain. p. 162

The patient with severe electric shock-like pain complains of significant pain not adequately relieved by the prescribed nonsteroidal antiinflammatory drug (NSAID). The nurse attributes this failed therapy to the patient having which type of pain? Visceral pain Cutaneous pain Neuropathic pain Breakthrough pain

Neuropathic pain The presence of severe electric shock-like pain in the thighs indicates that the patient has neuropathic pain, which is not effectively treated by NSAIDs. Neuropathic pain is the result of abnormal processing of pain messages from the site of injury to the nerve fibers. NSAIDs decrease prostaglandin levels, but do not increase neurotransmitters or halt nerve damage. Therefore neuropathic pain is not effectively treated by NSAIDs. Visceral pain, cutaneous pain, and breakthrough pain are effectively treated with NSAIDs, because they are examples of nociceptive pain. However, the patient who has visceral pain will experience a deep squeezing pressure with local tenderness. The patient who has cutaneous pain will experience a localized dull, aching pain. The patient who has breakthrough pain will have episodic pains with the symptoms of acute pain. p. 172

The patient with severe pain after surgery that is uncontrolled by regular analgesic administration is tachycardic and hypertensive. The nurse assesses the patient for which additional physiologic changes caused by uncontrolled pain? Select all that apply. Oliguria Joint stiffness Decreased respiratory rate Decreased adrenergic activity Decreased myocardial oxygen demand

Oliguria Joint stiffness If pain is not properly managed, the patient may have several uncontrolled pain responses, including oliguria, and joint stiffness. Severe pain increases, rather than decreases, the respiratory rate, adrenergic activity, and myocardial oxygen demand. p. 168

Which medication(s) would be helpful for a patient with diabetic neuropathy who reports burning, electric shock-like pain in the lower extremities? Select all that apply. Opioids Corticosteroids Antidepressants Anticonvulsants Muscle relaxants

Opioids Corticosteroids Antidepressants Anticonvulsants Opioids, corticosteroids, antidepressants, and anticonvulsants are all medications used to treat diabetic neuropathy. This condition is a neuropathic disorder that is associated with burning, electric shock-like pain in the lower extremities. Opioids alleviate neuropathic pain by activating the opioid receptors located in the spinal cord. These medications block the transmission of the pain impulses from the brain to thalamus. Antidepressants and anticonvulsant medications decrease the serotonin levels and increase gamma-aminobutyric acid (GABA), so these medications alleviate pain by blocking the transmission of pain impulses from the damaged nerves and reducing their sensitivity. Corticosteroids are prescribed for the treatment of nociceptive pain, which is associated with redness and inflammation at the site of injury. These medications reduce prostaglandin levels and inhibit inflammatory responses. Muscle relaxants are effective in preventing muscle spasm and can alleviate the pain associated with musculoskeletal injuries. These medications do not alter neurotransmitter levels, however, nor do they prevent neuropathic pain. p. 172

Which diagnosis in the medical record relates to the older patient's report of increased hip pain? Osteoarthritis Diabetes mellitus Chronic constipation Peripheral vascular disease

Osteoarthritis The most common disorders that cause pain in older adults include osteoporosis that can manifest as hip pain. Diabetes mellitus would cause numbness and tingling in the feet, which is peripheral neuropathy. Chronic constipation could cause abdominal pain. Peripheral vascular disease would cause pain in the lower extremities. p. 165

The patient with dementia fell and sustained a leg fracture. Which pain assessment tool would the nurse use to evaluate the intensity of the patient's pain? CRIES scale FLACC scale PAINAD scale FPS-R scale

PAINAD scale The PAINAD scale allows health care personnel to effectively assess the pain of patients with dementia who have impaired cognitive skills and may be unable to communicate the intensity of their pain verbally. This scale evaluates five common factors: breathing, vocalization, facial expression, body language, and consolability of the patient. The CRIES scale is used to assess the pain intensity in postoperative or preterm infants. FLACC is a different nonverbal pain assessment tool that helps evaluate pain intensity in infants and children younger than 3 years. The Faces Pain Scale-Revised (FPS-R) is used to evaluate the intensity of pain in younger children. It consists of six faces that show pain intensity, from "no pain" to "very much pain," with a rating scale of 0 to 10. P. 169

The aging patient with dementia appears agitated and is pacing and yelling. Which would the nurse infer as the cause of the agitation? Pain Worsening dementia Medication overdose Decreased prostaglandin levels

Pain When a patient with dementia experiences pain, he or she may exhibit agitation, pacing, and repetitive yelling. These findings do not indicate an exaggeration of dementia in the patient. Medication overdose may not cause agitation, pacing, and repetitive yelling, but causes other systemic symptoms. The pain worsens because of increased prostaglandin levels, not decreased prostaglandin levels. P. 169

Which phase of nociceptive pain signifies the conscious awareness of a painful sensation? Perception Modulation Transduction Transmission

Perception Perception is the third phase of nociceptive pain, and it signifies the conscious awareness of a painful sensation in the patient. During this phase, the limbic system interprets the noxious stimuli and elicits emotional responses to pain in the patient. During the modulation phase, the body slowly reduces the pain by stopping the processing of a painful stimulus. During the transduction phase, the pain signals are transmitted from the site of injury to the spinal cord. During the transmission phase, the pain signals move from the spinal cord to the brain; they do not elicit emotional responses to pain. p. 161

A patient with joint pain has edema and skin discoloration at the knees. The patient feels severe knee pain when the nurse touches the affected area with a cotton swab. The nurse also observes the patient has pale, dry, shiny skin and brittle nails. Which would the nurse anticipate administering to the patient? Select all that apply. Aspirin Pregabalin Prednisone Amitriptyline Acetaminophen

Pregabalin Prednisone Amitriptyline The presence of pale, dry skin, brittle nails, joint pain, edema, and discoloration of the affected extremity indicates that the patient has complex regional pain syndrome (CRPN). Damaged nerves result in impaired functioning of the sensory, motor, and autonomic nerves. Because of nerve damage, the patient feels severe pain even with the contact of a cotton swab. Pregabalin, prednisone, and amitriptyline block the pain impulses from the damaged nerves and help alleviate pain and inflammation. Therefore the primary health care provider would prescribe these medications to the patient. Aspirin and acetaminophen reduce prostaglandin levels and alleviate nociceptive pain. These drugs do not repair damaged nerve fibers and do not alleviate neuropathic pain. p. 173

A patient with a severe muscle cramp tells the nurse, "The pain is a little better when I massage the muscle or apply a cold pack." Which criterion of the PQRST method of pain assessment is addressed in the patient's statement? Severity Scale Quality/Quantity Region/Radiation Provocation/Palliation

Provocation/Palliation PQRST is a pain assessment scale; it stands for Provocation/Palliation, Quality/Quantity, Region/Radiation, Severity Scale, and Timing. Because the patient is describing methods that provide comfort and relieve the pain, it indicates that the patient is addressing Provocation/Palliation. If the patient reports about severity of pain on a scale of 0 to 10, then it indicates that the patient is addressing Severity. When addressing the Quality/Quantity of the pain, the patient describes the pain felt. If the patient reports about the site of pain, then the patient is addressing Region/Radiation. p. 166

A pregnant patient reports to the nurse, "I feel like my abdominal muscles are being stretched." Which criterion of the PQRST method of pain assessment would the patient's statement address? Severity scale Quality/Quantity Region/Radiation Provocation/Palliation

Quality/Quantity Stretching refers to the quality/quantity of pain on the PQRST pain assessment scale. The letters PQRST stand for Provocation/Palliation, Quality/Quantity, Region/Radiation, Severity Scale, and Timing. The patient informs the nurse that the abdominal muscles feel stretched, but she does not indicate the severity of the pain. This indicates the patient is addressing Quality/Quantity on the scale. If the patient reports about severity of pain on a scale of 0 to 10, then the patient is addressing the Severity Scale. If the patient reports directly about the site of pain, then the patient is addressing Region/Radiation. Information about the therapies that helped in relieving pain represents the element Provocation/Palliation. p. 166

Which is characteristic of C fibers? A large diameter Presence of a myelin sheath Rapid transmission of pain signals Presence of diffused sensations

Rapid transmission of pain signals Presence of diffused sensations C fibers are unmyelinated sensory fibers that cause pain signals to be more diffuse. The C primary sensory fibers produce a diffused and aching sensation. Because of the absence of Schwann cells, these fibers are not covered with a myelin sheath. Because the C primary sensory fiber is unmyelinated, it has a smaller diameter and transmits signals slowly. p. 161

Which type of pain would the nurse document in the medical record for a patient complaining of right upper quadrant abdominal pain that moves to the shoulder? Somatic Referred Cutaneous Breakthrough

Referred Pain that is felt at a different site than the site of origin is referred pain. Somatic pain originates from the musculoskeletal tissues. Cutaneous pain begins in the skin surface and subcutaneous tissues. Breakthrough pain spikes in between long-acting pain medications. p. 164

Which characteristics indicate that the patient is experiencing chronic pain? Select all that apply. Rubs his or her knee frequently Has symptoms of diaphoresis Grimaces and is restless Supports the knee when changing positions Constantly sighs during the assessment

Rubs his or her knee frequently Supports the knee when changing positions Constantly sighs during the assessment The patient with chronic pain may subconsciously rub the knee for pain relief. The pain may increase during a change of position from sitting to standing. The patient may support the knee when changing positions to help minimize the pain. The patient may also subconsciously respond to the pain by sighing constantly during the assessment. A patient with acute pain has increased autonomic functioning and will thus exhibit stillness, diaphoresis, restlessness, and facial grimacing. p. 168

During an admission interview, the nurse asks the patient, "Do you have discomfort or soreness?" Which aspect of pain assessment would this question satisfy? Quality Severity Duration Intensity

Severity During the interview, the nurse uses a variety of words such as discomfort or soreness to identify severity of pain. These types of questions help assess pain in patients who report pain only when it is severe. To identify the quality of pain, the interviewer can ask the patient what the pain feels like to him or her. To identify the onset and duration of the pain, the interviewer can ask the patient when the pain started. To identify the intensity of the pain, the interviewer can ask the patient how much pain he or she feels. p. 167

While assessing pain in a patient, the nurse asks about the effects of pain on the patient's mood, walking, functional ability, and sleep in the past 24 hours. Which pain assessment scale is the nurse using in the examination? Initial Pain Assessment Verbal Descriptor Scale The Brief Pain Inventory The McGill Pain Questionnaire

The brief pain inventory The nurse is using the Brief Pain Inventory scale. The assessment uses graduated scales from 0 to 10. The patient can rate the pain using these graduations based on the effect of pain on mood, walking, ability, and sleep in the past 24 hours. In the Initial Pain Assessment, the nurse asks questions concerning location, intensity, and duration of pain. The nurse would ask the patient to describe the feelings about the intensity of pain when using the Verbal Descriptor Scale. In the McGill Pain Questionnaire, the nurse asks the patient to rank a list of descriptors in terms of their intensity and to give an overall intensity rating of pain. p. 165

The patient with a broken leg reports swelling, stiffness, and a burning pain in the leg. The nurse also finds that the patient has brittle nails along with pale, dry, and shiny skin. Which condition would the nurse suspect? Osteoarthritis Alzheimer disease Acute coronary syndrome Reflexive sympathetic dystrophy

The patient with a broken leg may suffer from a nerve injury resulting in reflexive sympathetic dystrophy (RSD). The presence of swelling, stiffness, and a burning pain at the site of injury, along with brittle nails and pale, dry, and shiny skin all indicate that the patient has RSD. This is caused by impaired functioning of the sensory, motor, and autonomic nervous systems. Osteoarthritis is a degenerative joint disease that is caused by inflammation of the synovial membrane, not impaired nervous system functioning. The patient with Alzheimer disease has loss of memory and muscle weakness, but does not have pale, dry, and shiny skin. Acute coronary syndrome occurs as a result of reduced flow of blood to the heart. It manifests as chest pain, dyspnea, and diaphoresis. p. 173

Which is the purpose of functional magnetic resonance imaging (fMRI)? To determine the source of pain To help control the pain To find a genetic link for the pain To assess the intensity of the pain

To help control the pain An fMRI illustrates changes in brain activity during episodes of pain, which are shown to the patient in real time as the patient learns to use neurofeedback to control the pain. The fMRI is not used to determine the source of pain, find a genetic link for the pain, or to assess the intensity of the pain. p. 162

Which phase of nociceptive pain involves the release of bradykinin and prostaglandins? Perception Modulation Transmission Transduction

Transduction During the transduction phase, bradykinin and prostaglandins are released from the injured tissues. These chemicals transmit pain signals from the injury site to the spinal cord. Perception is the third phase of nociception and is associated with conscious awareness of a painful sensation. The modulation phase is associated with alleviation of the pain stimulus, because there is no release of bradykinin and prostaglandins from injured tissues. During the transmission phase, endogenous opioids are released, which activate opioid receptors and block the transmission of pain impulses. p. 161

The patient with a gastric ulcer reports dull, deep, squeezing pain in the stomach. Which term describes this pain? Somatic Visceral Referred Cutaneous

Visceral Gastric ulcer is usually associated with visceral pain, characterized by dull, deep, squeezing or cramping pain in the stomach. It usually originates in the visceral organs, including the stomach, intestine, gallbladder, and the pancreas. Pain originating from the musculoskeletal tissues or the body surface is identified as somatic pain. If the patient has an injury at a particular site but experiences pain elsewhere, it indicates that the patient is having referred pain. If the patient has pain resulting from damage to the skin surface, it indicates that the patient has cutaneous pain. p. 176

The nurse asks the patient to make a mark along a 10-cm horizontal line from "no pain" to "worst pain imaginable." Which pain assessment tool is the nurse using during the assessment? Numeric rating scale Visual Analogue Scale Simple descriptor scale Verbal Descriptor Scale

Visual Analogue Scale The Visual Analogue Scale is a pain assessment tool that helps identify the patient's level of pain. It has a 10-cm line with markings for "no pain" to "worst imaginable pain." Patients are asked to mark a point on the horizontal line based on the severity of their pain. When using the numeric rating scale, the nurse would ask the patient to choose a number to rate the pain's intensity. The simple descriptor scale consists of a list of words such as "no pain," "mild pain," "moderate pain," and "severe pain." These words help the patients describe the intensity of their pain. When using the Verbal Descriptor Scale, the nurse would ask patients to describe their feelings and the intensity of the pain that they are experiencing. P. 169