Pain
When should a nurse administer prescribed analgesic medication when treating a postoperative patient?
Before activity
What is the priority responsibility of the nurse related to pain?
Believe what the patient says about pain
The nurse explains that transcutaneous electrical nerve stimulation (TENS) provides a continuous mild electrical current to the skin. How does the TENS unit act to reduce pain?
Blocks pain impulses
What is the defining term for continuous or intermittent pain that does not serve as a warning of tissue damage?
Chronic
A patient is receiving an opioid narcotic. What common side effect should the nurse be aware of when assessing this patient?
Constipation
Describe the difference between acute pain and chronic pain.
-Acute pain is intense and of short duration, usually lasting less than 6 months, generally provides a warning to the person of actual or potential tissue damage, creates fight or flight response. -Chronic pain lasts longer than 6 months, sometimes continuous and sometimes intermittent, may also be as intense as acute pain, doesn't serve as a warning of tissue damage, it signals that such damage has occurred.
List the guidelines for individualizing pain therapy.
1) Use different types of pain relief measures. 2) Provide pain relief measures before pain becomes severe. 3) use measures the patient believes are effective. 4) Consider the patient's ability or willingness to participate in pain relief measures. 5) Choose pain relief measures appropriate to the severity of the pain as reflected by the patient's behavior. 6) If a therapy is ineffective at first, encourage the patient to try it again before abandoning it. 7) Keep an open mind about what has potential to relieve pain. 8) Keep trying. 9) Protect the patient.
To share assessment findings and pain relief interventions, which documentation sample is the most helpful?
1600: Patient reports sharp pain in left chest radiating to neck. Morphine sulfate 5 mg administered IM in right deltoid.
The nurse is using a pain scale of 0 to 10 to assess pain in a postoperative patient. What is considered the maximum pain level at which a patient can usually function effectively?
4
Where does the nurse recognize that many institutions are now including pain assessment in implementing patient care?
Assessing vital signs
When preparing a patient for sleep, diming the lights and decreasing the noise levels are examples of nursing interventions. What are these interventions designed to do?
Decrease environmental stimuli
A patient is receiving epidural analgesics. What should the nurse monitor closely in this patient?
Decrease in respirations from 16 to 14
An elderly patient came to the clinic with a severe headache. On assessment, the nurse finds that the spouse of the patient recently died. Which factor might have caused this pain?
Depression
A patient tells the nurse he is reluctant to report his pain because he does not want to be a bother. What problems is the nurse aware that unrelieved pain can cause?
Depression Respiratory dysfunction Decreased GI motility Irritability
A child reports stomach pain to a school nurse. What findings in the child would indicate that the child has severe pain?
Diaphoresis Dilated Pupils Hands over the stomach
The nurse is caring for a patient who has severe postoperative pain and is prescribed fentanyl (Actiq) and psyllium (Metamucil).What instructions should the nurse give the patient to enhance the effectiveness of psyllium (Metamucil)?
Drink more water Eat a fiber-rich diet Exercise regularly
The nurse is planning interventions for a patient experiencing pain. For what type of synergistic relationship should the nurse assess?
Fatigue
A nurse has been assigned to a patient with a chronic inflammatory disorder. The patient takes a nonsteroidal anti-inflammatory drug (NSAID). When the nurse performs the assessment, what patient complaint would the nurse suspect is related to a common adverse reaction associated with use of NSAIDS?
Hematemesis
An arthritic patient is on an acetaminophen regimen. The patient receives a daily dose of 4000 mg. For which toxic side effect should the nurse monitor the patient?
Hepatotoxicity
A surgical patient will receive patient-controlled analgesia (PCA) after a scheduled surgery. Before surgery, what essential information should the nurse teach the patient regarding the use of the PCA machine?
How to self administer the medication
The nurse is trying to establish an effective relationship with a patient in pain. What is the best statement for the nurse to make when beginning the assessment?
I believe you are in pain.
Which opioid is no longer a drug of choice for managing pain because of its toxic complications, such as causing seizures?
Meperidine
An older adult patient diagnosed with osteoarthritis suffers from chronic pain. Based on the patient's age and condition, which pain medication(s) will the HCP most likely avoid?
Meperidine Morphine Sulfate Nonsteriodal antiinflammatory drugs Combinations of opiod drugs
A 63-year-old patient underwent a lower anterior bowel resection yesterday. What common central nervous system analgesic is often prescribed for control pain?
Morphine
A nurse is caring for a patient who requires long-term management for severe pain. What should be the drug of choice for this patient?
Morphine
The nurse is assessing the patient's description of his back pain. He states that it is "immobilizing, intense, and on a scale of 0 to 10, it is an 8." What type of pain assessment scale is the patient using?
Numerical
The nurse clarifies that the term peripheral analgesics describes the group of drugs also referred to as ___________.
NSAIDs
A patient reports to the nurse that he is experiencing a moderate amount of back pain rated 6 out of 10 on the pain scale. What should the nurse recognize about this assessment?
Pain is subjective for the patient.
A 52-year-old patient admitted for deep vein thrombosis of the left internal iliac vein complains of excruciating pain in his left leg. What is the most appropriate response by the nurse?
Pain is what you say it is; I will assist you in whatever way I can
A patient complains of severe knee pain but does not exhibit any facial expressions indicative of pain. What should the nurse examine in the patient in order to assess pain?
Pulse rate Blood Pressure Respiration rate
The nurse listens attentively while the patient describes her angina pectoris pain as radiating down her left inner arm to the little finger and upward to the jaw and the shoulder. What term is used to classify this type of pain?
Referred
A patient has pain in the left arm secondary to coronary insufficiency. This is an example of what type of pain?
Referred pain
A male patient reports to the home health nurse that he does not feel rested although he has slept 8 hours. For what should the nurse assess?
Taking an anxiolytic medication
A patient with a diagnosis of chronic pain is admitted. Which interventions will be incorporated into the nursing care plan?
Teach relaxation exercises Promote the use of guided imagery Encourage to report pain or discomfort
The patient agrees to try guided imagery as a noninvasive method of pain relief. Before they begin the therapy, which instruction is the nurse most likely to give?
Tell me about a place and time where you felt relaxed and peaceful
The nurse enters the patient's room at 3:00 am and finds that the patient is awake and sitting up in a chair. The patient tells the nurse that she is not able to sleep. The nurse should first:
ask about methods that have helped her sleep.
Name the three methods of administering epidural analgesia.
bolus doses, by continuous infusion, and by patient-controlled epidural analgesia.
The nurse is talking to a patient who wants to try transcutaneous electric nerve stimulation. The nurse would alert the HCP if the patient reveals he has a:
cardiac pacemaker device
The nurse hears in report that the patient with diabetes has reported a tingling, burning sensation in the lower extremeties. Which drug is the nurse mostly likely to administer for this type of discomfort?
duloxetine (Cymbalta)
Regardless of age, patients typically receive comfort and a sense of well-being from what?
gentle touch and eye contact
The nurse is caring for a patient is who is recovering from an accident. The nurse finds that the patient is not socially active and is less responsive than normal during conversation. What can the nurse do to improve the patient's condition?
give therapy with soothing music
The nurse is caring for a patient who has arthritis. Which medication does the nurse anticipate the HCP will prescribe?
ibuprofen (Motrin)
A patient with severe back pain has undergone placebo treatment in a single-blind clinical trial. After 2 weeks the patient reports lower levels of pain. What would be the most likely reason for the reduction in pain?
increased endorphin levels in the central nervous system
What is pain a cardinal sign of?
inflammation
Research indicates that the risk of clinically significant opioid-induced respiratory depression is
less than 1%
The nurse is trying to reassure a patient who is concerned about receiving addictive drugs. What percentage of patients become addicted to analgesics?
less than 1%
Pain is most effectively controlled through a combination of what?
noninvasive pain relief measures and pharmacologic therapy
Explain the gate control theory.
pain impulses are regulated and blocked by gating mechanisms located along the CNS. The brain is not able to acknowledge pain while it is interpreting other stimuli. So if the gates are open to stimuli then the pain will flow in freely but if the gates are closed by stimuli such as visual or auditory then the pain doesn's flow and the brain is distracted to not register the pain.
Which statement best describes physical characteristic of pain?
pain often occurs where there is actual or potential tissue damage
Which evaluation of interventions indicates the patient has not met the goal of pain management?
patient pain level decreases sometimes when pain medication is administered
List the factors that affect sleep.
physical illness, anxiety and depression, drugs and substances, lifestyle, sleep patterns, stress, environment, exercise and fatigue, and nutrition
The nurse is caring for a patient using patient-controlled analgesia (PCA). What is a major advantage to this method?
quicker
A postoperative patient has a prescription for pain medication but refuses to take medication more than once a day in fear of becoming addicted to the medication. Which measure, if implemented, will best meet the needs of this patient?
request a pain medication that can be taken once daily
The patient had a surgical procedure this morning and is requesting pain medication. The nurse assesses the patient's vital signs and decides to withhold opioid medication based on the finding of:
respirations = 10/min
The nurse is aware that the state at which a person is mentally relaxed, free from worry, and is physically calm is __________.
rest
What is meant by the subjectivity of pain?
the interpretation and significance of pain depend on an individual's learned experiences and involve psychosocial and cultural factors.
A patient with a terminal diagnosis has pressed the call bell several times and is requesting for the nurse to sit at the bedside and talk. It has been 2 days since the patient has slept. What can the nurse assume is the rationale for the patient's behavior?
the patient may be afraid to go to sleep for fear of dying
Why are repeated intramuscular (IM) injections not recommended?
they are often painful and traumatic, which deters patients from requesting medications for relief of pain; they also have the potential to cause fibrosis of muscle and soft tissue as well as sterile abscesses.
The pain relief intervention that stimulates large cutaneous nerve fibers to close the gate is the _________ unit.
transcutaneous electrical nerve stimulator
The patient is receiving an epidural opioid. The nurse is alert for a complication of this treatment and observes the patient for:
urinary retention
Rest and sleep are essential requirements for all individuals. What is the most essential information a nurse can teach the patient about sleep and rest?
Achieving optimal rest and sleep is important to a patient's optimal recovery
Which nursing action demonstrates that the nurse is complying with the Joint Commission standards of pain management?
Assesses the patient's pain and reassesses pain after interventions
What are the emotional consequences of unrelieved pain?
anxiety, depression, irritability, and an inability to enjoy life
The home health nurse is caring for a patient with an implanted pacemaker. What type of pain management would be contraindicated?
A TENS unit
The home health nurse is instructing the family of an older adult patient with arthritis about sleep promotion. What intervention can best promote sleep for the older adult patient?
Administering diuretics in the mornings
The health care provider has ordered blood pressure, pulse, and respirations q2h x 12 hours. It is currently 8:00pm and the nurse knows that the patient has been having a lot of problems sleeping in the hospital. What strategy should the nurse try first?
Apply an automatic blood pressure cuff that can be programmed for q2h.
Summarize the essential message about pain assessment.
Ask patients about their pain, accept and respect what they say, intervene to relieve their pain, and ask them again about their pain.
Following surgery for a total knee replacement, a patient was given an epidural catheter for fentanyl epidural analgesia. What is the most important nursing intervention?
Assess respiratory rate
The HCP orders 1000mg acetaminophen every 4 hours as needed for pain. What should the nurse do?
Call the HCP and ask for clarification of the order
A registered nurse is assisting a primary health care provider in performing epidural analgesia to a patient. Which interventions should the nurse take to prevent infection in the patient?
Change the tubing at a 24 hour interval
The nurse is caring for several patients who are receiving morphine. Which patient is most likely to have respiratory depression?
Child who received an intramuscular injection prior to having fracture reduction of the forearm
The nurse is caring for an older, frail patient admitted to the hospital. What measure should the nurse take to ensure that the patient has good sleep?
Give the patient a warm cup of milk
What is the greatest advantages of using noninvasive pain managment techniques as an adjunct to pain medication?
Gives patients some control over pain
What are some down sides to invasive pain relief techniques?
Cost more and increased risks especially for infection
The nurse teaches noninvasive pain relief techniques, such as guided imagery, biofeedback, and relaxation. What is the primary advantage of these techniques?
Gives the patient some control
A patient tearfully declares the use of relaxation techniques does not work for her. What is the best action for the nurse to implement?
Encourage the patient to try again
A young athlete asks the nurse why he felt little pain when he broke his leg during a game. What does the nurse describe as having an effect on this patients perception of pain?
Endorphins
The nurse is giving a backrub to a patient to relieve pain. What pain theory is the nurse using?
Gate control
A patient with decreased kidney function has been prescribed an opioid pain medication that is metabolized in the kidneys. What should the priority intervention be for the nurse at this time?
Give the drug as prescribed because it is commonly prescribed for patients with decreased renal function
The nurse should administer an analgesic to an unconscious patient after observing which signs?
Increased heart rate from 82 to 94 Increased muscle tension Perspiration on upper lip Facial grimacing
A patient is undergoing a corn removal procedure of the foot. Which route of drug delivery should be used to administer analgesic to the patient?
Intravenous
Which route is most appropriate for treating rapidly escalating severe pain?
Intravenous (IV)
Why is meperidine (Demerol) no longer the drug of choice for pain management?
It has toxic complications, such as causing seizures, also in older adults many have some degree of renal insufficiency making this a bad choice.
The nurse is assessing pain reported by a Latino male patient. What is important for the nurse take into consideration when observing objective data?
Latino men feel it is unmanly to admit to pain.
The nurse reassures a patient that most acute pain is intense and of short duration. How long does can acute pain usually last?
Less than 6 months
What action should the nurse implement when assisting a postoperative patient with pain control and comfort?
Lift the patient up in bed
A patient with a low tolerance for pain has a major surgery. Which pain method would be best for this patient?
Patient controlled analgesic
What drug delivery system is used to control pain via a portable computerized pump with a chamber for a syringe?
Patient-controlled analgesia
What action should the nurse take when evaluating the effectiveness of new or revised therapies for pain relief?
Perform evaluation of outcome goals
Which nursing intervention demonstrates the application of the gate control theory of pain?
Performs a back massage using warmed lotion
What statement concerning unrelieved pain is most correct?
Physiologic and psychological complications can result fro unrelieved pain
An American Indian patient requests that an egg yolk be placed in a saucer and put under his bed to absorb the pain. What should the nurse do?
Place the egg in a saucer under the bed
What is the physiologic rationale for avoiding use of meperidine for patients with sickle cell disease?
Renal insufficiency will be present to some degree
The home health nurse sees an order for meperidine for a 63-year-old patient with cancer who requires long-term opioid treatment. What is the best rationale for the nurse to question this medication order?
Repeated administration of meperidine increases the risk of accumulation
The new nurse is looking at nursing jobs to consider after graduation. Which shift is most likely to cause the nurse to have sleep-wake cycle disruption?
Rotating day to night shift
Although denying pain, a patient is irritable, responds slowly, and exhibits periods of tachycardia. What should the nurse assess for in this patient?
Sleep deprivation
A patient admitted with severe cellulitis of the left breast states, "I have a severe burning pain, and it feels like my breast is on fire." She rates her pain as 7 on the 0-to-10 pain assessment scale. How would this collection of data by the nurse is assessing the patient's pain be classified?
Subjective
The nurse obtains information from a patient about the site, severity, and duration of the pain. What type of data is this considered?
Subjective data
The nursing student is discussing the gate control theory of pain. Which statement by the student indicates the need for further instruction?
The gates of the pain pathways can be opened with therapeutic massage and heat treatments. Pain has exclusive use of the pathways ahead of other stimuli, according to the theory. Pain is a manifestation of an intricate chain of electrochemical events.
The nurse is caring for two patients with similar injuries. One patient expresses severe pain and the other reports feeling fine with low levels of pain. Which statement is most correct?
The patient experiencing intense pain has lower levels of endorphins
A patient is scheduled to have surgery, and preoperative instructions are given on the use of the patient-controlled analgesia (PCA) drug delivery system. What is the most effective method for the nurse to evaluate whether the patient has a clear understanding of how to use the system?
The patient pushes the button only every ten minutes for pain relief
A patient was admitted to the orthopedic section for acute back pain. The HCP is planning to use cutaneous stimulation management. Which is an example of this pain control method?
Transcutaneous electric nerve stimulation (TENS)
Why should a nurse promptly administer a prescribed analgesic after a pain assessment?
Unrelieved pain can cause setbacks
What is the best approach for a nurse to use when planning pain relief measures?
Use a variety of pain relief methods
A surgical patient has been prescribed an opiate. What essential nursing problem should the nurse add to the nursing care plan to address the common side effects of opioid pain medication?
alteration in bowel elimination
The nursing student reports to the nurse that a postoperative patient is asking for pain medicaiton. What is the most important question that the nurse will ask the student to answer?
What did the patient tell you about his pain
The nurse is talking to an older adult who reports feeling tired and not getting enough sleep. Which question related to the patient's medication is most relevant to designing interventions for the patient's problem?
What time of the day do you usually take your diuretic medication?
A patient is experiencing sleep disturbance. Which drug should the nurse avoid administering to the patient at bedtime?
a diuretic
The patient now reports that the prescribed opioid dose does not seem to provide the same relief for his acute pain that it did when he first started to take the medication 4 weeks ago. Based on the nurse's knowledge of pharmacology, the nurse recognizes that the patient has developed:
a physical tolerance
