Prep U cap 35 Pain managment

Distraction

Playing a client's favorite music, deep breathing exercises, and imagery are diversional activities that assist coping with the pain.

The nurse is taking a history for a pregnant client who has been seen for chronic headaches for 2 years. Today, the client reports a headache that feels different than the normal headaches she has experienced in the past. Which assessment question helps the nurse assess quality of pain? "When did your pain begin?" "How long have you experienced this pain?" "Could you please rate your pain on a 1-10 scale?" "Can you describe the type of pain you are having?"

"Can you describe the type of pain you are having?" Rationale: Asking the client to describe the pain establishes quality. Asking the client to rate pain on a 1-10 scale reflects intensity. Asking how long the pain has existed reflects duration. Asking when the pain began reflects onset.

A middle-age client is reporting acute joint pain to a nurse who is assessing the client's pain in a clinic. Which question related to pain assessment should the nurse ask the client? "Does your diet include red meat and poultry products?" "Have you thought of the effects of your condition on your family?" "Does your pain level change after taking medications?" "Are your family members aware of your pain?"

"Does your pain level change after taking medications?" Rationale: The nurse should ask direct and specific questions about the nature of the pain and whether it changes with medication, as this helps the nurse to quickly gather objective data about the client's pain. The nurse should avoid asking irrelevant and closed-ended questions, such as whether the client's diet includes red meat and poultry products, or whether the client has thought about the effects of his condition on his family. These types of questions do not add any value to pain assessment, but could make the client feel more depressed and uncomfortable.

The nurse is taking a history for a client who is being seen for chronic unrelieved back pain. Which assessment question helps the nurse assess duration of pain? "Have you had this pain before?" "How long have you experienced this pain?" "Could you please rate your pain on a 1-10 scale?" "When did your pain begin?"

"How long have you experienced this pain?"

The nurse has completed a preoperative teaching session with a client who will receive morphine via a PCA pump after surgery. Which statement by the client indicates the need for further teaching? "I will remind my family member to push the PCA pump button for me if I doze off during the day." "I will let my nurse know if the pain medication is not effective enough to help me move after surgery." "I can push the button whenever I feel pain." "I will use the PCA pump until oral pain medication controls my pain."

"I will remind my family member to push the PCA pump button for me if I doze off during the day." Rationale: Sedation occurs before clinically significant respiratory depression. Thus, if the client is too sleepy to push the button (or ask that it be pushed), the button should not be pushed.

While caring for a client with chronic pain, the nurse talks with a family member. Which family member statement does the nurse identify as consistent with caregiver role strain? "Sometimes it seems like I can never get a moment to myself." "Even when I do extra tasks around the house, I'm glad to help my loved one." "Our insurance company finally found a way to cover my loved one's care." "I feel badly because my loved one is in pain all of the time."

"Sometimes it seems like I can never get a moment to myself." Rationale: Caregiver role strain may be exhibited by statements of exhaustion, frustration, or seeming overwhelmed. If the client states that time to themselves is rare, he or she may be feeling consumed with care for the client with chronic pain. Feeling badly regarding a loved one's pain, discussing insurance coverage, and helping the loved one by doing household tasks do not indicate caregiver role strain.

The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which response is most appropriate?

"The mild electrical impulses block the pain signal before it can reach the brain." Rationale: The unit does not generate heat, trick the mind, or produce numbness.

A nurse is performing pain assessments on clients in a physician's office. Which clients would the nurse document as having acute pain? Select all that apply. -A client who presents with the signs and symptoms of appendicitis -A client who has diabetic neuropathy -A client who fell and broke an ankle -A client who has bladder cancer -A client who is having a myocardial infarction -A client who has rheumatoid arthritis

-A client who presents with the signs and symptoms of appendicitis -A client who fell and broke an ankle -A client who is having a myocardial infarction

The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate? Select all that apply. -Delegate pain assessment to the UAP. -Consider cultural implications of the perception of pain. -Assess for pain control 30 minutes after administering an analgesic. -Infer that the client who does not complain has no pain. -Provide pain medication before activity that may increase pain.

-Consider cultural implications of the perception of pain. -Assess for pain control 30 minutes after administering an analgesic. -Provide pain medication before activity that may increase pain.

The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate? Select all that apply.

-Consider cultural implications of the perception of pain. -Assess for pain control 30 minutes after administering an analgesic. -Provide pain medication before activity that may increase pain. Rationale: Pain assessment should never be delegated to a UAP. Assumptions should not be made about pain.

The young female client had emergency surgery for appendicitis. She is a cigarette smoker, is breast-feeding her infant, and expressed a desire to continue to breast-feed when discharged from the hospital. The surgeon has prescribed acetaminophen/oxycodone for pain relief at home. What instructions would the nurse include when providing discharge teaching? Select all that apply. -You may smoke cigarettes during the day but not at night. -Client is allowed to have one drink of alcohol each day. -Keep a diary to record level of pain and time medication is taken. -You must check with your primary care provider before breast-feeding your infant. -For better absorption, take your pain medication on an empty stomach. -Do not drive a vehicle while taking this medication.

-Keep a diary to record level of pain and time medication is taken. -Do not drive a vehicle while taking this medication. -You must check with your primary care provider before breast-feeding your infant. Rationale: The client is to keep a diary about her pain experiences, which includes level of pain and time the medication was taken. This provides a more accurate documentation of the pain experience and prevents overdosage from taking the medication too frequently. The client is not to drink alcohol. Alcohol will depress the central nervous system when taken with an opioid and may lead to respiratory failure. The client may smoke, but someone will need to be present (for safety reasons) since the client may fall asleep due to the opioid. It does not matter whether it is day or night.

After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client? 3 2 4 1

3 Rationale: The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: 1= awake and alert- no action necessary 2= occasionally drowsy but easy to arouse; requires no action 3= frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose 4= somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

Which client would be the best candidate to receive epidural analgesia for pain management? -A client who is experiencing an acute onset of chest pain -A client who experiences frequent episodes of lower back pain -A client recovering from recent hip replacement surgery -A client with an inoperable brain tumor

A client recovering from recent hip replacement surgery Rationale: Epidural analgesia is being used more commonly to provide pain relief during the immediate postoperative phase and for chronic pain situations. Epidural pain management is also being used in children with terminal cancer and children undergoing hip, spinal, or lower-extremity surgery. Pain that is less severe or pain with an acute onset is not normally treated in this way. A brain tumor may or may not have manifestations that require an epidural analgesia.

The nurse is performing assessments for clients admitted in the emergency department. Which client is most likely experiencing somatic pain? -A client suspected to have a perforated peptic ulcer -A client who has appendicitis -A client with chest pain who is having a myocardial infarction -A client who has a sprained ankle

A client who has a sprained ankle Rationale: Somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep somatic pain. Visceral pain (splanchnic)- is poorly localized and originates in body organs in the thorax, cranium, and abdomen. One of the most common types of pain produced by disease, and occurs as organs stretch abnormally and become distended, ischemic, or inflamed such as with a ruptured peptic ulcer or appendicitis. Referred pain- A client having a myocardial infarction with chest pain

A nurse attempts to relieve the pain of a client by using cutaneous stimulation. Which of the following describes usage of this technique?

A nurse applies intermittent heat and cold to a client's leg. Rationale: Cutaneous stimulation is the intermittent application of heat or cold, or both. Heat accelerates the inflammatory response to promote healing, reduces muscle tension to promote relaxation, and helps to relieve muscle spasms and joint stiffness. Cold reduces muscle spasm, alters tissue sensitivity, and promotes comfort by slowing the transmission of pain stimuli.

The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opiod anesthesia, the nurse observes the client's respiratory rate decrease to 8 BPM. What is the priority action by the nurse? -Begin CPR -Administer a lower dose of the analgesic for the next dose -Administration of 0.4 mg of naloxone -Place the client in the supine position

Administration of 0.4 mg of naloxone Rationale: The client is experiencing impending respiratory arrest due to the effect of the medication and this should be reversed immediately prior to arrest. This is the priority action and will correct the respiratory depression immediately. CPR is not indicated at this time, because the client is not in full arrest. Placing the client in the supine position may decrease respirations further.

During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is: -relaxation techniques. -surgery. -analgesics. -cutaneous stimulation.

Analgesics

The nurse manager hears a nurse and a nurse aide talking about a female client who reports pain of 8 out of 10 on a 1-10 scale after a Caesarean birth to deliver twins. The nurse states, "I don't believe this client has any pain at all. I'm sure she is just drug seeking." What is the appropriate nurse manager action? -Continue listening to the conversation before intervening. -Ask the nurse to speak privately for a moment, and educate about bias in pain treatment. -Enter the conversation and tell the nurse and UAP that this type of discussion will not be tolerated. -Write the nurse up for disciplinary action.

Ask the nurse to speak privately for a moment, and educate about bias in pain treatment. Rationale: Research has shown that treatment bias may delay pain-relieving measures. The nurse manager should privately and professionally educate the nurse, and then subsequently educate the nurse aide. Addressing the concern quickly is important so the client can receive appropriate care and pain management. Entering the conversation is not the best action to educate the nurse and disciplinary action doesn't help to immediately address the current situation.

A client is receiving patient-controlled epidural analgesia (PCEA) following abdominal surgery. While assessing the client, the client states, "I've started having some back pain." The nurse should: -assess the client's cognition using the Glasgow Coma Scale. -assess the client's reflexes. -assess for epidural hematoma. -inspect the client's skin for signs of internal hemorrhage.

Assess for epidural hematoma Rationale: The client's report of back pain would alert the nurse to the possibility of an epidural hematoma. Often back pain is the first symptom. Hemorrhage is less likely and there is no obvious reason to assess the client's reflexes or cognition.

When performing a pain assessment on a client, the nurse observes that the client guards his arm, which was fractured in a car accident, and he refuses to move out of his chair. The nurse notes this reaction as what type of pain response? -Physiologic -Behavioral -Affective -Psychosomatic

Behavioral Rationale: Behavioral (voluntary) responses- moving away from painful stimuli, grimacing, moaning, crying, restlessness, protecting the painful area, and refusing to move the limb. Physiologic (involuntary) responses- increased BP, pulse & RR. Pupil dilation, muscle tension and rigidity, pallor (due to peripheral vasoconstriction), increased adrenaline output & blood glucose. Psychological responses- exaggerated weeping and restlessness, withdrawal, stoicism, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, and powerlessness.

A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as: -Therapeutic Touch (TT). -Transcutaneous electrical nerve stimulation (TENS). -Biofeedback -Hypnosis

Biofeedback Rational: Biofeedback uses a machine to monitor physiologic responses through electrode sensors on the client's skin. The unit transforms the data into a visual display, and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. The client learns voluntary control over autonomic functions such as heart rate, hand temperature, and muscle tension.

Which statement accurately describes pain experienced by the older adult? -Residents in long-term care facilities have a minimal level of pain. -The older client has decreased sensitivity to pain. -A heightened pain tolerance occurs in the older adult. -Boredom and depression may affect an older person's perception of pain.

Boredom and depression may affect an older person's perception of pain. Rationale: Boredom, loneliness, and depression may affect an older person's perception and report of pain. One myth held by many to be true is that older clients have a decreased sensitivity to pain and therefore a heightened pain tolerance. Numerous older adult clients residing in long-term care facilities have significant pain that negatively affects their quality of life.

The nurse is caring for a client who has had back pain for 2 years, following a fall from a ladder. How does the nurse going off-shift report this kind of pain to the oncoming nurse?

Chronic and Somatic Rationale: Somatic pain develops from injury to structures such as muscles, tendons, and joints.

A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and become chronic. What is a characteristic of chronic pain? -Chronic pain eases with healing and eventually disappears. -Chronic pain has far-reaching effects on the client. -Chronic pain can be severe in its initial stages. -Chronic pain will lead to psychological imbalance.

Chronic pain has far-reaching effects on the client. Rationale: Chronic pain has far-reaching effects on the client because the discomfort lasts longer than 6 months. Chronic pain is not as severe in the initial stage as acute pain, but does not disappear eventually with pain medication. Chronic pain need not always lead to psychological imbalance.

A client is prescribed oxycodone for pain relief. After teaching the client about the medication and common side effects, the nurse determines that the education was successful when the client identifies which side effect as most common? -pruritus -constipation -vomiting -delirium

Constipation Rationale: Full agonists such as morphine or oxycodone are most commonly associated with constipation. Other side effects may include vomiting, sedation, nausea, pruritus, respiratory depression, and delirium.

The nurse is caring for a client who reports throbbing pain at the site of a recent laceration from a pocketknife. How will the nurse document this type of pain?

Cutaneous and acute

A client is experiencing acute pain following the amputation of a limb. What nursing interventions would be most appropriate when treating this client? -Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. -Do not provide analgesia if there is any doubt about the likelihood of pain occurring. -Increase and decrease the serum level of the analgesic as needed. -Treat the pain only as it occurs to prevent drug addiction.

Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. Rationale: The client would benefit from the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. The phantom pain is real pain and should be treated as such. The nurse would not increase and decrease the serum level of the analgesic as needed. The nurse would not doubt the client's report of pain and would not withhold analgesia if she doubted the likelihood of the pain occurring.

Before inserting a urinary catheter, a nurse discusses the procedure with the client. When inserting the catheter, the nurse distracts the client by talking to him about his work. The nurse is attempting to relieve the client's procedural pain through: -decreasing the autonomic nervous system activity. -focusing on another stimuli in the environment. -using imagination to change the pain experience. -voluntarily controlling autonomic functions.

Focusing on another stimuli in the environment. Rationale: Not relaxation since it decreases autonomic nervous system activity.

Which medication would the nurse most likely see on the medication administration record (MAR) of a client with diabetic neuropathy? -gabapentin -hydromorphone -lorazepam -morphine

Gabapentin Rationale: Gabapentin is used to treat nerve pain.

When asking an older adult client about abdominal pain, the client reports, "I don't want to be a bother because nothing hurts too much." The nurse notes that the client grimaces and splints the abdomen when moving. What is the appropriate nursing action?

Gently mention that the client appears to be experiencing pain that can be treated. Rationale: Pain is underdetected and poorly managed among older adults, because they often do not want to be perceived as a complainer, or they feel that pain is part of growing older.

A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a p.r.n. drug regimen as an effective method of pain control would be the client: -experiencing acute pain. -experiencing chronic pain. -in the early postoperative period. -in the postoperative stage with occasional pain.

In the postoperative stage with occasional pain. Rationale: All other options would benefit from the dosage of pain medication with around the clock dosing.

Which statement is true of chronic pain? -It is always present and intense. -It lasts for less than 6 months. -It disappears with treatment. -It interferes with normal functioning.

It interferes with normal functioning. Rationale: Chronic pain is may be limited, intermittent, or persistent but lasts for 6 months or longer and interferes with normal functioning. It is commonly characterized by periods of remission and exacerbation.

Why is acute pain said to be protective in nature? -It enables the person to increase personal strength. -As a subjective experience, it serves no purpose. -It warns an individual of tissue damage or disease. -As an objective experience, it aids diagnosis.

It warns an individual of tissue damage or disease.

A nurse is administering prescribed medicine to a client who experienced acute pain in the lower back after a motor vehicle accident. The client tells the nurse that compared to the previous week, his pain had reduced considerably. Which phase of pain is the client experiencing? -perception -transduction -transmission -modulation

Modulation Rationale: The client is in the modulation phase of pain, during which the brain interacts with the spinal nerves in a downward fashion to subsequently alter the pain experience. Transduction phase refers to the conversion of chemical information at the cellular level into electrical impulses that move toward the spinal cord. In transmission phase, the stimuli move from the peripheral nervous system toward the brain. The perception phase occurs when the pain threshold is reached.

Which of the following nonpharmacologic pain relief measures has been found to be effective for soothing agitated newborns and comatose clients? -imagery -distraction -humor -music

Music Rationale: Listening to music can relax, soothe, decrease pain, and provide distraction. It has proven effective for soothing agitated newborns and comatose clients. Distraction- prevents someone from giving full attention to something else, used for school aged children and older. Imagery- Uses figurative language to represent objects, actions, and ideas in such a way that it appeals to our physical senses. Used for adolescents and older clients.

A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing? -cutaneous pain -chronic pain -neuropathic pain -visceral pain

Neuropathic pain Rationale: The client is experiencing neuropathic pain or functional pain. Neuropathic pain is often experienced days, weeks, or even months after the source of the pain has been treated and resolved.

A group of nursing students is reviewing information about the pain process. The students demonstrate understanding of the information when they identify stimulation of which as the first component in the transmission of the pain stimulus? -spinothalamic tract -nociceptors -A-delta fibers -C-fibers

Nociceptors Rationale: The 1st step in pain impulse transmission occurs in the periphery at the sight of injury. Energy is converted from one form to another and injured cells release substances that activate or sensitize nearby nociceptors. Nociceptors are located on two types of peripheral nerve cells (A-delta fibers and C-fibers). The spinothalamic tract transmits ascending impulses via secondary afferent neurons toward the brain and thalamus for interpretation.

Which principle should the nurse integrate into the pain assessment and pain management of pediatric clients? -Pain assessment may require multiple methods in order to ensure accurate pain data. -A numeric scale should be used to assess pain if the child is older than 5 years of age. -Pharmacologic pain relief should be used only as an intervention of last resort. -The developing neurologic system of children transmits less pain than in older clients.

Pain assessment may require multiple methods in order to ensure accurate pain data. Rationale: It is often necessary to use more than one technique for pain assessment in children. Though their neurologic system is indeed developing, children feel pain acutely, and it is inappropriate to withhold analgesics until they are a "last resort." It is simplistic to specify a numeric pain scale for all clients above a certain age; the assessment tool should reflect the client's specific circumstances, abilities, and development.

A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA) by a physician. What is an advantage that PCA offers? -The small doses of opioids delivered by PCA offer instant relief. -Pain can be kept within a consistently tolerable level. -Higher individual dosages reduce side effects. -The client has complete control over the timing and quantity of doses.

Pain can be kept within a consistently tolerable level. Rationale: Safe parameters for dosing are set by the care team. Small dosages of opioids do not offer instant relief, and side effects are reduced with smaller individual dosages and lower total dosages.

The nurse is visiting a client at home who is recovering from a bowel resection. The client reports constant pain and discomfort and displays signs of depression. When assessing this client for pain, what should be the nurse's focal point? -administering a placebo and performing a reassessment of the pain -judging whether the client is in pain or is just depressed -beginning pain medications before the pain is too severe -reviewing and revising the pain management treatment plan

Reviewing and revising the pain management treatment plan Rationale: The client is status-post bowel resection, so administering a placebo is not the correction option, and could be ethically wrong. The nurse would possibly do a depression assessment, but if the client is reporting constant pain, the pain management plan must be reviewed and revised. The question does not address if the client is taking pain medications, so the option addressing beginning pain medications before the pain is too severe is not correct.

A nurse is caring for a client who was administered opioid narcotics. The client reports constipation. What is another potential side effect of opioid narcotics? -insomnia -anxiety -diarrhea -sedation

Sedation Rationale: Opioids and opiates can cause sedation, nausea, and constipation. They also can cause respiratory depression, which is the main side effect to watch for with narcotics. Opioids and opiates do not lead to anxiety, diarrhea, or insomnia in clients.

A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his left leg, and the pain is worse with ambulation. The nurse will document this type of pain as: -cutaneous pain. -visceral pain. -somatic pain. -phantom pain.

Somatic pain Rationale: Phantom pain occurs in an amputated leg for which receptors and nerves are clearly absent, but the pain is a real experience for the client.

A client has required frequent scheduled and breakthrough doses of opioid analgesics in the 6 days since admission to the hospital. The client's medication regimen may necessitate which intervention? -frequent turns and application of skin emollients -supplementary oxygen and chest physiotherapy -stool softeners and increased fluid intake -calorie restriction and dietary supplements

Stool softeners and increased fluid intake Rationale: The most common side effect of opioid use is constipation. Opioids may cause respiratory depression, but this fact in and of itself does not create a need for oxygen supplementation or chest physiotherapy. The use of opioids does not create a need for calorie restriction, supplements, frequent turns, or the use of skin emollients.

Which of the following describes the correct use of a Transcutaneous electrical nerve stimulation (TENS) unit? -The unit should be turned on when repositioning or removing electrodes. -For acute pain, a recommended pulse of 30 to 50 microseconds should be used. -TENS should not be used when the etiology of the pain is unknown. -The electrodes should be placed over the carotid sinus nerves or over pharyngeal muscles.

TENS should not be used when the etiology of the pain is unknown. Rationale: TENS should not be used when the etiology of the pain is unknown because it may mask a new pathology. The electrodes should never be placed over the carotid sinus nerves or over laryngeal or pharyngeal muscles. The unit should be turned off to remove or reposition electrodes. For acute pain, the pulse should be 60 to 100 microseconds. TENS- A noninvasive alternative technique that involves electrical stimulation of large-diameter fibers to inhibit transmission of painful stimuli carried over small-diameter fibers.

A client with chronic lower back pain has been ordered transcutaneous electrical nerve stimulation (TENS). What should the nurse consider when using a TENS device? -TENS is most beneficial when used to treat pain that is generalized and diffuse. -TENS is a noninvasive pain management technique that relieves pain by providing psychological relief. -A TENS unit should not be used for more than 6 to 8 minutes at one time. -TENS stimulates large-diameter fibers to inhibit the transmission of painful impulses.

TENS stimulates large-diameter fibers to inhibit the transmission of painful impulses.

Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique? -Visual distraction -Auditory distraction -Project distraction -Tactile kinesthetic distraction

Tactile kinesthetic distraction Rationale: Tactile kinesthetic distractions occur when holding or stroking a loved one, pet, or toy, rocking, and slow rhythmic breathing. Project distraction- Playing a challenging game or performing meaningful work. Visual distraction- Reading or watching tv Auditory distraction- Listening to music

Which statement accurately represents a consideration when using an epidural analgesia for client pain management? -If the client develops a headache, a mild analgesic may be administered along with the epidural. -Slight resistance should be felt during the removal of an epidural catheter. -The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min. -If a client is experiencing adverse effects, a peripheral IV line should be installed to allow immediate administration of emergency drugs, if warranted.

The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min. Rationale: The anesthesiologist/pain management team should be notified immediately if the client exhibits a respiratory rate below 10 breaths/min or has unmanaged pain, leakage at the insertion site, fever, inability to void, paresthesia, itching, or headache. No other medications should be administered; a peripheral IV line should already be in place. Resistance should not be felt when removing an epidural catheter.

Which circumstance may preclude the use of cutaneous stimulation to relieve a client's pain? -The client has difficulty localizing his pain. -The client has a history of heart disease. -The client is receiving both scheduled and breakthrough analgesia. -The client's pain is chronic rather than acute.

The client has difficulty localizing his pain Rationale: Cutaneous stimulation requires that the client be able to localize his pain. It may be used on both chronic and acute pain, and neither analgesics nor heart problems contraindicate the use of cutaneous stimulation.

A middle-age client with cancer has been prescribed PCA. The nurse caring for the client explains the functioning of PCA. What is the main advantage of PCA? -The client requires less nursing care. -The client obtains pain relief slowly and steadily. -The client is able to have long hours of rest. -The client is actively involved in pain management.

The client is actively involved in pain management. Rationale: PCA gives the client the advantage of playing an active role in pain management, as the client is allowed to self-administer medication. Pain relief is rapid, not slow and steady, because the drug is delivered intravenously. PCA does not replace nursing care or reduce the amount of care that the client requires.

A nurse is caring for a client with cancer who is experiencing pain. What would be the most appropriate assessment of the client's pain? -the nurse's impression of the client's pain -nonverbal cues of the client -the client's recent responses to pain and to pain medication -the client's pain based on a pain rating

The client's pain based on a pain rating Rationale: Pain relief after nursing intervention is appropriate, but is a part of evaluation.

A client has been admitted to a post-surgical unit with a PCA system. Which statement is true of this medication delivery system? -The dose that is delivered when the client activates the machine is preset. -Thorough client education is necessary to prevent overdoses. -Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression. -An antidote is automatically delivered if the client exceeds the recommended dose.

The dose that is delivered when the client activates the machine is preset. Rationale: PCAs are designed to make it impossible for the client to exceed the client-specific dosing parameters programmed into the machine. PCAs do not administer antidotes, and they are almost always used to deliver opioid analgesics. The client does not need to be educated about overdoses.

Which statement accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain?

The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. Rationale: This approach can be used with oral analgesic agents as well as with infusions of opioid analgesic agents by intravenous, subcutaneous, epidural, and perineural routes. This drug delivery system may be used to manage acute and chronic pain in a health care facility or the home.

A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator may be responsible for this increased level of comfort?

The release of endorphins Rationale: Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that certain measures such as skin stimulation and relaxation techniques release endorphins.

Epidural analgesia is appropriate for postoperative analgesia and can be administered via continuous infusion pump, or by a patient-controlled epidural analgesia pump (PCEA).

True

Patient-controlled analgesia (PCA) can be used with oral analgesic agents to treat mild to moderate postoperative pain.

True Rationale: Intramuscular administration (IM) of analgesics is the least desirable route of administration. IM administration may cause additional pain and the client likely lacks the cognitive ability to ask for pain medication.

The nurse has just completed programming of a PCA pump using prescribed parameters. Which action should the nurse take next? -Check the pump's electrical cords for cracks, splits, or fraying. -Document implementation of the PCA on the client's chart. -Attach the PCA pump tubing to the client's intravenous access device. -Verify the settings with another nurse.

Verify the settings with another nurse. Rationale: The next action should be to verify the settings with another nurse. This action helps prevent errors. Settings should be verified before documentation. Settings should be verified before attaching the device to the client. Checking the pump's electrical cords for cracks, splits, or fraying should be performed before programming is initiated.

A nurse is caring for a client with dull ache in her abdomen. On the way to the health care facility, the client vomits and shows symptoms of pallor. What kind of pain is the client experiencing?

Visceral pain

A client has a severe abdominal injury with damage to the liver and colon from a motorcycle crash. What type of pain will predominate? -psychogenic pain -cutaneous pain -neuropathic pain -visceral pain

Visceral pain Neuropathic pain- occurs when there is actual nerve damage. Psychogenic pain (psychalgia)- Is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors. Headache, back pain, or stomach pain is common

A male college student age 20 years has been experiencing increasingly sharp pain in the RLQ of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is the client most likely experiencing? -somatic pain -referred pain -visceral pain -cutaneous pain

Visceral pain Rationale: Visceral pain is poorly localized and originates in body organs in the thorax, cranium, and abdomen. Occurs when organs stretch abnormally and become distended, ischemic, or inflamed. Appendicitis is characterized by inflammation of the vermiform appendix. Cutaneous pain- Superficial, in the dermis or epidermis. Somatic pain- Associated with tendons, ligaments, and bones. Referred pain- Perceived distant from its point of origin, but this client's pain is sensed near the location of his appendix.

A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain?

Whenever the vital signs are measured and documented Rationale: The nurse should assess the client's pain whenever the nurse measures and documents vital signs. When administering a prescribed analgesic, the nurse should assess pain before implementing a pain-management intervention, and again 30 minutes later. The nurse should assess the client's pain when the client is admitted to, not discharged from, the health care facility. Similarly, the nurse should assess pain once per shift when pain is an actual or potential problem.

A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain? -after the client is discharged from the health care facility -six hours after administering a prescribed analgesic -whenever the vital signs are measured and documented -once per day when the pain is a potential problem

Whenever the vital signs are measured and documented Rationale: The nurse should assess the client's pain whenever the nurse measures and documents vital signs. When administering a prescribed analgesic, the nurse should assess pain before implementing a pain-management intervention, and again 30 minutes later. The nurse should assess the client's pain when the client is admitted to, not discharged from, the health care facility. Similarly, the nurse should assess pain once per shift when pain is an actual or potential problem.

The triage nurse is assessing a 5-year-old client who has come to the emergency department with a caregiver after falling off of a skateboard. Which pain assessment tool will the nurse choose to use? -visual analog scale -Wong-Baker FACES scale -word scale -numeric scale

Wong-Baker FACES Scale Rationale: For children as young as 3 years of age

A nurse is assessing a mentally challenged adult client who is in pain after a fall from a staircase. Which scale should the nurse use to assess the client's pain? -FACES scale -numeric scale -linear scale -word scale

Wong-Baker FACES scale Rationale: This is best for children and clients who are culturally diverse or mentally challenged. Nurses generally use a numeric scale, a word scale, or a linear scale to quantify the pain intensity of adult clients who can express their pain intensity in words, numbers, or linear fashion.

A client reports throbbing pain caused by a laceration that occurred to the finger while cutting vegetables. Which terminology should the nurse use to document this pain?

cutaneous and acute