Fundamentals Chapter 36: Comfort and Pain Management

T/F: Patients who reside in low-income settings and minority populations are less likely to receive recommended treatments for pain in health care settings

True

The nociception process that involves the conversion of painful stimuli into electrical impulses that travel from periphery to the spinal cord is referred to as which of the following?

Transduction

3 multiple choice options

T/F: Pain is present whenever a person says it is, even when no specific cause of the pain can be found

True

Pain occurring in the periphery that is caused by metabolic and vascular changes and damage to peripheral and autonomic nerves is called:

Diabetic neuropathy

The multimodal approach to chronic pain management is used when treating pain in which of the following?

Children

3 multiple choice options

T/F: It is better to wait until pain is severe before giving a patient more pain medication to help lessen the side effects of pain medication

False

T/F: The FLACC behavioral pain scale is helpful when assessing pain in intubated or critically ill patients

False

Pain is considered chronic when it lasts longer than:

12 weeks

3 multiple choice options

Pain that is poorly localized and originates in body organs in the thorax, cranium, and abdomen is referred to as which of the following?

Visceral pain

3 multiple choice options

T/F: Referred pain is pain that is perceived in an area distant from its point of origin

True

A 77-year-old woman is on the nurse's unit s/p left knee replacement. The client typically stools every morning but has not had a bowel movement in 3 days. The nurse knows that which medication places the client at increased risk for constipation?

Hydromorphone

3 multiple choice options

A client comes to the emergency department complaining of a shooting pain in his chest. When assessing the client's pain, which behavioral response would the nurse expect to find?

Guarding of the chest area

3 multiple choice options

The nurse is assessing the pain of a preschooler. Which pain scales would be appropriate for the nurse to utilize? (Select all that apply.)

-FLACC Scale

-Wong-Baker Faces Scale

-0-10 Numeric Rating Scale

-COMFORT scale

-CRIES Pain scale

-FLACC Scale

-Wong-Baker Faces Scale

-COMFORT scale

The nurse is admitting a dying client with osteosarcoma. Which nursing action is priority?

Examine the effectiveness of the current pain regimen

3 multiple choice options

A client who is living with chronic pain has received a health care provider's order for TENS. When applying the device to the client's skin, the nurse should do what action?

Start with the lowest intensity and gradually increase it to the appropriate level

3 multiple choice options

The emergency room nurse is caring for a client who will need a lumbar puncture. The health care provider prescribes lidocaine 2.5% and prilocaine 2.5% cream (EMLA) to decrease the pain associated with the procedure. When should the nurse administer the cream?

One hour prior to the procedure

3 multiple choice options

A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a client being discharged. What process is involved in this pain relief measure?

Cutaneous stimulation

3 multiple choice options

A nurse is assessing a nonverbal client's pain. Which assessment finding will the nurse interpret as potentially indicating acute pain?

Increased blood pressure

3 multiple choice options

A client who has been harassed at her place of work tells the nurse, "Every time I think of my job, I get a debilitating headache and have to go lie down to make the pain go away." Which nursing intervention will the nurse perform to practice according to the Gate Control Theory?

Providing temple massages when head hurts

3 multiple choice options

Nurses assess clients who have physiologic responses to pain. Which examples of pain response are physiologic responses? Select all that apply.

-Exaggerated weeping and restlessness

-Protecting the painful area

-Increased blood pressure

-Muscle tension and rigidity

-Nausea and vomiting

-Grimacing and moaning

-Increased blood pressure

-Muscle tension and rigidity

-Nausea and vomiting

A nurse is taking care of a client who requests acetaminophen to help with a headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours as needed for pain. What type of order is this considered?

PRN order

3 multiple choice options

A client is postoperative day 1 and the nurse's assessment reveals signs of pain, such as grimacing and guarding. Which is the most reliable method for assessing the client's pain?

Ask the client to describe and rate their pain

3 multiple choice options

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

3 multiple choice options

The nurse is caring for a client utilizing a Patient Controlled Analgesia (PCA) pump that is programmed to allow a bolus dose every 10 minutes. The client is sleeping with visitors at the bedside. Which of the following instructions should the nurse give the client's visitors?

"Only the client should push the pump button."

3 multiple choice options

The nurse recognizes which statement is true of chronic pain?

It may cause depression in clients

3 multiple choice options

A client prescribed pain medication around the clock experiences pain 1 hour before the next dose of the pain medication is due. Which is the most appropriate action by the nurse?

Assess for medication prescription for breakthrough pain

3 multiple choice options

A client has been prescribed patient-controlled analgesia and the nurse is setting up the system and educating the client about safe and effective use of PCA. Which teaching point should the nurse provide to the client?

"The pump is programmed with safeguards to limit the possibility to overmedication."

3 multiple choice options

The nurse preparing to admit a client receiving epidural opioids should make sure that which of the following medications is readily available on the unit?

Naloxone

3 multiple choice options

A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. Which opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort?

Endorphins

3 multiple choice options

A client reports pain and requests the prescribed pain medication. When entering the client's room, the client is laughing with visitors and does not appear to be in pain. What is the appropriate action by the nurse?

Administer the pain medication

3 multiple choice options

A client is prescribed pain medication every 4 to 6 hours as needed. When the nurse enters the client's room to administer the medication, the client is laughing with visitors. The client's pulse rate is 64, respirations 16, and blood pressure 120/80. The client reports pain and wants the medication. What is the most appropriate action by the nurse?

Administer the pain medication

3 multiple choice options

The nurse is assessing a client for the chronology of the pain she is experiencing. Which interview question is considered appropriate to obtain this data?

How does the pain develop and progress?

3 multiple choice options

A client describes pain in the lower leg and has been diagnosed with a herniated lumbar disk. The pain in the leg is what type of pain?

Referred pain

3 multiple choice options

The nurse is performing an assessment of a client that is experiencing pain after a surgical procedure. What symptoms does the nurse assess based on the pain response?

Pupils are dilated

3 multiple choice options

The nurse has completed a preoperative teaching session with a client who will receive morphine via a patient-controlled analgesia (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 button for me if I doze off during the day."

3 multiple choice options

When performing an assessment on a client with chronic pain, the nurse notes that the client frequently shifts conversational topics. What does the nurse determine this may indicate?

Anxiety

3 multiple choice options

A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system?

The dose that is delivered when the client activates the machine is preset

3 multiple choice options

The nurse is caring for a client who reports nausea and vomiting for 1 week. How will the nurse document this type of pain? Select all that apply.

-Visceral

-Referred

-Neuropathic

-Acute

-Chronic

-Visceral

-Acute

The nurse is providing education to a client about the role of endogenous opioids in the transmission of pain. Which information about the release of endogenous opioids is most accurate?

They bind to opioid receptor sites throughout the CNS

3 multiple choice options

A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse caring for the client explains the functioning of PCA. What is the main advantage of PCA?

The client is actively involved in pain management

3 multiple choice options

The nurse is performing an assessment for a client related to pain. To determine the need for pain medication, on what primary source will the nurse base the decision?

The client's verbal report

3 multiple choice options

The nurse likes to use humor to help clients deal with pain. What guidelines should the nurse follow when using humor to foster pain relief?

Humor should take into account the client's personality and circumstances

3 multiple choice options

The spouse of a client with cancer asks why the client's breakthrough doses of morphine have recently needed to be higher and more frequent for the client to achieve pain relief? Which response by the nurse is appropriate?

Higher doses are needed because the client has developed a tolerance to the morphine

3 multiple choice options

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

3 multiple choice options

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.

-Assess for pain control 30 minutes after administering an analgesic.

-Consider cultural implications of the perception of pain.

-Infer that the client who does not complain has no pain.

-Provide pain medication before activity that may increase pain.

-Assess for pain control 30 minutes after administering an analgesic

-Consider cultural implications of the perception of pain

-Provide pain medication before activity that may increase pain

A client receiving epidural analgesia asks the nurse to put the head of the bed all the way down to sleep better. What is the correct response by the nurse?

"It is important that we keep the head of your bed elevated at least 30 degrees because this position helps to minimize the risk of respiratory depression."

3 multiple choice options

The nurse implements cutaneous stimulation for a client as part of a strategy for pain relief. Which nursing action exemplifies the use of this technique?

The nurse gives the client a massage before bed

3 multiple choice options

The nurse is caring for a client on their first postoperative day after chest surgery. The client appears stoic and does not request analgesia, The nurse should perform what action?

Actively solicit information about the client's pain level

3 multiple choice options

The nurse is reviewing relaxation techniques with the client who has chronic back pain that radiates to the legs. What information does the nurse include?

Close your eyes while practicing the relaxation exercises

3 multiple choice options

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.

-Do not drive a vehicle while taking this medication.

-Client is allowed to have one drink of alcohol each day.

-You may smoke cigarettes during the day but not at night.

-You must check with your primary care provider before breast-feeding your infant.

-For better absorption, take your pain medication on an empty stomach.

-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

-Keep a diary to record your level of pain and time medication is taken

A nurse giving a client a massage notes the presence of a nonblanching reddened area on the client's sacrum. What is the nurse's best action?

Avoid massaging this area and report the finding to the health care provider

3 multiple choice options

The nurse is caring for a client with terminal bone cancer. The client states, "My pain is getting worse and worse and the morphine doesn't help anymore." How would the nurse document the type of pain experienced by this client?

Intractable

3 multiple choice options

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:

Biofeedback

3 multiple choice options

The client reports back pain and requests medication for the pain. The client is prescribed a placebo. The client believes an opioid is prescribed. What action will the nurse take?

Contact the heath care provider

3 multiple choice options

The nurse is preparing a care plan for a client receiving opioid analgesics. Which factors associated with opioid analgesic use will the nurse include in the plan of care?

Preventing constipation

3 multiple choice options

The nurse is implementing environmental changes to promote a client's comfort and pain management. Which action is an example of this type of intervention?

Closing the client's room door to reduce unnecessary noises

3 multiple choice options

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 client's pain based on a pain rating

3 multiple choice options

A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. Which opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort?

Endorphins

3 multiple choice options

The nurse is conducting an admission assessment, and asks the client what medication is taken for pain. The client responds, “I take a little white pill to control my pain, but I don’t know the name of it,” and presents the nurse with a plastic baggie full of white pills. What is the priority nursing intervention?

Ask the client if he or she has the bottle the drug was dispensed in from the pharmacy

3 multiple choice options

A male college student age 20 years has been experiencing increasingly sharp pain in the right, lower quadrant 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?

Visceral pain

3 multiple choice options

The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opioid anesthesia, the nurse observes the client's respiratory rate decrease to 8 breaths per minute. What is the priority action by the nurse?

Administration of 0.4 mg of naloxone

3 multiple choice options

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

3 multiple choice options

An older adult client who is being treated in the hospital was given a hypnotic medication at bedtime. Which of the following possible consequences would indicate a paradoxical effect of this drug?

The client exhibits restless, uncharacteristic behavior after receiving the drug

3 multiple choice options

A 5-year-old client reports abdominal pain. Which action(s) will the nurse take to assess the pain? Select all that apply.

-Ask the parents if the client is in pain.

-Use the numeric rating scale.

-Use the Wong-Baker FACES pain rating scale.

-Observe the client.

-Ask the client to describe the pain.

-Use the Wong-Baker FACES pain rating scale

-Observe the client

-Ask the client to describe the pain

A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a client being discharged. What process is involved in this pain relief measure?

Cutaneous stimulation

3 multiple choice options

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

3 multiple choice options

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?

"Can you describe the type of pain you are having?"

3 multiple choice options

The nurse is developing a plan of care for a client in acute pain. Which nursing interventions should be included? (Select all that apply.)

-Encourage deep breathing.

-Play the client's favorite music.

-Promote a restful environment.

-Encourage increased protein.

-Encourage the use of a sitter.

-Encourage deep breathing

-Play the client's favorite music

-Promote a restful environment

A hospital client's pain is being treated with epidural analgesia. Which nursing action would pose a threat to the client's safety?

Administering an oral dose of morphine to treat the client's breakthrough

3 multiple choice options

The nurse is performing assessments for clients admitted in the emergency department. Which client is most likely experiencing somatic pain?

A client who has a sprained ankle

3 multiple choice options

What will the nurse place at the bedside of a client receiving epidural analgesia?

Ampule of 0.4 mg naloxone

3 multiple choice options

The health care provider has ordered a patient controlled analgesia (PCA) pump for a client. Which assessment finding would cause the nurse to question the order?

Client is disoriented to time and place

3 multiple choice options

A nurse is assessing a nonverbal client's pain. Which assessment finding will the nurse interpret as potentially indicating acute pain?

Increased blood pressure

3 multiple choice options

A nurse assesses a client who was administered an opioid analgesic and finds the client unresponsive to shaking and stimulation. Which is the nurse’s immediate plan of action?

Administer naloxone

3 multiple choice options

A nurse is preparing to give a client a massage. What action should the nurse perform during this intervention?

Using a light, gliding stroke, apply lotion to the client's shoulders, back, and sacral area.

3 multiple choice options

A client has just been started on opioid analgesia for pain control. The nurse assesses the client's level of sedation using a sedation scale and notes that the client is somewhat drowsy but is easily aroused by voice. The nurse would assign which rating?

2

3 multiple choice options

A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a PRN drug regimen as an effective method of pain control would be the client:

In the postoperative stage with occasional pain

3 multiple choice options

A postoperative vaginal hysterectomy client complains of pain that is more intense than this morning. This factor should be explained to the client as

"Acute pain tends to increase during the day and is called a routine pain response"

3 multiple choice options

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

3 multiple choice options

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?

Reviewing and revising the pain management treatment plan

3 multiple choice options

A nurse is caring for a client whose injured cells are releasing chemicals such as prostaglandins, bradykinin, histamine, and glutamate. Which phase of pain is the client experiencing?

Transduction

3 multiple choice options

How should the nurse position the head of the bed for a client receiving epidural opioids?

Elevated 30 degrees

3 multiple choice options

Evelyn is a 90-year-old woman who just returned from the operating room to your medical unit. She is otherwise healthy and has a history of some mild arthritis. As you examine Evelyn, you know that all of the following are signs of pain EXCEPT which?

Elevated kidney function

3 multiple choice options