Exam 7 - Pain/Comfort
Terms in this set (52)
A (Offer information and ask the client if he is interested in trying a relaxation technique.)
(Providing information will help the client to make an informed decision. A provider's order is not required for relaxation therapy. Providing reassurance may negate the client's fear. Providing more information without validating this as a need may increase his anxiety. The nurse should not give any therapy without informing the client and obtaining his consent. Telling him to relax does not acknowledge the impact of his anxiety.)
A nurse admits a client for abdominal surgery. The client's initial vital signs are temperature 37° C (98.6° F), pulse 98/min, respirations 20/min, and blood pressure 148/88 mm Hg. The client states, "I am really worried. This is the first surgery I have ever had." Which of the following is an appropriate use of a complementary alternative intervention?
A. Offer information and ask the client if he is interested in trying a relaxation technique.
B. Call the provider and get permission to use relaxation techniques with the client. C. Provide the client with reassurance and information about the procedure.
D. Give the client a therapeutic back massage and tell him to try to relax.
A ("Chiropractors use their hands to manipulate the spine to treat back pain.")
(Chiropractors use their hands to manipulate the spine. Acupuncture involves needles or pressure. Naturopathic medicine uses herbal remedies, and therapeutic touch practitioners use their hands to balance energy fields.)
A nurse is caring for a client who reports back pain and tells the nurse that a friend has recommended a chiropractor. She asks the nurse what a chiropractor does to relieve back pain. Which of the following responses by the nurse is correct?
A. "Chiropractors use their hands to manipulate the spine to treat back pain."
B. "Chiropractors insert needles or put pressure along meridians in the back." C. "Chiropractors use herbal remedies to treat back pain."
D. "Chiropractors use their hands to balance the energy fields in the back."
C (Body manipulation)
(Massage therapy is one type of body manipulation therapy. Alternative medical philosophy includes acupuncture and homeopathy. Biological therapy includes diet, vitamin and mineral supplementation, and herbal remedies. Mind-body therapy includes biofeedback, meditation, and psychotherapy.)
Massage therapy is an example of which category of alternative therapy?
A. Alternative medical philosophy
B. Biological therapy
C. Body manipulation
D. Mind-body therapy
(Serotonin and endorphins are natural substances within the body that decrease pain transmission. Substance P, bradykinin, and histamine all increase pain transmission.)
When caring for clients experiencing pain, a nurse should recognize that which of the following substances decrease pain transmission. (Select all that apply.)
A. Substance P
B ("My pain feels like a tight feeling in my chest.")
(Option B describes the quality of the pain, referring to how the pain feels to the client. This is typically a description such as throbbing, sharp, dull, or tight feeling. Option A describes associated symptoms such as difficulty sleeping, nausea, and anxiety. Option C describes the timing of the pain. Option D describes a relieving factor.)
A nurse is performing a pain assessment on a client. Which of the following subjective data describes the quality of the client's pain?
A. "My pain is so bad that I cannot sleep at night."
B. "My pain feels like a tight feeling in my chest."
C. "My pain started last week after I went for a hike."
D. "My pain feels better if I rest in an upright position."
B, C, D
(Nociceptive pain is usually localized, responds well to opioid analgesics, and may result in referred pain. Neuropathic pain arises from damaged pain nerves and is associated with phantom limb pain.)
Which of the following statements describes nociceptive pain? (Select all that apply.)
A. Arises from nerves by damaged pain
B. Usually well localized
C. Responds well to opioid analgesics
D. May result in referred pain
E. Associated with phantom limb pain
B (Pain rating of 9 on a scale of 0 to 10)
(The client's self-report of pain using a standardized pain scale is the most reliable indicator of pain. Vital signs, nonverbal communication, and other actions may be indicators of pain, but are not the most reliable.)
A nurse is caring for a postoperative client. Which of the following assessment findings is the most reliable indicator that the client is experiencing pain?
A. Blood pressure of 166/90 mm Hg
B. Pain rating of 9 on a scale of 0 to 10
C. Client grimaces when bed is moved
D. Client refuses to eat breakfast
D (Chronic back pain and arthritis)
(Evidence supports the use of many complementary therapies for chronic pain syndromes, particularly pain that is unremitting and unresponsive to conventional allopathic therapies.)
When planning patient education, it is important to remember that patients with which of the following often find relief in complementary therapies?
A) Lupus and diabetes
B) Ulcers and hepatitis
C) Heart disease and pancreatitis
D) Chronic back pain and arthritis
(These were identified as nurse-accessible complementary therapies. Massage therapists are licensed by local governmental agencies, and additional educational preparation is required to practice. Traditional Chinese medicine practitioners also attend training/educational programs, typically accredited by the Accreditation Commission for Acupuncture and Oriental Medicine.)
Which complementary therapies are most easily learned and applied by the nurse? (Select all that apply.)
A) Massage therapy
B) Traditional Chinese medicine
C) Progressive relaxation
D) Breath work and imagery
E) Therapeutic touch
C (Science in the field is just beginning. Before the 1990s there was little attention in the United States at the National Institutes of Health to support funding for studies about complementary therapies. Most of the evidence cited in systematic reviews throughout this chapter indicates preliminary support for the effectiveness of a variety of complementary therapies. Conditions that appear to be particularly responsive include chronic pain, chronic autoimmune disorders, anxiety, depression, impaired well-being and quality of life that accompany cancer and other chronic conditions, and some time-limited acute illnesses and the symptoms that accompany them "e.g., gastrointestinal disturbances, colds/flus".)
Which statement best describes the evidence associated with complementary therapies as a whole?
A) Many clinical trials in complementary therapies support their effectiveness in a wide range of clinical problems.
B) It is difficult to find funding for studies about complementary therapies. Therefore we should not expect to find evidence supporting its use.
C) The science supporting the effectiveness of complementary therapies is early in its development. Systematic reviews of the evidence often indicate beginning support for therapies, but there is a lack of strong evidence supporting their widespread use.
D) Most of the research examining complementary and alternative therapies has found little evidence, suggesting that although people like them, they are not effective.
C (Mind-body-spirit of the patient and their families)
(You could argue that, when you consider the totality of the patient/family, all of these come into play, but AHNA/ANA Standards of Holistic Nursing speak specifically to the mind-body-spirit focus of holistic nursing.)
The nurse understands that providing holistic care includes treating which of the following?
A) Disease, spirit, and family interactions
B) Desires and emotions of the patient
C) Mind-body-spirit of the patient and their families
D) Muscles, nerves, and spine disorders
B (The patient has provided permission and consent.)
(Nurse-accessible therapies are independent nursing interventions. As long as the Scope of Practice identified by the nurse's State Board of Nursing permits this activity, you do not need to obtain permission from the patient's primary provider or their family members unless the patient is underage. An adult can provide consent. Complete understanding of any procedure or intervention is impossible to ensure.)
In addition to an adequate patient assessment, when the nurse uses one of the nursing-accessible complementary therapies, he or she must ensure that which of the following has occurred?
A) The family has provided permission.
B) The patient has provided permission and consent.
C) The health care provider has given approval or provided orders for the therapy.
D) He or she has documented that the patient has a complete understanding of complementary and alternative medicine.
B (Actively involved in the treatment)
(One of the characteristics of complementary therapy users is that they want to be more involved in their care and decision making about the types of treatments that are used. Complementary therapies are one way to provide the patient with increased control of the health care.)
Which role do patients have in complementary and alternative medicine therapy?
A) Submissive to the practitioner
B) Actively involved in the treatment
C) An educator for other health care professionals
D) A total believer in what is being taught
D (Protect an individual from harm in the short term but cause negative responses over time)
(In the beginning stress responses serve as a warning and physiological "alarm" of sorts, preparing the person to respond to harm. In this way it can be a protective mechanism. However, stress that continues unmitigated for long periods of time creates states of "exhaustion" that translate ultimately into negative physiological and psychological events.)
The nurse is caring for a patient experiencing a stress response. The nurse plans care with the knowledge that systems respond to stress in what manner?
A) Always fail and cause illness and disease
B) Cause structural damage to the body
C) React the same way for all individuals
D) Protect an individual from harm in the short term but cause negative responses over time
D (Antihypertensive and thyroid-regulating medications.)
(Mind-body techniques, including meditation, create physiological responses in the cardiovascular and respiratory systems. These responses may include decreased blood pressure, reduced heart rate, and slowed respirations. They decrease the need for antihypertensive and other cardiac regulators and thyroid-regulating medications.)
When meditation therapy is used, nurses need to monitor patients' medications carefully because meditation may augment the effects of certain drugs such as:
A) Prednisone and antibiotics.
B) Insulin and vitamins.
C) Cough syrups and aspirin.
D) Antihypertensive and thyroid-regulating medications.
D (To learn how to control some autonomic nervous system responses)
A patient who has been using relaxation wants a better response. The nurse recommends the addition of biofeedback. What is the expected outcome related to using this additional modality?
A) To eat less food
B) To control diabetes
C) To live longer with acquired immune deficiency syndrome (AIDS)
D) To learn how to control some autonomic nervous system responses
A (Intentionally mobilizes energy to balance, harmonize, and repattern the recipient's biofield)
(TT is focused on healing the whole person and providing energy to the body that supports innate healing responses. The research literature is questionable; systematic analyses claim that the research designs are too weak for any conclusive evidence to be identified with confidence. Although TT is relatively safe and there have been very few negative events associated with its use, all therapies "complementary or conventional" should be used with caution in certain populations.)
A patient asks a nurse about therapeutic touch (TT). Which of the following does the nurse include when providing patient education about TT? Therapeutic touch:
A) Intentionally mobilizes energy to balance, harmonize, and repattern the recipient's biofield
B) Intentionally heals specific diseases or corrects certain symptoms
C) Is overwhelmingly effective in many conditions
D) Is completely safe and does not warrant any special precautions
B (Uses many modalities that are based on the individual and include herbal therapies, moxibustion, and acupuncture)
(TCM practitioners use a variety of interventions that are based on individual patient assessment findings and needs. Modalities include herbal therapies, acupuncture, moxibustion, cupping, prescribed exercise such as tai chi or qi gong, and lifestyle changes. Although acupuncture is often confused with TCM, when used alone acupuncture is not a whole system of medicine. Rather NIH/NCCAM considers it to be a mind-body technique that is often referred to as medical acupuncture. Although herbal therapies and exercise are considered to be part of the treatment repertoire of the TCM provider, these modalities are not considered to be primary interventions.)
A nurse provides care for a diverse group of patients, including many immigrants. To better understand various types of health care, the nurse learns the traditional Chinese medicine system:
A) Uses acupuncture as its primary intervention modality
B) Uses many modalities that are based on the individual and include herbal therapies, moxibustion, and acupuncture
C) Uses primarily herbal remedies (that are known to have high levels of lead products) and exercise
D) Is the equivalent of medical acupuncture
C (Patient with posttraumatic stress disorder "PTSD")
(Imagery can often recreate the traumatic experience, intensifying the sensations and emotions that accompany the memory of it and bringing the PTSD to a crisis level.)
The nurse is planning care for a group of patients who have requested the use of complementary health modalities. Which patient is not a good candidate for imagery?
A) Pregnant patient
B) Hypertensive patient
C) Patient with posttraumatic stress disorder (PTSD)
D) A pediatric patient
(Current research has been able to determine that reducing stress by using relaxation strategies in the workplace leads to improved staff relationships, communication, satisfaction, and retention "decreased turnover".)
Several nurses on a busy unit are using relaxation strategies while at work. What is the desired workplace outcome from this intervention? (Select all that apply.)
A) Improved health among the staff
B) Increased patient safety
C) Improved staff satisfaction
D) Increased staff retention
E) Fewer overtime assignments
D (They should be treated as though they were "drugs" of sorts because many have active ingredients that can interact with other medications and change physiological responses.)
(Herbal therapies are derived from plant materials and often contain the same active components as medications. Yet, they are viewed as dietary supplements and are not regulated by the FDA. You should always explicitly ask patients whether they are taking supplements or other herbal remedies or vitamins when you ask them about the medications that are currently being used during a health history. Many patients do not tell you about these products voluntarily because they do not view them as medications, they fear that conventional providers will not approve of these substances and they want to continue taking them, or they do not think that you are interested in a substance that was not prescribed.)
The nurse is caring for a patient who uses several herbal preparations in addition to prescribed medications. What does the nurse need to understand about herbal preparations?
A) They are regulated by the Food and Drug Administration (FDA); therefore patients and providers should feel confident that they are completely safe.
B) They are natural products and therefore are safe as long as you use them cautiously and prudently for the conditions that are indicated.
C) They are covered by insurance, including Medicare, Medicaid, and private payers.
D) They should be treated as though they were "drugs" of sorts because many have active ingredients that can interact with other medications and change physiological responses.
A, B, C, D, E
(All of the statements are true except "nurses learn how to provide all of the complementary modalities during their basic education." Nurses play an essential role in the safe use of complementary therapies in our emerging health care system. They have an appreciation for many types of interventions and can understand the patient's need to become more involved in their health care decisions and choices. They also understand patients' desire to take a more active role in their healing and health promotion processes. Culturally relevant care that uses a full complement of intervention strategies that are supported with evidence is a central tenet of contemporary nursing practice.)
The nurse manager of a community clinic arranges for staff in-services about various complementary therapies available in the community. What is the purpose of this training? (Select all that apply.)
A) Nurses have a long history of providing some of these therapies and need to be knowledgeable about their positive outcomes.
B) Nurses are often asked for recommendations and strategies that promote well-being and quality of life.
C) Nurses play an essential role in patient education to provide information about the safe use of these healing strategies.
D) Nurses appreciate the cultural aspects of care and recognize that many of these complementary strategies are part of a patient's life.
E) Nurses play an essential role in the safe use of complementary therapies.
F) Nurses learn how to provide all of the complementary modalities during their basic education.
B (Difficulty arousing the patient)
(Opioid-naive patients may develop a rare adverse effect of respiratory depression, and sedation always occurs before respiratory depression.)
Which of the following signs or symptoms in an opioid-naïve patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid?
A) Oxygen saturation of 95%
B) Difficulty arousing the patient
C) Respiratory rate of 10 breaths/min
D) Pain intensity rating of 5 on a scale of 0 to 10
A (Calls the health care provider, and questions the order)
(Fentanyl is 100 times more potent than morphine and not recommended for acute postoperative pain.)
A health care provider writes the following order for an opioidnaive patient who returned from the operating room following a total hip replacement. "Fentanyl patch 100 mcg, change every 3 days." Based on this order, the nurse takes the following action:
A) Calls the health care provider, and questions the order
B) Applies the patch the third postoperative day
C) Applies the patch as soon as the patient reports pain
D) Places the patch as close to the hip dressing as possible
B (Stimulant laxative)
(Patients usually become tolerant to the side effects of opioids, with the exception of constipation. Routinely administer stimulant laxatives, not simple stool softeners, to prevent and treat constipation.)
A patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication?
A) Stool softener
B) Stimulant laxative
C) H 2 receptor blocker
D) Proton pump inhibitor
B (The time interval)
(Controlled- or extended-release opioid formulations such as OxyContin are available for administration every 8 to 12 hours ATC. Health care providers should not order these long-acting formulations prn.)
A new medical resident writes an order for OxyContin SR 10 mg PO q12 hours prn. Which part of the order does the nurse question?
A) The drug
B) The time interval
C) The dose
D) The route
C (The amount of daily acetaminophen)
(The major adverse effect of acetaminophen is hepatotoxicity. The maximum 24-hour dose is 4 g. It is often combined with opioids (e.g., oxycodone [Percocet]) because it reduces the dose of opioid needed to achieve successful pain control.)
The nurse notices that a patient has received oxycodone/acetaminophen (Percocet) (5/325) two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most?
A) The patient's level of pain
B) The potential for addiction
C) The amount of daily acetaminophen
D) The risk for gastrointestinal bleeding
D (Physical dependence.)
(Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.)
A patient with chronic low back pain who took an opioid around-the-clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking chills, abdominal cramps, and joint pain. The nurse recognizes that this patient is experiencing symptoms of:
D) Physical dependence.
D (Assess patient's vital signs every 15 minutes for 2 hours)
(Reassess patients who receive naloxone every 15 minutes for 2 hours following drug administration because the duration of the opioid may be longer than the duration of the naloxone and respiratory depression may return.)
After having received 0.2 mg of naloxone (Narcan) intravenous push (IVP), a patient' s respiratory rate and depth are within normal limits. The nurse now plans to implement the following action:
A) Discontinue all ordered opioids
B) Close the room door to allow the patient to recover
C) Administer the remaining naloxone over 4 minutes
D) Assess patient's vital signs every 15 minutes for 2 hours
A (Only the patient should push the button.)
(Patient preparation and teaching are critical to the safe and effective use of PCA devices. Patients need to understand PCA and be physically able to locate and press the button to deliver the dose. Be sure to instruct family members not to "push the button" for the patient.)
Which one of the following instructions is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine?
A) Only the patient should push the button.
B) Do not use the PCA until the pain is severe.
C) The PCA prevents overdoses from occurring.
D) Notify the nurse when the button is pushed.
B (Request to have the ordered changed to ATC for the first 48 hours.)
(The American Pain Society (2003) states that, if you anticipate pain for most of the day, you should consider ATC administration. Insertion of a gastrostomy tube is painful. This patient will most likely experience pain for at least the next 48 hours.)
A patient with a history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The health care provider's order reads as follows: "Vicodin 1 tab, per tube, q4 hours, prn." Which action by the nurse is most appropriate?
A) No action is required by the nurse because the order is appropriate.
B) Request to have the ordered changed to ATC for the first 48 hours.
C) Ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3 hours, prn.
D) Begin the Vicodin when the patient shows nonverbal symptoms of pain.
D (Assess the characteristics of the pain.)
(It is necessary to monitor pain on a regular basis along with other vital signs. It is important for the nurse to understand that pain assessment is not simply a number.)
A patient returning to the nursing unit after knee surgery is verbalizing pain at the surgical site. The nurse's first action is to:
A) Call the patient's health care provider.
B) Administer pain medication as ordered.
C) Check the patient's vital signs.
D) Assess the characteristics of the pain.
B (The patient's report of pain is the best method for assessing the pain.)
(A patient's self-report of pain is the single most reliable indicator of the existence and intensity of pain.)
The patient rates his pain as a 6 on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. The patient's wife says that he can't be in that much pain since he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain?
A) The patient's wife is the best resource for determining the level of pain since she has been with him continually for the entire day.
B) The patient's report of pain is the best method for assessing the pain.
C) The patient's health care provider has the best knowledge of the level of pain that the patient that should be experiencing.
D) The nurse is the most experienced at assessing pain.
(Cold therapies are particularly effective for pain relief. Ice massage involves applying a frozen cup of ice firmly over the skin. When numbness occurs, remove the ice for usually 5 to 10 minutes.)
When using ice massage for pain relief, which of the following are correct? (Select all that apply.)
A) Apply ice using firm pressure over skin.
B) Apply ice until numbness occurs and remove the ice for 5 to 10 minutes.
C) Apply ice until numbness occurs and discontinue application.
D) Apply ice for no longer than 10 minutes.
D (TENS electrodes are applied near or directly on the site of pain.)
(TENS involves stimulation of the skin with a mild electrical current passed through external electrodes. The therapy requires a health care provider order. The TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. Place the electrodes directly over or near the site of pain.)
When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information do you include?
A) TENS works by causing distraction.
B) TENS therapy does not require a health care provider's order.
C) TENS requires an electrical source for use.
D) TENS electrodes are applied near or directly on the site of pain.
A (Transitioning use of adjuvants with nonsteroidal antiinfl ammatory drugs "NSAIDs" to opioids.)
(The WHO analgesic ladder transitions from the use of nonopioids "NSAIDS" with or without adjuvants to opioids with or without adjuvants. Acetaminophen is recommended for lesser levels of pain. Side effects related to the use of opioids may be unavoidable but are treatable. Treatment for severe pain may result in some level of sedation.)
While caring for a patient with cancer pain, the nurse knows that the World Health Organization (WHO) analgesic ladder recommends:
A) Transitioning use of adjuvants with nonsteroidal antiinfl ammatory drugs (NSAIDs) to opioids.
B) Using acetaminophen for refractory pain.
C) Limiting the use of opioids because of the likelihood of side effects.
D) Avoiding total sedation, regardless of how severe the pain is.
A (The sedative administered may have helped him sleep, but assessment of pain is still needed.)
(Sedatives, antianxiety agents, and muscle relaxants have no analgesic effect; however, they can cause drowsiness and impaired coordination, judgment, and mental alertness and contribute to respiratory depression. It is important to avoid attributing these adverse effects solely to the opioid. You need to conduct a thorough reassessment.)
A postoperative patient is currently asleep. Therefore the nurse knows that:
A) The sedative administered may have helped him sleep, but assessment of pain is still needed.
B) The intravenous (IV) pain medication is effectively relieving his pain.
C) Pain assessment is not necessary.
D) The patient can be switched
Begins in the periphery when a pain-producing stimulus sends an impulse across a peripheral nerve fiber (nociceptor), initiating an action potential.
Pain impulse travels to nervous system with the help of some excitatory neurotransmitters:
Point at which a person is aware of pain
Determines how we feel about pain
Once the brain perceives the pain, inhibitory neurotransmitters work to stop the transmission of pain and help produce an analgesic effect
Fight or flight
Low to moderate intenstiy of pain and superficial pain will elicit what reaction as general adaption syndrome
Continuous, severe or deep visceral pain will activate which brach of the nervous system? Resulting in
- Muscle Tension
- Decreased HR and BP
- Tachypnea + Irregular
Gate Control Pain Theory
Identify the theory:
Wall & Malzack (1965)
-Pain has physical, emotional and cognitive components
Pain impulses pass through when a gate is open and are blocked when gate is closed. Closing the gate is the basis for non-pharmacological pain relief interventions
Acupressure & puncture
Pain that extends beyond treated steady chronic pain
Pain that is predictable and elicited by specific behaviors
End-of-dose Failure Pain
Pain that occurs toward the end of the usual dosing interval of a regularly scheduled analgesic
Pain that is unpredictable and not associated with any activity or event
Identify the Pain
Greater than 6 months
Can not always identify the cause of pain
High rates of correlating depression
Identify the Pain
Less than 6 months
Can identify cause of pain
Two types of Nociceptive Pain
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