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chapter 35 comfort

Terms in this set (97)

A patient 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?

a) The release of dopamine
b) The release of melatonin
c) The release of endorphins
d) The release of serotonin
The release of endorphins

Explanation:
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 1131
A physician is explaining to the client the role of endogenous opioids in the transmission of pain. What happens when endogenous opioids are released?

a) They bind to sites on the nerve cell's membrane.
b) They occupy cell receptors for neurotransmitters.
c) They block glutamate receptors and peptides.
d) They react with acetylcholine and serotonin.
They bind to sites on the nerve cell's membrane.

Explanation:
When endogenous opioids are released, they are thought to bind to sites on the nerve cell's membrane that block the transmission of pain-conducting neurotransmitters such as substance P and prostaglandins. Endogenous opioids do not occupy cell receptors for neurotransmitters like acetylcholine and serotonin, but efforts are being made to develop pain-modulating drugs that will do so and will also block glutamate receptors and peptides. 1117
A nurse is assessing a client's pain. The nurse notes which of the following database findings that is indicative of acute pain?

a) Pupil constriction
b) Decreased pulse rate
c) Decreased respiratory rate
d) Increased blood pressure
Increased blood pressure

Explanation:
The increase in blood pressure that may accompany acute pain is believed to be due to overactivity of the sympathetic nervous system. 1115
A nurse observes that a client who underwent knee surgery two weeks ago needs progressively larger doses of analgesics to get relief from pain. The nurse interprets this as which of the following?

a) Addiction
b) Tolerance
c) Dependence
d) Sedation
Tolerance

Explanation:
The client is manifesting tolerance, which is characterized by the need for larger doses of analgesics to produce the original effect. The client is not manifesting addiction, dependence, or sedation. Addiction is a psychological condition characterized by a drive to obtain and take substances for other than the prescribed value. Dependence is a physiologic response wherein a person who is dependent on opioids responds to abrupt discontinuation with characteristic withdrawal symptoms. Sedation is an adverse effect of administration of opioid analgesics. 1129
A nurse is caring for a client with severe backache. The physician has prescribed transcutaneous electrical nerve stimulation (TENS). Which of the following candidates is most suitable for TENS?

a) Client involved in sports activities
b) Client who is pregnant
c) Client with chronic dysrhythmias
d) Client with cardiac pacemaker
Client involved in sports activities

Clients involved in sports activities are the most suitable candidates for transcutaneous electrical nerve stimulation (TENS). TENS is a non-narcotic, noninvasive method and has no toxic side effects, thus athletes prefer TENS when they are in acute pain. TENS is contraindicated in pregnant women because its effect on the unborn fetus has not been determined. Clients with cardiac pacemakers (especially the demand type), clients with chronic dysrhythmias, and clients who have had heart attacks are not candidates for TENS. 1131-1132
Which of the following principles should the nurse integrate into the pain assessment and pain management of pediatric clients?

a) Pharmacologic pain relief should be used only as an intervention of last resort.
b) The developing neurological system of children transmits less pain than in older clients.
c) A numeric scale should be used to assess pain if the child is older than 5 years of age.
d) Pain assessment may require multiple methods in order to ensure accurate pain data.
Pain assessment may require multiple methods in order to ensure accurate pain data.

Explanation:
It is often necessary to use more than one technique for pain assessment in children. Though their neurological 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. 1118
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 of the following responses is most appropriate?

a) "The mild electrical impulses block the pain signal before it can reach the brain."
b) "The electricity produces numbness and alters tissue sensitivity."
c) "The machine tricks the mind into believing the pain does not exist."
d) "The electrode patches generate heat and decrease muscle tension."
"The mild electrical impulses block the pain signal before it can reach the brain."

Explanation:
This statement explains the use of cold therapy for pain. 1131
A nurse is caring for a client who was administered opioid narcotics. The client complains of constipation. Which of the following is another potential side effect of opioid narcotics?

a) Diarrhea
b) Sedation
c) Insomnia
d) Anxiety
Sedation

Explanation:
Opioids and opiates cause sedation, nausea, constipation, and 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. 1134
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?

a) Project distraction
b) Tactile kinesthetic distraction
c) Auditory distraction
d) Visual distraction
Tactile kinesthetic distraction

Explanation:
Examples of tactile kinesthetic distraction include holding or stroking a loved one, pet, or toy; rocking; and slow rhythmic breathing. Project distraction includes playing a challenging game or performing meaningful work. Visual distraction can be accomplished through reading or watching television. Auditory distraction may occur when one listens to music. 1130
Besides controlling pain of the post-abdominal surgery client with narcotics, the nurse suggests to the client that he ...

a) think about the next dose
b) describe the pain
c) focus on pain relief
d) use distraction
use distraction

Explanation:
Distraction is useful when clients are undergoing brief periods of sharp, intense pain, such as dressing changes, wound débridement, biopsy, or incident pain from shifting positions. 1130
When assessing a patient on PCA therapy, the nurse finds the patient to be somnolent, with minimal or no response to physical stimulation, scoring a 4 on the sedation scale. What is the recommended intervention in this situation?

a) Stop the infusion and report the incident to the nurse manager in charge; follow the protocol of oxygen and naloxone administration.
b) Stop the PCA infusion, check the medication level, and restart the infusion at a lower dose.
c) Stop the medication infusion immediately and notify the primary care provider; prepare to administer oxygen and a narcotic antagonist, such as naloxone (Narcan).
d) Stop the PCA infusion, increase the frequency of sedation and respiratory rate monitoring to every 15 minutes, arouse the patient, and encourage deep breathing.
Stop the medication infusion immediately and notify the primary care provider; prepare to administer oxygen and a narcotic antagonist, such as naloxone (Narcan).

Explanation:
If a patient receiving a PCA infusion becomes somnolent, with a sedation score of 4, the nurse should stop the medication infusion immediately and notify the primary care provider. The nurse should prepare to administer oxygen and a narcotic antagonist, such as naloxone (Narcan). 1134
Which of the following patients would be the best candidate to receive epidural analgesia for pain management?

a) A child undergoing hip surgery
b) A patient with an inoperable brain tumor
c) A patient who is experiencing chest pains
d) A patient with a strained back
A child undergoing hip surgery

Explanation:
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. 1140
The nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. The nurse notes that the client's respiratory rate is 10 breaths per minute. The client is somnolent, with minimal response to physical stimulation. The nurse should prepare to administer which of the following medications?

a) Intravenous naloxone (Narcan)
b) Intravenous flumazenil (Romazicon)
c) Oral modafinil (Provigil)
d) Nebulized albuterol (Proventil)
Intravenous naloxone (Narcan)

Explanation:
Albuterol is a bronchodilator and not appropriate for this clinical situation. 1134
A patient 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 patient is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. What is this technique for pain control known as?

a) Therapeutic Touch
b) Biofeedback
c) Hypnosis
d) Transcutaneous electrical nerve stimulation
Biofeedback

Explanation:
Biofeedback is a technique that uses a machine to monitor physiologic responses through electrode sensors on the patient's skin. The unit transforms the data into a visual display, and through seeing the pain responses, the patient is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. Transcutaneous electrical nerve stimulation (TENS) is a noninvasive alternative technique that involves electrical stimulation of large-diameter fibers to inhibit transmission of painful stimuli carried over small-diameter fibers. Hypnosis is an alteration in a person's state of consciousness so that pain is not perceived as it normally would be. Therapeutic Touch involves using one's hands to direct an energy exchange consciously from the practitioner to the patient to facilitate healing or pain relief. 1132
After the nurse has instructed a client with low-back pain about the use of a transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what?

a) "I could use the TENS unit if I feel pain somewhere else on my body."
b) "I may need fewer pain medications with the TENS unit in place."
c) "Wearing the TENS unit should not interfere with my daily activities."
d) "One advantage of the TENS unit is it increases blood flow."
"I could use the TENS unit if I feel pain somewhere else on my body."

Explanation:
The client needs further instruction when she says she can use the TENS unit on other areas of the body. Such a statement would indicate that the client does not understand that the unit should be used as prescribed by the physician in the location defined by the physician. 1131
A nurse is caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain?

a) Phantom pain
b) Referred pain
c) Visceral pain
d) Cutaneous pain
Phantom pain

Explanation:
The nurse should document the pain as phantom pain, a type of neuropathic pain that is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. The client perceives that the amputated limb still exists and feels burning, itching, and deep pain in tissues that have been surgically removed. The client is not experiencing referred pain, visceral pain, or cutaneous pain. Visceral pain is associated with disease or injury. Referred pain is not experienced in the exact site where an organ is located. Cutaneous pain originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma. 1113
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?

a) Visceral pain
b) Chronic pain
c) Cutaneous pain
d) Neuropathic pain
Neuropathic pain

Explanation:
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. The client is not experiencing cutaneous, visceral, or chronic pain. In cutaneous pain, the discomfort originates at the skin level. In visceral pain, the discomfort arises from internal organs caused from a disease or injury. In chronic pain, the discomfort lasts longer than six months. 1113
Which of the following statements accurately represents a consideration when using an epidural analgesia for patient pain management?

a) If a patient is experiencing adverse effects, a peripheral IV line should be installed to allow immediate administration of emergency drugs, if warranted.
b) Slight resistance should be felt during the removal of an epidural catheter.
c) If the patient develops a headache, a mild analgesic may be administered along with the epidural.
d) The anesthesiologist/pain management team should be notified immediately if the patient exhibits a respiratory rate below 10 breaths/minute.
The anesthesiologist/pain management team should be notified immediately if the patient exhibits a respiratory rate below 10 breaths/minute.

Explanation:
The anesthesiologist/pain management team should be notified immediately if the patient exhibits a respiratory rate below 10 breaths/minute 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. 1140
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?

a) Referred pain
b) Somatic pain
c) Visceral pain
d) Cutaneous pain
Visceral pain

Explanation:
Visceral pain occurs when organs stretch abnormally and become distended, ischemic, or inflamed. Appendicitis is characterized by inflammation of the vermiform appendix. Cutaneous pain is superficial. Somatic pain is more commonly associated with tendons, ligaments, and bones. Referred pain is perceived distant from its point of origin, but this client's pain is sensed near the location of his appendix. 1112
The nurse has completed a preoperative education session with a client who will receive morphine via a patient-controlled analgesia pump (PCA) after surgery. Which of the following statements by the client indicates the need for further teaching?

a) "I can push the button whenever I feel pain."
b) "I will let my nurse know if the pain medication is not effective enough to help me move after surgery."
c) "I will use the PCA pump until oral pain medication controls my pain."
d) "I will remind my family member to push the PCA pump button for me if I doze off during the day."
"I will remind my family member to push the PCA pump button for me if I doze off during the day."

Explanation:
Sedation that prevents the client from delivering a dose of opioid contributes to the safety of intravenous PCA drug administration. If the client is too sleepy to push the button (or asks that it be pushed), the button should not be pushed. 1138
A client has required frequent scheduled and breakthrough doses of opioid analgesics in the six days since admission to the hospital. The client's medication regimen may necessitate which of the following interventions?

a) Frequent turns and application of skin emollients
b) Stool softeners and increased fluid intake
c) Calorie restriction and dietary supplements
d) Supplementary oxygen and chest physiotherapy
Stool softeners and increased fluid intake

Explanation:
The most common side effect of opioid use is constipation. Consequently, stool softeners and increased fluid intake may be indicated. 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.1134
A nurse attempts to relieve the pain of a patient by using cutaneous stimulation. Which of the following accurately describes usage of this technique?

a) A nurse guides a patient to use imagery.
b) A nurse distracts the patient by playing his favorite music.
c) A nurse applies intermittent heat and cold to a patient's leg.
d) A nurse uses deep-breathing exercises to distract a patient from his pain.
A nurse applies intermittent heat and cold to a patient's leg.

Explanation:
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. 1131
Epidural analgesia is appropriate for postoperative analgesia and can be administered via continuous infusion pump, or by a patient-controlled epidural analgesia pump (PCEA).

a) True
b) False
true
Which of the following guidelines regarding pain should be included in the nurse's education plan for a group of parents with infants and toddlers?

a) Infants cannot express pain until 8 months of age.
b) Pain can be a source of fear and threat to the toddler's security.
c) Toddlers often try to be brave and not cry.
d) Toddlers are often reluctant to express pain.
Pain can be a source of fear and threat to the toddler's security.

Explanation:
During the toddler and preschool years, children are achieving a sense of autonomy. Because pain can be a source of fear and threat to security, children respond with crying, anger, physical resistance, or withdrawal.1118
A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which of the following statements is true of this medication delivery system?

a) An antidote is automatically delivered if the client exceeds the recommended dose.
b) Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression.
c) Thorough client education is necessary to prevent overdoses.
d) The dose that is delivered when the client activates the machine is preset.
The dose that is delivered when the client activates the machine is preset.

Explanation:
PCAs are designed to make it impossible for the client to exceed the patient-specific dosing parameters programmed into the machine. PCAs do not administer antidotes, and they are almost always used to deliver opioid analgesics.1138
A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain?

a) Once per day when the pain is a potential problem
b) Six hours after administering a prescribed analgesic
c) After the client is discharged from the health care facility
d) Whenever the vital signs are measured and documented
Whenever the vital signs are measured and documented

Explanation:
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.1120
The acute care nurse is preparing to care for an 86-year-old patient who just returned to the unit after surgery to repair a fractured hip. The patient has severe dementia. Which of the following pain management strategies would be most appropriate for this patient?

a) Patient controlled analgesia (PCA)
b) Authorized agent-controlled analgesia (AACA)
c) As needed (PRN) administration of oral analgesic medications
d) As needed (PRN) administration of intramuscular analgesic medications
Authorized agent-controlled analgesia (AACA)

Explanation:
Intramuscular administration (IM) of analgesics is the least desirable route of administration. IM administration may cause additional pain and the patient likely lacks the cognitive ability to ask for pain medication.1139
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?

a) Acute pain
b) Referred pain
c) Chronic pain
d) Limited pain
Referred pain

Explanation:
Pain from the abdominal, pelvic, or back may be referred to areas far distant from the site of tissue damage. 1113
Which of the following statements accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain?

a) This approach can only be used with oral analgesics.
b) The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval.
c) A PCA pump must be used and monitored in a health care facility.
d) The PCA pump is not effective for chronic pain.
The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval.

Explanation:
The pump mechanism can be programmed to deliver a specified amount of analgesic within a given time interval. 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 1139
A client has an order for a narcotic analgesic every three to four hours and he received his last dose three hours earlier. Which of the following actions is most appropriate for the nurse to take in response to the client's request for pain medication on his first postoperative day?

a) Contact the physician for a change in medication
b) Tell the client that the pain cannot be severe
c) Provide the client with pain medication
d) Document and ask the client to wait one hour
Provide the client with pain medication

Explanation:
Inadequate or poor pain assessment is a leading factor in poor pain control, because the health care professional may not know a client has pain. The nurse must provide the next dose of pain medication. 1134
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 which of the following?

a) Voluntarily controlling autonomic functions
b) Using imagination to change the pain experience
c) Focusing on another stimuli in the environment
d) Decreasing the autonomic nervous system activity
Focusing on another stimuli in the environment

Explanation:
Distraction directs attention away from pain by directing mental focus onto other stimuli in the environment. Relaxation decrease autonomic nervous system activity.Imagery involves the use of one's own imagination to create sensory experiences to alter or change the pain experience itself. With biofeedback the client learns voluntary control over autonomic functions such as heart rate, hand temperature, and muscle tension. 1127
A middle-aged client with cancer has been prescribed patient-controlled analgesia (PCA) by a physician. Which of the following is an advantage that PCA offers?

a) Higher individual dosages reduce side effects.
b) Pain can be kept within a constant tolerable level .
c) The client can control the dosage of the intravenous medications .
d) Small dosages of opioids offer instant relief.
Pain can be kept within a constant tolerable level .

Explanation:
PCA allows the client to keep pain within a constant tolerable level; pain relief is rapid because the drug is delivered intravenously. The client cannot control the dosage of the drug because it is delivered intravenously. Small dosages of opioids do not offer instant relief, and side effects are reduced with smaller individual dosages and lower total dosages. 1138-1139
An 80-year-old woman has been suffering from knee pain for the past 3 years. The client requires a knee replacement and has diminished mobility. The most appropriate nursing diagnosis is

a) Chronic pain related to knee disability as defined by guarded gait
b) Altered mobility related to pain as defined by guarded gait
c) Inability to perform activities of daily living related to chronic pain
d) Acute pain related to degenerative joint disease as evidenced by static gait
Chronic pain related to knee disability as defined by guarded gait

Explanation:
The most appropriate nursing diagnosis is "Chronic pain related to knee disability as defined by guarded gait."1127
Based on your knowledge of pain and the body's response, when assessing a client in pain, you would anticipate the

a) Pupils are dilated
b) Blood pressure is normal
c) Respirations are shallow
d) Pulse rate is decreased
Pupils are dilated

Explanation:
Acute pain stimulates the sympathetic nervous system and produces the following objective symptoms: increased blood pressure, increased pulse, increased respiratory rate, dilated pupils, and diaphoresis.1115
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 which of the following?

a) Phantom pain
b) Somatic pain
c) Cutaneous pain
d) Visceral pain
Somatic pain

Explanation:
Somatic pain is diffuse or scattered pain, and it originates in tendons, ligaments, bones, blood vessels, and nerves. Cutaneous pain usually involves the skin or subcutaneous tissues. Visceral pain is poorly localized and originates in body organs. 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 1112
A nurse is caring for an elderly client who is unable to walk without a support due to knee pain. During his initial assessment, however, the client does not mention pain. Which of the following beliefs common in elderly clients may cause them to underreport their pain?

a) Pain is harmless.
b) Pain will draw their families closer to them.
c) Pain is a normal part of aging.
d) Pain can be eliminated with medication.
Pain is a normal part of aging.

Explanation:
When assessing elderly clients, the nurse should remember that they often underreport pain. Many elderly people believe that pain is a normal part of aging, may be a punishment for past actions, may result in a loss of independence, and may indicate that death is near. Elderly clients usually do not believe that pain is harmless, that medicine will eliminate pain, or that pain will draw the family closer to the elderly client. 1118
A nurse is assessing a mentally challenged adult client who is in pain after a fall from a staircase. Which of the following scales should the nurse use to assess the client's pain?

a) Linear scale
b) Faces scale
c) Word scale
d) Numeric scale
Faces scale

Explanation:
The nurse should use the Wong-Baker FACES scale, which 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 with the help of the respective scales. 1124-1126
A nurse is caring for a client with neck pain. The nurse is explaining neck pain and some basic methods for pain management to the client. Which of the following pain-management facts should the nurse mention to the client and the client's family?

a) Avoid performing abdominal breathing techniques.
b) Discuss pain-control methods with the physician.
c) Apply cold and hot packs to enhance pain control.
d) Take pain-relieving medication before physical activity.
Discuss pain-control methods with the physician.

Explanation:
The nurse should explain to the client the importance of discussing pain-control methods that have been effective and not effective with the physician. The nurse should ask the client to perform simple techniques such as abdominal breathing and jaw relaxation to increase comfort. The client should not take pain-relieving medication on his or her own before any physical activity. Instead, the client should ask for or take pain-relieving drugs when pain begins or before an activity that causes pain. The client should consult with the doctor or nurses about using cold or hot packs or any other non-drug technique to enhance pain control.1141
Which of the following opioid analgesics can be administered through iontophoresis via a patient-controlled transdermal system (PCTS)?

a) Morphine
b) Oxycodone
c) Codeine
d) Fentanyl
Fentanyl

Explanation:
The device is preprogrammed to deliver a fixed 40 mg dose when the patient pushes the device button.1139
Which assessment finding is consistent with the presence of pain?

a) Decreased pulse
b) Euphoria
c) Decreased blood pressure
d) Restlessness
Restlessness

Explanation:
Common assessment findings that are present when a patient is in pain include restlessness, grimacing, crying, clenching fists, guarding of the painful area, increased blood pressure and pulse, and reported pain 1115
When the male client on his first postoperative day after chest surgery appears stoic and does not ask for any pain medication, the nurse should

a) Ask the client's family if he ever uses pain medicines
b) Assume the client does not need medication
c) Document the client's lack of medication
d) Actively solicit information about the client's pain level
Actively solicit information about the client's pain level

Explanation:
Some cultures see pain tolerance as a virtue; often men are expected to tolerate pain more stoically than women do. Healthcare providers need to recognize the client's cultural beliefs and not impose their own judgments 1117
Which of the following principles should the nurse integrate into the pain assessment and pain management of pediatric clients?

a) The developing neurological system of children transmits less pain than in older clients.
b) A numeric scale should be used to assess pain if the child is older than 5 years of age.
c) Pain assessment may require multiple methods in order to ensure accurate pain data.
d) Pharmacologic pain relief should be used only as an intervention of last resort.
Pain assessment may require multiple methods in order to ensure accurate pain data.

Explanation:
It is often necessary to use more than one technique for pain assessment in children. Though their neurological 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.1118
Which of the following is an accurate step in the procedure for giving a patient a back massage?

a) Using a light, gliding stroke, apply lotion to the patient's shoulders, back, and sacral area.
b) Knead the patient's skin using effleurage (gently alternating grasping and compression motions).
c) Massage the patient's shoulder, entire back, areas over iliac crests, and sacrum with deep, penetrating up-and-down motions.
d) Start by placing hands beside each other at the top of the patient's spine and stroke downward to the buttocks in slow, continuous strokes.
Using a light, gliding stroke, apply lotion to the patient's shoulders, back, and sacral area.

Explanation:
Lotion should be applied using light, gliding strokes (effleurage). The massage should begin at the base of the patient's spine and work up and down the back using circular stroking motions 1147
When parents of a preschool child who is experiencing pain from ear surgery inform the nurse that the child is withdrawn from them and acts ambivalent, the nurse responds that the preschooler's behavior

a) Is a normal response
b) Indicates potential abuse
c) Demonstrates regression
d) Needs further evaluation
Is a normal response

Explanation:
Although parents are children's greatest source of comfort and support, children may appear ambivalent toward them, as though they blame them for pain. Encourage and support parents in such instances, helping them understand children's response.1124
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?

a) Perception
b) Modulation
c) Transmission
d) Transduction
Modulation

Explanation:
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. The client is not in the transduction, transmission, or perception phase of pain. 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, and the perception phase occurs when the pain threshold is reached.
1116-1117
The action of ibuprofen is to

a) Enhance the endorphins of the CNS
b) Have a antiprostaglandin effect on the CNS
c) Close the gate of the A-delta fibers
d) Provide narcotic pain relief
Have a antiprostaglandin effect on the CNS

Explanation:
NSAIDs are generally effective for pain-related tissue damage. The analgesic action of these drugs has antiprostaglandin effects in both the peripheral and central nervous systems. 1133
Nurse H. prides herself in her sense of humor and recognizes the potential benefits of using humor to help patients deal with pain. What guidelines should Nurse H. follow when using humor to foster pain relief?

a) Humor should be restricted to patients who are from the nurse's own cultural group
b) Humor is most effective when patients are experiencing moderate or severe pain.
c) Humor is not typically appreciated by elderly patients.
d) Humor should take into account the patient's personality and circumstances.
Humor should take into account the patient's personality and circumstances.

Explanation:
Humor should be used only with patients who are responsive to it and wish to use it. Consequently, the nurse must assess the patient's personality and circumstances carefully. It should not normally be used in the presence of moderate or severe pain, though it can be used, if appropriate, when caring for older patients or patients from other cultures. 1130
A middle-age client is complaining of acute joint pain to a nurse who is assessing the client's pain in a clinic. Which of the following questions related to pain assessment should the nurse ask the client?

a) "Are your family members aware of your pain?"
b) "Does your pain level change after taking medications?"
c) "Have you thought of the effects of your condition on your family?"
d) "Does your diet include red meat and poultry products?"
"Does your pain level change after taking medications?"

Explanation:
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. 1121
Choice Multiple question - Select all answer choices that apply.
Which of the following patient populations are at high risk for inadequate pain management? Select all that apply.

a) Patients who have dementia
b) Infants
c) Patients who are taking multiple medications
d) Patients who have significant visual impairment
e) Young children
f) Patients whose primary language is different from that of the healthcare team
• Infants
• Young children
• Patients who have dementia
• Patients whose primary language is different from that of the healthcare team

Explanation:
Providing a list does not directly increase comfort. Also, decisions about herbal preparations should include collaboration with the primary care provider.1121
A client complains of a dull, aching pain at the site where he was struck by a football during a game one week ago. The nurse understands that which of the following is responsible for the transmission of such pain?

a) A-delta fibers
b) Nociceptors
c) Spinal dorsal horn
d) C-fibers
C-fibers

Explanation:
Stimulation of C-fibers, which are slow conducting fibers, is responsible for the dull and poorly localized pain persistent after the injury. A-delta fibers give rise to bright, sharp, and well-localized pain that is immediately associated with the injury. Nociceptors are sensory pain receptors that respond to stimuli; they do not determine the nature of the pain. The spinal dorsal complex horn is the site where complex processing of messages occur.1116
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." The nurse determines the client's pain is


a) Diffuse
b) Malignant
c) Acute
d) Chronic
Malignant

Explanation:
Malignant pain is acute pain episodes, persistent chronic pain, or both associated with a progressive malignant-type process. The etiology for malignant pain is resistant to cure, and the pain may be described as intractable. 1112
Upon assessment of a patient, the nurse notices the following: the patient displays an occasional grimace and is withdrawn; his legs are kicking, his body is arched, and he is moaning in his sleep. When awakened, he is inconsolable. What score would this patient receive on the FLACC behavioral scale?

a) 6
b) 4
c) 8
d) 2
8

Explanation:
FLACC stands for Face, Legs, Activity, Cry, and Consolability. These are rated from 0 to 3, depending on the reaction of the patient. This patient scored an 8 of a possible 10 on the scale. 1125
A nurse is ordered to apply a transcutaneous electrical nerve stimulation (TENS) unit to a client recovering from abdominal surgery. Which of the following is a consideration when using this device?

a) A TENS unit is applied intermittently throughout the day and should not be worn for extended periods of time.
b) TENS involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers.
c) TENS is most beneficial when used to treat pain that is generalized.
d) TENS is an invasive technique for providing pain relief.
TENS involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers.

Explanation:
Transcutaneous electrical nerve stimulation (TENS) is a noninvasive technique for providing pain relief that involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers. It is most beneficial when the pain is localized and the unit can be worn for extended periods of time.1131
Choice Multiple question - Select all answer choices that apply.
You have presented an educational inservice about comfort and asks participants to provide examples of effective comfort measures. Which of the following responses by participants indicate a correct understanding of the concept? Select all that apply.

a) "Administering prescribed analgesic medications."
b) "Assisting a patient with hygiene needs."
c) "Keeping the patient's environment free from unpleasant odors."
d) "Providing a list of specific herbal preparations to use as an adjuvant to pain medications."
e) "Straightening wrinkled bed linens."
f) "Holding a patient's hand during an invasive procedure or during times of emotional stress."
• "Straightening wrinkled bed linens."
• "Holding a patient's hand during an invasive procedure or during times of emotional stress."
• "Assisting a patient with hygiene needs."
• "Keeping the patient's environment free from unpleasant odors."
• "Administering prescribed analgesic medications."

Explanation:
Providing a list does not directly increase comfort. Also, decisions about herbal preparations should include collaboration with the primary care provider. 1127
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?

a) Visceral pain
b) Cutaneous pain
c) Somatic pain
d) Neuropathic pain
Visceral pain

Explanation:
The client is experiencing visceral pain, which is associated with disease or injury. It is sometimes referred or poorly localized as it is not experienced in the exact site where an organ is located. In cutaneous pain, the discomfort originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma. Somatic pain develops from injury to structures such as muscles, tendons, and joints. Neuropathic pain is experienced days, weeks, or even months after the source of the pain has been treated and resolved. 1112
Patient controlled analgesia (PCA) can be used with oral analgesic agents to treat mild to moderate postoperative pain.

a) False
b) True
true

Intramuscular administration (IM) of analgesics is the least desirable route of administration. IM administration may cause additional pain and the patient likely lacks the cognitive ability to ask for pain medication. 1138
A nurse is assessing an adult client with back pain. The client is unable to speak in English. Which of the following pain scales should the nurse use to assess the client?

a) Numeric scale
b) Word scale
c) Faces scale
d) Linear scale
Numeric scale

Explanation:
A numeric scale is the most commonly used tool when assessing adults. Since the client is unable to speak in English, a word scale or linear scale may not be suitable as the client will be unable to describe or express the pain in words. The Wong-Baker Faces scale is best for children and clients who are culturally diverse or mentally challenged. The nurse can assess children as young as 3 years using the Faces scale. 1121
Choice Multiple question - Select all answer choices that apply.
For assessment of pain, objective data are used to supplement the subjective data. How can a nurse gather objective data about a client's pain? Select all that apply.

a) By observing facial expressions
b) By eliciting factual information
c) By using pain assessment questionnaires
d) By checking the vital signs
e) By diagnostic tests and procedures
• By checking the vital signs
• By observing facial expressions
• By eliciting factual information
• By diagnostic tests and procedures

Explanation:
Physical assessment is a mode of gathering objective data about a client's pain perception. It involves assessing the client's vital signs and observing facial expressions of pain. Diagnostic tests and procedures can provide objective data by validating painful events and identifying the source of pain. Eliciting factual information, such as the intensity of pain, aids normal pattern identification, which is a method to gather subjective data. Pain assessment questionnaires, such as the Memorial Pain Assessment Card, are measurement tools for pain perception. They help the nurse in collecting subjective data for dysfunction identification. 1121
Two hours after receiving a pain medication, the client states he still is suffering from pain. Which question is appropriate to ask the client first?

a) "Tell me more about your pain."
b) "Do you need your pain medication now?"
c) "Please describe your pain on a scale of 0 to 10."
d) "Tell me where your pain is located."
"Tell me more about your pain."

Explanation:
Pain intensity indicates the magnitude or amount of pain perceived. Terms used to describe pain intensity include none, mild slight, moderate, severe, and excruciating. Pain intensity also may be described on a numeric scale. The most appropriate assessment question is one which allows for all information and is a broad question. 1138
Endogenous opioids such as endorphins

a) Contribute to analgesia
b) Release neurotensin
c) Cause muscle spasms
d) Excite neural pathways
Contribute to analgesia

Explanation:
The opioid receptors, important for the inhibition of pain perception, are sites where endogenous opioids and exogenous opioids bind. Three groups of endogenous opioids relieve pain: enkephalins, endorphins, and dynorphins. 1117
A nurse is caring for a middle-aged client with acute abdominal pain at a health care facility. The physician has asked the nurse to administer a prescribed dosage of narcotics to the client to relieve the pain. The client has a throat infection and is unable to take the medication orally. What other delivery route might the physician prescribe?

a) Transdermal route
b) Sublingual route
c) Dermal route
d) Intramuscular route
Transdermal route

Explanation:
The nurse can administer the prescribed dosage of narcotics to the client by the transdermal, oral, rectal, or parenteral route. The nurse should avoid the sublingual, dermal, and intramuscular routes. Administration of the drug through the intramuscular route could result in slower absorption, leading to delayed onset of action, prolonged duration, and altered absorption with potential for toxicity. 1134
A middle-age client tells the nurse that her neck pain reduced considerably after she underwent a treatment in which thin needles were inserted into her skin. What kind of pain relief treatment did the client undergo?

a) Rhizotomy
b) Biofeedback
c) Acupuncture
d) Transcutaneous electrical nerve stimulation
Acupuncture

Explanation:
The client underwent acupuncture. Acupuncture is a pain-management technique in which long, thin needles are inserted into the skin. Transcutaneous electrical nerve stimulation (TENS) and biofeedback are nonsurgical and nondrug procedures used to treat pain. TENS is a medically prescribed pain-management technique that delivers bursts of electricity to the skin and underlying nerves. In biofeedback, a client learns to control or alter a physiologic phenomenon. Rhizotomy involves the surgical sectioning of a nerve root close to the spinal cord. 1131
Which of the following statements best describes the rationale for using nonpharmacologic methods to help manage pain?

a) Nonpharmacologic methods are less expensive.
b) Nonpharmacologic methods are more effective.
c) Nonpharmacologic methods do not require a primary care provider's prescription.
d) Use of nonpharmacologic methods can diminish the emotional component of pain.
Use of nonpharmacologic methods can diminish the emotional component of pain.

Explanation:
Nonpharmacologic interventions lessen the emotional impact of pain, but may not diminish the sensation of pain. A combine approach is often most effective. 1130
Choice Multiple question - Select all answer choices that apply.
A nurse is administering a dose of opioid prescribed by the physician to a client with acute abdominal pain at the health care facility. However, the client tells the nurse that he has developed a sore throat and has difficulty swallowing. What other routes of administration can the nurse use to give the opioid narcotics to the client? Select all that apply.

a) Parenteral route
b) Rectal route
c) Transdermal route
d) Sublingual route
e) Intramuscular route
• Rectal route
• Transdermal route
• Parenteral route

Explanation:
The nurse can administer the opioid medicine through the oral, rectal, transdermal, or parenteral route. It is not advisable to administer medicine through the sublingual route, where the absorption could be faster than necessary, or intramuscular route, for which absorption could be slower. 1139
Pain threshold is the point beyond which a person is no longer willing to endure pain.

a) True
b) False
false

1116
When implementing the gate-control theory of pain, which intervention will enhance the closing of the gate to the client's pain?

a) Give the client a back rub
b) Provide warm compresses
c) Darken the room
d) Position the client on several pillows
Give the client a back rub

Explanation:
Opening the gate is influenced by the A-delta and C-fibers, and closing the gate is influenced by the activity of the large A-alpha and A-beta fibers, the reticular formation in the brain stem, other brain sites, and the cerebral cortex. 1117
When a 17-year-old male athlete injures his knee during basketball practice and refuses to go to the school nurse, he states he does not have pain. The school nurse assesses the student's knee and recognizes that by stating he does not have pain the student is

a) In need of counseling
b) Not injured
c) Not showing weakness to his peers
d) Ignoring the pain
Not showing weakness to his peers

Explanation:
To recognize or give in to pain may seem a sign of weakness in the adolescent. 1118
A nurse is caring for a client whose injured cells are releasing chemicals such as substance P, prostaglandins, bradykinin, histamine, and glutamate. Which phase of pain is the client experiencing?

a) Transmission
b) Transduction
c) Modulation
d) Perception
Transduction

Explanation:
The client is going through the transduction phase, which is the first phase of pain in which injured cells release chemicals such as substance P, prostaglandins, bradykinin, histamine, and glutamate. The client is not going through the transmission, perception, or modulation phase of pain. Transmission is the phase during which stimuli move from the peripheral nervous system toward the brain. Perception occurs when the pain threshold is reached. Modulation is the last phase of pain impulse transmission, during which the brain interacts with the spinal nerves to alter the pain experience. 1115
Choice Multiple question - Select all answer choices that apply.
Which of the following are examples of the use of guided imagery to promote patient comfort? Select all that apply.

a) A nurse reads a book to a patient who is postcataract surgery.
b) A nurse instructs a patient how to breathe properly for relaxation.
c) A nurse plays a patient's favorite music in the background.
d) A nurse asks a patient to concentrate on the details of a pleasant image.
e) A nurse asks a patient to imagine sitting on the beach on a sunny day.
f) A nurse asks a patient to focus on tightening and relaxing a particular muscle group.
• A nurse asks a patient to imagine sitting on the beach on a sunny day.
• A nurse asks a patient to concentrate on the details of a pleasant image.

Explanation:
Guided imagery helps the patient to become gradually less aware of the discomfort or pain. Positive emotions evoked by the image help reduce the pain experience. Answers A and C are examples of distraction and B and F are examples of relaxation techniques. 1131
A postoperative client who has been receiving morphine for pain management is exhibiting a depressed respiratory rate and is not responsive to stimuli. What drug has the potential to reverse the respiratory-depressant effect of an opioid?

a) Naloxone
b) Atropine
c) Epinephrine
d) Diphenhydramine
Naloxone

Explanation:
Naloxone (Narcan) is an opioid antagonist that reverses the respiratory-depressant effect of an opioid. 1134
Whenever possible, the nurse who is treating the pain of older adults should avoid the use of which drug(s)?

a) Fentanyl
b) Hydromorphone
c) Morphine
d) Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs)

Explanation:
NSAIDs carry a risk of renal and gastric complications in older adults and should be used with particular caution. The use of opioids such as fentanyl, hydromorphone, and morphine requires vigilant pain assessment and close monitoring for side effects, but the drugs are not contraindicated. 1137
During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is which of the following?

a) Relaxation techniques
b) Cutaneous stimulation
c) Surgery
d) Analgesics
Analgesics

Explanation:
Analgesics are most often the primary treatment measure for pain, although a growing trend involves the integration of complementary, nonpharmacologic measures with conventional medicine. 1130
A nurse is assessing a client with arthritis. Which of the following should the nurse consider in the initial assessment of the client?

a) Pain level
b) Glucose level
c) Blood group
d) Anxiety level
Pain level

Explanation:
The nurse should first assess the client's pain level since the client has arthritis. Anxiety level, blood group, and glucose level are not vital signs which will help the nurse assess the client's pain during the initial assessment. 1120-1121
A nurse attempts to arouse a postsurgical client and finds him frequently drowsy and drifting off during conversation; however, he can be aroused. What would be the sedation score for this client?

a) 3
b) 1
c) 2
d) 4
3

Explanation:
The sedation score for this client is 3. A score of 1 is given to a client who is awake and alert, 2 is given to a client who is slightly drowsy but easily aroused, and 4 describes a client who is somnolent, with minimal or no response to physical stimulation. 1134
A patient has been reluctant to ask for breakthrough doses of the opioid his physician has prescribed, despite showing signs of pain. The patient tells the nurse that he is afraid of becoming addicted to the drug. How should the nurse respond to the patient's statement?

a) "There's only an extremely small chance that you will become addicted to this drug."
b) "If you start needing more doses to control your pain, then we'll address the question of addiction."
c) "It's best to focus on controlling your pain and not worry about issues like addiction."
d) "You could become addicted, but there are excellent resources available in the hospital to deal with that development."
"There's only an extremely small chance that you will become addicted to this drug."

Explanation:
Physical dependence and tolerance are expected responses to longer-term opioid use, but patients treated with opioids for pain rarely develop addiction. Despite the very low risk of addiction, it would be inappropriate for the nurse to dismiss the patient's concerns. 1134
A nurse is caring for a neonate age 2 days in a NICU. What pain assessment scale would best assess the pain for this client?

a) COMFORT Scale
b) Checklist of nonverbal indicators
c) CRIES Pain Scale
d) FLACC Scale
CRIES Pain Scale

Explanation:
The CRIES scale is appropriate for neonates (0 to 6 months). The COMFORT scale is used for infants, and adults who are unable to use other scales. The FLACC scale is used for infants and children (2 months to 7 years) unable to validate the presence of (or quantify) the severity of pain. The checklist of nonverbal indicators is appropriate for adults who are unable to validate the presence of (or quantify) the severity of pain using either the Numeric Rating Scale or Wong-Baker Faces Pain Rating Scale. 1125
A child describes intense pain in the chest and head while eating a popsicle. The pain the child is experiencing is termed

a) Allodynia
b) Fear
c) Hyperalgesia
d) Thermal stimulation
Allodynia

Explanation:
Allodynia is a pain sensation produced by an innocuous stimulus such as light touch. 1113
Which of the following describes the correct use of a TENS unit?

a) The electrodes should be placed over the carotid sinus nerves or over pharyngeal muscles.
b) For acute pain, a recommended pulse of 30 to 50 microseconds should be used.
c) TENS should not be used when the etiology of the pain is unknown.
d) The unit should be turned on when repositioning or removing electrodes.
TENS should not be used when the etiology of the pain is unknown.

Explanation:
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. 1131
A middle-aged client with cancer has been prescribed patient-controlled analgesia (PCA) by a physician. Which of the following is an advantage that PCA offers?

a) Small dosages of opioids offer instant relief.
b) Higher individual dosages reduce side effects.
c) Pain can be kept within a constant tolerable level .
d) The client can control the dosage of the intravenous medications .
Pain can be kept within a constant tolerable level .

Explanation:
PCA allows the client to keep pain within a constant tolerable level; pain relief is rapid because the drug is delivered intravenously. The client cannot control the dosage of the drug because it is delivered intravenously. Small dosages of opioids do not offer instant relief, and side effects are reduced with smaller individual dosages and lower total dosages. 1138-1139
Which statement accurately describes pain experienced by the older adult?

a) A heightened pain tolerance occurs in the older adult.
b) Boredom and depression may affect an older person's perception of pain.
c) The older client has decreased sensitivity to pain.
d) Residents in long-term care facilities have a minimal level of pain.
Boredom and depression may affect an older person's perception of pain.

Explanation:
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. 1126
A sudden blow to the head results in pain that is transmitted by which type of fibers?

a) D-delta
b) A-delta
c) C fibers
d) B-gamma
A-delta

Explanation:
A-delta fibers give rise to bright, sharp, well-localized pain that is immediately associated with injury. 1116
A client tells a nurse, "I feel as if someone is pounding my head with a hammer." The nurs interprets this statement as indicating which of the following about the pain?

a) Threshold
b) Temporal pattern
c) Intensity
d) Quality
Quality

Explanation:
The client is describing the quality of pain in his head. Quality refers to how the pain feels to the client or words that describe the pain's nature. Pain intensity indicates the magnitude or amount of pain perceived. It is described on a numeric scale or by terms such as none, mild, moderate, severe, or excruciating. Onset and duration are components of temporal pain pattern. Pain threshold is the amount of pain stimulation a person requires before feeling it. 1112
The nurse has just completed programming of a patient-controlled analgesia (PCA) pump using prescribed parameters. Which of the following actions should you take next?

a) Document implementation of the PCA on the client's chart.
b) Verify the settings with another nurse.
c) Attach the PCA pump tubing to the client's intravenous access device.
d) Check the pump's electrical cords for cracks, splits, or fraying.
Verify the settings with another nurse.

Explanation:
This action should be performed before programming is initiated. 1139
Which of the following is an example of a diffuse pain?

a) Pain related to stomach cancer
b) Pain related to a sore throat
c) Pain related to appendicitis
d) Pain related to a myocardial infarction
Pain related to stomach cancer

Explanation:
Diffuse pain is pain that covers a large area and, usually, the patient is unable to point to a specific area without moving the hand over a large surface, such as the entire abdomen. Pain related to appendicitis is sharp pain, pain related to an MI can be sharp and/or shifting, and pain related to a sore throat is usually dull pain. 1118
The nurse has provided a hot pack to a patient who has been experiencing neck pain. According to the gate control theory of pain transmission, why is this intervention likely to be effective?

a) Heat and pressure open the gates that conduct pain-relieving endorphins to the brain.
b) Heat stimulates the large-diameter fibers that inhibit pain transmission.
c) Heat overwhelms the small-diameter pain fibers and they stop transmitting pain signals.
d) Heat opens nerve gates so that they can transmit pain-inhibiting enkephalins.
Heat stimulates the large-diameter fibers that inhibit pain transmission.

Explanation:
Warmth stimulates large nerve fibers to close the gating mechanism that is thought to be located in substantia gelatinosa cells in the dorsal horn of the spinal cord. As a result, pain impulses from that area are blocked. The gate control theory does not encompass the actions of endorphins and enkephalins and heat does not overwhelm small-diameter, pain-conducting fibers. 1117
Choice Multiple question - Select all answer choices that apply.
A client with recurrent episodes of migraine headaches tells the nurse, "I am not comfortable taking medication for my pain." Which of the following are behavioral pain relief techniques that the nurse can use to help the client? Select all that apply.

a) Hypnosis
b) Biofeedback
c) Massage
d) Meditation
e) Relaxation
• Relaxation
• Meditation
• Biofeedback

Explanation:
Relaxation, meditation, and biofeedback are behavioral pain relief techniques that the nurse can use to help the client. Relaxation techniques involve a combination of a quiet environment, a comfortable position, a passive attitude, and a focus of concentration. Meditation is a technique in which the person focuses on a single thought or sound. In biofeedback, the client learns voluntary control over autonomic functions such as heart rate, hand temperature, and muscle tension. Massage is a physical pain relief technique used to relax muscles and reduce tension. Hypnosis is a cognitive pain relief technique, not a behavioral technique, which blocks the awareness of pain through suggestions or by substituting another feeling for pain. 1131
Which of the following circumstances may preclude the use of cutaneous stimulation to relieve a patient's pain?

a) The patient has a history of heart disease.
b) The patient has difficulty localizing his or her pain.
c) The patient is receiving both scheduled and breakthrough analgesia.
d) The patient's pain is chronic rather than acute.
The patient has difficulty localizing his or her pain.

Explanation:
Cutaneous stimulation requires that the patient be able to localize his or her pain. It may be used on both chronic and acute pain, and neither analgesics nor heart problems contraindicate the use of cutaneous stimulation. 1131
Patient controlled analgesia (PCA) can be used with oral analgesic agents to treat mild to moderate postoperative pain.

a) False
b) True
True

Explanation:
Intramuscular administration (IM) of analgesics is the least desirable route of administration. IM administration may cause additional pain and the patient likely lacks the cognitive ability to ask for pain medication. 1138
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?

a) Chronic pain can be severe in its initial stages.
b) Chronic pain has far-reaching effects on the client.
c) Chronic pain will lead to psychological imbalance.
d) Chronic pain eases with healing and eventually disappears.
Chronic pain has far-reaching effects on the client.

Explanation:
Chronic pain has far-reaching effects on the client because the discomfort lasts longer than six 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. 1112
A postoperative vaginal hysterectomy client complains of pain that is more intense than this morning. This factor should be explained to the client as

a) "Your present pain is worse because you had your packing removed."
b) "Acute pain tends to increase during the day and is called a routine pain response"
c) "I will call your doctor because you may have loosened sutures when walking."
d) "You will need more pain medication as the days progress."
"Acute pain tends to increase during the day and is called a routine pain response"

Explanation:
Acute pain occurs abruptly after an injury or disease and persists until healing occurs. Acute pain also may be associated with anxiety and fear. Acute pain consistently increases at night and during wound care, ambulation, coughing, and deep breathing. 1112
As per the physician's orders, a nurse is placing two electrodes on a client's lower back to perform transcutaneous electrical nerve stimulation (TENS). The nurse spaces the electrodes at least the width of one from the other on the client's skin. Which of the following reasons explains the nurse's action?

a) Provides wider and deeper stimulation
b) Promotes the integrity of the skin
c) Prevents the potential for burning the skin
d) Prevents premature stimulation of the skin
Prevents the potential for burning the skin

Explanation:
When performing TENS, the nurse spaces the electrodes at least the width of one from the other in order to prevent the potential for burning caused by close proximity of the electrodes. To promote skin integrity, the nurse changes the position of the electrodes slightly if skin irritation develops. To prevent premature stimulation of the skin, the nurse ensures the TENS unit is set to "off." To provide wider and deeper stimulation as the pulse width increases, the nurse should set the pulse width of the TENS. 1131-1132
In preparing a care plan for a patient receiving opioid analgesics, the nurse selects which of the following as an applicable nursing diagnosis associated with side effects of opioid use?

a) Bowel incontinence
b) Constipation
c) Diarrhea
d) Impaired urinary elimination
Constipation

Explanation:
The most common side effects associated with opioid use are sedation, nausea, and constipation. Respiratory depression is also a commonly feared side effect of opioid use. 1127
Endogenous opioids such as endorphins

a) Cause muscle spasms
b) Contribute to analgesia
c) Excite neural pathways
d) Release neurotensin
Contribute to analgesia

Explanation:
The opioid receptors, important for the inhibition of pain perception, are sites where endogenous opioids and exogenous opioids bind. Three groups of endogenous opioids relieve pain: enkephalins, endorphins, and dynorphins 1117
Which of the following is the most reliable method for assessing pain?

a) Asking the patient
b) Observing the patient
c) Asking significant others
d) Asking the primary care provider
Asking the patient

Explanation:
Pain is whatever the experiencing person says it is, existing whenever he or she says it does. This definition rests on the belief that the only one who can be a real authority on whether, and how, an individual is experiencing pain is that individual.
Because pain is subjective, self-report is generally considered the most reliable way to assess pain and should be used whenever possible (Spagrud et al., 2003). 1121
A middle-aged client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse caring for the client explains the functioning of PCA. What is the advantage of PCA?

a) The client obtains pain relief slowly and steadily.
b) The client is able to have long hours of rest.
c) The client administers the pain medication as needed.
d) The client is actively involved in pain management.
The client is actively involved in pain management.

Explanation:
Patient-controlled analgesia (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. The client cannot administer the pain medication as needed because the nurse programs the infusion device to prevent overdoses. 1138-1139
You are preparing to assess 3-year-old child's pain. Which of the following pain scales should you plan to use?

a) The CRIES Pain Scale
b) The Oucher Pain Scale
c) The Payen Behavior Pain Scale
d) The PAINAD Scale
The Oucher Pain Scale
Explanation:
This scale is used for intubated, critically ill patients. 1125
A nurse asks an adolescent female client to describe her pain using a number between 0 and 10 where 0 means no pain and 10 means severe pain. The nurse is assessing which of the following?

a) Quality of pain
b) Temporal pattern of pain
c) Tolerance to pain
d) Intensity of pain
Intensity of pain

Explanation:
By asking the client to assign her pain a number between 0 and 10, the nurse is using a scale to measure the intensity of pain. To measure the temporal pattern of pain, the nurse should ask the client the time of onset and the duration of pain to determine if the pain is acute, chronic, or malignant. The nurse could use a questionnaire or ask the client to describe the pain to elicit information about the quality. Tolerance to pain is the highest intensity of pain that a person is willing to endure. 1112
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