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Pain PrepU

Terms in this set (32)

A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as:

biofeedback.
transcutaneous electrical nerve stimulation (TENS).
hypnosis.
Therapeutic Touch (TT).
biofeedback.

Explanation:

Biofeedback is a technique that uses a machine to monitor physiologic responses through electrode sensors on the client's skin. The unit transforms the data into a visual display, and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. 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 client in order to facilitate healing or pain relief.
A male college student age 20 years has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is the client most likely experiencing?

Visceral pain
Referred pain
Cutaneous pain
Somatic 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.
Which principle should the nurse integrate into the pain assessment and pain management of pediatric clients?

-Pain assessment may require multiple methods in order to ensure accurate pain data.
-The developing neurologic system of children transmits less pain than in older clients.
-Pharmacologic pain relief should be used only as an intervention of last resort.
-A numeric scale should be used to assess pain if the child is older than 5 years of age.
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 neurologic system is indeed developing, children feel pain acutely, and it is inappropriate to withhold analgesics until they are a "last resort." It is simplistic to specify a numeric pain scale for all clients above a certain age; the assessment tool should reflect the client's specific circumstances, abilities, and development.
A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system?

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

Explanation:

PCAs are designed to make it impossible for the client to exceed the client-specific dosing parameters programmed into the machine. PCAs do not administer antidotes, and they are almost always used to deliver opioid analgesics.
A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing?

Cutaneous pain
Visceral pain
Chronic pain
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. 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 6 months.
A nurse is caring for a client who was administered opioid narcotics. The client reports constipation. What is another potential side effect of opioid narcotics?

Sedation
Anxiety
Diarrhea
Insomnia
Sedation

Explanation:

Opioids and opiates can cause sedation, nausea, and constipation. They also can cause respiratory depression, which is the main side effect to watch for with narcotics. Opioids and opiates do not lead to anxiety, diarrhea, or insomnia in clients.
Which guideline regarding pain should be included in the nurse's education plan for a group of parents with infants and toddlers?

-Pain can be a source of fear and threat to the toddler's security.
-Toddlers are often reluctant to express pain.
-Infants cannot express pain until 8 months of age.
-Toddlers often try to be brave and not cry.
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.
A nurse is assessing a client's pain. The nurse notes which database finding that is indicative of acute pain?

Pupil constriction
Decreased pulse rate
Increased blood pressure
Decreased respiratory rate
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.
Besides controlling pain of the postabdominal surgery client with narcotics, the nurse suggests to the client that he:

focus on pain relief.
use distraction.
describe the pain.
think about the next dose.
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.
A nurse is evaluating the effectiveness of the preoperative education regarding pain control. Which statement by the client would indicate a need for further education?

"I will push my PCA button before I get up to go to the bathroom."
"I will have my wife push the PCA button when I'm asleep."
"I will bring my favorite music to listen to after my surgery."
"I will make sure to drink plenty of water so I don't get constipated from the pain medication."
"I will have my wife push the PCA button when I'm asleep."

Explanation:

The client should be the only one to administer medication via the PCA pump. Using the pump prior to getting out of bed and/or ambulating will help decrease the pain. Distraction is an effective nonpharmacologic means of dealing with pain. Constipation is a common side effect from many pain medications. Increasing fluid intake is one way of attempting to prevent it.
A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort?

Endorphins
Serotonin
Melatonin
Dopamine
Endorphins

Explanation:

Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals, which have prolonged analgesic effects and produce euphoria. It is thought that certain measures, such as skin stimulation and relaxation techniques, release endorphins.
A client states that he is pain and requests the ordered pain medication. When entering the client's room, the client is laughing with visitors and does not appear to be in pain. What is the appropriate action by the nurse?

Hold the pain medication.
Administer the pain medication.
Reassess the client's pain in 30 minutes.
Contact the client's physician.
Administer the pain medication.

Explanation:

Pain is considered to be present whenever the client states it is. Therefore, the nurse should administer the client's pain medication. It would be inappropriate to delay administration or to hold the medication. There is no indication that the client's physician needs to be notified at this time.
Which of the following is considered to be the most potent neuromodulators?

Endorphins
Enkephalins
Efferent
Efferent
Endorphins

Explanation:

Endorphins and enkephalins are opioid neuromodulators. Endorphins are powerful pain blocking chemicals with prolonged analgesic effects. Enkephalins are considered less potent. There are no neuromodulators called efferent or afferent.
A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the nurse's best intervention in this situation?

-Ignore the boy's pain if he is not complaining about it. --Ask the boy to draw a cartoon about the color or shape of his pain.
-Medicate the boy with analgesics to reduce the anxiety of experiencing pain.
-Distract the boy so he does not notice his pain.
Ask the boy to draw a cartoon about the color or shape of his pain.

Explanation:

Asking the boy to draw a cartoon about the color or shape of his pain is an excellent intervention by the nurse. The child could be in pain and not complaining, so ignoring the boy's pain is not correct. Distracting the boy so he does not notice his pain would not be appropriate. Medicating the boy with analgesics to reduce the anxiety of experiencing the pain is not correct. Addressing the anxiety does not address the pain.
A client has just been started on opioid analgesia for pain control. The nurse assesses the client's level of sedation using a sedation scale and notes that the client is awake and alert. The nurse would assign which rating?

S
1
2
3
1

Explanation:

Using a sedation scale, 1 indicates that the client is alert and awake. S is used to document that the client is sleeping but easy to arouse. 2 is used to denote that the client is slightly drowsy but easy to arouse. 3 is used to denote that the client is frequently drowsy, arousable but drifts off to sleep during a conversation.
When asking an older adult client about abdominal pain, the client reports, "I don't want to be a bother because nothing hurts too much." The nurse notes that the client grimaces and splints the abdomen when moving. What is the appropriate nursing action?

-Document the client's statement, and do nothing further.
-Remind the client that pain can be tolerated instead of using addictive pain medication.
-Gently mention that the client appears to be experiencing pain that can be treated.
-Confirm that age is the reason for many types of pain.
Gently mention that the client appears to be experiencing pain that can be treated.

Explanation:

Pain is underdetected and poorly managed among older adults, because they often do not want to be perceived as a complainer, or they feel that pain is part of growing older. The nurse should gently mention that the client appears to be experiencing pain that can be treated, and then continue the conversation by reassuring that the client is not a bother. Documenting without addressing the client's report, confirming age as a reason for pain, and reminding that pain can be tolerated are inappropriate nursing actions.
The nurse is caring for a client who has had unrelieved back pain for 3 years. How will the nurse document this type of pain? (Select all that apply.)

cutaneous
somatic
visceral
referred
neuropathic
acute
chronic
somatic
chronic

Explanation:

Chronic pain is discomfort that lasts longer than 6 months. Somatic pain develops from injury to structures such as muscles, tendons, and joints. Therefore, the nurse appropriate documents this client's pain as somatic and chronic. Cutaneous, visceral, referred, neuropathic, and acute pain are not being depicted in this scenario.
The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate? (Select all that apply.)

-Delegate pain assessment to the UAP.
-Assess for pain control 30 minutes after administering an analgesic.
-Consider cultural implications of the perception of pain. -Infer that the client who does not complain has no pain. -Provide pain medication before activity that may increase pain.
-Assess for pain control 30 minutes after administering an analgesic.
-Consider cultural implications of the perception of pain.
-Provide pain medication before activity that may increase pain.

Explanation:

Pain assessment should never be delegated to a UAP. Pain medication should be given in advance of an activity that may increase pain. The nurse should consider cultural implications associated with pain, and assess for pain control after medication is given. Assumptions should not be made about pain.
The nurse manager hears a nurse and a nurse aide talking about a female client who reports pain of 8 out of 10 on a 1-10 after a Caesarean birth to deliver twins. The nurse states, "I don't believe this client has any pain at all. I'm sure she is just drug seeking." What is the appropriate nurse manager action?

-Continue listening to the conversation before intervening.
-Ask the nurse to speak privately for a moment, and educate about bias in pain treatment.
-Enter the conversation and tell the nurse and UAP that this type of discussion will not be tolerated.
-Write the nurse up for disciplinary action.
Ask the nurse to speak privately for a moment, and educate about bias in pain treatment.

Explanation:

Research has shown that treatment bias may delay pain-relieving measures. The nurse manager should privately and professionally educate the nurse, and then subsequently educate the nurse aide. Addressing the concern quickly is important so the client can receive appropriate care and pain management. Entering the conversation is not the best action to educate the nurse and disciplinary action doesn't help to immediately address the current situation.
The nurse is caring for four clients. Which client does the nurse identify as the most likely to have undertreated pain? (Select all that apply.)

18-year old with a broken ulna
29-year old who has a speech impediment
34-year old with schizophrenia
41-year old who is from a different country
53-year old with recurrent pancreatitis
a) 60-year old with early onset dementia
29-year old who has a speech impediment
34-year old with schizophrenia
41-year old who is from a different country
a) 60-year old with early onset dementia

Explanation:

Clients who are most likely to have underassessed and undertreated pain include infants; children younger than 7; culturally diverse clients; clients with mental challenges, dementia, hearing, or speech impairment; or those who experience psychological disturbances. The client with a broken ulna and the client with recurrent pancreatitis are not as likely to have undertreated pain.
Which statements accurately describes a consideration when using a patient-controlled analgesia (PCA) pump to relieve client pain?

-This approach can only be used with oral analgesics.
-A PCA pump must be used and monitored in a health care facility.
-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.
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.
Which of the following is the priority assessment for a nurse caring for a client with a Patient Controlled Analgesia (PCA) pump?

Respiratory
Cardiovascular
Peripheral Vascular
Neuromuscular
Respiratory

Explanation:

The priority assessment for the nurse caring for a client with a PCA pump is respiratory, with particular attention to the respiratory rate and pattern. Too much narcotic or a displaced catheter may allow the medication to have a depressant effect on the brainstem center, causing life-threatening respiratory depression.
A client prescribed pain medication around the clock experiences pain one hour before the next dose of the pain medication is due. Which is the most appropriate action by the nurse?

-Assess for medication order for breakthrough pain.
-Tell the client he has to wait for one hour.
-Administer the next dose of the pain medication.
-Assess the client for signs of narcotic addiction.
Assess for medication order for breakthrough pain.

Explanation:

Breakthrough pain is a temporary flare-up of moderate to severe pain that occurs even when the client is taking pain medication around the clock. It can occur before the next dose of analgesic is due (end of dose pain). It is treated most effectively with supplemental doses of a short-acting opioid taken on an "as needed basis." Therefore, the client should check the orders for breakthrough pain medication.
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?

"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."
"I may need fewer pain medications with the TENS unit in place."
"Wearing the TENS unit should not interfere with my daily activities."
"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.
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:

document the client's lack of medication.
assume the client does not need medication.
ask the client's family if he ever uses pain medicines.
actively solicit information about the client's pain level.
actively solicit information about the client's pain level.

Some cultures see pain tolerance as a virtue; often men are expected to tolerate pain more stoically than women do. Health care providers need to recognize the client's cultural beliefs and not impose their own judgments.
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?

"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."
"I may need fewer pain medications with the TENS unit in place."
"Wearing the TENS unit should not interfere with my daily activities."
"I could use the TENS unit if I feel pain somewhere else on my body."

The client needs further instruction when they say they 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. The TENS unit will decrease the amount of the pain medication used by the client as it increases the blood supply to the injured area and will not interfere with the activities of daily living.
A nurse observes a client that had a hysterectomy crying hysterically. What type of pain response is this client experiencing?

Behavioral Physiologic Parasympathetic Affective
Affective

Exaggerated weeping is an affective or psychological response. A behavior response is a voluntary physical response, such as moving away from the painful stimuli. A physiologic response is an involuntary physical response, such as increased blood pressure. A parasympathetic response is an involuntary physical response related to the sympathetic response, such as nausea and vomiting.
The nurse is teaching a client how to manage postoperative pain through a patient controlled analgesia (PCA) pump. The nurse determines that additional teaching is needed when the client make which statement?

"This will allow me to control my own pain medication."
"I should only take medication when my pain is intense."
"I give myself the pain medication by pushing the button."
"The pump is programmed to limit the chance of overmedicating."
"I should only take medication when my pain is intense."


PCA pumps allow the client to control the amount and timing of pain medication by pushing a button when the sensation of pain occurs versus waiting until the pain becomes intense. The pump is programmed with a lockout period that limits the chance of clients overmedicating themselves.
The nurse preparing to admit a client receiving epidural opioids should make sure that which of the following medications is readily available on the unit?

Naloxone Furosemide Lisinopril Digoxin
Naloxone

The nurse should ensure that naloxone is readily available on the unit, as it can reverse the respiratory depressant effects of opioids. Naloxone is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. Furosemide is a loop diuretic and used to treat hypertension (high blood pressure) and edema. Lisinopril is an angiotensin converting enzyme (ACE) inhibitor used for treating high blood pressure, heart failure and for preventing kidney failure due to high blood pressure and diabetes. Digoxin is used to treat congestive heart failure.
When performing a pain assessment on a client, the nurse observes that the client guards his arm, which was fractured in a car accident, and he refuses to move out of his chair. The nurse notes this reaction as what type of pain response?

Behavioral Physiologic Affective Psychosomatic
Behavioral

Behavioral (voluntary) responses would include moving away from painful stimuli, grimacing, moaning, crying, restlessness, protecting the painful area, and refusing to move the limb. Physiologic (involuntary) responses would include increased blood pressure, increased pulse and respiratory rates, pupil dilation, muscle tension and rigidity, pallor (due to peripheral vasoconstriction), increased adrenaline output, and increased blood glucose. Psychological responses would include exaggerated weeping and restlessness, withdrawal, stoicism, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, and powerlessness.
A nurse is performing pain assessments on clients in a physician's office. Which clients would the nurse document as having acute pain? Select all that apply.

A client who is having a myocardial infarction

A client who has diabetic neuropathy

A client who presents with the signs and symptoms of appendicitis

A client who fell and broke an ankle

A client who has rheumatoid arthritis

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



The client having an MI, the client presenting with signs and symptoms of appendicitis, and the client with a broken ankle would be having acute pain. Clients with diabetic neuropathy, rheumatoid arthritis, and bladder cancer would have chronic pain.
The nurse is caring for a client who reports chest pain for 30 minutes that radiates down the left arm. How will the nurse document this type of pain? (Select all that apply.)

cutaneous
somatic
visceral
referred
neuropathic
acute
chronic
referred
acute


Referred pain is not experienced in the exact site where an organ is located. Acute pain lasts for a few seconds to less than 6 months. Therefore, the nurse documents that the client as acute, referred pain. Somatic, visceral, cutaneous, chronic, and neuropathic pain are not demonstrated in this scenario.
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