Med_Surg_Chapter_12

Med-Surg Chapter 12: Pain Management Question A client arrives in the orthopedic clinic with complaints of twisting the right ankle while playing softball. The nurse collects data including complaints of pain and swelling in the right ankle. What intervention will the nurse provide that will decrease vasodilation and reduce localized swelling? • Ice bag Question A client being treated for rheumatoid arthritis has been prescribed a glucocorticosteroid. How should the nurse best ensure this client's safety during treatment? • Ensure the client knows to taper down the dose if it is discontinued by the care provider. Question A client comes to the outpatient clinic to receive cortisone injections in the neck for pain that has been occurring consistently for 8 months. What type of pain is this client experiencing? • Chronic pain Question A client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. The client is without breakthrough pain at this point in time. How would this client's pain be classified? • neuropathic and chronic Question A client has been prescribed a fentanyl patch for pain control. The nurse understands that this patch should be replaced every • 48–72 hours. Question A client has been using nonnarcotic analgesics daily over an extended period. Which of the following effects should the nurse carefully monitor for in this client? • Gastrointestinal bleeding Question A client informs the nurse that he has been taking ibuprofen every 6 hours for 3 weeks to help alleviate the pain of arthritis. The client has a history of a gastric ulcer and is taking a proton pump inhibitor for the treatment of this disorder. What should the nurse instruct the client about the use of the ibuprofen? • "It would be best to contact the physician prior to take any over-the-counter medications." Question A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing? • visceral Question A client is being taught to self-administer a narcotic analgesic by means of an intravenous pump system. Which of the following would help prevent accidental overdosage? • Programming the dosage and time interval into the device Question A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect? • Addiction Question A client is on a second round of radiation therapy for an inoperable tumor and asks the nurse for medication to help with pain. The nurse suspects that the client’s pain is the result of nerve damage from the radiation. Which type of pain is the client likely experiencing? • neuropathic pain Question A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends • increasing the amount of bran and fresh fruits and vegetables Question A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies • "What do you mean by the word sick?" Question A client is receiving morphine through a patient–controlled analgesia (PCA) system following surgery. The nurse states to the client • "Only you are to push the button for medication." Question A client is recovering from abdominal surgery and sleeping. The client had received an opioid medication 3 hours ago. The client's son requests pain medication for the client, stating "I do not want her to wake up in pain." The first nursing action is • Instruct the son about lack of client consent. Question A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client • That medication will be prescribed for pain relief Question A client receives hydromorphone 2 mg intravenously for report of postoperative pain. Fifteen minutes later, the nurse notes respirations are 6 breaths/minute and the client is nonresponsive. The nurse administers prescribed naloxone (Narcan). The next time the client reports pain, the best nursing action is: • Consult with the healthcare provider to reduce the dose. Question A client reports abdominal pain as "8" on a pain intensity scale of 0–10 thirty minutes after receiving an opioid intravenously. Her past medical history includes partial–thickness burns to approximately 60% of her body several years ago. The nurse assesses • That the client's past experiences with pain may influence her perception of current pain Question A client sustained severe burns over both lower extremities 1 week ago. The client informs the nurse that he had to wait for 30 minutes last night to receive pain medication, which caused the pain not to be relieved after administration. What suggestions could the nurse make to the physician to provide adequate relief of pain? • Provide the client with a patient-controlled analgesia (PCA) pump. Question A client who fell at home is hospitalized for a hip fracture. The client is in Buck's traction, anticipating surgery, and reports pain as "2" on a pain intensity scale of 0 to 10. The client also exhibits moderate anxiety and moves restlessly in the bed. The best nursing intervention to address the client's anxiety is to • Assess the reason for the client's anxiety. Question A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing? • Neuropathic pain Question A client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. The initial surgeries occurred more than 2 months ago, and the nurse is concerned about the repeated requests. What does the nurse suspect to be the cause of the client's frequent appeals for pain medication? • tolerance Question A female client with sickle-cell disease is hospitalized for pain management. The client's BUN is 24 mg/dL and creatinine is 1.6 mg/dL. To assist with management of the pain, the nurse • Applies warm soaks to the extremities Question A high school football player hurts his foot while playing a game. The client complains of intense pain with muscle spasms and swelling of the toe. Which pain assessment tool will the nurse most likely use to assess the client’s pain level? • Numeric Rating Scale (NRS) Question A new surgical patient has been prescribed an opioid analgesic intravenously for pain control. The nurse should be aware of which most serious adverse effect of this medication? • Respiratory depression Question A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be: • Prolonged in duration. Question A nurse is employed at a healthcare facility with a recent influx of many clients from a particular culture. The nurse is presenting information about the effect of one's culture on pain perception to a group of unlicensed assistive personnel (UAP). The nurse evaluates that the students need reteaching when one of them states • "A client from this culture always exaggerates his or her pain." Question A physician orders morphine sulfate 1 mg IV stat for chest pain. The drug is available in 2 mg per 1 mL syringe. How many mL does the nurse administer? Enter the correct number ONLY. • 0.5 Question A preventative approach to pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) means that the medication is given: • Before pain is experienced. Question About which issue should the nurse inform clients who use pain medications on a regular basis? • Inform the primary health care provider about the use of salicylates before any procedure and avoid over-the-counter analgesics consistently without consulting a physician. Question According to The Joint Commission’s pain assessment and management standards, which of the following are essential components of a comprehensive pain assessment? • location, onset, alleviating factors, and aggravating factors Question Acute pain can be distinguished from chronic pain by assessing which characteristic? • Acute pain is specific and localized. Question An elderly client has a fractured hip and is in Buck's traction. The client is disoriented and cannot express herself. At 0730 the client was calm. Now, at 0930, the client is restless and agitated. The nurse reviews the medication administration record. The last dose of opioid was at 0330. The nurse assesses the client's agitation may be from • Recurring pain Question An older adult has been medicated with an oral opioid for postoperative pain. To make the pain medication more effective, the nurse first • Provides the client with a fresh gown and changes the bed linens Question An older adult is being treated with opioids for pain relief. Which of the following should the nurse strongly recommend to this client? • Follow a bowel regimen. Question How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client? • Administering the analgesics every three hours Question Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission? • A child quickly removing a hand when touching a hot object Question Opioid analgesics are effective pain management tools for many clients. A significant portion of a nurse's practice is older adults who suffer from chronic pain. What impact does a client's age have on initial dosing? • Older clients should receive a reduced dose. Question Prostaglandins are chemical substances with which of the following properties? • Increased sensitivity of pain receptors Question Regarding tolerance and addiction, the nurse understands that • although clients may need increasing levels of opioids, they are not addicted. Question The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe? • Gabapentin Question The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to • Educate the client that this goal may not be achievable. Question The client is taking continuous-release oxycodone (Oxycontin) for chronic pain and now reports constipation. The first question the nurse asks is • "When was your last bowel movement?" Question The client is taking oxycodone (Oxycontin) for chronic back pain and reports decreased pain relief when he began taking a herb to improve his physical stamina. The nurse asks if the herb is • ginseng Question The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply. • "How long have you experienced this pain?" • "Please point to where you are experiencing pain." • "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." • "What aggravates your chest pain?" Question The client takes naproxen (Aleve) for arthritic pain and is now prescribed warfarin (Coumadin) for persistent atrial fibrillation. Due to the interactions of the medications, the nurse • Assesses the client's stool for color Question The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting: • Severity of the pain as judged by the patient Question The nurse assessed a patient's pain subsequent to a broken ankle. The nurse documented that the patient's pain was categorized as: • Acute Question The nurse informs the patient that a preventive approach for pain relief will be used, involving nonsteroidal anti-inflammatory drugs. What will this mean for the patient? • The pain medication will be administered before the pain is experienced. Question The nurse is administering a narcotic analgesic for the control of a newly postoperative client’s pain. What medication will the nurse administer to this client? • Fentanyl (Duragesic) Question The nurse is administering an analgesic to an older adult patient. Why is it important for the nurse to assess the patient carefully? • Older people are more sensitive to drugs. Question The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient? • Older people experience reduced sensory perception. Question The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for? • Bradypnea Question The nurse is caring for a client with kidney stones who is complaining of severe pain. What type of pain does the nurse understand this client is experiencing? • Visceral Pain Question The nurse needs to carefully monitor a client with traumatic injuries. How often should the nurse check and document the client's pain? • Every time the client's vital signs are assessed Question The nurse needs to carefully monitor a client with traumatic injuries. Which action by the nurse demonstrates understanding of the most essential component of the client’s pain assessment? • The nurse administers pain medication based on the client’s reported pain level. Question The nurse understands that which statement is true about tolerance and addiction? • Although clients may need increasing levels of opioids, they are not addicted. Question The nurse’s major area of assessment for a patient receiving patient-controlled analgesia is assessment of what system? • Respiratory Question The physician has ordered a mu opioid analgesic for a patient with pain. What drug does the nurse anticipate administering? • Fentanyl Question When a nurse asks a patient to describe the quality of the pain, what type of descriptive term does the nurse expect the patient to use? • Burning Question When caring for a patient who is deaf, which of the following should be used to elicit information regarding the patient’s level of pain? • An outside interpreter should be used. Question When completing a teaching plan for a patient receiving patient-controlled analgesia (PCA), which component would be importance to stress? • The pump will deliver a preset amount of medication. Question When using transdermal Fentanyl, the nurse and patient should be aware of which sign or symptom of Fentanyl overdose? • Confusion Question Which is a true statement regarding placebos? • Placebos should never be used to test a client's truthfulness about pain. Question Which of the following, approved by the U.S. Food and Drug Administration, is the only use for lidocaine 5% (Lidoderm) patch? • Postherpetic neuralgia Question Which of the following is a disadvantage to using the IV route of administration for analgesics? • Short duration Question Which of the following is a physiologic response to pain? • Pallor Question Which of the following is a reliable source for quantifying pain? • The client's description of the pain Question Which of the following is a true statement with regards to the preventative approach to the use of analgesics? • Smaller doses of medication are needed. Question Which of the following is the appropriate intervention to avoid physical dependence on drugs in a client? • Discontinue drugs gradually. Question Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy? • Risk for impaired gas exchange Question Which of the following is true regarding the use of narcotic analgesics in older adults? • There is an increased potential for falls related to sedation. Question Which of the following nursing interventions contributes to achieving a client’s pain relief? • Collaborate with the client about his or her goal for a level of pain relief. Question Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain? • Do not administer if respirations are less than 12 per minute Question Which phase of pain transmission occurs when the brain experiences pain at a conscious level? • Perception Question Which phase of pain transmission occurs when the one is made aware of pain? • Perception Question Which substance reduces the transmission of pain? • Endorphins