Chapter 44 Pain Management-Fundamentals of Nursing

Chapter 44: Pain Management
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MULTIPLE CHOICE ra




1. A hospital client has recently had surgery. Which action is best for the nursing attendant t
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o take to assess this hospital client ’s pain?
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a. Assess the hospital client ’s body language. ra ra ra ra ra ra




b. Ask the hospital client to rate the level of pain.
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c. Observe the cardiac monitor for increased heart rate. ra ra ra ra ra ra ra




d. Have the hospital client describe the effect of pain on the ability to cope.
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ACCURATE ar



ANSWER:-B
One of the most subjective and therefore most useful characteristics for reporting pain is its s
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everity. Therefore, the best way to assess a hospital client ’s pain is to ask the hospital client to
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rate the pain. Nonverbal communication, such as body language, is not as effective in assessin
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g pain, especially when the hospital client is oriented. Heart rate sometimes increases when a
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hospital client is in pain, but this is not a symptom that is specific to pain. Pain sometimes aff
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ects a hospital client ’s ability to cope but assessing the effect of pain on coping assesses the h
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ospital client ’s ability to cope; it does not assess the hospital client ’s pain.
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DIF:Apply (application) ra



OBJ:Apply clinical judgment in assessing a hospital client ex ra ra ra ra ra ra ra ra



periencing pain. TOP:Assessment ra ra



MSC: Physiological ra ar



Adaptation

2. A nursing attendant is caring for a hospital client who recently had abdominal surgery and is
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experiencing severe pain. The hospital client ’s blood pressure is 110/60 mm Hg, and heart ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra



t
e is 60 beats/min. Additionally, the hospital client does not appear to be in any physical distr
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ess. Which response by the nursing attendant is most therapeutic?
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a. ―Your vitals do not show that you are having pain; can you describe your pain?‖
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b. ―OK, I will go get you some narcotic pain relievers immediately.‖ ra ra ar ra ra ra ra ra ar ra




c. ―What would you like to try to alleviate your pain?‖ ra ra ra ra ra ar ra ra ra




d. ―You do not look like you are in pain.‖ ra ra ra ra ra ra ra ra




ACCURATE ANSWER:-C ra



Be sure the hospital client is a partner in making decisions about the best approaches for man
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aging pain. A hospital client knows the most about his or her pain and is an important partne
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r in selecting successful pain therapies. The nursing attendant must believe that a hospital cli
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ent is in pain whenever the hospital client reports that he or she is in pain, even if the hospital
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client does not appear to be in pain. The nursing attendant must be careful to not judge the ho
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spital client based on vital signs or nonverbal communication and must not assume that the h
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ospital client is seeking narcotics. The hospital client is a partner in pain management, so goi
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ng to get narcotics to treat the pain without consulting with the hospital client first is not ap
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propriate.

, DIF:Apply (application) ra



OBJ:Explain the nursing guidelines for administering analgesics safely. ra ra ra ra ra ra ra



TOP:Communication and Documentation MSC: Physiological Adaptation ra ra ra ra




3. A nursing attendant teaches the hospital client about the gate control theory. Which stat
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ement made by a hospital client reflects a correct understanding about the relationship b
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et ween the gate control theory of pain and the use of meditation to relieve pain?
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a. ―Meditation controls pain by blocking pain impulses from coming through the gate.‖ ra ra ra ra ra ra ra ar ra ar ar




b. ―Meditation alters the chemical composition of pain neuroregulators, which closes ra ra ra ra ra ra ra ra ra ar




the gate.‖ ra




c. ―Meditation will help me sleep through the pain because it opens the gate.‖ ra ra ra ra ra ra ra ra ra ra ra ra




d. ―Meditation stops the occurrence of pain stimuli.‖ ra ar ar ar ar ar




ACCURATE ANSWER:-A ra



According to this theory, gating mechanisms located along the central nervous system regula
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te or block pain impulses. Pain impulses pass through when a gate is open and are blocked w
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hen a gate is closed. Nonpharmacological painrelief measures, such as meditation, work by closin
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g the gates, which keeps pain impulses from
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coming through. Meditation does not open pain gates or stop pain from occurring. Meditatio
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n also does not have an effect on pain neuroregulators.
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DIF:Apply (application) ra OBJ:Describe the physiology of nociceptive pain. ra ra ra ra ra



TOP:Teaching/Learning MSC: Physiological Adaptation ra ra




4. A nursing attendant is planning care for an olderadult hospital client who is experiencin
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g pain. Which statement made by the nursing atte
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ndant indicates the supervising nursing attendant needs to follow up? a.
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―As adults age, their ability to perceive pain decreases.‖
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b. ―Older hospital client s may have low serum albumin in their blood, causing t ra ra ra ra ra ra ra ar ra ra ra ra ar



oxic effects of analgesic drugs.‖ ra ra ra ra




c. ―Hospital client s who have dementia probably experience pain, and their ra ra ra ra ra ra ar ra ra ra ar



pain is not always well controlled.‖ ra ra ra ra ra




d. ―It is safe to administer opioids to older adults as long as you start with small doses a
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nd frequently assess the hospital client ’s response to the medication.‖
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ACCURATE ANSWER:-A ra



Pain is not an inevitable part of aging. Likewise, pain perception does not decrease with age. T
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his misconception must be corrected by the supervising nursing attendant . All the other sta
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tements are true and require no followup. Opioids are safe to use in older adults as long as they ar
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e slowly titrated, and the nursing
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attendant frequently monitors the hospital client . Hospital client s with dementia most lik
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ely experience unrelieved pain because their pain is difficult to assess. Older adults frequent
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ly eat poorly, resulting in low serum albumin levels. Many drugs are highly protein bound. In
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the presence of low serum albumin, more free drug (active form) is available, thus increasing
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the risk for side and/or toxic effects.
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DIF:Apply (application) ra



OBJ:Identify environmental and individual factors that create barriers to effective pain management.
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TOP:Teaching/Learning MSC: Management of Care ra ra ra




5. The nursing attendant is caring for two hospital client s; both are having a hysterectomy
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. The first hospital client is having the hysterectomy after a complicated birth. The seco
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, nd arhospital client ra r a has uterine cancer. What
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will most likely influence the experience of p
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Meaning of pain ra ra




b. Neurological factors ra




c. Competency of the surgeon ra ra ra




d. Postoperative support personnel ra ra




ACCURATE ANSWER:-A ra



The degree and quality of pain perceived by a hospital client are related to the meaning of the
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pain. The hospital client ’s perception of pain is influenced by psychological factors, such as a
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nxiety and coping, which in turn influence the hospital client ’s experience of pain. Each hosp
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ital client ’s experience is different. Neurological factors can interrupt or influence pain perce
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ption, but neither of these hospital client s is experiencing alterations in neurological functio
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n. The knowledge, attitudes, and beliefs of nursing attendant s, health care providers, the surg
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eon, and other health care personnel about pain affect pain management but do not necessaril
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y influence a hospital client ’s pain perceptions.
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DIF:Understand (comprehension) ra



OBJ:Identify environmental and individual factors that create barriers to effective pain management.
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TOP:Assessment MSC: Psychosocial Integrity ra ra




6. The nursing attendant is preparing pain medications. To which hospital client doe
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s the nursing attendant anticipate administering an opioid fentanyl patch? a. A 15-
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year-old adolescent with a fractured femur ra ra ra ra ra




b. A 30-year-old adult with cellulitis
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c. A 50-year-old hospital client with prostate cancer
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d. An 80-year-old hospital client with a broken hip
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ACCURATE ANSWER:-C ra



Transdermal fentanyl (patch), which is 100 times more potent than morphine, is available for
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opioid-
tolerant hospital client s with cancer or chronic pain (prostate cancer). It delivers predeterm
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ined doses that provide analgesia for up to 72 hours. The other hospital client s are expected t
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o experience acute pain (fractured femur, cellulitis, and broken hip). Therefore, they will mo
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st likely benefit from oral or IV opioids for short-term pain relief.
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DIF:Apply (application) ra



OBJ:Explain how clinical judgment guides selection of various nonpharmacological versus p
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harmacological approaches to treating pain. TOP:Planning ra ra ra ra



MSC: Pharmacological and Parenteral Therapies
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7. A hospital client is receiving opioid medication through an epidural infusion. Which actio
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n will the nursing attendant take to protect the hospital client ’s safety? a.
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Restrict fluid intake. ra ra




b. Label the tubing that leads to the epidural catheter. ra ra ra ra ra ra ra ra




c. Apply a gauze dressing to the epidural catheter insertion site. ra ra ra ra ra ra ra ra ra




d. Ask the nursing assistive personnel to check on the hospital client at least once
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every 2 hours. ra ra




ACCURATE ANSWER:-B ra



To reduce the accidental administration of IV medications into the epidural catheter, the tubi
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ng that leads to the epidural catheter needs to be labeled clearly. The epidural insertion site nee
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ds to be covered by a transparent dressing to prevent infection and allow the nursing attenda
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