NURS 3320- assessing pain the 5th vital sign

NURS 3320- assessing pain the 5th vital sign 1. A palliative care nurse is explaining the basis of pain to a group of nurses who provide care on a general medical unit. Which of the following factors would the nurse include? Select all that apply. A) Physiologic B) Psychosocial C) Cutaneous D) Somatic E) Visceral 2. A group of students is reviewing information about pain transmission and the fibers involved. The students demonstrate understanding when they state that A-delta primary afferent fibers transmit pain that is felt as which of the following? A) Burning B) Throbbing C) Sharp D) Aching 3. A nurse is assessing the pain of a client who has had major surgery. The client also has been experiencing depression. Which of the following principles should guide the nurse's assessment of a client's pain? A) The client is likely experiencing less pain than he is reporting. B) The client's depression exists independently of the level of pain. C) It is likely that the client's pain rating will be influences by his emotional state. D) The degree of surgery will be the key indicator for level of pain experienced. 4. A client has received a diagnosis of chronic nonmalignant pain. The nurse who is planning this client's nursing care should understand that this client has experienced this pain for at least how many months? A) 3 B) 6 C) 9 D) 12 5. A nurse educator is presenting an in-service program to a group of nurses who will be working on an oncology unit. Which of the following characteristics of cancer pain should the nurse describe? A) Its basis is usually chronic neuropathy. B) It is most often caused by a specific recent trauma. C) It usually appears in the first month after cancer develops. D) It is typically caused by compressed peripheral nerves. Page 2 6. A nurse is admitting a client to the postsurgical unit following breast reconstruction surgery. Which of the following would the nurse use as the primary assessment for the client's pain? A) The client's spiritual view of the pain B) Current pain therapies used preoperatively C) The client's report of her pain D) Psychosocial questions related to her perceptions of pain 7. The nurse is using the Verbal Descriptor Scale to assess a client's pain. The nurse will prioritize which of the following data? A) The client's facial expressions B) The client's report on a 0 to 10 numeric scale C) The client's rating on a 0 to 10 visual analog scale D) The client's explanation of how her pain feels 8. The nurse collects vital signs on a hospital client who has recently been experiencing pain. Which of the following would suggest most strongly to the nurse that the client is experiencing pain? A) Respiratory rate of 18 breaths per minute B) Temperature of 99.1∞F C) Heart rate of 110 beats per minute D) Blood pressure of 120/70 mm Hg 9. Based on the analysis of assessment data from a client with pain, the nurse writes a health promotion diagnosis. Which of the following diagnoses would be most appropriate? A) Readiness for enhanced spiritual well-being related to coping with prolonged physical pain B) Risk for activity intolerance related to chronic pain and immobility C) Bathing self-care deficit related to severe pain D) Chronic pain related to chronic inflammatory process of rheumatoid arthritis 10. A nurse is preparing to document a collaborative problem for a client with pain. Which of the following would be most appropriate? A) ìImpaired physical mobility related to chronic painî B) ìRisk for powerlessness related to chronic painî C) ìReadiness for enhanced comfort levelî D) ìRC: peripheral nerve compressionî Page 3 11. The nurse is assessing a client whose chronic pain is poorly controlled. Which assessment finding should the nurse expect under these circumstances? A) Decreased heart rate B) Hypoglycemia C) Increased urinary output D) Decreased gastric motility 12. A client rates his pain as 9 on a scale of 1 to 10. The nurse would expect to assess which of the following? A) Constricted pupils B) Hypotension C) Increased serum glucose D) Flaccid muscles 13. The nurse is assessing a client's pain. Which question would be most appropriate to ask the client when the goal is to identify precipitating factors that might have exacerbated the pain? A) ìWhat were you doing when the pain first stated?î B) ìDo concurrent symptoms accompany the pain?î C) ìWhen did the pain start?î D) ìIs the pain continuous or intermittent?î 14. A client has questioned why the nurse asked him how his family members usually treat their pain. Which of the following would be the most appropriate response by the nurse? A) ìIt is just a way for me to more fully understand you and your upbringing.î B) ìIt helps me to direct interventions toward your cultural history.î C) ìIt helps me to determine how the family understands and perceives pain.î D) ìIt will allow me to see if you are more likely to react to pain in a negative manner.î 15. When assessing pain in an older adult client who is alert and oriented, which assessment tool would be most appropriate to use? A) Numerical rating scale B) Faces Pain Scale-Revised C) FLACC Scale D) Graphic rating sca