NURSE 220-Pain Management Test Bank, Potter & Perry: Fundamentals of Nursing, 7th Edition

NURSE 220 chp 43 -Pain Management Test Bank, Potter & Perry: Fundamentals of Nursing, 7th Edition Chapter 43: Pain Management MULTIPLE CHOICE 1. Which one of the following nursing interventions for a client in pain is based on the gatecontrol theory? 1. Giving the client a back massage 2. Changing the client’s position in bed 3. Giving the client a pain medication 4. Limiting the number of visitors ANS: 1 The gate-control theory suggests that cutaneous stimulation activates larger, faster-transmitting A-beta sensory nerve fibers. This decreases pain transmission through small-diameter A-delta and C fibers. A back massage is a nursing intervention based on the gatecontrol theory. Changing the client’s position in bed is not a form of cutaneous stimulation used to relieve pain. Giving the client a pain medication is a pharmacological approach to relieving pain. Limiting the number of visitors may provide a quiet environment conducive to relaxation, but it is not based on the gate-control theory. 2. A priority nursing intervention when caring for a client who is receiving an epidural infusion for pain relief is to: 1. Use aseptic technique 2. Label the port as an epidural catheter 3. Monitor vital signs every 15 minutes 4. Avoid supplemental doses of sedatives ANS: 3 When clients are receiving epidural analgesia, monitoring occurs as often as every 15 minutes, including assessment of respiratory rate, respiratory effort, and skin color. Complications of epidural opioid use include nausea and vomiting, urinary retention, constipation, respiratory depression, and pruritus. A common complication of epidural anesthesia is hypotension. Assessing vital signs is the priority nursing intervention. Because of the catheter location, strict surgical asepsis is needed to prevent a serious and potentially fatal infection. To reduce the risk for accidental epidural injection of drugs intended for IV use, the catheter should be clearly labeled “epidural catheter.” Supplemental doses of opioids or sedative/hypnotics are avoided because of possible additive central nervous system adverse effects. 3. The nurse should describe pain that is causing the client a “burning sensation in the epigastric region” as: 1. Referred 2. Radiating 3. Deep or visceral 4. Superficial or cutaneous ANS: 3 Deep or visceral pain is diffuse and may radiate in several directions. Visceral pain may be described as a burning sensation. Referred pain is felt in a part of the body separate from the source of pain, such as with a myocardial infarction, in which pain may be referred to the jaw, left arm, and left shoulder. Radiating pain feels as though it travels down or along a body part, such as low back pain that is accompanied by pain radiating down the leg from sciatic nerve irritation. Superficial or cutaneous pain is of short duration and is localized as in a small cut. 4. Which of the following is most appropriate when the nurse assesses the intensity of the client’s pain? 1. Ask about what precipitates the pain. 2. Question the client about the location of the pain. 3. Offer the client a pain scale to objectify the information. 4. Use open-ended questions to find out about the sensation. ANS: 3 Descriptive scales are a more objective means of measuring pain intensity. Asking the client what precipitates the pain does not assess intensity, but rather it is an assessment of the pain pattern. Asking the client about the location of pain does not assess the intensity of the client’s pain. To determine the quality of the client’s pain, the nurse may ask openended questions to find out about the sensation experienced. 5. The nurse on a postoperative care unit is assessing the quality of the client’s pain. In order to obtain this specific information about the pain experience from the client, the nurse should ask: 1. “What does your discomfort feel like?” 2. “What activities make the pain worse?” 3. “How much does it hurt on a scale of 0 to 10?” 4. “How much discomfort are you able to tolerate?” ANS: 1 To determine the quality of the client’s pain the nurse might say, “What does your discomfort feel like?” It is more accurate to have clients describe the pain in their own words whenever possible. Inquiring about what activities make the pain worse is a type of question directed at determining the pain pattern. Having the client rate his or her pain on a pain scale is a method of measuring the intensity of pain. To determine the client’s expectations, the nurse may ask the client, “How much discomfort are you able to toler- ate?” 6. When a client’s husband questions how a patient-controlled analgesia (PCA) pump works, the nurse explains that the client: 1. Has control over the frequency of the intravenous (IV) analgesia 2. Can choose the dosage of the drug received 3. May request the type of medication received 4. Controls the route for administering the medication ANS: 1 With a PCA system the client controls medication delivery. The PCA system is designed to deliver no more than a specified number of doses. The client does not choose the dosage. The health care provider prescribes the type of medication to be used. The advantage for the client is that he or she may self-administer opioids with minimal risk for overdose. The client does not control the route for administration. Systemic PCA typically involves IV drug administration but can also be given subcutaneously. 7. An older client with mild musculoskeletal pain is being seen by the primary care provider. The nurse anticipates that treatment of this client’s level of discomfort will include: 1. Fentanyl 2. Diazepam 3. Acetaminophen 4. Meperidine hydrochloride ANS: 3 A nonopioid analgesic, such as acetaminophen, is used to effectively treat mild musculoskeletal pain. Fentanyl is about 100 times more potent than morphine. It is typically used for cancer pain, not mild musculoskeletal pain. Diazepam is given as an antianxiety agent. Meperidine hydrochloride is an opioid analgesic used to treat moderate to severe acute pain, not mild pain. 8. Before inserting a Foley catheter, the nurse explains that the client may feel some discomfort. This is an example of: 1. Distraction 2. Reducing pain perception 3. Anticipatory response 4. Self-care maintenance ANS: 3 Pain can be prevented by anticipating painful events. Before performing procedures, the nurse considers the client’s condition, aspects of the procedure that may be uncomfortable, and techniques to avoid causing pain. The nurse who tells the client that the urinary catheter insertion may feel uncomfortable is an example of anticipatory response. Distraction directs a client’s attention to something else and thus can reduce the awareness of pain and even increase tolerance. Reducing pain perception means to remove stimuli that are uncomfortable or to prevent stimuli that are painful, such as changing wet linens, or preventing constipation with fluids, diet, and exercise. Self-care maintenance implies the client is able to carry out necessary activities to care for himself or herself. This may include pain management measures. 9. The nurse knows that a PCA pump would be most appropriate for the client who: 1. Has psychogenic discomfort 2. Is recovering after a total hip replacement 3. Experiences renal dysfunction 4. Recently experienced a cerebrovascular accident (stroke) ANS: 2 Patient-controlled analgesia is a safe method for postoperative pain management, such as the client recovering from total hip replacement surgery. PCA would not be the mode of choice for treating psychogenic pain or for the client with renal dysfunction. The client with renal impairment would be at increased risk for drug toxicity because of decreased drug excretion. Clients must be able to understand the use of the equipment and be physically able to locate and press the button to deliver the dose. The client who recently experienced a cerebrovascular accident may have difficulty managing the PCA system. 10. A client with chronic back pain has an order for a transcutaneous electrical nerve stimulation (TENS) unit for pain control. The nurse should instruct the client to: 1. Keep the unit on high 2. Use the unit when pain is perceived 3. Remove the electrodes at bedtime 4. Use the therapy without medications ANS: 2 When a client feels pain, the TENS unit is turned on and a buzzing or tingling sensation is created. The tingling sensation can be applied until pain relief occurs. The client may adjust the intensity of skin stimulation. It does not have to remain on high. The electrodes do not have to be removed at bedtime. Medication can be administered with a TENS unit. 11.The nurse caring for a terminally ill client with liver cancer u