Brunner Ch 9 - Pain Management
1. The nurse, who is a member of the palliative care team, is assessing a client. The
client reports saving client-controlled analgesics (PCA) until the pain is intense because
pain control has been inadequate. What client education should the nurse give this
client?
A. Medication should be taken when pain levels are low so the pain is easier to reduce.
B. Pain medication can be increased when the pain becomes intense.
C. It is difficult to control chronic pain, so this is an inevitable part of the disease
process.
D. The client will likely benefit more from distraction than pharmacologic interventions. -
answerA
Rationale: Better pain control can be achieved with a preventive approach, reducing the
amount of time clients are in pain. Low levels of pain are easier to reduce or control
than intense levels of pain. Pain medication is used to prevent pain so pain medication
is not increased when pain becomes intense. Chronic pain is treatable. Giving the client
alternative methods to control pain is good, but it will not work if the client is in so much
pain that they cannot implement reliable alternative methods.
2. Two clients have recently returned to the postsurgical unit after knee arthroplasty.
One client is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other client is
reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most
plausible rationale for understanding the clients' different perceptions of pain?
A. Awareness and emotions affect the perception of pain.
B. One of the clients is exaggerating the sense of pain.
C. The clients are likely experiencing a variance in vasoconstriction.
D. One of the clients may be experiencing opioid tolerance - answerA
Rationale: Different people feel different degrees of pain from similar stimuli due to the
effects of awareness and emotions, which vary from person to person. The nurse
should not assume the client is exaggerating the pain, because clients are the best
authority on their pain, and definitions for pain state that pain is "whatever the person
says it is, existing whenever the experiencing person says it does." Variances in
vasoconstriction do not affect pain perception. Opioid tolerance is associated with
chronic pain treatment and would not likely apply to these clients.
The nurse is caring for a 71-year-old client who experienced a humeral fracture in a fall.
The client is receiving an opioid for pain control. Which principle of pain management
for an older adult should the nurse apply?
A. Monitor for signs of drug toxicity.
B. Assess for an increase in absorption of the drug.
, C. Monitor for a paradoxical increase in pain.
D. Administer higher doses of opioids to relieve pain. - answer: A
Rationale: Because older adults have an increased sensitivity to co-analgesic agents
and more comorbidities compared with younger people, the nurse should monitor for
drug toxicity. Absorption of drugs is not increased in older adults, nor is there a
paradoxical increase in pain. Higher doses of opioids should not be administered to
older adults; rather, the dose should be reduced because they are more likely to have
adverse effects.
4. The nurse is assessing a client's pain while the client awaits a cholecystectomy. The
client is tearful, hesitant to move, and grimacing, but reports feeling pain as a 2 at this
time on a 0-to-10 pain scale. How should the nurse best respond to this assessment
finding?
A. Remind the client that they are indeed experiencing pain.
B. Reinforce education about the pain scale number system.
C. Reassess the client's pain in 30 minutes.
D. Administer an analgesic and then reassess. - answerB
Rationale: The client's numerical pain rating (2) does not match the physical signs of
pain they are exhibiting. The nurse may need to provide further client education so the
client can correctly rate the pain. The nurse may also need to verify that the same scale
is being used by the client and caregiver, to promote continuity. Although all answers
are correct, the best initial approach would be to reinforce education about the pain
scale.
5. The nurse is creating a nursing care plan for a client with a primary diagnosis of
cellulitis and a secondary diagnosis of chronic pain. What common trait of clients who
live with chronic pain should be integrated into care planning?
A. They are typically more comfortable with underlying pain than clients without chronic
pain.
B. They often have a lower pain threshold than clients without chronic pain.
C. They often have an increased tolerance of pain.
D. They can experience acute pain in addition to chronic pain. - answerD
Rationale: It is tempting to expect that people who have had multiple or prolonged
experiences with pain will be less anxious and more tolerant of pain than those who
have had little experience with pain. However, this is not true for many people. The
more experience a person has had with pain, the more frightened they may be about
subsequent painful events. Chronic pain and acute pain are not mutually exclusive.
These clients may not have a different pain threshold or tolerance to pain.
6. A client with osteoarthritis of the hip for a number of years reports a dull, aching pain
with ambulation and pain shooting down the leg at night while sleeping. The nurse
recognizes that the client is experiencing which type of pain?
A. Acute pain
1. The nurse, who is a member of the palliative care team, is assessing a client. The
client reports saving client-controlled analgesics (PCA) until the pain is intense because
pain control has been inadequate. What client education should the nurse give this
client?
A. Medication should be taken when pain levels are low so the pain is easier to reduce.
B. Pain medication can be increased when the pain becomes intense.
C. It is difficult to control chronic pain, so this is an inevitable part of the disease
process.
D. The client will likely benefit more from distraction than pharmacologic interventions. -
answerA
Rationale: Better pain control can be achieved with a preventive approach, reducing the
amount of time clients are in pain. Low levels of pain are easier to reduce or control
than intense levels of pain. Pain medication is used to prevent pain so pain medication
is not increased when pain becomes intense. Chronic pain is treatable. Giving the client
alternative methods to control pain is good, but it will not work if the client is in so much
pain that they cannot implement reliable alternative methods.
2. Two clients have recently returned to the postsurgical unit after knee arthroplasty.
One client is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other client is
reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most
plausible rationale for understanding the clients' different perceptions of pain?
A. Awareness and emotions affect the perception of pain.
B. One of the clients is exaggerating the sense of pain.
C. The clients are likely experiencing a variance in vasoconstriction.
D. One of the clients may be experiencing opioid tolerance - answerA
Rationale: Different people feel different degrees of pain from similar stimuli due to the
effects of awareness and emotions, which vary from person to person. The nurse
should not assume the client is exaggerating the pain, because clients are the best
authority on their pain, and definitions for pain state that pain is "whatever the person
says it is, existing whenever the experiencing person says it does." Variances in
vasoconstriction do not affect pain perception. Opioid tolerance is associated with
chronic pain treatment and would not likely apply to these clients.
The nurse is caring for a 71-year-old client who experienced a humeral fracture in a fall.
The client is receiving an opioid for pain control. Which principle of pain management
for an older adult should the nurse apply?
A. Monitor for signs of drug toxicity.
B. Assess for an increase in absorption of the drug.
, C. Monitor for a paradoxical increase in pain.
D. Administer higher doses of opioids to relieve pain. - answer: A
Rationale: Because older adults have an increased sensitivity to co-analgesic agents
and more comorbidities compared with younger people, the nurse should monitor for
drug toxicity. Absorption of drugs is not increased in older adults, nor is there a
paradoxical increase in pain. Higher doses of opioids should not be administered to
older adults; rather, the dose should be reduced because they are more likely to have
adverse effects.
4. The nurse is assessing a client's pain while the client awaits a cholecystectomy. The
client is tearful, hesitant to move, and grimacing, but reports feeling pain as a 2 at this
time on a 0-to-10 pain scale. How should the nurse best respond to this assessment
finding?
A. Remind the client that they are indeed experiencing pain.
B. Reinforce education about the pain scale number system.
C. Reassess the client's pain in 30 minutes.
D. Administer an analgesic and then reassess. - answerB
Rationale: The client's numerical pain rating (2) does not match the physical signs of
pain they are exhibiting. The nurse may need to provide further client education so the
client can correctly rate the pain. The nurse may also need to verify that the same scale
is being used by the client and caregiver, to promote continuity. Although all answers
are correct, the best initial approach would be to reinforce education about the pain
scale.
5. The nurse is creating a nursing care plan for a client with a primary diagnosis of
cellulitis and a secondary diagnosis of chronic pain. What common trait of clients who
live with chronic pain should be integrated into care planning?
A. They are typically more comfortable with underlying pain than clients without chronic
pain.
B. They often have a lower pain threshold than clients without chronic pain.
C. They often have an increased tolerance of pain.
D. They can experience acute pain in addition to chronic pain. - answerD
Rationale: It is tempting to expect that people who have had multiple or prolonged
experiences with pain will be less anxious and more tolerant of pain than those who
have had little experience with pain. However, this is not true for many people. The
more experience a person has had with pain, the more frightened they may be about
subsequent painful events. Chronic pain and acute pain are not mutually exclusive.
These clients may not have a different pain threshold or tolerance to pain.
6. A client with osteoarthritis of the hip for a number of years reports a dull, aching pain
with ambulation and pain shooting down the leg at night while sleeping. The nurse
recognizes that the client is experiencing which type of pain?
A. Acute pain
