Pain management - Pottery and Perry Test Bank PDF

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Potter & Perry: Fundamentals of Nursing, 7th Edition Test Bank 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, fastertransmitting A-beta sensory nerve fibers. This decreases pain transmission through smalldiameter A-delta and C fibers. A back massage is a nursing intervention based on the gate-control 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. DIF: A REF: 1053-1054 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 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. DIF:

C

REF: 1078

OBJ: Analysis

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TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 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. DIF: A REF: 1056 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 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. DIF: A REF: 1063 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 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:

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“What does your discomfort feel like?” “What activities make the pain worse?” “How much does it hurt on a scale of 0 to 10?” “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 tolerate?” DIF: A REF: 1063-1065 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 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. DIF: A REF: 1076 OBJ: Comprehension TOP: Nursing Process: Implementation MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 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 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

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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. DIF: A REF: 1073 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 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. DIF: A REF: 1073 OBJ: Comprehension TOP: Nursing Process: Implementation MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 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

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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. DIF: C REF: 1076 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 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. DIF: A REF: 1071 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 11. The nurse caring for a terminally ill client with liver cancer understands which of the following goals would be most appropriate? 1. Increasingly administer narcotics to oversedate the client and thereby decrease the pain. 2. Continue to change the analgesics until the right narcotic is found that completely alleviates the pain. 3. Adapt the analgesics as the nursing assessment reveals the need for specific medications. 4. Withhold analgesics because they are not being effective in relieving discomfort. ANS: 3

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The best choice of treatment often changes as the client’s condition and the characteristics of pain change. It is realistic to expect that a terminally ill client’s need for pain medication will change over time with disease progression. The goal is not to oversedate the client but to provide pain control without excessive sedation. It would be unrealistic to expect that the pain of terminal cancer will be completely alleviated. Analgesics should not be withheld, because this would only increase the client’s level of pain. The medication regimen may need to be adapted to meet the client’s needs. DIF: C REF: 1078-1079 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 12. A client is having severe, continuous discomfort from kidney stones. Based on the client’s experience, the nurse anticipates which of the following findings in the client’s assessment? 1. Tachycardia 2. Diaphoresis 3. Pupil dilation 4. Nausea and vomiting ANS: 4 Acute severe or deep pain, as with kidney stones, will cause a parasympathetic response. The client would likely exhibit nausea and vomiting. Tachycardia is a response of sympathetic stimulation, commonly seen with pain of low to moderate intensity and superficial pain. Diaphoresis is a response of sympathetic stimulation, commonly seen with pain of low to moderate intensity and superficial pain. Pupil dilation is a response of sympathetic stimulation, commonly seen with pain of low to moderate intensity and superficial pain. DIF: A REF: 1064 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 13. Nurses working with clients in pain need to recognize and avoid common misconceptions and myths about pain. In regard to the pain experience, which of the following is correct? 1. The client is the best authority on the pain experience. 2. Chronic pain is mostly psychological in nature. 3. Regular use of analgesics leads to drug addiction. 4. The amount of tissue damage is accurately reflected in the degree of pain perceived. ANS: 1

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A client’s self-report of pain is the single most reliable indicator of the existence and intensity of pain and any related discomfort. Pain is individualistic. A misconception about pain is that chronic pain is psychological. The belief that administering analgesics regularly will lead to drug addiction is a misconception. Another misconception about pain is that the amount of tissue damage is accurately reflected in the degree of pain perceived. DIF: C REF: 1057 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 14. A nonpharmacological approach that the nurse may implement for clients experiencing pain that focuses on promoting pleasurable and meaningful stimuli is: 1. Acupressure 2. Distraction 3. Biofeedback 4. Hypnosis ANS: 2 Pleasurable stimuli cause the release of endorphins. The nurse assesses activities enjoyed by the client that may act as distractions. Distraction directs a client’s attention to something else and thus can reduce the awareness of pain and even increase tolerance. Acupressure does not focus on promoting pleasurable and meaningful stimuli. Acupressure is finger pressure applied therapeutically at selected points on the body. Biofeedback focuses on an individual’s physiological responses (e.g., blood pressure or tension) and ways to exercise voluntary control over those responses. Hypnosis does not focus on promoting pleasurable and meaningful stimuli. Hypnosis is a condition resembling sleep in which the mind is susceptible to suggestions. DIF: A REF: 1071 OBJ: Comprehension TOP: Nursing Process: Implementation MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 15. Which of the following is the most appropriate nursing intervention for a client who is receiving epidural analgesia? 1. Change the tubing every 48 to 72 hours. 2. Change the dressing every shift. 3. Secure the catheter to the outside skin. 4. Use a bulky occlusive dressing over the site. ANS: 3 To prevent catheter displacement, the catheter should be secured carefully to the outside skin. The infusion tubing should be changed every 24 hours to prevent infection. To prevent infection, the dressing should not be routinely changed over the site. A transparent dressing should be used over the site to secure the catheter and aid inspection.

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DIF: A REF: 1078 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 16. The client is experiencing breakthrough pain while receiving opioids. An order is written for the client to receive a transmucosal fentanyl “unit.” In teaching about this medication, the nurse should instruct the client to: 1. Swab the unit over the cheeks 2. Do not chew the unit after administration 3. Take no more than two units per episode of discomfort 4. Allow the unit to dissolve slowly in the mouth over 15 minutes or more ANS: 2 The unit needs to be left intact and not chewed. The unit is placed in the client’s mouth and swabbed over the inside of the cheeks and lower gums. No more than two units should be used per breakthrough pain episode. The unit needs to be allowed to dissolve and absorb over a 15-minute period. DIF: A REF: 1080 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 17. When caring for a client who is experiencing continuous severe pain, the nurse should expect that the pain management plan would include: 1. Focusing on intramuscular administration of analgesics 2. Waiting for pain to become more intense before administering opioids 3. Administering opioids with nonopioid analgesics for severe pain experiences 4. Administering large doses of opioids initially to clients who have not taken the medications before ANS: 3 To treat a client who is experiencing continuous severe pain, the nurse should expect the client to receive opioid and nonopioid analgesics for severe pain experiences. Intramuscular administration of analgesics is not expected because the injection itself is painful, and there may be inconsistent erratic absorption of the drug. The nurse should administer opioids before the client’s pain becomes intense. It is easier to maintain pain control than it is to get intense pain under control. Large doses of opioids are not given initially to clients who have not taken the medications before because they may cause respiratory depression. The expectation is to begin with lower doses and titrate upward. DIF: A REF: 1073-1074 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort

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18. Which of the following symptoms would the nurse expect with a client who is experiencing acute pain? 1. Bradycardia 2. Bradypnea 3. Diaphoresis 4. Decreased muscle tension ANS: 3 An expected assessment finding of a client experiencing acute pain would be diaphoresis resulting from sympathetic nerve stimulation. Additional assessment findings of a client experiencing acute pain would be an increased heart rate, respiratory rate, and muscle tension. DIF: A REF: 1054 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic C...