TB-Chapter 11 Pain Assessment PDF

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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK

TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

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Chapter11:PainAssessment MULTIPLECHOICE 1.Whenevaluatingapatientspain,thenurseknowsthatanexampleofacutepainwouldbe: a.

Arthriticpain.

b.

Fibromyalgia.

c.

Kidneystones.

d.

Lowbackpain.

ANS:C Acutepainisshort-termanddissipatesafteraninjuryheals,suchaswithkidneystones.Theotherconditions areexamplesofchronicpainduringwhichthepaincontinuesfor6monthsorlongeranddoesnotstopwhen theinjuryheals. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 2.Whichstatementindicatesthatthenurseunderstandsthepainexperiencedbyanolderadult? NURSINGTB.COM

a.

Olderadultsmustlearntotoleratepain.

b.

Painisanormalprocessofagingandistobeexpected.

c.

Painindicatesapathologicconditionoraninjuryandisnotanormalprocessofaging.

d.

Olderindividualsperceivepaintoalesserdegreethandoyoungerindividuals.

ANS:C Painindicatesapathologicconditionoraninjuryandshouldneverbeconsideredsomethingthatanolderadul shouldexpectortolerate.Painisnotanormalprocessofaging,andnoevidencesuggeststhatpainperception isreducedwithaging. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 3.A4-year-oldboyisbroughttotheemergencydepartmentbyhismother.Shesayshepointstohisstomach andsays,Ithurtssobad.Whichpainassessmenttoolwouldbethebestchoicewhenassessingthischildspain a.

DescriptorScale

b.

Numericratingscale

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

c.

BriefPainInventory

d.

FacesPainScaleRevised(FPS-R)

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ANS:D Ratingscalescanbeintroducedattheageof4or5years.TheFPS-Risdesignedforusebychildrenandasks thechildtochooseafacethatshowshowmuchhurt(orpain)youhavenow.Youngchildrenshouldnotbe askedtoratepainbyusingnumbers. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 4.Apatientstatesthatthepainmedicationisnotworkingandrateshispostoperativepainata10ona1-to-10 scale.Whichoftheseassessmentfindingsindicatesanacutepainresponsetopoorlycontrolledpain? a.

Confusion

b.

Hyperventilation

c.

Increasedbloodpressureandpulse

d.

Depression NURSINGTB.COM

ANS:C Responsestopoorlycontrolledacutepainincludetachycardia,elevatedbloodpressure,andhypoventilation. Confusionanddepressionareassociatedwithpoorlycontrolledchronicpain. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 5.A60-year-oldwomanhasdevelopedreflexivesympatheticdystrophyafterarthroscopicrepairofher shoulder.Akeyfeatureofthisconditionisthatthe: a.

Affectedextremitywilleventuallyregainitsfunction.

b.

Painisfeltatonesitebutoriginatesfromanotherlocation.

c.

Patientspainwillbeassociatedwithnausea,pallor,anddiaphoresis.

d.

Slightesttouch,suchasasleevebrushingagainstherarm,causessevereandintensepain.

ANS:D Akeyfeatureofreflexivesympatheticdystrophyisthatatypicallyinnocuousstimuluscancreateasevere, intenselypainfulresponse.Theaffectedextremitybecomeslessfunctionalovertime.

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

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DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 6.Thenurseisassessingapatientspain.Thenurseknowsthatthemostreliableindicatorofpainwouldbethe a.

Patientsvitalsigns.

b.

Physicalexamination.

c.

Resultsofacomputerizedaxialtomographicscan.

d.

Subjectivereport.

ANS:D Thesubjectivereportisthemostreliableindicatorofpain.Physicalexaminationfindingscanlendsupport,but thecliniciancannotexclusivelybasethediagnosisofpainonphysicalassessmentfindings. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 7.Apatienthashadarthriticpaininherhipsforseveralyearssinceahipfracture.Sheisabletomovearound inherroomandhasnotofferedanycomplaintssofarthismorning.However,whenasked,shestatesthather painisbadthismorningandratesitatan8ona1-to-10scale.Whatdoesthenursesuspect?Thepatient: NURSINGTB.COM

a.

Isaddictedtoherpainmedicationsandcannotobtainpainrelief.

b.

Doesnotwanttotroublethenursingstaffwithhercomplaints.

c.

Isnotinpainbutratesithightoreceivepainmedication.

d.

Hasexperiencedchronicpainforyearsandhasadaptedtoit.

ANS:D Personswithchronicpaintypicallytrytogivelittleindicationthattheyareinpainand,overtime,adapttothe pain.Asaresult,theyareatriskforunderdetection. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 8.Thenurseisreviewingtheprinciplesofpain.Whichtypeofpainisduetoanabnormalprocessingofthe painimpulsethroughtheperipheralorcentralnervoussystem? a.

Visceral

b.

Referred

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c.

Cutaneous

d.

Neuropathic

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ANS:D Neuropathicpainimpliesanabnormalprocessingofthepainmessage.Theothertypesofpainarenamed accordingtotheirsources. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 9.Whenassessingthequalityofapatientspain,thenurseshouldaskwhichquestion? a.

Whendidthepainstart?

b.

Isthepainastabbingpain?

c.

Isitasharppainordullpain?

d.

Whatdoesyourpainfeellike?

ANS:D NURSINGTB.COM

Toassessthequalityofapersonspain,thepatientisaskedtodescribethepaininhisorherownwords. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 10.Whenassessingapatientspain,thenurseknowsthatanexampleofvisceralpainwouldbe: a.

Hipfracture.

b.

Cholecystitis.

c.

Second-degreeburns.

d.

Painafteralegamputation.

ANS:B Visceralpainoriginatesfromthelargerinteriororgans,suchasthegallbladder,liver,orkidneys. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare 11.Thenurseisreviewingtheprinciplesofnociception.Duringwhichphaseofnociceptiondoestheconsciou awarenessofapainfulsensationoccur?

NURSINGTB.COM

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a.

Perception

b.

Modulation

c.

Transduction

d.

Transmission

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ANS:A Perceptionisthethirdphaseofnociceptionandindicatestheconsciousawarenessofapainfulsensation. Duringthisphase,thesensationisrecognizedbyhighercorticalstructuresandidentifiedaspain. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 12.Whenassessingtheintensityofapatientspain,whichquestionbythenurseisappropriate? a.

Whatmakesyourpainbetterorworse?

b.

Howmuchpaindoyouhavenow?

c.

Howdoespainlimityouractivities? NURSINGTB.COM

d.

Whatdoesyourpainfeellike?

ANS:B Askingthepatienthowmuchpaindoyouhave?isanassessmentoftheintensityofapatientspain;various intensityscalescanbeused.Askingwhatmakesonespainbetterorworseassessesalleviatingoraggravating factors.Askingwhetherpainlimitsonesactivitiesassessesthedegreeofimpairmentandqualityoflife. Askingwhatdoesyourpainfeellikeassessesthequalityofpain. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 13.Apatientiscomplainingofseverekneepainaftertwistingitduringabasketballgameandisrequesting painmedication.Whichactionbythenurseisappropriate? a.

Completingthephysicalexaminationfirstandthengivingthepainmedication

b.

Tellingthepatientthatthepainmedicationmustwaituntilafterthex-rayimagesarecompleted

c.

Evaluatingthefullrangeofmotionofthekneeandthenmedicatingforpain

d.

Administeringpainmedicationandthenproceedingwiththeassessment

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

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ANS:D AccordingtotheAmericanPainSociety(1992),Incasesinwhichthecauseofacutepainisuncertain, establishingadiagnosisisapriority,butsymptomatictreatmentofpainshouldbegivenwhiletheinvestigation isproceeding.Withoccasionalexceptions,(e.g.,theinitialexaminationofthepatientwithanacutecondition oftheabdomen),itisrarelyjustifiedtodeferanalgesiauntiladiagnosisismade.Infact,acomfortablepatient isbetterabletocooperatewithdiagnosticprocedures. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 14.Thenurseknowsthatwhichstatementistrueregardingthepainexperiencedbyinfants? a.

Painininfantscanonlybeassessedbyphysiologicchanges,suchasanincreasedheartrate.

b.

TheFPS-Rcanbeusedtoassesspainininfants.

c.

Aprocedurethatinducespaininadultswillalsoinducepainintheinfant.

d.

Infantsfeelpainlessthandoadults.

ANS:C Ifaprocedureordiseaseprocesscausespaininanadult,thenitwillalsocausepaininaninfant.Physiologic changescannotbeexclusivelyusedtoconfirmordenypainbecauseotherfactors,suchasmedications,fluid NURSINGTB.COM status,orstressmaycausephysiologicchanges.TheFPS-Rcanbeusedstartingatage4years. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 15.Apatienthasbeenadmittedtothehospitalwithvertebralfracturesrelatedtoosteoporosis.Sheisin extremepain.Thistypeofpainwouldbeclassifiedas: a.

Referred.

b.

Cutaneous.

c.

Visceral.

d.

Deepsomatic.

ANS:D Deepsomaticpaincomesfromsourcessuchasthebloodvessels,joints,tendons,muscles,andbone.Referred painisfeltatonesitebutoriginatesfromanotherlocation.Cutaneouspainisderivedfromtheskinsurfaceand subcutaneoustissues.Visceralpainoriginatesfromthelarger,interiororgans. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort

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MULTIPLERESPONSE 1.Duringassessmentofapatientspain,thenurseisawarethatcertainnonverbalbehaviorsareassociatedwith chronicpain.Whichofthesebehaviorsareassociatedwithchronicpain?Selectallthatapply. a.

Sleeping

b.

Moaning

c.

Diaphoresis

d.

Bracing

e.

Restlessness

f.

Rubbing

ANS:A,D,F Behaviorsthathavebeenassociatedwithchronicpainincludebracing,rubbing,diminishedactivity,sighing, andchangesinappetite.Inaddition,thosewithchronicpainmaysleepinanattemptatdistraction.Theother behaviorsareassociatedwithacutepain. DIF:CognitiveLevel:Applying(Application) NURSINGTB.COM

MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 2.Duringanadmissionassessmentofapatientwithdementia,thenurseassessesforpainbecausethepatient hasrecentlyhadseveralfalls.Whichoftheseareappropriateforthenursetoassessinapatientwithdementia? Selectallthatapply. a.

Askthepatient,Doyouhavepain?

b.

Assessthepatientsbreathingindependentofvocalization.

c.

Notewhetherthepatientiscallingout,groaning,orcrying.

d.

Havethepatientratepainona1-to-10scale.

e.

Observethepatientsbodylanguageforpacingandagitation.

ANS:B,C,E Patientswithdementiamaysaynowhen,inreality,theyareveryuncomfortablebecausewordshavelosttheir meaning.Patientswithdementiabecomelessabletoidentifyanddescribepainovertime,althoughpainisstill present.Peoplewithdementiacommunicatepainthroughtheirbehaviors.Agitation,pacing,andrepetitive yellingmayindicatepainandnotaworseningofthedementia.(SeethePainAssessmentinAdvanced Dementia[PAINAD]scale,whichmayalsobeusedtoassesspaininpersonswithdementia.) DIF:CognitiveLevel:Applying(Application)

NURSINGTB.COM

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT 8TH EDITION JARVIS TEST BANK TestBank-PhysicalExaminationandHealthAssessment8e(byJarvis)

MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort

NURSINGTB.COM

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