Fundamentals exam 4

Question 1

Both the ______ and the _______ process stimuli. This processing mobilizes the ________(the sensory receptors for noxious stimuli) and activates their pathways. Once the pathways are activated, the subjective response that a client experiences is described as ______

Answer 1

(CNS) and the peripheral nervous system
peripheral nervous system (PNS)
nociceptors
pain.

Question 2

Pain can also arise from the ________the sensory system within the brain that receives _________ from areas throughout body. Pain can be experienced due to injury of tissue, environmental elements, heat or cold, or damaged or misfiring nerves

Answer 2

somatosensory cortex
impulses

Question 3

Merkel’s identified pain as not only _________, but also linked to both the _______and _______–psychological experiences of individuals.

Answer 3

subjective,
physical and emotional

Question 4

Pain can be caused by _________ that are actual or anticipated,

Answer 4

stimuli

Question 5

(IASP) redefined pain as “an unpleasant sensory and ________ experience associated with, or ________that associated with, actual or potential _______ damage.”

Answer 5

emotional
resembling
tissue

Question 6

When discussing pain, the nurse should be mindful of two terms: pain _______ and pain _______. Both terms are _______, so they vary among clients.

Answer 6

threshold
tolerance

Question 7

pain threshold is the point at which a stimulus causes the client to ______ pain. Pain tolerance is how _____ of a stimulus the client is ______ to accept.

Answer 7

perceive
much
willing

Question 8

The ________ model of pain suggests that three categories of factors form the experience of pain: ______,______ and_______. __________factors identified by Fillingim include disease severity, _______, inflammation, and ______ function.

Answer 8

biopsychosocial
biological, psychological, and social.
biopsychosocial
nociception
brain

Question 9

Psychological factors comprise ______/affect, catastrophizing (______ the worst), stress, and ______. Social factors include ______ and economic factors, the ______ environment, and social support. The biopsychosocial model provides an example of_____ to approach a client’s pain from a _____ perspective.

Answer 9

Psychological factors
mood
assuming
coping

Social factors
cultural
social

biopsychosocial
how
holistic

Question 10

Types of Pain
Acute Versus Chronic

Acute pain has a sudden or slow onset of any intensity and an ______ or _____ end. lasts less than_____ months

Chronic pain has a sudden or slow onset of any intensity and is ________ or ________ without an anticipated or predictable end. longer than ______months

Answer 10

acute pain: anticipated or predictable, 6
chronic: constant or recurring, 6

Question 11

Nociceptive

nociceptive pain, including somatic (with pain occurring in the skin, bones, joints, muscles, or connective tissues), visceral (with pain occurring in the internal organs and), and cutaneous (with pain occurring in the skin or subcutaneous tissue). Cutaneous pain may also be referred to as somatic pain. Nociceptive pain is usually localized and described as ______ or ______.

Answer 11

throbbing or aching

Question 12

Neuropathic

Neuropathic pain is often referred to as nerve pain and arises from the _______ system. Neuropathic pain can include _____ neuropathy, ______ limb pain, and pain associated with a ______cord injury. Neuropathic pain is frequently described as intense, shooting, or ______. Some clients may describe the pain as numbness, “pins and needles,” and even an intense itching.

Answer 12

somatosensory
diabetic
phantom
spinal
burning

Question 13

cancer

Types of pain that may arise from cancer include tumor pain, ______ pain, and treatment-associated pain such as chronic _______pain, ______-induced pain, and neuropathies related to chemotherapy. Each type of cancer pain requires special considerations and treatments.

Answer 13

bone
postsurgical
radiation

Question 14

Children are at a particularly high risk of having pain that may be ______ or not properly assessed.

Answer 14

ignored

Question 15

nurse should use pain scales appropriate for children, such as the Wong-Baker FACES scale, FLACC scale, or CRIES scale to determine the child’s level of pain.

Answer 15

FACES
FLACC
CRIES

Question 16

Adults and older adults can experience pain that is more prevalent and unique to their particular age. Clients in their 30s, 40s, and 50s have more complaints of headaches, abdominal and back pain, and ________ problems than any other age group.

Answer 16

temporomandibular

Question 17

As age increases, pain increase with neuropathic conditions, joint pain, lower extremities

As client ages, the likelihood of experiencing chronic pain conditions also increases. ______conditions such as arthritis, diabetes, and diseases of the heart, liver, kidney, and lungs are all likely to cause pain on a ______basis.

Answer 17

Chronic
daily

Question 18

Clients with _______ impairment or communication challenges (e.g., expressive aphasia) require careful nursing assessment. These clients may not report pain effectively, so the nurse should look for behaviors that suggest pain is present, such as guarding, ______, restlessness, and other behavioral changes.

Answer 18

cognitive
grimacing

Question 19

Not adhering to standards of care for pain management can lead to a charge of ________, defined as a negligent act that has been performed by a professional or trained individual—in this case, a nurse.

Answer 19

malpractice

Question 20

_______ is defined as failing to perform in a manner that a reasonable and ______ person would perform. Along with meeting the current standards of care, nurses should follow pain management practices in accordance with their facility’s policies and procedures.

Answer 20

Negligence
prudent

Question 21

_______is the study of moral principles that guide personal or group behavior. Ethical dilemmas can occur when there are no clear _____ and ______ solutions for a problem. Ethical decisions within health care can be complex, with pain management being included in this complexity.

Answer 21

Ethics, right and wrong

Question 22

Doing good and acting in the best interest of clients by providing care that benefits them is an act of ________ To do good also requires that nurses decrease the suffering of their clients. Controlling and alleviating pain is one way in which nurses can minimize suffering.

Answer 22

beneficence.

Question 23

Another ethical concept involved in pain management is ___________or working to do no harm. Failing to manage a client’s pain can indeed cause harm, and it is each nurse’s ethical responsibility to avoid this outcome.

Answer 23

nonmaleficence,

Question 24

Providing ________to clients entails granting them the right of self-determination. ________ allows clients the freedom of choice, but that choice must be based on ________ decisions.

Answer 24

autonomy
Autonomy
informed

Question 25

The final ethical principle supporting pain management is ______ which requires that all clients be treated equally. The relief of pain should be ______ to all, regardless of age, race, background, or _____

Answer 25

justice,
justice,
history.

Question 26

Nightingale Pledge from 1935 in relation to ethics and pain management:

“I will abstain from whatever is ______and ______and will not take or knowingly administer any harmful drug.”

Answer 26

deleterious
mischievous

Question 27

provider-assisted suicide is legal; in the United States, it is illegal except in _____states.

The nurse may feel this practice is ______and not want to take part in it. In this case, the nurse has the right to refuse to provide care that violates the nurse’s own moral or _____beliefs, and can ask that someone else provide this care.

Answer 27

five
immoral
ethical

Question 28

Providing effective pain management is both an ____ and _____ issue

Answer 28

ethical and moral issue

Question 29

Client rights include the right to pain management, with the caveat that clients should discuss pain with their ______ providers.

Answer 29

health care

Question 30

The terms “_____” and “____” are often used interchangeably and seemingly go hand in hand, but actually have somewhat different meanings.

Answer 30

morality
ethics

Question 31

End-of-Life Care

End-of-life care refers to the ______ that clients receive as they are ______death. Clients nearing the end of life may also believe nothing can be done about their pain so that they _______ report their pain to their families or their health care provider.

Answer 31

support
nearing
do not

Question 32

Subjective and Objective Indicators of Pain

Subjective indicators of pain are based on the client’s ______ or _____

When using a pain ______, the nurse can determine the client’s view of the _____of pain. Further subjective reporting from the client includes the location of the pain, the length of time the pain has been present, what precipitated the pain, what relieves the pain, any radiation of the pain, and how the client characterizes the pain.

Objective indicators of pain are manifestations that the nurse can ________and measure, such as crying, sweating, restlessness, grimacing, or guarding by the client.

Objective indicators are manifestations that can be observed by the nurse using the senses of sight, hearing, smell, and touch. To monitor the client’s objective pain, the nurse can collect objective data such as ______signs, physical assessment findings, laboratory tests and imaging reports, and any other diagnostic information the provider has prescribed.

Answer 32

Subjective indicators of pain
report or opinion.
scale
severity

Objective indicators of pain
observe
vital

Question 33

SUBJECTIVE VS OBJECTIVE INDICATORS OF PAIN

Subjective indicators of pain: pain ____ _____ along with _______ and ______of pain

Objective indicators of pain: _______,_______,_______

Answer 33

subjective: scale score, quantity, quality

objective: grimacing, guarding, crying

Question 34

PQRST

To determine a client’s pain, nurses frequently employ the PQRST mnemonic.

P
Q
R
S
T

Answer 34

P: “What were you doing when the pain started?”

Q: “Describe what your pain feels like.”

R: “Show me the location where you are experiencing pain.”

S: “On a scale of 1 to 10, how would you rate your pain?” (Use one of the pain scales discussed in the next section.)

T: “When did your pain first begin? Have you experienced this pain before?”

Question 35

PAIN SCALE
1 to 3 is _____pain, 4 to 6 is______ pain, and 7 to 10 is _______ pain.

Answer 35

mild
moderate
severe

Question 36

Visual Analog Scale

The Visual Analog Scale (VAS) The VAS consists of either a ______or ______ single line, with one end representing no pain, and the other end representing the worst pain imaginable. The nurse asks the client to select a point along the line that represents the intensity of their pain.

Answer 36

vertical
horizontal