Pain Management Flashcards
During the transduction phase of nociception, which method of pain control is most effective?
1. Tricyclic antidepressants
2. Opioids
3. Ibuprofen
4. Distraction
- Answer: 3. Rationale: During the transduction phase, tissue injury triggers the release of biochemical mediators such as prostaglandin. Ibuprofen works by blocking the production of prostaglandin. The coanalgesic medication in option 1 would affect the modulation phase because coanalgesics inhibit the reuptake of norepinephrine and serotonin, which increases the modulation phase that helps inhibit painful ascending stimuli. Opioids block the release of neurotransmitters, particularly substance P, which stops the pain at the spinal level that occurs during the transmission phase (option 2). Distraction is best used during the perception phase when the client becomes conscious of the pain. Distraction (e.g., music, guided imagery, TV) can help direct the client’s attention away from the pain (option 4). Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 46-2.
When a client has arrived at the nursing unit from surgery, the nurse is most likely to give priority to which of the following assessments?
1. Pain tolerance
2. Pain intensity
3. Location of pain
4. Pain history
- Answer: 2. Rationale: The client’s pain intensity needs to be assessed first for effective pain management. In a postoperative client it is important to assess pain intensity frequently to manage the acute pain experience. Option 1: The most pain a person is willing to tolerate before taking action can be discussed with the client after the pain intensity has been assessed. Option 3, location of pain, is important, but it is not the priority. Option 4: This information is important but not for a client in acute pain. The priority would be to assess the pain intensity. Cognitive Level: Analyzing. Client Need: Safe, Effective Care Environment. Nursing Process: Assessment. Learning Outcome: 46-5.
A client who describes his pain as 7 on a scale of 0 to 10 is classified as having which of the following?
1. No pain
2. Mild pain
3. Moderate pain
4. Severe pain
- Answer: 3. Rationale: A rating of 7 is considered severe and demands immediate attention. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 46-5.
A client who had abdominal surgery 4 hours ago is receiving a continuous epidural infusion of an analgesic. Which of the following observations indicates the nurse should monitor the client closely?
1. Drowsy; drifts off to sleep before completing a sentence
2. Respirations = 18/min
3. Drowsy; easily aroused
4. Pain rating 1–2/10
- Answer: 1. Rationale: This indicates an increasing level of sedation, which can be an early sign of impending respiratory depression. Option 2 is normal. Option 3 can indicate increasing sedation; however, option 1 describes a higher level of sedation and an intervention such as notifying the primary care provider. Option 4 indicates pain management that may be tolerable for the client. Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Implementation. Learning Outcome: 46-7.
The client has an order of morphine 2.5 to 5.0 mg intravenous (IV) every 4 hours. He received 2.5 mg IV 4 hours ago for pain rated at 3 on a scale of 0 to 10. He is now watching television and visiting with family members. When asked about his pain, he rates it as a 5. His vital signs are stable. What nursing intervention is the most appropriate?
1. Give morphine 3.5 mg IV and inform him to continue watching TV because it is a distraction from the pain.
2. Give 2.5 mg of morphine IV to avoid the client becoming addicted.
3. Give nothing at this time because he is not exhibiting any signs of pain.
4. Give morphine 5.0 mg IV and reassess in 20 minutes.
- Answer: 4. Rationale: The client’s perception/intensity rating of his pain is the most important even though other signs may suggest he is not having pain. His pain rating warrants a higher dose of the asneeded (prn) morphine. With option 1, you would be undermedicating the client based on his perception or rating of the pain. Option 2: Research shows that few clients become addicted, plus there are no signs of addiction. This answer, based on the data, would lead to the client being undermedicated. Option 3 does not address the intensity as well as option 4. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Evaluation. Learning Outcome: 46-7.
During an admission nursing assessment, a client with diabetes describes his leg pain as a “dull, burning sensation.” The nurse recognizes this description to be characteristic of which type of pain?
1. Physiological
2. Somatic
3. Visceral
4. Neuropathic
- Answer: 4. Rationale: Options 2 and 3 are subcategories of physiological pain (option 1). A clue to the answer is that the client has diabetes, which often leads to diabetic peripheral neuropathy. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Assessment. Learning Outcome: 46-1.
Which interventions, when implemented by the nurse, would apply the gate control theory of pain? Select all that apply.
1. Oral analgesics around the clock
2. Massage
3. Patient-controlled analgesia
4. Heat or cold application
5. Acupressure
- Answer: 2, 4, and 5. Rationale: Massage, heat and cold, and acupressure are cutaneous stimulation techniques that can “close” the gates and inhibit the transmission of further pain. Options 1 and 3 are pharmacologic interventions, which are important; however, they inhibit the pain during the transmission phase of nociception. Cognitive Level: Applying. Client Need: Physiological Integrity. Nursing Process: Implementation. Learning Outcome: 46-3.
Which statement best reflects the nurse’s assessment of the fifth vital sign?
1. “Do you have any complaints?”
2. “Are you experiencing any discomfort right now?”
3. “Is there anything I can do for you now?”
4. “Do you have any complaints of pain?”
- Answer: 2. Rationale: The words pain or complain may have emotional or sociocultural meanings (options 1 and 4). It is better to ask clients if they are having any discomfort—they can then elaborate in their own words. Option 3 is too general and expects clients to report their pain without being asked. Cognitive Level: Applying. Client Need: Safe, Effective Care Environment. Nursing Process: Assessment. Learning Outcome: 46-5.
When planning care for pain control of older clients, which principles should the nurse apply? Select all that apply.
1. Pain is a natural outcome of the aging process.
2. Pain perception increases with age. 3. The client may deny pain.
4. The nurse should avoid use of opioids.
5. The client may describe pain as an “ache” or “discomfort.”
- Answer: 3 and 5. Rationale: Older clients may deny complaints of pain because it may indicate a worsening of their condition that may threaten their independence. Older adults may use words other than pain. Although many perceive pain as a natural outcome of aging, it is not a natural part of aging (option 1). Pain perception may decrease (option 2) and narcotics can be used with careful monitoring by the nurse (option 4). Cognitive Level: Understanding. Client Need: Physiological Integrity. Nursing Process: Planning. Learning Outcome: 46-7.
A client recovering from abdominal surgery refuses analgesia, saying that he is “fine, as long as he doesn’t move.” Which nursing diagnosis should be a priority?
1. Deficient Knowledge (pain control measures)
2. Ineffective Health Maintenance
3. Risk for Ineffective Airway Clearance 4. Impaired Physical Mobility
- Answer: 1. Rationale: Based on the information provided, the nurse needs to determine the client’s understanding of the effects of pain on recovery and if the client has misconceptions about pain. Option 2 usually pertains more to chronic pain and fatigue. Options 3 and 4 could be true, but the priority is option 1. Movement enhances respiratory, cardiovascular, and GI recovery from general anesthesia and the outcomes associated with a surgical procedure. Cognitive Level: Analyzing. Client Need: Physiological Integrity. Nursing Process: Diagnosis. Learning Outcome: 46-6.
