PrepU Comfort & Rest

Question 1

The nurse is caring for a cl. who report N/V for 1 week. How will the nurse document (SATA)
A. neuropathic
B. referred
C. chronic
D. acute
E. visceral

Answer 1

D, E
Visceral pain associated with disease or injury.
Acute pain lasts for a few seconds to less than 5 months.

Question 2

A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse explains the functioning of PCA to the client. What is the MAIN advantage of PCA?
A. Pain is relieved steadily and slowly
B. Reduced visits to HCP
C. The client is actively involved in pain management

Answer 2

C. = self-administers medication
-pain relief is rapid due to IV admin.

Question 3

A client describes pain in the lower leg and has been diagnosed with a herniated lumbar disk. The pain in the leg is what type of pain?
A. Acute
B. Chronic
C. referred
D. limited

Answer 3

C: pain from abdominal, pelvic, or back region may be referred to areas far distant from the site of tissue damage.
Acute pain = more sharp and severe and lasts from 3 to 5 months
Chronic pain= lasting more than 12 weeks

Question 4

Which is considered to be the most potent neuromodulators?
A. afferent
B. efferent
C. endorphins
D. enkephalins

Answer 4

C: endorphins and enkephalins are opioid neuromodulators, endorphins are more powerful and have prolonged analgesic effects.

Question 5

While assessing an infant, the nurse notes that the infant displays an occasional grimace and is withdrawn; legs are kicking, body is arched, and the infant is moaning during sleep. When awakened, the infant is inconsolable. Which scale/score should the nurse use while assessing pain in this infant?
A. Braden scale
B. FACES scale
C. FLACC scale
D. Apgar score

Answer 5

C: (face, legs, activity, cry, and consolability) measures pain for children between ages 2 months and 7 years.
Braden scale is used to predict pressure sore risk
FACES assesses pain in older children using a series of faces, ranging from happy to crying.
Apgar score assesses how well infant tolerated birthing process (done at birth).

Question 6

A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the nurse’s BEST intervention in this situation?
A. ignore the boy’s pain, as he is not complaining
B. Ask the boy to draw a cartoon about the color or shape of his pain
C. Medicate the boy with analgesics to reduce anxiety of experiencing pain
D. Distract the boy so he does not notice his pain.

Answer 6

B. Addressing anxiety does not take care of pain

Question 7

What type of process is involved in pain relief measures done by performing acupressure?

Answer 7

Cutaneous stimulation. E.G. Massage, application of heat and cold, and transcutaneous electrical nerve stimulations (TENS)
Also called “Gate-control theory”

Question 8

Mechanism of action of endogenous opioids:

Answer 8

Binds to opioid receptor sites throughout the CNS = blocks release or production of pain-transmitting substances.

Question 9

Most common side effects associated with opioid use:

Answer 9

sedation, nausea, and constipation

Question 10

The nurse is caring for a client who reports having kidney pain from a urinary tract infection for 3 days. How will the nurse describe this pain when reporting off via SBAR? (SATA)
A. cutaneous
B. somatic
C. visceral
D. referred
E. neuropathic
F. acute
G. chronic

Answer 10

C, F
Visceral pain: discomfort arising from internal organs; associated with disease or injury: appendicitis (inflammation and vermiform appendix)

Question 11

You are a new nurse in an ambulatory care setting. You know that the Joint Commission requires that pain be addressed at each visit. When is the most appropriate time to do so?
A. First question I ask
B. When obtaining client vital signs
C. At discharge
D. At several points throughout your history-taking

Answer 11

B

Question 12

A client has been experiencing persistent back pain despite the regular use of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs). The nurse should encourage the client to speak with the care provider about the use of what adjuvant medication for pain control?
A. antiplatelet aggregator
B. antidepressant
C. cardiotonic
D. potassium-sparing diuretic

Answer 12

B: Antidepressants have been shown to be effective in treating and managing nerve pain. Mechanism of action unkown.

Question 13

A client prescribed pain medication around the clock experiences pain 1 hours before the next dose of pain medication is due. Which is the most appropriate action by the nurse?
A. Assess for medication prescription for breakthrough pain
B. Tell the pt. they will have to wait for 1 hour
C. Administer the next pain medication dose
D. Assess the pt. for opioid addiction

Answer 13

A. Breakthrough pain is temporary flare-up of moderate to severe pain that occurs even when the client is taking pain medication around the clock.

Question 14

When can breakthrough pain occur?

Answer 14

Before the next dose of analgesic is due (end of dose pain)

Question 15

What is breakthrough pain treated with most effectively?

Answer 15

Supplemental doses of a short-acting opioid taken on an “as needed bases”

Question 16

Which types of pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves?

Answer 16

Somatic pain

Question 17

The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After administration of an opioid anesthesia, the nurse observes the client’s resp. rate decreases to 8 breaths per minute. What is the priority action of the nurse?
A. Place cl. in supine position
B. Administer a smaller dose when the next dose is to be given.
C. Administer 0.4 mg of naloxone
D. Perform CPR

Answer 17

C. The client is experiencing impending respiratory arrest due to effect of medication - should be reversed immediately. CPR is only performed if cl. is in full arrest.
Supine position may further decrease respirations.

Question 18

The nurse is caring for a client whose pain is being treated with epidural analgesia. Which nursing action is MOST appropriate:
a. if a client is experiencing adverse effects, a peripheral IV line should be inserted to allow immediate administration of emergency drugs, if warranted.
b. the anesthesiologist/pain management team should be notified immediately if the client’s resp. rate is below 10 breath/min.
c. if the client gets a headache administer a low dose of OxyContin
d. the nurse should anticipate resistance when removing the epidural cathetor

Answer 18

b. breath rate below 10 breaths/min should be notified to the anesthesiologist/pain management team as should unmanaged pain, leakage at the insertion site, fever, inability to void, paresthesia, itching, or headache.
-no other meds. should be administered
-peripheral IV line should already be in place
-resistance should not be felt when removing an epidural cath.

Question 19

A client has just been started on opioid analgesia for pain control. The nurse assesses the client’s level of sedation using a sedation scale and notes that the client is somewhat drowsy but is easily aroused by voice. The nurse would assign which rating?

Answer 19

2: using sedation scale:
1 = client alert and awake
2 = client slightly drowsy but easy to arouse
3 = client is frequently drowsy, arousable but drifts of to sleep during conversation

Question 20

A neonatal nurse is caring for a 2-day-old infant who experienced shoulder subluxation during delivery. What pain assessment scale should the nurse use to assess this client’s pain?
A. Wong-Baker
B. CRIES Pain Scale
C. FLACC Scale
D. PAINAD Scale

Answer 20

B : (0-6 m.o.)
Wong-Bake Faces Pain Rating = 3 y.o.
FLACC = infants and children 2 m.o. - 7 y.o.) unable to validate presence of or quantify pain severity
-PAINAD =client with dementia

Question 21

How should the nurse position the head of the bed for a client receiving epidural opioids?
A. Flat
B. elevated 30 degrees
C. trendelenburg
D. reverse trendelenburg

Answer 21

B: Unless contraindicated. This minimizes upward migration of the opioid in the spinal cord, decreasing risk for resp. depression.
-Trendelenburg is when the feet are higher than the head.
-Reverse Trendelenburg = supine position = head higher than the feet

Question 22

A client comes to the emergency department complaining of shooting pain in chest. When assessing client pain, which behavioral response would the nurse expect to find?
A. High blood pressure
B. Guarding of the chest area
C. Increase respiratory rate
D. Decreased heart rate

Answer 22

B: Behavioral includes: guarding painful area, grimacing, crying or moaning.
Physiologic (sympathetic) response to moderate pain = increase bp and resp. rate.
-Physiologic (parasympathetic) response to severe pain = decreased HR

Question 23

A client tells the nurse that they are experiencing stabbing pain in the mouth, gums, teeth, and chin following brushing her teeth. These are symptoms of:
A. diabetic neuropathy
B. trigeminal neuralgia
C. postherpetic neuralgia
D. complex regional pain syndrome

Answer 23

B: symptomology = paroxysoms of lightning-like stabs of intense pain in the distribution of one or more divisions of the trigeminal nerve, the 5th cranial nerve. Pain experienced in mouth, gums, lips, nose, cheek, chin, and surface of the head and may be triggered by everyday activities like talking, eating, shaving, or brushing one’s teeth.
-Postherpetic neuralgia affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear, usually from chickenpox virus.
-Complex regional pain syndrome (CRPS) = chronic pain condition that most often affects one limb (arm, leg, hand, or foot), usually after an injury = caused by damage to or malfunction of the peripheral and CNS, developing after injury, surgery, stroke, or heart attack.
-Diabetic neuropathy= nerve damage that can occur if a client has diabetes-causing damages to the nerves in the legs and feet

Question 24

A postoperative vaginal hysterectomy client complains of pain that is more intense than this morning. This factor should be explained to the client as:
A. Your present pain is worse because you had your packing removed
B. Acute pain tends to increase during the day and is called a routine pain response
C. You will need more pain medication as the days progress
D. I will call your doctor because you may have loosened sutures when walking

Answer 24

B: occurs abruptly after injury or disease and persists until healing occurs. may be associated with anxiety and fear; consistently increases at night and during wound care, ambulation, coughing, and deep breathing

Question 25

Which client would be the BEST candidate to receive epidural analgesia for pain management?
A. A client recovering from recent hip replacement surgery
B. A client who experiences frequent episodes of lower back pain
C. A client with a brain tumor

Answer 25

A: more commonly used to provide pain relief during the immediate postoperative phase and for chronic pain situations. Also used for children with terminal cancer and children undergoing hip, spinal, or lower-extremity surgery.
-Pain that is less severe or has an acute onset is not normally treated this way.
-A brain tumor may or may not have manifestations that require an epidural analgesia.

Question 26

A client presents with reports of acute pain. The nurse’s assessment indicates the client is likely experiencing moderate, superficial acute pain. What assessment finding(s) would corroborate this conclusion? (SATA)
A. cool, moist skin
B. increased BP
C. decreased level of consciousness
D. increased pulse
E. increased resp. rate

Answer 26

B. D. E. : SNS response to moderate superficial cute pain.
-Cool, moist skin may be present but this is associated with many other diagnoses apart from pain.

Question 27

What is a good question to ask to assess chronology of pain a client is experiencing?

Answer 27

How does the pain develop and progress?

Question 28

What is a good question to assess the quality of cl. pain?

Answer 28

How would you describe the pain?

Question 29

A nurse is caring for a postgurgical client whose pain in being treated with the opioid hydromorphone. The nurse’s most recent assessment reveals that the client is drowsy and drifting off during conversation with the nurse; however, the client can be aroused. What is the nurse’s MOST appropriate action?

Answer 29

Report this finding to the primary care provider and seek a decrease in the client’s opioid dosing.

-Sedation score is a 3. Requires collaboration with PCP to decrease analgesic dose. Naloxone is not likely necessary (check resp. rate)

Question 30

After the nurse has instructed a client with low-back pain about the use of transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what?
A. I may need fewer pain medications with the TENS unit in place.
B. Wearing the TENS unit should not interfere with my daily activities
C. I could use the TENS unit if I feel pain somewhere else in my body
D. One advantage of the TENS unit is it increases blood flow.

Answer 30

C:
Unit should be used as prescribed and location defined by the HCP.

Question 31

What will the nurse place at the bedside of a client receiving epidural analgesia?

Answer 31

Ampule of 0.4 mg naloxone

Question 32

A nurse giving a client a massage notes the presence of a nonblanching reddened area on the client’s sacrum. What is the nurse’s BEST action?
A. Avoid massaging this area and report the finding to the health care provider
B. Avoid massaging the area and apply a thin layer of a topical antibiotic ointment.

Answer 32

A. Document and repot. Antibiotic ointments are not applied to areas of possible skin breakdown.

Question 33

The nurse is caring for a client who frequently comes to the ED reporting a headache that is an 8 or 9 on a pain scale of 1 to 10. The client is noted to be laughing while on the phone and chatting with staff after reporting a headache that is a 10. Which action will the nurse perform prior to initiating treatment.
A. Discuss observations with the client
B. Assess for nonverbal cues to pain

Answer 33

B: Nurse must not make assumptions about how a client experiences or interprets pain; should acknowledge pain as client reports.