Chapter 9: Pain Management Flashcards
(40 cards)
- The nurse, who is a member of the palliative care team, is assessing a client. The client
reports saving client-controlled analgesics (PCA) until the pain is intense because pain
control has been inadequate. What client education should the nurse give this client?
A. Medication should be taken when pain levels are low so the pain is easier to
reduce.
B. Pain medication can be increased when the pain becomes intense.
C. It is difficult to control chronic pain, so this is an inevitable part of the disease
process.
D. The client will likely benefit more from distraction than pharmacologic
interventions.
ANS: A
Rationale: Better pain control can be achieved with a preventive approach, reducing the amount of time clients are in pain. Low levels of pain are easier to reduce or control than intense levels of pain. Pain medication is used to prevent pain so pain medication is not increased when pain becomes intense. Chronic pain is treatable. Giving the client alternative methods to control pain is good, but it will not work if the client is in so much pain that they cannot implement reliable alternative methods.
- Two clients have recently returned to the postsurgical unit after knee arthroplasty. One
client is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other client is
reporting a pain level of 3 to 4 on the same pain scale. What is the nurse’s most plausible
rationale for understanding the clients’ different perceptions of pain?
A. Awareness and emotions affect the perception of pain.
B. One of the clients is exaggerating the sense of pain.
C. The clients are likely experiencing a variance in vasoconstriction.
D. One of the clients may be experiencing opioid tolerance.
ANS: A
Rationale: Different people feel different degrees of pain from similar stimuli due to the effects of awareness and emotions, which vary from person to person. The nurse should not assume the client is exaggerating the pain, because clients are the best authority on their pain, and definitions for pain state that pain is “whatever the person says it is, existing whenever the experiencing person says it does.” Variances in vasoconstriction do not affect pain perception. Opioid tolerance is associated with chronic pain treatment and would not likely apply to these clients.
- The nurse is caring for a 71-year-old client who experienced a humeral fracture in a
fall. The client is receiving an opioid for pain control. Which principle of pain management
for an older adult should the nurse apply?
A. Monitor for signs of drug toxicity.
B. Assess for an increase in absorption of the drug.
C. Monitor for a paradoxical increase in pain.
D. Administer higher doses of opioids to relieve pain.
ANS: A
Rationale: Because older adults have an increased sensitivity to co-analgesic agents and more comorbidities compared with younger people, the nurse should monitor for drug
toxicity. Absorption of drugs is not increased in older adults, nor is there a paradoxical increase in pain. Higher doses of opioids should not be administered to older adults; rather, the dose should be reduced because they are more likely to have adverse effects.
- The nurse is assessing a client’s pain while the client awaits a cholecystectomy. The
client is tearful, hesitant to move, and grimacing, but reports feeling pain as a 2 at this
time on a 0-to-10 pain scale. How should the nurse best respond to this assessment
finding?
A. Remind the client that they are indeed experiencing pain.
B. Reinforce education about the pain scale number system.
C. Reassess the client’s pain in 30 minutes.
D. Administer an analgesic and then reassess.
ANS: B
Rationale: The client’s numerical pain rating (2) does not match the physical signs of pain they are exhibiting. The nurse may need to provide further client education so the client can correctly rate the pain. The nurse may also need to verify that the same scale is being used by the client and caregiver, to promote continuity. Although all answers are correct, the best initial approach would be to reinforce education about the pain scale.
- The nurse is creating a nursing care plan for a client with a primary diagnosis of
cellulitis and a secondary diagnosis of chronic pain. What common trait of clients who live
with chronic pain should be integrated into care planning?
A. They are typically more comfortable with underlying pain than clients without
chronic pain.
B. They often have a lower pain threshold than clients without chronic pain.
C. They often have an increased tolerance of pain.
D. They can experience acute pain in addition to chronic pain.
ANS: D
Rationale: It is tempting to expect that people who have had multiple or prolonged experiences with pain will be less anxious and more tolerant of pain than those who have
had little experience with pain. However, this is not true for many people. The more experience a person has had with pain, the more frightened they may be about subsequent painful events. Chronic pain and acute pain are not mutually exclusive. These clients may not have a different pain threshold or tolerance to pain.
- A client with osteoarthritis of the hip for a number of years reports a dull, aching pain
with ambulation and pain shooting down the leg at night while sleeping. The nurse
recognizes that the client is experiencing which type of pain?
A. Acute pain
B. Breakthrough pain
C. Chronic pain
D. Neuropathic pain
ANS: C
Rationale: The pain from osteoarthritis is a chronic pain that persists over a period of time due to the degeneration of the hip joint. Acute pain has a shorter duration and resolves
with healing. Breakthrough pain is a temporary increase in controlled persistent pain. Neuropathic or pathophysiologic pain is caused by injury to a nerve with impaired
processing of sensory input.
- A client has just returned from the postanesthesia care unit (PACU) following left tibia
open reduction internal fixation. The client is reporting pain, and the nurse is preparing to
administer intravenous hydromorphone. Prior to administering the drug, the nurse
should prioritize which assessment?
A. Electrolyte levels
B. Heart rate
C. Respiratory status
D. Hydration
ANS: C
Rationale: Before administering an opioid, the nurse should assess the client’s respiratory rate and depth of respirations because opioids can cause respiratory depression, especially coupled with the effects of anesthesia. The nurse should also monitor electrolyte levels, heart rate, and hydration, but respiratory rate and depth are the priority assessment.
- A client is receiving postoperative morphine through a client-controlled analgesia
(PCA) pump and the client’s prescriptions specify an initial bolus dose. What is the nurse’s
priority assessment?
A. Assessment for decreased level of consciousness (LOC)
B. Assessment for respiratory depression
C. Assessment for fluid overload
D. Assessment for paradoxical increase in pain
ANS: B
Rationale: A client who receives opioids by any route must be assessed frequently for changes in respiratory status. Sedation is an expected effect of a narcotic analgesic,
though severely decreased LOC is problematic. Fluid overload and paradoxical increase in pain are unlikely, though opioid-induced hyperalgesia (OIH) occurs in rare instances.
- A client is asking for a breakthrough dose of analgesia. The pain-medication
prescriptions are written as a combination of an opioid analgesic and a nonsteroidal
anti-inflammatory drug (NSAID) given together. What is the primary rationale for
administering pain medication in this manner?
A. To prevent respiratory depression
B. To eliminate the need for additional medication during the night
C. To achieve better pain control than with one medication alone
D. To eliminate the potentially adverse effects of the opioid
ANS: C
Rationale: A multimodal regimen combines drugs with different underlying mechanisms, which allows better pain control than with one medication alone. This, in turn, allows for lower doses of each of the drugs in the treatment plan, reducing the potential for each to produce adverse effects. This method also reduces, but does not eliminate, adverse
effects of the opioid. This regimen is not motivated by the need to prevent respiratory depression or to eliminate nighttime dosing.
- The nurse is caring for a client with metastatic bone cancer. The client asks the nurse,
“Why am I getting larger doses of this pain medication? It does not seem to be affecting
me.” What is the nurse’s best response?
A. “Over time you become more tolerant of the drug.”
B. “You may have become immune to the effects of the drug.”
C. “You may be developing a mild addiction to the drug.”
D. “Your body absorbs less of the drug due to the cancer.”
ANS: A
Rationale: Over time, the client is likely to become more tolerant of the dosage. Little evidence indicates that clients with cancer become addicted to the opioid medications.
Clients do not become immune to the effects of the drug, and the body does not absorb less of the drug because of the cancer.
- A client is receiving care on the oncology unit for breast cancer that has metastasized
to the lungs and liver. When addressing the client’s pain in the plan of nursing care, the
nurse should consider which characteristic of cancer pain?
A. Cancer pain is often related to the stress of the client knowing they have cancer
and requires relatively low doses of pain medications along with a high dose of
anti-anxiety medications.
B. Cancer pain is always chronic and challenging to treat, so distraction is often the
best intervention.
C. Cancer pain can be acute or chronic and typically requires comparatively high
doses of pain medications.
D. Cancer pain is often misreported by clients because of confusion related to their
disease process.
ANS: C
Rationale: Pain associated with cancer may be acute or chronic. Pain resulting from cancer is so ubiquitous that when cancer clients are asked about possible outcomes, pain is reported to be the most feared outcome. Higher doses of pain medication are usually needed with cancer clients, especially with metastasis. Cancer pain is not treated with anti-anxiety medications. Cancer pain can be chronic and difficult to treat so distraction may help, but higher doses of pain medications are usually the best intervention. No research indicates cancer clients misreport pain because of confusion related to their disease process.
- The nurse is admitting a client with an abdominal tumor who is experiencing
increasing unrelieved pain over the last three days despite taking opioids, as prescribed.
Which sign—a manifestation of unrelieved pain—should the nurse expect to assess in this
client?
A. Hyperglycemia
B. Bradycardia
C. Hyperactive bowel sounds
D. Poor skin turgor
ANS: A
Rationale: Unrelieved pain produces harmful effects on many body systems. Reduced insulin secretion can cause elevated blood glucose levels. Tachycardia (not bradycardia)
may occur with the increased release of catecholamines. Decreased gastric and bowel motility would occur, resulting in hypoactive (not hyperactive) bowel sounds. With
increased secretion of antidiuretic hormone, fluid volume overload can occur. Poor skin turgor is a sign of fluid volume deficit, or dehydration.
- The nurse in a pain clinic is caring for a client who has long-term, intractable pain. The
pain team feels that first-line pharmacologic methods of pain relief have been ineffective.
Which recommendation should guide this client’s subsequent care?
A. The client may benefit from new alternative pain management options that are
available in other countries.
B. The client may benefit from a multimodal approach to pain management.
C. The client may need to increase exercise and activity levels significantly to
create distractions.
D. The client may need to relocate to long-term care to have activities of daily living
needs met.
ANS: B
Rationale: In some situations, especially with long-term severe intractable pain, pharmacologic methods of pain relief alone are ineffective. In those situations, a
multimodal approach to pain management, including nonpharmacologic interventions, may be considered. Investigating new alternative pain-management options that are available abroad is unrealistic and may even be dangerous advice. Increasing exercise and activities to create distractions is unrealistic when a client is in intractable pain, and this recommendation conveys the attitude that the pain is not real. Moving to a long-term care facility so others may care for the client does not address the issue of pain.
- The home health nurse is caring for a homebound client who is terminally ill and is
delivering a client-controlled analgesia (PCA) pump at today’s visit. The family members
will be taking care of the client. What would the nurse’s priority interventions be for this
visit?
A. Teach the family the theory of pain management and the use of alternative
therapies.
B. Provide psychosocial family support during this emotional experience.
C. Provide client and family teaching regarding the operation of the pump,
monitoring the IV site, and knowing the side effects of the medication.
D. Provide family teaching regarding use of morphine, recognizing morphine
overdose, and offering spiritual guidance.
ANS: C
Rationale: If PCA is to be used in the client’s home, the client and family are taught about the operation of the pump as well as the side effects of the medication and strategies to
manage them. The family would also need to monitor the IV site and notify the nurse of any changes, such as infiltration, that could endanger the client. Teaching the family the
theory of pain management or the use of alternative therapies and the nurse providing emotional support are important, but the family must be able to operate the pump as well as know the side effects of the medication and strategies to manage them. Offering spiritual guidance would not be a priority at this point and morphine is not the only medication given by PCA.
- A client with cancer expresses concern to the nurse that increasingly higher doses of
opioids are needed to control pain and the client is concerned about opioid overdose and
addiction. Which concept of pain management should guide the nurse’s response to this
client?
A. Addiction occurs when higher doses are needed to control pain.
B. The need for increasing doses of opioids to control pain is a sign of substance use
disorder (SUD).
C. Opioid-induced hyperalgesia results in the need for increasing doses of opioids.
D. Tolerance develops when higher doses are needed to control pain.
ANS: D
Rationale: Clients requiring opioids for chronic pain, especially cancer clients, need increasing doses to relieve pain. The requirement for higher drug doses results in a
greater drug tolerance, which is a physical dependency as opposed to addiction, which is a psychological dependency. Although tolerance to the drug will increase, addiction (also
known as substance use disorder) is not dose related, but is a separate psychological dependency issue. Opioid-induced hyperalgesia causes an increased sensitivity (lowered
threshold) for pain and does not result in the need for higher doses of opioids.
- The nurse is caring for a client with back pain. The nurse reviews the medications and
sees that an NSAID (ibuprofen) is prescribed every 6 hours as needed. How should the
nurse best implement preventive pain measures?
A. Let the client know ibuprofen is available every 6 hours, if needed.
B. Administer ibuprofen if the client’s pain rating is 5 or higher, on a 0 to 10 scale.
C. Use a pain scale to assess client’s pain and offer ibuprofen every 6 hours.
D. Assume the client is not in pain if the client does not request pain medication.
ANS: C
Rationale: Offering pain medication every 6 hours, rather than as needed, provides better pain control since analgesic blood levels are maintained at a stable level. The nurse
should let the client know the analgesic is available every 6 hours, if needed, but the nurse should also offer the analgesic every 6 hours and encourage its use to maintain
better pain control. An analgesic should be administered when the client is uncomfortable, which is not the same level in all clients and not necessarily at a rating of
5 out of 10. Each client reacts to pain differently, and the nurse should not assume that a client is not in pain if the client does not request an analgesic.
- A client who had abdominal surgery reports extreme pain when the bed sheet
touches the abdomen. Which concept does the nurse use to explain this phenomenon to
the client?
A. Hyperalgesia
B. Nociceptive pain
C. Phantom pain
D. Allodynia
ANS: D
Rationale: This client is experiencing allodynia, pain which occurs due to a non-noxious stimulus (the bed sheet) that does not normally cause pain, caused by nerve injury
around the abdominal incision. Hyperalgesia (an increased intensity of pain) and nociceptive pain are caused by noxious stimuli. Phantom pain is a postsurgical pain syndrome due to peripheral nerve damage that may occur after amputation of a limb.
- The nurse is caring for a client with dementia who has a fractured femur secondary to
a fall. Which approach should the nurse take in regard to pain management with this
client?
A. Assume that a client with dementia does not feel pain.
B. Document that the client is not in pain if the client is sleeping.
C. Assess vital signs to determine if the client is in pain.
D. Assume that a fracture is painful and the client is in pain.
ANS: D
Rationale: When assessing a nonverbal or uncommunicative client for pain, such as the client with dementia, consider whether the client has a condition that is typically painful
and treat the client accordingly. A client with dementia can feel pain even if the client is unable to verbalize pain. Being asleep is not an indicator that the client does not have
pain. While vital signs may change with pain, they are the least sensitive indicators of pain.
- An unlicensed assistive personnel (UAP) reports to the nurse that a postsurgical client
has pain rated as 8 on a 0-to-10-point scale. The UAP tells the nurse that the client is
exaggerating and does not need pain medication. What is the nurse’s best response?
A. “Since pain often comes and goes with postsurgical clients, reassess the client’s
pain in 30 minutes.”
B. “We need to provide pain medications because it is the law, and we must always
follow the law.”
C. “Unless there is strong evidence to the contrary, we should take the client’s
report at face value.”
D. “It’s not unusual for clients to misreport pain to get our attention when we are
busy.”
ANS: C
Rationale: Self-report is considered the most reliable measure of the existence and intensity of the client’s pain and is recommended by the Joint Commission. A broad
definition of pain is “whatever the person says it is, existing whenever the experiencing person says it does.” Action should be taken unless there are demonstrable extenuating
circumstances. Rechecking without offering an intervention would be insufficient, and the law is not the sole reason for providing care. It would be wrong for the nurse to teach the
UAP that clients report pain to get the nurse’s attention.
- The home health nurse is developing a plan of care for a client who will be managing
chronic pain at home with NSAID analgesics. Which pain management interventions
should the nurse teach the client? Select all that apply.
A. Use a pain assessment tool to monitor pain levels and response to interventions.
B. Monitor for adverse analgesic effects and notify the health care provider if they
occur.
C. Take an analgesic when the pain reaches an intolerable level.
D. Discuss signs and symptoms and risk of addiction.
E. Discuss the use of nonpharmacologic measures of pain control.
ANS: A, B, E
Rationale: To promote self-management of pain at home, the nurse teaches the client to use a pain rating scale to monitor the level of pain in response to interventions. The client should also be taught adverse effects of medications that require medical attention. The client should be instructed to take an analgesic when pain is first felt, not when it reaches an intolerable level. Additionally, the nurse should also discuss nonpharmacologic measures to control pain, such as heat/cold, transcutaneous electrical nerve stimulation, and relaxation breathing. Since this client is not using opioid medications to control pain, there is no risk of addiction.
- The emergency department nurse is caring for an adult client who was in a motor
vehicle accident. Radiography reveals an ulnar fracture. Which type of pain is the nurse
addressing with this client?
A. Chronic
B. Acute
C. Intermittent
D. Osteopenic
ANS: B
Rationale: Acute pain is usually of recent onset and commonly associated with a specific injury. Acute pain indicates that damage or injury has occurred. Chronic pain is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributed to a specific cause or injury. Phantom pain occurs when the body experiences a loss, such as an amputation, and still feels pain in the missing part. “Osteopenic” pain is not a recognized category of pain.
- A client’s spouse is concerned because the client is requiring increasingly high doses
of analgesia. The spouse reports that the client, “was in pain long before the cancer
diagnosis because of a broken back about 20 years ago. For that problem, though, the
pain medicine wasn’t just raised and raised.” What would be the nurse’s best response?
A. “I did not know that. I will speak to the health care provider about your
husband’s pain control.”
B. “Much cancer pain is caused by tumor involvement and needs to be treated in a
way that brings the client relief.”
C. “Cancer is a chronic kind of pain, so the more it hurts the client, the more
medicine we give the client until it no longer hurts.”
D. “Does the increasing medication dosage concern you?”
ANS: B
Rationale: Much pain associated with cancer is a direct result of tumor involvement. Conveying client/family concerns to the health care provider is something a nurse does,
but is not the best response by the nurse. Cancer pain can be either acute or chronic, and you do not tell a family member that you are going to keep increasing the dosage of the medication until “it does not hurt anymore.” The family member is obviously concerned.
- A 75-year-old client has been admitted to the rehabilitation facility after falling and
fracturing the left hip. The client has not regained functional ability and may have to be
readmitted to an acute-care facility. When planning this client’s care, what should the
nurse know about the negative effects of the stress associated with pain?
A. Stress is less pronounced in older adults because they generally have more
sophisticated coping skills than younger adults.
B. Stress is particularly harmful in older adults who have been injured or who are
ill.
C. It affects only those clients who are already debilitated prior to experiencing
pain.
D. It has no inherent negative effects; it just alerts the person/health care team of
an underlying disease process.
ANS: B
Rationale: The widespread endocrine, immunologic, and inflammatory changes that occur with the stress of pain can have significant negative effects. This is particularly
harmful in clients whose health is already compromised by age, illness, or injury. Older adults are not immune to the negative effects of stress. Prior debilitation does not have
to be present in order for stress to cause potential harm.
- The nurse is caring for a client with a fractured pelvis and a ruptured bladder resulting
from a motor vehicle accident. The nurse’s aide (NA) reports concern to the nurse
because the client’s resting heart rate is 110 beats per minute, respirations are 24
breaths per minute, temperature is 37.3°C (99.1°F) axillary, and the blood pressure is
125/85 mm Hg. What other information is most important as the nurse assesses this
client’s physiologic status?
A. The client’s understanding of pain physiology
B. The client’s serum glucose level
C. The client’s white blood cell count
D. The client’s rating of their pain
ANS: D
Rationale: The nurse’s assessment of the client’s pain is a priority. There is no suggestion of diabetes, and leukocytosis would not occur at this early stage of recovery. The client
does not need to fully understand pain physiology to communicate the presence, absence, or severity of pain.
