Question 1

The nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. The nurse notes that the client's respiratory rate is 10 breaths per minute. The client is somnolent, with minimal response to physical stimulation. The nurse should prepare to administer which of the following medications?

Accepted Answer

Morphine is an opioid analgesic, which can cause respiratory depression as a side effect. The client's respiratory rate of 10 breaths per minute indicates significant respiratory depression. Somnolence is also a sign of opioid overdose. Narcan is an opioid antagonist that can reverse the effects of morphine and restore respiratory function. Flumazenil is a benzodiazepine antagonist and is not indicated in this case. Modafinil is a wakefulness-promoting agent and is not indicated in the treatment of respiratory depression. Albuterol is a bronchodilator and is not indicated in this case of opioid-induced respiratory depression.

Question 2

A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and become chronic. What is a characteristic of chronic pain?

Accepted Answer

Chronic pain is defined as pain that persists for an extended period of time, often beyond the normal healing time for an injury or condition. It can have far-reaching effects on the client, including physical and emotional symptoms, and may require long-term management strategies. Chronic pain may not necessarily be severe in its initial stages, and it may not disappear completely with healing. Psychological imbalance may be a potential consequence of chronic pain, but it is not a defining characteristic.

Question 3

A client has an order for a narcotic analgesic every three to four hours and he received his last dose three hours earlier. Which of the following actions is most appropriate for the nurse to take in response to the client's request for pain medication on his first postoperative day?

Accepted Answer

The client has a legitimate order for the medication and it has been long enough since the last dose for another to be administered. The nurse should provide the client with pain medication according to the prescribed frequency and dosage. Choice B is inappropriate because it dismisses the client's pain and does not address the issue. Choice C is also inappropriate as it delays the client's relief and could be seen as neglectful. Choice D is not necessary unless there is an issue with the prescribed medication, which is not specified in this scenario.

Question 4

The nurse is caring for a client with terminal bone cancer. The client states, My pain is getting worse and worse, and the morphine doesn't help anymore. The nurse determines the client's pain is which of the following?

Accepted Answer

Intractable pain is severe, constant, and not relieved by standard medical treatments, such as morphine, which aligns with the client's description.

Question 5

A nurse is assessing a mentally challenged, adult client who is in pain after a fall. Which of the following scales should the nurse use to assess the client's pain?

Accepted Answer

The Pain Assessment in Advanced Dementia (PAINAD) scale is specifically designed for use with patients with advanced dementia or cognitive impairment who are unable to self-report pain. This scale includes five categories of observable behaviors that indicate pain: breathing, negative vocalization, facial expression, body language, and consolability. It has been validated in the literature and is specifically designed for use with clients who have cognitive impairments. The other three scales listed are more appropriate for use with clients who can self-report their pain levels.

Question 6

The nurse has just completed programming of a patient-controlled analgesia (PCA) pump using prescribed parameters. Which of the following actions should you take next?

Accepted Answer

Verifying the settings of a patient-controlled analgesia (PCA) pump with another nurse is a critical safety step to ensure that the medication dosage and limits are correctly programmed according to the physician's orders, reducing the risk of medication errors.

Question 7

A nurse is caring for a client with acute back pain. When should the nurse assess the client's pain?

Accepted Answer

Pain assessment should be an ongoing process, especially when it's a known issue such as acute back pain. Assessing pain whenever vital signs are measured ensures regular monitoring and timely management of the client's pain. This approach allows for adjustments in pain management strategies based on the client's current needs.

Question 8

A nurse asks a client to rate his pain on a scale of 0 to 10, with 0 being no pain and 10 being worst pain. What characteristic of pain is the nurse assessing?

Accepted Answer

The nurse is assessing the intensity of the client's pain by asking them to rate it on a scale of 0 to 10.

Question 9

A nurse is assessing the vital signs of a client who is moaning due to the acute onset of pain. What would be the expected objective findings?

Accepted Answer

When a client is experiencing acute pain, their body will typically respond with an increased pulse and blood pressure, as the body releases stress hormones. Respirations may also increase or become shallow. The client's temperature may or may not change, and it is possible for there to be no change in the client's normal vital signs. However, the presence of moaning suggests that the pain is significant enough to cause physiological changes.

Question 10

A mother calls the nurse practitioner to say, "I don't know what is wrong with my baby. He cried all night and kept pulling at his ear." How would the nurse respond?

Accepted Answer

The baby's symptoms of crying all night and pulling at his ear are indicative of ear pain. Therefore, the nurse should recommend that the mother bring the baby in to be checked for an ear infection or other ear-related issue. Choices A and D make assumptions and do not address the specific symptoms mentioned, while choice B dismisses the mother's concern without providing any guidance.

Question 11

A nurse is assessing a client with arthritis. Which of the following should the nurse consider in the initial assessment of the client?

Accepted Answer

Pain level is important to assess in a client with arthritis as it is a primary symptom. Blood group and glucose level are not directly related to arthritis and anxiety level may be important to assess but is not as crucial as pain level.

Question 12

Besides controlling pain of the post-abdominal surgery client with narcotics, the nurse suggests to the client that he ...

Accepted Answer

Using distraction techniques can be an effective way to manage pain and take the client’s focus away from the discomfort. Focusing solely on pain relief (choice A) or thinking about the next dose (choice D) can increase anxiety and potentially lead to addiction. Describing the pain (choice C) can be helpful for the nurse to assess and manage the pain, but may not necessarily provide relief for the client.

Question 13

The Joint Commission supports the client's right to pain management, and published standards for assessment and management of pain in hospitals, ambulatory care settings, and home care settings (Joint Commission, 2008b). Which of the following are recommended guidelines for pain management? Select all that apply.

Accepted Answer

The Joint Commission recommends teaching clients to use a pain rating scale, determining a pain-rating goal with each client, and manipulating factors that affect the pain experience as guidelines for pain management. Using pharmacologic pain relief measures first and keeping the primary care provider in charge of all pain relief measures are not recommended guidelines.

Question 14

A nurse is ordered to apply a transcutaneous electrical nerve stimulation (TENS) unit to a client recovering from abdominal surgery. Which of the following is a consideration when using this device?

Accepted Answer

TENS involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers. It is a non-invasive technique for providing pain relief. TENS can be used to treat specific or localized pain. The TENS unit can be worn for extended periods of time, but the electrodes should be moved periodically to avoid skin irritation.

Question 15

The nurse talks with a client who states, "My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?" Which of the following responses is most appropriate?

Accepted Answer

TENS units work by sending mild electrical impulses to the nerves along the affected area. These impulses interfere with the pain signals and prevent them from reaching the brain, therefore reducing or blocking pain sensation.

Quiz 34: Comfort and Pain Management