Question 1

A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia.The client scores a zero.What action by the nurse is best?

Accepted Answer

Assessing pain in a nonverbal client is difficult despite the use of a scale specifically designed for this population.The nurse should next look at physiologic indicators of pain and vital signs for clues to the presence of pain.Even a low score on this index does not mean the client does not have pain; he or she may be holding very still to prevent more pain.Documenting pain is important but not the most important action in this case.The nurse can try a small dose of analgesia,but without having indices to monitor,it will be difficult to assess for effectiveness.However,if the client has a condition that could reasonably cause pain (i.e.,recent surgery),the nurse does need to treat the client for pain.

Question 2

A new nurse reports to the precepting nurse that a client requested pain medication,and when the nurse brought it,the client was sound asleep.The nurse states the client cannot possibly sleep with the severe pain the client described.What response by the experienced nurse is best?

Accepted Answer

A client's description is the most accurate assessment of pain.The nurse should believe the client and provide pain relief.Physiologic changes due to pain vary from client to client,and assessments of them should not supersede the client's descriptions,especially if the pain is chronic in nature.Asking if the new nurse has had pain is judgmental and flippant,and does not provide useful information.This amount of information does not warrant an assessment for drug addiction.Putting the medication back and ignoring the client's report of pain serves no useful purpose.

Question 3

A nurse is assessing pain on a confused older client who has difficulty with verbal expression.What pain assessment tool would the nurse choose for this assessment?

Accepted Answer

All are valid pain rating scales; however,some research has shown that the FACES Pain Scale-Revised is preferred by both cognitively intact and cognitively impaired adults.

Question 4

A client has received an opioid analgesic for pain.The nurse assesses that the client has a Pasero Scale score of 3 and a respiratory rate of 7 shallow breaths/min.The client's oxygen saturation is 87%.What action should the nurse perform first?

Accepted Answer

The Pasero Opioid-Induced Sedation Scale is used to assess for unwanted opioid-associated sedation.A Pasero Scale score of 3 is unacceptable but is managed by trying to arouse the client in order to take deep breaths and staying with the client until he or she is more alert.Administering oxygen will not help if the client's respiratory rate is 7 breaths/min.Giving naloxone and calling for a Rapid Response Team would be appropriate for a higher Pasero Scale score.

Question 5

The nurse is assessing a client's pain and has elicited information on the location,quality,intensity,effect on functioning,aggravating and relieving factors,and onset and duration.What question by the nurse would be best to ask the client for completing a comprehensive pain assessment?

Accepted Answer

A comprehensive pain assessment includes the items listed in the question plus the client's opinion on a functional goal,such as what pain rating would be acceptable to him or her.Asking about addiction is not warranted in an initial pain assessment.Asking about spiritual meanings for pain may give the nurse important information,but getting the basics first is more important.Asking about pain tolerance may give the client the idea that pain tolerance is being judged.

Question 6

A registered nurse (RN)and nursing student are caring for a client who is receiving pain medication via patient-controlled analgesia (PCA).What action by the student requires the RN to intervene?

Accepted Answer

The client is the only person who should press the PCA button.If the client cannot reach it,the student should either reposition the client or the button,and should not press the button for the client.The RN should intervene at this point.The other actions are appropriate.

Question 7

A hospitalized client has a history of depression for which sertraline (Zoloft)is prescribed.The client also has a morphine allergy and a history of alcoholism.After surgery,several opioid analgesics are prescribed.Which one would the nurse choose?

Accepted Answer

Hydromorphone is a good alternative to morphine for moderate to severe pain.The nurse should not choose Lorcet because it contains acetaminophen (Tylenol)and the client has a history of alcoholism.Tramadol should not be used due to the potential for interactions with the client's sertraline.Meperidine is rarely used and is often restricted.

Question 8

A hospitalized client uses a transdermal fentanyl (Duragesic)patch for chronic pain.What action by the nurse is most important for client safety?

Accepted Answer

The old fentanyl patch should be removed when applying a new patch so that accidental overdose does not occur.The other actions are appropriate,but not as important for safety.

Question 9

A nurse is preparing to give a client ketorolac (Toradol)intravenously for pain.Which assessment findings would lead the nurse to consult with the provider?

Accepted Answer

Drugs in this category can affect renal function.Clients should be adequately hydrated and demonstrate good renal function prior to administering ketorolac.A urine output of 20 mL/2 hr is well below normal,and the nurse should consult with the provider about the choice of drug.Crackles and hypoactive bowel sounds are not related.A pain report of 3 does not warrant a call to the physician.The medication may be part of a round-the-clock regimen to prevent and control pain and would still need to be given.If the medication is PRN,the nurse can ask the client if he or she still wants it.

Question 10

The nurse in the surgery clinic is discussing an upcoming surgical procedure with a client.What information provided by the nurse is most appropriate for the client's long-term outcome?

Accepted Answer

The best outcome after a surgical procedure is timely and satisfactory pain control,which diminishes the likelihood of chronic pain afterward.The nurse suggests that the client advocate for himself and discuss acceptable pain control with the surgeon.Stating that pain after surgery is usually short lived does not provide the client with options to have personalized pain control.To prevent or reduce nausea and other side effects from opioids,a multimodal pain approach is desired.For acute pain after surgery,giving pain medications around the clock instead of waiting until the client requests it is a better approach.

Question 11

A nurse on the postoperative inpatient unit receives a hand-off report on four clients using patient-controlled analgesia (PCA)pumps.Which client should the nurse see first?

Accepted Answer

Continuous delivery of opioid analgesia can lead to respiratory depression and extreme sedation.A respiratory rate of 8 breaths/min is below normal,so the nurse should first check this client.The client sleeping soundly could either be overly sedated or just comfortable and should be checked next.Pressing the button every 10 minutes indicates the client has a high level of pain,but the device has a lockout determining how often a bolus can be delivered.Therefore,the client cannot overdose.The nurse should next assess that client's pain.The client who has not needed a bolus of pain medicine in several hours has well-controlled pain.

Question 12

A student nurse asks why several clients are getting more than one type of pain medication instead of very high doses of one medication.What response by the registered nurse is best?

Accepted Answer

Pain is a complex phenomenon and often responds best to a regimen that uses different types of analgesia.This is called a multimodal approach.Using this terminology,however,may not be clear to the student if the terminology is not understood.Doctors may be more liberal with pain medications,but that is not the best reason for this approach.Saying that clients are consumers who demand medications sounds as if the nurse is discounting their pain experiences.

Question 13

An older adult has diabetic neuropathy and often reports unbearable foot pain.About which medication would the nurse plan to educate the client?

Accepted Answer

Antidepressants and anticonvulsants often are used for neuropathic pain relief.Morphine would not be used for this client.However,older adults do not tolerate tricyclic antidepressants very well,which eliminates desipramine and nortriptyline.Duloxetine would be the best choice for this older client.

Question 14

An emergency department (ED)manager wishes to start offering clients nonpharmacologic pain control methodologies as an adjunct to medication.Which strategy would be most successful with this client population?

Accepted Answer

Listening to music on a headset would be the most successful cognitive-behavioral pain control method for several reasons.First,in the ED,the nurse does not have time to teach clients complex modalities such as guided imagery or biofeedback.Second,clients who are anxious and in pain may not have good concentration,limiting the usefulness of video games.Playing music on a headset only requires the client to wear the headset and can be beneficial without strong concentration.A wide selection of music will make this appealing to more people.

Question 15

A nurse is assessing pain in an older adult.What action by the nurse is best?

Accepted Answer

Some older clients do not report pain because they think it is a normal part of aging or because they do not want to be a bother.Sitting down conveys time,interest,and availability.Ask only one question at a time and allow the client enough time to answer it.Yes-or-no questions are an example of poor communication technique.Giving the client a pain scale,then leaving,might give the impression that the nurse does not have time for the client.Plus the client may not know how to use it.There is no normal pain from aging.

Question 16

The nurse receives a hand-off report.One client is described as a drug seeker who is obsessed with even tiny changes in physical condition and is "on the light constantly" asking for more pain medication.When assessing this client's pain,what statement or question by the nurse is most appropriate?

Accepted Answer

This is an example of therapeutic communication.A client who is preoccupied with physical symptoms and is "demanding" may have some psychosocial impact from the pain that is not being addressed.The nurse is providing the client the chance to explain the emotional effects of pain in addition to the physical ones.Saying the nurse wishes he or she could do more is very empathetic,but this response does not attempt to learn more about the pain.Simply telling the client when the next medication is due also does not help the nurse understand the client's situation."Why" questions are probing and often make clients defensive,plus the client may not have an answer for this question.

Question 17

A client is put on twice-daily acetaminophen (Tylenol)for osteoarthritis.What finding in the client's health history would lead the nurse to consult with the provider over the choice of medication?

Accepted Answer

The major serious side effect of acetaminophen is hepatotoxicity and liver damage.Drinking 3 to 5 beers each day may indicate underlying liver disease,which should be investigated prior to taking chronic acetaminophen.The nurse should relay this information to the provider.Smoking is not related to acetaminophen side effects.Acetaminophen does not cause bleeding,so a previous peptic ulcer or taking warfarin would not be a problem.

Question 18

A client who had surgery has extreme postoperative pain that is worsened when trying to participate in physical therapy.What intervention for pain management does the nurse include in the client's care plan?

Accepted Answer

Severe pain related to surgery or tissue trauma is best managed with round-the-clock dosing.Breakthrough pain associated with specific procedures is managed with additional medication.An as-needed regimen will not control postoperative pain.A client-controlled analgesia pump might be a good idea but needs basal (continuous)and bolus (intermittent)settings to accomplish adequate pain control.Pain control needs to be continuous,not just administered prior to therapy.

Question 19

A nurse on the medical-surgical unit has received a hand-off report.Which client should the nurse see first?

Accepted Answer

Acute pain often serves as a physiologic warning signal that something is wrong.The client with new-onset abdominal pain needs to be seen first.The postoperative client needs 45 minutes to an hour for the oral medication to become effective and should be seen shortly to assess for effectiveness.The client going home requires teaching,which should be done after the first two clients have been seen and cared for,as this teaching will take some time.The client resting comfortably can be checked on quickly before spending time teaching the client who is going home.

Question 20

A student asks the nurse what is the best way to assess a client's pain.Which response by the nurse is best?

Accepted Answer

Many ways to measure pain are in use,including numeric pain scales,behavioral assessments,and other objective observations.However,the most accurate way to assess pain is to get a self-report from the client.

Quiz 3: Assessment and Care of Patients with Pain

A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia.The client scores a zero.What action by the nurse is best?

A new nurse reports to the precepting nurse that a client requested pain medication,and when the nurse brought it,the client was sound asleep.The nurse states the client cannot possibly sleep with the severe pain the client described.What response by the experienced nurse is best?

A nurse is assessing pain on a confused older client who has difficulty with verbal expression.What pain assessment tool would the nurse choose for this assessment?

A client has received an opioid analgesic for pain.The nurse assesses that the client has a Pasero Scale score of 3 and a respiratory rate of 7 shallow breaths/min.The client's oxygen saturation is 87%.What action should the nurse perform first?

The nurse is assessing a client's pain and has elicited information on the location,quality,intensity,effect on functioning,aggravating and relieving factors,and onset and duration.What question by the nurse would be best to ask the client for completing a comprehensive pain assessment?

A registered nurse (RN) and nursing student are caring for a client who is receiving pain medication via patient-controlled analgesia (PCA) .What action by the student requires the RN to intervene?

A hospitalized client has a history of depression for which sertraline (Zoloft) is prescribed.The client also has a morphine allergy and a history of alcoholism.After surgery,several opioid analgesics are prescribed.Which one would the nurse choose?

A hospitalized client uses a transdermal fentanyl (Duragesic) patch for chronic pain.What action by the nurse is most important for client safety?

A nurse is preparing to give a client ketorolac (Toradol) intravenously for pain.Which assessment findings would lead the nurse to consult with the provider?