Question 1

A 24-year-old Asian woman is in labour and refuses to receive any sort of anaesthetic.Which alternative treatment is best for this patient?

Accepted Answer

In some cultures,nonpharmacological measures are preferred for pain control.In the case of a patient in labour,relaxation with guided imagery is often an effective supplement for pain management because it provides women with a sense of control over their pain.Relaxation and guided imagery can be used during any phase of health or illness.TENS units are typically used to manage postsurgical and procedural pain.Herbal supplements need to be evaluated for safety during pregnancy;in addition,some patients consider herbal supplements to be another form of medication,and they are not typically used to control acute pain.A pudendal block is a type of regional anaesthetic;administering it shows a lack of respect for the patient's wishes for nonpharmacological pain control.

Question 2

The nurse recognizes that which of the following is a modifiable contributor to a patient's perception of pain?

Accepted Answer

The nurse can take measures to ease the patient's anxiety and fear related to pain.Age,gender,culture,and previous pain experience are all nonmodifiable factors that the nurse can help the patient to understand in relation to pain,but the nurse cannot alter them.

Question 3

A nurse is providing discharge teaching for a patient with a fractured humerus.The patient is going home with hydrocodone bitartrate and acetaminophen (Vicodin).What important patient education does the nurse provide?

Accepted Answer

A common side effect of opioid analgesics is constipation.Therefore,the nurse encourages the patient to drink fluids and eat fibre to prevent constipation.Although medications can be irritating to the stomach,a diet high in fat does not prevent gastric ulcers.To best manage pain,the patient needs to take pain medication before painful procedures or activities or before pain becomes severe.As the patient's pain gets better,the strength of the medications will decrease.Intramuscular,IV,and topical analgesics are used for more severe and chronic pain.

Question 4

A nurse is providing medication education to a patient who just started taking ibuprofen,a nonselective nonsteroidal anti-inflammatory drug (NSAID).Which statement made by the nurse best indicates how ibuprofen works?

Accepted Answer

NSAIDs such as ibuprofen probably work by decreasing the synthesis of prostaglandins to inhibit cellular responses to inflammation.Ibuprofen does not remove factors that cause pain,nor does it enhance coping with pain.Opioids bind with opiate receptors to modify perceptions of pain.

Question 5

A nurse has brought the patient his scheduled pain medication.The patient asks the nurse to wait to give pain medication until the time for the dressing change,which is 2 hours away.Which response by the nurse is most therapeutic?

Accepted Answer

As-needed (prn)doses of medication can be given to patients in certain circumstances,as with an extensive dressing change.By asking to hold off on the dose,the patient is indicating that the dressing changes are extremely painful.The regularly scheduled dose might not be as effective for the patient.Oral medications take 30 to 60 minutes to take effect.If the nurse began the dressing change right then,the medication would not have been absorbed yet.The patient has the right to refuse to take a medication.It is the nurse's responsibility to communicate with the provider and with the patient about a pain control plan that works for both.

Question 6

A nurse is caring for a patient who is experiencing pain after abdominal surgery.What information is important for the nurse to tell the patient when providing patient education about effective pain management?

Accepted Answer

The best way to manage pain is to develop a schedule of medications that are given around the clock to prevent breakthrough pain.The nurse should not wait until the patient is in pain because it takes medications 10 to 30 minutes to begin to relieve pain.The nurse administers pain medications before painful activities,such as walking,and administers intravenous medications when pain is severe.

Question 7

Which of the following statements made by the patient indicates to the nurse that teaching on a patient-controlled analgesia (PCA)device has been effective?

Accepted Answer

A PCA device allows the patient to determine the level of pain relief delivered,which reduces the risk of oversedation.Its use often eases anxiety because the patient is not reliant on the nurse for pain relief.Other medications,such as oral analgesics,can be given in addition to the PCA device.The PCA device does have a minimum time limit to prevent overdose,but the patient can lengthen the amount of time between doses.One benefit of PCA is that the patient does not need to rely on the nurse to administer pain medication;the patient determines when to take the medication.

Question 8

What is the most appropriate way to assess the pain of a patient who is oriented and has recently had surgery?

Accepted Answer

Pain is a subjective measure.Therefore,the best way to assess a patient's pain is to ask the patient to rate the pain.Nonverbal communication,such as body language,is not as effective in assessing pain,especially when the patient is oriented.Heart rate sometimes increases when a patient is in pain,but this is not a symptom that is specific to pain.Pain sometimes affects a patient's ability to cope,but assessing the effect of pain on coping assesses the patient's ability to cope;it does not assess the patient's pain.

Question 9

The nurse anticipates administering an opioid fentanyl patch to which patient?

Accepted Answer

A fentanyl patch is an extended-relief opioid that provides pain relief for 24 hours a day.This is ideal for patients who have chronic severe pain,such as those who have cancer.The other patients are expected to experience acute pain.Therefore,they will probably benefit more from oral or intravenous (IV)opioids for short-term pain relief.

Question 10

What nursing intervention is most effective in preventing injury to a patient after administration of epidural anaesthetic?

Accepted Answer

To reduce the accidental administration of IV medications into the epidural catheter,the tubing that leads to the epidural catheter needs to be labelled clearly.Medications used to reverse the action of the anaesthetic medication need to be kept in a secured location,not in the patient's room in an unsecured location.The epidural insertion site needs to be covered by a clear occlusive dressing to prevent infection and allow the nurse to assess the site.Patients receiving epidural anaesthetic need to be monitored every 15 minutes until stabilized and then at least hourly.

Question 11

Which of the following statements made by a patient indicates that the patient understands the relationship between the gate control theory of pain and the use of meditation to relieve pain?

Accepted Answer

According to the gate theory,pain impulses cause pain when they get through gates that are open.Pain is blocked when the gates are closed.Nonpharmacological pain relief measures,such as meditation,work by closing the gates,which keeps pain impulses from coming through.Meditation does not open pain gates or stop pain from occurring.Meditation also does not have an effect on pain neuroregulators.

Question 12

A nurse is caring for a patient who recently had spinal surgery.The nurse knows that patients usually experience acute pain after this type of surgery.The patient refuses to get up and walk and is not moving around in the bed.However,the patient is stoic and denies experiencing pain at this time.What most likely explains this patient's behaviour and response to surgery?

Accepted Answer

A patient's culture can influence the patient's expression of pain.In this case,the patient has just had surgery,and the nurse knows that this surgical procedure usually causes pain.It is important at this time for the nurse to examine cultural and ethnic factors that are possibly affecting the patient's denial of pain at this time.Even if surgery corrects neurological factors that create chronic pain,surgery causes pain in the acute period.Urinary retention usually creates pain and does not mask surgical pain.The nurse is not allowing personal beliefs to influence pain management because the nurse is attempting to determine the reason why the patient is not verbalizing the experience of pain.

Question 13

The nurse is evaluating the effectiveness of guided imagery for pain management as used for a patient who has second- and third-degree burns and needs extensive dressing changes.Which situation best indicates that guided imagery is controlling the patient's pain effectively during dressing changes?

Accepted Answer

The purpose of guided imagery is to allow the patient to alter the perception of pain.Guided imagery works in conjunction with analgesic medications,potentiating their effects.If the patient needs less pain medication during dressing changes,then guided imagery is helping to manage the patient's pain.A rating of 6 on a 0-to-10 pain scale indicates that the patient is having moderate pain and is not experiencing pain relief at this time.A person who is stoic is not showing feelings,which makes it difficult to know whether the patient is experiencing pain.The ability to change dressings more frequently is not a way to evaluate the effectiveness of guided imagery.

Question 14

A patient who has had type 2 diabetes for 26 years is beginning to experience peripheral neuropathy in the feet and lower legs,which is causing the patient to have a decreased ability to feel pain in the lower extremities.The nurse is providing education to the patient to prevent injury to the feet.The nurse tells the patient to always wear shoes or slippers when walking.Which of the following statements made by the nurse best explains the rationale for this instruction?

Accepted Answer

This patient is losing the ability to feel pain because of peripheral neuropathy.The patient will no longer have protective reflexes to prevent injury to the feet.Wearing shoes prevents the patient from injuring the feet because they protect the feet.Shoes do not block pain perception,nor do they help people adapt to pain.Shoes are not a form of nonpharmacological pain relief.Wearing shoes will not have an effect on opening or closing the pain gates.

Question 15

A nurse is caring for a patient who recently had an abdominal hysterectomy and states that she is experiencing severe pain.The patient's blood pressure is 110/60,and her heart rate is 60.In addition,the patient does not appear to be in any distress.Which response by the nurse is most therapeutic?

Accepted Answer

The nurse must believe that a patient is in pain whenever the patient reports that he or she is in pain,even if the patient does not appear to be in pain.Whenever the patient reports pain,the nurse needs to collaborate with the patient to determine the best method of pain relief,whether it be medication,meditation,or repositioning.The nurse must be careful to not judge the patient on the basis of vital signs or nonverbal communication and must not assume that the patient is seeking narcotics.The patient is a partner in pain management,and so going to get narcotics to treat the pain without consulting with the patient first is not appropriate.

Question 16

A nursing student is planning care for an older patient who is experiencing pain.Which of the following statements made by the nursing student indicates the need for the nursing professor to clarify the nursing student's knowledge?

Accepted Answer

Aging does not affect the ability to perceive pain.Sometimes older persons have difficulty interpreting their pain and determining its cause because multiple diseases and vague symptoms affect similar parts of the body.Opioids are safe to use in older persons as long as they are slowly titrated and the nurse frequently monitors the patient.Current evidence shows that patients with dementia probably experience unrelieved pain because their pain is difficult to assess.

Question 17

A nurse is assessing a patient who started to have severe pain 3 days ago.When the nurse asks the patient to describe the pain,the patient states,"The pain feels like it is in my stomach.It is a burning pain,and it spreads out in a circle around the spot where it hurts the most." What type of pain does the nurse document that the patient is having at this time?

Accepted Answer

Visceral pain comes from visceral organs,such as those of the gastrointestinal tract.Visceral pain is diffuse and radiates in several directions.Superficial pain has a short duration and is usually a sharp pain.Pain of an unknown cause is idiopathic pain.Chronic pain lasts longer than 6 months.

Question 18

A patient who had a motor vehicle accident 2 days ago is experiencing pain and is receiving patient-controlled analgesia (PCA).How does the nurse know that the patient is experiencing effective pain management with the PCA?

Accepted Answer

The effectiveness of pain relief measures is determined by the patient's generally rating pain at the level of 3 or less on a 0-to-10 pain scale.If the patient is satisfied with the amount of pain relief,then pain measures are effective.A patient who is sleeping and is difficult to arouse is possibly oversedated;the nurse needs to assess this patient further.The amount of medication left in the PCA syringe does not indicate whether pain management is effective.Pressing the button shows that the patient knows how to use the PCA but does not evaluate pain management.

Question 19

A patient arrives at the emergency department experiencing a headache and rates the pain as 7 on a 0-to-10 pain scale.What nonpharmacological intervention does the nurse implement for this patient while awaiting orders for pain medication from the health care provider?

Accepted Answer

The appropriate nonpharmacological pain management intervention is to quietly play music that the patient finds relaxing.Music diverts a person's attention away from pain and creates relaxation.Reassessing the patient's pain scores is done during evaluation.Building the patient's expectation of the provider's arrival does not address the patient's pain.Although yoga promotes relaxation,nurses teach relaxation techniques only when a patient is not experiencing acute pain.Because the patient is having acute pain,this is not an appropriate time to provide patient teaching.

Question 20

The nurse is caring for two patients;both are having a hysterectomy.The first patient is having the hysterectomy after a complicated birth.The second patient has uterine cancer.What will most likely influence the experience of pain for these two patients?

Accepted Answer

The patient's perception of pain is influenced by psychological factors,such as anxiety and coping,which in turn influence the patient's experience of pain.Each patient's experience is different.The degree and quality of pain perceived by a patient are related to the meaning of the pain.Neurological factors can interrupt or influence pain perception,but neither of these patients is experiencing alterations in neurological function.The knowledge,attitudes,and beliefs of nurses,physicians,and other health care personnel about pain affect pain management but do not necessarily influence a patient's pain perceptions.

Quiz 31: Pain Assessment and Management