Chapter 32: Pain Management

1.A patient is admitted to the trauma unit with the diagnosis of spinal cord injury resulting from an ATV accident. The health care provider has diagnosed the patient as a paraplegic. Which of the following is one of the most important topics for patient teaching to prevent further injury to the patient?

a.
Reminding him that he can be injured and not feel pain below his waist
b.
Suggesting that his parents purchase a motorized wheelchair to prevent arm muscle strain
c.
Reminding the patient to decrease fluid intake due to lack of mobility
d.
Reminding the patient to drink plenty of fluids to maintain hydration

ANS: A

Some patients such as those with spinal cord injuries are unable to sense painful stimuli. You must take special precautions to protect them from additional injury. Safety is the number one priority for this patient due to lack of sensation and movement in the lower extremities. Providing precautions against taking too much pain medication and reminding the patient to drink plenty of fluids to maintain hydration are important interventions. Determination of which type of wheelchair the patient will need would be determined by the health care team closer to discharge. Pain processes require an intact peripheral nervous system and spinal cord. Common factors that disrupt the pain experience include trauma, drugs, tumor growth, and metabolic disorders.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:871OBJ:Describe the physiology of pain.

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

2.A graduate nurse is working for a diabetes unit. The nurse manager has prepared a very thorough orientation, which includes check-offs for taking vital signs. The nurse manager has informed the graduate nurse that their hospital has adopted the Joint Commission’s pain standard and that they will be assessing five vital signs. The graduate nurse knows that the fifth vital sign is which of the following?

a.
Arterial blood gasses
b.
Blood sugar
c.
Blood pressure
d.
Pain

ANS: D

National and international organizations have made efforts to correct this problem. The Joint Commission (2013) has a pain standard for health care workers to assess all patients for pain on a regular basis. Many health care institutions have adopted this standard by recommending that pain be assessed as the “fifth vital sign.”

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:874OBJ:Assess a patient experiencing pain.

TOP:Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

3.A registered nurse working for the emergency department sees a lot of patients who seek services because of pain. The nurse is aware that pain is which of the following?

a.
Caused by a single physiological sensation
b.
Caused by a specific stimulus
c.
Subjective
d.
Universally the same for everyone

ANS: C

Pain is more than a single physiological sensation caused by a specific stimulus. It is subjective and highly individualized. The person having pain is the only authority on it.

According to McCaffery’s classic definition, “Pain is whatever the experiencing person says it is, existing whenever he says it does.”

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:870OBJ:Assess a patient experiencing pain.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

4.A registered nurse, who has practiced for more than 20 years and has had a lot of experience caring for postsurgical patients, was questioned by a student nurse about why many nurses do not give the full amount of pain medication ordered by surgeons. The nurse replied that the literature shows that many nurses do not give the full amount of pain medication because they:

a.
do not believe that the patient is experiencing that much pain.
b.
do not want to contribute to pain medication addiction.
c.
believe that limiting the amount of pain medication lowers costs.
d.
are concerned about drug interactions with pain medication and other postsurgical medications.

ANS: B

Many nurses avoid acknowledging a patient’s pain because of their own fear of contributing to addiction. These fears and beliefs lead to mistrust between the nurse and patient, increased patient recovery time, increased complications and mortality, increased psychological problems, and increased cost.

PTS:1DIF:Cognitive Level: Applying (Application)

REF: 874 OBJ: Discuss nursing implications for administering analgesics.

TOP:Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment

5.When a person touches a hot stove, the resulting cellular damage causes a reaction that converts the stimuli into a pain impulse. What is the term for this conversion?

a.
Transduction
b.
Transmission
c.
Perception
d.
Modulation

ANS: A

Transduction converts energy produced by these stimuli into electrical energy. The process begins in the periphery when a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential. Once transduction is complete, transmission of a pain impulse begins. Transmission is the cellular damage from thermal, mechanical, or chemical injury results in the release of excitatory neurotransmitters such as prostaglandins, histamine, bradykinin, and substance P. Perception occurs when the pain impulse ascends to the brain, the central nervous system extracts information such as location, duration, and quality of the pain impulse. Modulation occurs when a person perceives a harmful impulse, the brain releases inhibitory neurotransmitters such as endogenous opioids, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA). The neurotransmitters hinder the transmission of pain to help produce an analgesic effect.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:870 | 871OBJ:Describe the physiology of pain.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

6.When a person cuts a finger, nerve impulses travel to the spinal cord along afferent peripheral nerve fibers. What is this process?

a.
Transduction
b.
Transmission
c.
Perception
d.
Modulation

ANS: B

Transmission is the cellular damage from thermal, mechanical, or chemical injury results in the release of excitatory neurotransmitters such as prostaglandins, histamine, bradykinin, and substance P. These pain-sensitizing substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response. The pain stimulus enters the spinal cord via the dorsal horn and travels one of several routes until ending within the gray matter of the spinal cord. At the dorsal horn substance P is released, causing a synaptic transmission from the afferent (sensory) nerve to spinothalamic tract nerves, which cross to the opposite side. Transduction converts energy produced by these stimuli into electrical energy. The process begins in the periphery when a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential. Once transduction is complete, transmission of a pain impulse begins. Perception occurs when the pain impulse ascends to the brain, the central nervous system extracts information such as location, duration, and quality of the pain impulse. Modulation occurs when a person perceives a harmful impulse, the brain releases inhibitory neurotransmitters such as endogenous opioids, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA). The neurotransmitters hinder the transmission of pain to help produce an analgesic effect.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:870 | 871OBJ:Describe the physiology of pain.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

7.Pain impulses are sent to the brain, where the central nervous extracts information regarding location, duration and quality of the pain impulse. What is this process?

a.
Transduction
b.
Transmission
c.
Perception
d.
Modulation

ANS: C

Perception occurs when the pain impulse ascends to the brain, the central nervous system extracts information such as location, duration, and quality of the pain impulse. Modulation occurs when a person perceives a harmful impulse, the brain releases inhibitory neurotransmitters such as endogenous opioids, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA). The neurotransmitters hinder the transmission of pain to help produce an analgesic effect. Transmission is the cellular damage from thermal, mechanical, or chemical injury results in the release of excitatory neurotransmitters such as prostaglandins, histamine, bradykinin, and substance P. These pain-sensitizing substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response. The pain stimulus enters the spinal cord via the dorsal horn and travels one of several routes until ending within the gray matter of the spinal cord. At the dorsal horn substance P is released, causing a synaptic transmission from the afferent (sensory) nerve to spinothalamic tract nerves, which cross to the opposite side. Transduction converts energy produced by these stimuli into electrical energy. The process begins in the periphery when a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential. Once transduction is complete, transmission of a pain impulse begins.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:870 | 871OBJ:Describe the physiology of pain.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

8.When a person accidentally touches a hot pan, their protective reflex causes them to immediately withdraw their hand from the hot pan. This protective reflex is known as which of the following?

a.
Transduction
b.
Transmission
c.
Perception
d.
Modulation

ANS: D

Modulation is a protective reflex response also occurs with pain. When a person is injured, a noxious stimulus from the skin travels along sensory neurons to the dorsal horn of the spinal cord where it synapses with spinal motor neurons. The impulse continues to travel along the spinal nerve to the skeletal muscle, causing the person to withdraw from the source of the pain. Perception occurs when the pain impulse ascends to the brain, the central nervous system extracts information such as location, duration, and quality of the pain impulse. Transmission is the cellular damage from thermal, mechanical, or chemical injury results in the release of excitatory neurotransmitters such as prostaglandins, histamine, bradykinin, and substance P. These pain-sensitizing substances surround the pain fibers in the extracellular fluid, spreading the pain message and causing an inflammatory response. The pain stimulus enters the spinal cord via the dorsal horn and travels one of several routes until ending within the gray matter of the spinal cord. At the dorsal horn substance P is released, causing a synaptic transmission from the afferent (sensory) nerve to spinothalamic tract nerves, which cross to the opposite side. Transduction converts energy produced by these stimuli into electrical energy. The process begins in the periphery when a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential. Once transduction is complete, transmission of a pain impulse begins.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:870 | 871OBJ:Describe the physiology of pain.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

9.The patient who has undergone triple cardiac bypass surgery 1 week ago is being seen for a follow up appointment at their health care facility. The incisions are healing well, but the patient is complaining of pain at the incision sites on his legs. The nurse knows that this is _____ pain.

a.
acute
b.
chronic/persistent noncancer
c.
chronic episodic
d.
idiopathic

ANS: A

Acute pain is protective, usually has an identifiable cause, is of short duration, and has limited tissue damage and emotional response. It is common after acute injury, disease, or surgery. Acute pain warns people of injury or disease; thus it is protective. It eventually resolves after the damaged tissue heals. Chronic/persistent noncancer pain is prolonged, varies in intensity, and usually lasts longer (typically at least 6 months) than is typically

expected or predicted . It does not always have an identifiable cause and leads to great personal suffering. Examples of chronic noncancer pain include arthritis, low back pain, myofascial pain, headache, and peripheral neuropathy. Chronic episodic pain is pain that occurs sporadically over an extended period of time is episodic pain. Pain episodes last for hours, days, or weeks. Examples are migraine headaches and pain related to sickle cell crisis. Idiopathic pain is chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition. An example of idiopathic pain is complex regional pain syndrome (CRPS).

PTS:1DIF:Cognitive Level: Applying (Application)

REF:873 | 874OBJ:Assess a patient experiencing pain.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

10.A student nurse is caring for an elderly patient with rheumatoid arthritis. The patient states that he or she experiences constant pain, is having difficulty sleeping, and has lost weight over the past 2 months. The patient is very tearful and states, “I’m not sure how long I can keep going with this pain.” What is the most important question for the student nurse to ask the patient?

a.
“Have you started a new diet?”
b.
“Have you ever thought of suicide?”
c.
“What are you taking for your pain?”
d.
“Do you take naps during the day?”

ANS: B

Chronic pain affects a patient’s activity (eating, sleeping, hygiene, social interactions), thinking (confusion, forgetfulness, helplessness), or emotions (anger, depression,

irritability, frustration) and quality of life and productivity. The incidence of depression is very high in patients with chronic pain. They experience many losses, such as their ability to enjoy life, to be in control, to work, to socialize, and to be independent. Suicidal thoughts are relatively common; therefore you need to routinely assess for suicidal tendencies.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:872 | 876OBJ:Assess a patient experiencing pain.

TOP:Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment

11.An older adult nurse has been seeing a rheumatologist for the management of Rheumatoid Arthritis (RA). The patient also uses herbal remedies and seeks acupuncture for pain relief and reads the latest research regarding RA. This coping style is best described as a(n) ______ loci of control.

a.
external
b.
interior
c.
internal
d.
exterior

ANS: C

Patients with internal loci of control perceive themselves as having personal control over their environments and the outcome of events. They ask questions, desire information, and like having choices for treatment. Patients with external loci of control perceive other factors in their environments such as nurses as being responsible for the outcome of events. These patients tend to be less demanding, follow directions, and are more passive in managing their pain. They want specific instructions but become anxious if you give them too much information. Interior and exterior loci are not a copying style.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:876OBJ:Assess a patient experiencing pain.

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

12.A student nurse is assessing the pain of a teenage patient with cancer. The student nurse ask the patient about precipitating factors, quality, relieving factors, where the pain is, the severity of pain, and the effect of the pain has on the patient. What is the other indicator that the student nurse should make part of this pain assessment?

a.
Medications the patient is taking for pain
b.
Timing of the pain
c.
Side effects of the patient’s chemotherapy
d.
The patient’s ability to take oral pain medication

ANS: B

The comprehensive assessment of pain aims to gather information about the cause of a person’s pain and determine its effect on his or her ability to function.

• Palliative or provocative factors—What makes your pain worse or better?

• Quality—How do you describe your pain?

• Relief measures—What do you take at home to gain pain relief?

• Region (location)—Show me where you hurt.

• Severity—On a scale of 0 to 10, with 10 being worst, how bad is your pain now?

• Timing (onset, duration, and pattern)—Is your pain constant, intermittent, or both?

• U (effect of pain on patient)—What are you not able to do because of your pain?

PTS:1DIF:Cognitive Level: Applying (Application)

REF:877 | 878OBJ:Assess a patient experiencing pain.

TOP:Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment

13.A patient has a morphine sulfate patient controlled analgesia (PCA) to control postoperative pain. When the nurse enters the room, the patient complains of pain. The nurse’s first response is which of the following?

a.
Stop the infusion.
b.
Call the physician or health care provider immediately.
c.
Ask the patient to describe the pain.
d.
Speak to the patient in a calming tone to reduce anxiety.

ANS: C

Nurses need to assess the patient first. Next, assess the lines, catheter, and infusion pump. Notify the physician or health care provider or follow protocols should a problem exist. Speaking in a calm voice demonstrates caring behavior.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 897 OBJ: Discuss nursing implications for administering analgesics.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

14.A patient in sickle cell crisis states that the pain is lessened when watching television. The patient’s physiological response is best attributed to which of the following?

a.
The perception of pain
b.
Nociceptor stimulation
c.
A negative protective reflex response
d.
The application of the gate control theory

ANS: D

The gate control theory gives you a way to understand pain-relief measures. The gate control theory of Melzack and Wall (1996) suggests that gating mechanisms along the central nervous system can regulate and possibly block pain impulses. The gating mechanism occurs within the spinal cord, thalamus, reticular formation, and limbic system. Closing the gate is the basis for nonpharmacological pain-relief interventions. The gate control theory suggests the importance of psychological variables (thoughts and feelings) and physiological sensations in the perception of pain. Pain is perceived in the central nervous system (CNS). The CNS extracts information such as location, duration, and quality. Nociceptors, the receptors that respond to harmful stimuli, convert the original stimuli into a pain impulse (transduction). A positive protective response occurs with pain.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:872

OBJ:Explain how the gate control theory relates to the selection of nursing therapies for pain relief.TOP:Nursing Process: Assessment

MSC:Client Needs: Physiological Integrity

15.According to established standards, nurses must frequently assess patients experiencing pain. The most appropriate action for the nurse to take when assessing a patient’s pain is which of the following?

a.
Ask what precipitates pain.
b.
Question the patient about the location of the pain.
c.
Offer the patient a pain scale to objectify the patient’s response.
d.
Use closed-ended questions to find out about the patient’s sensations.

ANS: C

One of the most subjective and therefore most useful characteristics for reporting pain is its severity or intensity. Nurses use a variety of pain scales to help patients communicate pain intensity. Asking what precipitates pain helps the nurse to plan interventions. Location of the pain is part of the PQRSTU. The use of the pain scale is subjective and will assist the nurse in implementing a plan of care. Closed-ended question does not encourage an open dialogue to discuss the patient’s pain.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:879 | 880OBJ:Assess a patient experiencing pain.

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

16.An adult patient has just undergone surgery for repair of a torn left knee anterior cruciate ligament (ACL). When informing the patient of several pain relief interventions, the nurse most appropriately urges the patient to select which of the following?

a.
NSAIDs
b.
Nonopioids
c.
Adjuvant therapy
d.
Patient-controlled analgesia pain management

ANS: D

In patient-controlled analgesia (PCA), patients benefit from having control over their pain therapy. Patient-controlled analgesia (PCA) is a safe method for a variety of painful conditions, including but not limited to postoperative, traumatic, sickle cell crisis, cancer, and burns. NSAIDs are nonsteroidal anti-inflammatory agents, which are effective in treating mild to moderate pain. NSAIDs act by inhibiting synthesis of prostaglandins and by inhibiting the cellular responses during inflammation. Adjuvants or coanalgesic agents, such as sedatives, anticonvulsants, steroids, antidepressants, antianxiety agents, and muscle relaxants, have analgesic properties, enhance pain control, or relieve symptoms.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:889-891

OBJ:Describe interventions for the relief of acute pain following operative or medical procedures.TOP:Nursing Process: Implementation

MSC:Client Needs: Physiological Integrity

17.A smiling and cooperative patient complains of severe pain. Nurses caring for patients who report pain need to recognize and avoid common misconceptions and myths about pain. To properly care for patients in pain, nurses need to remember which of the following?

a.
Chronic pain is psychological in nature.
b.
Patients are the best authority of their pain experience.
c.
Regular use of narcotic analgesics leads to drug addiction.
d.
The amount of tissue damage is reflected in the severity of the pain perceived.

ANS: B

Chronic pain is prolonged, varies in intensity, and usually lasts longer (typically at least 6 months) than is typically expected or predicted. It does not always have an identifiable cause and leads to great personal suffering. Examples of chronic noncancer pain include arthritis, low back pain, myofascial pain, headache, and peripheral neuropathy. Health care providers are usually less willing to treat chronic pain with opioids, although a policy statement supports the use of opioids for it. Common biases and misconceptions about pain include administering analgesics regularly leads to patients’ tolerance and drug dependence. Another common misconception is that the amount of tissue damage in an injury accurately indicates pain intensity. Nurses need to discourage patients from having multiple health care providers for treating pain and refer them to specialists. Pain centers use nonpharmacological and pharmacological strategies for a holistic approach to pain management.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF: 873 OBJ: Discuss common misconceptions about pain.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

18.A patient with developmental disabilities and poor verbal communication skills has been admitted for observation after a motor vehicle accident. The patient has been moaning, facial grimacing, and restless since being admitted to the floor. The nurse needs to first assess the patient for which of the following?

a.
Safety, because the patient will not use the call light
b.
Hydration, because the patient is not able to verbally communicate his or her needs
c.
Bathroom privileges, because of lack of communication skills
d.
Pain, because the patient is unable to communicate effectively

ANS: D

Patients unable to communicate effectively often require special attention during assessment. Some examples are the following:

• Infants and children

• Patients who are critically ill and/or unconscious

• Patients with dementia

• Patients who are mute or aphasic

• Patients with an intellectual disability

• Patients at the end of life

These patients all require different assessment approaches. However, be alert for subtle behaviors that indicate pain. Note a patient’s vocal response (e.g., moaning, crying, gasping), facial movements (e.g., grimacing, clenched teeth, tightly closed eyes), and body movements (e.g., restlessness, increased hand and finger movements, pacing), or inactivity. While the other responses are appropriate, the patient is currently exhibiting signs of pain, making it the priority.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:879OBJ:Identify components of the pain experience.

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

19.Aspirin and ibuprofen are classified as:

a.
narcotics.
b.
nonopioids.
c.
opioids.
d.
nonsteroidal antiinflammatory analgesics.

ANS: B

The most common method of pain relief is analgesics. There are three types of analgesics: (1) nonopioids, including acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs); (2) opioids (traditionally called narcotics); and (3) adjuvant or coanalgesics, a variety of medications that enhance analgesics or analgesic properties that were originally unknown. Nonselective NSAIDs such as aspirin and ibuprofen provide relief for mild-to-moderate acute intermittent pain such as that from headache or muscle strain.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:889

OBJ:Describe applications for use of pharmacological pain therapies.

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

20.A terminally ill patient with cancer is experiencing increased pain. Nursing implications used to care for this patient include which of the following?

a.
Giving medications as needed
b.
Using the World Health Organization three-step approach
c.
Using a holistic approach to pain management
d.
Holding regular doses to prevent life-threatening side effects

ANS: B

Administering analgesics to treat cancer-related pain requires applying principles different from those used to treat acute pain. The WHO (1990) has recommended a three-step approach to managing cancer pain. Therapy begins with NSAIDs and/or adjuvants and progresses to strong opioids if pain persists. Side effects of opioids such as nausea and constipation are treated aggressively so patients are able to continue using them. Patients usually become tolerant to their side effects, with the exception of constipation. For patients with cancer the aim of drug therapy is to anticipate and prevent or minimize pain. Therefore it is necessary to give required analgesic dosages regularly, even when pain subsides. Regular administration maintains blood levels for ongoing pain control.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:893 | 895

OBJ:Differentiate the nursing implications associated with managing cancer pain versus noncancer pain.TOP:Nursing Process: Implementation

MSC:Client Needs: Physiological Integrity

21.A patient is started on morphine via patient-controlled analgesia (PCA) to control persistent cancer pain. The nurse knows that to prevent central nervous system (CNS) depression the patient should do which of the following?

a.
Monitor IV site for patency.
b.
Monitor the patient closely for the 15 minutes.
c.
Record baseline blood pressure and respiratory rates before the start of the medication.
d.
Give a small dose of naloxone prior to starting the morphine.

ANS: C

Another measure for treating severe persistent cancer pain is morphine given by continuous IV drip or intermittently by a PCA pump. When a patient starts on IV morphine, you need to prevent overdose and central nervous system depression. Record baseline blood pressure and respiratory rates before the infusion begins. Monitor the patient closely for the first hour of the infusion and then according to agency policy. If the patient’s blood pressure or respirations decrease, reduce the infusion rate according to the health care provider’s order or agency policy. Small IV doses of naloxone can be ordered for severe respiratory depression and to increase respiratory rate and depth but not to reverse the pain relief

PTS:1DIF:Cognitive Level: Applying (Application)

REF: 895 OBJ: Evaluate a patient’s response to pain therapies.

TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity

22.The hospice nurse is assessing the patient at home for the first time. The patient has a lot of questions regarding what the role hospice will have as the illness progresses. The patient states, “I don’t want to be in pain and kept alive, but I’m not ready to die either.” What is the best response that will educate the patient of the role hospice will play in his or her care?

a.
Hospice will make sure you are pain free, how long you live is up to you and the doctor.
b.
Hospice focuses on the quality of life, including pain management, rather than how long you will live.
c.
Hospice will give you enough pain medication to keep you pain free. This is a higher priority than quality of life.
d.
Hospice allows you time to get your affairs in order.

ANS: B

Hospice programs care for the terminally ill by helping patients continue to live at home in comfort and privacy with the help of a health care team. The emphasis is on quality of life over quantity, and pain control is a priority. Under the guidance of hospice nurses, families learn to monitor patients’ symptoms and become the primary caregivers.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 896 OBJ: Evaluate a patient’s response to pain therapies.

TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity

MULTIPLE RESPONSE

1.A patient presents to the emergency department with a large leg laceration received in a bicycle accident. The nurse knows that the physician or health care provider chose a local anesthetic because of which of the following? (Select all that apply.)

a.
The patient appears very apprehensive.
b.
It has very few side effects.
c.
The potential for hemorrhage precludes the use of IV anesthesia.
d.
It produces temporary loss of sensation by inhibiting nerve conduction.
e.
It allows sedative effects to calm the patient.

ANS: B, D

Health care providers use local anesthetic (e.g., lidocaine, bupivacaine, ropivacaine) during brief surgical procedures such as removing a skin lesion or suturing a wound. The drugs produce temporary loss of sensation by inhibiting nerve conduction. Local anesthetics also block motor and autonomic functions, depending on the amount used and the location and depth of an injection. Smaller sensory nerve fibers are more sensitive to local anesthetics than large motor fibers. Thus a patient loses sensation before losing motor function; conversely motor function returns before sensation. Local anesthetics cause side effects, depending on their absorption into the circulation. Itching or burning of the skin or a localized rash is common after topical applications. Apprehension can be alleviated when a nurse uses guided imagery. This patient is a candidate for local anesthesia because a specific body part needs to be localized. Epidural Analgesia has the occurrence of minimal sedation.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:891 | 892

OBJ: Describe guidelines for selecting and individualizing pain therapies.

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

2.The student nurse is working on the surgical floor. The student nurse is assigned to take care of a patient with hemiplegia and communication deficits from a previous stroke. The patient is 1-day postoperative from abdominal surgery. Which of the following interventions would promote comfort and help the patient remain pain free? (Select all that apply.)

a.
Keep the bed sheet wrinkle free.
b.
Only change wet dressings or bed linens once a shift.
c.
Remove noxious stimuli from the room.
d.
Continue to use the establish pain scale for this patient.
e.
Give pain medication after ambulation down the hall.

ANS: A, C, D

One simple way to promote comfort is to remove or prevent painful stimuli. For example, tighten and smooth wrinkled bed linen and be sure to position patients off tubing and other equipment. Change wet dressings or bed linen immediately. Removing noxious stimuli is especially important for patients who are immobile. You can prevent pain by anticipating painful activities (e.g., ambulation, turning). Before performing a procedure, consider the patient’s condition, aspects of the procedure that are painful, and ways to avoid causing pain. Always use an established pain scale to promote accurate assessment of pain.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:887

OBJ: Describe guidelines for selecting and individualizing pain therapies.

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

3.The patient is being seen for chronic back pain. The patient states, “I’m always in pain, and I don’t like taking the pain medication because it makes me sleepy. I have to work to support my family.” The nurse is aware that this patient may be a candidate for cutaneous stimulation. Cutaneous stimulation includes which of the following? (Select all that apply.)

a.
TENS unit
b.
NSAIDs
c.
Massage
d.
Yoga
e.
Ice bags

ANS: A, C, E

Cutaneous stimulation of the skin helps to relieve pain. A massage, warm bath, ice bag, and transcutaneous electrical nerve stimulation (TENS) are simple ways to reduce pain perception. How cutaneous stimulation works is unclear, but it may cause release of endorphins, thus blocking transmission of painful stimuli. NSAIDs are nonsteroidal anti-inflammatory drugs that can help relieve chronic back pain through pharmaceutical therapy. Yoga is used as a diversional or holistic therapy.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:887 | 888

OBJ: Describe guidelines for selecting and individualizing pain therapies.

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity