The nurse applying heat to an injured hip of a patient is careful not to leave the heat on longer than:
B. If a heating device is left on more than 30 minutes, the effectiveness of the treatment is diminished and injury to the tissues may occur.
The patient with an extensive abdominal operation is assessed by the nurse as having predictable pain. Analgesics for this patient will be most effective when administered:
A. It is best for the nurse to use a preventive approach for this patient’s pain management, because the pain is predictable and major.
The nurse is alert for sympathetic responses to pain, such as:
B. The sympathetic nervous system controls blood pressure, pulse, and respiration and is stimulated during pain.
The doctor has ordered either heat or cold treatments for the older adult patient with a leg injury. The nursing care plan reflects secondary diagnoses of peripheral vascular disease (PVD), diabetes, and allergy to latex. Which of the ordered treatments would the nurse administer, and why?
B. Patients with PVD have blood flow problems that physiologically slow circulation. This problem would be exacerbated by cold. Heat will increase the circulation, which would be a desired effect.
The nurse notices that the patient seems calm and peaceful in spite of an assessment that the patient’s injuries might be causing severe pain. The patient tells the nurse that the use of yoga, meditation, and ____ lessens the perceptions of pain to tolerable levels.
A. Alternate methods of pain relief are effective for many patients. Activities such as yoga, meditation, reading a relaxing book, and listening to music are helpful.
The gate-control theory of pain was first defined by which of the following persons?
A. These doctors first proposed the gate-control theory of pain.
To perform a nursing assessment correctly, the nurse must remember that pain perception involves several different variables, including afferent and efferent pathways, which are part of the:
D. Pain perception ascends to the brain and back down again to imprint the pain. These are functions of the CNS.
The nurse is instructing a patient about a TENS unit, how it is used, and how it works. Appropriate information for this patient would be:
B. The exact mechanism for the pain relief is unknown. The effects last for the period of time that the unit is applied to the client and a short time thereafter.
The nurse explains that transmission of impulses from the spinal cord to the brain can be controlled by the:
D. Pain as a cognitive sensation is carried via the afferent system according to the gate-control system theory.
The patient still complains of pain after administration of the ordered analgesic. The nurse changes the nursing care plan because the:
D. The sensation of pain is perceived as increased when the pain threshold is lowered. There are not enough data in the situation to lead to the assumption of addiction or attention seeking.
The nurse administers morphine sulfate, but the family is worried about the patient and thinks that this drug is too strong and will cause harm. The nurse assures the family that opioid analgesia is:
D. When nonopioid analgesia does not work, or it is known that the pain is severe, opioids such as morphine are used.
A patient admitted with the diagnosis of possible myocardial infarction complains of pain and tingling in his left arm says, “How in the world could I be having a heart attack when it’s just my arm that is giving me trouble?” The nurse explains that the patient is experiencing:
A. Pain is what the patient says it is and should be communicated as such. However, pain in specific areas may be referred pain, and left arm discomfort is typically referred from the heart. The nurse administers the analgesic as ordered and frequently checks to see if the pain is relieved.
The patient reports to the nurse that every time the right arm is raised, pain in the right shoulder is triggered. The nurse charts this as an example of a(n):
A. This is important information to be gathered by the nurse and communicated specifically in the chart and to the RN.
A patient who is 2 days post–myocardial infarction has been eating well, ambulating with assistance, and receiving antibiotics and morphine by IV drip. The patient complains of constipation this morning. The nurse assesses the probable cause of the constipation as:
B.
A patient who is obviously in pain refuses the morphine that has been ordered for pain control, because of fear of addiction. The nurse explains that the percentage of persons on prescribed pain protocols who become addicted is estimated at:
A. When used for severe pain management relief, opioids rarely result in addiction.
An order for an 80-year-old emphysemic patient who weighs 100 pounds is morphine sulfate, 0.5 gr. IM PRN for pain. The most appropriate action for the LPN to take is to:
B. Morphine is usually given in a dose of 10 mg (one-sixth grain) IM. The usual oral dose is 0.5 gr. (30 mg). The order should be called to the attention of the RN so that it can be clarified as to intent for the older patient, who usually requires a smaller dose.
The patient is 67 years old and in chronic pain, for which a daily analgesic is needed. The nurse implements the preferred method of administration of this medication for a geriatric patient as:
B. Medication for long-term use for geriatric patients is best given orally.
In performing a pain assessment, the LPN would follow which steps?
A. The assessment of pain requires the nurse to perform six specific steps. Vital signs are important in addition, but are not part of the six steps.
Two patients are hospitalized with the same diagnosis, but one is 23 years old, with acute recent pain from an injury, and the other is 64 years old, with pain of long-standing duration of several years. The difference in anticipated assessment is which of the following?
C. Older adult patients with chronic pain do not report pain as severe at the same level as younger patients for several reasons. For example, older adult patients believe that pain comes with old age, or they do not want to bother the staff. Chronic pain of long standing frequently does not change vital sign normal values.
The sensation of pain has been defined by the International Association for the Study of Pain as:
D. The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience.
The nurse is notified when the patient, newly admitted with liver and gallbladder disease, complains of pain in the right midback and asks for some pain medication. As the basis for the assessment, the nurse uses knowledge of pain to determine that the patient:
D. Referred pain is a very real physical complaint and the nurse should give the patient the pain med as ordered.
The nurse has assessed that prolonged and unrelieved pain will:
A. Pain that is unrelieved lowers the pain threshold, because the patient becomes anxious that the pain may not ever be relieved. The blood pressure increases and the effects of endorphins and gate control have been exhausted.
The nurse is administering morphine IM, ordered for a patient reporting severe pain. To evaluate the patient’s response to this drug, the nurse will assess primarily for:
C. Morphine initially produces sedation that allows the patient to sleep and rest from the pain. This is considered a side effect.
The nurse explains to a patient that the gate-control theory of pain explains that the pain is perceived as stimulation of receptors in the:
C. Perception of pain is made through small nerve fibers, which transmit impulses up to the brain, where they are interpreted as pain. Large nerve fiber receptors block the “gate” to decrease transmission to the interpretive brain area.
When the patient with sciatica seats himself in a chair, he gasps and complains of a burning and shooting pain in his hip. The nurse assesses that this is ____ pain.
C. Neuropathic pain is characterized by burning and shooting sensations without a stimulus. This is not a situation of acute pain, because neuropathic pain does not follow a nociceptor path as does visceral and referred pain.
The nurse explains the standards for pain management published by The Joint Commission (TJC). The nurse will (select all that apply):
1. perform organized pain assessment.
2. record results of analgesia.
3. give adequate discharge instruction about pain relief.
4. recognize the right of a patient to manage pain.
5. teach patients about pain control methods.
1, 2, 3, 4, 5
All options are included in the TJC standards.
The nurse instructs a patient who has had a rhizotomy for leg pain that (select all that apply):
1. relief may not be permanent.
2. the leg will tingle and burn occasionally.
3. the foot may discolor and twitch at times.
4. snug shoes should be worn at all times.
5. caution should be taken to prevent injury to leg.
1, 5
The relief may not be permanent because of regeneration of nerve tissue. Extra caution should be taken to prevent injury, because pain perception is altered. Snug shoes would cause injury. Tingling and twitching are not usual with a rhizotomy.
The nurse explains that afferent pathways are activated by pain receptors called ____________________.
Nociceptors
____________________ and ____________________ are natural opioid-like substances that block pain perception.
