8
a. The patient will have a behavioral response if pain is perceived.
b. The area should be treated as a painful lesion, using gentle cleansing and dressing.
c. The area can be thoroughly scrubbed because the patient is not able to perceive pain.
d. All nociceptive stimuli that are transmitted to the brain result in the perception of pain.
7. Number in order the nociceptive processes that occur to communicate tissue damage to the central nervous system (CNS). Number 1 is the first process and number 4 is the last process.
_____ a. Perception _____ b. Modulation _____ c. Transmission _____ d. Transduction
8. Match the following types of pain in the left column with a category of pain from the upper right column and an example of the source of the pain from the lower right column.
Types of Pain Categories of Pain
_____ a. Pain from loss of afferent input
_____ b. Pain persisting from sympathetic nervous system (SNS) activity _____ c. Pain caused by dysfunction in the CNS
_____ d. Pain arising from skin and subcutaneous tissue; well localized _____ e. Pain arising from muscles and bones; localized or diffuse and radiating _____ f. Pain felt along the distribution of peripheral nerve(s) from nerve damage _____ g. Pain arising from visceral organs; well or poorly localized; referred cutaneously
1. Nociceptive pain 2. Neuropathic pain Sources of Pain
3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain
9. Patient-Centered Care: Amitriptyline is prescribed for a patient with chronic pain from
fibromyalgia. When the nurse explains that this drug is an antidepressant, the patient states that she is in pain, not depressed. What is the nurse's best response to the patient?
a. Antidepressants will improve the patient's attitude and prevent a negative emotional response to the pain.
b. Chronic pain almost always leads to depression, and the use of this drug will prevent depression from occurring.
c. Some antidepressant drugs relieve pain by releasing neurotransmitters that prevent pain impulses from reaching the brain.
d. Certain antidepressant drugs are metabolized in the liver to substances that numb the ends of nerve fibers, preventing the onset of pain.
10. A patient with trigeminal neuralgia has moderate to severe burning and shooting pain. In helping the patient to manage the pain, the nurse recognizes what about this type of pain?
a. Includes treatment with adjuvant analgesics b. Will be chronic and require long-term treatment
c. Responds to small to moderate around-the-clock doses of oral opioids
d. Can be well controlled with salicylates or nonsteroidal antiinflammatory drugs (NSAIDs) 11. In the following scenario, identify the assessment finding that corresponds to the elements of a
pain assessment.
A 62-yr-old male patient is admitted to the medical unit from the emergency department. On arrival, he is trembling and nearly doubled over with severe, cramping abdominal pain. He indicates that he has severe right upper quadrant pain that radiates to his back and he is more comfortable walking bent forward than lying in bed. He notes that he has had several similar bouts of abdominal pain in the last month but “not as bad as this. This is the worst pain I can imagine.” The other episodes lasted only about 2 hours. Today he experienced an acute onset of pain and nausea after eating fish and chips at a fast-food restaurant about 4 hours ago.
Element of Pain Assessment Assessment Finding Onset
Duration and pattern of pain Location
Intensity Quality
Associated symptoms Management strategies
12. List the 10 basic principles that should guide the treatment of all pain.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
13. A patient with advanced colorectal cancer has continuous, poorly localized abdominal pain at an intensity of 5 on a scale of 0 to 10. How does the nurse teach the patient to use pain medications?
a. On an around-the-clock schedule
b. As often as necessary to keep the pain controlled
c. By alternating two different types of drugs to prevent tolerance d. When the pain cannot be controlled with distraction or relaxation
14. A patient who has been taking ibuprofen and imipramine (Tofranil) for control of cancer pain is having increased pain. What would nurse recommend to the HCP as an appropriate change in the medication plan?
a. Add PO oxycodone to the other medications.
b. Substitute PO ketorolac, an NSAID, for imipramine.
c. Add transdermal fentanyl (Duragesic) to the use of the other medications.
d. Substitute PO hydrocodone with acetaminophen for the other medications.
15. A patient with chronic cancer-related pain has started using MS Contin for pain control and has developed common side effects of the drug. The nurse reassures the patient that tolerance will develop to most of these side effects but that continued treatment will most likely be required for what?
a. Pruritus b. Dizziness c. Constipation
d. Nausea and vomiting
16. A postoperative 68-yr-old opioid-naive patient is receiving morphine by patient-controlled analgesia (PCA) for postoperative pain. What is the rationale for not initiating the PCA analgesic with a basal dose of analgesic as well?
a. Opioid overdose b. Nausea and itching c. Lack of pain control
d. Adverse respiratory outcomes
17. Which measures or drugs may be effective in controlling pain in the physiologic pain process stage of transduction (select all that apply)?
a. Distraction b. Corticosteroids c. Epidural opioids d. Local anesthetics e. Antiseizure medications
f. Nonsteroidal antiinflammatory drugs (NSAIDs)
18. A patient is receiving a continuous infusion of morphine via an epidural catheter following
major abdominal surgery. Which actions should the nurse include in the plan of care (select all that apply)?
a. Label the catheter as an epidural access.
b. Assess the patient's pain relief frequently.
c. Use sterile technique when caring for the catheter.
d. Monitor the patient's level of consciousness (LOC).
e. Monitor patient vital signs (blood pressure, heart rate, respirations).
f. Assess the motor and sensory function of the patient's lower extremities.
19. A patient with multiple injuries resulting from an automobile accident tells the nurse that he has
“bad” pain but that he can “tough it out” and does not require pain medication. To gain the patient's participation in pain management, what is most important for the nurse to explain to the patient?
a. Patients have a responsibility to keep the nurse informed about their pain.
b. Unrelieved pain has many harmful effects on the body that can impair recovery.
c. Using pain medications rarely leads to addiction when they are used for actual pain.
d. Nonpharmacologic therapies can be used to relieve his pain if he is afraid to use pain medications.
20. The patient has chronic pain that is no longer relieved with oral morphine. Which medication would the nurse expect to be ordered to provide better pain relief for this patient?
a. Fentanyl b. Hydrocodone
c. Intranasal butorphanol d. Morphine sustained-release
21. After the family members of a postoperative patient leave, the patient tells the nurse that his family gave him a headache by fussing over him so much. What is an appropriate intervention by the nurse?
a. Administer the PRN analgesic prescribed for his postoperative pain.
b. Ask the patient's permission to use acupressure to ease his headache.
c. Reassure the patient that his headache will subside now that his family has gone.
d. Teach the patient biofeedback methods to relieve his headaches by controlling cerebral blood flow.
Case Study
Pain
(©BananaStock/Thinkstock)
Patient Profile
R.D. is a 62-yr-old man being evaluated for a change in his pain therapy for chronic malignant pain from metastatic cancer.
Subjective Data
• Patient desires 0 pain but will accept pain level of 3 to 4 on a scale of 0 to 10.
• He has been taking two Percocet tablets q4hr while awake, but his pain is now usually at 4 to 5
with the medication.
• Patient reports that pain varies over 24 hours from 5 to 10.
• He always awakens in the morning with pain at 10 with nervousness, nausea, and a runny nose.
• When pain becomes severe, he stays in bed and concentrates on blocking the pain by emptying his mind.
• He is worried that increased pain means his disease is worsening.
• He is afraid to take additional doses or other opioids because he fears addiction.
Objective Data
• Height: 6 ft 0 in (183 cm)
• Weight: 150 lb (68 kg)
• Rigid posturing, slow gait Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What additional assessment data should the nurse obtain from R.D. before making any decisions about his problem?
2. What data from the nursing assessment are characteristic of the affective, behavioral, and cognitive dimensions of the pain experience?
3. Based on R.D.'s lack of pain control with his current dosage of opioid and his symptoms on arising in the morning, what changes are indicated in his medication regimen?
4. Priority Decision: What are the priority teaching needs that should be included in a teaching plan for R.D. to titrate his analgesic dose effectively?
5. Patient-Centered Care: How could the nurse best help R.D. overcome his fear of addiction to opioid drugs?
6. Teamwork and Collaboration: What additional pain therapies could the interprofessional team plan to help R.D. manage his pain?
7. Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses? Are there any collaborative problems?