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Potter & Perry: Fundamentals of Nursing, 7thEdition

Test Bank

Chapter 4: Pain !anagement

!"#T$P#E C%$CE

1. Which one of the following nursing interventions for a client in pain is based on the gate-control theory?

1. Giving the client a back massage

2. Changing the clients position in bed!. Giving the client a pain medication

". #imiting the number of visitors

$%&' 1(he gate-control theory suggests that cutaneous stimulation activates larger) faster-

transmitting $-beta sensory nerve fibers. (his decreases pain transmission through small-

diameter $-delta and C fibers. $ back massage is a nursing intervention based on thegate-control theory. Changing the clients position in bed is not a form of cutaneous

stimulation used to relieve pain. Giving the client a pain medication is a pharmacological

approach to relieving pain. #imiting the number of visitors may provide a *uietenvironment conducive to rela+ation) but it is not based on the gate-control theory.

,' $ /0' 1!-1" 345' Comprehension(36' %ursing 6rocess' $ssessment

7&C' %C#089 test plan designation' 6harmacological (herapies:6harmacological

6ain 7anagement; 6hysiological ntegrity:4asic Care and Comfort

2. $ priority nursing intervention when caring for a client who is receiving an epidural

infusion for pain relief is to'1.

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(36' %ursing 6rocess' 6lanning



!. (he nurse should describe pain that is causing the client a burning sensation in the

epigastric region@ as'1. /eferred

2. /adiating

!. ,eep or visceral". &uperficial or cutaneous

$%&' !

,eep or visceral pain is diffuse and may radiate in several directions. >isceral pain maybe described as a burning sensation. /eferred pain is felt in a part of the body separate

from the source of pain) such as with a myocardial infarction) in which pain may be

referred to the =aw) left arm) and left shoulder. /adiating pain feels as though it travelsdown or along a body part) such as low back pain that is accompanied by pain radiating

down the leg from sciatic nerve irritation. &uperficial or cutaneous pain is of shortduration and is localiEed as in a small cut.

,' $ /0' 1F 345' Comprehension

(36' %ursing 6rocess' $ssessment7&C' %C#089 test plan designation' 6harmacological (herapies:6harmacological


". Which of the following is most appropriate when the nurse assesses the intensity of the

clients pain?

1. $sk about what precipitates the pain.

2. uestion the client about the location of the pain.!. 3ffer the client a pain scale to ob=ectify the information.

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1. What does your discomfort feel like?@

2. What activities make the pain worse?@

!. How much does it hurt on a scale of to 1?@". How much discomfort are you able to tolerate?@

$%&' 1

(o determine the *uality of the clients pain the nurse might say) What does yourdiscomfort feel like?@ t is more accurate to have clients describe the pain in their own

words whenever possible. n*uiring about what activities make the pain worse is a typeof *uestion directed at determining the pain pattern. Having the client rate his or her pain

on a pain scale is a method of measuring the intensity of pain. (o determine the clients

e+pectations) the nurse may ask the client) How much discomfort are you able to

tolerate?@

,' $ /0' 1F!-1F 345' Comprehension(36' %ursing 6rocess' $ssessment



F. When a clients husband *uestions how a patient-controlled analgesia I6C$J pump

works) the nurse e+plains that the client'

1. Has control over the fre*uency of the intravenous I>J analgesia2. Can choose the dosage of the drug received

!. 7ay re*uest the type of medication received

". Controls the route for administering the medication

$%&' 1

With a 6C$ system the client controls medication delivery. (he 6C$ system is designed

to deliver no more than a specified number of doses. (he client does not choose thedosage. (he health care provider prescribes the type of medication to be used. (he

advantage for the client is that he or she may self-administer opioids with minimal riskfor overdose. (he client does not control the route for administration. &ystemic 6C$

typically involves > drug administration but can also be given subcutaneously.

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A. $n older client with mild musculoskeletal pain is being seen by the primary careprovider. (he nurse anticipates that treatment of this clients level of discomfort willinclude'

1. entanyl

2. ,iaEepam

!. $cetaminophen". 7eperidine hydrochloride

$%&' !

7osby items and derived items 2D) 2 by 7osby) nc.) an affiliate of 0lsevier nc.

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$ nonopioid analgesic) such as acetaminophen) is used to effectively treat mild

musculoskeletal pain. entanyl is about 1 times more potent than morphine. t is

typically used for cancer pain) not mild musculoskeletal pain. ,iaEepam is given as anantian+iety agent. 7eperidine hydrochloride is an opioid analgesic used to treat moderate

to severe acute pain) not mild pain.

,' $ /0' 1A! 345' Comprehension

(36' %ursing 6rocess' 6lanning7&C' %C#089 test plan designation' 6harmacological (herapies:6harmacological


B. 4efore inserting a oley catheter) the nurse e+plains that the client may feel somediscomfort. (his is an e+ample of'

1. ,istraction

2. /educing pain perception!. $nticipatory response

". &elf-care maintenance$%&' !

6ain can be prevented by anticipating painful events. 4efore performing procedures) the

nurse considers the clients condition) aspects of the procedure that may be

uncomfortable) and techni*ues to avoid causing pain. (he nurse who tells the client thatthe urinary catheter insertion may feel uncomfortable is an e+ample of anticipatory

response. ,istraction directs a clients attention to something else and thus can reduce the

awareness of pain and even increase tolerance. /educing pain perception means toremove stimuli that are uncomfortable or to prevent stimuli that are painful) such as

changing wet linens) or preventing constipation with fluids) diet) and e+ercise. &elf-care

maintenance implies the client is able to carry out necessary activities to care for himself

or herself. (his may include pain management measures.

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D. (he nurse knows that a 6C$ pump would be most appropriate for the client who'

1. Has psychogenic discomfort

2. s recovering after a total hip replacement!. 0+periences renal dysfunction

". /ecently e+perienced a cerebrovascular accident IstrokeJ

$%&' 2


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6atient-controlled analgesia is a safe method for postoperative pain management) such as

the client recovering from total hip replacement surgery. 6C$ would not be the mode of

choice for treating psychogenic pain or for the client with renal dysfunction. (he clientwith renal impairment would be at increased risk for drug to+icity because of decreased

drug e+cretion. Clients must be able to understand the use of the e*uipment and be

physically able to locate and press the button to deliver the dose. (he client who recentlye+perienced a cerebrovascular accident may have difficulty managing the 6C$ system.

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(36' %ursing 6rocess' $ssessment



1. $ client with chronic back pain has an order for a transcutaneous electrical nerve

stimulation I(0%&J unit for pain control. (he nurse should instruct the client to'1. Keep the unit on high

2.

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(he best choice of treatment often changes as the clients condition and the

characteristics of pain change. t is realistic to e+pect that a terminally ill clients need for

pain medication will change over time with disease progression. (he goal is not tooversedate the client but to provide pain control without e+cessive sedation. t would be

unrealistic to e+pect that the pain of terminal cancer will be completely alleviated.

$nalgesics should not be withheld) because this would only increase the clients level ofpain. (he medication regimen may need to be adapted to meet the clients needs.

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12. $ client is having severe) continuous discomfort from kidney stones. 4ased on the

clients e+perience) the nurse anticipates which of the following findings in the clientsassessment?

1. (achycardia2. ,iaphoresis!. 6upil dilation

". %ausea and vomiting

$%&' "$cute severe or deep pain) as with kidney stones) will cause a parasympathetic response.

(he client would likely e+hibit nausea and vomiting. (achycardia is a response of

sympathetic stimulation) commonly seen with pain of low to moderate intensity andsuperficial pain. ,iaphoresis is a response of sympathetic stimulation) commonly seen

with pain of low to moderate intensity and superficial pain. 6upil dilation is a response of

sympathetic stimulation) commonly seen with pain of low to moderate intensity and

superficial pain.

,' $ /0' 1F" 345' Comprehension(36' %ursing 6rocess' $ssessment



1!. %urses working with clients in pain need to recogniEe and avoid common misconceptions

and myths about pain. n regard to the pain e+perience) which of the following is correct?

1. (he client is the best authority on the pain e+perience.2. Chronic pain is mostly psychological in nature.

!. /egular use of analgesics leads to drug addiction.". (he amount of tissue damage is accurately reflected in the degree of pain

perceived.

$%&' 1


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$ clients self-report of pain is the single most reliable indicator of the e+istence and

intensity of pain and any related discomfort. 6ain is individualistic. $ misconception

about pain is that chronic pain is psychological. (he belief that administering analgesicsregularly will lead to drug addiction is a misconception. $nother misconception about

pain is that the amount of tissue damage is accurately reflected in the degree of pain

perceived.

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1". $ nonpharmacological approach that the nurse may implement for clients e+periencing

pain that focuses on promoting pleasurable and meaningful stimuli is'

1. $cupressure2. ,istraction

!. 4iofeedback". Hypnosis

$%&' 2

6leasurable stimuli cause the release of endorphins. (he nurse assesses activities en=oyed

by the client that may act as distractions. ,istraction directs a clients attention tosomething else and thus can reduce the awareness of pain and even increase tolerance.

$cupressure does not focus on promoting pleasurable and meaningful stimuli.

$cupressure is finger pressure applied therapeutically at selected points on the body.4iofeedback focuses on an individuals physiological responses Ie.g.) blood pressure or

tensionJ and ways to e+ercise voluntary control over those responses. Hypnosis does not

focus on promoting pleasurable and meaningful stimuli. Hypnosis is a condition

resembling sleep in which the mind is susceptible to suggestions.

,' $ /0' 1A1 345' Comprehension(36' %ursing 6rocess' mplementation



1. Which of the following is the most appropriate nursing intervention for a client who is

receiving epidural analgesia?

1. Change the tubing every "B to A2 hours.2. Change the dressing every shift.

!. &ecure the catheter to the outside skin.".

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1B. Which of the following symptoms would the nurse e+pect with a client who is

e+periencing acute pain?1. 4radycardia

2. 4radypnea

!. ,iaphoresis". ,ecreased muscle tension

$%&' !$n e+pected assessment finding of a client e+periencing acute pain would be diaphoresis

resulting from sympathetic nerve stimulation. $dditional assessment findings of a client

e+periencing acute pain would be an increased heart rate) respiratory rate) and muscle

tension.

,' $ /0' 1" 345' Comprehension(36' %ursing 6rocess' $ssessment



1D. Which of the following statements made by a nurse shows the greatest understanding of

the personal nature of the pain e+perience?

1. have e+perienced pain before) and so have great compassion for anyone dealingwith pain.@

2. 6eople handle pain differently) but everyone in pain is only interested in having

the pain stop.@!. 7anaging a clients pain is the single most important thing a nurse can do for a

client e+periencing pain.@

". can only accept what the client reports concerning the pain being felt and attempt

to intervene successfully in its management.@

$%&' "(he nurse cannot see or feel the clients pain. 6ain is purely sub=ective; no two persons

e+perience pain in the same way) and no two painful events create identical responses or

feelings in a person. $ nursing responsibility re*uires that the nurse make good faith

attempts to help minimiEe the pain and to advocate for the client to this end. (heremaining options) while not inappropriate) do not e+press the most therapeutic attitude

toward the nursing role regarding client pain.

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(36' %ursing 6rocess' 6lanning7&C' %C#089 test plan designation' 6harmacological (herapies:6harmacological6ain 7anagement; 6hysiological ntegrity:4asic Care and Comfort

2. Which of the following statements made by a nurse re*uires follow-up with additional

instruction regarding the personal nature of pain?1. have e+perienced pain before) and so have great compassion for anyone dealing

with pain.@


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2. 7y postsurgical clients get the prescribed pain medications on schedule with no

diversion from that schedule.@

!. f were e+periencing severe pain) certainly would want someone to devote theirtime to managing for me.@

". Clients dont always re*uest pain medication) and so always ask them if they

want it according to the schedule.@$%&' 2

(he nurse cannot see or feel the clients pain. 6ain is purely sub=ective; no two personse+perience pain in the same way) and no two painful events create identical responses or

feelings in a person. le+ibility is a necessary component in pain management. (he

remaining options do not re*uire follow-up because they do not e+press any attitudes that

are not compatible with good nursing care of the client in pain.




21. Which of the following statements made by a client reporting severe pain e+presses the

most insight into how pain impacts a clients energy reserves?

1. cant sleep if dont get something for this pain.@2. f only could get an hour when was free of this pain.@

!. m e+hausted physically and emotionally trying to live with this pain.@

". dont see how can continue to cope with this pain; need some relief.@

$%&' !

6ain is e+hausting and demands a persons energy. (he remaining options do e+press this

fact but not as directly as the answer.

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22. Which of the following statements made by a nurse caring for a client reporting severe

pain e+presses the most insight into how pain impacts a clients energy reserves?

1. f cant get his pain under control) his recovery will take a lot longer.@2. 6ain certainly interferes with the clients ability to rest and recuperate.@

!. m going to call for another pain prescription so he can get some rest.@". (rying to cope with pain is using up the energy that his recovery re*uires.@

$%&' "

6ain is e+hausting and demands a persons energy. (he remaining options do e+press this

fact but not as directly as the answer.

,' C /0' 1FF 345' $nalysis(36' %ursing 6rocess' $ssessment


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2!. Which of the following statements made by the nurse regarding the clients self-

assessment of pain re*uires immediate follow-up regarding the personal nature of pain?

1. (he medication should be providing enough relief; try to ambulate her.@2. ve never known anyone to have such pain after that procedure.@

!. He should be able to ambulate with only minimal pain by now.@

". &he says shes in pain) but she doesnt act like she is in pain.@

$%&' "

t is not the responsibility of clients to prove that they are in pain; it is the nurses

responsibility to accept clients report of pain. $lthough the other options appear to beinsensitive to the clients pain) they are not as overtly critical.

,' C /0' 1A 345' $nalysis


7&C' %C#089 test plan designation' 6harmacological (herapies:6harmacological6ain 7anagement; 6hysiological ntegrity:4asic Care and Comfort

2". (he nurse recogniEes that the most likely reason a runner who has in=ured his ankle

during a race is not aware of it until after he crosses the finish line is that'1. (he emotional e+hilaration of running the race masked the pain of the in=ury

2. His endorphin levels were high as a result of the physical stressors of the race

!. He was mentally distracted by the need to concentrate on the ever-changing natureof the race

". (he physical effects of the in=ury slowly increased during the race and reached

pain-producing capacity only after the race

$%&' 2

&tress) e+ercise) and other factors increase the release of endorphins) raising anindividuals pain threshold Ithe point at which a person feels painJ. 4ecause the amount

of circulating substances varies with each individual) the response to pain will be

different. $lthough the other options may have affected his pain perception) they did not

e+ert as much influence as the answer.

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2. Which of the following statements by the nurse reflects a need for immediate follow-up

regarding the physical effects of chronic pain on body function?

1. His pulse and blood pressure are within his normal baseline limits) so m sure the

pain medication is working.@2. 6lease take his pulse and blood pressure) and let me know if they are elevated

above his normal baselines.@


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!. f his pulse and blood pressure are above his normal baseline) let me know) and

will medicate him for pain.@

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2. $ need to be in control of his pain

!. $n understanding that it is easier to prevent the pain than to stop the pain

". $n acceptance of the pain that the dressing change will obviously cause him

$%&' !

Clients often seek relief before pain occurs) having learned that pain is easier to prevent

than to treat.$lthough the other options may not be incorrect) the likelihood is greater forthe answer.

,' C /0' 1 345' $nalysis



2B. (he nurse in*uires of a postoperative client as to the need for pain medication. (he clientdenies the need then but ! minutes later reports) am really in a lot of pain. Can you

bring me my pain pill now?@ (he nurse recogniEes that the most immediate need for

client education is related to e+plaining that'1. His oral medication will take appro+imately ! minutes to affect his pain

2. (here may be a need to administer his pain medication via the intravenous route

!. 6ain medication is more effective if blood levels are maintained at a constant level

". His pain will be more effectively managed if he reports a need for pain medicationwhile the pain is still tolerable

$%&' "(each clients the importance of reporting their pain sooner rather than later because the

pain is better managed while it is still tolerable. 7edication routes do affect the amount

of time it will take to feel relief) and blood levels are a factor in pain management as well.

(he answer addresses the most general and immediate educational need.

,' C /0' 1 345' $nalysis(36' %ursing 6rocess' 6lanning



2D. (he nurse is caring for a cognitively impaired client who has e+perienced a painful

procedure. (he nurse is most effective in determining the clients pain medication needs

when using which of the following assessment methods?1. 7edicating the client with the as-needed IprnJ analgesic as often as ordered

2.

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4ody movements and facial e+pressions that indicate pain include clenching the teeth)

holding the painful part) bent posture) and grimaces. &ome clients cry or moan) are

restless) or make fre*uent re*uests of a nurse. Lou will soon learn to recogniEe patterns ofbehavior that reflect pain. (his becomes especially important in clients who are unable to

report their pain) such as the cognitively impaired. However) lack of pain e+pression does

not necessarily mean that the client is not e+periencing pain. (he remaining options arenot always as effective for the cognitively impaired or reflect inappropriate use of

analgesics.

,' C /0' 1FA 345' $nalysis



!. (he nurse is attempting to ambulate a postoperative client who continues to rate his painas a A on a scale of to 1) with 1 being the most severe. (he client is reluctant to walk

and consents to move only to the chair) reporting that it hurts too much to walk.@ (henurses primary concern regarding the clients recovery related to his pain e+perience isthat'

1. His pain medications are not effectively managing his pain

2. He does not fully understand the importance of ambulation

!. He is e+pending too much of his energy dealing with the pain". He is not ready to participate in the activities needed to recover *uickly

$%&' "0fforts aimed at teaching and motivating the client toward self-care are often hampered

until the pain is successfully managed. (hus a primary nursing goal is to provide pain

relief that allows clients to participate in their recovery. $lthough the remaining options

are not inappropriate) they do not e+press the ma=or concern regarding his recovery.




!1. (he nurse is attempting to ambulate an older adult client who recently e+perienced a fall

at the assisted living facility where he resides. (he client is reluctant to walk and consents

to move only to the chair) reporting that it hurts too much to walk.@ Which of thefollowing nursing interventions is most therapeutic regarding this client?

1. $llow the client to remain in bed in order to conserve his energy.2. (ransfer him to the chair) realiEing some activity is preferable to none.!. Call his health care provider to discuss the apparent ineffectiveness of his pain

medications.

". $ssess the client for other factors that may be affecting his ability and motivation

to ambulate.

$%&' "


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(he perception of pain is affected by both physical and emotional factors. (he client may

be e+pressing concern over his ability or desire to return to the assisted living facility and

so perceives the pain as a barrier to ambulating. (hus physical pain can causepsychological pain and vice versa. (he other options are either not therapeutic or not the

initial action to be taken.

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(36' %ursing 6rocess' mplementation7&C' %C#089 test plan designation' 6harmacological (herapies:6harmacological


!2. $ client with chronic pain states) =ust want to be pain-free. ,o something to make thathappen.@ (he most therapeutic response is'

1. (ogether we will all work at making your pain tolerable.@

2. will do everything can to manage your pain; promise.@!. $re you feeling depressed or an+ious because of your pain?@

". Lou sound an+ious. Would you like something for your nerves?@$%&' 1

Complete pain relief is not always achievable) but reducing pain to a tolerable level is

realistic. (he remaining options either address issues other than pain or make promises

that may be difficult or impossible to keep.

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!!. (he greatest barrier to a !-year-old clients ability to self-assess her pain is'1. $ limited vocabulary

2. ncreased separation an+iety!. /eluctance to talk to strangers

". nability to grasp the concept of pain

$%&' 1Loung children who have not developed full vocabularies have difficulty verbally

describing and e+pressing pain to parents or caregivers. (oddlers and preschoolers are

unable to recall e+planations about pain or associate pain with e+periences that occur invarious situations. (he remaining options may have an effect on self-assessment of pain)

but only to a limited degree.

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!". (he nurse is discussing the effects of pain with an older adult client diagnosed with

osteoarthritis. (he most therapeutic response to the clients comment of) wonder

whether it would hurt if took a nap in the afternoon?@ would be'1. $s long as it did not interfere with your getting a good nights sleep.@

2. d suggest taking your nap right after you take your pain medication.@

!. f it helps you cope better with the pain) dont see any harm in taking a nap.@". think a nap is a good idea because we seem to feel pain more when we are tired.@

$%&' "atigue heightens the perception of pain and decreases coping abilities. f fatigue occurs

along with sleeplessness) the perception of pain is even greater. 6ain is often e+perienced

less after a restful sleep than at the end of a long day. (he other options are not

inappropriate but are not as informative regarding the benefit of rest on the perception oreffects of pain.

,' $ /0' 1A-1D 345' $nalysis

(36' %ursing 6rocess' mplementation


!. Which of the following statements is the most appropriate response to a clients

statement) thought you could tell was in pain@?1. How do you e+press a need for pain medication if not by asking?@

2. m so very sorry; may get you your pain medication right now?

!. dont think its wise to assume can effectively read your mind regarding theneed for pain medication.@

". will make a point of asking you to rate your pain at least every 2 hours) so this

miscommunication wont happen again.@

$%&' "

4e sensitive to variations in communication styles. &ome cultures feel nonverbale+pression of pain is sufficient to describe the pain e+perience) whereas others assume

that if pain medication is appropriate) the nurse will bring it; thus asking is inappropriate.

(he remaining options are not as effective at addressing the root of the problem or

providing a possible solution.

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!F. $ ""-year-old client shares with the admitting nurse that the client is having epigastric

pain that the client identifies as a A on a to 1 scale. n order to plan for the pain

management of this client) which is the most appropriate response from the nurse?

1. MWhat would be a satisfactory level of pain control for us to achieve?M2. MLou dont look like youre in that much pain.M

!. MLoull be pain-free following your surgery.M


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". Mve cared for a client with a nail in his head who only rated his pain as a ; are

you sure your pain is a A?M

$%&' 1

Complete pain relief is not always achievable) but reducing pain to a tolerable level is

realistic. (hus a primary nursing goal is to provide pain relief that allows clients to

participate in their recovery. &uccessful pain management does not necessarily mean painelimination) but rather attainment of a mutually agreed-upon pain-relief goal that allows

clients to control their pain instead of the pain controlling them. $ person in pain feelsdistress or suffering and seeks relief. However) you as the nurse cannot see or feel the

clients pain. t is realistic that the client will most likely e+perience postoperative pain.

(he nurse should not use a pain scale to compare the pain of one client to that of another

client.

,' 4 /0' 1F 345' $nalysis(36' %ursing 6rocess' $ssessment



!A. (he home care nurse notes that a FA-year-old female diabetic clients blood glucose level

has been elevated since she strained her back the previous week. (he client states that she

cannot understand why her blood glucose level is elevated. (he nurse suspects the mostlikely cause for the elevated blood sugar is'

1. (he decreased activity level of the client since the in=ury

2. 6arasympathetic stimulation from the bodys normal response to pain!. (he client is consuming more food as a comfort measure

". (he client may not be taking her medication as ordered

$%&' 2$n increased blood glucose level is the bodys physiological response to pain) which is

triggered by the parasympathetic nervous system in order to provide additional glucosefor additional energy.

,' $ /0' 1FA 345' Comprehension



!B. $ client with chronic pain presents in the emergency department of the local hospital

stating =ust cant take this anymore.@ 3n *uestioning the client) the nurse discovers thatthe client have e+perienced chronic pain since being involved in an accident 2 yearspreviously. (he client states that he has been labeled a drug seeker@ because he is

looking for relief for the pain and feels hopeless) angry) and powerless to do anything

about the situation. (he nurse understands that this client is at risk for'

1. Criminal activity2. 3pioid abuse

!. &uicide


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". ,rug addiction

$%&' !(he possible unknown cause of noncancer pain) combined with the unrelenting pain and

uncertainty of its duration) frustrates the client) fre*uently leading to psychological

depression and perhaps suicide. (here is no evidence to demonstrate a relationship

between chronic pain and criminal activity. Health care workers are usually less willingto treat chronic noncancer pain with opioids) although a recent policy statement supports

the use of opioids for noncancer pain. n addition) the $merican &ociety of$nesthesiologists developed the 6ractice Guidelines for Chronic 6ain 7anagement)

which includes the use of opioids. 7any health care providers and clients fear addiction

when long-term opioid use is prescribed to manage pain) although this fear is often

inappropriate. 4ecause of this concern) health care providers re*uire opioid agreementsand random urine testing in clients who re*uire long-term opioid therapy. (he

effectiveness of agreements is lacking) and there are ethical concerns about using them

for all clients who re*uire long-term opioid therapy. (his raises the *uestion as to whetheragreements protect clients or health care providers.

,' $ /0' 1A 345' Comprehension




!D. $ client who had knee replacement surgery the previous day refuses to take any pain

medication) even though he rates his pain as an B on a to 1 scale.

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". $ !B-year-old client presents to the pain clinic with complaints of phantom pain. (he

client was involved in a farming accident ! years previously that resulted in a below-the-

elbow amputation of his right arm. (he nurse knows that phantom pain is categoriEed as'1. 6ainful polyneuropathy

2. &omatic pain

!. &ympathetically maintained pain". ,eafferentation pain

$%&' ",eafferentation pain comes from in=ury to either the peripheral or central nervous system.

6hantom pain reflects in=ury to the peripheral nervous system. n painful polyneuropathy

the client feels pain along the distribution of many peripheral nerves; e+amples include

diabetic neuropathy) alcohol-nutritional neuropathy) and Guillain-4arrN syndrome.&omatic pain comes from bone) =oint) muscle) skin) or connective tissue. t is usually

aching or throbbing in *uality and is well localiEed. &ympathetically maintained pain is

associated with dysregulation of the autonomic nervous system; e+amples include painassociated with refle+ sympathetic dystrophy:causalgia Icomple+ regional pain

syndrome) type ) type J.

,' $ /0' 1" 345' Comprehension



"1. (he daughter of an BB-year-old female client tells the nurse that her mother has recently*uit going on walks in the neighborhood because of pain in her legs. Which of the

following is the best response from the nurse?

1. M would like to speak with your mother to get more information.M

2. M3lder people fre*uently suffer from arthritis that can cause leg pain.M!. MLour mother probably has poor circulation in her legs) which is causing the pain.M

". M&he is lucky to be as healthy as she is at her age.M

$%&' 1

(he presence of pain in an older adult re*uires aggressive assessment) diagnosis) and

management. 6ain is not an inevitable part of aging.

,' $ /0' 1 345' Comprehension



"2. (he nursery nurse is e+plaining postcircumcision care to a new mother. Which of the

following statements by the new mother indicates that additional teaching needs to occur?

1. 4abies dont e+perience pain) so dont need to worry about hurting him when

touch the penis.@2. need to be careful not to put his diaper on too tight to avoid discomfort.@

!. can comfort my baby following the procedure by holding him.@


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(est 4ank

". (he health care provider will numb the area before performing the procedure.@

$%&' 1(erm neonates have the same sensitivity to pain as older infants and children. 6reterm

neonates have a greater sensitivity to pain than term neonates or older children.

,' C /0' 1 345' $nalysis(36' %ursing 6rocess' $ssessment7&C' %C#089 test plan designation' 6harmacological (herapies:6harmacological


"!. (aking into consideration the hospice clients chronic pain from bone cancer) the mostappropriate person to collaborate with regarding management of pain is'

1. 3ccupational therapist to devise a splint for the clients leg

2. 6hysical therapist to determine e+ercises to strengthen the leg muscles!. $rt therapist to provide creative therapy as a diversion

". $n oncology nurse

$%&' "

$n oncology nurse specialist is very familiar with pharmacological and

nonpharmacological interventions that are most effective for chronic:persistent pain. (he

client is terminally ill) and although occupational therapy) physical therapy) and arttherapy are all important therapies to consider) in this case the most appropriate discipline

is the nurse who cares for this type of client and is familiar with the interventions that

would be most appropriate.

,' C /0' 1F 345' $nalysis



"". n creating the plan of care for a newly diagnosed breast cancer client) the nurse is

concerned about pain control. (he client has e+pressed an interest in rela+ation therapy as

a complementary pain therapy. (he nurse knows that the best time to teach the client is'

1. mmediately following the clients mastectomy2. 4efore giving pain medication to evaluate if the complementary therapy works

!. mmediately preceding surgery

". When the client is comfortable

$%&' "

or effective rela+ation) teach techni*ues only when the client is not distracted by acutediscomfort. (he nurse would want to teach the client before the surgery so that the client

could practice the techni*ue before e+periencing postsurgical pain.

,' 4 /0' 1A 345' $pplication




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