Chapter 15 Pain and Comfort

Chapter 15  Pain and Comfort

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. Compared with acute pain, which of the following statements is true of persistent pain?
a.
Leads to significantly altered vital signs.
b.
Is usually described as a burning pain.
c.
Is generally gone within 4 months.
d.
Can bring about long term changes in lifestyle.

ANS: D
Persistent pain affects the patient’s experience on a continuing basis. Both acute pain and persistent pain can affect the vital signs. Persistent pain may be described in many possible ways. Persistent pain is unrelenting.

PTS: 1 DIF: Understand REF: 4-5
TOP: Nursing Process: Assessment MSC: Physiological Integrity

2. The nurse admits an older man who had abdominal surgery. Admission vital signs are heart rate (pulse) (P), 73 beats per minute (bpm); respiration rate (R), 20 breaths per minute; blood pressure (BP), 136/84 mm Hg. He is receiving intravenous (IV) fluids but has not requested pain medication since surgery. Seven hours later, his vital signs are P, 98 bpm; R, 26 breaths per minute; and BP, 164/90 mm Hg; and he denies pain. Which intervention should the nurse implement?
a.
Administer an opioid medication by IV route.
b.
Check the surgical dressing for bleeding.
c.
Report the vital signs to the health care provider.
d.
Ask if he has about discomfort at the surgical site or any other location.

ANS: D
The patient’s P, R, and BP increased significantly since his admitting vital signs and indicate the potential for pain or discomfort from the surgical incision. The older adult patient may also be experiencing pain unrelated to the surgery due to arthritic changes, neuropathies, etc. The patient can be misunderstanding the nurse’s question or be barred from saying, “yes,” by cultural patterns. Such miscommunication is common; therefore the nurse rewords the question using another term for pain such as discomfort, burning, or pressure. Administering an opioid medication by IV route is unethical without the patient’s request. When checking the surgical dressing for bleeding, the patient may show signs of pain rather than blood loss. Reporting the vital signs to the health care provider would be premature; the patient’s pain assessment is not complete.

PTS: 1 DIF: Apply REF: 7-10
TOP: Nursing Process: Implementation MSC: Communication and Documentation

3. An older woman had hip replacement surgery 1 day ago, and the nurse thinks that the woman also has dementia. Which patient assessment does the nurse use to determine whether this woman is experiencing pain?
a.
Holds abdomen tightly.
c.
Is not verbalizing.
b.
Has stable vital signs.
d.
Moves during sleep.

ANS: A
Because this older adult has a potential cognitive impairment and is likely to self-report pain unreliably, the nurse uses additional clinical indicators to detect pain. Muscle rigidity and guarding are clinical indicators of pain for a postoperative older adult, regardless of a cognitive impairment. An individual experiencing pain is unlikely to have stable vital signs. Not verbalizing can indicate a sensory impairment and warrants further investigation by the nurse. Nonetheless, this older adult’s verbalizations are potentially unreliable indicators of pain. Older adults move normally during sleep to adjust their position in bed; moving during sleep is not an indicator of pain unless the movements are agitated or restless in nature.

PTS: 1 DIF: Apply REF: 7-10
TOP: Nursing Process: Assessment MSC: Physiological Integrity

4. The safest opioid analgesic choice for an older patient who has severe acute pain is which of the following?
a.
Meperidine (Demerol)
c.
Morphine sulfate (Morphine)
b.
Pentazocine (Talwin)
d.
Safe opioids do not exist.

ANS: C
Morphine sulfate (Morphine), oxycodone (Oxycontin), hydrocodone (Hycodan), hydromorphone (Dilaudid), and fentanyl (Sublimaze) are opioids that can be safely used with older patients. Meperidine and pentazocine are both contraindicated for older adults because their metabolites can produce confusion, psychotic behavior, and seizures. Used properly, opioids have a lower risk of certain side effects than nonsteroidal antiinflammatory agents (NSAIDs).

PTS: 1 DIF: Understand REF: 11-15
TOP: Nursing Process: Assessment MSC: Physiological Integrity