Chapter 15 Pain Assessment and Basic Comfort Measures

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Chapter 15  Pain Assessment and Basic Comfort Measures

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

MULTIPLE CHOICE

1. The nurse is caring for a patient who is a devout Orthodox Jew. The patient is on a patient-controlled analgesia (PCA) pump. What accommodations might the nurse have to make to conform to the patient’s cultural needs?
a.
Ask the patient whether he will need alternative forms of medication for the Sabbath.
b.
Ask the patient specific questions because Jews tend to be stoic regarding pain.
c.
Medicate the patient “around the clock” instead of as needed (“prn”).
d.
Understand that Jews believe that suffering is a consequence of actions in a previous life.

ANS: A
Orthodox or Observant Jews may not use electrical equipment during the Sabbath and on Holy Days; therefore, the staff should program the PCA to achieve optimum pain relief. Alternative methods will be needed during these times. Cultures vary regarding when to recognize pain, what words to use in expressing pain, when to seek treatment, and what treatments are desirable. Russians, Asians, and Native Americans tend to be stoic, whereas Italians, Puerto Ricans, and Jews tend to be more expressive. The nurse should ask the patient about his preferences. Some Hindu patients believe that suffering is a consequence of actions in a previous life. For example, a belief in the concept of Karma motivates the patient to bear the pain, refuse pain medications, and suffer in silence. Some Jews view pain as a communal suffering that they should share with others to affirm their life experience.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 348
OBJ: Assess a patient’s level of pain. TOP: Cultural Considerations
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The patient is admitted with chronic pain. She states that nothing takes the pain away totally, but that “Dilaudid works best.” The fact that the patient calls the medication by name should alert the nurse to:
a.
suspect that the patient is drug seeking.
b.
expect that the patient may need smaller doses than normal.
c.
assess the patient’s acceptable level of comfort.
d.
accept the fact that nothing will help this patient’s pain.

ANS: C
It is important to assess the patient’s acceptable level of comfort so that both you and the patient are striving for the same outcome. Some patients with prior pain conditions can alert the nurse to pain-relieving measures that were successful. Patients with chronic/persistent pain are often familiar with the names and actions of medications, including opioid medications. This should not cause you to view the patient negatively or with suspicion. Patients currently receiving opioids for chronic pain often require higher doses of analgesics to alleviate new pain. Do not accept that “there is nothing that will help this patient’s pain.” Learn the institutional policy for how to proceed in this situation.

DIF: Cognitive Level: Application REF: Text reference: pp. 348-349
OBJ: Assess a patient’s level of comfort.
TOP: Assessment of Comfort Level KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. The nurse frequently must assess a patient who is experiencing pain. When assessing the intensity of the pain, the nurse should:
a.
ask whether there are any precipitating factors.
b.
question the patient about the location of the pain.
c.
offer the patient a pain scale to objectify the information.
d.
use open-ended questions to find out about the sensation.

ANS: C
Descriptive scales are an objective means of measuring pain intensity. Use a pain intensity scale appropriate to the patient’s age, developmental level, and comprehension, and ask the patient to rate the pain. An appropriate pain rating scale is reliable, easily understood, and easy to use, and it reflects changes in pain intensity. Asking the patient what precipitates the pain does not assess intensity, but rather assesses the pain pattern. Asking the patient about the location of pain does not assess the intensity of the patient’s pain. To determine the quality of the patient’s pain, the nurse may ask open-ended questions to find out about the sensation experienced (e.g., “Tell me what your pain feels like”). This approach assists in identifying the underlying pain mechanism (e.g., somatic or neuropathic pain), but it may not reveal intensity or changes in intensity.

DIF: Cognitive Level: Application
REF: Text reference: pp. 347-348|Text reference: pp. 362-363
OBJ: Assess a patient’s level of comfort. TOP: Assessing Pain Intensity
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

4. The nurse who is caring for a patient postoperatively notes that he is expressing discomfort and is diaphoretic. Which of the following interventions is most appropriate?
a.
Straighten the bed linens.
b.
Change the saturated surgical dressing.
c.
Administer prescribed pain medications.
d.
Check for displaced equipment underneath the patient.

ANS: C
Administer pain-relieving medications as ordered. Analgesics are the cornerstone of pain management. Smoothing wrinkles in bed linens may reduce pressure and irritation to the skin; however, pain-relieving medication should be given first. Changing a wet surgical dressing might not be needed if the patient has received a wet-to-dry dressing as treatment, or if not changing the dressing will reduce irritation to the skin but will not address the discomfort. Reposition underlying tubes, wires, or equipment that may apply pressure directly to dependent skin surfaces. Removing these stimuli may maximize the response to pain-relieving interventions such as medication, but pain-relieving medication should be administered first.

DIF: Cognitive Level: Application REF: Text reference: p. 350
OBJ: Identify skills appropriate for relieving a patient’s reported pain.
TOP: Treatment of Pain KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

5. The patient’s family is concerned that the patient may get too much pain medication after surgery and become addicted to the medication if he is placed on a PCA pump. They also voice concern about the effectiveness of the PCA. The nurse should instruct the family and the patient that:
a.
pain relief with the PCA pump is not as good as when the nurse provides it, but it does save on nursing time.
b.
pain relief is good when the medication peaks, but less so when the levels drop, and that is when the patient will know that he needs more.
c.
because the device provides medication as soon as the patient needs it, he will probably use less of the medication.
d.
the patient will be kept in bed for several days after surgery to make sure it is safe to ambulate.

ANS: C
Because the device provides medication on demand as soon as the patient feels the need, the total amount of opioid use is reduced. Because the blood level stays within a narrow range of the minimum effective analgesia concentration for the individual, pain relief is enhanced, and the incidence of side effects, such as sedation and respiratory depression, is decreased. The PCA has several advantages. It allows more constant serum levels of the opioid and, as a result, avoids the peaks and troughs of a large bolus. An advantage of PCA is that when used postoperatively, fewer complications arise because earlier and easier ambulation occurs as a result of effective pain relief.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 353
OBJ: Teach a patient to use a PCA device.
TOP: Patient-Controlled Analgesia (PCA)
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

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