Milestone Chapter 04 Assessment And Care Of Patients With Pa 1

Milestone Chapter 04: Assessment and Care of Patients with Pain (Concepts for Interprofessional Collaborative Care College Test Bank)

MULTIPLE CHOICE

• A student asks the nurse what is the best way to assess a clients pain. Which response by the

nurse is best?

• Numeric pain scale
• Behavioral assessment
• Objective observation
• Clients self-report

ANS: D

Many ways to measure pain are in use, including numeric pain scales, behavioral assessments, and other objective observations. However, the most accurate way to assess pain is to get a self-report from the client.

DIF: Remembering/Knowledge REF: 46 KEY: Pain| pain assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Health Promotion and Maintenance

• A new nurse reports to the precepting nurse that a client requested pain medication, and when

the nurse brought it, the client was sound asleep. The nurse states the client cannot possibly sleep with the severe pain the client described. What response by the experienced nurse is best?

• Being able to sleep doesnt mean pain doesnt exist.
• Have you ever experienced any type of pain?
• The client should be assessed for drug addiction.
• Youre right; I would put the medication back.

ANS: A

A clients description is the most accurate assessment of pain. The nurse should believe the client and provide pain relief. Physiologic changes due to pain vary from client to client, and assessments of them should not supersede the clients descriptions, especially if the pain is chronic in nature. Asking if the

new nurse has had pain is judgmental and flippant, and does not provide useful information. This amount of information does not warrant an assessment for drug addiction. Putting the medication back and ignoring the clients report of pain serves no useful purpose.

DIF: Understanding/Comprehension REF: 49 KEY: Pain| pain assessment MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Health Promotion and Maintenance

• The nurse in the surgery clinic is discussing an upcoming surgical procedure with a client. What

information provided by the nurse is most appropriate for the clients long-term outcome?

• At least you know that the pain after surgery will diminish quickly.
• Discuss acceptable pain control after your operation with the surgeon.
• Opioids often cause nausea but you wont have to take them for long.
• The nursing staff will give you pain medication when you ask them for it.

ANS: B

The best outcome after a surgical procedure is timely and satisfactory pain control, which diminishes the likelihood of chronic pain afterward. The nurse suggests that the client advocate for himself and discuss acceptable pain control with the surgeon. Stating that pain after surgery is usually short lived does not provide the client with options to have personalized pain control. To prevent or reduce nausea and other side effects from opioids, a multimodal pain approach is desired. For acute pain after surgery, giving pain medications around the clock instead of waiting until the client requests it is a better approach.

DIF: Applying/Application REF: 47 KEY: Pain| acute pain MSC: Integrated Process: Teaching/Learning

NOT: Client Needs Category: Health Promotion and Maintenance

• A nurse is assessing pain on a confused older client who has difficulty with verbal expression.

What pain assessment tool would the nurse choose for this assessment?

• Numeric rating scale
• Verbal Descriptor Scale

• FACES Pain Scale-Revised
• Wong-Baker FACES Pain Scale

ANS: C

All are valid pain rating scales; however, some research has shown that the FACES Pain Scale-Revised is preferred by both cognitively intact and cognitively impaired adults.

DIF: Applying/Application REF: 51 KEY: Pain assessment| FACES MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Health Promotion and Maintenance

• The nurse is assessing a clients pain and has elicited information on the location, quality,

intensity, effect on functioning, aggravating and relieving factors, and onset and duration. What question by the nurse would be best to ask the client for completing a comprehensive pain assessment?

• Are you worried about addiction to pain pills?
• Do you attach any spiritual meaning to pain?
• How high would you say your pain tolerance is?
• What pain rating would be acceptable to you?

ANS: D

A comprehensive pain assessment includes the items listed in the question plus the clients opinion on a functional goal, such as what pain rating would be acceptable to him or her. Asking about addiction is not warranted in an initial pain assessment. Asking about spiritual meanings for pain may give the nurse important information, but getting the basics first is more important. Asking about pain tolerance may give the client the idea that pain tolerance is being judged.

DIF: Applying/Application REF: 50 KEY: Pain assessment MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

• A nurse is assessing pain in an older adult. What action by the nurse is best?

• Ask only yes-or-no questions so the client doesnt get too tired.
• Give the client a picture of the pain scale and come back later.
• Question the client about new pain only, not normal pain from aging.
• Sit down, ask one question at a time, and allow the client to answer.

ANS: D

Some older clients do not report pain because they think it is a normal part of aging or because they do not want to be a bother. Sitting down conveys time, interest, and availability. Ask only one question at a time and allow the client enough time to answer it. Yes-or-no questions are an example of poor communication technique. Giving the client a pain scale, then leaving, might give the impression that the nurse does not have time for the client. Plus the client may not know how to use it. There is no normal pain from aging.

DIF: Applying/Application REF: 53 KEY: Pain assessment| older adult MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Psychosocial Integrity

• The nurse receives a hand-off report. One client is described as a drug seeker who is obsessed

with even tiny changes in physical condition and is on the light constantly asking for more pain medication. When assessing this clients pain, what statement or question by the nurse is most appropriate?

• Help me understand how pain is affecting you right now.
• I wish I could do more; is there anything I can get for you?
• You cannot have more pain medication for 3 hours.
• Why do you think the medication is not helping your pain?

ANS: A

This is an example of therapeutic communication. A client who is preoccupied with physical symptoms and is demanding may have some psychosocial impact from the pain that is not being addressed. The nurse is providing the client the chance to explain the emotional effects of pain in addition to the