Chapter 13: Pain Management

Chapter 13: Pain Management

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse teaches the patient progressive self-relaxation techniques. Which should the nurse implement first?

a.	Direct the patient to envision sailing on a sailboat.
b.	Instruct the patient to increase respiratory rate and depth.
c.	Establish the patient’s ability to participate and cooperate.
d.	Darken the patient’s room significantly and close the door.

 

 

ANS:  C

The nurse begins by assessing the patient’s ability to participate and cooperate to tailor the teaching techniques and vocabulary to him or her. This increases the likelihood of the patient benefiting from the instruction. Envisioning pleasant things is part of teaching guided imagery but is not the initial step. After assessing the patient, the nurse provides a brief overview of the technique and sets a proper learning environment. Deep respirations are an indication of relaxation; however, instructing a patient to breathe in a certain way does not induce relaxation.

 

DIF:    Cognitive Level: Comprehend          REF:   Page 326

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning

 

2. The nurse massages the patient to promote relaxation. Which is a suitable intervention for the nurse to implement during the massage?

a.	Use the friction technique over the spine.
b.	Assess for pain, anxiety, and discomfort.
c.	Instruct the patient to sit upright and forward.
d.	Knead the patient’s scalp with warm lotion.

 

 

ANS:  B

The nurse’s goal during a massage is to keep the patient comfortable and relaxed and induce a lingering sense of well-being and relaxation at the completion of the massage. If the patient is in pain, anxious, or uncomfortable, relaxation does not occur until the noxious stimuli are eliminated. The nurse asks the patient about pain and comfort during the massage and does not wait for the patient to offer such statements. The friction technique (i.e., strong, circular strokes enhancing perfusion at the skin’s surface) is contraindicated for bony prominences such as the spine because the regional skin is already thin and under tension by nature of its location over a bone. Sitting upright and forward can be contraindicated or uncomfortable for the patient. Occasionally the patient’s scalp is massaged with a few drops of oil on the fingertips; it is impossible to knead the scalp because the scalp is devoid of large, thick muscles.

 

DIF:    Cognitive Level: Comprehend          REF:   Page 321

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning

 

3. The patient awakens at 3:00 AM requesting pain medication, but the nurse does not administer additional pain medication. What justifies the nurse’s decision to withhold the medication?

a.	The patient had a reaction to aspirin 5 years ago.
b.	The nurse wants to help the patient avoid drug addiction.
c.	The patient is asleep when the nurse returns with analgesia.
d.	The patient wants pain medication every 3 3/4 hours exactly.

 

 

ANS:  C

The nurse receives contradictory messages about the patient’s pain level because the patient is relaxed enough to fall asleep again. To avoid oversedation and complications, the nurse withholds the medication but assesses the patient for other indicators of pain before leaving the room. The nurse promptly administers pain medication if other indicators of pain are present or when the patient awakens. Frequently nurses feel a duty to protect patients from drug addiction and to withhold pain medication when they suspect that the patient exhibits addictive behavior or asks for too much pain medication. Experts, including The Joint Commission, agree that healthcare professionals should rely on the patient’s report of pain. The patient has the right to effective pain management, and the nurse is bound ethically to provide pain relief when the patient asks for it. If the patient asks for pain medication every 3 3/4 hours, he or she may be watching the clock. Many healthcare professionals describe this behavior as “drug seeking,” meaning that the patient is seeking pain medication for unrelated reasons; this description labels the patient unfairly. This behavior can also indicate inadequate pain relief or the onset of a new patient health problem. For these reasons this type of patient request for pain medication warrants further investigation. To manage this situation, the nurse remembers the patient’s right to pain relief and the nurse’s role as patient advocate.

 

DIF:    Cognitive Level: Analyze                REF:   Page 317| Page 328-329

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Evaluation

 

4. The patient has hypotension, receives as much opioid analgesia as the prescription allows, and continues to have difficulty sleeping at night because of pain. Which should the nurse implement to relieve pain and improve sleep?

a.	Encourage controlled breathing.
b.	Provide a glass of wine at bedtime.
c.	Give a sedative 1 hour before sleep.
d.	Increase fluids and reposition the patient.

 

 

ANS:  A

The nurse encourages the patient with controlled breathing exercises that serve as a distraction to increase relaxation, decrease pain, and promote sleep. The nurse applies a nonpharmacological relaxation technique because the patient has hypotension and additional analgesia is likely to lower the blood pressure further, potentially leading to serious complications, including loss of consciousness, decreased perfusion to vital organs, and cardiopulmonary arrest. Alcohol is contraindicated for use with opioids; in addition, alcohol consumption is likely to lower the blood pressure by vasodilation. The nurse avoids administering a sedative because hypotension is an adverse effect of most sedatives and sedatives will aggravate the patient’s hypotension. The nurse increases fluid if the patient has a fluid volume deficiency; however, restoring fluid balance is unlikely to promote relaxation to relieve pain and improve sleep. Until the patient’s hypotension is resolved, the nurse repositions him or her in the supine position or with the head slightly elevated to prevent increasing venous return from the head to the heart.

 

DIF:    Cognitive Level: Analyze                REF:   Page 330

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning