CHAPTER 9 Pain Management

CHAPTER 9 Pain Management

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

9.1•The nurse aide reports to the charge nurse that the client in room 210 is complaining of “severe pain” in the lower extremities. On review of the client record, the nurse notes that the client has not received pain medication in the past 18 hours. The client is in a nursing home, has severe arthritis, and often presents with musculoskeletal pain. The client is usually given pain medication every 4 to 6 hours. The nurse may interpret this report of an increase of pain as a result of which of the following?

1. client dependency on narcotics
2. untreated pain resulting in lower pain threshold
3. client need for alternative measures for pain relief
4. inaccuracy of the nurse aide’s assessment of the client complaint

Answer: 2

Rationale: With untreated pain, the nociceptors become sensitive and more responsive to stimuli resulting in a lowered pain threshold. This client experienced a long period of time between administrations of pain medication, and this causes an increase in the pain experienced. Contrary to belief, narcotic dependency in the elderly is unlikely. Although alternative measures may help, a regular administration schedule of pain medication works best. The nurse aide’s assessment is quoting the client’s words. This should be considered accurate as it reflects the client’s own perception of the pain.

Assessment

Physiological Integrity

Analysis

9.2•A 75-year-old client arrives in the emergency department complaining of abdominal pain. The pain started last night and is rated 5 out of 10 on the pain scale. At the same time a 32-year-old-female client arrives stating that she has severe pain in the left lower quadrant of the abdomen that started this morning. This client rates her pain 10 out of 10 on the pain scale. In assessing the severity of pain in these clients, the nurse may consider which factor regarding the reported intensity of pain?

1. Visceral pain is more severe in the older client, but they are less likely to complain.
2. Visceral pain is less severe in the older client and may be reported as mild.
3. The younger client tends to be more dramatic when complaining of pain.
4. Visceral pain is less severe in younger clients, but this may be reported high in intensity when it is the client’s first experience with pain.

Answer: 2

Rationale: Visceral pain is often less severe in the older client and reported with vague complaints. This often is an explanation for the higher incidence of silent myocardial infarctions and less dramatic presentations of abdominal problems requiring surgery in older adults. Although older clients often do not complain of pain, their visceral pain is not more severe. There is no evidence that younger clients are more dramatic or that visceral pain is less severe. Evidence indicates that younger clients experience more severe visceral pain.

Assessment

Physiological Integrity

Analysis

9.3•The nurse is completing a home care visit of an 86-year-old client. The client has been taking narcotic medication for the treatment of chronic pain from rectal cancer. The client reports a need to take twice as much pain medication for abdominal pain over the past 24 hours. The nurse interprets this report by the client as

1. a need for the client’s medication to be changed because of tolerance of opioids.
2. not an unusual finding and the client should continue to adjust the medication as needed.
3. a sign that there may be underlying issues that the client needs to have evaluated by a clinician.
4. a need for the client to try alternative methods for pain relief instead of pain medication.

Answer: 3

Rationale: A sudden need for increased pain medication is an indication that there is an underlying issue that needs to be investigated. Pain medication tolerance occurs at a more gradual pace in the face of a stable disease. The client should not continue to increase medication that is seemingly ineffective, and, although alternative methods of pain relief are often helpful, the sudden increase in pain must be examined.

Assessment

Physiological Integrity

Analysis

9.4•An 82-year-old client is brought to the emergency department with complaints of headache, dizziness, and ataxia. On review of the client’s medication, you note that the client is taking Propoxyphene for arthritic pain and occasional headaches. The nurse would consider this drug to

1. not contribute to the client’s symptoms.
2. be more effective in treating the client’s pain than aspirin or acetaminophen.
3. be less effective in older clients for pain relief.
4. cause toxic side effects similar to the client’s symptoms and should not be taken by the elderly.

Answer: 4

Rationale: Propoxyphene is not recommended for treatment of persistent pain in older persons because it tends to cause accumulations of toxic metabolites that can cause delirium, ataxia, and dizziness. Although it can be effective in treating the client’s pain, it is no more effective than aspirin or acetaminophen, nor is it less effective in the elderly.

Assessment

Psychosocial Integrity

Analysis