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Chapter 043

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Potter & Perry: Fundamentals of Nursing, 7th Edition Test Bank Chapter 43: Pain Management MULTIPLE CHOICE 1. Which one of the following nursing interventions for a client in pain is based on the gatecontrol theory? 1. Giving the client a back massage 2. Changing the client’s position in bed 3. Giving the client a pain medication 4. Limiting the number of visitors ANS: 1 The gate-control theory suggests that cutaneous stimulation activates larger, fastertransmitting A-beta sensory nerve fibers.
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  Potter & Perry: Fundamentals of Nursing, 7 th  Edition Test Bank Chapter 4: Pain !anagement! #T$P#E C%$CE 1.Which one of the following nursing interventions for a client in pain is based on the gate-control theory?1.Giving the client a back massage2.Changing the clients position in bed!.Giving the client a pain medication .#imiting the number of visitors$%&'1(he gate-control theory suggests that cutaneous stimulation activates larger) faster-transmitting $-beta sensory nerve fibers. (his decreases pain transmission through small-diameter $-delta and C fibers. $ back massage is a nursing intervention based on the gate-control theory. Changing the clients position in bed is not a form of cutaneous stimulation used to relieve pain. Giving the client a pain medication is a pharmacological approach to relieving pain. #imiting the number of visitors may provide a *uiet environment conducive to rela+ation) but it is not based on the gate-control theory.,'$/0'1!-1 345'Comprehension(36'%ursing 6rocess' $ssessment7&C'%C#089 test plan designation' 6harmacological (herapies:6harmacological 6ain 7anagement; 6hysiological ntegrity:4asic Care and Comfort2.$ priority nursing intervention when caring for a client who is receiving an epidural infusion for pain relief is to'1.<se aseptic techni*ue2.#abel the port as an epidural catheter !.7onitor vital signs every 1 minutes .$void supplemental doses of sedatives$%&'!When clients are receiving epidural analgesia) monitoring occurs as often as every 1 minutes) including assessment of respiratory rate) respiratory effort) and skin color. Complications of epidural opioid use include nausea and vomiting) urinary retention) constipation) respiratory depression) and pruritus. $ common complication of epidural anesthesia is hypotension. $ssessing vital signs is the priority nursing intervention. 4ecause of the catheter location) strict surgical asepsis is needed to prevent a serious and  potentially fatal infection. (o reduce the risk for accidental epidural in=ection of drugs intended for > use) the catheter should be clearly labeled epidural catheter.@ &upplemental doses of opioids or sedative:hypnotics are avoided because of possible additive central nervous system adverse effects.,'C/0'1AB345'$nalysis 7osby items and derived items  2D) 2 by 7osby) nc.) an affiliate of 0lsevier nc.  (est 4ank (36'%ursing 6rocess' 6lanning7&C'%C#089 test plan designation' 6harmacological (herapies:6harmacological 6ain 7anagement; 6hysiological ntegrity:4asic Care and Comfort!.(he nurse should describe pain that is causing the client a burning sensation in the epigastric region@ as'1./eferred2./adiating!.,eep or visceral .&uperficial or cutaneous$%&'!,eep or visceral pain is diffuse and may radiate in several directions. >isceral pain may  be described as a burning sensation. /eferred pain is felt in a part of the body separate from the source of pain) such as with a myocardial infarction) in which pain may be referred to the =aw) left arm) and left shoulder. /adiating pain feels as though it travels down or along a body part) such as low back pain that is accompanied by pain radiating down the leg from sciatic nerve irritation. &uperficial or cutaneous pain is of short duration and is localiEed as in a small cut.,'$/0'1F345'Comprehension(36'%ursing 6rocess' $ssessment7&C'%C#089 test plan designation' 6harmacological (herapies:6harmacological 6ain 7anagement; 6hysiological ntegrity:4asic Care and Comfort .Which of the following is most appropriate when the nurse assesses the intensity of the clients pain? 1.$sk about what precipitates the pain.2.uestion the client about the location of the pain.!.3ffer the client a pain scale to ob=ectify the information. .<se open-ended *uestions to find out about the sensation.$%&'!,escriptive scales are a more ob=ective means of measuring pain intensity. $sking the client what precipitates the pain does not assess intensity) but rather it is an assessment of the pain pattern. $sking the client about the location of pain does not assess the intensity of the clients pain. (o determine the *uality of the clients pain) the nurse may ask open-ended *uestions to find out about the sensation e+perienced.,'$/0'1F!345'Comprehension(36'%ursing 6rocess' $ssessment7&C'%C#089 test plan designation' 6harmacological (herapies:6harmacological 6ain 7anagement; 6hysiological ntegrity:4asic Care and Comfort.(he nurse on a postoperative care unit is assessing the *uality of the clients pain. n order to obtain this specific information about the pain e+perience from the client) the nurse should ask' 7osby items and derived items  2D) 2 by 7osby) nc.) an affiliate of 0lsevier nc. !-2  (est 4ank 1.What does your discomfort feel like?@2.What activities make the pain worse?@!.How much does it hurt on a scale of  to 1?@ .How much discomfort are you able to tolerate?@$%&'1(o determine the *uality of the clients pain the nurse might say) What does your discomfort feel like?@ t is more accurate to have clients describe the pain in their own words whenever possible. n*uiring about what activities make the pain worse is a type of *uestion directed at determining the pain pattern. Having the client rate his or her pain on a pain scale is a method of measuring the intensity of pain. (o determine the clients e+pectations) the nurse may ask the client) How much discomfort are you able to tolerate?@,'$/0'1F!-1F345'Comprehension(36'%ursing 6rocess' $ssessment7&C'%C#089 test plan designation' 6harmacological (herapies:6harmacological 6ain 7anagement; 6hysiological ntegrity:4asic Care and ComfortF.When a clients husband *uestions how a patient-controlled analgesia I6C$J pump works) the nurse e+plains that the client'1. Has control over the fre*uency of the intravenous I>J analgesia2.Can choose the dosage of the drug received!.7ay re*uest the type of medication received .Controls the route for administering the medication$%&'1With a 6C$ system the client controls medication delivery. (he 6C$ system is designed to deliver no more than a specified number of doses. (he client does not choose the dosage. (he health care provider prescribes the type of medication to be used. (he advantage for the client is that he or she may self-administer opioids with minimal risk for overdose. (he client does not control the route for administration. &ystemic 6C$ typically involves > drug administration but can also be given subcutaneously.,'$/0'1AF345'Comprehension(36'%ursing 6rocess' mplementation7&C'%C#089 test plan designation' 6harmacological (herapies:6harmacological 6ain 7anagement; 6hysiological ntegrity:4asic Care and ComfortA.$n older client with mild musculoskeletal pain is being seen by the primary care  provider. (he nurse anticipates that treatment of this clients level of discomfort will include'1.entanyl2.,iaEepam!.$cetaminophen .7eperidine hydrochloride$%&'! 7osby items and derived items  2D) 2 by 7osby) nc.) an affiliate of 0lsevier nc. !-!  (est 4ank $ nonopioid analgesic) such as acetaminophen) is used to effectively treat mild musculoskeletal pain. entanyl is about 1 times more potent than morphine. t is typically used for cancer pain) not mild musculoskeletal pain. ,iaEepam is given as an antian+iety agent. 7eperidine hydrochloride is an opioid analgesic used to treat moderateto severe acute pain) not mild pain.,'$/0'1A!345'Comprehension(36'%ursing 6rocess' 6lanning7&C'%C#089 test plan designation' 6harmacological (herapies:6harmacological 6ain 7anagement; 6hysiological ntegrity:4asic Care and ComfortB.4efore inserting a oley catheter) the nurse e+plains that the client may feel some discomfort. (his is an e+ample of'1.,istraction2./educing pain perception!.$nticipatory response .&elf-care maintenance$%&'!6ain can be prevented by anticipating painful events. 4efore performing procedures) the nurse considers the clients condition) aspects of the procedure that may be uncomfortable) and techni*ues to avoid causing pain. (he nurse who tells the client that the urinary catheter insertion may feel uncomfortable is an e+ample of anticipatory response. ,istraction directs a clients attention to something else and thus can reduce theawareness of pain and even increase tolerance. /educing pain perception means to remove stimuli that are uncomfortable or to prevent stimuli that are painful) such as changing wet linens) or preventing constipation with fluids) diet) and e+ercise. &elf-care maintenance implies the client is able to carry out necessary activities to care for himself or herself. (his may include pain management measures.,'$/0'1A!345'Comprehension(36'%ursing 6rocess' mplementation7&C'%C#089 test plan designation' 6harmacological (herapies:6harmacological 6ain 7anagement; 6hysiological ntegrity:4asic Care and ComfortD.(he nurse knows that a 6C$ pump would be most appropriate for the client who'1.Has psychogenic discomfort2.s recovering after a total hip replacement!.0+periences renal dysfunction ./ecently e+perienced a cerebrovascular accident IstrokeJ$%&'2 7osby items and derived items  2D) 2 by 7osby) nc.) an affiliate of 0lsevier nc. !-

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Chapter 038

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