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Vital signs are an accurate indicator of the presence of chronic pain and serve to validate the client’s report of pain.
Vital signs (pulse and blood pressure) increase immediately following an acute pain stimulus but quickly return to normal. In the client with chronic pain, vital signs are not accurate indicators of pain and should not be used to validate the presence of pain. Changes in vital signs may be indicative of problems other than pain.
Many diagnostic tests to identify the cause of a client’s chronic low back pain come back negative. This indicates to the physician and nurse that the client’s pain is:
A. Overestimated
B. Psychological
C. A sign of low pain tolera
d. Although a cause for pain cannot be identified via laboratory or diagnostic tests, that does not mean that the pain is not real. It may indicate that the current tests are not sophisticated enough to detect the abnormality.
a, b, and c. These cannot be supported by the available data.
Just before friends visit, a client reports to the nurse that his pain is a 7 out of 10. The nurse returns to the room with the ordered analgesic and finds the client laughing and joking with the friends. The nurse decides to:
A. Withhold the anal
b. Pain is what the client says it is. There is no one "look" to pain. Clients may be temporarily distracted from their pain when friends are visiting. Clients in pain may not want their friends and family members to know how much pain they are experiencing. In addition, laughing with friends or family members may be a distraction that diverts attention from the pain. The pain rating of 7 out of 10 requires immediate treatment.
When setting goals for a client in chronic pain, it is important for the nurse to begin with the following:
A. Asking “What pain rating is acceptable to your family?”
B. Getting an idea of what pain intensity will allow the client to per
d. Understanding what the pain prevents the client from doing that is important helps to establish a goal that the nurse can measure. This also assists in identifying what is important to the client.
a. A pain rating that is acceptable to the client is more important than one that is acceptable to the family member. An acceptable pain rating is unique and individual to the client.
b. Client's may perform ADLs even though in pain because they are often necessary for survival.
c. Although identifying the cause of pain is important, it is not essential in establishing goals.
A client describes the pain radiating down the leg as sharp, shooting, and electric-like. The nurse recognizes this as indicative of:
A. Visceral pain
B. Somatic pain
C. Neuropathic pain
D. Idiopathic pain
c. Neuropathic pain is usually described as burning, shooting, or electric-like. It is important to report these characteristics to the physician because neuropathic pain may not respond as well to opioids.
a and b. The characteristics of visceral and somatic pain often include "aching,""throbbing," and "pounding."
d. Idiopathic pain does not have specific descriptive terms.
The nurse is sure to observe for nonverbal indicators of pain in a client who is nonverbal when the client is: _____________.
A client who is not active often does not experience pain; however, the body is meant to move, and prolonged inactivity can contribute to deconditioning and other hazards of immobility.
Because of the concern for respiratory depression when administering opioids, the nurse assesses for __________, which always precedes respiratory depression.
It is important for the nurse to routinely assess for sedation in the client who is opioid-naive and receiving opioids because the brain's alert and awake center is more sensitive to opioids than the respiratory center. Besides the rate of respirations, the depth should be assessed. Shallow respirations are more of a concern than deep respirations.
Which of the following are myths regarding pain and pain treatment in older adults? (Select all that apply.)
A. Pain is an inevitable part of aging.
B. Older adult clients are at greater risk for the development of conditions that are painfu
a, c, and d. Pain is not an inevitable part of aging. Older adult clients can tolerate opioids, although they are best begun at a low dose and gradually increased as needed. There is no one pain center in the brain, and the nervous system associated with pain transmission does not diminish over time.
b. It is true that as one ages, one is at risk for developing more painful conditions.
Important adverse effects from nonsteroidal antiinflammatory drugs (NSAIDs) that the nurse continually assesses for in older adult clients receiving long-term NSAID therapy include (select all that apply):
A. Liver failure
B. Renal insuffici
b and c. Renal insufficiency and GI bleeding are frequent adverse effects in older clients. The normal aging process results in decreased renal function, and the addition of NSAIDs may accelerate this process. NSAIDS are common over-the-counter drugs, and as a result, clients may believe they are safe in high doses.
a. Liver failure can occur with consumption of acetaminophen.
d. Diarrhea is not usually an adverse effect of NSAIDs
The nurse questions the advisability of implementing the following pain-relieving strategies in postoperative opioid-naive clients and thus advocates for the client by consulting with the ordering physician. (Select all that apply.)
A. Patient-con
a and d. PCA basal dosing is not recommended for postoperative treatment of surgical pain. It places the client at increased risk for respiratory depression. Fentanyl is much more potent than other opioids and thus is reserved for clients with chronic pain that has been stabilized with opioids over an extended period of time.
b and c. Small doses of opioid given IV around-the clock and prn opioids for pain that exceeds client goal are acceptable pain-relieving strategies.

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