Fundamentals 43 Pain Management

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1

The pain experience is complex, involving physical, emotional, and ____________ components.

cognitive

2

________ converts energy produced by these stimuli into electrical energy.

Transduction

3

What is a sensory peripheral pain nerve fiber called?

nociceptor

4

Cellular damage caused by thermal, mechanical, or chemical stimuli results in the release of excitatory _____________ such as ___________.

neurotransmitters
prostaglandins

5

Nerve impulses resulting from the painful stimulus travel along _________ peripheral nerve fibers.

afferent (sensory)

6

Two types of peripheral nerve fibers conduct painful stimuli: the fast, myelinated _________ fibers and the slow, small, unmyelinated _______ fibers.

A-delta
C-delta

7

The _______ fibers send sharp, localized, and distinct sensations that specify the source of the pain and detect its intensity.

A-delta

8

The _______ fibers relay impulses that are poorly localized, burning, and persistent.

C-delta

9

_______ is the point at which a person is aware of pain.

Perception

10

Are generated from the breakdown of phospholipids in cell membranes and thought to increase sensitivity to pain.

Prostaglandins

11

Released from plasma that leaks from surrounding blood vessels at the site of tissue injury. Binds to receptors on peripheral nerves, increasing pain stimuli. Binds to cells that cause the chain reaction producing prostaglandins.

Bradykinin

12

Found in the pain neurons of the dorsal horn (excitatory peptide). Needed to transmit pain impulses from the periphery to higher brain centers. Causes vasodilation and edema.

Substance P

13

Produced by mast cells causing capillary dilation and increases capillary permeability.

Histamine

14

Released from the brainstem and dorsal horn to inhibit pain transmission.

Serotonin

15

Are natural supply of morphine-like substances in the body. Activated by stress and pain. Located within the brain, spinal cord, and gastrointestinal tract. Causes analgesia when they attach to opiate receptors in the brain. Present in higher levels in people who have less pain than others with a similar injury.

Neurotransmitters (inhibitory)

16

________ involve transmitter chemicals that signal postsynaptic cells.

Chemical synapses

17

Once the brain perceives pain, there is a release of inhibitory neurotransmitters such as endogenous opioids, serotonin, norepinephrine, and gamma aminobutyric (GABA), which work to hinder the transmission of pain and help produce an __________ effect.

analgesic

18

The inhibition of the pain impulse is the fourth and last phase of the nociceptive process known as ___________.

modulation

19

The point at which a person feels pain.

Pain threshold

20

The level of pain a person is willing to accept.

Pain tolerance

21

Pain of low to moderate intensity and superficial pain. Increased heart rate. Increased muscle tension. Dilation of pupils. Provides increased oxygen intake. Provides additional energy. Prepares muscles for action. Affords better vision. Dilation of pupils.

Sympathetic Stimulation

22

Severe or deep pain. Muscle tension. Decreased heart rate and blood pressure. Rapid, irregular breathing. Results from fatigue. Causes body defenses to fail under prolonged stress of pain.

Parasympathetic Stimulation

23

_______ is protective, has an identifiable cause, is of short duration, and has limited tissue damage and emotional response.

Acute pain

24

_______ lasts longer than 6 months and is constant or recurring with a mild to severe intensity. Does not always have an identifiable cause and leads to great personal suffering.

Chronic pain

25

A person with chronic pain who consults with numerous health care providers is labeled a drug seeker, when he or she is actually seeking adequate pain relief. This situation is called_________.

pseudoaddiction

26

Pain that occurs sporadically over an extended period of time. Pain episodes can last for hours, days, or weeks.

Chronic Episodic Pain

27

Nociceptive pain includes ___________ and __________ pain.

somatic (musculoskeletal)
visceral (internal organ)

28

__________ is chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition.

Idiopathic pain

29

Studies of nurses' attitudes regarding pain management show that a nurse's personal opinion about a patient's report of pain affects pain assessment and titration of opioid doses.

True

30

Pain is a complex process, involving physiological, social, spiritual, psychological, and cultural influences. Thus each individual's pain experience is different. Consider all factors that affect the patient in pain to ensure a holistic approach to the assessment and care of the patient.

True

31

Age influences pain, particularly in infants and older adults. Developmental differences found between these age groups influence how children and older adults react to pain.

True

32

Toddlers and preschoolers are unable to recall explanations about pain or associate it with experiences that occur in various situations.

True

33

_______ heightens the perception of pain and decreases coping abilities. If it occurs along with sleeplessness, the perception of pain is even greater. Pain is often experienced less after a restful sleep than at the end of a long day.

Fatigue

34

Research on healthy human subjects suggests that ________ passed on by parents possibly increases or decreases the person's sensitivity to pain and determines pain threshold or pain tolerance.

genetic information

35

Any factor that interrupts or influences normal pain reception or perception affects the patient's awareness of and response to pain.

True

36

Increased _________ is associated with increased pain, whereas distraction is associated with diminished pain response.

attention

37

Previous frequent episodes of pain without relief or bouts of severe pain cause ________ or fear.

anxiety

38

Normal processing of stimuli that damages normal tissues or has the potential to do so if prolonged; usually responsive to nonopioids and or opioids. Includes somatic pain and visceral pain.

Nociceptive pain

39

Abnormal processing of sensory input by the peripheral or central nervous system; treatment usually includes adjuvant analgesics. Includes sympathetically maintained pain and peripherally generated pain.

Neuropathic pain

40

People in pain often depend on family or friends for support, assistance, or protection. Although the pain still exists, the presence of family or friends can often make the pain experience less stressful.

True

41

Anxiety often increases the perception of pain and pain causes feelings of anxiety. It is difficult to separate the two sensations.

True

42

Persons with internal loci of control perceive themselves as having control over events in their life and the outcomes such as pain.

True

43

A patient's self-report of pain is the single most reliable indicator of its existence and intensity.

True

44

Patients are better prepared to handle almost any situation when they understand it.

True

45

There are three types of analgesics. Nonopioids-acetaminophen and nonsteriodal antiinflammatory drugs (NSAIDs); Opioids- narcotics; and Adjuvants- a variety of medications that enhance analgesics or have properties that were originally unknown.

True

46

A drug delivery system called _______ is a safe method for pain management that many patients prefer. It allows patients to self administer opioids with minimal risk of overdose.

patient-controlled analgesia

47

_______ is the local infiltration of an anesthetic medication to induce loss of sensation to a body part.

Local anesthesia

48

________ is the injection of a local anesthetic to block a group of sensory nerve fibers.

Regional anesthesia

49

_______ is common for the treatment of acute post-operative pain, labor and delivery pain, and chronic cancer pain.

Epidural analgesia

50

YOU maintain responsibility for providing emotional support to patients receiving local or regional anesthesia by explaining the insertion technique and warning patients that they will temporarily lose sensory function within minutes of injection.

True

51

__________ is a transient flare of moderate to severe pain superimposed on continuous or persistent pain.

Breakthrough pain

52

A state of adaptation that is manifested by a drug class specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

Physical dependence

53

A primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Behaviors include impaired control over drug use, compulsive use, continued use despite harm, and craving.

Addiction

54

A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more effects of the drug over time.

Drug Tolerance

55

Medications or procedures that produce positive or negative effects in patients. These effects are not related to the specific physical or chemical properties. If this is ordered, you MUST question the order. It is considered unethical and deceitful to administer them.

Placebo

56

Pain is purely a subjective physical and psychosocial experience.

True

57

misconceptions about pain often result in doubt about the degree of the patient's suffering and unwillingness to provide relief.

True

58

knowledge of the ___________ pain process of the pain experience- transmission, transduction, perception, and modulation- provides guidelines for selecting pain relief measures.

nociceptive

59

An interaction of psychological and cognitive factors affects pain perception.

True

60

A person's cultural background influences the meaning of pain and how it is expressed.

True

61

It is common for older patients not to report pain.

True

62

Patients who are in _______ are unlikely to show behavioral changes.

chronic pain

63

The difference between acute and chronic pain involves the concept of harm. Acute pain is protective, thus preventing harm; chronic pain is no longer protective.

True

64

Do not collect an in depth pain history when the patient is experiencing severe discomfort.

True

65

Pain causes _______ signs and symptoms similar to those of other diseases.

physical

66

Individualize pain interventions by collaborating closely with the patient, using assessment findings, and trying a variety of interventions.

True

67

Eliminating sources of painful stimuli is a basic nursing measure for promoting comfort.

True

68

Using a regular schedule _________ for analgesic administration is more effective than an as needed schedule in pain control.

around the clock (ATC)

69

__________ is an adverse effect of opioids that always precedes respiratory depression (which is rare).

Sedation

70

A ______ device gives patients pain control with low risk of overdose.

PCA

71

While caring for a patient who receives local anesthesia, protect him or her from injury.

True

72

Nursing implications for administering epidural analgesia include preventing infection and monitoring closely for respiratory depression.

True

73

________ rarely occurs in patients who take opioids to relieve pain.

Addiction

74

The goal of pain management is to anticipate and prevent pain rather than to treat it.

True

75

Pain evaluation includes measuring the changing character of pain, the patient's response to interventions, and the patient's perceptions of the effectiveness of a therapy.

True

76

Which of the following signs or symptoms in an opioid-naive patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid?
A) Oxygen saturation of 95%
B) Difficulty arousing the patient
C) Respiratory rate of 10 breaths/min
D) Pain intensity rating of 5 on a scale of 0-10

B) Difficulty arousing the patient

77

A health care provider writes the following order for an opioid-naive patient who returned from the operating room following a total hip replacement. "Fentanyl patch 100 mcg, change every 3 days." Based on this order, the nurse takes the following action:
A) Calls the health care provider and questions the order
B) Applies the patch the third postoperative day
C) Applies the patch as soon as the patient reports pain
D) Places the patch as close to the hip dressing as possible.

A) Calls the health care provider and questions the order

78

A patient is being discharged home on an around the clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication?
A) Stool softener
B) Stimulant laxative
C) H2 receptor blocker
D) Proton pump inhibitor

B) Stimulant laxative

79

A new medical resident writes an order for OxyContin SR 10 mg PO q12 hours prn. Which part of the order does the nurse question?
A) The drug
B) The time interval
C) The dose
D) The route

B) The time interval

80

The nurse notices that a patient has received oxycodone/acetaminophen (Percocet) (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most?
A) The patient's level of pain
B) The potential for addiction
C) The amount of daily acetaminophen
D) The risk for gastrointestinal bleeding

C) The amount of daily acetaminophen

81

A patient with chronic low back pain who took an opioid around the clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking chills, abdominal cramps, and joint pain. The nurse recognizes that this patient is experiencing symptoms of:
A) Addiction
B) Tolerance
C) Pseudoaddiction
D) Physical dependence

D) Physical dependence

82

After having received 0.2 mg of naloxone (Narcan) intravenous push (IVP), a patient's respiratory rate and depth are within normal limits. The nurse now plants to implement the following action:
A) Discontinue all ordered opioids
B) Close the room door to allow the patient to recover
C) Administer the remaining naloxone over 4 minutes
D) Assess patient's vital signs every 15 minutes for 2 hours

D) Assess patient's vital signs every 15 minutes for 2 hours

83

Which one of the following instructions is crucial for the nurse to give both family members and the patient who is about to be started on a patient controlled analgesia (PCA) of morphine?
A) Only the patient should push the button
B) Do not use the PCA until the pain is severe
C) The PCA prevents overdose from occurring
D) Notify the nurse when the button is pushed

A) Only the patient should push the button

84

A patient with a history of a stoke that left her confused and unable to communicate returns from interventional radiology following placement of a gastronomy tube. The health care provider's order reads as follows: "Vicodin 1 tab, per tube, q4 hours, prn." Which action by the nurse is most appropriate?
A) No action is required by the nurse because the order is appropriate
B) Request to have the order changed to ATC for the first 48 hours
C) Ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3 hours, prn.
D) Begin the Vicodin when the patient shows nonverbal symptoms of pain

B) Request to have the order changed to ATC for the first 48 hours

85

A patient is returning to the nursing unit after knee surgery is verbalizing pain at the surgical site. The nurse's first action is to:
A) Call the patient's health care provider
B) Administer pain medication as ordered
C) Check the patient's vital signs
D) Assess the characteristics of the pain

D) Assess the characteristics of the pain

86

The patient rates his pain as a 6 on a scale of 0-10 with 0 being no pain and 10 being the worst pain. The patient's wife says that he cant be in that much pain since he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain?
A) The patient's wife is the nest resource for determining the level of pain since she has been with him continually for the entire day.
B) The patient's report of pain is the best method for assessing the pain.
C) the patient's health care provider has the best knowledge of the level of pain that the patient should be experiencing.
D) The nurse is the most experienced at assessing pain.

B) The patient's report of pain is the best method for assessing the pain.

87

When using ice massage for pain relief, which of the following are correct? (select all that apply)
A) Apply ice using firm pressure over skin
B) Apply ice until numbness occurs and remove the ice for 5-10 minutes
C) Apply ice until numbness occurs and discontinue application
D) Apply ice for no longer than 10 minutes

A) Apply ice using firm pressure over skin
B) Apply ice until numbness occurs and remove ice for 5 to 10 minutes

88

When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information do you include?
A) TENS works by causing distraction
B) TENS therapy does not require a health care provider's order
C) TENS requires an electrical source for use
D) TENS electrodes are applied near or directly on the site of pain

D) TENS electrodes are applied near or directly on the site of pain

89

While caring for a patient with cancer pain, the nurse knows that the World Health Organization (WHO) analgesic ladder recommends:
A) Transitioning use of adjuvants with nonsteroidal antiinflammatory drugs (NSAIDs) to opioids.
B) Using acetaminophen for refractory pain
C) Limiting the use of opioids because of the likelihood of side effects
D) Avoiding total sedation, regardless of how severe the pain is

A) Transitioning use of adjuvants with nonsteroidal antiinflammatory drugs (NSAIDs) to opioids

90

A postoperative patient is currently asleep. Therefore the nurse knows that:
A) The sedative administered may have helped him sleep, but assessment of pain is still needed.
B) The intravenous (IV) pain medication is effectively relieving his pain.
C) Pain assessment is not necessary.
D) The patient can be switched to the same amount of medication by the oral route.

A) The sedative administered may have helped him sleep but the assessment of pain is still needed.