Assessment and Care of Patients with Pain Ignatavicius: Medical-Surgical Nursing, 8th Edition
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A student asks the nurse what is the best way to assess a client’s pain. Which response by the nurse is best?
a. Numeric pain scale
b. Behavioral assessment
c. Objective observation
d. Client’s self-report
ANS: D
Many ways to measure pain are in use, including numeric pain scales, behavio...
assessment and care of patients with pain ignatavicius medical surgical nursing
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8th EDITION
Chapter 3: Assessment and Care of Patients with Pain
Ignatavicius: Medical-Surgical Nursing, 8th Edition
MULTIPLE CHOICE
1. A student asks the nurse what is the best way to assess a client’s pain. Which response by the nurse is best?
a. Numeric pain scale
b. Behavioral assessment
c. Objective observation
d. Client’s self-report
ANS: D
Many ways to measure pain are in use, including numeric pain scales, behavioral assessments, and other objective
observations. However, the most accurate way to assess pain is to get a self-report from the client.
2. A new nurse reports to the precepting nurse that a client requested pain medication, and when the nurse brought it,
the client was sound asleep. The nurse states the client cannot possibly sleep with the severe pain the client
described. What response by the experienced nurse is best?
a. “Being able to sleep doesn’t mean pain doesn’t
exist.”
b. “Have you ever experienced any type of pain?”
c. “The client should be assessed for drug addiction.”
d. “You’re right; I would put the medication back.”
ANS: A
A client’s description is the most accurate assessment of pain. The nurse should believe the client and provide pain
relief. Physiologic changes due to pain vary from client to client, and assessments of them should not supersede the
client’s descriptions, especially if the pain is chronic in nature. Asking if the new nurse has had pain is judgmental and
flippant, and does not provide useful information. This amount of information does not warrant an assessment for
drug addiction. Putting the medication back and ignoring the client’s report of pain serves no useful purpose.
DIF: Understanding/Comprehension REF: 28
KEY: Pain| pain assessment
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Health Promotion and Maintenance
3. The nurse in the surgery clinic is discussing an upcoming surgical procedure with a client. What information provided
by the nurse is most appropriate for the client’s long-term outcome?
a. “At least you know that the pain after surgery will
diminish quickly.”
b. “Discuss acceptable pain control after your
operation with the surgeon.”
c. “Opioids often cause nausea but you won’t have to
take them for long.”
d. “The nursing staff will give you pain medication
when you ask them for it.”
1
, ANS: B
The best outcome after a surgical procedure is timely and satisfactory pain control, which diminishes the likelihood of
chronic pain afterward. The nurse suggests that the client advocate for himself and discuss acceptable pain control
with the surgeon. Stating that pain after surgery is usually short lived does not provide the client with options to have
personalized pain control. To prevent or reduce nausea and other side effects from opioids, a multimodal pain
approach is desired. For acute pain after surgery, giving pain medications around the clock instead of waiting until the
client requests it is a better approach.
DIF: Applying/Application REF: 26 KEY: Pain| acute pain
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance
4. A nurse is assessing pain on a confused older client who has difficulty with verbal expression. What pain assessment
tool would the nurse choose for this assessment?
a. Numeric rating scale
b. Verbal Descriptor Scale
c. FACES Pain Scale-Revised
d. Wong-Baker FACES Pain Scale
ANS: C
All are valid pain rating scales; however, some research has shown that the FACES Pain Scale-Revised is preferred
by both cognitively intact and cognitively impaired adults.
5. The nurse is assessing a client’s pain and has elicited information on the location, quality, intensity, effect on
functioning, aggravating and relieving factors, and onset and duration. What question by the nurse would be best to
ask the client for completing a comprehensive pain assessment?
a. “Are you worried about addiction to pain pills?”
b. “Do you attach any spiritual meaning to pain?”
c. “How high would you say your pain tolerance is?”
d. “What pain rating would be acceptable to you?”
ANS: D
A comprehensive pain assessment includes the items listed in the question plus the client’s opinion on a functional
goal, such as what pain rating would be acceptable to him or her. Asking about addiction is not warranted in an initial
pain assessment. Asking about spiritual meanings for pain may give the nurse important information, but getting the
basics first is more important. Asking about pain tolerance may give the client the idea that pain tolerance is being
judged.
6. A nurse is assessing pain in an older adult. What action by the nurse is best?
a. Ask only “yes-or-no” questions so the client doesn’t
get too tired.
b. Give the client a picture of the pain scale and come
back later.
c. Question the client about new pain only, not normal
2
, pain from aging.
d. Sit down, ask one question at a time, and allow the
client to answer.
ANS: D
Some older clients do not report pain because they think it is a normal part of aging or because they do not want to
be a bother. Sitting down conveys time, interest, and availability. Ask only one question at a time and allow the client
enough time to answer it. Yes-or-no questions are an example of poor communication technique. Giving the client a
pain scale, then leaving, might give the impression that the nurse does not have time for the client. Plus the client
may not know how to use it. There is no normal pain from aging.
7. The nurse receives a hand-off report. One client is described as a drug seeker who is obsessed with even tiny
changes in physical condition and is “on the light constantly” asking for more pain medication. When assessing this
client’s pain, what statement or question by the nurse is most appropriate?
a. “Help me understand how pain is affecting you right
now.”
b. “I wish I could do more; is there anything I can get
for you?”
c. “You cannot have more pain medication for 3
hours.”
d. “Why do you think the medication is not helping
your pain?”
ANS: A
This is an example of therapeutic communication. A client who is preoccupied with physical symptoms and is
“demanding” may have some psychosocial impact from the pain that is not being addressed. The nurse is providing
the client the chance to explain the emotional effects of pain in addition to the physical ones. Saying the nurse wishes
he or she could do more is very empathetic, but this response does not attempt to learn more about the pain. Simply
telling the client when the next medication is due also does not help the nurse understand the client’s situation. “Why”
questions are probing and often make clients defensive, plus the client may not have an answer for this question.
DIF: Applying/Application REF: 33
KEY: Pain| pain assessment
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Psychosocial Integrity
8. A nurse on the medical-surgical unit has received a hand-off report. Which client should the nurse see first?
a. Client being discharged later on a complicated
analgesia regimen
b. Client with new-onset abdominal pain, rated as an
8 on a 0-to-10 scale
c. Postoperative client who received oral opioid
analgesia 45 minutes ago
d. Client who has returned from physical therapy and
is resting in the recliner
ANS: B
3
, Acute pain often serves as a physiologic warning signal that something is wrong. The client with new-onset
abdominal pain needs to be seen first. The postoperative client needs 45 minutes to an hour for the oral medication
to become effective and should be seen shortly to assess for effectiveness. The client going home requires teaching,
which should be done after the first two clients have been seen and cared for, as this teaching will take some time.
The client resting comfortably can be checked on quickly before spending time teaching the client who is going home.
DIF: Analyzing/Analysis REF: 25
KEY: Acute pain| pain assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
9. A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia.
The client scores a zero. What action by the nurse is best?
a. Assess physiologic indicators and vital signs.
b. Do not give pain medication as no pain is indicated.
c. Document the findings and continue to monitor.
d. Try a small dose of analgesic medication for pain.
ANS: A
Assessing pain in a nonverbal client is difficult despite the use of a scale specifically designed for this population. The
nurse should next look at physiologic indicators of pain and vital signs for clues to the presence of pain. Even a low
score on this index does not mean the client does not have pain; he or she may be holding very still to prevent more
pain. Documenting pain is important but not the most important action in this case. The nurse can try a small dose of
analgesia, but without having indices to monitor, it will be difficult to assess for effectiveness. However, if the client
has a condition that could reasonably cause pain (i.e., recent surgery), the nurse does need to treat the client for
pain.
10. A student nurse asks why several clients are getting more than one type of pain medication instead of very high
doses of one medication. What response by the registered nurse is best?
a. “A multimodal approach is the preferred method of
control.”
b. “Doctors are much more liberal with pain
medications now.”
c. “Pain is so complex it takes different approaches to
control it.”
d. “Clients are consumers and they demand lots of
pain medicine.”
ANS: C
Pain is a complex phenomenon and often responds best to a regimen that uses different types of analgesia. This is
called a multimodal approach. Using this terminology, however, may not be clear to the student if the terminology is
not understood. Doctors may be more liberal with pain medications, but that is not the best reason for this approach.
Saying that clients are consumers who demand medications sounds as if the nurse is discounting their pain
experiences.
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