Quiz 2 Name: Yr. and Sec: 1.

A client who had abdominal surgery 3 days earlier complains of sharp, throbbing abdominal pain that ranks 8 on scale of 1(no pain) to 10(worst pain). Which intervention should the nurse implement first? a. Obtaining an order for a stronger medication because the clients pain has increased. b. Assessing the client to rule out possible complications secondary to surgery. c. Checking the clients chart to determine when pain medication was last administered. d. Explaining to the client that the pain should not be this severe 3 days post-operatively. 2. Which terms refers to pain that has a slower onset, is diffuse, radiates, and is marked by somatic pain from organs in any body activity? a. Acute Pain b. Chronic Pain c. Superficial Pain d. Deep Pain 3. Which intervention should the nurse include as a nonpharmacologic pain relief intervention for chronic pain? a. Referring the client to a therapist for hypnosis b. Administering pain medication as prescribed. c. Removing all glaring lights and excessive noise. d. Using transcutaneous electric nerve stimulation. 4. A 10 year old boy falls off his bicycle, grabs his wrist, and cries, Oh, my wrist! Help! The pain is so sharp, I think I broke it. Based on these data, the pain the boy is experiencing is caused by impulses traveling from receptors to the spinal cord along which type of nerve fibers? a. Somatic efferent fibers b. Type C fibers c. Autonomic nerve fibers d. Type A-delta fibers 5. Which pain theory provides information most useful to nurses in planning pain reduction interventions? a. Central control theory b. Gate control theory c. Specificity theory d. Pattern theory 6. One day after open reduction and internal fixation of the left hip, a client is complaining of pain. Which data would cause the nurse to refrain from administering the

pain medication and to notify the health care provider instead? a. Left hip dressing dry and intact b. Blood pressure of 114/78 mmHg; pulse rate of 82 bpm c. Left leg in functional anatomic position d. Left foot cold to touch; no palpable pedal pulse. 7. Which term would the nurse use to document pain at one site that is perceived in another site? a. Referred pain b. Phantom pain c. Intractable pain d. Aftermath pain 8. A client who had abdominal pain 1 day earlier complains of abdominal pain that ranks 9 on a scale of 1(no pain) to 10(worst pain). Which interventions should the nurse implement? (Select all that apply) a. Assessing the clients bowel sound b. Taking the clients blood pressure and apical pulse c. Obtaining a pulse oximeter reading d. Notifying the health care provider e. Determining the last time the client received pain medication f. Encouraging the client to turn, cough, and deepbreathe. 9. A client who has a chronic pain, loss of self-esteem, no job, and bodily disfigurement from severe burns over the trunk and arms admitted to a pain center. Which evaluation criteria would indicate the clients successful rehabilitation? a. The client remains free of the aftermath phase of the pain experience. b. The client experiences decreased frequency of acute pain episodes. c. The client continues normal growth and development with intact support systems. d. The client developed increase tolerance for severe pain in the future. 10. When evaluating a clients adaptation to pain, which behavior indicates appropriate adaptation? a. The client distracts himself during pain episodes b. The client denies the existence of any pain c. The client reports pain reduction with decreased activity d. The client reports no need for family support

Rationale 1. Answer is B. The nurses immediate action should be to assess the client in an attempt to exclude possible complications that may be causing the clients complaint. The health care provider ordered the pain medication for routine postoperative pain that is expected after abdominal surgery, not for such complications as hemorrhage, infection, or dehiscence. The nurse should never administer pain medication without assessing the client first. Obtaining an order for stronger medication may be appropriate after the nurse assesses the client and checks the chart to see whether the current analgesic is ineffective. 2. Answer is D. deep pain has slow onset, is diffuse and radiates, and is marked by somatic pain from organs in any body activity. Acute pain is rapid in onset, usually temporary (less than 6 months), and subsides spontaneously. Chronic pain is marked by gradual onset and lengthy duration (more than 6 months). Superficial pain has abrupt onset with a sharp stinging quality. 3. Answer is D. Nonpharmacologic pain relief intervention interventions includes cutaneous stimulation, back rubs, biofeedback, acupuncture, transcutaneous nerve stimulation, and more. Hypnosis is considered an alternative therapy. Medications are pharmacologic measures. Although removing glaring lights and excessive noise help to reduce or remove noxious stimuli, it is not specific to pain relief. 4. Answer is D. Type A-delta fibers conduct impulses at a very rapid rate and are responsible for transmitting acute sharp pain signals from the peripheral nerves to the spinal cord. Only type A-delta fibers transmit sharp, piercing pain. Somatic efferent fibers affect voluntary movement of skeletal muscles and joints. Type C fibers transmit sensory input at much slower rate and produce a slow, chronic type of pain. The autonomic system regulates involuntary vital functions and organ control such as breathing. 5. Answer is A. No one explains all the factors underlying the pain experience, but the central control theory discusses brain opiates with analgesic properties and how their release can be affected by actions initiated by the client and caregivers. The gate control, specificity, and pattern theories do not address pain control to the depth included in the central control theory. 6. Answer is D. A left foot cold to touch without palpable pedal pulse represents an abnormal finding on neurovascular assessment of the left leg. The client is

most likely experiencing some complication from surgery, which requires immediate medical intervention. The nurse should notify the health care provider of these findings. A dry and intact hip dressing, blood pressure of 114/78 mmHg, PR of 82 bpm, and a left foot in functional anatomic position are all normal assessment findings that do not require medical intervention. 7. Answer is A. Referred pain is occurring at one site that is perceived in another site. Referred pain follows dermatome and nerve root patterns. Phantom pain refers to pain in a part of the body that is no longer there, such as in amputation. Intractable pain refers to moderate to severe pain that cannot be relieved by any known treatment. Aftermath of pain, a phase of the pain experience and the most neglected phase, addresses the clients response to the pain experience. 8. Answer is A, B, and E. The nurse must rule out complications prior to administering a pain medication, so her interventions would include assessing to make sure the client has bowel sounds and determining if the client is hemorrhaging by checking the clients blood pressure and pulse. The nurse must also make sure the pain medication is due according to the health care providers order. Obtaining a pulse oximeter reading and turning, coughing, and deep breathing will not help the clients pain. There is no need to notify the health provider in this situation. 9. Answer is C. Even though the client experience may experience an aftermath phase, progress is still possible, as is effective rehabilitation. Aftermath reactions may occur but need not interfere with rehabilitation. Acute pain is not expected at this stage of recovery. Conditioning probably produces less pain tolerance. 10. Answer is A. Distraction is an appropriate method of reducing pain. Denying the existence of pain is inappropriate and not indicative of coping. Exclusion of family members and other sources of support represent a maladaptive response. ROM exercises and at least mild activity, not decreased activity, can help reduced pain and are important to prevent complications of immobility.