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Pain Management

I. Interpretation, Completion, and Comparison

Multiple Choice. Read each question carefully. Circle your answer. 1. Although the criterion is arbitrary, acute pain can be classified as chronic when it has persisted for: a. 12 months. c. 35 months. b. 3 months. d. longer than 6 months. 2. Acute pain may be described as having the following characteristic. a. It does not usually respond well to treatment. c. It serves no useful purpose. b. It is associated with a specific injury. d. It responds well to placebos. 3. A physiologic response not usually associated with acute pain is: a. decreased cardiac output. c. increased metabolic rate. b. altered insulin response. d. decreased production of cortisol. 4. Chronic pain may be described as: a. attributable to a specific cause. b. prolonged in duration. 5. An example of chronic benign pain is: a. a migraine headache. b. an exacerbation of rheumatoid arthritis. c. rapidly occurring and subsiding with treatment. d. separate from any central or peripheral pathology. c. low back pain. d. sickle cell crisis.

6. A chemical substance thought to inhibit the transmission of pain is: a. acetylcholine. c. enkephalin. b. bradykinin. d. histamine. 7. All of the following statements about endorphins are true except: a. Their release inhibits the transmission of c. They are endogenous neurotransmitters painful impulses. structurally similar to opioids. b. They represent the same mechanism of pain d. They are found in heavy concentrations in the relief as non-narcotic analgesics. central nervous system. 8. The nurse assessing for pain should: a. believe a patient when he or she states that pain is present. b. doubt that pain exists when no physical origin can be identified. c. realize that patients frequently imagine and state that they have pain without actually feeling painful sensations. d. do all of the above.

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Copyright 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer Business. Student Access to thePoint Solution for the Study Guide for Brunner & Suddarths Textbook of MedicalSurgical Nursing, First Canadian Edition, by Pauline Paul, Rene A. Day, and Bev Williams

9. When a nurse asks a patient to describe the quality of his or her pain, the nurse expects the patient to use a descriptive term such as: a. burning. c. intermittent. b. chronic. d. severe. 10. A physiologic indicator of acute pain is: a. diaphoresis. b. bradycardia. c. hypotension. d. lowered respiratory rate.

11. A nursing measure to manage anxiety during the anticipation of pain should include: a. focusing the patients attention on another c. using an anxiety-reducing technique, such as problem. desensitization. b. teaching about the nature of the impending d. any or all of the above. pain and associated relief measures. 12. A nursing plan of care for pain management should include: a. altering factors that influence the pain c. selecting goals for nursing intervention. sensation. d. all of the above. b. determining responses to the patients behaviour toward pain. 13. The nurses major area of assessment for a patient receiving patient-controlled analgesia (PCA) is assessment of the _____ system. a. cardiovascular b. integumentary c. neurologic d. respiratory

14. Pain in the elderly requires careful assessment, because older people: a. are expected to experience chronic pain. c. experience reduced sensory perception. b. have a decreased pain threshold. d. have increased sensory perception. 15. Administration of analgesics to the elderly requires careful patient assessment, because older people: a. metabolize drugs more rapidly. c. are more sensitive to drugs. b. have increased hepatic, renal, and d. have lower ratios of body fat and muscle mass. gastrointestinal function. 16. A preventive approach to pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs) means that the medication is given: a. before the pain becomes severe. c. when pain is at its peak. b. before the pain is experienced. d. when the level of pain tolerance has been exceeded. 17. The advantage of using intraspinal infusion to deliver analgesics is: a. reduced side effects of systemic analgesia. c. reduced need for frequent injections. b. reduced effects on pulse, respirations, and d. all of the above. blood pressure. 18. The drug of choice for epidural administration of analgesia is: a. codeine. c. Dilaudid. b. Demerol. d. morphine. 19. The most worrisome adverse effect of epidural opioids is: a. asystole. c. bradypnea. b. hypertension. d. tachycardia. 20. Cutaneous stimulation is helpful in reducing painful sensations, because it: a. provides distraction from the pain source and c. stimulates large-diameter nerve fibres and reduces decreases awareness. the intensity of pain. b. releases endorphins. d. accomplishes all of the above.

Copyright 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer Business. Student Access to thePoint Solution for the Study Guide for Brunner & Suddarths Textbook of MedicalSurgical Nursing, First Canadian Edition, by Pauline Paul, Rene A. Day, and Bev Williams

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Fill-In. Read each statement carefully. Write your response in the space provided. 1. Name three categories used to describe pain: _______________, _______________, and _______________. 2. Pain transmission to and from the brain involves nerve mechanisms and structures known as: _____________ and _______________. 3. List five algogenic substances that are released into the tissues and affect the sensitivity of nociceptors: _______________, _______________, _______________, _______________, and _______________. 4. List eight common physiologic responses to pain: _______________, _______________, _______________, _______________, _______________, _______________, _______________, and _______________. 5. Name the three general categories of analgesic agents that are used in some combination form to achieve balanced anesthesia: _______________, _______________ and _______________. 6. The two most common types of electrical stimulation are: _______________ and _______________. Complete the following crossword puzzle using terminology associated with pain management. Down 1. Pain receptors in the skin. 2. Nonsteroidal agents that decrease inflammation and increase the effects of analgesics. 3. A type of analgesia that is controlled by the patient using a special pump. 4. A drug is prescribed on an as needed basis for pain management. 5. The only commercially available transdermal opioid medication. 6. Significantly increases a persons response to pain. Across 1. Chemicals known to inhibit the transmission or perception of pain. 2. This substance, released in response to a painful stimuli, causes vasodilation. 3. An inactive substance given in place of pain medication. 4. Medication administration directly into the subarachnoid space and cerebrospinal fluid. 5. A type of cutaneous stimulation that decreases pain transmission through the descending pain pathway. 6. Transcutaneous stimulation of nonpain receptors in the same area of an injury. 7. Term used to describe a pains rhythm.
4 1 1 7 5 6

3 4

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Copyright 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer Business. Student Access to thePoint Solution for the Study Guide for Brunner & Suddarths Textbook of MedicalSurgical Nursing, First Canadian Edition, by Pauline Paul, Rene A. Day, and Bev Williams

II. Critical Thinking Questions and Exercises

Discussion and Analysis
1. Explain what characteristics need to be present for pain to be classified as chronic. 2. Describe the classic Gate Control Theory of pain as described by Melzack and Well in 1965. 3. Explain how the technique of distraction works to relieve acute and chronic pain.

Clinical Situations
Read the following case study. Circle the correct answer.
CASE STUDY: Pain Experience

Courtney is a young, healthy adult who slipped off the stairs going down to the basement and struck her forehead on the cement flooring. Courtney did not lose consciousness but did sustain a mild concussion and a hematoma that was 5 cm in width and protruded outward about 6 cm. She experienced immediate acute pain at the site of injury plus a pounding headache. 1. An immediate assessment of the localized pain, based on the patients description, is that it should be: a. brief in duration. c. persistent after healing has occurred. b. mild in intensity. d. recurrent for 3 to 4 months. 2. During the assessment process, the nurse attempts to determine Courtneys physiologic and behavioural responses to her pain experience. The nurse is aware that a patient can be in pain yet appear to be pain free. A behavioural response indicative of acute pain is: a. an expressionless face. c. muscle tension. b. clear verbalization of details. d. physical inactivity. 3. The nurse uses distraction to help Courtney cope with her pain experience. A suggested activity is: a. promoting relaxation. c. using cutaneous stimulation. b. playing music or using a videotape. d. any or all of the above. 4. After treatment, Courtney is discharged to home while still in pain. The nurse should: a. clarify that Courtney knows what type of pain c. review methods of pain management. signals a problem. d. do all of the above. b. remind Courtney that acute pain may persist for several days.

Copyright 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer Business. Student Access to thePoint Solution for the Study Guide for Brunner & Suddarths Textbook of MedicalSurgical Nursing, First Canadian Edition, by Pauline Paul, Rene A. Day, and Bev Williams

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