A child who has undergone an appendectomy reports pain in the abdomen. The nurse
uses the FLACC scale to evaluate the intensity of the pain and finds that the child has
mild discomfort. What score on the FLACC scale support's the nurse's conclusion? -
Answer-3
The FLACC scale is a pain assessment tool that helps to evaluate the intensity of pain
in infants and children less than 3 years of age. It has a score range from 0 to 10. A
score of 1 to 3 indicates that the child has mild discomfort. A score of 0 indicates that
the child is relaxed and comfortable without any discomfort. A pain score in the range of
4 to 5 indicates that the child has moderate pain. A score range of 7 to 10 indicates that
the child has severe discomfort or pain.
/.A nursing instructor is teaching a group of students about fetal brain development and
its response to pain. Which statement made by a student indicates the need for further
teaching? - Answer-The fetus is sensitive to pain stimuli due to the presence of
inhibitory neurotransmitters.
A fetus responds to pain stimuli due to the development of sensory fibers. The presence
of inhibiting neurotransmitters in the fetus is responsible for the pain perception in a full-
term fetus. In the 20th week of gestation, the fetus develops ascending sensory fibers
and connections to the thalamus, which may help in experiencing "emotional pain". A
fetus that has proper cortex development will respond to pain stimuli in the 20th week of
gestation.
/.A patient reports severe back pain after sustaining a fall. The nurse finds that the pain
shoots down to the legs and the patient is unable to perform hip flexion or extension.
What does the nurse document in the patient's assessment findings? - Answer-The
patient has acute pain due to herniated lumbar disc.
The patient may experience severe back pain due to a sudden fall. If the pain shoots
down to the legs and the patient is unable to perform hip extension and flexion, it
indicates that the patient has herniation of the lumbar disc. If the patient has an irregular
pattern of pain and swelling in the back and frequently rubs the lower back, it indicates
that the patient has chronic pain with increased intensity. The patient does not have
pain due to damage of the large internal organs. Therefore, the patient is not
experiencing visceral pain. When pain is short-term and is associated with an acute
event such as a lumbar disc herniation, it is acute pain, not chronic.
/.A patient who has severe electric shock-like pain in the thighs has been prescribed a
nonsteroidal antiinflammatory drug (NSAID). After assessing the patient, the nurse
concludes that the NSAIDs are not effectively alleviating the patient's symptoms. What
,is the most likely reason the NSAIDs are inadequate in relieving this pain? - Answer-
The patient has neuropathic pain.
The presence of severe electric shock-like pain in the thighs indicates that the patient
has neuropathic pain. Neuropathic pain is the result of abnormal processing of pain
messages from the site of injury to the nerve fibers. NSAIDs decrease prostaglandin
levels, but do not increase neurotransmitters or halt nerve damage. Therefore,
neuropathic pain is not effectively treated by NSAIDs. Visceral pain, cutaneous pain,
and breakthrough pain are effectively treated with NSAIDs, because they are examples
of nociceptive pain. However, the patient who has visceral pain will experience a deep
squeezing pressure with local tenderness. The patient who has cutaneous pain will
experience a localized dull, aching pain. The patient who has breakthrough pain will
have episodic pains with the symptoms of acute pain.
/.A patient with a severe muscle cramp tells the nurse, "The pain is a little better when I
massage the muscle or apply a cold pack." Which criterion of the PQRST method of
pain assessment is addressed in the patient's statement? - Answer-
Provocation/Palliation
PQRST is a pain assessment scale; it stands for Provocation/Palliation,
Quality/Quantity, Region/Radiation, Severity Scale, and Timing. Because the patient is
describing methods that provide comfort and relieve the pain, it indicates that the patient
is addressing Provocation/Palliation. If the patient reports about severity of pain on a
scale of 0 to 10, then it indicates that the patient is addressing Severity. When
addressing the Quality/Quantity of the pain, the patient describes the pain felt. If the
patient reports about the site of pain, then the patient is addressing Region/Radiation.
/.A patient with a shoulder injury tells the nurse, "My shirt is chafing my shoulder and
causing me pain. Can you get me a sleeveless shirt?" What does the nurse interpret
from the patient's response? - Answer-The patient has allodynia.
An increase in pain due to a slight touch of a cloth or cotton swab indicates that the
patient has allodynia, which is damage to the nerve fibers at the injury site. If a patient
experiences no pain at the injury site, then it could indicate analgesia. If the patient has
pain at a particular site due to movement, then it indicates incident pain. If the patient
experiences a transient spike in pain despite taking analgesics to control pain, this is
called breakthrough pain.
/.A patient with cancer reports having severe pain. The health care provider prescribes
opioid analgesics for pain relief. Which event of nociception will be inhibited after
administering opioid analgesics to the patient? - Answer-Movement of the pain impulses
from the spinal cord to the thalamus via the ascending fibers
Opioid analgesics block the transmission of pain impulses and relieve pain. These
analgesics activate the opioid receptors located in the spinal cord and block the
transmission of the pain impulses from the spinal cord to the thalamus; this occurs in
, the second phase of nociception. The secretion of histamine, bradykinin, prostaglandin,
glutamate, and adenosine triphosphate (ATP) takes place during the first phase of
nociception. The opioid analgesics do not inhibit the events of the first phase, because
they do not block the receptors which secrete histamine, bradykinin, prostaglandin and
glutamate. The transmission of the pain impulses across the synaptic cleft to the dorsal
horn neurons takes place due to the secretion of glutamate and ATP. Because the
opioid analgesics do not inhibit the secretion of glutamate, they do not hinder the
transmission of the impulses across the synaptic cleft to the dorsal horn neurons.
/.A patient with carpal tunnel syndrome reports having a tingling and burning sensation
in the thumb, middle, and index fingers. What does the nurse interpret from these
symptoms? - Answer-The patient has neuropathic pain.
The presence of a tingling, burning sensation in the thumb, middle, and index fingers
indicates that the patient has neuropathic pain. It is caused by impaired processing of
the pain impulses from the site of injury to the nerve fibers. The patient with referred
pain has an injury at a particular site, but experiences pain at other sites of the body.
Referred pain is caused by damage to a spinal nerve, which sends signals to two
different parts of the body. If the patient has pain due to skin surface damage, it
indicates that the patient has cutaneous pain. Nociceptive pain is associated with
aching, throbbing, and a cramping sensation. Because the patient does not report
having any aching or throbbing sensation, the nurse would not interpret that the patient
has nociceptive pain.
/.A patient with diabetic neuropathy reports burning, electric shock-like pain in the lower
extremities. Which category of medications would be helpful in treating this patient? -
Answer-Opioids
Corticosteroids
Antidepressants
Anticonvulsants
Diabetic neuropathy is a neuropathic disorder that is associated with burning, electric
shock-like pain in the lower extremities. Opioids alleviate neuropathic pain by activating
the opioid receptors located in the spinal cord. These medications block the
transmission of the pain impulses from the brain to the thalamus. Antidepressants and
anticonvulsant medications decrease the serotonin levels and increases gamma-
aminobutyric acid (GABA), so these medications alleviate pain by blocking the
transmission of pain impulses from the damaged nerves and reducing their sensitivity.
Corticosteroids are prescribed for the treatment of nociceptive pain, which is associated
with redness and inflammation at the site of injury. These medications reduce
prostaglandin levels, and inhibit inflammatory responses. Muscle relaxants are effective
in preventing muscle spasm and can alleviate the pain associated with musculoskeletal
injuries. These medications do not alter neurotransmitter levels, however, nor do they
prevent neuropathic pain.
