1. A student asks the nurse what is the best way to assess a clients pain. Which response by theÂ
nurse is best?
a. Numeric pain scale
b. Behavioral assessment
c. Objective observation
d. Clients self-report
ANS: D
Many ways to measure pain are in use, including numeric pain scales, behavioral assessments, and otherÂ
objective observations. However, the most accurate way to assess pain is to get a self-report from theÂ
client.
DIF: Remembering/Knowledge REF: 46 KEY: Pain| pain assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Health Promotion and Maintenance
2. A new nurse reports to the precepting nurse that a client requested pain medication, and whenÂ
the nurse brought it, the client was sound asleep. The nurse states the client cannot possibly sleep withÂ
the severe pain the client described. What response by the experienced nurse is best?
a. Being able to sleep doesnt mean pain doesnt exist.
b. Have you ever experienced any type of pain?
c. The client should be assessed for drug addiction.
d. Youre right; I would put the medication back.
ANS: A
A clients description is the most accurate assessment of pain. The nurse should believe the client andÂ
provide pain relief. Physiologic changes due to pain vary from client to client, and assessments of themÂ
should not supersede the clients descriptions, especially if the pain is chronic in nature. Asking if theÂ
new nurse has had pain is judgmental and flippant, and does not provide useful information. ThisÂ
amount of information does not warrant an assessment for drug addiction. Putting the medication backÂ
and ignoring the clients report of pain serves no useful purpose.
DIF: Understanding/Comprehension REF: 49 KEY: Pain| pain assessment
MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: HealthÂ
Promotion and Maintenance
3. The nurse in the surgery clinic is discussing an upcoming surgical procedure with a client. WhatÂ
information provided by the nurse is most appropriate for the clients 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 wont have to take them for long.
d. The nursing staff will give you pain medication when you ask them for it.
ANS: B
The best outcome after a surgical procedure is timely and satisfactory pain control, which diminishes theÂ
likelihood of chronic pain afterward. The nurse suggests that the client advocate for himself and discussÂ
acceptable pain control with the surgeon. Stating that pain after surgery is usually short lived does notÂ
provide the client with options to have personalized pain control. To prevent or reduce nausea andÂ
other side effects from opioids, a multimodal pain approach is desired. For acute pain after surgery,Â
giving pain medications around the clock instead of waiting until the client requests it is a betterÂ
approach.