NURS (FUNDAMENTAL): Ch 34 NCLEX
Comfort and Pain Management
A nurse instructor is teaching a class of student nurses about the nature of pain. Which
statements accurately describe this phenomenon? Select all that apply.
a) Pain is whatever the physician treating the pain says it is.
b) Pain exists whenever the person experiencing it says it exists.
c) Pain is an emotional and sensory reaction to tissue damage.
d) Pain is a simple, universal, and easy-to-describe phenomenon.
e) Pain that occurs without a known cause is psychological in nature.
f) Pain is classified by duration, location, source, transmission, and etiology. – answer b,
c, f
The classic definition of pain that is probably of greatest benefit to nurses and their
patients: "Pain is whatever the experiencing person says it is, existing whenever he (or
she) says it does." The International Association for the Study of Pain (IASP) further
defines pain as an unpleasant sensory and emotional experience associated with actual
or potential tissue damage (IASP, 1994). Pain is an elusive and complex phenomenon,
and despite its universality, its exact nature remains a mystery. Pain is present
whenever a person says it is, even when no specific cause of the pain can be found.
Pain may be classified according to its duration, its location or source, its mode of
transmission, or its etiology.
One of the most common distinctions of pain is whether it is acute or chronic. Which
examples describe chronic pain? Select all that apply.
a) A patient is receiving chemotherapy for bladder cancer.
b) An adolescent is admitted to the hospital for an appendectomy.
c) A patient is experiencing a ruptured aneurysm.
d) A patient who has fibromyalgia requests pain medication.
e) A patient has back pain related to an accident that occurred last year.
f) A patient is experiencing pain from second-degree burns. – answer a, d, e
Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond
the normal healing period. Examples are cancer pain, fibromyalgia pain, and back pain.
Acute pain is generally rapid in onset and varies in intensity from mild to severe, as
occurs with an emergency appendectomy, a ruptured aneurysm, and pain from burns.
A patient complains of abdominal pain that is difficult to localize. The nurse documents
this as which type of pain?
a) Cutaneous
b) Visceral
,c) Superficial
d) Somatic – answer b) Visceral
The patient's pain would be categorized as visceral pain, which is poorly localized and
can originate in body organs in the abdomen. Cutaneous pain (superficial pain) usually
involves the skin or subcutaneous tissue. A paper cut that produces sharp pain with a
burning sensation is an example of cutaneous pain. Deep somatic pain is diffuse or
scattered and originates in tendons, ligaments, bones, blood vessels, and nerves.
Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep
somatic pain.
A female patient who is having a myocardial infarction complains of pain that is situated
in her jaw. The nurse documents this as what type of pain?
a) Transient pain
b) Superficial pain
c) Phantom pain
d) Referred pain – answer d) Referred pain
Referred pain is perceived in an area distant from its point of origin, whereas transient
pain is brief and passes quickly. Superficial pain originates in the skin or subcutaneous
tissue. Phantom pain may occur in a person who has had a body part amputated, either
surgically or traumatically.
The three types of responses to pain are physiologic, behavioral, and affective. Which
are examples of behavioral responses to pain? Select all that apply.
a) A patient cradles a wrist that was injured in a car accident.
b) A child is moaning and crying due to a stomachache.
c) A patient's pulse is increased following a myocardial infarction.
d) A patient in pain strikes out at a nurse who attempts to bathe him.
e) A patient who has chronic cancer pain is depressed and withdrawn.
f) A child pulls away from a nurse trying to give him an injection. – answer a, b, f
Protecting or guarding a painful area, moaning and crying, and moving away from
painful stimuli are behavioral responses. Examples of a physiologic or involuntary
response would be increased blood pressure or dilation of the pupils. Affective
responses, such as anger, withdrawal, and depression, are psychological in nature.
An elderly patient is confined to bedrest following cervical spine surgery to treat nerve
pinching. The nurse is vigilant about turning the patient and assessing the patient
regularly to prevent the formation of pressure ulcers. What type of agent is the stimulus
for pressure ulcers?
a) Mechanical
b) Thermal
, c) Chemical
d) Electrical – answer a) Mechanical
Receptors in the skin and superficial organs may be stimulated by mechanical, thermal,
chemical, and electrical agents. Friction from bed linens causing pressure sores and
pressure from a cast are mechanical stimulants. Sunburn is a thermal stimulant. An acid
burn is the result of a chemical stimulant. The jolt from a lightening bolt is an electrical
stimulant.
A nurse uses a whirlpool to relax a patient following intense physical therapy to restore
movement in her legs. What is a potent pain-blocking neuromodulator, released through
relaxation techniques?
a) Prostaglandins
b) Substance P
c) Endorphins
d) Serotonin – answer c) Endorphins
Endorphins are produced at neural synapses at various points along the CNS pathway.
They are powerful pain-blocking chemicals that have prolonged analgesic effects and
produce euphoria. It is thought that endorphins are released through pain relief
measures, such as relaxation techniques. Prostaglandins, substance P, and serotonin
(a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and
produce vasoconstriction) are neurotransmitters or substances that either excite or
inhibit target nerve cells.
A patient is postoperative following an emergency cesarean section birth. The patient
asks the nurse about the use of pain medications following surgery. What would be a
correct response by the nurse?
a) "It's not a good idea to ask for pain medication regularly as it can be addictive."
b) "It is better to wait until the pain gets unbearable before asking for pain medication."
c) "It's natural to have to put up with pain after surgery and it will lessen in intensity in a
few days."
d) "Your doctor has ordered pain medications for you, which you should not be afraid to
request any time you have pain." – answer d) "Your doctor has ordered pain
medications for you, which you should not be afraid to request any time you have pain."
Many pain medications are ordered on a PRN (as needed) basis. Therefore, nurses
must be diligent to assess patients for pain and administer medications as needed. A
patient should not be afraid to request these medications and should not wait until the
pain is unbearable. Few people become addicted to the medications if used for a short
period of time. Pain following surgery can be controlled and should not be considered a
natural part of the experience that will lessen in time.
Comfort and Pain Management
A nurse instructor is teaching a class of student nurses about the nature of pain. Which
statements accurately describe this phenomenon? Select all that apply.
a) Pain is whatever the physician treating the pain says it is.
b) Pain exists whenever the person experiencing it says it exists.
c) Pain is an emotional and sensory reaction to tissue damage.
d) Pain is a simple, universal, and easy-to-describe phenomenon.
e) Pain that occurs without a known cause is psychological in nature.
f) Pain is classified by duration, location, source, transmission, and etiology. – answer b,
c, f
The classic definition of pain that is probably of greatest benefit to nurses and their
patients: "Pain is whatever the experiencing person says it is, existing whenever he (or
she) says it does." The International Association for the Study of Pain (IASP) further
defines pain as an unpleasant sensory and emotional experience associated with actual
or potential tissue damage (IASP, 1994). Pain is an elusive and complex phenomenon,
and despite its universality, its exact nature remains a mystery. Pain is present
whenever a person says it is, even when no specific cause of the pain can be found.
Pain may be classified according to its duration, its location or source, its mode of
transmission, or its etiology.
One of the most common distinctions of pain is whether it is acute or chronic. Which
examples describe chronic pain? Select all that apply.
a) A patient is receiving chemotherapy for bladder cancer.
b) An adolescent is admitted to the hospital for an appendectomy.
c) A patient is experiencing a ruptured aneurysm.
d) A patient who has fibromyalgia requests pain medication.
e) A patient has back pain related to an accident that occurred last year.
f) A patient is experiencing pain from second-degree burns. – answer a, d, e
Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond
the normal healing period. Examples are cancer pain, fibromyalgia pain, and back pain.
Acute pain is generally rapid in onset and varies in intensity from mild to severe, as
occurs with an emergency appendectomy, a ruptured aneurysm, and pain from burns.
A patient complains of abdominal pain that is difficult to localize. The nurse documents
this as which type of pain?
a) Cutaneous
b) Visceral
,c) Superficial
d) Somatic – answer b) Visceral
The patient's pain would be categorized as visceral pain, which is poorly localized and
can originate in body organs in the abdomen. Cutaneous pain (superficial pain) usually
involves the skin or subcutaneous tissue. A paper cut that produces sharp pain with a
burning sensation is an example of cutaneous pain. Deep somatic pain is diffuse or
scattered and originates in tendons, ligaments, bones, blood vessels, and nerves.
Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep
somatic pain.
A female patient who is having a myocardial infarction complains of pain that is situated
in her jaw. The nurse documents this as what type of pain?
a) Transient pain
b) Superficial pain
c) Phantom pain
d) Referred pain – answer d) Referred pain
Referred pain is perceived in an area distant from its point of origin, whereas transient
pain is brief and passes quickly. Superficial pain originates in the skin or subcutaneous
tissue. Phantom pain may occur in a person who has had a body part amputated, either
surgically or traumatically.
The three types of responses to pain are physiologic, behavioral, and affective. Which
are examples of behavioral responses to pain? Select all that apply.
a) A patient cradles a wrist that was injured in a car accident.
b) A child is moaning and crying due to a stomachache.
c) A patient's pulse is increased following a myocardial infarction.
d) A patient in pain strikes out at a nurse who attempts to bathe him.
e) A patient who has chronic cancer pain is depressed and withdrawn.
f) A child pulls away from a nurse trying to give him an injection. – answer a, b, f
Protecting or guarding a painful area, moaning and crying, and moving away from
painful stimuli are behavioral responses. Examples of a physiologic or involuntary
response would be increased blood pressure or dilation of the pupils. Affective
responses, such as anger, withdrawal, and depression, are psychological in nature.
An elderly patient is confined to bedrest following cervical spine surgery to treat nerve
pinching. The nurse is vigilant about turning the patient and assessing the patient
regularly to prevent the formation of pressure ulcers. What type of agent is the stimulus
for pressure ulcers?
a) Mechanical
b) Thermal
, c) Chemical
d) Electrical – answer a) Mechanical
Receptors in the skin and superficial organs may be stimulated by mechanical, thermal,
chemical, and electrical agents. Friction from bed linens causing pressure sores and
pressure from a cast are mechanical stimulants. Sunburn is a thermal stimulant. An acid
burn is the result of a chemical stimulant. The jolt from a lightening bolt is an electrical
stimulant.
A nurse uses a whirlpool to relax a patient following intense physical therapy to restore
movement in her legs. What is a potent pain-blocking neuromodulator, released through
relaxation techniques?
a) Prostaglandins
b) Substance P
c) Endorphins
d) Serotonin – answer c) Endorphins
Endorphins are produced at neural synapses at various points along the CNS pathway.
They are powerful pain-blocking chemicals that have prolonged analgesic effects and
produce euphoria. It is thought that endorphins are released through pain relief
measures, such as relaxation techniques. Prostaglandins, substance P, and serotonin
(a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and
produce vasoconstriction) are neurotransmitters or substances that either excite or
inhibit target nerve cells.
A patient is postoperative following an emergency cesarean section birth. The patient
asks the nurse about the use of pain medications following surgery. What would be a
correct response by the nurse?
a) "It's not a good idea to ask for pain medication regularly as it can be addictive."
b) "It is better to wait until the pain gets unbearable before asking for pain medication."
c) "It's natural to have to put up with pain after surgery and it will lessen in intensity in a
few days."
d) "Your doctor has ordered pain medications for you, which you should not be afraid to
request any time you have pain." – answer d) "Your doctor has ordered pain
medications for you, which you should not be afraid to request any time you have pain."
Many pain medications are ordered on a PRN (as needed) basis. Therefore, nurses
must be diligent to assess patients for pain and administer medications as needed. A
patient should not be afraid to request these medications and should not wait until the
pain is unbearable. Few people become addicted to the medications if used for a short
period of time. Pain following surgery can be controlled and should not be considered a
natural part of the experience that will lessen in time.
