Vital Signs Measurement > Fundamentals
Exam Review
Pain Assessment
Total Questions : 5
Showing 5 questions, Sign in for moreA nurse is assessing a client's pain level. Which pain assessment tool is commonly used for self-reporting pain in adults?
Explanation
Answer: d. Numeric Rating Scale
Explanation: The Numeric Rating Scale is commonly used for self-reporting pain in adults. It involves asking the client to rate their pain on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain imaginable.
a. The Wong-Baker FACES Pain Rating Scale uses a series of facial expressions to assess pain in children, but it is not commonly used for self-reporting pain in adults.
b. The FLACC Pain Assessment Scale is used to assess pain in nonverbal or preverbal individuals, such as infants and young children.
c. The PAINAD Scale is used to assess pain in individuals with advanced dementia who may have difficulty self-reporting pain.
A nurse is assessing a client's pain and notes that the client is grimacing, guarding the affected area, and rating their pain as 8 out of 10. What action should the nurse take?
Explanation
Answer: c. Provide non-pharmacological pain relief measures.
Explanation: The client's grimacing, guarding, and high pain rating indicate significant pain. The nurse should initiate non-pharmacological pain relief measures, such as positioning, relaxation techniques, heat or cold therapy, or distraction, to help alleviate the pain.
a. Documenting the findings and reassessing the pain in 30 minutes may delay appropriate pain relief measures if the client is experiencing significant pain.
b. Administering the maximum prescribed dose of pain medication should be based on a comprehensive pain assessment and healthcare provider's order.
d. Initiating a consultation with a physical therapist may be appropriate in certain cases, but immediate non-pharmacological pain relief measures should be provided first.
A nurse is assessing a client's pain and determines that the pain is neuropathic in nature. Which medication would be most appropriate for managing neuropathic pain?
Explanation
Answer: d. Gabapentin (Neurontin)
Explanation: Gabapentin is an anticonvulsant medication commonly used to manage neuropathic pain. It helps stabilize nerve activity and reduce pain in conditions such as diabetic neuropathy or postherpetic neuralgia.
a. Acetaminophen and ibuprofen are more commonly used for managing mild to moderate nociceptive pain rather than neuropathic pain.
c. Morphine sulfate is an opioid analgesic and may be used for severe nociceptive pain but is not specific to neuropathic pain.
A nurse is assessing a client's pain and decides to use the FLACC Pain Assessment Scale. Which population is this scale primarily designed for?
Explanation
Answer: c. Infants and young children
Explanation: The FLACC Pain Assessment Scale is primarily designed for assessing pain in infants and young children who may not be able to self-report pain. It assesses facial expression, leg movement, activity, cry, and consolability.
a. Pain assessment tools designed for adults, such as the Numeric Rating Scale or Wong-Baker FACES Pain Rating Scale, are more appropriate for assessing pain in adults.
b. There are specific pain assessment tools for older adults that take into account age-related changes in pain perception, but the FLACC scale is not primarily designed for this population.
d. Individuals with cognitive impairment may require pain assessment tools specific to their condition, such as the PAINAD Scale, but the FLACC scale is primarily used for infants and young children.
A nurse is assessing a client's pain and notes that the client has dilated pupils, increased blood pressure, and increased heart rate. Which type of pain is the client likely experiencing?
Explanation
Answer: a. Acute pain Explanation: The client's symptoms of dilated pupils, increased blood pressure, and increased heart rate are consistent with the physiological responses associated with acute pain. Acute pain is typically a temporary and intense pain response.
b. Chronic pain refers to pain that lasts for an extended period, typically more than three months, and may not be associated with the same physiological responses as acute pain.
c. Visceral pain refers to pain originating from the internal organs, and the symptoms described are not specific to this type of pain.
d. Neuropathic pain is caused by nerve damage or dysfunction, and the symptoms described are not specific to this type of pain.
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