A nurse is caring for a patient who is experiencing pain related to a musculoskeletal disorder.
Which statement regarding chronic pain is most accurate?
A patient with chronic pain may have physical signs of tissue injury.
Chronic pain may not manifest in a change of vital signs.
Chronic pain is limited and short in duration.
Chronic pain could cause restlessness, pacing, grimacing, and other facial expressions of pain.
The Correct Answer is B
Choice A rationale
While acute pain often correlates with visible signs of tissue injury and subsequent inflammatory responses, chronic pain is defined as pain persisting or recurring for more than three months and may be due to neuropathic changes or central sensitization rather than ongoing tissue damage. Physical signs like swelling or redness are less consistent in chronic pain presentations.
Choice B rationale
Chronic pain involves long-term activation of pain pathways, potentially leading to physiological adaptation by the autonomic nervous system over time. This adaptation can mean that sympathetic responses, such as increases in heart rate, blood pressure, or respiratory rate, which are common in acute pain, may be absent, making vital signs an unreliable indicator of the pain's severity.
Choice C rationale
This statement describes acute pain, which is typically sudden in onset, resolves with healing, and serves as a protective mechanism signaling tissue damage. Chronic pain, by definition, is persistent or recurrent, lasting beyond the usual course of an acute illness or injury, often for more than three months.
Choice D rationale
Restlessness, pacing, grimacing, and other overt facial expressions are more characteristic of acute pain or breakthrough pain episodes, reflecting a sympathetic nervous system response. Individuals with chronic pain often exhibit more subtle behavioral changes, such as withdrawal, fatigue, or irritability, due to the sustained pain experience.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The client's pH of 7.6 is alkaline (normal range 7.35-7.45), indicating an alkalosis. The PaCO_2 of 40 mm Hg is within the normal range (normal range 35-45 mm Hg), ruling out a primary respiratory cause. The HCO_3 of 32 mEq/L is elevated (normal range 22-26 mEq/L). An elevated pH with an elevated HCO_3 and a normal PaCO_2 indicates uncompensated metabolic alkalosis.
Choice B rationale
Respiratory alkalosis is characterized by a high pH (alkaline) and a low PaCO_2 (primary respiratory derangement), due to hyperventilation. The client's PaCO_2 is 40 mm Hg, which is within the normal range, thus ruling out a primary respiratory alkalosis.
Choice C rationale
Respiratory acidosis is characterized by a low pH (acidic) and a high PaCO_2 (primary respiratory derangement), due to hypoventilation. The client's pH is 7.6 (alkaline) and PaCO_2 is 40 mm Hg (normal), directly contradicting the criteria for respiratory acidosis.
Choice D rationale
Metabolic acidosis is characterized by a low pH (acidic) and a low HCO_3 (primary metabolic derangement). The client's pH is 7.6 (alkaline) and the HCO_3 is 32 mEq/L (high), which is the opposite of the findings expected in metabolic acidosis.
Correct Answer is D
Explanation
Choice A rationale
End-organ dysfunction (or the progressive stage) is characterized by a failure of compensatory mechanisms and widespread tissue hypoxia. While the patient is confused and has crackles, the hypothermia (76°F) and pale, clammy skin are most consistent with the initial compensatory response to significant fluid loss and peripheral vasoconstriction. The BP of 79/56 mm Hg reflects a decompensating state, but this presentation is classically taught as early burn shock.
Choice B rationale
Early reversible (or compensatory) shock is characterized by a mean arterial pressure greater than 65 mm Hg, and the body effectively maintaining tissue perfusion through mechanisms like tachycardia and vasoconstriction. This patient's hypotension (BP 79/56 mm Hg) signifies a profound drop in cardiac output and the failure of compensatory mechanisms, meaning the patient is beyond the truly early reversible stage.
Choice C rationale
Irreversible shock is the final stage where cellular and tissue injury is so severe that no intervention can save the patient, often marked by profound lactic acidosis and multiple organ failure. The patient's presentation with hypotension and altered consciousness is severe, but the stage that includes this immediate post-burn systemic response to massive fluid shifts, before the full cascade of multiple organ failure, is often termed Preshock or Hypovolemic shock.
Choice D rationale
Preshock (or initial stage) is often used to describe the early stages of hypovolemic shock, which is the primary concern in the initial hours following a major burn. The massive capillary permeability and subsequent fluid shift out of the circulation causes profound hypovolemia, leading to the observed hypotension (BP 79/56 mm Hg) and tachycardia (HR 132 beats/min). This is the systemic response before the patient fully enters the progressive stage.
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