Deck 5: Acute Pain Management

Question 1

A trauma patient has just been sedated,intubated,and placed on mechanical ventilation.The nurse documents the patient's pain level as 9 on the 1-10 scale.How should this action be interpreted?

A)The patient should receive the highest dose of analgesic medication ordered.
B)The nurse has inappropriately scaled the patient's pain.
C)The nurse should wait until the patient has adapted to the mechanical ventilator before scaling the level of pain.
D)Pain will decrease now that the patient does not have to work to breathe.

Answer 1

The nurse has inappropriately scaled the patient's pain.

Question 2

A nurse is administering naloxone (Narcan)to a patient who is minimally responsive after receiving an opioid.Which nursing action is indicated?

A)Bolus the medication at a rate of 0.4 mg/min.
B)Give the medication without dilution.
C)Discontinue the naloxone as soon as the patient's respirations normalize.
D)Plan to repeat the dose every hour for the next 4 hours.

Answer 2

Discontinue the naloxone as soon as the patient's respirations normalize.

Question 3

The nurse prepares to administer a nonsteroidal anti-inflammatory drug to the patient with postoperative knee pain.The nurse should consider which pharmacological properties of NSAIDs? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)NSAIDs inhibit the manufacture of bradykinins.
B)NSAIDs bind with opioid receptors throughout the nervous system.
C)NSAIDs exert peripheral effects.
D)NSAIDs inhibit the formation of prostaglandins.
E)NSAIDS may affect renal function.

Answer 3

NSAIDs inhibit the manufacture of bradykinins.
NSAIDs exert peripheral effects.
NSAIDs inhibit the formation of prostaglandins.
NSAIDS may affect renal function.

Question 4

A semi-conscious patient with pancreatic cancer requires pain management.After multiple attempts,the oncology nurses are unable to establish venous access.What is the best alternative route for pain medication administration until venous access can be obtained?

A)Rectal suppository
B)Injection in deltoid muscle
C)Subcutaneous injection in abdominal tissue
D)Oral liquid

Question 5

The intensive care nurse plans to test nociception in the patient with a closed-head injury.Which nursing action is indicated?

A)Move an object across the patient's visual field.
B)Place a container of ground coffee close to the patient's nostrils.
C)Ask the patient to squeeze and release the nurse's hand.
D)Press the patient's nail bed.

Question 6

A patient with myocardial infarction is treated with intravenous morphine sulfate for chest pain.Which nursing action has the highest priority when administering this medication?

A)Determine the patient's sedation level.
B)Check breath sounds every 15 minutes.
C)Observe for signs of opioid addiction.
D)Assess for medication infiltration into tissues.

Question 7

A 78-year-old female patient is admitted to a medical-surgical unit with left lower extremity pain and discoloration.The patient's laboratory values are: hemoglobin 12 g/100 mL,hematocrit 37%,glucose 110 mg/dL,potassium 6.5 mEq/L,BUN 60 mg/dL,and creatinine 3.2 mg/dL.Which statement by the nurse represents a clear understanding of this patient's pain management needs?

A)"This patient may need more pain medication because of anemia."
B)"This patient may need less pain medication because of acute renal failure."
C)"This patient may need less pain medication because of diabetes mellitus."
D)"This patient will need potassium replacement before pain treatment begins."

Question 8

A patient has achieved pain control with an oral opioid and is tolerant of its sedative effects but is having severe constipation.The nurse has contacted the healthcare provider about prescribing a different opioid.What should the nurse anticipate regarding the new drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)The new opioid will be administered by the intravenous route.
B)There will be an increased need to observe the patient for sedation.
C)The starting dose of the new medication will be lower than the equianalgesic dose of the original medication.
D)It will be necessary to add an adjuvant medication to achieve equal pain control.
E)The newly prescribed medication will be a pure opioid agonist.

Question 9

Admission vital signs for the mechanically ventilated patient in the neurosurgery intensive care unit are heart rate: 60 beats per minute,blood pressure: 110/82,and respiratory rate: 20 breaths per minute.Which statement by the nurse reflects an accurate understanding of the patient's current pain experience?

A)"This patient's vital signs reflect a sympathetic nervous system response to pain."
B)"Since the vital signs are normal,the patient is not experiencing pain."
C)"This patient needs further assessment to determine if pain is present."
D)"Since the patient is mechanically ventilated,pain is unlikely."

Question 10

A patient tells the nurse that his back has not "bothered" him for months but now that he's in the intensive care unit,his back is "killing" him.The nurse considers which cause of this pain when designing interventions?

A)Lack of mobility due to hospitalization
B)Worsening of the disease process that caused the hospital admission
C)An undiagnosed injury to the back
D)Tolerance to pain medication

Question 11

Which actions should be considered by the nurse planning pain relief interventions for the patient with a history of substance abuse? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Planning for comorbid psychiatric disorder treatment
B)Administering long-acting analgesics
C)Using oral medications in place of intravenous ones when possible
D)Treating pain with NSAIDs instead of opioid drugs
E)Avoiding using drugs that are similar in action to the abused drug

Question 12

A patient undergoing spinal surgery is receiving low-dose intravenous lidocaine prior to surgery.The patient reports being lightheaded and having numbness in his tongue.What nursing action is indicated?

A)Increase the rate of the lidocaine drip.
B)Give a 250-mL normal saline bolus intravenously.
C)Discontinue the lidocaine drip.
D)Start intravenous lipids at an infusion frat of 1.5 mL/kg/min.

Question 13

A patient has received a pain medication that blocks pain signals from the spinal cord.The nurse anticipates the effects of this medication will result in which level of pain?

A)0 on a scale from 0-10
B)8 on a scale from 0-10
C)5 on a scale from 0-10
D)2 on a scale from 0-10

Question 14

A patient with a tension pneumothorax requires insertion of a pleural chest tube.The nurse assists the physician as multiple doses of a local anesthetic are administered prior to tube insertion.Which observation by the nurse warrants immediate physician attention?

A)The patient's respiratory rate changes from 22 to 26 breaths per minute.
B)The patient complains of pain during anesthetic injections.
C)The patient's systolic blood pressure changes from 156 to 138 mmHg.
D)The patient's heart rate changes from 100 to 75 beats per minute.

Question 15

While giving an end-of-shift report,the exiting nurse describes treatment for a patient's complaint of arm pain.The nurse receiving the report should question the validity of which statement?

A)"The patient is resting quietly in bed."
B)"The patient's blood pressure is normal so the pain is gone."
C)"I administered 800 mg of ibuprofen."
D)"I also applied a hot pack to the arm at the patient's request."

Question 16

A patient who takes an opioid pain reliever says,"I don't want to take my pain medication too often.It might not work when I really need it." What does the nurse teach this patient regarding tolerance to pain medications?

A)"Tolerance is a myth and does not exist."
B)"If you need larger doses of your medication we can provide it."
C)"We do have to be concerned about oversedation."
D)"It is best not to take too much of any drug."

Question 17

A nurse is providing moderate sedation for a patient having a diagnostic endoscopy.Which actions should the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Bolus of a sedative
B)Using a drug with rapid onset
C)Titration of pain medication
D)Use of a combination of drugs in a single IV line
E)Monitor a slow continuous dose of medication

Question 18

A patient receiving moderate sedation for a colonoscopy has progressed to a state of deep anesthesia.The nurse administering this sedation has which priority intervention?

A)Monitor the heart rate.
B)Contact the rapid response team.
C)Manage the airway and provide ventilation.
D)Monitor the blood pressure.

Question 19

A patient complains of a dull,aching sensation in the lower back after long periods of sitting.The nurse anticipates the administration of medication to suppress pain impulse transmission in which fibers to treat the patient's complaint?

A)A delta fibers
B)C fibers
C)Myelinated fibers
D)Enkephalins

Question 20

The nurse observes the patient during a major abdominal dressing change.Which facets of pain can be observed by the nurse during this procedure?

A)Expressing behaviors
B)Pain
C)Nociception
D)Suffering