Deck 31: Pain

Question 1

A client reports taking acetaminophen to control osteoarthritis. Which instruction should the nurse give the client requiring long-term acetaminophen use?
1)Caution the client against combining acetaminophen with alcohol.
2)Inform the client that acetaminophen increases the risk for bleeding.
3)Advise taking acetaminophen with meals to prevent gastric irritation.
4)Explain that physical dependence may occur with long-term oral use.

Answer 1

1

Question 2

A patient is prescribed morphine sulfate 4 mg intravenously for postoperative pain. Which action should the nurse take before administering the medication?
1)Monitor the patient's respiratory status.
2)Auscultate the patient's heart sounds.
3)Check blood pressure with the patient in the supine and sitting positions.
4)Assess the patient for elevated temperature.

Answer 2

1

Question 3

In which process do peripheral nerves carry the pain message to the dorsal horn of the spinal cord?
1)Transduction
2)Transmission
3)Perception
4)Modulation

Answer 3

2

Question 4

The nurse is teaching a client who sustained an ankle injury about cold application. Which instruction should the nurse include in the teaching plan?
1)Place the cold pack directly on the skin over the ankle.
2)Apply the cold pack to the ankle for 30 minutes at a time.
3)Check the skin frequently for extreme redness.
4)Keep the cold pack in place for at least 24 hours.

Question 5

How should the nurse classify pain that a patient with lung cancer is experiencing?
1)Cutaneous
2)Deep somatic
3)Visceral
4)Neuropathic

Question 6

A patient prescribed a nonsteroidal anti-inflammatory drug (NSAID), naproxen, for the treatment of arthritis reports stomach upset. What should the nurse instruct the patient to do?
1)Take the medication on an empty stomach.
2)Take the medication with food.
3)Take the medication with 8 ounces of water.
4)Take the medication before bedtime.

Question 7

After receiving ibuprofen 800 mg orally for right hip pain, the patient states that the pain is 8 out of 10 on the numerical pain scale. Which action should the nurse take next?
1)Use nonpharmacological therapy while waiting 3 more hours before the next dose.
2)Administer an additional 800 mg oral dose of ibuprofen right away.
3)Do nothing because the patient's facial expression indicates an absence of pain.
4)Notify the prescriber that the current pain management plan is ineffective.

Question 8

A nurse is preparing to administer pain medications to a client. Which statement by the nurse indicates correct understanding of the guidelines for pain management?
1)"I will administer the pain medication around the clock."
2)"I will encourage the client to wait as long as possible between doses."
3)"I will wait to give pain medication until the client shows signs of pain."
4)"I will assess the need for medication only if the client reports pain."

Question 9

A patient reports using music therapy to help control the chronic pain. Music therapy works by prompting the release of endogenous opioids during which stage of the pain process?
1)Perception
2)Transduction
3)Transmission
4)Modulation

Question 10

The nurse administers acetaminophen 325 mg and codeine 30 mg orally to a patient reporting a severe headache. When should the nurse reassess the patient's pain?
1)15 minutes after administration
2)30 minutes after administration
3)90 minutes after administration
4)Immediately before the next dose is due

Question 11

The male nurse uses his hands to direct energy fields surrounding the patient's body. After this intervention, the patient states that the pain has lessened. How should the nurse document the intervention?
1)Tactile distraction was performed and appeared effective in reducing pain.
2)Guided imagery was effective in relaxing the patient and reducing the pain.
3)Therapeutic touch was performed; patient verbalized lessening of pain after treatment.
4)Sequential muscle relaxation was performed; patient states pain is less.

Question 12

A patient suddenly develops right-lower-quadrant pain, nausea, vomiting, and rebound tenderness. How should the nurse classify this patient's pain?
1)Acute
2)Chronic
3)Intractable
4)Neuropathic

Question 13

Which side effect associated with opioid use may improve after taking a few doses of the drug?
1)Paradoxical reaction
2)Drowsiness
3)Dry mouth
4)Difficulty with urination

Question 14

A patient who sustained rib fractures in a motor vehicle accident is stating that the pain medication is ineffective. Inadequate pain control places this patient at risk for which complication?
1)Metabolic alkalosis
2)Overventilation
3)Pneumonia
4)Hypocarbia

Question 15

The nurse is assessing an intubated patient who returned from coronary artery bypass surgery 3 hours ago. Which assessment finding might indicate that this patient is experiencing pain?
1)Blood pressure 160/82 mm Hg
2)Temperature 100.6°F (38.1°C)
3)Heart rate 80 beats/min
4)Oxygen saturation 95%

Question 16

A patient who had surgery is receiving patient-controlled analgesia (PCA). Which statement by the patient indicates an understanding of PCA use?
1)"I will not push the button too many times, so I won't get overdosed."
2)"I will need to be careful not to roll over the button when I sleep."
3)"I will be the only one that presses the button."
4)"I will use this button to help me sleep better."

Question 17

A nurse is working in nursery and observes an infant crying after a procedure. Which action would be appropriate for the nurse to take?
1)Nothing, newborns are not as sensitive.
2)Place the infant under a warmer.
3)Administer oral sucrose.
4)Give a pain injection.

Question 18

A patient who underwent left above-the-knee amputation reports pain in the left foot. The nurse should document this finding as what type of pain?
1)Psychogenic
2)Phantom
3)Referred
4)Radiating

Question 19

When should the nurse assess pain?
1)With a change in the patient's condition
2)After the nurse finishes charting
3)Every 4 hours for the first 2 days after surgery
4)Only when the patient reports pain

Question 20

The nurse plays music for a child with leukemia who is experiencing pain. Which pain management technique is this nurse using?
1)Distraction
2)Guided imagery
3)Sequential muscle relaxation
4)Hypnosis

Question 21

The nurse is caring for an immobile patient with chronic, unrelieved pain that is frequently severe. For which potential complication should the nurse monitor?
1)Urinary retention
2)Hypotension
3)Dehydration
4)Hypoglycemia

Question 22

Which characteristic about pain would the nurse most consider when developing a pain management plan for a patient with chronic lower back pain?
1)An objective experience that disrupts daily living that can be measured with altered vital signs
2)An unpleasant sensory and emotional experience association with actual or potential tissue damage, or described in terms of such damage
3)A generalized response of the body as a result of trauma or damage to the tissues resulting in discomfort
4)An emotional response to tissue damage that differs significantly from one individual to another

Question 23

An older adult receiving hospice care has dementia as a result of metastasis to the brain. The bone cancer has progressed to an advanced stage. Why might the client fail to request pain medication as needed?
1)Experiences less pain than in earlier stages of cancer
2)Cannot communicate the character of the pain effectively
3)Does not feel pain because of the dementia
4)Relies on caregiver to provide pain relief without asking

Question 24

The nurse conducting a pain assessment for a patient would recognize deep somatic pain as having which characteristic?
1)Achy
2)Superficial
3)"Pins and needles"
4)Crampy

Question 25

A nurse using the Richmond Agitation-Sedation Scale documents a patient has a score of +1 before pain medication but after pain medication has a score of -
1)Was restless before the pain medication but after pain medication awakens with eye contact to verbal stimulation.
2) Which patient behaviors did the nurse observe?
2)Was agitated before the pain medication but after pain medication was not responsive to voice or physical stimulation.
3)Was pulling on IV tubing before the pain medication but after pain medication was alert and calm.
4)Was combative before the pain medication but after pain medication was drowsy.

Question 26

The pediatric nurse is caring for a 4-year-old child who is experiencing chronic pain secondary to tissue and joint injury from past sickle cell anemia crises. Which nonpharmacological pain reduction intervention might the nurse have the child try?
1)Perform vigorous activity.
2)Practice visualization.
3)Listen to rap music.
4)Watch a funny movie.

Question 27

Which pain management task can be safely delegated to the unlicensed assistive personnel (UAP)?
1)Assessing the quality and intensity of the patient's pain
2)Evaluating the effectiveness of pain medication
3)Providing a therapeutic back massage
4)Administering oral dose of acetaminophen

Question 28

What is the primary reason the nurse incorporates pain assessment as a part of routine care?
1)Asking about pain may prompt patients to report pain more readily.
2)Frequent pain assessment is required by the state's nurse practice act.
3)Pain is a vital sign much like blood pressure and heart rate.
4)Performing a pain assessment indicates the nurse cares about the patient.

Question 29

A patient develops a respiratory rate of 6 breaths/min after receiving intravenous hydromorphone 2 mg. Which medication should the nurse anticipate administering to this patient after notifying the prescriber of this side effect?
1)Piroxicam
2)Oxycodone
3)Naloxone
4)Meperidine

Question 30

After undergoing dural puncture while receiving epidural pain medication, a patient reports a headache. Which action can help alleviate the patient's pain?
1)Suggest the client ambulate to promote flow of spinal fluid.
2)Offer caffeinated beverages to constrict blood vessels in the head.
3)Encourage coughing and deep breathing to increase intracranial pressure.
4)Restrict oral fluid intake to prevent excess spinal pressure.

Question 31

A 70-year-old male with diabetic peripheral neuropathy reports a burning sensation in his feet. He also states, "Those pain pills make me feel funny, and they don't help my pain, so I don't take them." Which medication is likely to be most beneficial in treating this patient's neuropathic pain?
1)Morphine
2)Fentanyl
3)Gabapentin
4)Hydromorphone

Question 32

Which expected outcome is best for the patient with a nursing diagnosis of Acute Pain related to movement and secondary to surgical resection of a ruptured spleen and possible inadequate analgesia?
1)The patient will verbalize reduction in pain after receiving pain medication and repositioning.
2)The patient will rest quietly when undisturbed.
3)On a scale of 0 to 10, the patient will rate pain as a 3 while in bed or as a 4 during ambulation.
4)The patient will receive pain medication every 2 hours, as prescribed.

Question 33

The nurse is caring for several clients with patient controlled analgesia. It would be most important to assess for respiratory depression in the client with:
1)Diverticulitis
2)Gallbladder disease
3)Sleep apnea
4)Seasonal allergies

Question 34

To provide the most analgesic effect, a medication should bind with and block the pain impulse especially at which opioid receptor sites?
1)Mu
2)Delta
3)Kappa
4)Sigma

Question 35

A patient had a bowel resection 5 days ago. Which patient behavior might alert the nurse that the patient has a history of substance abuse?
1)Requests oral pain medication once every 6 to 8 hours
2)Wants continued use of Patient-controlled analgesic
3)Requests oral pain medication instead of the IV form
4)Wants only nonpharmacological pain measures

Question 36

A patient with Raynaud's disease receives no symptomatic relief with medication. Which surgical intervention might be a treatment option for this patient to help provide pain relief?
1)Cordotomy
2)Rhizotomy
3)Neurectomy
4)Sympathectomy

Question 37

A patient with a history of mitral valve replacement on long-term anticoagulant therapy, hypertension, and type 2 diabetes mellitus undergoes emergency abdominal surgery. Which factor contraindicates the use of epidural analgesia in this patient?
1)Anticoagulant therapy
2)Diabetes mellitus
3)Hypertension
4)Emergency abdominal surgery

Question 38

The postoperative patient who had arthroscopic right shoulder joint surgery is receiving pain medication through a pump directly into the shoulder joint. Which route for pain medication will the nurse report the patient is receiving?
1)Transdermal
2)Intrathecal
3)Intra-articular
4)Epidural

Question 39

What is typically the most reliable indicator of pain?
1)Patient's self-report
2)Past medical history
3)Description by caregivers
4)Behavioral cues

Question 40

The patient has an epidural catheter for analgesia. Which signs and symptoms would alert the nurse to local anesthesia toxicity?
1)Loss of motor function
2)Leaking at the site
3)Urinary retention
4)Ringing in the ears

Question 41

The patient reports pain after surgery, ranking it 6 on a scale of 1 to 10. The patient tells the nurse, "I don't want to be all doped up. My family is coming to visit and I want to be alert enough to visit with them." Which medication would most likely be effective for postoperative pain relief without excessive sedation?
1)Fentanyl IV
2)Morphine IV
3)Ibuprofen PO
4)Hydrocodone PO

Question 42

A 64-year-old female patient just returned from surgery. She is breathing rapidly and moving constantly in bed. She states, "I am scared, and I hurt so much." What would be appropriate interventions? Select all that apply.
1)Immediately notify the surgeon of these data (physical symptoms and patient's statement).
2)State calmly, "I am going to do everything I can to make you more comfortable."
3)Tell the patient, "Let's take some deep breaths together; watch me, and we will breathe together."
4)Have the unlicensed assistive personnel (UAP) stay with the patient, and prepare to administer an analgesic.
5)Ask the patient to describe where she is hurting and the intensity of the pain.

Question 43

The nurse is talking to a patient with chronic pain secondary to permanent joint damage from rheumatoid arthritis about developing a pain management program. Which goal identified by the patient would be realistic for the program?
1)"I would like all my pain to be gone and not recur in the future."
2)"I want to be able to do all the things I used to do before this pain started."
3)"I want to control the pain enough to allow me to perform my daily activities."
4)"I would like to lead a normal life without experiencing so much pain every day."

Question 44

Which action would the nurse prioritize first for the older adult patient who is experiencing neuropathic pain that interferes with activities of daily living (ADLs) and cannot find relief using a variety of methods?
1)Maintain a pain journal to document quality of the pain experience.
2)Meet with the healthcare team to discuss a pain management plan.
3)Attempt to take only analgesic medication when absolutely needed.
4)Suggest use of a deep-pressure back massage with effleurage technique.

Question 45

A 73-year-old patient admitted after a stroke has expressive aphasia (inability to express words accurately). Which pain intensity scale would be most appropriate to use with this patient?
1)Simple descriptor scale
2)Numerical rating scale
3)Wong-Baker FACES rating scale
4)PAINAD scale