Question 1

What does the nurse understand about nociceptive pain?&#10;A) It has a discrete cause&#10;B) Often called nerve pain&#10;C) Usually arises from skin&#10;D) Treated with adjuvant analgesics

Accepted Answer

Nociceptive pain is related to damage to nonneural tissue and activation of nociceptors and has a discrete cause. Neuropathic pain, often called nerve pain, is due to abnormal processing of sensory input by the peripheral or central nervous system. Superficial somatic pain arises from the skin, mucous membranes, and subcutaneous tissue. Neuropathic pain is often treated with adjuvant analgesics.

Question 2

The nursing student asks why clients with chronic pain usually don't have elevated heart rates and blood pressures. What response by the faculty member is best?&#10;A) &#34;Chronic pain does not cause the same anxiety as acute pain.&#34;&#10;B) &#34;Their autonomic nervous system may have adapted over time.&#34;&#10;C) &#34;Often it means they are malingering, or exaggerating their pain.&#34;&#10;D) &#34;It's because they have taken pain medication for so long.&#34;

Accepted Answer

When clients have chronic pain, they may not have some of the expected physical signs of pain such as increased blood pressure or increased heart rate because their autonomic nervous system may have adapted over time. It is not due to decreased anxiety, exaggeration, or from taking pain medication.

Question 3

The nurse understands that which of the following is the best indicator of pain?&#10;A) A validated pain scale&#10;B) The client's report&#10;C) Changes in vital signs&#10;D) Altered behaviors

Accepted Answer

The client's report of pain is the most accurate indicator of pain. Pain is what the client says it is. Results of a pain scale assessment, changes in vital signs, and alteration in usual behavior are clues to pain, however; the nurse understands the best indicator is what the client says.

Question 4

The nurse has assessed a client's pain with a visual analogue scale. The client rates pain at an 8. What action does the nurse take next?&#10;A) Ask if the client would like pain medication&#10;B) Document the finding in the health record&#10;C) Inquire as to the client's acceptable pain level&#10;D) Teach the client to use nonpharmacologic measures

Accepted Answer

The most recent Joint Commission guidelines emphasize that a client's personal goals regarding pain control and function is a critical part of the pain assessment. The nurse would ask the client what his or her pain goal is. This helps guide the nurse's care. If it is time for medication, the nurse would ask if the client wanted it. The nurse will document after the assessment and interventions are done. If the client is willing to use them, nonpharmacologic measures are often helpful in relieving pain.

Question 5

A nurse is planning to assist a client who recently had abdominal surgery with deep breathing exercises to help with pain control. What action by the nurse will best to ensure success?&#10;A) Provide a pillow for the client to splint the incision.&#10;B) Give extra pain medication before beginning the activity.&#10;C) Instruct the client on journaling after the exercises&#10;D) Ask the client what time they prefer for deep breathing

Accepted Answer

Deep breathing may stimulate coughing in a postoperative patient. Having a pillow to splint the abdominal incision will reduce the pain associated with coughing. The nurse would not give extra pain medication beforehand because that would mask the benefit of the deep breathing. Journaling is important, but splinting the incision is more so. Respect for the client includes honoring his or her preferences, including what time is best for this activity, but will not contribute as much to success as not increasing incisional pain.

Question 6

A client is in the Emergency Department reporting severe pressure in the chest. When the nurse asks the client to rate the pain on a scale, the client states "I don't have pain." What is the best action for the nurse to take?

A) Use an observational tool instead.
B) Use the word "pressure" in the assessment.
C) Tell staff you aren't sure there really is pain.
D) Withhold medication until pain is quantified.

Accepted Answer

The nurse would rephrase the assessment and use the word the client has used when describing the discomfort. Since the client can verbalize, there is no reason to use an observational tool. Nurses believe the client when it comes to pain. Withholding needed pain medication is cruel and against the ethical principle of beneficence. The nurse must adapt in order to assess the client's pain fully.

Question 7

The nurse in the clinic is speaking to a client's spouse over the phone. The spouse reports that after the client applied a TENS unit, the client got dizzy, and the client's pulse felt really slow. What response by the nurse is best?

A) "Describe what you mean when you say 'slow'."
B) "Where on the body is the TENS located?"
C) "Does your spouse have a cardiac history?"
D) "You should come into the clinic right away."

Accepted Answer

The nurse would rapidly assess the location of the TENS. If applied on or around the carotid sinuses, bradycardia could result. If this were the case, the nurse could have the spouse remove it immediately to eliminate the problem. After determining if this is the case and getting the TENS removed, the nurse can collect more data such as a better description of "slow" and past medical history. If the client were having symptomatic bradycardia that did not stop, the nurse would advise calling 911 and going to the nearest Emergency Department.

Question 8

A student applied a cold pack to a client earlier in the shift and the faculty member is checking up on the results. What statement or action by the student indicates a need for further instruction?&#10;A) &#34;I inspected the bag for tears and leaks before using it.&#34;&#10;B) &#34;Halfway through the application, I checked skin integrity.&#34;&#10;C) &#34;There was no relief at first, but after 30 minutes the pain was gone.&#34;&#10;D) &#34;I placed the bag inside a pillowcase before applying it.&#34;

Accepted Answer

Heat and cold therapies should be limited to no more than 20 minutes. When the student states it took 30 minutes to obtain relief, the faculty member needed to provide more education. Inspecting the bag for tears and leaks, checking skin integrity, and protecting the client's skin are all appropriate.

Question 9

A client has a PCA pump and the nurse determines the client's Pasero score is 4. What action by the nurse is most appropriate?&#10;A) Document the score in the medical record.&#10;B) Turn the PCA pump off immediately.&#10;C) Reassess the client's pain with a pain scale.&#10;D) Notify the provider and ask for naloxone.

Accepted Answer

The Pasero Opioid-Induced Sedation Scale (POSS) is used to monitor clients on PCA pumps or otherwise getting opioids. The score components include S (Sleep, easy to arouse), 1 (Awake and Alert), 2 (Slightly drowsy, easily aroused), 3 (frequently drowsy, arousable, but drifts off to sleep during conversation), and 4 (Somnolent, minimal, or not responsive to physical stimulation). A score of 3 or 4 is considered unacceptable and requires immediate action. With a score of 4, the nurse turns the PCA pump off immediately. This is done before requesting or giving naloxone, an opioid antagonist. The nurse would document the score and resulting action after the client has been cared for and is stable. The nurse would reassess the client's pain after the client is stable as well.

Question 10

The nurse is caring for 4 clients being treated for pain. Which client does the nurse see first as the priority?&#10;A) Posttrauma, given IV pain medications 45 minutes ago&#10;B) Postpartum, given first dose of oral medication an hour ago&#10;C) Postoperative, sleeping heavily after PCA pump was initiated&#10;D) Postprocedure, reporting back pain from being confined to bed

Accepted Answer

Since sedation usually precedes respiratory depression, the client's level of sedation is the most critical parameter for predicting respiratory depression in clients receiving intravenous opioids. The client "sleeping heavily" could actually be over-sedated, so the nurse's priority is to assess this client. The nurse would next assess the posttrauma client because any IV opioid can cause respiratory depression plus the half-life of IV medications is short, and the client might be in pain again. The nurse next assesses the postpartum client as the oral medication is working by now and any side effects will start to become apparent. The postprocedure client may only need repositioning; the nurse delegates this to unlicensed personnel with instructions that include any positioning restrictions.

Question 11

The nurse has prepared a PCA pump for a client. The nurse has educated the client, completed the independent safety checks, and has ensured the medication cassette is loaded properly. What action does the nurse take next?

A) Turn the pump on at the basal rate.
B) Have a second nurse verify the safety checks.
C) Have the client demonstrate PCA use.
D) Document the procedure in the record.

Accepted Answer

The answer of The nurse has prepared a PCA pump...

Question 12

A known drug-abusing client had a knee replacement. One month later the client is admitted for severe pain in that knee. The nursing staff is slow to provide pain medications because the client is "obviously addicted and just wants more medication." What action by the nurse manager is most appropriate?

A) Remind the staff that there are standards related to pain control.
B) Conduct a "lunch-n-learn" on chemical dependency.
C) Ask the nursing staff to evaluate their beliefs about pain.
D) Inform the staff that even people with addictions can have pain.

Accepted Answer

The answer of A known drug-abusing client had a knee...

Question 13

The nurse is delegating massages to a unlicensed personnel. Which instruction by the nurse is most appropriate?&#10;A) Older client: Do not use effleurage&#10;B) Frail client: Do not use petrissage&#10;C) Radiation client: Use ample lotion&#10;D) Client with DVT: Warm the lotion

Accepted Answer

The answer of The nurse is delegating massages to a...

Question 14

For which client does the nurse delegate providing a sitz bath?&#10;A) Post appendectomy&#10;B) Reports itchy rash&#10;C) Postpartum&#10;D) Chronic back pain

Accepted Answer

The answer of For which client does the nurse delegate...

Question 15

The nurse knows that which type of pain is described as shooting, prickly, tingling, or like an electric shock?&#10;A) Neuropathic&#10;B) Nociceptive&#10;C) Somatic&#10;D) Visceral

Accepted Answer

The answer of The nurse knows that which type of...

Question 16

Which regime is an example of multimodal pain therapy?&#10;A) Ice packs applied for a broken leg&#10;B) IV morphine and guided imagery&#10;C) Ibuprofen every 6 hours around the clock&#10;D) IV opioid with before and after pain assessments

Accepted Answer

The answer of Which regime is an example of multimodal...

Question 17

A client with a late-stage cancer has pain that is well-controlled with a strict regimen. Today the client is reporting "unbearable" pain after a daily walk. What does the nurse understand is happening to this client?

A) The client's cancer has progressed.
B) The client is tolerant to the regime.
C) The client is drug-seeking.
D) The client is having breakthrough pain.

Accepted Answer

The answer of A client with a late-stage cancer has...

Question 18

The nurse is applying a TENS unit on a client. What action by the nurse demonstrates the need for further education on this pain modality?&#10;A) Places electrodes at least 2 inches (5 cm) apart on the client&#10;B) Places an electrode over the surgical incision on the knee&#10;C) Turns the unit on at the lowest strength possible&#10;D) Instructs client to use the highest intensity tolerated

Accepted Answer

The answer of The nurse is applying a TENS unit...

Question 19

What are some consequences of unrelieved pain? (Select all that apply.)&#10;A) Anxiety&#10;B) Fear&#10;C) Depression&#10;D) Suicide&#10;E) Reduced quality of life&#10;F) Relationship impacts

Accepted Answer

The answer of What are some consequences of unrelieved pain?...

Question 20

A nurse is admitting a client transferred from another facility. On assessment, the nurse notices the epidural IV tubing is attached to a bag of dextrose-containing IV fluid and the IV line is connected to an epidural pump containing morphine. What actions by the nurse take priority? (Select all that apply.)

A) Call the Rapid Response Team.
B) Turn both medications off.
C) Complete a variance report.
D) Conduct a full head-to-toe assessment.
E) Assess respiratory status.

Accepted Answer

The answer of A nurse is admitting a client transferred...

Question 21

A student is applying heat and cold therapies to several clients. Which client/therapy combination demonstrates appropriate knowledge of these treatments? (Select all that apply.)&#10;A) Sprained ankle 8 hours ago: Heat therapy&#10;B) Sickle cell anemia: Cold therapy&#10;C) Chronic back pain: Heat therapy&#10;D) Acute elbow bursitis: Cold therapy&#10;E) Poison ivy rash: Heat therapy&#10;F) Fractured leg today: Cold therapy

Accepted Answer

The answer of A student is applying heat and cold...

Question 22

For safety, which of the following actions are priorities when caring for clients on epidural pain control? (Select all that apply.)&#10;A) Ensure naloxone and oxygen are available at the bedside.&#10;B) Cover any injection ports on the tubing with tape.&#10;C) Clearly label tubing close to the entry site and pump.&#10;D) Infuse only solutions with active preservatives.&#10;E) Cover the insertion site with several gauze dressings.&#10;F) Tape the tubing securely to the client without tension.

Accepted Answer

The answer of For safety, which of the following actions...

Question 23

A nurse is caring for several clients reporting pain. Which clients have contraindications for epidural pain relief? (Select all that apply.)&#10;A) Has thrombocytopenia&#10;B) Admitted for meningitis&#10;C) Is 8 hours postpartum&#10;D) Takes warfarin&#10;E) Allergic to morphine

Accepted Answer

The answer of A nurse is caring for several clients...

Question 24

Which of the following are assessed using the Checklist of Nonverbal Pain Indicators (CNPI)? (Select all that apply.)&#10;A) Vocal sounds such as groans&#10;B) Facial grimaces&#10;C) Bracing&#10;D) Restlessness&#10;E) Rubbing or massaging one area&#10;F) Verbal expressions

Accepted Answer

The answer of Which of the following are assessed using...

Question 25

What are objective signs of pain? (Select all that apply.)&#10;A) Grimacing&#10;B) Guarding&#10;C) Restlessness&#10;D) Sleeping&#10;E) Irritability

Accepted Answer

The answer of What are objective signs of pain? (Select...

Deck 7: Comfort Care