Question 1

Aclient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. Which of the following reasons provide the basis for the nurse's response in relation totheeffectiveness of these strategies?

Accepted Answer

Cognitive therapies impact on the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.

Question 2

When doing a pain assessment for a client who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the client's pain?

Accepted Answer

Because pain is a multidimensional experience, asking a question that addresses the client's experience with the pain is likely to elicit more information than the more specific information asked in the other three responses. All of these questions are appropriate, but the response beginning "How would you describe your pain?" is the best initial question.

Question 3

These medications are prescribed by the health care provider for a client who uses long-acting morphine for chronic back pain, but still has ongoing pain. Which of the following medications should the nurse question?

Accepted Answer

Opioid agonist-antagonists can precipitate withdrawal if used in a client who is physically dependent on agonist drugs such as morphine. The other medications are appropriate for the client.

Question 4

The nurse is admitting a client to hospital with a history of chronic cancer pain. When reviewing the client's home medications, which of the following medications should be of most concern?

Accepted Answer

Meperidine is contraindicated for chronic pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods. The ibuprofen, amitriptyline, and oxycodone are all appropriate medications for long-term pain management.

Question 5

Aclient who uses a fentanyl patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0-10 scale) and requests "something for pain that will work quickly." Which of the following types of pain is the most appropriateforthe nurse to document for this client?

Accepted Answer

Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.

Question 6

Apostoperative client asks the nurse how the prescribed ibuprofen will control the incisional pain. The nurse will teach the client that ibuprofen interferes with the pain process by decreasing which of the following physiological responses?

Accepted Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by the NSAIDs.

Question 7

Aclient with second-degree burns has been receiving morphine through patient-controlled analgesia (PCA) for a week. The client wakes up frequently during the night complaining of pain. Which of the following actions should the nurse implement?

Accepted Answer

PCAs are best for controlling acute pain; this client's history indicates chronic pain and a need for a pain management plan that will provide adequate analgesia while the client is sleeping. Administering a dose of morphine when the client already has severe pain will not address the problem. Teaching the client to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a client through PCA.

Question 8

The nurse is caring for a client who has just started taking sustained-release morphine sulphate for chronic pain and is nausea with abdominal fullness. Which of the following interventions is the most appropriate for the nurse to implement?

Accepted Answer

Nausea is frequently experienced with the initiation of opioid therapy, and antiemetics usually are prescribed to treat this expected adverse effect. There is no indication that a different opioid is needed, although if the nausea persists, the health care provider may order a change of opioid. Although tolerance develops and the nausea will subside in about a week, it is not appropriate to allow the client to continue to be nauseated. A clear liquid diet may decrease the nausea, but the best choice would be to administer the antiemetic medication and allow the client to eat.

Question 9

The nurse assesses a postoperative client who is receiving morphine through

Accepted Answer

The client's respiratory rate indicates a need to decrease the PCA dose or change the medication in order to avoid further respiratory depression. The other information also may require intervention, but is not as urgent to report as the respiratory rate.

Question 10

The nurse is preparing a client for discharge who has been receiving morphine 10 mg IV for pain and will continue to take morphine PO at home. Which of the following dosages is an equianalgesic oral dose for this client?

Accepted Answer

The approximate equianalgesic oral dose for morphine 10 mg parentally is 30 mg PO.

Question 11

The nurse is caring for a client with chronic back pain who has arrived at the pain clinic for a follow-up appointment. In order to evaluate whether the pain management is effective, which of the following questions is most appropriate for the nurse to ask?

Accepted Answer

The goal for the treatment of chronic pain usually is to enhance function and quality of life. The other questions also are appropriate to ask, but information about client function is more useful in evaluating effectiveness.

Question 12

The nurse visits a hospice client and assesses a respiratory rate of 8 breaths/minute and the client states "I am having severe pain." Which of the following interventions should the nurse implement at this time?

Accepted Answer

The goal of opioid use in terminally ill clients is effective pain relief regardless of adverse effects such as respiratory depression. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the client's respiratory rate. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly.

Question 13

The nurse is caring for a client with diabetes who has chronic burning leg pain even when taking oxycodone twice daily. Which of the following prescribed medications is the most appropriate choice for the nurse to administer as an adjuvant to decrease theclient's pain?

Accepted Answer

The client's pain symptoms are consistent with neuropathic pain and the tricyclic antidepressants are effective for treating this type of pain. Acetylsalicylic acid and acetaminophen are more effective for nociceptive pain and dextroamphetamine is used in managing opioid-induced sedation.

Question 14

The nurse is caring for a client who is taking an opioid for postoperative pain. Which of the following interventions should the nurse include in the clients plan of care to manage possible adverse effects of opioids?

Accepted Answer

Examples of ways to manage anticipated adverse effects of opioids are to administer stool softeners to prevent constipation and an antiemetic to prevent nausea. The medication should have a scheduling dosage regimen to maintain blood levels rather than only PRN. Changing to a different medication in the same classification may be appropriate rather than changing the drug classification. Another way to manage an adverse effect is to use an administration route that minimizes rather than maximizes drug concentrations at the site of the adverse effect.

Question 15

The nurse is caring for a client who has chronic musculo-skeletal pain and states "I feel depressed because I ache too much to play golf." The client says the pain is usually at a level 7 (0-10 scale). Which of the following client goals has the highestpriority when the nurse is developing the treatment plan?

Accepted Answer

For chronic pain, clients are encouraged to set functional goals such as being able to perform daily activities and hobbies. The client has identified playing golf as the desired activity, so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment. The nurse also should assess for depression, but the client has identified the depression as being due to the inability to play golf, so the goal of being able to play 1 or 2 rounds of golf is the most appropriate.

Question 16

The nurse is caring for a client who is receiving epidural morphine. Which of the following information obtained by the nurse indicates that the client may be experiencing an adverse effect of the medication?

Accepted Answer

Urinary retention is a common adverse effect of epidural opioids. Headache is not an anticipated adverse effect of morphine, although if there is a cerebro-spinal fluid leak, the client may develop a "spinal" headache. Sedation (rather than restlessness or agitation) would be a possible adverse effect. Hypotonic bowel sounds and constipation (rather than abdominal cramping) are concerns.

Question 17

Aclient who is receiving sustained-release morphine sulphate every 12 hours for chronic pain experiences level 9 (0-10 scale) breakthrough pain and anxiety. Which of these prescribed medications should the nurse anticipate administering?

Accepted Answer

The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid such as the immediate-release morphine. The ibuprofen and amitriptyline may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of antianxiety agents for pain control is inappropriate because this client's anxiety is caused by the pain.

Question 18

The nurse is caring when caring for a client with cancer pain that the client describes as at "level 8 (0-10 scale), deep, and aching." Which of the following prescribed medications should the nurse administer first?

Accepted Answer

The client's pain level indicates that a rapidly acting medication such as an IV opioid is needed. The other medications also may be appropriate to use, but will not work as rapidly or as effectively as hydromorphone IV.

Question 19

A client with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of morphine sulphate extended-release is due. Which of the following actions is priority for the nurse to implement?

Accepted Answer

The client's pain requires rapid treatment and the nurse should administer the immediate-release morphine. Increasing the morphine sulphate extended-release dose and use of alternative therapies also may be needed, but the initial action should be to use the prescribed analgesic medications.

Question 20

The nurse is caring for a client diagnosed with tendinitis in the outpatient clinic and advises that the client use a topical ointment to assist with pain relief. The client informs the nurse that they have never used a topical ointment for pain reliefbeforeso the nurse provides education related to the correct use of the ointment. Which of the following information should the nurse include in the teaching plan?

Accepted Answer

Skin testing is advisable when the client has not used the particular medication before because the strengths of the medications vary and different intensities of sensation are produced. On application, these medications usually produce a strong hot or cold sensation and should not be used after massage or a heat treatment when blood vessels are already dilated. An eutectic mixture of local anaesthetics (EMLA) is not appropriate for tendonitis and should not be applied prior to another pain-relieving ointment.

Quiz 10: Pain