Deck 10: Nursing Care of Patients in Pain

Question 1

A patient with chronic back pain has a new order for a fentanyl (Duragesic) patch. As the nurse applies the patch, the patient states, "I'm really glad to get that patch on. I am really hurting bad." Which response by the nurse is correct?

A)"You should feel some relief of your pain within about half an hour."
B)"The patch may take a while to work. Would you like a pain shot in the meantime?"
C)"Other analgesics can't be given while the patch is on, so try to bear it until it takes effect."
D)"Because it is absorbed right through the skin, you will feel relief within minutes after I apply this patch."

Answer 1

"The patch may take a while to work. Would you like a pain shot in the meantime?"

Question 2

The nurse enters the room of a patient who is moaning loudly and thrashing around in bed. What action should the nurse take first?

A)Ask the patient to quiet down.
B)Ask the patient what is wrong.
C)Go and get a dose of the patient's prn pain medication.
D)Administer a sedative, and then assess the patient's pain after it has taken effect.

Answer 2

Ask the patient what is wrong.

Question 3

A patient with chronic pain is on a sustained-release opioid that is ordered every 12 hours. After 6 hours, the patient complains of increasing pain. Which of the following interventions by the nurse is appropriate?

A)Explain to the patient that the medication being administered lasts for 12 hours.
B)Assess the patient's vital signs, and administer the next dose of opioid early.
C)Teach the patient a relaxation technique to use until the next dose is due.
D)Obtain an order for an immediate-release opioid for breakthrough pain.

Answer 3

Obtain an order for an immediate-release opioid for breakthrough pain.

Question 4

The nurse answers a patient's call for a pain shot, only to find the patient laughing and joking with visitors. Which of the following responses by the nurse is appropriate?

A)"I'll bring your shot back later, after your visitors are gone."
B)"I can see your pain is better. Call again when you need your shot."
C)"You don't need this pain shot after all, do you?"
D)"Would you like your visitors to step out while I give you your pain shot?"

Question 5

A patient has abdominal pain after gallbladder surgery. Which type of pain is the patient experiencing?

A)Neuropathic
B)Nociceptive
C)Chronic
D)Nonphysiological

Question 6

A patient tells the nurse, "My belly feels as if a watermelon is stuck in it" when describing his pain. What is the best way to document this?

A)Patient's abdomen is distended.
B)Patient feels bloated.
C)Patient has acute pain related to distended abdomen.
D)Patient states his "belly feels as if a watermelon is stuck in it."

Question 7

A patient has been on opioids for 3 months after receiving multiple injuries in a car accident. The patient now asks about the risk of withdrawal symptoms when the drugs are no longer needed. What is the nurse's most appropriate response?

A)"You were using the drugs for legitimate pain, so you will not have to go through withdrawal when you stop them."
B)"Ask your doctor for a sedative to get you through the worst of the withdrawal symptoms."
C)"As long as you taper the drug dose down slowly, you should not experience withdrawal symptoms."
D)"You would have to be on these drugs much longer than 3 months to have problems with withdrawal."

Question 8

The nurse is having difficulty assessing the pain of a mentally impaired patient who has an approximate functional level of a 4-year-old child. Which of the following methods would best help the nurse determine the patient's pain level?

A)Ask, "Are you hurting?"
B)Explain to the patient how to use a 0 to 10 pain scale, with 0 being no pain, and 10 being the worst possible pain.
C)Use the Wong-Baker Faces scale.
D)Observe the patient's facial expression.

Question 9

The nurse is preparing to provide an opioid medication for surgical pain. Which of the following actions should the nurse take first?

A)Determine the respiratory rate.
B)Observe the patient's skin color.
C)Take the patient's oral temperature.
D)Ask the patient when he last ate something.

Question 10

A 91-year-old nursing home resident has been receiving meperidine (Demerol) injections for right shoulder pain. During the morning assessment, the nurse finds the resident irritable and jumpy. Which of the following nursing actions and rationales is appropriate?

A)Administer a dose of Demerol because these are symptoms of pain in an elderly patient.
B)Administer a dose of Demerol because the patient is exhibiting signs of withdrawal.
C)Notify the RN or physician that the resident may be experiencing toxic effects of Demerol.
D)Assess the patient's pain level before determining the appropriate dose of Demerol to administer.

Question 11

A patient with terminal cancer describes a pain rating of 7 on a 0 to 10 scale. The nurse notes that the patient's vital signs are unchanged and recalls that vital signs may be elevated with pain. What is the best explanation for this?

A)The patient is not really in pain.
B)The patient has adapted to chronic pain.
C)The patient's vital signs are not responding because of the cancer.
D)Acute pain is not associated with elevated vital signs.

Question 12

A nurse provides an opioid antidote to a patient experiencing opioid toxicity. Which of the following is expected?

A)Tachypnea
B)Confusion
C)Pain
D)Sedation

Question 13

A patient who has just returned from abdominal surgery states, "I learned relaxation exercises, so I won't need any drugs." Which of the following statements about relaxation therapy is true?

A)Effective use of relaxation therapy can eliminate the need for analgesics postoperatively.
B)Relaxation therapy is an excellent adjunct treatment for pain when used with analgesics.
C)Relaxation therapy is not useful for postoperative patients or for severe pain.
D)Relaxation therapy works much the same as a placebo.

Question 14

A licensed vocational nurse (LVN) is working with a technician who says, "I wouldn't give that high dose of morphine if I were you. I once saw someone quit breathing with a dose that high." The LVN knows that the patient has been receiving the same dose for several days without any respiratory compromise. Which of the following responses by the LVN is best?

A)"As long as the dose is increased gradually, patients develop tolerance to the side effects of morphine."
B)"You are correct; several days of this high a dose could be cumulative and cause problems."
C)"As long as I monitor the patient closely after giving the dose, breathing will not be affected."
D)"I am a licensed professional and am able to decide what a safe dose is for my patient."

Question 15

The nurse enters a room just as a patient's daughter pushes the button of his intravenous patient-controlled analgesia (PCA) pump. Which response by the nurse is appropriate?

A)"It is dangerous for anyone but your dad to push the button. Remind him to push it himself if he needs it."
B)"Thanks for helping out your dad. Is he too weak to push the button?"
C)"It is against hospital policy for anyone but the patient to push the button. If I see you pushing it again, I will have to call the supervisor."
D)"If you need to push the button for your dad, first be sure his respiratory rate is higher than 10."

Question 16

A patient with peripheral neuropathy states, "I don't know why the doctor put me on an antidepressant. I am not depressed!" Which of the following responses by the nurse is best?

A)"Maybe you are more depressed than you realize. Would you like to talk about it?"
B)"Antidepressants are sometimes used to treat nerve pain such as you are experiencing."
C)"Depression is often a factor in pain. Treating the depression helps treat the pain."
D)"Why don't you try it for a while, and if you don't feel better, you can ask your doctor if you can stop it?"

Question 17

A physician writes an order to give a saline injection to a patient who has been requesting frequent meperidine (Demerol) shots. Which initial response by the LPN is best?

A)Administer the saline and carefully document the patient's response.
B)Tell the patient that the physician has ordered a placebo.
C)Tell the patient that a pain shot is being administered, without revealing exactly what it is.
D)Tell the physician that he or she is not comfortable administering saline if the patient thinks it is Demerol.

Question 18

Which of the following definitions of pain should guide the nurse's practice?

A)Pain is an unpleasant sensation caused by physical injury.
B)Pain is discomfort manifested by elevated vital signs and grimacing.
C)Pain is whatever the experiencing person says it is.
D)Pain is a sensation that causes the patient to avoid its source.

Question 19

What is the best way for the nurse to know whether pain medication has been effective?

A)The patient stops groaning.
B)The patient's vital signs return to normal.
C)The patient goes to sleep.
D)The patient states the pain is relieved.

Question 20

A patient receiving large doses of opioids is lethargic and difficult to arouse, with a respiratory rate of 6 per minute and constricted pupils. Which of the following medications should the nurse anticipate being prescribed?

A)Diazepam (Valium)
B)Furosemide (Lasix)
C)Flumazenil (Romazicon)
D)Naloxone (Narcan)

Question 21

A patient who had an appendectomy for a ruptured appendix yesterday has an order for morphine 4 mg q 6 hours prn. Every 5 hours and 55 minutes, the patient puts on the call light and asks for the morphine. A staff member comments that the patient is drug-seeking. Which action by the nurse is most appropriate first?

A)Explain to the patient that weaning off the morphine as soon as possible is essential to reduce the risk of addiction.
B)Administer the morphine every 4 hours instead of every 6 hours.
C)Consult with the RN or physician about ordering a higher or more frequent dose of morphine.
D)Explain to the staff member that labeling the patient as drug seeking is inappropriate.

Question 22

The nurse is caring for a patient with terminal cancer pain. His family is very supportive; there are always at least six or seven family members in the room. They constantly call the nurse in to report that the patient is in pain or needs to be moved or needs a drink. The nurse is having difficulty caring for other patients because this family is so demanding. What is the best way to deal with this situation?

A)Ask the family to leave.
B)Show the family the hospital policy stating that only two visitors are allowed in the room at a time.
C)Negotiate with the family that if they avoid using the call light, the nurse will check on the patient every 30 minutes.
D)Teach the family how to help provide for the patient's basic needs.

Question 23

A patient comes into the emergency department after vomiting blood. The nurse would be most concerned if the patient reported taking which of the following medications?

A)Acetaminophen (Tylenol)
B)Aspirin
C)Codeine
D)Meperidine (Demerol)

Question 24

A patient receiving morphine sulfate 5 mg IV every 4 hours around the clock and acetaminophen PO every 4 hours reports intense itching. Assuming all are ordered, which prn medication should the nurse administer?

A)Nalbuphine (Nubain)
B)Fentanyl (Duragesic)
C)Methadone (Dolophine)
D)Ibuprofen (Motrin)

Question 25

Which of the following drugs are adjuvant agents used in the management of pain? (Select all that apply.?

A)Steroids
B)Antibiotics
C)Tricyclic antidepressants
D)Benzodiazepines
E)Cox 2 inhibitors
F)Anticonvulsants

Question 26

What type of pain is most often associated with a change in vital signs?

A)Chronic nonmalignant pain
B)Acute pain from trauma
C)Cancer pain
D)Neuropathic pain

Question 27

A nursing home resident complains of joint pain. Orders are on the chart for all of the following medications. Which should the nurse choose first to relieve the patient's pain?

A)Ibuprofen (Motrin)
B)Acetaminophen (Tylenol)
C)Acetaminophen/codeine (Tylenol no. 3)
D)Acetaminophen/oxycodone (Vicodin)

Question 28

A patient has been requesting hydrocodone/acetaminophen (Vicodin) for pain every 4 hours for several days. Now the patient calls the nurse after only 3 hours and says, "I need more Vicodin. The pain is worse." On which initial assumption should the nurse base a decision about what to do next?

A)The patient is becoming addicted to Vicodin.
B)The patient is exhibiting drug-seeking behavior.
C)The patient is physically dependent on Vicodin.
D)The patient is in pain.

Question 29

In what category of pain is phantom limb pain?

A)Acute pain
B)Cancer pain
C)Chronic nonmalignant pain
D)Intermittent pain

Question 30

A patient admitted with liver disease complains of pain in his right shoulder. Which of the following explanations for this is most likely to be true?

A)The patient hurt his shoulder.
B)The patient is experiencing referred pain.
C)The patient is pretending to have more pain to obtain more analgesics.
D)The patient is tense because of concern about the possible diagnosis.

Question 31

The nurse is providing care for a patient being discharged on opioid therapy. Which of the following statements should be included in the discharge teaching? (Select all that apply.?

A)"It is important to drink 8 to 10 glasses of fluid each day."
B)"Fiber or bulk laxatives may be needed to prevent constipation."
C)"You should wait as long as possible to take your pain medication to prevent addiction."
D)"Avoid driving or operating machinery for a few days."
E)"You may feel sleepy when you take this medication."
F)"If you experience nausea, stop taking the medication."
Completion
Complete each statement.

Question 32

The nurse is admitting a new patient to a medical unit with pancreatitis. Which of the following would be included in the pain history? (Select all that apply.?

A)Is the patient having difficulty sleeping, eating, or working?
B)How has the pain affected the patient's ability to perform activities of daily living?
C)Are there any aggravating or alleviating factors that alter the pain?
D)Is the patient experiencing any nausea, vomiting, or anorexia associated with the pain?
E)How does the patient describe the pain in his or her own words?
F)How much alcohol does the patient drink each day?

Question 33

What class of medications is most likely to be effective for the treatment of pain with a neuropathic component?

A)Tricyclic antidepressants
B)Opioids
C)Nonsteroidal anti-inflammatory drugs
D)Beta blockers

Question 34

Which of the following statements is a myth about the management of pain?

A)A patient who is laughing and talking is not in pain.
B)A patient can sleep and still experience severe pain.
C)Respiratory depression can occur in patients receiving opioids.
D)Oral pain medication can be as effective as injected medication.

Question 35

Which of the following are characteristics of nonopioid drugs? (Select all that apply.?

A)They work in the central nervous system.
B)They have a ceiling effect.
C)They work peripherally.
D)They produce tolerance.
E)They are used for acute and chronic pain.
F)They can be safely increased to treat increasing pain.

Question 36

What is the best analgesic schedule for a patient with chronic pain?

A)Around the clock
B)prn
C)qid
D)Only when pain is severe, to prevent tolerance

Question 37

A patient is given a prescription for oxycodone/acetaminophen (Vicodin), two tablets to be taken every 4 to 6 hours as needed for pain. Which of the following statements should be included in the teaching?

A)"It is important to not to take this more often than prescribed because acetaminophen can cause dangerous side effects if taken more frequently."
B)"You shouldn't take this more than every 4 hours because oxycodone will cause respiratory depression."
C)"Oxycodone and acetaminophen interact to form a dangerous metabolite if they are taken less than 4 hours apart."
D)"Be careful not to take this more than every 4 hours because Vicodin always relieves pain for at least 4 hours."

Question 38

Which of the following best describes "physical dependence"?

A)The patient is addicted to pain medication.
B)It takes more medication than previously to relieve the patient's pain.
C)Stopping the drug causes symptoms of withdrawal.
D)The patient requests pain medication more often than it is ordered.

Question 39

Which of the following is equivalent to a 10-mg dose of subcutaneous morphine? (Select all that apply.?

A)30 mg oral morphine
B)10 mg IV morphine
C)5 mg IV morphine
D)25 mg IM morphine
E)10 mg oral morphine
F)15 mg IM morphine

Question 40

What is the priority instruction for a patient experiencing constipation while taking hydromorphone for cancer pain?

A)Instruct the patient to take a mild laxative.
B)Teach the patient to eat a high-fiber diet and increase fluid intake.
C)Encourage the patient to slowly decrease the dose of hydromorphone.
D)Teach the patient how to self-administer a Fleet enema.Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 41

A nurse is preparing an order for grain of morphine IM. It is supplied as 10 mg per mL. How many mL should the nurse administer? Round to the nearest 10th mL. ________________mL

Question 42

How many grams of acetaminophen can be safely administered per day (24 hours)? ________________grams