Deck 10: Nursing Care of Patients in Pain

Question 1

The nurse is reviewing orders for a patient with diabetic neuropathy. Which medication should the nurse expect to administer?

A)Carbamazepine (Tegretol)
B)Midazolam (Versed)
C)Oxycodone (OxyContin)
D)Celecoxib (Celebrex)

Answer 1

Carbamazepine (Tegretol)

Question 2

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 2

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

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 intervention by the nurse is appropriate?

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

Answer 3

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

Question 4

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 licensed practical nurse (LPN) is best?

A)Tell the patient that the physician has ordered a placebo.
B)Administer the saline and carefully document the patient's response.
C)Tell the patient that a pain shot is being administered, without revealing exactly what it is.
D)Tell the physician about feeling uncomfortable administering saline if the patient thinks it is Demerol.

Question 5

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 method should the nurse use to determine the patient's pain level?

A)Use the FACES scale.
B)Ask, "Are you hurting?"
C)Observe the patient's facial expression.
D)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.

Question 6

The nurse is caring for a group of patients. Which patient is experiencing chronic pain?

A)A patient who underwent heart surgery 2 days ago
B)A patient who fractured a tibia in a motorcycle accident
C)A patient who fell off a ladder 6 months ago and injured his back
D)A patient who sprained her wrist yesterday rollerblading

Question 7

A patient has been on opioids for 3 months to control pain caused by injuries from a motor vehicle crash. The patient asks about the risk of withdrawal symptoms when the drugs are no longer needed. How should the nurse respond to the patient?

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

Question 8

The nurse is caring for a group of patients. Which patient is experiencing acute pain?

A)A patient who has experienced back pain for 2 years
B)A patient with a diagnosis of pancreatitis
C)A patient who experienced a knee injury in high school 12 years ago
D)A patient diagnosed with osteoarthritis last year

Question 9

The nurse is performing a pain assessment on a newly admitted patient. Which question best assesses the severity of pain?

A)"Can you tell me when the pain began?"
B)"Is there anything that makes the pain better or worse?"
C)"Can you point to where the pain is located?"
D)"Can you please rate your pain on a scale of 0 to 10?"

Question 10

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

A)"Depression is often a factor in pain. Treating the depression helps treat the pain."
B)"Maybe you are more depressed than you realize. Would you like to talk about it?"
C)"Antidepressants are sometimes used to treat nerve pain such as you are experiencing."
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 11

The nurse is caring for a patient who is receiving morphine via PCA. Which finding would be of most concern to the nurse?

A)Blood pressure 114/72 mm Hg
B)Pulse 76 beats/min
C)Respirations 10 breaths/min
D)Report of level 3 pain on 0-to-10 scale

Question 12

The nurse is caring for a patient who underwent an amputation of the left arm. The patient reports level 9 pain on a 0-to-10 scale. Which action should the nurse take?

A)Encourage the patient to use only nonpharmacological therapies.
B)Administer normal saline and tell the patient it is morphine.
C)Remind the patient there is nothing there to "hurt."
D)Administer 4 mg of morphine intravenously as prescribed.

Question 13

The nurse is caring for a patient with lung cancer who has been receiving morphine for 2 weeks and reports the medication is no longer effective. Which is the patient likely experiencing?

A)Physical dependence
B)Tolerance
C)Addition
D)Pseudoaddiction

Question 14

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 medication should the nurse anticipate being prescribed?

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

Question 15

The nurse is caring for a patient who was in a motor vehicle accident and has multiple fractures. The patient reports level 9 pain on a 0-to-10 scale. Which route should the nurse use to administer the medication for quickest relief of pain?

A)Oral
B)Rectal
C)Intramuscular (IM)
D)IV

Question 16

The nurse is preparing to provide an opioid medication for a patient's postoperative pain. Which action 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 17

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

A)"Thanks for helping out your dad. Is he too weak to push the button?"
B)"If you need to push the button for your dad, first be sure his respiratory rate is higher than 10."
C)"It is dangerous for anyone but your dad to push the button. Remind him to push it himself if he needs it."
D)"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."

Question 18

A patient reports that she has been having bloody stools for the past month. Which medication can the nurse expect to note on the medication history?

A)Gabapentin (Neurontin)
B)Duloxetine (Cymbalta)
C)Naproxen (Aleve)
D)Fentanyl (Duragesic)

Question 19

The nurse is caring for a patient with metastatic cancer. The patient is receiving 4 mg of morphine intravenously every 6 hours as needed and 5 mg hydrocodone/acetaminophen (Lortab) every 6 hours orally as needed for breakthrough pain. The patient reports the medication is effective, but the medication wears off before the dose is due. The nurse notifies the health care provider. Which order should the nurse anticipate?

A)Changing the morphine to a different opioid
B)Changing medications to an around-the-clock schedule
C)Adding an additional medication
D)Increasing the dose of the current medication

Question 20

A patient who has just returned from abdominal surgery states, "I learned relaxation exercises, so I won't need any drugs." Which statement about relaxation therapy should the nurse use to guide care for this patient?

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

Question 21

The nurse is providing education for a patient being discharged with a fentanyl (Duragesic) patch. Which statements made by the patient indicate an understanding of the teaching? (Select all that apply.)

A)"This medication is good for me because I usually need something that works quickly."
B)"I should place heat over the patch to help it stick better."
C)"Since I smoke, this medication may not be as effective for me."
D)"If I am running a fever, I should avoid this medication."
E)"I should avoid touching the medication when applying the patch."

Question 22

A patient with a gastrostomy tube is prescribed a sustained-released opioid medication. What should the nurse do when preparing to provide this medication to the patient?

A)Provide the medication orally for the patient to swallow.
B)Crush the medication and administer it through the tube.
C)Dissolve the medication in water and administer it through the tube.
D)Ask the physician to prescribe the medication as an elixir for tube administration.

Question 23

The nurse is reviewing orders for a patient and notes an order for extra-strength Tylenol 2 tablets (1,000 mg) every 4 hours around the clock. What action should the nurse take?

A)Seek clarification from the health care provider.
B)Administer the medication as prescribed.
C)Give the patient half of the ordered dose.
D)Administer regular acetaminophen (325 mg) every 4 hours around the clock.

Question 24

The nurse is preparing to administer midazolam (Versed) 1 mg intravenously. The available dose is midazolam (Versed) 1 mg/1 mL. How many mL will the nurse administer? Enter the numeral only

Question 25

The nurse is caring for a group of patients. Which patient should the nurse see first?

A)A patient who underwent an appendectomy 2 hours ago reporting level 8 pain on a 0-to-10 scale
B)A patient who underwent a knee replacement 3 days ago reporting level 2 pain on a 0-to-10 scale
C)A patient with chronic back pain reporting level 8 pain on a 0-to-10 scale
D)A patient with a sprained ankle reporting level 5 pain on a 0-to-10 scale

Question 26

A patient taking hydromorphone for cancer pain is experiencing constipation. What should the nurse teach to help this patient?

A)Take a mild laxative.
B)How to self-administer a Fleet enema.
C)Slowly decrease the dose of hydromorphone.
D)Eat a high-fiber diet and increase fluid intake.

Question 27

The nurse is preparing to administer morphine 5 mg intravenously to a patient with cancer. Available is morphine 10 mg/mL. How many mL will the nurse administer? Enter the numeral only.

Question 28

The nurse is teaching a patient about nonpharmacological therapies. Which topics should the nurse include in the teaching? (Select all that apply.)

A)Use of guided imagery
B)Taking medication around the clock
C)Watching television for distraction
D)Biofeedback technique
E)Application of heat 6.Application of a Duragesic patch

Question 29

The nurse is preparing to administer Roxanol 5 mg orally to a patient. The available dose is 20 mg/mL. How many mL will the nurse administer? Enter the numeral only.

Question 30

The nurse is reviewing medications prescribed for a patient experiencing pain. Which medications should the nurse realize are being used as adjuvant agents for this patient's pain? (Select all that apply.)

A)Steroids
B)Antibiotics
C)Cylclooxygenase-2 (COX-2) inhibitors
D)Anticonvulsants
E)Benzodiazepines
F)Tricyclic antidepressants