Deck 15: Pain Assessment and Basic Comfort Measures

Question 1

A primary advantage of PCA is that it:

A) Allows the family to participate in pain management for the patient
B) Prevents mistakes in medication administration
C) Can be used by all patients
D) Provides a more constant serum level

Answer 1

Provides a more constant serum level

Question 2

A patient who is expressing discomfort and is diaphoretic should obtain the most relief from:

A) Straightening of the bed linens
B) Change of a wet surgical dressing
C) Administration of prescribed medications
D) A check for tubing or other equipment stuck underneath the patient

Answer 2

Administration of prescribed medications

Question 3

The nurse,while checking a patient's record,determines that intraspinal analgesia is contraindicated as a result of:

A) The postoperative state
B) Elevated prothrombin times
C) A history of cardiopulmonary complications
D) A diagnosis of advanced cancer

Answer 3

Elevated prothrombin times

Question 4

The patient is admitted for chronic pain.He states that meperidine (Demerol)used to help,but that he has been needing to use more and more drug and is getting less and less of an effect.This patient's plan of care will have to incorporate steps to deal with which of the following?

A) Addiction
B) Pseudoaddiction
C) Drug tolerance
D) Physical dependence

Question 5

The patient is in the hospital and has gone for major abdominal surgery.When the patient returns from the recovery room,the nurse expects that he most likely will be receiving pain medication:

A) By mouth
B) Intramuscularly
C) Via epidural route
D) Intravenously

Question 6

The nurse is caring for a patient who is a devout Orthodox Jew.The patient is on a patient-controlled analgesia (PCA)pump.The nurse realizes that she may need to:

A) Ask the patient if he will need alternative forms of medication for the Sabbath
B) Ask the patient specific questions because Jews tend to be stoic regarding pain
C) Medicate the patient "around the clock" instead of as needed ("PRN")
D) Understand that Jews believe that suffering is a consequence of actions in a previous life

Question 7

The patient is admitted with chronic pain.She states that nothing takes the pain away totally,but that "Dilaudid does the best." The fact that the patient calls the medication by name should alert the nurse to:

A) Suspect that the patient is drug seeking
B) Expect that the patient may need smaller doses than normal
C) Assess the patient's acceptable level of comfort
D) Accept the fact that nothing will help this patient's pain

Question 8

A nurse is evaluating the epidural catheter insertion site and suspects that the intraspinal catheter has punctured the dura when:

A) Clear drainage is noted
B) Bloody drainage is noted
C) Purulent drainage is noted
D) Redness, warmth, and swelling are noted

Question 9

The patient's family is concerned that the patient may get too much pain medication after surgery and become addicted to the medication if he is placed on a PCA pump.They also voice concern about the effectiveness of the PCA.The nurse should instruct the family and the patient that:

A) Pain relief with the PCA pump is not as good as when the nurse provides it, but it does save on nursing time
B) Pain relief is good when the medication peaks, but less so when the levels drop, and that is when the patient will know that he needs more
C) Because the device provides medication as soon as the patient needs it, he will probably use less of the medication
D) The patient will be kept in bed for several days after surgery to make sure it is safe to ambulate

Question 10

The patient has had knee replacement surgery and has a local infusion pump to provide a local anesthetic to the surgical site.The patient puts on the call light and complains that the pain at the site is more intense than it has ever been and is getting worse.The nurse checks the site and finds that the dressing is damp but intact.The infusion pump is pumping,and there is medication in the bag.The most probable cause of the problem might be:

A) The catheter may be clogged
B) The pump may be releasing too much drug into the site
C) The catheter may be displaced
D) The patient may be exaggerating the pain

Question 11

When the effectiveness of a medication administered via PCA pump is evaluated,it is noted that the patient is sedated and is not aroused easily.The nurse would:

A) Insert an airway
B) Turn patient to the side
C) Stop the PCA
D) Expect this as a patient outcome of the therapy

Question 12

The nurse frequently must assess a patient experiencing pain.When assessing the intensity of the pain,the nurse should:

A) Ask about what precipitates the pain
B) Question the patient about the location of the pain
C) Offer the patient a pain scale to objectify the information
D) Use open-ended questions to find out about the sensation

Question 13

When assessing a local infusion pump site,the nurse would correct which of the following?

A) Label is on the device, indicating that anesthetic is being used.
B) The catheter connections are loose.
C) Surgical dressings are dry and intact.
D) No evidence indicates that blood is backing up the tubing.

Question 14

Before administering an epidural medication,the nurse aspirates and suspects that the catheter has migrated into subarachnoid space when:

A) Clear drainage is noted
B) No drainage is noted
C) Purulent drainage is noted
D) Redness, warmth, and swelling are noted

Question 15

The patient is scheduled for surgery later that afternoon.He is scheduled to have PCA therapy after surgery.The nurse should:

A) Teach the patient about PCA after the patient comes out of recovery
B) Teach the patient about PCA before surgery and before preoperative medication administration
C) Tell the patient not to use PCA unless he can no longer tolerate the pain
D) Inform the patient's family to watch him carefully and to depress the PCA administration button whenever they think he needs it

Question 16

The nurse is preparing to administer a bolus of epidural medication.The nurse must remember to:

A) Clean injection cap with povidone-iodine or anti-infective according to agency policy
B) Clean injection cap of epidural catheter with alcohol
C) Inject opioids quickly and smoothly
D) Flush with saline after the injection

Question 17

An advantage of intraspinal analgesia is the:

A) Smaller doses of epidural medication than intrathecal
B) Lack of significant patient complications
C) Systemic distribution of morphine faster than fentanyl
D) Ability to produce deeper analgesia with smaller dosages

Question 18

A nonpharmacological approach that the nurse may implement for patients who are experiencing pain that focuses on diverting the patient's attention away from the pain sensation by promoting pleasurable and meaningful stimuli is:

A) Massage
B) Heat/cold
C) Guided imagery
D) Distraction

Question 19

A nurse checks the continuous IV infusion for the intraspinal analgesia.The IV setup should be changed if:

A) Tubing with a Y-port is attached
B) An infusion pump is attached
C) The tubing connections are all taped
D) A diluted, preservative-free medication is used

Question 20

The patient is unable to rest even after medication.The nurse decides to give the patient a backrub.Which of the following strokes should the nurse use when finishing the backrub?

A) Long firm stroking movements down the back
B) Light strokes while moving up the back in a circular motion
C) Kneading movements toward the sacrum
D) Circular motion upward from buttocks to shoulders

Question 21

________________ draws on internal experiences of memories,dreams,fantasies,and visions; explores the inner world of experience; protects the privacy of the patient; and fosters the imagination.

Question 22

The patient voices concern to the nurse regarding his PCA pump.He states that he is afraid of getting an overdose if he pushes the button too many times.The nurse reassures the patient,stating that: (Select all that apply.)

A) There is a time delay (lockout) between patient doses
B) The physician limits the total amount of drug that can be received
C) The patient has a right to be concerned and needs to be careful
D) The patient could be put on a continuous infusion instead, because it is safer

Question 23

Massaging upward and outward from the vertebral column and back again is known as __________________.

Question 24

___________ has an identifiable cause and rapid onset and generally disappears with healing.

Question 25

Which of the following is categorized as a neurobiological disease?

A) Physical dependence
B) Addiction
C) Pseudoaddiction
D) Drug tolerance

Question 26

________________ is a method of preventing pain while reducing overall opioid use.

Question 27

The application of touch and movement to muscles,tendons,and ligaments without manipulation of the joints is called _________________.

Question 28

The ______________ is just around the spinal cord and contains CSF.Only physicians and nurse anesthetists administer drugs in this space.

Question 29

_______________________ is a massage technique used on tense muscles to "knead" muscles,promote relaxation,and stimulate local circulation.

Question 30

The _______________ is a potential space between the vertebral bones and the dura mater,the outermost meninges covering the brain and spinal cord.

Question 31

Pain is experienced differently by different people.This is because pain perception is based on which of the following? (Select all that apply.)

A) Past pain experiences
B) Values
C) Cultural expectations
D) Emotions
E) None of above

Question 32

Which of the following is true about evaluating patients in pain?

A) The best judge of the existence of pain is the nurse.
B) Visible signs always accompany pain.
C) Patients often are hesitant to report pain.
D) Nonpharmacological interventions are better than pain medications.

Question 33

The patient has morphine sulfate ordered for pain every 4 hours "PRN." The patient complains of severe pain and usually requests more morphine an hour before it is due.The nurse should: (Select all that apply.)

A) Request a "placebo order" from the physician
B) Offer the patient medication "around the clock" instead of "PRN"
C) Offer the patient massage between medication doses
D) Offer the patient a nonopioid medication between morphine doses if ordered

Question 34

__________________ is an interactive method of pain management that permits patient control over pain through self-administration of analgesics.

Question 35

Drugs administered in the epidural space spread by: (Select all that apply.)

A) Diffusion
B) Transport through blood vessels
C) Absorption by fat
D) Absorption through muscle

Question 36

The patient states that the PCA is not controlling his pain.The nurse checks the infusion setup and the IV site,then evaluates the patient's skill at using the system.All looks in order.The nurse should notify the physician to: (Select all that apply.)

A) Report suspected drug-seeking behavior
B) Possibly change the drug being used
C) Adjust the dosage of the drug being used
D) Request placebo medication to evaluate true pain

Question 37

Which of the following are characteristics of cancer pain? (Select all that apply.)

A) It may be acute.
B) It may be chronic.
C) It usually is related to tumor recurrence or treatment.
D) It often is of less intensity than the patient reports.

Question 38

Pain that extends beyond the period of healing and often lacks an identified pathology is known as _______________.

Question 39

Some patients exhibit drug-seeking behaviors when in fact they are seeking pain relief.This is termed _________________.