Deck 36: Pain Management

Question 1

The nurse is caring for a patient with rheumatoid arthritis who is in constant severe pain.Which nursing diagnosis is the highest priority for this patient?

A) Impaired walking r/t patient's need to use a cane or walker with ambulation
B) Readiness for enhanced comfort r/t sedentary lifestyle and poor physical condition
C) Effective therapeutic regimen management r/t mistrust of health care personnel
D) Chronic pain r/t ongoing inflammatory tissue damage and joint destruction

Answer 1

Chronic pain r/t ongoing inflammatory tissue damage and joint destruction

Question 2

The nurse is caring for a cancer patient with ongoing pain from widespread metastasis to her bones.The nurse notes that the patient's morphine dosage had to be increased to sufficiently manage her discomfort.What is the nurse's interpretation of this assessment finding?

A) The patient became tolerant to the previous morphine dosage.
B) The patient is becoming addicted to her pain medication.
C) The patient has been abusing her prescribed pain medications.
D) The patient is seeking to end her life with an overdose of morphine.

Answer 2

The patient became tolerant to the previous morphine dosage.

Question 3

The nurse is caring for a 6-month-old infant who has just undergone surgery.The infant's facial muscles are tight with a furrowed brow and the infant's respirations are shallow and irregular.The infant is mildly fussy and softly crying without muscular rigidity in the arms and legs.What score will the nurse give to the infant on the Neonatal Infant Pain Scale?

A) 2
B) 3
C) 4
D) 5

Answer 3

4

Question 4

What is the priority nursing assessment for a patient who his receiving postoperative epidural analgesia with hydromorphone (Dilaudid)?

A) Respiratory rate,depth,and pattern
B) Skin underneath the epidural dressing
C) Bladder scanning to check for urinary retention
D) Itching on the trunk and/or extremities

Question 5

Which assessment question helps the nurse determine the character of the patient's pain?

A) "What does the pain feel like,i.e.stabbing,burning or throbbing?"
B) "When did the pain first start?"
C) "What interventions make the pain better?"
D) "Is there any pattern to when the pain occurs?"

Question 6

The nurse is caring for a patient who just underwent laparoscopic appendectomy.The patient tells the nurse that she is experiencing severe postoperative pain between her shoulder blades.Which term best describes the pain that this patient is having?

A) Referred pain
B) Phantom pain
C) Neuropathic pain
D) Psychogenic pain

Question 7

The nurse is caring for a trauma patient with the nursing diagnosis of Acute pain r/t fracture and muscle spasms.Which is an appropriate goal for this nursing diagnosis?

A) The patient will experience less pain when participating in physical therapy.
B) The patient will describe meditation techniques that can be used to cope with pain.
C) Nursing staff will explain the ordered pain management approach to the patient.
D) The patient will feel less pain each day when range-of-motion therapy is performed.

Question 8

The nurse is caring for a patient who will be using a hydromorphone (Dilaudid)PCA analgesia pump following surgery.Which intervention is the highest priority for the nurse to include in the patient's care plan for the diagnosis: Readiness for enhanced knowledge r/t appropriate management of PCA pump?

A) Assess the patient's respiratory status every 30 minutes after PCA pump started.
B) Review patient's medication profile to check for interactions with hydromorphone.
C) Teach the patient how to use PCA pump when awake and aware and pain level is tolerable.
D) Keep naloxone (Narcan)available at the bedside in case of respiratory suppression.

Question 9

The nurse is caring for a patient who is recovering from knee replacement surgery.The patient complains of severe pain in the knee after receiving hydrocodone with acetaminophen (Vicodin)2 hours previously.What is the nurse's best action?

A) Administer another dose of Vicodin.
B) Apply ice packs to the knee.
C) Apply heat packs to the knee.
D) Perform gentle range of motion.

Question 10

Which is the best pain medication option for a patient to manage severe long-term cancer pain at home?

A) Duragesic 50 mcg transdermal patch q 72 hours
B) Meperidine (Demerol)50 mg IM q 6 hours
C) Hydromorphone (Dilaudid)0.2 mg q 10 minutes IV via PCA pump
D) Hydromorphone (Dilaudid)0.08 mg/hour infusion through epidural catheter

Question 11

The nurse is caring for a patient who only speaks a foreign language.What is the best method for the nurse to assess the patient's pain level?

A) Perform a pain assessment using a translator.
B) Check the patient's vital signs and pulse oximetry.
C) Check the patient's respiratory rate,depth,and rhythm.
D) Look to see if the patient appears to be resting comfortably.

Question 12

The nurse administered 100 mcg sublingual fentanyl spray (Subsys)at 10:00 A.M.to a patient experiencing severe breakthrough pain.At what time will the nurse ask the patient if pain relief was obtained?

A) 10:30 A.M.
B) 11:00 A.M.
C) 11:30 A.M.
D) 12:00 noon

Question 13

The nurse is caring for a patient who is recovering from thoracotomy surgery.The patient's respirations are regular but very shallow.Which intervention is the highest priority for the nurse to include in the patient's care plan for the diagnosis: Ineffective breathing pattern r/t fatigue and pain?

A) Encourage the patient to use incentive spirometer after administration of pain medication.
B) Ask the patient to describe prior pain experiences and effectiveness of methods used to manage pain.
C) Help the patient to understand that comfort is a priority goal of nursing care in the postoperative period.
D) Assist the patient to minimize the effects of pain on interpersonal relationships with family members.

Question 14

The nurse is caring for a diabetic patient who has painful neuropathy in her feet.The patient asks why the nurse is administering gabapentin (Neurontin)when she does not have a history of seizure disorder.What is the nurse's best response?

A) "Neurontin will help you sleep at night so you can deal with the pain more effectively."
B) "Long-term diabetes can put patients at risk for certain type of seizures."
C) "Neurontin can help relieve your anxiety from being admitted to the hospital."
D) "Neurontin works on the nervous system to help relieve the burning pain in your feet."

Question 15

The nurse is caring for a patient who has severe abdominal pain caused by acute cholecystitis.What type of pain is this patient experiencing?

A) Visceral pain
B) Somatic pain
C) Radiating pain
D) Referred pain

Question 16

The nurse is caring for a patient who has a PCA pump following total hysterectomy surgery.The nurse sees the visitor push the PCA button while the patient is sleeping quietly.What is the best response of the nurse?

A) "Thank you for pushing the button for her to help keep her comfortable after surgery."
B) "Please do not push the button for the patient-she could receive more medication than she needs."
C) "You can push the button for her now,but please have her do it herself when she awakens."
D) "PCA pumps are great because she doesn't have to wait for me to administer her pain medication."

Question 17

The nurse is caring for a patient who has been taking ibuprofen (Advil,Motrin)800 mg TID for the last several months to relieve arthritis pain in her knees.Which assessment finding must be reported to the physician promptly?

A) The patient has abdominal pain and pale skin.
B) The patient has constipation and takes stool softeners daily.
C) The patient enjoys a glass of wine every Friday and Saturday evening.
D) The patient has gained 15 lb in the last 3 months.

Question 18

Which patient is best suited for PCA analgesia?

A) A patient who is confused after a head injury
B) A patient recovering from total hysterectomy surgery
C) A patient who has severe psychogenic pain
D) A patient with arthritis who is unable to push the nurse call button

Question 19

The nurse is checking on the patient after administering pain medication 30 minutes previously.Which assessment finding best indicates to the nurse that the pain medication was effective?

A) The patient is sleeping quietly.
B) The patient states that she has no pain.
C) The patient's respirations are slow and regular.
D) The patient's blood pressure has returned to baseline.

Question 20

The nurse is caring for a patient with severe chronic pain.The nurse applied the first 50 mcg transdermal fentanyl (Duragesic)patch 2 hours ago.The patient states that the pain is presently rated at 9 on a 1-10 scale.What is the nurse's best action?

A) Instruct the patient that the Duragesic patch will start to work soon.
B) Administer a short-acting narcotic medication like morphine liquid (Roxanol).
C) Give the patient a gentle back rub and encourage guided imagery.
D) Apply a second 25-mcg transdermal fentanyl (Duragesic)patch now.

Question 21

The nurse is caring for a patient who has severe burning pain in his right arm caused by a compressed nerve in his neck.Which medications can be used along with a narcotic pain reliever to relieve the patient's pain until surgery can be performed to release the nerve? (Select all that apply. )

A) Diphenhydramine (Benadryl)50 mg PO daily
B) Amitriptyline (Elavil)50 mg PO BID
C) Ondansetron (Zofran)8 mg PO q 4 hours PRN
D) Gabapentin (Neurontin)400 mg PO BID
E) Senna (Senokot)8.6 mg PO daily

Question 22

The nurse is caring for a patient who just had knee replacement surgery.Which factors will affect how the patient experiences pain after this surgery? (Select all that apply. )

A) The patient has had rheumatoid arthritis for the last 16 years.
B) The patient is allergic to aspirin and strawberries.
C) The patient owns a business and is self-insured.
D) The patient has been a vegetarian for the last 8 years.
E) The patient had her other knee replaced 2 years ago.
F) The patient was a marathon runner in high school and college.

Question 23

The nurse is caring for a patient who has pain following abdominal surgery.Which of the following are independent nursing interventions that can be used to make the patient more comfortable? (Select all that apply. )

A) Encourage the patient to relax and imagine that he is resting on a tropical beach.
B) Provide headphones so that the patient can listen to his favorite music.
C) Increase pain medication dosage if prescribed regimen is ineffective to manage pain.
D) Teach the patient to take pain medication before discomfort becomes severe.
E) Switch the patient from IV to oral pain medication when bowel sounds return.
F) Demonstrate the use of relaxation breathing before painful procedures.