Question 1

Morphine 10 mg IV every four to six hours as needed is ordered for a patient with a pancreatic tumour who has a history of alcoholism.After three days of receiving the morphine every six hours,the patient tells the nurse that the medication is needed more frequently to control the pain.In responding to the patient's request,what does the nurse recognize?

A) A tolerance to the morphine is developing,and the patient should receive the drug more frequently.
B) Administering the morphine more frequently will increase the patient's physical dependence on the drug.
C) Physical dependence should be avoided at all costs,and the drug should continue to be administered every six hours.
D) The patient is becoming addicted to the morphine,and it should be administered less frequently than every six hours.

Accepted Answer

The patient's request for more frequent dosing may indicate the development of tolerance to morphine, which is a common occurrence with long-term opioid use. Administering the drug more frequently may be necessary to maintain adequate pain control. However, the nurse should carefully monitor and assess for signs of physical dependence or addiction. It is important to balance pain management with the potential risks of opioid use, and to follow a careful dosing schedule to prevent adverse effects.

Question 2

A patient with extensive second-degree burns on his legs and trunk is using patient-controlled analgesia (PCA)with IV morphine to be delivered at 1 mg every 10 minutes to control his pain.Several times during the night,he awakens in severe pain,and it takes more than an hour to regain pain relief.What is the most appropriate nursing action at this time?

A) Administer a dose of morphine every hour from the PCA machine while the patient sleeps.
B) Request that the physician order a bolus dose of morphine to be given when the patient awakens with pain.
C) Consult with the patient's physician about adding a continuous morphine infusion to the PCA regimen at night.
D) Teach the patient to push the button every 10 minutes for an hour before he goes to sleep,even if he has minimal pain at that time.

Accepted Answer

The patient's pain is not being effectively managed with the current PCA regimen. Adding a continuous infusion to the PCA regimen may provide better pain control throughout the night, especially during the times when the patient wakes up in severe pain. Option A is not appropriate because the patient should be in charge of administering his own medication according to his pain level, not on a scheduled basis. Option B may be a temporary solution, but it does not address the underlying problem of inadequate pain control. Option D is not appropriate because the patient should not be advised to use the PCA machine unnecessarily, which could lead to respiratory depression and other adverse effects.

Question 3

The physician tells a patient to use ibuprofen (Motrin,Advil)to relieve the pain after treating a laceration on the patient's forearm from a dog bite.The patient tells the nurse that he does not think ibuprofen will control his pain.The nurse's response is based on the knowledge that ibuprofen interferes with the pain by decreasing what process?

A) Perception
B) Modulation
C) Transduction
D) Transmission

Transduction

Accepted Answer

Ibuprofen works by decreasing the production of prostaglandins, which are involved in the process of transduction in the pain pathway. Prostaglandins are chemicals that promote inflammation, pain, and fever. By inhibiting the enzyme (COX) that produces prostaglandins, ibuprofen reduces inflammation and pain at the site of tissue damage.

Question 4

A postoperative patient who has undergone extensive bowel surgery moves as little as possible and does not use his incentive spirometer unless specifically reminded.He rates his pain severity as an 8 on a 10-point scale but tells the nurse that he can "tough it out." To encourage the patient to use pain medication,what should the nurse explain about the effects of withholding or delaying analgesics?

A) Very few patients become addicted to opioids when using them for pain control.
B) He should not worry about side effects because these problems usually decrease over time.
C) Multiple options of medications are available,and if one drug does not relieve his pain,other drugs may be tried.
D) Unrelieved pain can be harmful because it impairs respiratory and gastrointestinal function and can impair his recovery from surgery.

Accepted Answer

The nurse should explain to the patient that unrelieved pain can be harmful as it impairs respiratory and gastrointestinal function and can impair his recovery from surgery. This will encourage the patient to use pain medication and thereby improve his recovery. Option A is not relevant to the question at hand. Option B is not accurate, as side effects can vary from patient to patient and may not always decrease over time. Option C is true, but not directly related to the importance of using pain medication.

Question 5

When caring for a patient who is receiving epidural fentanyl,the nurse should monitor the patient for which common side effect?&#10;A) Headache&#10;B) Agitation&#10;C) Urinary retention&#10;D) Abdominal cramping and diarrhea

Accepted Answer

Urinary retention is a common side effect of epidural fentanyl due to its effects on the central nervous system, and it is important for the nurse to monitor the patient for this potential complication. Headache, agitation, and abdominal cramping and diarrhea are less common side effects of epidural fentanyl.

Question 6

It is determined that a step 3 drug as proposed by the World Health Organization (WHO)is necessary for a patient whose cancer pain is unrelieved by step 2 drugs.Which is an appropriate drug and route for this patient?

A) Oral codeine
B) Oral morphine
C) Intramuscular meperidine (Demerol)
D) Intravenous oxymorphone (Numorphan)

Accepted Answer

Oral morphine is the appropriate drug for step 3 pain management according to WHO guidelines. Intramuscular meperidine and intravenous oxymorphone are less commonly used and associated with greater risk of side effects. Oral codeine is a step 2 drug and thus not appropriate for this patient.

Question 7

A patient with a kidney stone in her right ureter has pain in her right flank area and also complains of pain in her right inner thigh.She asks the nurse whether something is wrong with her leg.In responding to the question,on what knowledge does the nurse base the patient's understanding of pain?

A) Referred pain results when dorsal horn neurons receive input from both C fibres and A-beta fibres.
B) Stimulation of the cerebral cortex by small C fibres causes muscle spasm,leading to pain perception in large muscle groups.
C) Radiating type of pain results from activation of normally inactive receptors by repetitive nociceptive signals to the dorsal horn.
D) Poor localization of pain occurs when PANs release neurotransmitters that inhibit nerve cells in the dorsal column.

Accepted Answer

Referred pain occurs when pain originating in one part of the body is perceived in an area distant from its point of origin. This is due to the convergence of nerve fibers from different areas onto the same neurons in the spinal cord, leading to confusion in the brain about the source of the pain signal. In this case, the pain from the kidney stone in the ureter is perceived in the inner thigh due to shared neural pathways.

Question 8

In developing a concept of pain to use in working with patients experiencing pain,what does the nurse acknowledge about pain?&#10;A) Pain always causes suffering.&#10;B) All pain serves a physiological purpose.&#10;C) Pain is a phenomenon.&#10;D) Pain is present whenever nociception occurs.

Accepted Answer

Pain is a phenomenon that involves both sensory and emotional experiences, and is subjective to the individual experiencing it. It does not always cause suffering and not all pain serves a physiological purpose. Nociception, which refers to the transmission of nerve signals from a painful stimulus, does not necessarily equate to the experience of pain.

Question 9

What is the mechanism of action of NSAIDs?&#10;A) They block action potential initiation.&#10;B) They block prostaglandin production.&#10;C) They inhibit cyclo-oxygenase action.&#10;D) They interfere with serotonin uptake.

Accepted Answer

The answer of What is the mechanism of action of...

Question 10

Amitriptyline,a tricyclic antidepressant,is being administered to a patient with chronic cancer pain.What does the nurse recognize as the expected outcome of administration of this drug?&#10;A) Increased pain threshold by stimulating the release of endogenous enkephalins&#10;B) Decreased perception of pain by blocking opiate receptors in the brain and descending inhibitory nerves&#10;C) Decreased transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses&#10;D) Increased pain tolerance through relief of depression by increasing the amounts of norepinephrine in the brain

Accepted Answer

Amitriptyline is a tricyclic antidepressant that works by altering the activity of serotonin and norepinephrine at nerve synapses. This results in a decreased transmission of pain impulses, which can help to alleviate chronic pain. It does not directly stimulate the release of endogenous enkephalins, block opiate receptors, or increase pain tolerance through relief of depression by increasing norepinephrine levels.

Question 11

Which type of pain is caused by damage to somatic tissue?&#10;A) Visceral&#10;B) Nociceptive&#10;C) Neuropathic&#10;D) Sensory-discriminative

Accepted Answer

The answer of Which type of pain is caused by...

Question 12

A patient in a publicly funded pain clinic asks the nurse how long he will have to wait to see a health care provider who is an expert in pain.The nurse's response is based on the fact that the average wait time in Canada for expert pain-related care is approximately how long?

A) One month
B) Three months
C) Six months
D) One year

Accepted Answer

The answer of A patient in a publicly funded pain...

Question 13

An 86-year-old man has severe degenerative arthritis in his hips.In planning care for the patient,what does the nurse recognize about chronic pain in an older adult?&#10;A) It is more readily tolerated than in younger patients.&#10;B) It does not require the use of narcotic drugs for control.&#10;C) It is poorly tolerated because of past experiences with pain.&#10;D) It is often believed by the patient to be an inevitable part of aging.

Accepted Answer

The answer of An 86-year-old man has severe degenerative arthritis...

Question 14

A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis.What does the nurse recognize about how these cognitive strategies work?&#10;A) They reduce the sensory and affective components of pain.&#10;B) They prevent transmission of nociceptive stimuli to the cortex.&#10;C) They decrease the intensity of the pain that the patient is willing to tolerate.&#10;D) They decrease sensitization by increasing the production of glutamate in the spinal cord.

Accepted Answer

The answer of A patient with chronic abdominal pain has...

Question 15

A 45-year-old woman has breast cancer that has spread to her liver and spine.She has been taking oxycodone (Percodan)and amitriptyline (Elavil)for pain control at home,but she now has constant severe pain and is hospitalized for pain control and development of a pain management program.During assessment of the patient,what information related to her pain is most important for the nurse to obtain initially?

A) The pattern,area,intensity,and nature of her pain
B) Identification of trigger points of pain by palpation of painful areas
C) The schedule and total dosages of the drugs she is currently taking and when breakthrough pain occurs
D) The presence of a sympathetic response,such as tachycardia,diaphoresis,and a rise in blood pressure

Accepted Answer

The answer of A 45-year-old woman has breast cancer that...

Question 16

Which of the following is a possible musculoskeletal consequence of unrelieved pain?&#10;A) Decreased peristalsis&#10;B) Hypermobility&#10;C) Muscle spasm&#10;D) Muscle protein catabolism

Accepted Answer

The answer of Which of the following is a possible...

Question 17

The physician plans to titrate narcotic analgesic to provide pain relief for a patient with surgical pain.What does the nurse's role in include?&#10;A) Monitoring the effects of continuous intravenous (IV)infusion of narcotic analgesics&#10;B) Teaching the patient to try to increase the time between doses of pain medication&#10;C) Assisting the patient to plan the use of a specific total dose of analgesic over a 24-hour period&#10;D) Determining with the patient the optimal analgesic dosage required for pain relief with attention to the side effects produced

Accepted Answer

The answer of The physician plans to titrate narcotic analgesic...

Question 18

Which of the following is true of persistent pain?&#10;A) It occurs within the normal healing time.&#10;B) The course of pain decreases over time.&#10;C) It is accompanied by an increased heart and pulse rate.&#10;D) It is often accompanied by changes in affect and withdrawal from other people.

Accepted Answer

The answer of Which of the following is true of...

Question 19

To obtain the most complete assessment data about a patient's chronic pain pattern,what should the nurse ask the patient?&#10;A) &#34;Can you describe where your pain is the worst?&#34;&#10;B) &#34;What is the intensity of your pain on a scale of 0 to 10?&#34;&#10;C) &#34;Would you describe your pain as aching,throbbing,or sharp?&#34;&#10;D) &#34;Can you describe your daily activities in relation to your pain?&#34;

Accepted Answer

The answer of To obtain the most complete assessment data...

Deck 10: Pain