Deck 9: Nursing Care of Patients in Pain

Question 1

A patient asks the nurse why the pain he experienced prior to a myocardial infarction was felt primarily in his left arm. The nurse's best response would be which of the following?

A)"Pain in the arm related to cardiac tissue damage is a type of referred pain."
B)"Cardiac pain is generally unexplainable."
C)"Were you doing some physical activity with your arm just prior to the event?"
D)"What you are describing relates to psychogenic pain."

Answer 1

"Pain in the arm related to cardiac tissue damage is a type of referred pain."

Question 2

The nurse asks a patient, who refuses to take pain medication for chronic back pain, to explain his reasons for avoiding medication. This nurse is attempting to do which of the following?

A)Identify a barrier to the patient's pain control treatment plan.
B)Determine if the patient should remain in the hospital.
C)Decide if the patient is being argumentative.
D)Figure out if the patient should leave the hospital against medical advice.

Answer 2

Identify a barrier to the patient's pain control treatment plan.

Question 3

A patient with chronic orthopedic pain is considering the use of a transcutaneous electrical nerve stimulator to reduce the pain. The nurse realizes that which of the following are advantages of this device with pain control?

A)avoid the side effects of pain medication
B)low cost
C)can be used by all patients
D)can relieve all types of pain

Answer 3

avoid the side effects of pain medication

Question 4

If using the neuromatrix theory of pain, which of the following will the nurse include when assessing a patient's amount of pain?

A)cultural and genetic factors
B)specificity
C)pattern
D)previous sensitization

Question 5

The nurse, caring for a patient recovering from surgery, knows that which intervention will provide the most pain relief for the patient?

A)Offer pain relief before the patient complains of pain.
B)Wait until the patient can describe the pain specifically.
C)Assess the pain level every four hours around the clock.
D)Allow the patient to "sleep off" the anesthesia, and then offer pain medication.

Question 6

The nurse is planning care for a patient with chronic pain. Which of the following would be the most appropriate pain control goal for this patient?

A)Reduce the focus on pain.
B)Reduce the sympathetic stress response.
C)Be completely pain free.
D)Improve patient outcomes.

Question 7

A patient is watching a comedy on the television and has not requested pain medication for over six hours. The nurse realizes that the patient is utilizing which of the following as a form of pain control?

A)distraction
B)meditation
C)guided imagery
D)biofeedback

Question 8

The nurse is planning to administer a pain medication to a patient who is two hours postoperative following bowel resection surgery. The patient has four standing orders for pain medication. The nurse should administer which medication based on this situation?

A)Select the one to be administered intravenously by patient demand and under patient control.
B)Select the one that will be given intramuscularly to work quickly.
C)Select the one that is ordered on a prn basis.
D)Select the one to be administered orally.

Question 9

Which of the following explains why the nurse should assess each patient's pain response individually in every situation?

A)Everyone has a unique tolerance to pain.
B)Everyone has the same pain threshold.
C)Everyone perceives painful stimuli at the same intensity.
D)Most people have the same the pain response to surgery.

Question 10

The nurse is managing care for a group of patients with pain. Which of the following is an example of a process that may cause acute pain?

A)cholecystectomy
B)phantom limb pain
C)complex regional pain syndrome
D)degenerative joint disease

Question 11

A patient scheduled for knee surgery tells the nurse, "I know I won't feel as much pain with this knee surgery as I did with the other one when I was 20 years younger." Which of the following should the nurse respond to this patient?

A)"There might be more pain since the pain response can get worse with aging."
B)"You are most likely correct."
C)"It should not be quite as bad with the newer technology."
D)"Pain responses decrease with age."

Question 12

A female patient tells the nurse that at times the pain that she has is so severe that she cannot move or get out of bed at home. The nurse realizes that this amount of pain can be due to which of the following?

A)gender
B)overuse of alcohol
C)overuse of pain medication
D)too much sleep and rest

Question 13

A patient recovering from abdominal surgery is refusing hydromorphone (Dilaudid) because she has heard that people may become addicted. She is crying and rates her pain 10 of 10. Which of the following statements should the nurse include as part of the patient's education? Select all that apply.

A)Narcotics result in addiction in less than 1-3% of patients.
B)Untreated pain can result in poor wound healing.
C)Patients with uncontrolled pain have increased risk of blood clots.
D)Dehydration can result from poorly managed pain.
E)Family members will not want to visit patients with visible signs of pain.

Question 14

After assessing a patient for pain, the nurse concludes that the patient's pain is caused by a mechanical stimulus. Which of the following would cause this type of pain?

A)muscle tear
B)burn
C)frost bite
D)myocardial infarction

Question 15

A patient, diagnosed with depression, tells the nurse that his pain has been "unrelenting" over the last several weeks. The nurse realizes that which of the following can explain this patient's amount of pain?

A)Depression can cause an increase in pain sensations.
B)The pain medication has not been working.
C)Medication to treat the patient's depression is interfering with the control of pain.
D)The patient is exaggerating the amount of pain.

Question 16

A patient tells the nurse that he has had deep burning muscle pain for most of his adult life. With this information, the nurse realizes that this patient's pain is being transmitted along which of the following?

A)C fibers
B)A-delta fibers
C)endorphins
D)dynorphins

Question 17

A patient is being treated for chronic pain. The nurse realizes that which of the following is typical of chronic pain?

A)The pain rating may be inconsistent with underlying pathology.
B)There is usually a clear, physiologic cause.
C)Pain typically lasts two months or less.
D)The pain reported is usually less severe than acute pain.

Question 18

A patient tells the nurse that she is unable to sleep throughout the night because of leg pain. Which of the following will the nurse most likely assess in this patient?

A)an increase in pain
B)a decrease in pain
C)a decrease in anxiety
D)an increase in concentration

Question 19

A patient with severe nerve pain from spinal cord compression is considering surgery to sever the nerves in order to relieve the pain. Which of the following should the nurse encourage the patient to consider prior to having this surgery?

A)Potential loss of motor function associated with the nerves that will be severed can occur.
B)The surgery will need to be repeated when the nerves regenerate.
C)Pain medication will still be needed after the surgery.
D)The patient will be a paraplegic after the surgery.

Question 20

A patient is receiving a narcotic for severe acute pain. Which of the following should the nurse encourage the patient to consume on a greater level due to the pain medication?

A)fiber
B)vitamin D
C)protein
D)carbohydrates

Question 21

The nurse is helping a patient in pain by gently massaging the painful area. The nurse is utilizing which form of pain control with the patient?

A)acupuncture
B)biofeedback
C)guided imagery
D)cutaneous stimulation

Question 22

A 47-year-old female patient has a history of scoliosis and back pain. Which of the following types of pain does the nurse realize this patient most likely is experiencing?

A)recurrent acute pain
B)ongoing time-limited pain
C)chronic malignant pain
D)chronic intractable nonmalignant pain syndrome

Question 23

A patient with chronic pain tells the nurse that he "rarely sleeps more than three hours a night." The nurse realizes that this patient is at risk for developing which of the following?

A)chronic insomnia
B)depression
C)anxiety
D)high pain tolerance
E)adult attention deficit disorder

Question 24

A patient learns that he has no physical cause for the ongoing back pain he experiences. The nurse realizes this patient might be experiencing which of the following?

A)central pain
B)phantom pain
C)chronic postoperative pain
D)psychogenic pain

Question 25

The patient complaining of pain has been waiting for medication to relieve the pain. Which of the following should the nurse realize about this patient?

A)The patient's pain is real.
B)The patient just wants medication.
C)The patient wants attention.
D)The patient is demanding.

Question 26

A patient is complaining of muscle pain. The nurse realizes that the transmission of this pain is which of the following?

A)over the A-delta fibers
B)over the B nerve fibers
C)over the C nerve fibers
D)over the D nerve fibers

Question 27

A patient is hospitalized with suspected gallstones and inflammatory gall bladder disease. Place an "X" over the area in the body where the nurse would expect the patient to locate the pain.

Question 28

A patient has periodic severe nerve pain that is not being well-controlled with pain medication. The nurse thinks that this patient might benefit from which of the following?

A)a nonsteroidal anti-inflammatory drug (NSAID)
B)a narcotic
C)an antidepressant
D)a local anesthetic

Question 29

A patient with chronic pain is desperately searching for something to relieve the pain. Which of the following would be helpful for this patient to consider?

A)A thorough analyzing of the pain to determine if it is truly pain
B)Avoid the use of narcotics
C)Evaluation by a psychiatrist to determine if the patient is really depressed
D)Develop a pain medication schedule to help avoid the onset of pain

Question 30

A patient with a long history of pain rarely appears to be in pain and often forgoes the use of pain medication. The nurse realizes that this patient

A)has a high pain tolerance.
B)has a low pain tolerance.
C)addicted to pain medication.
D)does not really have pain.

Question 31

The nurse is assessing a patient's pain perception. Which of the following methods of assessment would be useful for this?

A)FACES scale
B)psychological evaluation tool
C)PQRST guide
D)biofeedback rating

Question 32

A patient who is receiving pain medication around the clock complains of an acute exacerbation of pain. What should the nurse do to help this patient?

A)Provide the medication ordered for breakthrough pain.
B)Talk the patient through the pain.
C)Encourage the patient to ignore the pain.
D)Give the patient a nonsteroidal anti-inflammatory drug (NSAID).

Question 33

Which patient/patients' physiologic assessment findings are consistent with those of an adult patient experiencing acute pain? 11ea992e_0a83_6584_9f38_d1f67ca949e9

A)Patients A and C
B)Patient A only
C)Patients B and D
D)Patient C only

Question 34

A patient is hospitalized with a history of high blood pressure and cardiac arrhythmias is admitted after having EKG changes consistent with a myocardial infarction. Place an "X" over the area in the body where the nurse would expect the patient to locate the pain.

Question 35

A patient with chronic pain is being started on a "patch." Which of the following should be included when instructing the patient about this pain-relieving delivery system?

A)It will not work as well as oral pain medications.
B)Dosing will start with a lower dose.
C)The patient will never experience breakthrough pain.
D)The patient will never overdose with this delivery method.

Question 36

A patient is seen talking and laughing in the clinic's waiting room yet complains of excruciating pain. The nurse realizes this patient is most likely demonstrating which of the following?

A)the desire for narcotics
B)denial
C)fake pain
D)inconsistent behavioral response to pain

Question 37

The nurse is assessing a patient's vital signs. Which of the following should be assessed during this time?

A)peripheral pulses
B)pain
C)ability to ambulate
D)urine output

Question 38

Which patient/patients' symptoms are most likely due to side effects of an opioid pain medication treatment regimen? 11ea992e_0a83_8c95_9f38_7f8ecb4d5e3f

A)Patients A and C
B)Patient C only
C)Patients B and D
D)Patient D only

Question 39

A patient with a history of lumbar spinal cord nerve compression continues to complain of burning pain. The nurse realizes that this patient is experiencing which of the following?

A)complex regional pain syndrome
B)myofascial pain syndrome
C)chronic postoperative pain
D)phantom limb pain

Question 40

A patient with a history of chronic pain tells the nurse, "I do a variety of things to make my body produce its own pain reliever." The nurse realizes that this patient is describing:

A)a theory of denial
B)a belief in alternative methods
C)one reason to reduce the amount of pain medication prescribed
D)the body's ability to make endorphins

Question 41

Rank the order of steps occurring in the neural pain pathway. Click and drag the options below to move them up or down.

A)In the thalamus and cerebral cortex, the pain impulse becomes pain when the sensation reaches conscious levels and is perceived and evaluated by the person experiencing the sensation.
B)Dorsal horn synapses relay impulses up the spinal cord.Spinal neurons transmit the impulses via axons that cross over to the spinothalamic tract.
C)The impulses ascend the spinothalamic tracts and pass through the medulla and midbrain to the thalamus.
D)A noxious stimulus is perceived by cutaneous nociceptors and then transmitted through, A-delta (AΔ) and even smaller C nerve fibers to the spinal cord dorsal horn.

Question 42

Which patient/patients' description of their pain is consistent with that of phantom pain? 11ea992e_0a83_8c96_9f38_df04944612bb

A)Patients A and D
B)Patient A only
C)Patients B and D
D)Patient C only

Question 43

A nurse is caring for elderly patients in a long-term care facility. Which of the following are factors influencing pain management for these patients? Select all that apply. Select all that apply.

A)Increased A fiber transmission cause increased potential for addiction in the elderly.
B)Increased risk of depression in the elderly is related to chronic pain.
C)Decreased report of referred pain may mask myocardial infarction in the elderly.
D)Assessment of pain in the cognitively impaired older adult is not possible.

Question 44

What order of actions should the nurse complete when administering an analgesic medication transdermally to a male patient with heavy chest hair distribution? Click and drag the options below to move them up or down.

A)Choose a new site and cleanse and dry an upper torso location.
B)Clip chest hair and open the medication package.
C)Check the Medication Administration Record (MAR) and remove the previous patch.
D)Place patch making sure all edges are in contact with the skin.

Question 45

A nurse is teaching pain management to a homebound, hospice patient, already being treated with opioids. This patient has been diagnosed with metastatic breast cancer and has a great deal of anxiety about keeping her pain under control. Which non-pharmacologic complimentary methods might the nurse suggest? Select all that apply.

A)guided imagery
B)progressive muscle relaxation
C)distraction
D)acupuncture
E)yoga

Question 46

A patient is being discharged on Fentanyl Patch for pain control. The patch is to be reapplied every 72 hours transdermally for adequate pain control. They patient receives his last dose before discharge in the hospital on Monday, June 11 at 1000 hours. If the patient receives a box of five medication patches, when will the last dose be applied?

Question 47

A patient has been receiving morphine sulphate 10 mg. intramuscularly every four hours for the past few days. The nurse is anticipating discharge and wants to calculate the oral dose necessary for this patient. Calculate this oral dosage range using the equianalgesic dosing formula.

Question 48

Use the WHO analgesic ladder to rank the weakest to the strongest analgesics. Click and drag the options below to move them up or down.

A)Morphine Sulfate 5 mg IV
B)Ibuprofen 400 mg PO with the anticonvulsant, Gabapentin (Neurontin) 300 mg PO
C)Propoxyphene HCL (Darvon) 250 mg.PO
D)Acetaminophen (Tylenol) 325 mg PO