Question 1

Acute pain usually corresponds to&#10;A) the healing process but should not exceed 9 months.&#10;B) the healing process but should not exceed 6 months.&#10;C) persistent pain more than 6 months after the healing process.&#10;D) damage to the patient's nervous system unrelated to the initial injury.

Accepted Answer

Acute pain has a short duration, and it usually corresponds to the healing process (30 days)but should not exceed 6 months.It implies tissue damage that is usually from an identifiable cause.If undertreated, acute pain may bring a prolonged stress response and lead to permanent damage to the patient's nervous system.In such instance, acute pain can become chronic.

Question 2

The patient is sedated and breathing with the use of mechanical ventilation.The patient is unable to communicate any aspects of his pain to the nurse.The nurse knows that the best tool for pain assessment for this patient is

A) FLACC.
B) Wong-Baker FACES.
C) BIS.
D) BPS or CPOT.

BPS or CPOT.

Accepted Answer

The BPS and the CPOT are supported by experts in critical care and are suggested for use in medical, postoperative, and nonbrain trauma critically ill adults unable to self-report in the clinical guidelines of the Society of Critical Care Medicine (SCCM).FLACC is a pediatric pain assessment tool.The Wong-Baker FACES tool requires the patient to associate a level of pain to a facial representation.BIS is as an objective measure of sedation levels during neuromuscular blockade in the ICU.

Question 3

Using a specific pain intensity scale in the CCU&#10;A) eliminates the need for the subjectivity of the patient.&#10;B) allows for one tool for all patient types.&#10;C) provides consistency of assessment and documentation.&#10;D) is not necessary because all pain is treated equally in the CCU.

Accepted Answer

Many CCUs use a specific pain intensity scale because a single tool provides consistency of assessment and documentation.A pain intensity scale is useful in the critical care environment.Asking the patient to grade his or her pain on a scale of 0 to 10 is a consistent method and aids the nurse in objectifying the subjective nature of the patient's pain.However, the patient's tool preference should be considered.

Question 4

The neural processes of encoding and processing noxious stimuli necessary but not sufficient for pain is known as&#10;A) perception.&#10;B) nociception.&#10;C) transduction.&#10;D) transmission.

Accepted Answer

Nociception represents the neural processes of encoding and processing noxious stimuli necessary, but not sufficient, for pain.Transduction refers to mechanical (e.g., surgical incision), thermal (e.g., burn), or chemical (e.g., toxic substance)stimuli that damage tissues.As a result of transduction, an action potential is produced and is transmitted by nociceptive nerve fibers in the spinal cord that reach higher centers of the brain.This is called transmission, and it represents the second process of nociception.Pain sensation transmitted by the NS pathway reaches the thalamus, and the pain sensation transmitted by the PS pathway reaches brainstem, hypothalamus, and thalamus.These parts of the CNS contribute to the initial perception of pain.

Question 5

A patient underwent a thoracotomy 12 hours ago.The patient currently has an epidural catheter in place and is receiving continuous epidural analgesia with morphine.In addition to respiratory depression, the patient should be monitored for which of the following complications?

A) Urinary retention, undue somnolence, itching, nausea, and vomiting
B) Urinary incontinence, photophobia, headache, and skin rash
C) Apprehension, anxiety, restlessness, sadness, anger, and myoclonus
D) Gastric bleeding, nasal discharge, cerebrospinal fluid leak, and calf pain

Accepted Answer

Epidural analgesia is commonly used in critical care units after major abdominal surgery, nephrectomy, thoracotomy, and major orthopedic procedures.Monitor for adverse reactions, including respiratory depression, urinary retention, undue somnolence, itching, seizures, nausea, and vomiting.

Question 6

The subjective characteristic implies that pain is&#10;A) an uncomfortable experience present only in the patient with an intact nervous system.&#10;B) an unpleasant experience accompanied by crying and tachycardia.&#10;C) activation of the sympathetic nervous system from an injury.&#10;D) whatever the patient experiencing it says it is, occurring when that patient says it does.

Accepted Answer

Pain is described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.This definition emphasizes the subjective and multidimensional nature of pain.More specifically, the subjective characteristic implies that pain is whatever the person experiencing it says it is and that it exists whenever he or she says it does.

Question 7

The use of PCA infusion pumps allows the patient to&#10;A) act preemptively by administering a bolus of medication when pain begins.&#10;B) choose between the use of opioids or NSAID medication to control pain.&#10;C) decrease the risk of respiratory depression.&#10;D) control pain medication in 2-hour increments.

Accepted Answer

The patient can self-administer a bolus of medication the moment the pain begins, acting preemptively.Allowing the patient to self-administer opioid doses does not diminish the role of the critical care nurse in pain management.The nurse advises about necessary changes to the prescription and continues to monitor the effects of the medication and doses.The patient is closely monitored during the first 2 hours of therapy and after every change in the prescription.If the patient's pain does not respond within the first 2 hours of therapy, a total reassessment of the pain state is essential.If the patient is pressing the button to bolus medication more often than the prescription, the dose may be insufficient to maintain pain control.Naloxone must be readily available to reverse adverse opiate respiratory effects.

Question 8

A patient complains of pain at his incision site.The nurse is aware that four processes are involved in nociception.The proper order of the processes is&#10;A) transmission, perception, modulation, and transduction.&#10;B) perception, modulation, transduction, and transmission.&#10;C) modulation, transduction, transmission, and perception.&#10;D) transduction, transmission, perception, and modulation.

Accepted Answer

Four processes are involved in nociception: transduction, transmission, perception, and modulation.

Question 9

The patient is admitted to the CCU with hemodynamic instability and an allergy to morphine.The nurse anticipates that the physician will order which medication for severe pain?&#10;A) Hydromorphone&#10;B) Codeine&#10;C) Fentanyl&#10;D) Methadone

Accepted Answer

Fentanyl is a synthetic opioid preferred for critically ill patients with hemodynamic instability or morphine allergy.Hydromorphone is a semisynthetic opioid that has an onset of action and a duration similar to those of morphine.It is more potent than morphine.Hydromorphone produces an inactive metabolite (i.e., hydromorphone-3-glucuronide), making it the opioid of choice for use in patients with end-stage renal disease.Codeine has limited use in the management of severe pain.It is rarely used in critical care units.It provides analgesia for mild to moderate pain.It is usually compounded with a nonopioid.Methadone is a synthetic opioid with morphine-like properties but less sedation.It is longer acting than morphine and has a long half-life.This makes it difficult to titrate in the critical care patient.

Question 10

Relaxation, distraction, guided imagery, and music therapy are all examples of&#10;A) physical techniques for pain management.&#10;B) cognitive-behavioral techniques for pain management.&#10;C) PCA management of pain.&#10;D) equianalgesic management of pain.

Accepted Answer

Using the cortical interpretation of pain as the foundation, several interventions can reduce the patient's pain report.These modalities include cognitive techniques such as relaxation, distraction, guided imagery, and music therapy.

Question 11

Which of the following statements are true regarding pain assessment and management?&#10;A) The single most important assessment tool available to the nurse is the patient's self-report.&#10;B) The only way to assess pain in patients unable to verbalize because of mechanical ventilation is through observation of behavioral indicators.&#10;C) The concept of equianalgesia uses morphine as a basis for dosage comparison for other medications.&#10;D) Transcutaneous electrical nerve stimulation and application of heat or cold therapy stimulate the nonpain sensory fibers.&#10;E) Meperidine, a synthetic form of morphine, is much stronger and is given at lower doses at less frequent intervals.

Accepted Answer

The answer of Which of the following statements are true...

Question 12

Which of the following assessment findings might indicate respiratory depression after opioid administration?&#10;A) Flushed, diaphoretic skin&#10;B) Shallow respirations with a rate of 24 breaths/min&#10;C) Tense, rigid posture&#10;D) Sleep apnea

Accepted Answer

The answer of Which of the following assessment findings might...

Question 13

A patient states that he has been taking Demerol 50 mg tablets four times a day for the past 5 years, but they are not working like they use to.The nurse is concerned that the patient has developed&#10;A) addiction to Demerol.&#10;B) physical dependence and tolerance.&#10;C) physical dependence and addiction.&#10;D) a method to withdraw himself off the medication.

Accepted Answer

The answer of A patient states that he has been...

Question 14

Which of the following combinations of drugs has been found to be effective in managing the pain associated with musculoskeletal and soft tissue inflammation?&#10;A) Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids&#10;B) NSAIDs and antidepressants&#10;C) Opioid agonists and opioid antagonists&#10;D) Adjuvants and partial agonists

Accepted Answer

The answer of Which of the following combinations of drugs...

Deck 8: Pain and Pain Management