Deck 8: Pain

Question 1

A patient who is receiving sustained-release morphine sulfate (MS Contin)every 12 hours for chronic pain experiences level 9 (0 to 10 scale)breakthrough pain and anxiety. Which action by the nurse is appropriate for treating this change in assessment?

A)Suggest amitriptyline 10 mg orally.
B)Administer lorazepam (Ativan) 1 mg orally.
C)Give ibuprofen (Motrin) 400 to 800 mg orally.
D)Offer immediate-release morphine 30 mg orally.

Answer 1

Offer immediate-release morphine 30 mg orally.

Question 2

Which question asked by the nurse will give the most information about the patient's metastatic bone cancer pain?

A)"How long have you had this pain?"
B)"How would you describe your pain?"
C)"How often do you take pain medication?"
D)"How much medication do you take for the pain?"

Answer 2

"How would you describe your pain?"

Question 3

A patient with chronic neck pain is seen in the pain clinic for follow-up. To evaluate whether the pain management is effective,which question is best for the nurse to ask?

A)"Has there been a change in pain location?"
B)"Can you describe the quality of your pain?"
C)"How would you rate your pain on a 0 to 10 scale?"
D)"Does the pain keep you from activities that you enjoy?"

Answer 3

"Does the pain keep you from activities that you enjoy?"

Question 4

The following medications are prescribed by the health care provider for a middle-aged patient who uses long-acting morphine (MS Contin)for chronic back pain but still has ongoing pain. Which medication should the nurse question?

A)Morphine
B)Dexamethasone
C)Pentazocine (Talwin)
D)Celecoxib (Celebrex)

Question 5

The nurse teaches a student nurse about the action of ibuprofen. Which statement,if made by the student,indicates that teaching was effective?

A)"The drug decreases pain impulses in the spinal cord."
B)"The drug decreases sensitivity of the brain to painful stimuli."
C)"The drug decreases production of pain-sensitizing chemicals."
D)"The drug decreases the modulating effect of descending nerves."

Question 6

The nurse is caring for a patient who has diabetes and complains of chronic,burning leg pain even when taking oxycodone (OxyContin)twice daily. Which prescribed medication is the best choice for the nurse to administer as an adjuvant to decrease the patient's pain?

A)Aspirin
B)Amitriptyline
C)Celecoxib (Celebrex)
D)Acetaminophen (Tylenol)

Question 7

Which medication should the nurse administer for a patient with cancer who describes the pain as "deep,aching and at a level 8 on a 0 to 10 scale"?

A)Ketorolac tablets
B)Fentanyl (Duragesic) patch
C)Hydromorphone (Dilaudid) IV
D)Acetaminophen (Tylenol) suppository

Question 8

A nurse assesses a patient with chronic cancer pain who is receiving imipramine (Tofranil)in addition to long-acting morphine (MS Contin). Which statement,if made by the patient,indicates to the nurse that the patient is receiving adequate pain control?

A)"I'm not anxious during the day."
B)"Every night I get 8 hours of sleep."
C)"I can accomplish activities without much discomfort."
D)"I feel less depressed since I've been taking the Tofranil."

Question 9

A patient with terminal cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin)is due. Which action should the nurse take first?

A)Use distraction by talking about things the patient enjoys.
B)Suggest the use of alternative therapies such as heat or cold.
C)Administer the prescribed PRN immediate-acting morphine.
D)Consult with the doctor about increasing the MS Contin dose.

Question 10

A patient who has fibromyalgia reports pain at level 7 (0 to 10 scale). The patient tells the nurse,"I feel depressed because I ache too much to play golf." Which patient goal has the highest priority when the nurse is developing the treatment plan?

A)The patient will report pain at a level 2 of 10.
B)The patient will be able to play a round of golf.
C)The patient will exhibit fewer signs of depression.
D)The patient will say that the aching has decreased.

Question 11

Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP)when caring for a patient who is using a fentanyl (Duragesic)patch and a heating pad for treatment of chronic back pain?

A)Check the skin under the heating pad.
B)Count the respiratory rate every 2 hours.
C)Ask the patient whether pain control is effective.
D)Monitor sedation using the sedation assessment scale.

Question 12

The nurse is caring for a patient who had abdominal surgery yesterday and is receiving morphine through patient-controlled analgesia (PCA). What action by the nurse is a priority?

A)Assessing for nausea
B)Auscultating bowel sounds
C)Checking the respiratory rate
D)Evaluating for sacral redness

Question 13

A patient who uses a fentanyl (Duragesic)patch for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone tablets,but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take?

A)Wake the patient and administer the hydrocodone.
B)Wait until the patient wakes up and reassess the pain.
C)Suggest the use of nondrug therapies for pain relief instead of additional opioids.
D)Consult with the health care provider about changing the fentanyl (Duragesic) dose.

Question 14

A patient who has just started taking sustained-release morphine sulfate (MS Contin)for chronic arthritic joint pain after a traumatic injury complains of nausea and abdominal fullness. Which action should the nurse take initially?

A)Administer the ordered antiemetic medication.
B)Order the patient a clear liquid diet until the nausea decreases.
C)Tell the patient that the nausea should subside in about a week.
D)Consult with the health care provider about using a different opioid.

Question 15

The nurse assesses that a home hospice patient with terminal cancer who complains of severe pain has a respiratory rate of 11 breaths/min. Which action should the nurse take?

A)Inform the patient that increasing the morphine will cause the respiratory drive to fail.
B)Tell the patient that additional morphine can be administered when the respirations are 12.
C)Titrate the prescribed morphine dose up until the patient indicates adequate pain relief.
D)Administer a nonsteroidal antiinflammatory drug (NSAID) to improve patient pain control.

Question 16

A patient who has had good control for chronic pain using a fentanyl (Duragesic)patch reports rapid onset pain at a level 9 (0 to 10 scale)and requests "something for pain that will work quickly." How will the nurse document the type of pain reported by this patient?

A)Somatic pain
B)Referred pain
C)Neuropathic pain
D)Breakthrough pain

Question 17

The nurse is completing the medication reconciliation form for a patient admitted with chronic cancer pain. Which medication is of most concern to the nurse?

A)Amitriptyline 50 mg at bedtime
B)Ibuprofen 800 mg 3 times daily
C)Oxycodone (OxyContin) 80 mg twice daily
D)Meperidine (Demerol) 25 mg every 4 hours

Question 18

A patient with chronic back pain has learned to control the pain with the use of imagery and hypnosis. The patient's spouse asks the nurse how these techniques work. Which response by the nurse is accurate?

A)"The strategies work by affecting the perception of pain."
B)"These techniques block the pain pathways of the nerves."
C)"These strategies prevent transmission of stimuli from the back to the brain."
D)"The therapies slow the release of chemicals in the spinal cord that cause pain."

Question 19

The nurse assesses that a patient receiving epidural morphine has not voided for more than 10 hours. What action should the nurse take initially?

A)Place an indwelling urinary catheter.
B)Monitor for signs of narcotic overdose.
C)Ask if the patient feels the need to void.
D)Encourage the patient to drink more fluids.

Question 20

A patient with a deep partial thickness burn has been receiving hydromorphone through patient-controlled analgesia (PCA)for 1 week. The nurse caring for the patient during the previous shift reports that the patient wakes up frequently during the night complaining of pain. What action by the nurse is appropriate?

A)Administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.
B)Consult with the health care provider about using a different treatment protocol to control the patient's pain.
C)Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
D)Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.

Question 21

The nurse reviews the medication orders for an older patient with arthritis in both hips who reports level 3 (0 to 10 scale)hip pain while ambulating. Which medication should the nurse offer as initial therapy?

A)Naproxen 200 mg orally
B)Oxycodone 5 mg orally
C)Acetaminophen 650 mg orally
D)Aspirin (acetylsalicylic acid) 650 mg orally

Question 22

A nurse assesses a postoperative patient 2 days after chest surgery. What findings indicate that the patient requires better pain management ?

A)Confusion
B)Hypoglycemia
C)Poor cough effort
D)Shallow breathing
E)Elevated temperature

Question 23

A patient with chronic pain who has been receiving morphine sulfate 20 mg IV over 24 hours is to be discharged home on oral sustained-release morphine (MS Contin)administered twice a day. What dosage of MS Contin will be needed for each dose to obtain an equianalgesic dose for the patient? (Morphine sulfate 10 mg IV is equianalgesic to morphine sulfate 30 mg orally.)

Question 24

The health care provider orders a patient-controlled analgesia (PCA)machine to provide pain relief for a patient with acute surgical pain who has never received opioids before. Which nursing actions regarding opioid administration are appropriate at this time ?

A)Assess for signs that the patient is becoming addicted to the opioid.
B)Monitor for therapeutic and adverse effects of opioid administration.
C)Emphasize that the risk of some opioid side effects increases over time.
D)Teach the patient about how analgesics improve postoperative activity levels.
E)Provide instructions on decreasing opioid doses by the second postoperative day.

Question 25

A patient who is using both a fentanyl (Duragesic)patch and immediate-release morphine for chronic cancer pain develops new-onset confusion,dizziness,and a decrease in respiratory rate. Which action should the nurse take first?

A)Remove the fentanyl patch.
B)Obtain complete vital signs.
C)Notify the health care provider.
D)Administer prescribed PRN naloxone

Question 26

The nurse on a surgical inpatient unit is caring for several patients. Which patient should the nurse assess first?

A)Patient with postoperative pain who received morphine sulfate IV 15 minutes ago
B)Patient who received hydromorphone (Dilaudid) 1 hour ago and is currently asleep
C)Patient who was treated for pain just prior to return from the postanesthesia care unit
D)Patient with neuropathic pain who is scheduled to receive a dose of hydrocodone (Lortab) now