Deck 91: Pain Management

Question 1

A nursing student is planning care for an elderly patient who is experiencing pain.Which of the following statements made by the nursing student indicates the need for the nursing professor to clarify the nursing student's knowledge?

A) "Older patients often have difficulty determining what is causing their pain."
B) "It is safe to administer opioids to older adults as long as you start with small doses and frequently assess the patient's response to the medication."
C) "As adults age, their ability to perceive pain decreases."
D) "Patients who have dementia probably experience pain, and their pain is not always well controlled."

Answer 1

B
Aging does not affect the ability to perceive pain.Sometimes older adults have difficulty interpreting their pain and determining its cause because multiple diseases and vague symptoms affect similar parts of the body.Opioids are safe to use in older adults as long as they are slowly titrated and the nurse frequently monitors the patient.Current evidence shows that patients with dementia most likely experience unrelieved pain because their pain is difficult to assess.

Question 2

The nurse is caring for two patients; both are having a hysterectomy.The first patient is having the hysterectomy after a complicated birth.The second patient has uterine cancer.What will most likely influence the experience of pain for these two patients?

A) Neurological factors
B) Competency of the surgeon
C) Meaning of pain
D) Postoperative support personnel

Answer 2

C
The patient's perception of pain is influenced by psychological factors,such as anxiety and coping,which in turn influence the patient's experience of pain.Each patient's experience is different.The degree and quality of pain perceived by a patient are related to the meaning of the pain.Neurological factors can interrupt or influence pain perception,but neither of these patients is experiencing alterations in neurological function.The knowledge,attitudes,and beliefs of nurses,physicians,and other health care personnel about pain affect pain management but do not necessarily influence a patient's pain perceptions.

Question 3

A nurse is assessing a patient who started to have severe pain 3 days ago.When the nurse asks the patient to describe the pain,the patient states,"The pain feels like it is in my stomach.It is a burning pain,and it spreads out in a circle around the spot where it hurts the most." What type of pain does the nurse document that the patient is having at this time?

A) Superficial pain
B) Idiopathic pain
C) Chronic pain
D) Visceral pain

Answer 3

D
Visceral pain comes from visceral organs,such as those from the gastrointestinal tract.Visceral pain is diffuse and radiates in several directions.Superficial pain has a short duration and is usually a sharp pain.Pain of an unknown cause is called idiopathic pain.Chronic pain lasts longer than 6 months.

Question 4

A nurse is providing medication education to a patient who just started taking ibuprofen,a nonselective nonsteroidal antiinflammatory drug (NSAID).Which statement made by the nurse best indicates how ibuprofen works?

A) "Ibuprofen helps to remove factors that cause or stimulate pain."
B) "Ibuprofen reduces anxiety, which will help you better cope with your pain."
C) "Ibuprofen helps to decrease the production of prostaglandins."
D) "Ibuprofen binds with opiate receptors to reduce your pain."

Question 5

A nurse is caring for a patient who recently had spinal surgery.The nurse knows that patients usually experience acute pain following this type of surgery.The patient refuses to get up and walk and is not moving around in the bed.However,the patient is stoic and denies experiencing pain at this time.What most likely explains this patient's behavior and response to surgery?

A) The surgery successfully cured the patient's pain.
B) The patient's culture is possibly influencing the patient's experience of pain.
C) The patient is experiencing urinary retention because of manipulation of the spine during surgery; this is preventing the patient from experiencing pain.
D) The nurse is allowing personal beliefs about pain to influence pain management at this time.

Question 6

The nurse anticipates administering an opioid fentanyl patch to which patient?

A) A 15-year-old adolescent with a broken femur
B) A 30-year-old adult with cellulitis
C) A 50-year-old patient with prostate cancer
D) An 80-year-old patient with a broken hip

Question 7

A nurse is caring for a patient who recently had an abdominal hysterectomy and states that she is experiencing severe pain.The patient's blood pressure is 110/60,and her heart rate is 60.Additionally,the patient does not appear to be in any distress.Which response by the nurse is most therapeutic?

A) "Your vitals do not show that you are having pain; can you describe your pain?"
B) "You do not look like you are in pain."
C) "OK, I will go get you some narcotic pain relievers immediately."
D) "What would you like to try to alleviate your pain?"

Question 8

A nurse is providing discharge teaching for a patient with a fractured humerus.The patient is going home with Vicodin (5/325).What important patient education does the nurse provide?

A) "Be sure to eat a meal high in fat before taking the medication, to avoid a stomach ulcer."
B) "Narcotics can be addictive, so do not take them unless you are in severe pain."
C) "You need to drink plenty of fluids and eat a diet high in fiber."
D) "As your pain severity lessens, you will begin to give yourself once-daily intramuscular injections."

Question 9

Which of the following statements made by the patient indicates to the nurse that teaching on a patient-controlled analgesia (PCA)device has been effective?

A) "This is the only pain medication I will need to be on."
B) "I can administer the pain medication as frequently as I need to"
C) "I feel less anxiety about the possibility of overdosing."
D) "I will need the nurse to notify me when it is time for another dose."

Question 10

A 24-year-old Asian woman is in labor and refuses to receive any sort of anesthesia medication.Which alternative treatment is best for this patient?

A) Relaxation and guided imagery
B) Transcutaneous electrical nerve stimulation (TENS)
C) Herbal supplements with analgesic effects
D) Pudendal block

Question 11

The nurse recognizes that which of the following is a modifiable contributor to a patient's perception of pain?

A) Age and gender
B) Anxiety and fear
C) Culture
D) Previous pain experience

Question 12

A patient who had a motor vehicle accident 2 days ago is experiencing pain and is receiving patient-controlled analgesia (PCA).How does the nurse know that the patient is experiencing effective pain management with the PCA?

A) The patient is sleeping and is difficult to arouse.
B) The patient rates pain at an acceptable level of 3 on a 0 to 10 scale.
C) Sufficient medication is left in the PCA syringe.
D) The patient presses the control button to deliver pain medication.

Question 13

A nurse is caring for a patient who is experiencing pain following abdominal surgery.What information is important for the nurse to tell the patient when providing patient education about effective pain management?

A) "To prevent overdose, you need to wait to ask for pain medication until you begin to experience pain."
B) "You should take your medication after you walk to make sure you do not fall while you are walking."
C) "We should work together to create a regular schedule of medications that does not allow for breakthrough pain."
D) "You need to take oral pain medications when you experience severe pain."

Question 14

A nurse has brought the patient his scheduled pain medication.The patient asks the nurse to wait to give pain medication until the time for the dressing change,which is 2 hours away.Which response by the nurse is most therapeutic?

A) "This medication will still be providing you relief at the time of your dressing change."
B) "OK, swallow this pain pill, and I will return in a minute to fill your wound."
C) "Would you like medication to be given for dressing changes on top of your regularly scheduled medication?"
D) "Your medication is scheduled for this time, and I can't adjust the time for you. I'm sorry, but you must take your pill right now."

Question 15

What is the most appropriate way to assess the pain of a patient who is oriented and has recently had surgery?

A) Assess the patient's body language.
B) Observe cardiac monitor for increased heart rate.
C) Ask the patient to rate the level of pain.
D) Ask the patient to describe the effect of pain on the ability to cope.

Question 16

A patient arrives at the emergency department experiencing a headache and rates the pain as 7 on a 0 to 10 pain scale.What nonpharmacological intervention does the nurse implement for this patient while awaiting orders for pain medication from the health care provider?

A) Frequently reassesses the patient's pain scores
B) Reassures the patient that the provider will come to the emergency department soon
C) Softly plays music that the patient finds relaxing
D) Teaches the patient how to do yoga

Question 17

The nurse is evaluating the effectiveness of guided imagery for pain management as used for a patient who has second- and third-degree burns and needs extensive dressing changes.Which statement best describes that guided imagery is effectively controlling the patient's pain during dressing changes?

A) The patient's need for analgesic medication decreases during the dressing changes.
B) The patient rates pain during the dressing change as a 6 on a scale of 0 to 10.
C) The patient's facial expressions are stoic during the procedure.
D) The patient can tolerate more pain, so dressing changes can be performed more frequently.

Question 18

A patient who has had type 2 diabetes for 26 years is beginning to experience peripheral neuropathy in the feet and lower legs,which is causing the patient to have a decreased ability to feel pain in the lower extremities.The nurse is providing education to the patient to prevent injury to the feet.The nurse tells the patient to always wear shoes or slippers when walking.Which of the following statements made by the nurse best explains the rationale for this instruction?

A) "Wearing shoes blocks pain perception and helps you adapt to pain, which ends up protecting your feet."
B) "Shoes provide nonpharmacological pain relief to people with diabetes and peripheral neuropathy."
C) "Since you cannot feel pain as much in your feet, you need to open your neurological gates to allow pain sensations to come through. Wearing shoes helps to open those gates, which protects your feet."
D) "You have lost the ability to withdraw from pain because of your peripheral neuropathy. If you step on something and are not wearing shoes, you will not feel it; this could possibly cause injury to your foot."

Question 19

What nursing intervention is most effective in preventing injury to a patient following administration of epidural anesthesia?

A) Keeping the reversal agent in a syringe in the patient's bedside table
B) Applying a gauze dressing to the epidural catheter insertion site
C) Labeling the tubing that leads to the epidural catheter
D) Asking the nursing assistive personnel to check on the patient at least once every 2 hours

Question 20

Which of the following statements made by a patient reflects that the patient understands the relationship between the gate control theory of pain and the use of meditation to relieve pain?

A) "Meditation controls pain by blocking pain impulses from coming through the gate."
B) "Meditation will help me sleep through the pain because it opens the gate."
C) "Meditation stops the occurrence of pain stimuli."
D) "Meditation alters the chemical composition of pain neuroregulators, which closes the gate."

Question 21

The nurse knows that which technique is best for assessing pain in a child who is 4 years of age?

A) Ask the parents if they think their child is in pain.
B) Use the FACES scale.
C) Ask the child to rate the level of pain on a 0 to 10 pain scale.
D) Check to see what previous nurses have charted.

Question 22

The nurse is caring for a patient who suddenly experiences chest pain.What is the nurse's first priority?

A) Call the rapid response team.
B) Ask the patient to rate and describe the pain.
C) Raise the head of the bed.
D) Administer pain relief medications.

Question 23

A nurse receives an order from a health care provider to administer Vicodin ES,which contains 750 mg acetaminophen and 7.5 mg hydrocodone,to a patient who is experiencing 8/10 postsurgical pain.The order is to give 2 tablets every 6 hours by mouth as needed for pain.What is the nurse's best next action?

A) Give the Vicodin ES to the patient immediately because the patient is experiencing severe pain.
B) Ask the health care provider to verify the dosage and frequency of the medication.
C) Ask the health care provider for an order for a nonsteroidal antiinflammatory drug (NSAID).
D) Ask the health care provider for an order to play music for the patient, in addition to providing the pain medication.

Question 24

The nurse is assessing a patient for opioid tolerance.Which finding supports the nurse's assessment?

A) Increasingly higher doses of opioid are needed to control pain.
B) The patient needed a substantial dose of naloxone (Narcan).
C) The patient asks for pain medication close to the time it is due around the clock.
D) The patient no longer experiences sedation from the usual dose of opioid.

Question 25

The nurse is administering pain medication for several patients.Which patient does the nurse administer medication to first?

A) The patient who needs to take a scheduled dose of maintenance pain medication
B) The patient who needs to be premedicated before walking
C) The patient with a PCA running who needs to have the syringe replaced
D) The patient who is experiencing 8/10 pain and has a STAT order for pain medication

Question 26

A nurse is supervising a student who is caring for a patient with chronic pain.Which statement by the student indicates an understanding of pain management?

A) "This patient says her pain is a 5, but she is not acting like it. I am not going to give her any pain medication."
B) "The patient is sleeping, so I pushed her PCA button for her."
C) "I need to reassess the patient's pain 1 hour after administering oral pain medication."
D) "It wasn't time for the patient's medication, so when she requested it, I gave her a placebo."

Question 27

The nurse is caring for an infant in the intensive care unit.Which of the following is the most accurate description of factors that will influence the perception and management of pain for this patient?

A) Infants cannot tolerate analgesics owing to an underdeveloped metabolism.
B) Infants have an increased sensitivity to pain when compared with older children.
C) Pain cannot be accurately assessed in infants.
D) Infants respond behaviorally and physiologically to painful stimuli.

Question 28

Which of the following is the best way for the nurse to manage pain for a patient with chronic pain from arthritis?

A) Administer pain medication before any activity.
B) Provide intravascular bolus as needed for breakthrough pain.
C) Give medications around-the-clock.
D) Administer pain medication only when nonpharmacological measures have failed.

Question 29

A nurse is caring for a patient with rheumatoid arthritis who is now going to be taking 2 acetaminophen (Tylenol)tablets every 6 hours to control pain.Which part of the patient's social history is the nurse most concerned about?

A) Patient drinks 1 to 2 glasses of wine every night.
B) Patient smokes 2 packs of cigarettes a day.
C) Patient occasionally smokes marijuana.
D) Patient takes antianxiety medications.

Question 30

The nurse is assessing how a patient's pain is affecting mobility.Which assessment question is most appropriate?

A) "Have you considered working with a physical therapist?"
B) "What activities, if any, has your pain prevented you from doing?"
C) "Would you please rate your pain on a scale from 1 to 10 for me?"
D) "What effect does your pain medication typically have on your pain?"

Question 31

A nurse is caring for a patient who fell on the ice and has connective tissue damage in the wrist and hand.What does type of pain does the nurse document that the patient has?

A) Visceral pain
B) Somatic pain
C) Peripherally generated pain
D) Centrally generated pain

Question 32

The nurse is administering ibuprofen (Advil)to an older patient.Which of the following assessment data causes the nurse to hold the medication?

A) Past medical history of gastric ulcer
B) Patient states last bowel movement was 4 days ago
C) Stated allergy to aspirin
D) Patient states has 2/10 intermittent joint pain
E) Patient experienced respiratory depression after administration of an opioid medication

Question 33

The nurse is teaching a student nurse about pain assessment scales.Which statement by the student indicates correct understanding?

A) "You cannot use a pain scale to compare the pain of my patient with the pain of your patient."
B) "When patients say they don't need pain medication, they aren't in pain."
C) "Pain assessment scales determine the quality of a patient's pain."
D) "A patient's behavior is more reliable than the patient's report of pain."

Question 34

Which statement made by a nursing educator best explains why it is important for nurses to determine a patient's medical history and recent drug use?

A) "Health care providers have a responsibility to prevent drug seekers from gaining access to drugs."
B) "This information is useful in determining what type of pain interventions will most likely be effective in providing pain relief."
C) "Some recreational drugs have pharmaceutical counterparts that may be more effective in managing pain."
D) "Getting this information gives the nurse an opportunity to provide patient teaching about drug abstinence."

Question 35

The nurse is caring for a patient who recently had surgery to repair a hernia.The patient's pain was 7 out of 10 before receiving pain medication.One hour after receiving an oral opioid,the patient ranks his pain at 3 out of 10.The patient asks the nurse why he isn't receiving more pain medication.Which is the nurse's best response?

A) "This medication can be given only every 4 hours. It is not time for you to have any other pain medication right now."
B) "I will notify the health care provider to come perform an assessment if your pain doesn't improve in 30 minutes."
C) "If the pain becomes severe, we may need to transfer you to an intensive care unit."
D) "It can take 2 hours for oral pain medication to work, and your pain is going down. Let's try boosting you up in bed and putting an ice pack on the incision to see if that helps."