Deck 5: Pain: The Fifth Vital Sign

Question 1

A client with arthritic pain is considering taking an herbal supplement to relieve arthritic pain.What teaching is most important for the nurse to carry out with this client?

A) Inform any health care providers about the use of this supplement.
B) Practice imagery along with taking the herbal supplement.
C) Take only herbal supplements that are prescribed.
D) Take herbal supplement at the onset of pain.

Answer 1

Inform any health care providers about the use of this supplement.

Question 2

A home care client who is currently on hydromorphone (Dilaudid)for pain management presents to the hospital reporting abdominal cramping,nausea,and sweating.When taking the client's history,the nurse asks which question first?

A) "Are you currently in severe pain?"
B) "Did you take more Dilaudid than prescribed?"
C) "When did you take your last dose of Dilaudid?"
D) "When was your last bowel movement?"

Answer 2

"When did you take your last dose of Dilaudid?"

Question 3

When a client is assessed,which behavior best indicates that he or she is experiencing changes associated with acute pain?

A) Anger and hostility
B) Expressed hopelessness
C) Inability to concentrate
D) Psychosocial withdrawal

Answer 3

Inability to concentrate

Question 4

A home care client who is taking morphine for pain management abruptly stops taking the medication.Which symptom would indicate physical dependence?

A) Abdominal cramping
B) Craving for morphine
C) Decreased heart rate
D) Elevated temperature

Question 5

The nurse is assessing a client with a long-term history of arthritic pain.Assessment reveals a heart rate of 115 beats/min and blood pressure of 170/80 mm Hg.Which intervention will the nurse carry out first?

A) Administer blood pressure medication.
B) Administer a drug to lower the heart rate.
C) Assess whether the client needs anti-arthritis medication.
D) Continue to assess for possible causes of elevated vital signs.

Question 6

The client was given 15 mg of morphine IM for postsurgical pain.When the nurse checks the client for pain relief 1 hour later,the client is sleeping and has a respiratory rate of 10 breaths/min.What is the nurse's first action?

A) Administering naloxone (Narcan) IV push
B) Administering oxygen by nasal cannula
C) Arousing the client by calling his or her name
D) Documenting the findings and continuing to monitor

Question 7

A client with cholecystitis has pain in the right shoulder area and asks,"What is happening to me? What did I do to my shoulder?" What is the nurse's best response?

A) "You are weak from staying in bed."
B) "Does your other arm hurt too?"
C) "Sometimes pain from a certain organ is referred elsewhere in the body."
D) "I am going to hold your medication until we can determine what is happening."

Question 8

What instruction should the nurse include in the discharge teaching plan of a client who has a transcutaneous electrical nerve stimulation (TENS)unit?

A) "Pain relief is sustained when stimulation is stopped."
B) "The current is adjusted by the physician."
C) "The electrodes are placed away from the painful site."
D) "You can perceive a pins and needles sensation."

Question 9

The physician orders a dose of medication that does not resolve the client's chronic pain.When the nurse questions the order,the physician explains that he or she fears the client will develop an addiction with higher drug dosages.What is the nurse's best response?

A) Administer the medication as ordered.
B) Assist the client to use guided imagery.
C) Consult with the pain control specialist.
D) Explain to the client that lower doses are better.

Question 10

During preoperative assessment,the client tells the nurse about taking NSAIDs for years.What question is most important for the nurse to ask?

A) "Did you ever have a problem with bleeding?"
B) "Do you bruise easily?"
C) "How many tablets do you take every day?"
D) "When was the last time you took your NSAID?

Question 11

The nurse is assigned to care for the following four clients who have the potential for having pain.Which client is most likely not to be treated adequately for this problem?

A) Middle-aged woman with a fractured arm
B) Client with expressive aphasia
C) Younger adult with metastatic cancer
D) Client who has undergone an appendectomy

Question 12

The nurse anticipates that the client who rates pain as 10 on a scale of 1 to 10 has undergone which surgical procedure?

A) Cranial surgery
B) Leg surgery
C) Neck surgery
D) Upper abdominal surgery

Question 13

The nurse is caring for four clients who are reporting pain.Based on the following assessments and histories,which client's pain is most likely chronic in nature?

A) Foley catheter inserted 30 minutes ago with a heart rate of 100 beats/min
B) History of heart disease with a heart rate of 120 beats/min
C) History of fibromyalgia with a blood pressure of 110/70 mm Hg
D) Hip replacement surgery with a blood pressure of 170/90 mm Hg

Question 14

The client is taking an oxycodone-acetaminophen combination (Tylox)at home daily for chronic pain management.What instruction does the nurse give this client?

A) "Avoid taking aspirin while you are on this medication."
B) "Drink plenty of water and eat foods high in fiber."
C) "Stop this medication after 3 days if the pain persists."
D) "Weigh yourself daily to determine whether you are retaining sodium or water."

Question 15

When is the nurse correct in decreasing the dose of pain medication in a client with end-stage cancer?

A) The spouse is worried that the client may become addicted.
B) The client wants to remain alert during the visit of a long-time friend.
C) The client has lost considerable weight and does not want to eat.
D) The client is becoming combative at night.

Question 16

The nurse is caring for a client who was medicated for pain 1 hour ago.The client states that the medication is not working and the pain is still present.What is the first action that the nurse will take?

A) Assess the client to determine a pain score.
B) Believe the client's report of pain.
C) Wait until it is time for the next pain medication dose.
D) Teach the client how to use guided imagery.

Question 17

A client who has been taking oxycodone (OxyContin)for an extended period of time comes to the clinic reporting that the drug is no longer relieving his pain.Which category would be given to the client's complaint?

A) Addiction
B) Physical dependence
C) Pseudoaddiction
D) Tolerance

Question 18

A client with chronic pain is being discharged from the hospital.When planning the client's pain relief regimen for home,it is most important for the nurse to communicate with which member of the health care team?

A) Advanced practice nurse
B) Home health care nurse
C) Primary physician
D) Psychologist

Question 19

Why does the nurse always ask the client his or her pain level after taking routine vital signs?

A) To determine whether pain is influencing blood pressure and heart rate
B) To determine the need for more frequent vital sign measurement
C) To ensure that pain assessment occurs on a regular basis
D) To follow McCaffery's guidelines on pain management

Question 20

Which assessment finding is cause for concern in a client who has taken 4 grams of acetaminophen (Tylenol)to relieve back pain?

A) Difficulty with urination
B) Decreased respiratory rate
C) Gastrointestinal bleeding
D) Increased liver function tests

Question 21

Which instruction is the most accurate for the nurse to give a client who has a patient-controlled analgesia device (PCA)after abdominal surgery?

A) "Instruct your visitors to press the button for you when you are sleeping."
B) "Push the button every 15 minutes whether you feel pain at that time or not."
C) "Push the button when you first feel pain instead of waiting until pain is severe."
D) "Try to go as long as you possibly can before you press the button."

Question 22

A client is postoperative day one and has a patient-controlled analgesia (PCA)pump with a continuous basal dose for pain control.Currently,the client is stating that the operative pain is escalating.What is the first action of the nurse?

A) Try diversion to take the client's mind off the pain.
B) Ask the client to ambulate around the unit.
C) Assess the client's pain according to PQRST.
D) Call the physician to request an order to increase the basal dose.

Question 23

When assessing a client who is taking long-term ibuprofen (Motrin)for pain,the nurse finds numerous areas of bruising.What is the nurse's first action?

A) Assess for gastric discomfort.
B) Assess for the presence of pain.
C) Continue to monitor bruising.
D) Place client on falls precaution.

Question 24

A client is stating that he has the sensation of burning,aching,and dullness.Which afferent nerve fibers should be transmitting the pain?

A) A delta fibers
B) C fibers
C) A alpha fibers
D) A beta fibers

Question 25

Which client would the nurse suggest should try subcutaneous opioid analgesia for pain management?

A) Client who has had a surgical procedure
B) Client with back pain who likes to walk
C) Client with cancer who is nauseous
D) Client experiencing acute chest pain

Question 26

Which client does the nurse assess first for pain control?

A) Older client with chronic rheumatoid arthritis
B) Client postoperative day three walking in the hallway
C) Sleeping client with an epidural pump
D) Quiet client with pancreatic cancer curled up in bed

Question 27

A client is admitted to the hospital with a history of oxycodone (Percodan)abuse.For which clinical manifestations does the nurse observe the client?

A) Anorexia and weight loss
B) Decreased heart rate and respirations
C) Muscle twitching and profuse perspiration
D) Sedation and constipation

Question 28

Which is most indicative of pain in an older client who is confused?

A) Decreased blood pressure
B) Screaming
C) Facial grimace
D) Restlessness
E) Crying
F) Decreased respirations

Question 29

A client who is at the end of life is being given morphine for pain management.The family expresses concern that the morphine may cause the client to stop breathing and die.What is the nurse's best response?

A) "He needs the morphine to prevent pain."
B) "His respirations are not affected by the morphine."
C) "We will decrease the dose if his breathing slows."
D) "We will give him oxygen to help with his breathing."

Question 30

Before surgery,the nurse observes the client listening to music on the radio.Based on this observation,the nurse may try which nonpharmacologic intervention for pain relief in the postoperative setting?

A) Cutaneous skin stimulation
B) Hypnosis
C) Imagery
D) Radiofrequency ablation

Question 31

The nurse assesses several postoperative clients receiving patient-controlled epidural analgesia (PCEA).Which client does the nurse prioritize to assess first?

A) Client receiving bupivacaine (Marcaine) describing "inability to move legs"
B) Client receiving fentanyl (Sublimaze) describing "itchy arms"
C) Client receiving hydromorphone (Dilaudid) describing "full feeling"
D) Client receiving morphine describing "difficulty staying awake"

Question 32

A client has epidural analgesia with bupivacaine (Marcaine)for pain relief.For which condition should the nurse assess this client?

A) Extremity itching
B) Inability to raise legs off the bed
C) Nausea and vomiting
D) Respiratory rate of 8 breaths/min

Question 33

A client has a history of alcohol abuse.Which pain relief regimen does the nurse anticipate if morphine (MS Contin)is given for pain?

A) A higher dose of opioids will be needed to provide effective pain relief.
B) A lower dose of opioids will be needed to provide effective pain relief.
C) The appropriate drug selection is an opioid agonist-antagonist combination.
D) The client will receive no pain relief from the morphine.

Question 34

The nurse is caring for four clients.Which client assessment is the most indicative of having pain?

A) Blood pressure 150/70 mm Hg and sleeping
B) Client stating that he is "anxious"
C) Heart rate of 105 beats/min and restlessness
D) Postoperative client with a neck incision

Question 35

The nurse accidentally administers 10 mg of morphine intravenously to a client who had been given another dose of morphine,5 mg IV,about 30 minutes earlier.What action must the nurse be prepared to take?

A) Administer naloxone (Narcan).
B) Administer oxygen.
C) Assist with intubation.
D) Monitor pain level.

Question 36

Which statement made by a nurse represents the need for further education regarding pain management in older adult clients?

A) "Older adults are at greatest risk for undertreated pain."
B) "Older adults tend to report pain less often than younger adults."
C) "Older clients usually have more experience with pain than younger clients."
D) "Older clients have a different pain mechanism and do not feel it as much."

Question 37

An older client just returned from surgery and is rating pain as "8" on a 0 to 10 scale.Which medications are unsafe choices for treatment of severe pain in this older adult?

A) Meperidine (Demerol)
B) Methadone (Dolophine)
C) Propoxyphene (Darvocet)
D) Morphine (Durmorph)
E) Codeine

Question 38

A client with colon cancer is discharged to home with morphine for pain management.He is having episodes of nausea and vomiting.Which route of morphine administration would be most advantageous to use?

A) Oral
B) Rectal
C) Intravenous
D) Intramuscular