Deck 31: Pain

Question 1

After receiving ibuprofen (Motrin)800 mg orally for right hip pain,the patient states that his pain is 8 out of 10 on the numerical pain scale.Which action should the nurse take?

A) Use nonpharmacological therapy while waiting 3 more hours before next dose.
B) Administer an additional 800 mg oral dose of ibuprofen right away.
C) Do nothing because the patient's facial expression indicates he is comfortable.
D) Notify the prescriber that the current pain management plan is ineffective.

Answer 1

Notify the prescriber that the current pain management plan is ineffective.

Question 2

Which drug might the primary care provider prescribe to help facilitate pain management in a client with chronic pain?

A) Selective serotonin reuptake inhibitor
B) Selective norepinephrine reuptake inhibitor
C) Opioid analgesic
D) Anti-emetic

Answer 2

Selective serotonin reuptake inhibitor

Question 3

A patient reports that he uses music therapy to help control his chronic pain.Music therapy works by prompting the release of endogenous opioids during which stage of the pain process?

A) Perception
B) Transduction
C) Transmission
D) Modulation

Answer 3

Modulation

Question 4

When should the nurse assess pain?

A) Whenever a full set of vital signs is taken
B) During the admission interview
C) Every 4 hours for the first 2 days after surgery
D) Only when the patient reports pain

Question 5

A patient is prescribed morphine sulfate 4.0 mg intravenously for postoperative pain.Which action should the nurse take before administering the medication?

A) Monitor the patient's respiratory status.
B) Auscultate the patient's heart sounds.
C) Check blood pressure in supine and sitting positions.
D) Monitor the patient for psychological drug dependence.

Question 6

How should the nurse classify pain that a patient with lung cancer is experiencing?

A) Radiating
B) Deep somatic
C) Visceral
D) Referred

Question 7

A patient who underwent a left above-the-knee amputation reports pain in his left foot.The nurse should document this finding as what type of pain?

A) Psychogenic
B) Phantom
C) Referred
D) Radiating

Question 8

The nurse plays music for a child with leukemia who is experiencing pain.Which pain management technique is this nurse using?

A) Distraction
B) Guided imagery
C) Sequential muscle relaxation
D) Hypnosis

Question 9

Which side effects associated with opioid use may improve after taking a few doses of the drug?

A) Constipation
B) Drowsiness
C) Dry mouth
D) Difficulty with urination

Question 10

A patient who sustained rib fractures in a motor vehicle accident is stating that his pain medication is ineffective.Inadequate pain control places this patient at risk for which complication?

A) Metabolic alkalosis
B) Pneumothorax
C) Pneumonia
D) Hemothorax

Question 11

The nurse uses his hands to direct energy fields surrounding the patient's body.After this intervention,the patient states that his pain has lessened.How should the nurse document the intervention?

A) Tactile distraction was performed and appeared effective in reducing pain.
B) Guided imagery was effective to relax the patient and reduce the pain.
C) Therapeutic touch was performed; patient verbalized lessening of pain after treatment.
D) Sequential muscle relaxation was performed; patient states pain is less.

Question 12

A patient prescribed an NSAID,naproxen (Aleve,Naprosyn),for treatment of arthritis reports stomach upset.What should the nurse instruct the patient to do?

A) Notify the prescriber immediately.
B) Take the medication with food.
C) Take the medication with 8 ounces of water.
D) Take the medication before bedtime.

Question 13

The nurse administers acetaminophen 325 mg and codeine 30 mg orally to a patient reporting a severe headache.When should the nurse reassess the patient's pain?

A) 15 minutes after administration
B) 60 minutes after administration
C) 90 minutes after administration
D) Immediately before the next dose is due

Question 14

The nurse is assessing an intubated patient who returned from coronary artery bypass surgery 3 hours ago.Which assessment finding might indicate that this patient is experiencing pain?

A) Blood pressure 160/82 mm Hg
B) Temperature 100.6°F
C) Heart rate 80 beats/min
D) Oxygen saturation 95%

Question 15

A client reports taking acetaminophen (Tylenol)to control osteoarthritis.Which instruction should the nurse give the patient requiring long-term acetaminophen use?

A) Caution the patient against combining acetaminophen with alcohol.
B) Explain that acetaminophen increases the risk for bleeding.
C) Advise taking acetaminophen with meals to prevent gastric irritation.
D) Explain that physical dependence may occur with long-term oral use.

Question 16

In which process do peripheral nerves carry the pain message to the dorsal horn of the spinal cord?

A) Transduction
B) Transmission
C) Perception
D) Modulation

Question 17

A patient suddenly develops right lower-quadrant pain,nausea,vomiting,and rebound tenderness.How should the nurse classify this patient's pain?

A) Acute
B) Chronic
C) Intractable
D) Neuropathic

Question 18

A patient who sustained a leg laceration in an industrial accident is brought to the emergency department.The area around the laceration is red,swollen,and tender.Which substance is responsible for causing this response?

A) Histamine
B) Prostaglandin
C) Bradykinin
D) Serotonin

Question 19

The nurse is teaching a client who sustained an ankle injury about cold application.Which instruction should the nurse include in the teaching plan?

A) Place the cold pack directly on the skin over the ankle.
B) Apply the cold pack to the ankle for 30 minutes at a time.
C) Check the skin frequently for extreme redness.
D) Keep the cold pack in place for at least 24 hours.

Question 20

Which nursing diagnosis is most appropriate for the patient who returns from the postanesthesia care unit after undergoing right hemicolectomy surgery for colon cancer?

A) Acute Pain secondary to surgery
B) Acute Pain (abdominal) secondary to surgery for colon cancer
C) Chronic Pain secondary to cancer diagnosis
D) Chronic Pain (abdominal) secondary to abdominal surgery

Question 21

What physiological process causes the severe pain of menstrual cramps?

A) Mechanical stimuli
B) Thermal stimuli
C) Prostaglandin activity
D) Histamine activity

Question 22

A patient with Raynaud's disease receives no symptomatic relief with diltiazem (Cardizem).Which surgical intervention might be a treatment option for this patient to help provide symptomatic relief?

A) Cordotomy
B) Rhizotomy
C) Neurectomy
D) Sympathectomy

Question 23

A patient had a bowel resection 5 days ago.Which request by the patient might alert the nurse that the patient has a history of substance abuse?

A) Oral pain medication once every 6 to 8 hours
B) Patient-controlled analgesic
C) Oral pain medication instead of the IV form
D) Only nonpharmacological pain measures

Question 24

A patient with a history of mitral valve replacement,hypertension,and type 2 diabetes mellitus undergoes emergency surgery to remove an embolus in her right leg.Which factor contraindicates the use of epidural analgesia in this patient?

A) Anticoagulant therapy
B) Diabetes mellitus
C) Hypertension
D) Embolectomy

Question 25

A patient develops a respiratory rate 6 breaths/min after receiving IV hydromorphone (Dilaudid)2.0 mg.Which medication should the nurse anticipate administering to this patient after notifying the prescriber of this side effect?

A) Physostigmine (Antilirium)
B) Flumazenil (Romazicon)
C) Naloxone (Narcan)
D) Protamine sulfate

Question 26

The pediatric nurse is caring for a 4-year-old child who is experiencing chronic pain secondary to tissue injury from past sickle cell anemia crises.Which of the following nonpharmacological pain reduction interventions might the nurse implement? Have the child:

A) Perform vigorous activity
B) Practice visualization
C) Listen to rap music
D) Watch a funny movie

Question 27

Which characteristic about pain would the nurse most consider when developing a pain management plan for a patient with chronic lower back pain?

A) An objective experience that disrupts daily living that can be measured with altered vital signs
B) An unpleasant sensory and emotional experience association with actual or potential tissue damage, or described in terms of such damage
C) A generalized response of the body as a result of trauma or damage to the tissues resulting in discomfort
D) An emotional response to tissue damage that differs significantly from one individual to another

Question 28

A 70-year-old male with diabetic peripheral neuropathy reports a burning sensation in his feet.He also states,"Those pain pills make me feel funny and they don't help my pain,so I don't take them." Which of the following is likely to be most beneficial for treating this patient's neuropathic pain?

A) Opioid analgesic (morphine)
B) NSAID (ibuprofen)
C) Antiepileptic drug (gabapentin)
D) Narcotic analgesic with acetaminophen (hydrocodone)

Question 29

Which action should the nurse take first when the patient has a score of 4 on the sedation rating scale?

A) Stimulate the patient.
B) Prepare to administer naloxone (Narcan).
C) Administer a dose of pain medication.
D) Notify the physician immediately.

Question 30

To provide the most analgesic effect,a medication should bind with and block the pain impulse especially at which of the following opioid receptor sites?

A) Mu
B) Delta
C) Kappa
D) Sigma

Question 31

The nurse conducting a pain assessment for a patient would recognize deep somatic pain as which of the following?

A) Achy
B) Superficial
C) Radiating
D) Crampy

Question 32

An older adult receiving hospice care has dementia as a result of metastasis to the brain.His bone cancer has progressed to an advanced stage.Why might the client fail to request pain medication as needed? The client:

A) Experiences less pain than in earlier stages of cancer
B) Cannot communicate the character of his pain effectively
C) Knowledges pain at a later time than when it occurs
D) Relies on caregiver to provide pain relief without asking

Question 33

Which expected outcome is best for the patient with a nursing diagnosis of Acute Pain related to movement and secondary to surgical resection of a ruptured spleen and possible inadequate analgesia?

A) The patient will verbalize a reduction in pain after receiving pain medication and repositioning.
B) The patient will rest quietly when undisturbed.
C) On a scale of 0 to 10, the patient will rate pain as a 3 while in bed or as a 4 during ambulation.
D) The patient will receive pain medication every 2 hours as prescribed.

Question 34

The nurse is caring for a patient with chronic low back pain.The patient reports taking 800 mg of ibuprofen tid for the past 12 years.For this patient,which lab result is most important for the nurse to review?

A) WBC with differential
B) Serum sodium, potassium, chloride, and CO₂
C) Hemoglobin and hematocrit
D) Platelet count

Question 35

What is the primary reason the nurse incorporates pain assessment as a part of vital signs measurement?

A) Asking about pain may prompt patients to report pain more readily.
B) Frequent pain assessment is required by the state's nurse practice act.
C) Pain is a vital sign much like blood pressure and heart rate.
D) Pain assessment indicates the nurse cares about the patient.

Question 36

A patient receiving an epidural analgesic complains of a headache.Which of the following should the nurse suspect?

A) Catheter migration
B) Local anesthesia toxicity
C) Common side effect of the analgesic
D) Dural puncture

Question 37

After undergoing dural puncture while receiving epidural pain medication,a patient reports a headache.Which action can help alleviate the patient's pain?

A) Encourage the client to ambulate to promote flow of spinal fluid.
B) Offer caffeinated beverages to constrict blood vessels in his head.
C) Encourage coughing and deep breathing to increase CSF pressure.
D) Restrict oral fluid intake to prevent excess spinal pressure.

Question 38

Which pain management task can be safely delegated to nursing assistive personnel?

A) Assessing the quality and intensity of the patient's pain
B) Evaluating the effectiveness of pain medication
C) Providing a therapeutic back massage
D) Administering oral dose of acetaminophen

Question 39

What is typically the most reliable indicator of pain?

A) Patient's self-report
B) Past medical history
C) Description by caregiver(s)
D) Behavioral cues

Question 40

The nurse is caring for an immobile patient with chronic,unrelieved pain that is frequently severe.For what potential complication should the nurse monitor?

A) Deep vein thrombosis
B) Hypotension
C) Dehydration
D) Hypoglycemia

Question 41

The patient reports pain after surgery,ranking it 6 on a scale of 1 to 10.She tells the nurse,"I don't want to be all doped up.My family is coming to visit and I want to be alert enough to visit with them." Which of the following medications would likely be most effective for postoperative pain relief without excessive sedation?

A) Fentanyl IV
B) Morphine IV
C) Ibuprofen PO
D) Hydrocodone PO

Question 42

The nurse is caring for a patient in the late stage of Alzheimer's disease who is noncommunicative.The nurse suspects the patient is experiencing pain based on what assessment findings? Select all that apply.

A) Rapid blinking
B) Labored breathing
C) Reduced respiratory rate
D) Nighttime wakefulness
E) Restlessness

Question 43

The nurse meets with a patient with chronic pain who has tried a new program to manage pain.On a scale of 1 to 10,she reports pain reduction from an 8 to a 5.What questions would the nurse ask to further evaluate the effectiveness of this program? Select all that apply.

A) "Does this reduction in pain allow you to perform daily activities?"
B) "Are you satisfied with the degree of pain relief you have achieved?"
C) "May I review what you have recorded in your pain journal?"
D) "Is the pain less than before you started the program?"
E) "How has your family responded to the reduction in your pain?"

Question 44

The nurse is talking to a patient with chronic pain secondary to psoriatic arthritis in multiple joints about developing a pain management program.Which goal identified by the patient would be realistic for the program?

A) "I would like for all my pain to be gone and not recur in the future."
B) "I want to be able to do all the things I used to do before this pain started."
C) "I want to control the pain enough to allow me to sleep through the night."
D) "My goal is to lead a normal life without experiencing so much pain every day."

Question 45

A 64-year-old patient just returned from surgery.She is breathing rapidly and moving constantly in bed.She states,"I am scared and I hurt so much." What would be an appropriate intervention? Select all that apply.

A) Immediately notify the surgeon of these data (physical symptoms and patient's statement).
B) State calmly, "I am going to do everything I can to make you more comfortable."
C) Tell the patient you would like to help her calm down and take some deep breaths.
D) Ask the nursing assistive personnel to stay with the patient while you get an analgesic for her.
E) Turn on the television to distract her from the pain and anxiety.

Question 46

A 73-year-old patient admitted after a stroke has expressive aphasia.Which pain intensity scales would be appropriate to use with this patient? Select all that apply.

A) Visual analogue
B) Numerical rating
C) Wong-Baker face rating
D) Simple descriptor
E) PAINAD scale

Question 47

Which of the following actions would the nurse prioritize for the patient who is experiencing chronic back pain that interferes with activities of daily living (ADLs)?

A) Maintain a pain journal to document quality of his pain experience.
B) Meet with the healthcare team to discuss a pain management plan.
C) Attempt to take only analgesic medication when absolutely needed.
D) Suggest use of a deep-pressure back massage with effleurage technique.