Question 1

The nurse is reviewing orders for a patient with diabetic neuropathy. Which medication should the nurse expect to administer?

Accepted Answer

Carbamazepine (Tegretol) is commonly used to treat neuropathic pain, including diabetic neuropathy, by stabilizing neural membranes and reducing pain signals.

Question 2

A patient with chronic back pain has a new order for a fentanyl (Duragesic) patch. As the nurse applies the patch, the patient states, "I'm really glad to get that patch on. I am really hurting bad." Which response by the nurse is correct?

Accepted Answer

Fentanyl patches are designed for slow release of medication over an extended period, typically taking several hours to begin providing pain relief. Offering an immediate-release pain medication in the meantime is appropriate for managing acute pain until the patch begins to work.

Question 3

A patient with chronic pain is on a sustained-release opioid that is ordered every 12 hours. After 6 hours, the patient complains of increasing pain. Which intervention by the nurse is appropriate?

Accepted Answer

Obtaining an order for an immediate-release opioid for breakthrough pain is appropriate in this situation. Sustained-release opioids are designed for continuous pain control, but patients may sometimes experience breakthrough pain before the next scheduled dose. Immediate-release opioids can be used to manage this without disrupting the schedule of the sustained-release medication.

Question 4

A physician writes an order to give a saline injection to a patient who has been requesting frequent meperidine (Demerol) shots. Which initial response by the licensed practical nurse (LPN) is best?

Accepted Answer

The best initial response by the LPN is to communicate their discomfort with the physician's order to administer saline under the guise of it being Demerol. This approach respects the nurse's ethical obligation to maintain honesty and transparency in patient care.

Question 5

The nurse is having difficulty assessing the pain of a mentally impaired patient who has an approximate functional level of a 4-year-old child. Which method should the nurse use to determine the patient's pain level?

Accepted Answer

The FACES scale is designed for children and individuals with cognitive impairments, allowing them to point to a face that best represents their pain level, making it suitable for someone with the functional level of a 4-year-old.

Question 6

The nurse is caring for a group of patients. Which patient is experiencing chronic pain?

Accepted Answer

Chronic pain is defined as pain that persists for more than three to six months. The patient who fell off a ladder 6 months ago and injured his back is experiencing chronic pain, as the duration exceeds this timeframe.

Question 7

A patient has been on opioids for 3 months to control pain caused by injuries from a motor vehicle crash. The patient asks about the risk of withdrawal symptoms when the drugs are no longer needed. How should the nurse respond to the patient?

Accepted Answer

Tapering the dose of opioids gradually is a standard method to avoid or minimize withdrawal symptoms. This approach allows the body to adjust slowly to lower levels of the drug, reducing the risk and severity of withdrawal symptoms.

Question 8

The nurse is caring for a group of patients. Which patient is experiencing acute pain?

Accepted Answer

Acute pain is typically sudden and sharp, often related to a specific injury or illness, and is of short duration. Pancreatitis, an inflammation of the pancreas, causes acute pain in the abdominal area, fitting the criteria for acute pain. The other options describe conditions that are chronic, meaning the pain lasts for a longer period, often months or years.

Question 9

The nurse is performing a pain assessment on a newly admitted patient. Which question best assesses the severity of pain?

Accepted Answer

Rating pain on a scale of 0 to 10 is a direct method to assess the severity of pain, allowing for quantifiable and subjective measurement from the patient's perspective.

Question 10

A patient with peripheral neuropathy states, "I don't know why the doctor put me on an antidepressant. I am not depressed!" Which response by the nurse is best?

Accepted Answer

Antidepressants, particularly those in the tricyclic antidepressant category, have been found to be effective in treating neuropathic pain, even in the absence of depression. This is due to their effects on neurotransmitters involved in pain modulation.

Question 11

The nurse is caring for a patient who is receiving morphine via PCA. Which finding would be of most concern to the nurse?

Accepted Answer

Respirations of 10 breaths/min indicate respiratory depression, which is a serious side effect of morphine and requires immediate attention.

Question 12

The nurse is caring for a patient who underwent an amputation of the left arm. The patient reports level 9 pain on a 0-to-10 scale. Which action should the nurse take?

Accepted Answer

Administering 4 mg of morphine intravenously as prescribed is appropriate for managing severe pain (level 9 on a 0-to-10 scale) following an amputation. Pain management is crucial in post-operative care, and morphine is a potent analgesic used for severe pain.

Question 13

The nurse is caring for a patient with lung cancer who has been receiving morphine for 2 weeks and reports the medication is no longer effective. Which is the patient likely experiencing?

Accepted Answer

Tolerance occurs when a patient's body becomes accustomed to a medication over time, requiring higher doses to achieve the same effect. In this case, the patient's need for an increased dose of morphine to manage pain indicates tolerance, not physical dependence, addiction, or pseudoaddiction.

Question 14

A patient receiving large doses of opioids is lethargic and difficult to arouse, with a respiratory rate of 6 per minute and constricted pupils. Which medication should the nurse anticipate being prescribed?

Accepted Answer

Naloxone (Narcan) is an opioid antagonist used to reverse the effects of opioid overdose, including respiratory depression and central nervous system depression. The patient's symptoms suggest opioid overdose.

Question 15

The nurse is caring for a patient who was in a motor vehicle accident and has multiple fractures. The patient reports level 9 pain on a 0-to-10 scale. Which route should the nurse use to administer the medication for quickest relief of pain?

Accepted Answer

The IV (intravenous) route is the fastest way to deliver medications directly into the bloodstream, providing the quickest relief of pain, especially in a situation involving severe pain like a level 9 on the pain scale.

Question 16

The nurse is preparing to provide an opioid medication for a patient's postoperative pain. Which action should the nurse take first?

Accepted Answer

Determining the respiratory rate is crucial before administering an opioid medication because opioids can depress the respiratory system, leading to respiratory distress or failure if the patient's respiratory rate is already low.

Question 17

The nurse enters a room just as a patient's daughter pushes the button of his IV patient-controlled analgesia (PCA) pump. Which response by the nurse is appropriate?

Accepted Answer

C is the correct response because patient-controlled analgesia (PCA) pumps are designed for the patient to self-administer pain medication within prescribed limits. Allowing someone other than the patient to push the button can lead to overdose or other complications, as the person pushing the button may not be aware of the patient's current pain level or respiratory status.

Question 18

A patient reports that she has been having bloody stools for the past month. Which medication can the nurse expect to note on the medication history?

Accepted Answer

Naproxen (Aleve) is a nonsteroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal bleeding, which may present as bloody stools. NSAIDs can damage the stomach lining and increase the risk of ulcers and bleeding in the gastrointestinal tract.

Question 19

The nurse is caring for a patient with metastatic cancer. The patient is receiving 4 mg of morphine intravenously every 6 hours as needed and 5 mg hydrocodone/acetaminophen (Lortab) every 6 hours orally as needed for breakthrough pain. The patient reports the medication is effective, but the medication wears off before the dose is due. The nurse notifies the health care provider. Which order should the nurse anticipate?

Accepted Answer

Switching to an around-the-clock medication schedule can help maintain a consistent level of pain control and prevent the pain from becoming severe before the next dose is due, which is beneficial for managing chronic pain conditions like metastatic cancer.

Question 20

A patient who has just returned from abdominal surgery states, "I learned relaxation exercises, so I won't need any drugs." Which statement about relaxation therapy should the nurse use to guide care for this patient?

Accepted Answer

Relaxation therapy can be a valuable adjunct to traditional pain management strategies, such as the use of analgesics, especially in postoperative patients. It can help reduce the perception of pain, decrease anxiety, and improve patient outcomes, but it does not typically eliminate the need for medication entirely.

Quiz 10: Nursing Care of Patients in Pain