Chapter 34- Pain Management Nursing School Test Banks

 

1.

The nurse is administering medications to a patient with neuropathic pain. The patient asks why he is getting an antidepressant medication because he is not depressed. Which of the following is the best response by the nurse?

A)

All patients with pain have at least some depression.

B)

Antidepressants have been shown to have pain-relieving qualities in patients with neuropathic pain.

C)

Treating your depression, even if you dont think you have it, will help control your pain.

D)

The doctor thinks it will help with your pain.

Ans:

B

Feedback:

Antidepressants are helpful in treating neuropathic and persistent pain. All patients with pain dont necessarily have depression.

2.

A nurse is evaluating the effectiveness of the pre-operative teaching regarding pain control. Which statement by the patient would indicate a need for further education?

A)

I will push my PCA button before I get up to go to the bathroom.

B)

I will have my wife push the PCA button when Im asleep.

C)

I will bring my favorite music to listen to after my surgery.

D)

I will make sure to drink plenty of water so I dont get constipated from the pain medication.

Ans:

B

Feedback:

The patient should be the only one to administer medication via the PCA pump. Using the pump prior to getting out of bed and/or ambulating will help decrease the pain. Distraction is an effective nonpharmacologic means of dealing with pain. Constipation is a common side effect from many pain medications. Increasing fluid intake is one way of attempting to prevent it.

3.

A nurse is caring for a patient who is receiving morphine via a patient controlled analgesia (PCA) pump. When assessing the patient, she notes that his respiratory rate is 4. What should the nurse do first?

A)

Notify the physician

B)

Stop the PCA pump

C)

Administer naloxone

D)

Increase the primary IV rate

Ans:

B

Feedback:

A side effect of morphine is respiratory depression. In this situation, the nurse should first stop the PCA pump and then notify the physician. Naloxone is used to reverse the sedative effects of opioids but this is not the first step.

4.

A student nurse is preparing a presentation on pain management. What information regarding nonpharmacological interventions should he include? Select all that apply.

A)

Use cold packs for muscle spasms and surgical site pain.

B)

Dry heat penetrates deeper than moist heat.

C)

Ice packs should not be left on longer than 20 minutes.

D)

Massage can stimulate circulation.

E)

Distraction is useful for short pain periods.

Ans:

A, C, D, E

Feedback:

Moist heat penetrates deeper than dry heat. Cold packs are useful for muscle spasms, back pain, and surgical site pain. Cold packs should not be left in place for greater than 20 minutes at a time. Massage can stimulate circulation and aid in relaxation. Distraction is a useful tool for short pain periods such as starting an IV or changing a dressing.

5.

The physician has ordered a patient controlled analgesia (PCA) pump for a patient. Which assessment finding would cause the nurse to question the order?

A)

B/P 178/92 and pulse 118

B)

Confused to time and place

C)

Right shoulder immobilizer in place

D)

Rates pain an 8 on a 1 to 10 scale

Ans:

B

Feedback:

Patients must be cognitively and physically capable of using the PCA equipment safely. Confusion in a patient would lead the nurse to question the patients ability to correctly use the PCA.

6.

The action of ibuprofen is to

A)

Provide narcotic pain relief

B)

Have a antiprostaglandin effect on the CNS

C)

Close the gate of the A-delta fibers

D)

Enhance the endorphins of the CNS

Ans:

B

Feedback:

NSAIDs are generally effective for pain-related tissue damage. The analgesic action of these drugs has antiprostaglandin effects on both the peripheral and central nervous systems.

7.

Besides controlling pain of the post-abdominal surgery patient with narcotics, the nurse suggests to the patient that he

A)

Focus on pain relief

B)

Use distraction

C)

Describe the pain

D)

Think about the next dose

Ans:

B

Feedback:

Distraction is useful when patients are undergoing brief periods of sharp, intense pain such as dressing changes, wound debridement , biopsy, or incident pain from shifting positions.

8.

An 80-year-old woman has been suffering from knee pain for the past 3 years. The patient requires a knee replacement and has diminished mobility. The most appropriate nursing diagnosis is

A)

Chronic pain related to knee disability as defined by guarded gait

B)

Acute pain related to degenerative joint disease as evidenced by static gait

C)

Altered mobility related to pain as defined by guarded gait

D)

Inability to perform activities of daily living related to chronic pain

Ans:

A

Feedback:

The most appropriate nursing diagnosis is Chronic pain related to knee disability as defined by guarded gait.

9.

Which of the following actions is most appropriate for the nurse to take in response to the patients request for pain medication on his first postoperative day? The patient has an order for a narcotic analgesic every 3 to 4 hours and he received his last dose 3 hours earlier.

A)

Provide the patient with pain medication

B)

Tell the patient that the pain cannot be severe

C)

Document and ask the patient to wait 1 hour

D)

Contact the physician for a change in medication

Ans:

A

Feedback:

Inadequate or poor pain assessment is a leading factor in poor pain control because the healthcare professional may not know a patient has pain. The nurse must provide the next dose of pain medication.

10.

A nurse is assessing a patients pain. The nurse notes which of the following database findings that is indicative of acute pain?

A)

Pupil constriction

B)

Decreased pulse rate

C)

Increased blood pressure

D)

Decreased respiratory rate

Ans:

C

Feedback:

The increase in blood pressure that may accompany acute pain is believed to be due to overactivity of the sympathetic nervous system.

11.

When the male patient on his first postoperative day after chest surgery appears stoic and does not ask for any pain medication, the nurse should

A)

Document the patients lack of medication

B)

Assume the patient does not need medication

C)

Ask the patients family if he ever uses pain medicines

D)

Actively solicit information about the patients pain level

Ans:

D

Feedback:

Some cultures see pain tolerance as a virtue; often men are expected to tolerate pain more stoically than women do. Healthcare providers need to recognize the patients cultural beliefs and not impose their own judgments.

12.

A child describes intense pain in the chest and head while eating a popsicle. The pain the child is experiencing is termed

A)

Fear

B)

Allodynia

C)

Thermal stimulation

D)

Hyperalgesia

Ans:

B

Feedback:

Allodynia is a pain sensation produced by an innocuous stimulus such as light touch.

13.

When a 17-year-old male athlete injures his knee during basketball practice and refuses to go to the school nurse, he states he does not have pain. The school nurse assesses the students knee and recognizes that by stating he does not have pain the student is

A)

Not injured

B)

In need of counseling

C)

Not showing weakness to his peers

D)

Ignoring the pain

Ans:

C

Feedback:

To recognize or give in to pain may seem like a sign of weakness in the adolescent.

14.

When parents of a preschool child who is experiencing pain from ear surgery inform the nurse that the child is withdrawn from them and acts ambivalent, the nurse responds that the preschoolers behavior

A)

Is a normal response

B)

Needs further evaluation

C)

Demonstrates regression

D)

Indicates potential abuse

Ans:

A

Feedback:

Although parents are childrens greatest source of comfort and support, children may appear ambivalent toward them, as though they blame them for pain. Encourage and support parents in such instances, helping them understand childrens responses.

15.

Which of the following guidelines regarding pain should be included in the nurses teaching plan for a group of parents with infants and toddlers?

A)

Pain can be a source of fear and threat to the toddlers security

B)

Toddlers are often reluctant to express pain

C)

Infants cannot express pain until 8 months of age

D)

Toddlers often try to be brave and not cry

Ans:

A

Feedback:

During the toddler and preschool years, children are achieving a sense of autonomy. Because pain can be a source of fear and threat to security, children respond with crying, anger, physical resistance, or withdrawal.

16.

The nurse identifies the pain described by a patient whose back discomfort began after an automobile accident and has persisted for 8 months as

A)

Acute

B)

Recurrent

C)

Chronic

D)

Malignant

Ans:

C

Feedback:

Chronic pain lasts for a prolonged period, and its cause is not amenable to specific treatment.

17.

Two hours after receiving a pain medication, the patient states he still is suffering from pain. Which question is appropriate to ask the patient first?

A)

Do you need your pain medication now?

B)

Please describe your pain on a scale of 0 to 10.

C)

Tell me where your pain is located.

D)

Tell me more about your pain.

Ans:

D

Feedback:

Pain intensity indicates the magnitude or amount of pain perceived. Terms used to describe pain intensity include none, mild, slight, moderate, severe, and excruciating. Pain intensity also may be described on a numeric scale. The most appropriate assessment question is one which allows for all information and is a broad question.

18.

When assessing a patients pain, the nurse should question the patient about location, intensity, quality of the pain, and

A)

Pain tolerance

B)

Level of consciousness

C)

Temporal pattern

D)

Objective signs

Ans:

C

Feedback:

Verbal reports by the patient indicate more clearly its location, intensity, quality, and temporal pattern. Level of consciousness and objective signs are assessments the nurse makes.

19.

Endogenous opioids such as endorphins

A)

Excite neural pathways

B)

Contribute to analgesia

C)

Cause muscle spasms

D)

Release neurotensin

Ans:

B

Feedback:

The opioid receptors, important for the inhibition of pain perception, are sites where endogenous opioids and exogenous opioids bind. Three groups of endogenous opioids relieve pain: enkephalins, endorphins, and dynorphins.

20.

The most important pathway for pain sensation is the

A)

Corticospinal tract

B)

Dorsal horn neural tract

C)

Afferent tract

D)

Spinothalamic tract

Ans:

D

Feedback:

The spinothalamic tract appears to be the most important pathway for pain sensation.

21.

A sudden blow to the head results in pain that is transmitted by which type of fibers?

A)

A-delta

B)

B-gamma

C)

C fibers

D)

D-delta

Ans:

A

Feedback:

A-delta fibers give rise to bright, sharp, well-localized pain that is immediately associated with injury.

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