Chapter 43: Pain Management Nursing School Test Banks

Test Bank

MULTIPLE CHOICE

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

a.

Assess the patients 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.

ANS: C

Pain is a subjective measure. Therefore, the best way to assess a patients pain is to ask the patient to rate the pain. Nonverbal communication, such as body language, is not as effective in assessing pain, especially when the patient is oriented. Heart rate sometimes increases when a patient is in pain, but this is not a symptom that is specific to pain. Pain sometimes affects a patients ability to cope, but assessing the effect of pain on coping assesses the patients ability to cope; it does not assess the patients pain.

DIF: Understand REF: 962-963

OBJ: Be able to perform an assessment of a patient experiencing pain.

TOP: Assessment MSC: Pain

2. A nurse is caring for a patient who recently had an abdominal hysterectomy and states that she is experiencing severe pain. The patients 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?

ANS: D

The nurse must believe that a patient is in pain whenever the patient reports that he or she is in pain, even if the patient does not appear to be in pain. Whenever the patient reports pain, the nurse needs to collaborate with the patient to determine the best method of pain relief, whether it be medication, meditation, or repositioning. The nurse must be careful to not judge the patient based on vital signs or nonverbal communication and must not assume that the patient is seeking narcotics. The patient is a partner in pain management, so going to get narcotics to treat the pain without consulting with the patient first is not appropriate.

DIF: Understand REF: 962-963

OBJ: Describe guidelines for selecting and individualizing pain interventions.

TOP: Implementation MSC: Pain

3. 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.

ANS: A

The gate theory states that pain impulses cause pain when they get through gates that are open. Pain is blocked when the gates are closed. Nonpharmacologic pain relief measures, such as meditation, work by closing the gates, which keeps pain impulses from coming through. Meditation does not open pain gates or stop pain from occurring. Meditation also does not have an effect on pain neuroregulators.

DIF: Evaluate REF: 964 OBJ: Describe the physiology of pain.

TOP: Evaluation MSC: Pain

4. 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 students 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 patients 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.

ANS: 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.

DIF: Evaluate REF: 967-968 OBJ: Discuss common misconceptions about pain.

TOP: Planning MSC: Pain

5. 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

ANS: C

The patients perception of pain is influenced by psychological factors, such as anxiety and coping, which in turn influence the patients experience of pain. Each patients 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 patients pain perceptions.

DIF: Understand REF: 966-969 OBJ: Identify components of the pain experience.

TOP: Assessment MSC: Pain

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

ANS: C

A fentanyl patch is an extended-relief opioid that provides pain relief for 24 hours a day. This is ideal for patients who have chronic severe pain, such as those who have cancer. The other patients are expected to experience acute pain. Therefore, they will most likely benefit from oral or IV opioids for short-term pain relief.

DIF: Apply REF: 983

OBJ: Explain various pharmacological approaches to treating pain.

TOP: Implementation MSC: Pain

7. 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 patients 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

ANS: C

To reduce the accidental administration of IV medications into the epidural catheter, the tubing that leads to the epidural catheter needs to be labeled clearly. Medications used to reverse the action of the anesthetic medication need to be kept in a secured location, not in the patients room in an unsecured location. The epidural insertion site needs to be covered by a clear occlusive dressing to prevent infection and allow the nurse to assess the site. Patients receiving epidural anesthesia need to be monitored every 15 minutes until stabilized and then at least hourly.

DIF: Apply REF: 985-986

OBJ: Discuss nursing implications for administering analgesics.

TOP: Implementation MSC: Pain

8. 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

ANS: A

Some cultures prefer nonpharmacological measures for pain control. In the case of a patient in labor, relaxation with guided imagery is often an effective supplement for pain management because it provides women with a sense of control over their pain. Relaxation and guided imagery can be used during any phase of health or illness. TENS units are typically used to manage postsurgical and procedural pain. Herbal supplements need to be evaluated for safety during pregnancy. Additionally, some patients consider herbal supplements to be another form of medication, and they are not typically used to control acute pain. A pudendal block is a type of regional anesthesia; use of it does not respect the patients wishes for nonpharmacological pain control.

DIF: Apply REF: 977-981

OBJ: Describe applications for use of nonpharmacological pain interventions.

TOP: Implementation MSC: Pain

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.

ANS: C

A PCA is a device that allows the patient to determine the level of pain relief delivered, reducing the risk of oversedation. Its use often eases anxiety because the patient is not reliant on the nurse for pain relief. Other medications, such as oral analgesics, can be given in addition to the PCA machine. The PCA does have a time limit to prevent overdose, but the patient can lengthen the amount of time between doses. One benefit of PCA is that the patient does not need to rely on the nurse to administer pain medication; the patient determines when to take the medication.

DIF: Evaluate REF: 983-984

OBJ: Explain various pharmacological approaches to treating pain.

TOP: Implementation MSC: Pain

10. 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.

ANS: C

The best way to manage pain is to develop a schedule of medications that are given around the clock to prevent breakthrough pain. The nurse should not wait until pain is experienced because it takes medications 10-30 minutes to begin to relieve pain. The nurse administers pain medications before painful activities, such as walking, and administers intravenous medications when a patient is having severe pain.

DIF: Apply REF: 983

OBJ: Discuss nursing implications for administering analgesics.

TOP: Implementation MSC: Pain

11. 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 patients behavior and response to surgery?

a.

The surgery successfully cured the patients pain.

b.

The patients culture is possibly influencing the patients 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.

ANS: B

A patients culture often influences the patients expression of pain. In this case, the patient has just had surgery, and the nurse knows that this surgical procedure usually causes patients to experience pain. It is important at this time for the nurse to examine cultural and ethnic factors that are possibly affecting the patients lack of expression of pain at this time. Even if surgery corrects neurological factors that create chronic pain, surgery causes pain in the acute period. Urinary retention usually creates pain and does not mask surgical pain. The nurse is not allowing personal beliefs to influence pain management because the nurse is attempting to determine the reason why the patient is not verbalizing the experience of pain.

DIF: Apply REF: 969

OBJ: Explain how cultural factors influence the pain experience.

TOP: Assessment MSC: Pain

12. 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.

ANS: C

A common side effect of opioid analgesics is constipation. Therefore, the nurse encourages the patient to drink fluids and eat fiber to prevent constipation. Although medications can be irritating to the stomach, eating a diet high in fat does not prevent gastric ulcers. To best manage pain, the patient needs to take pain medication before painful procedures or activities or before pain becomes severe. As the patients pain gets better, the strength of the medications will decrease. IM, IV, and topical analgesics are used for more severe and chronic pain.

DIF: Apply REF: 981-982

OBJ: Discuss nursing implications for administering analgesics.

TOP: Implementation MSC: Pain

13. 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 patients 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

ANS: C

The appropriate nonpharmacological pain management intervention is to quietly play music that the patient finds relaxing. Music diverts a persons attention away from pain and creates relaxation. Reassessing the patients pain scores is done during evaluation. Building the patients expectation of the providers arrival does not address the patients pain. Although yoga promotes relaxation, nurses teach relaxation techniques only when a patient is not experiencing acute pain. Because the patient is having acute pain, this is not an appropriate time to provide patient teaching.

DIF: Apply REF: 978

OBJ: Describe applications for use of nonpharmacological pain interventions.

TOP: Implementation MSC: Pain

14. 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.

ANS: D

This patient is losing the ability to feel pain owing to peripheral neuropathy. The patient will no longer have protective reflexes to prevent injury to the feet. Wearing shoes prevents the patient from injuring the foot because they protect the feet. Shoes do not block pain perception, nor do they help people adapt to pain. Shoes are not a form of nonpharmacological pain relief. Wearing shoes will not have an effect on opening or closing the pain gates.

DIF: Apply REF: 964 OBJ: Describe the physiology of pain.

TOP: Implementation MSC: Pain

15. 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

ANS: 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.

DIF: Analyze REF: 965-966| 972-973

OBJ: Be able to perform an assessment of a patient experiencing pain.

TOP: Assessment MSC: Pain

16. 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.

ANS: B

The effectiveness of pain relief measures is determined by the patient. If the patient is satisfied with the amount of pain relief, then pain measures are effective. A patient who is sleeping and is difficult to arouse is possibly oversedated; the nurse needs to assess this patient further. The amount of medication left in the PCA syringe does not indicate whether pain management is effective. Pressing the button shows that the patient knows how to use the PCA but does not evaluate pain management.

DIF: Evaluate REF: 983-984| 989-992

OBJ: Evaluate a patients response to pain interventions. TOP: Evaluation

MSC: Pain

17. The nurse recognizes that which of the following is a modifiable contributor to a patients perception of pain?

a.

Age and gender

b.

Anxiety and fear

c.

Culture

d.

Previous pain experience

ANS: B

The nurse can take measures to ease the patients anxiety and fear related to pain. Age, gender, culture, and previous pain experience are all nonmodifiable factors that the nurse can help the patient to understand, but the nurse cannot alter them.

DIF: Understand REF: 966-969 OBJ: Identify components of the pain experience.

TOP: Assessment MSC: Pain

18. 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 patients pain during dressing changes?

a.

The patients 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 patients facial expressions are stoic during the procedure.

d.

The patient can tolerate more pain, so dressing changes can be performed more frequently.

ANS: A

The purpose of guided imagery is to allow the patient to alter the perception of pain. Guided imagery works in conjunction with analgesic medications, potentiating their effects. If the patient needs less pain medication during dressing changes, then guided imagery is helping to manage the patients pain. A rating of 6 on a 0 to 10 scale indicates that the patient is having moderate pain and shows that this patient is not experiencing pain relief at this time. A person who is stoic is not showing feelings, which makes it difficult to know whether or not the patient is experiencing pain. The ability to change dressings more frequently is not a way to evaluate the effectiveness of guided imagery.

DIF: Evaluate REF: 978-979| 989-990

OBJ: Evaluate a patients response to pain interventions. TOP: Evaluation

MSC: Pain

19. 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.

ANS: C

NSAIDs like ibuprofen most likely work by decreasing the synthesis of prostaglandins to inhibit cellular responses to inflammation. Ibuprofen does not remove factors that cause pain, nor does it enhance coping with pain. Opioids bind with opiate receptors to modify perceptions of pain.

DIF: Understand REF: 963| 981-982

OBJ: Explain how the physiology of pain relates to selecting interventions for pain relief.

TOP: Implementation MSC: Pain

20. 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 cant adjust the time for you. Im sorry, but you must take your pill right now.

ANS: C

STAT doses of medication can be given to patients in certain circumstances, as with an extensive dressing change. By asking to hold off on the dose, the patient is indicating that the dressing changes are extremely painful. The regularly scheduled dose might not be as effective for the patient. Oral medications take 30 to 60 minutes to take effect. If the nurse began the dressing change right then, the medication would not have been absorbed yet. The patient has the right to refuse to take a medication. It is the nurses responsibility to communicate with the provider and with the patient about a pain control plan that works for both.

DIF: Evaluate REF: 983

OBJ: Explain various pharmacological approaches to treating pain.

TOP: Implementation MSC: Pain

21. 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 nurses 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.

ANS: B

The maximum 24-hour dosage for acetaminophen is 4 grams. If the patient took 2 tablets of Vicodin ES every 6 hours, the patient would take in 6 grams of acetaminophen in 24 hours. This exceeds the safe dosage of acetaminophen, so the best action is to question this order. Giving the medication as ordered would possibly result in the patient taking more acetaminophen than what is considered a safe dose. Acetaminophen overdose can result in liver failure. NSAIDs are used to treat mild to moderate pain. At this moment, the patient is experiencing severe pain. Implementing music therapy is a nursing intervention and is an independent nursing action. Thus, an order to start music therapy is not needed.

DIF: Evaluate REF: 981-983

OBJ: Discuss nursing implications for administering analgesics.

TOP: Implementation MSC: Pain

22. 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.

ANS: B

Assessing pain intensity in children requires special techniques. Young children often have difficulty expressing their pain. The FACES scale assesses pain in children who are verbal. Because a 4-year-old is verbal, this is an appropriate scale to use with this child. Parents statement of pain is not an effective way to assess pain in children because childrens statements are the most important. The 0 to 10 pain scale is too difficult for a 4-year-old child to understand. Previous documentation by nurses will tell you what the childs pain has been but will not tell you the childs current pain intensity.

DIF: Understand REF: 967| 970-974

OBJ: Describe the components of pain assessment. TOP: Assessment

MSC: Pain

23. Which statement made by a nursing educator best explains why it is important for nurses to determine a patients 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.

ANS: B

In providing effective pain management, it is important to understand the patients history, what drugs the patient has already tried, and what interventions work best or have negative actions. It is not the nurses responsibility to judge or question a patients pain or label her as a drug seeker. Nurses need to avoid labeling patients as drug seekers because this term is poorly defined and creates bias and prejudice among other health care providers. Although certain recreational drugs do have pharmaceutical counterparts, this is not the sole purpose of assessing drug use. The nurse needs more information beyond a patients medical and medication history to determine whether a patient needs teaching about drug abstinence.

DIF: Evaluate REF: 966-974| 988-989

OBJ: Identify barriers to effective pain management. TOP: Assessment

MSC: Pain

24. 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 patients pain 1 hour after administering oral pain medication.

d.

It wasnt time for the patients medication, so when she requested it, I gave her a placebo.

ANS: C

Because oral medications usually peak in about an hour, you need to reassess the patients pain within an hour of administration. Nurses must believe any patient report of pain, even if nonverbal communication is not consistent with pain ratings. The patient is the only person who should push the PCA button. Pushing the PCA when a patient is sleeping is dangerous and may lead to narcotic overdose or respiratory depression. Giving the patient a placebo and telling her it is her medication is unethical.

DIF: Evaluate REF: 983-989

OBJ: Discuss nursing implications for administering analgesics.

TOP: Evaluation MSC: Pain

25. The nurse is assessing how a patients 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?

ANS: B

Because the nurse is interested in knowing whether the patients pain is affecting mobility, the priority assessment question is to ask the patient how the pain affects his or her ability to participate in normal activities of daily living. Although a physical therapist is a good resource to have, especially if pain is severely affecting mobility, considering working with a physical therapist does not describe the effect of pain on the patients mobility. Assessing quality of pain and effectiveness of pain medication does not help the nurse to understand how it is affecting the patients mobility.

DIF: Understand REF: 974-975

OBJ: Be able to perform an assessment of a patient experiencing pain.

TOP: Assessment MSC: Pain

26. 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 dont need pain medication, they arent in pain.

c.

Pain assessment scales determine the quality of a patients pain.

d.

A patients behavior is more reliable than the patients report of pain.

ANS: C

To gain a better understanding of a patients current pain status and to determine what interventions are needed, the nurse should assess both current and previous pain scores. A patient who rates pain at 4 might find the pain manageable if over the previous 24 hours, he had rated his pain at 10. Some patients do not express their pain or do not wish to take medications to relieve the pain. This does not mean they arent in pain; the nurse can try nonpharmacological therapies for this patient.

DIF: Evaluate REF: 972

OBJ: Be able to perform an assessment of a patient experiencing pain.

TOP: Assessment MSC: Pain

27. 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

ANS: D

STAT medications need to be given as soon as possible. In addition, this patient is the priority because of the report of severe pain. The other patients need pain medication, but their situations are not as high a priority as that of the patient with the STAT medication order.

DIF: Analyze REF: 977

OBJ: Discuss nursing implications for administering analgesics.

TOP: Implementation MSC: Pain

28. The nurse is assessing a patient for opioid tolerance. Which finding supports the nurses 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.

ANS: A

Opioid tolerance occurs when a patient needs higher doses of an opioid to control pain. Naloxone (Narcan) is an opioid antagonist that is given to reverse the effects of opioid overdose. Taking pain medications regularly around the clock is an effective way to control pain. The pain medication for this patient is most likely effectively managing the patients pain because the patient is not asking for the medication before it is due. A patient no longer experiencing a side effect of an opioid does not indicate opioid tolerance.

DIF: Understand REF: 986-989 OBJ: Evaluate a patients response to pain interventions.

TOP: Assessment MSC: Pain

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 patients 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.

ANS: A

The major adverse effect of acetaminophen is hepatotoxicity. Because both alcohol and acetaminophen are metabolized by the liver, when taken together, they can cause liver damage. Smoking cigarettes and smoking marijuana are not healthy behaviors, but their effects on health are not affected by acetaminophen. Antianxiety medications can be taken with acetaminophen.

DIF: Apply REF: 981

OBJ: Discuss nursing implications for administering analgesics.

TOP: Assessment MSC: Pain

30. The nurse is caring for a patient who suddenly experiences chest pain. What is the nurses 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.

ANS: B

The nurses ability to establish a nursing diagnosis, plan and implement care, and evaluate the effectiveness of care depends on an accurate and timely assessment. The other responses are all interventions; the nurse cannot know which intervention is appropriate until the nurse completes the assessment, makes a nursing diagnosis, and plans care.

DIF: Apply REF: 969-973

OBJ: Describe guidelines for selecting and individualizing pain interventions.

TOP: Assessment MSC: Pain

31. The nurse is caring for a patient who recently had surgery to repair a hernia. The patients 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 isnt receiving more pain medication. Which is the nurses 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 doesnt 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. Lets try boosting you up in bed and putting an ice pack on the incision to see if that helps.

ANS: D

The patient is responding well to the oral pain medication and it can take up to 2 hours for oral medications to relieve pain. Trying nonpharmacological interventions as an addition to opioid medications is appropriate at this time. If nonpharmacological interventions combined with the oral opioid are ineffective, the nurse needs to notify the health care provider and ask for a change in the medication or for additional pain medication. Saying that the patient has to wait 4 hours for additional pain medication is inaccurate because the nurse needs to provide further nursing interventions if pain is not relieved at an acceptable level for the patient. Admission to an intensive care unit is not typically necessary to manage pain following surgery for a hernia.

DIF: Apply REF: 977-983

OBJ: Describe guidelines for selecting and individualizing pain interventions.

TOP: Implementation MSC: Pain

32. 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.

ANS: C

When a patient with arthritis has chronic pain, the best way to manage pain is to take medication regularly throughout the day to maintain constant pain relief. Before activity is nonspecific, and the medication may not have time to work before activity. If the patient waits until having pain to take the medication, pain relief takes longer. Nonpharmacological measures are used in conjunction with medications unless requested otherwise by the patient.

DIF: Understand REF: 986

OBJ: Describe guidelines for selecting and individualizing pain interventions.

TOP: Implementation MSC: Pain

33. 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

ANS: B

Somatic pain comes from bone, joint, or muscle. Visceral pain arises from the visceral organs such as the GI tract and pancreas. Peripherally generated pain can be caused by polyneuropathies or mononeuropathies. Centrally generated pain results from injury to the central or peripheral nervous system.

DIF: Remember REF: 965-966

OBJ: Be able to perform an assessment of a patient experiencing pain.

TOP: Assessment MSC: Pain

34. 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.

ANS: D

Infants cannot verbally express their pain, but they do express pain with behavioral cues and physiological indicators. Infants can tolerate analgesics, but proper dosing and close monitoring are essential. Infants and older children have the same sensitivity to pain. Pain can be assessed even though the neonate cannot verbalize; the nurse can observe behavioral clues. Nurses use behavioral cues and physiological responses to assess pain in infants.

DIF: Understand REF: 967 OBJ: Identify components of the pain experience.

TOP: Assessment MSC: Pain

MULTIPLE RESPONSE

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

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

ANS: A, C

NSAIDs can cause bleeding, especially in the gastrointestinal (GI) tract; therefore, NSAIDs are most likely contraindicated in this patient. Patients with an allergy to aspirin are sometimes also allergic to other NSAIDs. The nurse needs to verify that the health care provider is aware of the history of GI bleeding and of allergy to aspirin before administering ibuprofen. NSAIDs do not interfere with bowel function and are used for the treatment of mild to moderate acute intermittent pain. NSAIDs also do not suppress the central nervous system.

DIF: Understand REF: 981

OBJ: Explain various pharmacological approaches to treating pain.

TOP: Assessment MSC: Pain

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