NUR 221A: Comfort/Pain

A client with terminal cancer is to receive 4 mg of hydromorphone intravenously (IV) every 4 hours as needed for severe breakthrough pain. It is supplied at 10 mg/mL. When the client complains of severe pain, how much solution of hydromorphone should the nurse administer? Record your answer using one decimal place and leading zero if applicable. ___ mL

0.4 mL

A 37-year-old client with endometriosis visits the women's health clinic because she has dysmenorrhea and dyspareunia. Which statement is the most accurate description of dysmenorrhea? 1. pain with menses 2. endometrial hyperplasia 3. bleeding between menses 4. heavy bleeding with menses

1

A client describes abdominal discomfort following ingestion of milk. Which enzyme, as a result of a genetic deficiency, should the nurse consider to be the cause of the client's discomfort? 1. lactase 2. sucrase 3. maltase 4. amylase

1

A client is experiencing a myocardial infarction. What should the nurse identify as the primary cause of the pain experienced by a client with a coronary occlusion? 1. arterial spasm 2. heart muscle ischemia 3. blocking of the coronary veins 4. irritation of nerve endings in the cardiac plexus

2

A client with peripheral arterial insufficiency tells the nurse that walking sometimes results in severe pain in the calf muscles. Which information should the nurse share with the client? 1. this is called rest pain 2. this is called intermittent claudication 3. this is called phantom limb sensation 4. this is called raynaud phenomenon

2

Morphine via an epidural catheter is prescribed for a client after abdominal surgery. The client asks the nurse why this medicine is necessary. What primary rationale does the nurse give for the administration of an opioid analgesic after abdominal surgery? 1. facilitates oxygen use 2. relieves abdominal pain 3. decreases anxiety and restlessness 4. dilates coronary and peripheral blood vessels

2

On the third postoperative day after a subtotal gastrectomy, a client reports having severe abdominal pain. The nurse palpates the client's abdomen and determines rigidity. What should be the nurse's first action? 1. assist the client to ambulate 2. obtain the client's vital signs 3. administer the prescribed analgesic 4. encourage the incentive spirometer

2

A teenager is admitted with an acute onset of right lower quadrant pain at McBurney point. Appendicitis is suspected. For which clinical indicator should the nurse assess the client to determine if the pain is secondary to appendicitis? 1. urinary retention 2. gastric hyperacidity 3. rebound tenderness 4. increased lower bowel motility

3

A client is receiving oxycodone postoperatively for pain. The healthcare provider's prescription indicates that the dose should be administered every 3 hours for eight doses. What should the nurse assess before administering each dose of oxycodone? 1. respiratory rate and level of consciousness 2. color, character, and amount of urine output 3. intravenous site and patency of the intravenous catheter 4. amount and character of drainage in the portable drainage system

1

A client with a skin infection reports an itching sensation associated with pain at the site of infection. The assessment finding shows erythematous blisters and interdigital scaling and maceration. What could be the possible condition in the client? 1. tinea pedis 2. tinea cruris 3. tinea corporis 4. tinea unguium

1

After an amputation of a limb, a client begins to experience extreme discomfort in the area where the limb once was. What is the nurse's greatest concern at this time? 1. addressing the pain 2. reversing feelings of hopelessness 3. promoting mobility in the residual limb 4. acknowledging the grieving for the lost limb

1

Which pain scale should a nurse use to measure the intensity of pain in toddlers? 1. FACES scale 2. visual analogue scale 3. numerical rating scale 4. verbal descriptor scale

1

Why would a client with acquired immunodeficiency syndrome (AIDS) be administered pregabalin? 1. to reduce neuropathic pain 2. to reduce cognitive difficulty 3. to reduce swallowing difficulty 4. to reduce muscle and joint pain

1

A pain scale of 1 to 10 is used by a nurse to assess a client's degree of pain. The client rates the pain as an 8 before receiving an analgesic and a 7 after being medicated. What conclusion should the nurse make regarding the client's response to pain medication? 1. client has a low pain tolerance 2. medication is not adequately effective 3. medication has sufficiently decreased the pain level 4. client needs more education about the use of the pain scale

2

An 8-year-old child who is experiencing a sickle cell pain episode is admitted to the child health unit. What is the most appropriate nursing care during this acute period? 1. limiting fluids until the crisis ends 2. administering prescribed analgesics 3. applying cold compresses to painful joints 4. performing range-of-motion exercises of affected joints

2

A client is diagnosed with a peptic ulcer. What should the nurse expect when assessing the client's pain? 1. intensifies after vomiting 2. occurs one to three hours after meals 3. increases when an excess of fatty foods is ingested 4. begins in the epigastrium, then radiates to the abdomen

2

The nurse is providing postoperative care to a client who had an abdominal cholecystectomy and choledochostomy who has a T-tube and a nasogastric tube in place. The client refuses deep breathing and coughing exercises. Which conclusion by the nurse is the most probable reason for the noncompliance? 1. t-tube movement increases 2. pain at the incision site increases 3. the nasogastric tube gets irritating 4. the bandage on the abdomen is constricting

2

Two hours after a cardiac catheterization that was accessed through the right femoral route, an adult client complains of numbness and pain in the right foot. What action should the nurse take first? 1. call the primary healthcare provider 2. check the client's pedal pulses 3. take the client's blood pressure 4. recognize the response is expected

2

Which factor may cause a client neck pain? 1. headache 2. poor posture 3. low body weight 4. sedentary lifestyle

2

Which herbal therapies can be recommended to a client with breast pain? Select all that apply. 1. dong quai 2. chamomile 3. bugleweed 4. chaste tree fruit 5. black cohosh root

2, 3, 4

A 14-year-old girl in whom scoliosis has been diagnosed undergoes spinal fusion. On the first postoperative day her face is red, she is rigid, and she is crying because she is in pain. She has prescriptions for morphine sulfate for severe pain and an acetaminophen-codeine compound for moderate pain. What information should influence the nurse's choice of analgesic? 1. one dose or morphine may be given, but the drug should be restricted thereafter because it is addictive 2. adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury 3. spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic 4. the acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest

3

A client who had a myocardial infarction receives 15 mg of morphine sulfate for chest pain. Fifteen minutes after receiving the drug, the client complains of feeling dizzy. What action should the nurse take? 1. determine if this is an allergic reaction 2. elevate the clients head and keep the extremities warm 3. place the client in the supine position and take the vital signs 4. tell the client that this is not a typical sensation after receiving morphine sulfate

3

A client with multiple sclerosis is informed that it is a chronic progressive neurologic condition. The client asks the nurse, "Will I experience pain?" What is the nurse's best response? 1. "tell me about your fears regarding pain" 2. "analgesics will be prescribed to control the pain" 3. "pain is not a characteristic symptom of this condition" 4. "lets make a list of the things you need to ask your primary healthcare provider"

3

A nurse is about to perform a wound irrigation on a client who had a left hemispheric stroke 1 year ago. Which assessment is most important for the nurse to perform before beginning the irrigation? 1. neurologic 2. wound 3. pain 4. skin

3

An adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations. How should the nurse respond when the client complains of pain and requests medication? 1. By withholding the medication to help prevent addiction 2. By stating that the limb has been removed and that the pain is psychological 3. by acknowledging that the pain is real and administering medication to relieve it 4. By explaining that the phantom limb sensation will subside within a few more days

3

Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the drug is being used primarily for which of its properties? 1. analgesic 2. antipyretic 3. antiinflammatory 4. antiplatelet

3

The nurse provides discharge teaching to a client with a history of angina. The nurse instructs the client to call for emergency services immediately if the client's pain exhibits which characteristic? 1. causes mild perspiration 2. occurs after moderate exercise 3. continues after rest and nitroglycerin 4. precipitates discomfort in the arms and jaw

3

Which clinical indicator is the nurse most likely to identify when assessing a client with a ruptured cerebral aneurysm? 1. tonic-clonic seizures 2. decerebrate posturing 3. sudden severe headache 4. narrowed pulse pressure

3

Which is a sign of a ruptured ectopic pregnancy in an adolescent? 1. labor pains 2. abdominal pain and bleeding 3. abdominal pain and hypotension 4. abdominal pain and hypertension

3

Which statement indicates a nurse has a correct understanding about trigeminal autonomic cephalalgia (cluster headaches)? 1. it is most common in women 2. it is manifested by intense bilateral pain 3. it is caused by an overactive hypothalamus 4. it is associated with headaches of long duration

3

A client is admitted to the hospital with severe flank pain, nausea, and hematuria caused by a ureteral calculus. What should be the nurse's initial intervention? 1. strain all urine output 2. increase oral fluid intake 3. obtain a urine specimen for culture 4. administer the prescribed analgesic

4

A client reports burning sensation and sharp pain on the sole of a foot. Which condition does the nurse suspect in the client? 1. torticollis 2. pes planus 3. crepitation 4. plantar fasciitis

4

A nurse applies a cold pack to treat an acute musculoskeletal injury. Cold therapy decreases pain by doing what? 1. promoting analgesia and circulation 2. numbing the nerves and dilating the blood vessels 3. promoting circulation and reducing muscle spasms 4. causing local vasoconstriction, preventing edema and muscle spasms

4

The nurse assesses for which major complication in a client who has had a gastroscopy? 1. difficulty swallowing 2. increased gastrointestinal (GI) mobility 3. nausea with vomiting 4. abdominal distention with pain

4

The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium daily. Before discharge, the nurse instructs the client about what potential side effect? 1. rectal bleeding 2. fecal impaction 3. nausea and vomiting 4. mild abdominal cramping

4

What does a nurse consider the most significant influence on many clients' perception of pain when interpreting findings from a pain assessment? 1. age and sex 2. physical and physiological status 3. intelligence and economic status 4. previous experience and cultural values

4