Chapter 11 Pain Management Prep U 40 questions

The nurse is assessing an 86-year-old postoperative client who has an unexpressive, stoic demeanor. The client is curled into the fetal position, vital signs are elevated and he is diaphoretic. On a 10-point scale, the client indicates a pain level of "3 or so." How should the nurse treat this client's pain? A.Treat the client on the basis of objective signs of pain and reassess him frequently. B.Call the physician for new prescriptions because it is apparent that the pain medicine is not working. C. Believe what the client says, reinforce education, and reassess often. D.Ask the family what they think and treat the client accordingly.

C. Believe what the client says, reinforce education, and reassess often.

A 10-year-old client twisted an ankle playing soccer. The ankle can't support weight and has already begun to swell despite application of an ice pack. As part of the pain assessment, the nurse must determine the intensity of the client's pain. Which question will the nurse ask to obtain this information? A."Which one of the faces on this card shows how much your ankle hurts?" B."How long ago did you hurt your ankle?" C."Do you feel the pain only in your ankle or does it hurt anywhere else?" D."Tell me if it hurts when I touch your ankle here."

A."Which one of the faces on this card shows how much your ankle hurts?"

The majority of clients in a pain management practice have chronic pain. The physician group utilizes several different methodologies to treat pain. During the holiday season, they sent CDs featuring a popular comedian to all their clients—not only as a gift but also as a treatment modality. This is an example of which treatment modality? A.All responses are correct. B.Humor C.Distraction D.Relaxation

A.All responses are correct.

A patient who is postoperative day 1 following a discectomy has lit his call light and requested a dose of hydromorphone, which he receives on a p.r.n. basis for breakthrough pain. What should the nurse first do in response to the patient's request? A.Assess the characteristics of the patient's pain. B.Draw up the prescribed dose of hydromorphone. C.Propose the use of nonpharmacologic interventions. D.Discuss the use of NSAIDs as an alternative to opioids.

A.Assess the characteristics of the patient's pain.

A client's physician prescribes opiate pain medication to manage post-surgical pain. Which contraindication applies to opiate analgesics? A.Do not administer if respirations are less than 12 breaths/minute. B.Do not administer if the client is a smoker. C.Do not administer if blood pressure is higher than 120/80 mm Hg. D.Do not administer if the client consumes only a vegetarian diet.

A.Do not administer if respirations are less than 12 breaths/minute.

Two clients have recently returned to the postsurgical unit after knee arthroplasty. One client is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other client is reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most plausible rationale for understanding the clients' different perceptions of pain? A.Endorphin levels may vary between clients, affecting the perception of pain. B.One of the clients is exaggerating the sense of pain. C.The clients are likely experiencing a variance in vasoconstriction. D.One of the clients may be experiencing opioid tolerance.

A.Endorphin levels may vary between clients, affecting the perception of pain.

A client being treated for rheumatoid arthritis has been prescribed a glucocorticosteroid. How should the nurse best ensure this client's safety during treatment? A.Ensure the client knows to taper down the dose if it is discontinued by the care provider. B.Educate the client about the need to avoid grapefruit and grapefruit juice during treatment. C.Teach the client the signs and symptoms of gastrointestinal bleeding. D. Educate the client about the difference between tolerance and dependence.

A.Ensure the client knows to taper down the dose if it is discontinued by the care provider.

The nurse who is a member of the palliative care team is assessing a client. The client indicates that he has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate. What teaching should the nurse do with this client? A.Medication should be taken when pain levels are low so the pain is easier to reduce. B.Pain medication can be increased when the pain becomes intense. C.It is difficult to control chronic pain, so this is an inevitable part of the disease process. D.The client will likely benefit more from distraction than pharmacologic interventions.

A.Medication should be taken when pain levels are low so the pain is easier to reduce.

A new surgical patient has been prescribed an opioid analgesic intravenously for pain control. The nurse should be aware of which most serious adverse effect of this medication? A.Respiratory depression B.Nausea and vomiting C.Constipation D.Pruritus

A.Respiratory depression

The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting: A.Severity of the pain as judged by the patient B.Anticipated harmful effects of the pain experience C.Anticipated duration of the pain D.Medical interventions for pain management

A.Severity of the pain as judged by the patient

A client reports abdominal pain as "8" on a pain intensity scale of 0-10 thirty minutes after receiving an opioid intravenously. Her past medical history includes partial-thickness burns to approximately 60% of her body several years ago. The nurse assesses A.That the client's past experiences with pain may influence her perception of current pain B.That based on her past experiences the client's perception of pain should be less C.That the client has become dependent on drugs from her previous experience of burns D.That the client is experiencing pain relating to the burn injuries from several years ago

A.That the client's past experiences with pain may influence her perception of current pain

The nurse is caring for a client with sickle cell disease who lives in the community. Over the years, there has been joint damage, and the client is in chronic pain. The client has developed a tolerance to her usual pain medication. When does the tolerance to pain medication become the most significant problem? A.When it results in inadequate relief from pain B.When dealing with withdrawal symptoms resulting from the tolerance C.When having to report the client's addiction to her physician D.When the family becomes concerned about increasing dosage

A.When it results in inadequate relief from pain

A patient with a spirally fractured femur had surgical repair of the bone. After surgery, the client reports a pain rating of 7 (on a 0 to 10 scale). How would the nurse expect the client to describe the characteristics of the pain? A.local, sharp, intense B.generalized, dull, aching C.burning, sharp discomfort D.dull intermittent ache

A.local, sharp, intense

You are the emergency department (ED) nurse caring for a 9-year-old who was in a motor vehicle accident. The mother arrives at the ED, and you explain that the child is in pain from a broken arm, which will need surgical intervention to set the bones. You ask the mother to comfort the child. What type of pain are you dealing with in this patient? A.Chronic B.Acute C.Intermittent D.Phantom

B.Acute

The emergency department (ED) nurse is caring for an adult client who was in a motor vehicle accident. Radiography reveals an ulnar fracture. What type of pain is the nurse addressing with this client? A.Chronic B.Acute C.Intermittent D.Osteopenic

B.Acute

An older adult client has been admitted to the rehabilitation facility after falling and fracturing her left hip. The client has not regained functional ability and may have to be readmitted to an acute-care facility. When planning this client's care, what should the nurse know about the negative effects of the stress associated with pain? A.Stress is less pronounced in older adults because they generally have more sophisticated coping skills than younger adults B.Stress is particularly harmful in the elderly who have been injured or who are ill. C.It affects only those clients who are already debilitated prior to experiencing pain. D.It has no inherent negative effects; it just alerts the person/health care team of an underlying disease process.

B. Stress is particularly harmful in the elderly who have been injured or who are ill.

A client's intractable neuropathic pain is being treated using a multimodal approach to analgesia. After administering a recently increased dose of IV morphine to the client, the nurse has returned to assess the client and finds the client unresponsive to verbal and physical stimulation with a respiratory rate of five breaths per minute. The nurse has called a code blue and should anticipate the administration of what drug? A.Acetylcysteine B.Naloxone C.Celecoxib D.Acetylsalicylic acid

B.Naloxone

An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical client rates her pain as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the client is exaggerating and does not need pain medication. What is the nurse's best response? A."Pain often comes and goes with postsurgical clients. Please ask her about pain again in about 30 minutes." B."We need to provide pain medications because it is the law, and we must always follow the law." C."Unless there is strong evidence to the contrary, we should take the client's report at face value.'" D.It's not unusual for clients to misreport pain to get our attention when we are busy."

C."Unless there is strong evidence to the contrary, we should take the client's report at face value.'"

The nurse is caring for a client whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem? A.Anxiety B.Skin breakdown C.Depression D.Hallucinations

C.Depression

The patient develops respiratory depression after the nurse administers fentanyl for pain. What medication can the nurse anticipate administering to counteract the effects of the fentanyl? A.Nubain B.Morphine C.Narcan D.Lidocaine

C.Narcan

The nurse on a rehabilitation unit receives report about a new client who has fibromyalgia and has difficulty with her ADLs. The off-going nurse also reports that the client is withdrawn, refusing visitors, and has been vacillating between tears and anger all afternoon. What aspect of chronic pain syndromes could account for this client's behavior? A.Fibromyalgia is not a chronic pain syndrome, so further assessment is necessary. B.The client is likely frustrated because she has to be in the hospital. C.The client likely has an underlying psychiatric disorder. D.Chronic pain can cause intense emotional responses.

D.Chronic pain can cause intense emotional responses.

The nurse caring for an older adult client with osteoarthritis is reviewing the client's chart. This client is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this client? A.Depression B.Chronic illness C.Inadequate pain control D.Drug interactions

D.Drug interactions

The nurse is accepting care of an adult client who has been experiencing severe and intractable pain. When reviewing the client's medication administration record, the nurse notes the presence of gabapentin. The nurse is justified in suspecting what phenomenon in the etiology of the client's pain? A.Neuroplasticity B.Misperception C.Psychosomatic processes D.Neuropathy

D.Neuropathy

The nurse is caring for a victim of a motor vehicle accident with a fractured pelvis and a ruptured bladder. The nurse's aide (NA) tells the nurse that she is concerned because the client's resting heart rate is 110 beats per minute, her respirations are 24 breaths per minute, temperature is 37.3°C (99.1°F) axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as the nurse assesses this client's physiologic status? A.The client's understanding of pain physiology B.The client's serum glucose level C.The client's white blood cell count D.The client's rating of her pain

D.The client's rating of her pain

The nurse is creating a nursing care plan for a client with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of clients who live with chronic pain should be integrated into care planning? A.They are typically more comfortable with underlying pain than clients without chronic pain. B.They often have a lower pain threshold than clients without chronic pain. C.They often have an increased tolerance of pain. D.They can experience acute pain in addition to chronic pain.

D.They can experience acute pain in addition to chronic pain.