Med Surg Exam 3

When taking a client history, the nurse notes that the client has been taking herbal remedies in addition to acetaminophen for several years. Based on admission history, the nurse understands that the client is experiencing which type of pain after an amputation? a. breakthrough pain b. chronic pain c. phantom pain d. acute pain

b. chronic pain

A client has been prescribed a fentanyl patch for pain control. The nurse understands that this patch should be replaced every. a. 48-72 hours b. 24-36 hours c. 12-24 hours d. 36-60 hours

a. 48-72 hours Fentanyl patches should be replaced every 48-72 hours, depending on patient response. The other time frames are incorrect.

When applying a fentanyl patch, the last dose of sustain-release morphine should be administered at what point? a. at the same time the first patch is applied b. 1 hour after application c. there are no administration requirements d. 1 hour before application

a. At the same time the first patch is applied Because it takes 12 to 18 hours for the fentanyl concentrations to gradually increase from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied. The other time frames are incorrect.

Which route of administration of medication is preferred in the most acute care situations? a. Intravenous b. Epidural c. Subcutaneous d. Intramuscular

a. Intravenous The intravenous route is the preferred parenteral route in most acute care situations because it is much more comfortable for the client and peak serum concentrations and pain relief occur more rapidly and reliably. Epidural administration is used to control postoperative and chronic pain. Subcutaneous administration results results in slow absorption of medication. Medication administered intramuscularly is absorbed more slowly than intravenously administered medication.

A high school football player hurts his foot while playing a game. The client complains of intense pain with muscle spasms and swelling of the toe. Which pain assessment tool will the nurse most likely use to assess the client's pain level? a. numeric rating scale (NRS) b. verbal descriptor scales (VDS) c. visual analog scale (VAS) d. Wong-Baker FACES pain rating scale

a. Numeric rating scale (NRS) NRS is the most appropriate for this client. The VDS requires the patient to use words or phrases; in this situation, intense pain may affect the client's ability to use this scale appropriately. The FACES scale is most often used in adults and children as young as 3 years of age. The VAS is impractical for use in daily clinical practice.

When a client who has been taking opioids becomes less sensitive to the drug's analgesic properties, that client is said to have developed a(n) a. Tolerance b. Balanced analgesia c. Dependence d. Addiction

a. Tolerance, is a normal response that occurs with regular administration of a drug and is characterized by the need for higher doses to maintain the same level of pain relief. Addiction refers to a behavioral pattern of substance use characterized by the need for higher doses to maintain the same level of pain relief.

In which case it is most likely that pain management may not be readily forthcoming to an adult patient who is in pain? a) When a numeric scale is used to assess pain intensity b) When analgesics are contraindicated for the patient's condition c) When the pain is chronic d) When the patient's expressions of pain are incongruent with the nurse's expectations

a. When the client's expressions of pain are incongruent with the nurse's expectations. If a client's expression of pain are incongruent with the nurse's expectations, pain management may not be readily forthcoming. A number rating scale is used when assessing adults and is not inappropriate. If analgesics are contraindicated for the client's condition, several non drug interventions can be used. The risk for improper management of pain does not increase specifically in the case of chronic pain.

The nurse understands that which statement is true about tolerance and addiction? a. although clients may need increasing levels of opioids, they are not addicted b. addiction to opioids commonly develops c. the nurse must be primarily concerned about development of addiction by a client in pain d. tolerance to opioids is uncommon

a. although clients may need increasing levels of opioids, they are not addicted Physical tolerance usually occurs in the absence of addiction. Tolerance to opioids is common. Addiction to opioids is rare and should never be the primary concern for a client in pain.

The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe? a. gabapentin b. hydromorphone c. tramadol d. ketamine

a. gabapentin

Which condition, approved by the U.S. Food and Drug Administration, is the only use for the lidocaine 5% patch? a. posterpetic neuralgia b. epidural anesthesia c. general anesthesia d. diabeticneuropathy

a. posterpetic neuralgia

What pain assessment scale would be best to use with a 5-year-old child? a) A Numerical Pain Scale b) A pain assessment scale is inappropriate for a 5-year-old child. c) The FACES scale d) A Visual Analog Scale

a. the FACES scale

The nurse needs to carefully monitor a patient with traumatic injuries. Which of the following actions by the nurse demonstrates understanding of the most essential component of the patient's pain assessment? a) The nurse administers ketorolac (Toradol) on admission to the unit. b) The nurse validates the patient's report of pain by assessing the patient's blood pressure. c) The nurse administers pain medication based on the patient's reported pain level. d) The nurse assesses the response to medication after every meal consumed by the patient.

a. the nurse administers pain medication based on the client's reported pain level

When a client who has been taking opioids becomes less sensitive to the drug's analgesic properties, that client is said to have developed a(n) a. tolerance b. balanced analgesia c. addiction d. dependence

a. tolerance Tolerance is a normal response that occurs with regular administration of an opioid and is characterized by the need for higher doses to maintain the same level of pain relief.

Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which of the following actions illustrates the nociception process of pain transmission? a. a surgeon making an incision to perform surgery b. a child quickly removing a hand when touching a hot object c. a mother in labor utilizing imagery to reduce pain d. a patient taking tramadol to enhance pain management

b. a child quickly removing a hand when touching a hot object Transduction, the first process involved in nocicpeption, refers to the process by which noxious stimulus, such as a burn, releases a number of excitatory compounds, which move pain along the pain pathway.

Which statement made by a client with cancer who has moderate to severe pain and was prescribed oxymorphone indicates further instruction is required? a. "I can also have this medication in an extended-release tablet" b. "I will take this medication with breakfast for the best results" c. "I will stop drinking beer while I'm taking this medication" d. "The IR indicates I will get fast relief when I take the medication"

b. "I will take this medication with breakfast for the best results"

A nurse is caring for a client diagnosed with depression in the mental health unit. The nurse understands that therapeutic effects of tricyclic antidepressants occur at which time point? a. 1 week b. 3 weeks c. 2 weeks d. 4 weeks

b. 3 weeks Patients need to know that a therapeutic may not take effect until they have taken the medication for 3 weeks. The other time points are incorrect.

A 75-year-old client had surgery for a hip fracture yesterday. The client is under stress because of the pain, the medications, sleep deprivation, and hospital surroundings. Which nursing interventions to treat the client's pain should the nurse question when ordered by the doctor? a. morphine rather than Advil for pain management b. Advil for pain management c. acetaminophen for pain management d. use of transelectrical nerve stimulator (TENS)

b. Advil for pain management

The nurse needs to carefully monitor a client with traumatic injuries. How often should the nurse check and document the client's pain? a. An hour after analgesic are administered b. Every time the client's vital signs are assessed c. After every meal consumed by the client d. Upon admission and discharge

b. Every time the client's vital signs are assessed. The nurse should check and document the client's pain every time the client's temperature, pulse, respirations, and the blood pressure are assessed. The American Pain Society (APS) has proposed that pain assessment should be considered the fifth vital sign. Pain does not need to be assessed an hour after analgesics are administered or after every meal consumed by the client. Pain should not be assessed only on admission and discharge of the client.

About which issue should the nurse inform clients who use pain medications on a regular basis? a. avoid harsh sunlight for 2 hours after administering analgesic agents or salicylates b. Inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesic consistently without consulting a physician c. Minimize fiber intake during the therapy d. Consume the medications just before or along with meals

b. Inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesic consistently without consulting a physician. Clients should be advised to inform the primary health care provider or dentist before any procedure when they use pain medications, especially salicylates or non steroidal anti-inflammatory agents, on a regular basis.

What is a true state regarding placebos? a. A positive response to a placebo indicates the client's pain is not real. b. Placebos should never be used to test a client's truthfulness about pain. c. A placebo effect is an indication that the client does not have pain. d. A placebo should be used as the first line of treatment for a client.

b. Placebos should never be used to test a client's truthfulness about pain. Many pain guidelines, position papers, nurse practice acts, and hospital policies nationwide agree that placebos should not be used to assess or manage pain in any client, regardless of age or diagnosis. Perception of pain is highly individualized. A placebo effect is a true physiologic response. A placebo should never be interpreted as an indication that the person's pain is not real.

A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect? a. tolerance b. addiction c. dependence d. placebo

b. addiction

About which issue should the nurse inform clients who use pain medications on a regular basis? a. avoid harsh sunlight for 2 hours after administering analgesic agents or salicylates b. inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesics consistently without consulting a physician c. consume the medications just before or along with meals d. minimize fiber intake during the therapy

b. inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesics without consulting physician

Which route of medication administration should the nurse consider after IV removal in a postoperative client with an NPO (nothing by mouth) order? a. subcutaneous b. rectal c. topical d. intrathecal

b. rectal

The nurse understands the definition of pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Which of the following comments by a client confirm the client's understanding of the fundamental concepts of pain? Select all that apply. a. "I used to walk every day for exercise;pain in my knee made me stop walking" b. "I would love to go to church, but my back pain is too uncomfortable to make it through service." c. "I am tired of living with this nagging pain; I'm not sure how much longer I can go on." d. "I feel good in knowing that my doctor will determine when and how I get pain medication" e. "I will depend on you and your experience to treat my pain, as you feel appropriate"

c. "I am tired of living with this nagging pain; I'm not sure how much longer I can go on." b. "I would love to go to church, but my back pain is too uncomfortable to make it through service." a. "I used to walk every day for exercise;pain in my knee made me stop walking"

Regarding tolerance and addiction, the nurse understands that a. Tolerance to opioids is uncommon b. Addiction to opioids often develops c. although clients may need increasing levels of opioids, they are not addicted d. the nurse must be primarily concerned about the development of addiction by a client in pain

c. Although clients may need increasing levels of opioids, they are not addicted. Physical tolerance usually occurs in the absence of addiction. Tolerance to opioids is common. Addiction to opioids is rare and should never be the primary concern for a client in pain.

Which substance reduces the transmission of pain? a. Acetylcholine b. Substance P c. Endorphins d. Serotonin

c. Endorphins Chemicals that reduce or inhibit the transmission of perception of pain include endorphins and enkephalin, which are morphine-like endogenous neurotransmitters. Acetylcholine, serotonin, and substance P are chemicals that increase the transmission of pain.

When taking a client history, the nurse notes that the client is taking herbal remedies in addition to acetaminophen. Which herb, when taken in conjunction with acetaminophen, enhances the risk of bleeding? a. Willow b. Echinacea c. Gingko d. Kava

c. Gingko

Prostaglandins are chemical substances with what property? a. Inhibit the transmission of noxious stimuli b. Inhibit the transmission of pain c. Increase the sensitivity of pain receptors d. Reduce the perception of pain

c. Increase the sensitivity of pain receptors. Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin. Endorphins and enkephalins reduce or inhibit transmission of perception of pain. Morphine and other opioid medications inhibit the transmission of noxious stimuli by mimicking enkephalin and endorphin.

Which of the following is a physiologic response to pain? a. Hypotension b. Dry skin c. Pallor d. Bradycardia

c. Pallor Physiologic responses to pain include pallor, tachycardia, diaphoresis, and hypertension.

What condition is a heightened response that occurs after exposure to a noxious stimulus? a. Pain tolerance b. Dependence c. Sensitization d. Pain threshold

c. Sensitization

Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain? a. monitor blood counts and liver function tests b. monitor weight, vital signs, and serum glucose concentration c. do not administer if respirations are <12 breaths per minute d. avoid caffeine or other stimulants, such as decongestants

c. do not administer if respirations are <12 breaths per minute

Which is a gastrointestinal route for administration of analgesics? a. oral mucosa b. epidural space c. rectal d. subcutaneous

c. rectal a gastrointestinal route of administration of analgesic is the rectal route. The epidural space, oral mucosa, and subcutaneous sites are not related to the gastrointestinal route.

The advance practice nurse is treating a client experiencing a neuropathic pain syndrome. Which statements by the client demonstrates an understanding of concepts related to neuropathic pain? a. "when the inflammation in my foot resolves, I will no longer have pain from neuropathy" b. "Neuropathic pain is the body's normal response to tissue damage that causes pain" c. "Neuropathic pain will only last a few days and is easily treated with COX-2 analgesic agents" d. "My phantom limb pain serves no purpose, and I may need to take antidepressants to help"

d. "My phantom limb pain serves no purpose, and I may need to take antidepressants to help." Neuropathic pain is chronic and not treated with COX-2 analgesics.

What is a true statement regarding placebos? a. a placebo should be used as the first line treatment for a client b. a placebo effect is an indication that the client does not have pain c. a positive response to a placebo indicates that the client's pain is not real d. a placebo should never be used to test a client's truthfulness about pain

d. A placebo should never be used to test a client's truthfulness about pain Perception of pain is high individualized.

A home health nurse is visiting a client who has been taking the same dose of acetaminophen/hydrocodone for 2 months. To monitor for the presence of expected side effects of this medication, what should the nurse include in the assessment of the client? a. Observe respiratory rate and depth b. Take the client's blood pressure c. Assess level of consciousness d. Ask about the client's bowel pattern

d. Ask about the client's bowel pattern

Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain? a. Avoid caffeine or other stimulants, such as decongestants b. Monitor blood counts and liver function tests c. Monitor weight, vital signs and serum glucose concentration d. Do not administer if respirations are <12 breaths per minute

d. Do not administer if respirations are <12 breaths per minute. The nurse should not administer the prescribed opiate therapy if respirations are <12 breaths per minute.

A home health nurse is visiting a client who has been taking the same dose of acetaminophen/hydrocodone for 2 months. To monitor for the presence of expected side effects of this medication, what should the nurse include in the assessment of the client? a. observe respiratory rate and depth b. take the client's blood pressure c. assess level of consciousness d. ask about the client's bowel pattern

d. ask about the client's bowl pattern

When administering a fentanyl patch, the last dose of sustained-release morphine should be administered at what point? a. there are no administration requirements b. before respiratory assessment c. immediately after the morning shower d. at the same time the first patch is applied

d. at the same time the first patch is applied

Which action by the nurse indicates understanding of one basic principle of providing effective pain management? a. continuing to provide around-the-clock pain medications 72 hours after a surgical procedure b. administering pain medications on a PRN (as needed) basis c. administering a dose of an analgesic agent via client-controlled analgesia (PCA) during round d. awakening a new postoperative client to take pain medication

d. awakening a new postoperative client to take pain medication

Which route of administration of medication is preferred in the most acute care situations? a. intramuscular b. epidural c. subcutaneous d. intravenous

d. intravenous Intravenous is the preferred route in most acute care situations because it is much more comfortable for the patient, and peak serum concentrations and pain relief occur more rapidly and reliably.

For which reasons are nonpharmacologic pain management techniques used? Select all that apply. a. They allow clients to match the technique to their own individual and cultural preferences. b. They can successfully replace pain medications. c. They lower the risk of clients becoming addicted to pain medications. d. They help decrease the distress a client experiences as a result of pain. e. They help decrease the sensation of pain.

e. They help decrease the sensation of pain d. they help decrease the distress a client experiences as a result of pain a. they allow clients to match the technique to their own individual and cultural preferences.