NCLEX PAIN Management Questions, Comprehensive Set

An example of distraction to provide pain relief is a. TENS. b. music. c. exercise. d. biofeedback.

b. music. Distraction involves redirection of attention away from the pain and to something else. Distraction can be achieved by engaging the patient in any activity that can hold his or her attention (e.g., watching TV or a movie, conversing, listening to music, playing a game).

Which client is at greater risk for respiratory depression while receiving opioids for analgesia? A. an elderly chronic pain client with a hip fracture B. a client with a heroin addiction and back pain C. a young female client with advanced multiple myeloma D. a child with an arm fracture and cystic fibrosis

D. a child with an arm fracture and cystic fibrosis at greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors.

A non-english speaking hispanic client is moaning and appears to be in pain. How does the nurse intervene to faciliatate adequate pain management?

If an interpreter is available, explain that pain is related to illness and by treating the pain healing will promote wellness Moaning and crying are used to alleviate the pain rather than communicate a need for intervention. If the patient understands that pain is related to illness there is a higher likelihood that the patient will accept treatment.

When assessing chronic pain in the older adult, which question will be most helpful in determining appropriate interventions?

"What treatments have you used and which have been most helful?" Chronic pain may begin insidiously and many remedies may have been tried before seeking treatment.

A patient with bronchial carcinoma reports constipation for the past 2 months. The patient has been on meperidine and ibuprofen for pain relief for the past 6 months. The patient has also been taking metformin and captopril for the past 10 years. What could be the most probable reason for constipation in the patient? 1 Side effects of the opioid 2 Side effects of the captopril 3 Interaction of metformin and captopril 4 Metastasis of cancer to other organs

1 Constipation is a common side effect of opioids that are used for pain relief. Captopril is an ACE-inhibitor drug that is used to treat hypertension. Cough is the common side effect of captopril. Metformin is an oral hypoglycemic drug. Interaction between metformin and captopril does not cause constipation. It is unlikely that metastasis of cancer caused the constipation.

A postoperative patient is currently asleep. Which statement is correct? 1 The sedative administered may have helped him sleep, but assessment of pain is still needed. 2 The intravenous (IV) pain medication is effectively relieving his pain. 3 Pain assessment is not necessary. 4 The patient can be switched to the same amount of medication by the oral route.

1 Sedatives, antianxiety agents, and muscle relaxants have no analgesic effect; however, they can cause drowsiness impaired coordination, judgment, and mental alertness and contribute to respiratory depression. It is important to avoid attributing these adverse effects solely to the opioid. You need to conduct a thorough reassessment.

The nurse is teaching a patient the use of patient-controlled analgesia (PCA). Which interventions should the nurse perform? Select all that apply.

1, 2, 3 The nurse should teach the patient about PCA and evaluate the patient's understanding by asking the patient to repeat what the nurse has taught. The patient should control the administration of the medication based on the pain. The device is programmed to prevent overdose. The family members should not operate the PCA device for the patient because the dose depends on the patient's perception of pain. The patient should be taught the use of the device before the procedures in order to be ready to administer the analgesia after awakening from sedation.

A client with an acute bowel obstruction is having ischemic abdominal pain. This type of pain is best described as: A. Visceral B. Somatic C. Intractable D. Cutaneous

A

Binds to receptors on peripheral nerves, increasing pain stimuli: A. Bradykinin B. Substance P C. Pain Experience D. Pain Tolerance

A

During a preoperative assessment, a patient reports history of a heart attack and use of anticoagulant medications. If epidural anesthesia is administered to the patient for the surgery, for which possible complication should the nurse look? 1 Synergistic effects 2 Hematoma 3 Allergic reaction 4 Respiratory depression

2 Because anticoagulants reduce the action of the blood's platelets, hematoma is a possible complication when epidural anesthesia is administered to a patient on anticoagulants. Anticoagulants and anesthesia have different actions, so a synergistic effect is not a concern. Anticoagulants do not predispose a patient to an allergic reaction to epidural anesthesia. Respiratory depression is an adverse effect of opioids, but anticoagulants do not make it more likely.

Pain that is predictable & elicited by specific behaviors: A. Incident pain B. End-of-dose pain C. Spontaneous pain D. Acute pain

A

The point at which a person is aware of pain: A. Perception B. Nociceptor C. Modulation D. Prostaglandins

A

Which term refers to the pain that has a slower onset, is diffuse, radiates, and is marked by somatic pain from organs in any body activity? A. Acute pain B. Chronic pain C. Superficial pain D. Deep pain

27. Answer: D. Deep pain Deep pain has a slow onset, is diffuse, and radiates, and is marked by somatic pain from organs in any body activity. Acute pain is rapid in onset, usually temporary (less than 6 months), and subsides spontaneously. Chronic pain is marked by gradual onset and lengthy duration (more than 6 months). Superficial pain has abrupt onset with sharp, stinging quality.

The nurse notices that a patient has received oxycodone/acetaminophen (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most? 1 The patient's level of pain 2 The potential for addiction 3 The amount of daily acetaminophen 4 The risk for gastrointestinal bleeding

3 The major adverse effect of acetaminophen is hepatotoxicity. The maximum 24-hour dose is 4 g. It is often combined with opioids (e.g., oxycodone) because it reduces the dose of opioid needed to achieve successful pain control. Tylenol should not exceed 3000-4000 mg per day; 650 mg of Tylenol should not be given more frequently than every 4 hours, which is 6 doses per day, for a total of 3900 mg Tylenol per day,

Which NSAID drug might be administered to inhibit platelet aggregation in a patient at risk for thrombophlebitis? 1) Ibuprofen (Motrin) 2) Celecoxib (Celebrex) 3) Aspirin (Ecotrin) 4) Indomethacin (Indocin)

3) Aspirin (Ecotrin)

After assessing pain in a 9-year-old child using a numeric rating scale (NRS), the nurse documents the score as 5. What does the nurse interpret from this score? 1 The child has no pain. 2 The child has mild pain. 3 The child has severe pain. 4 The child has moderate pain.

4 The score range of 4 to 6 indicates moderate pain. A score of 0 indicates that the child is relaxed and comfortable without any pain. The score range of 1 to 3 indicates that the child has mild pain. The score range of 7 to 10 indicates that the child has severe pain.

What should be the maximum 24-hour dose of acetaminophen for an adult patient whose liver and kidney function tests are normal? Record your answer using a whole number, and please note that no comma is needed. ___ mg

4000 Acetaminophen is one of the safest analgesics available. However, its mode of action is unknown. The maximum 24-hour dose given to an adult with no kidney or liver diseases is 4000 mg.

Patient-controlled analgesia (PCA) effectiveness is evaluated by: a. The number of minutes on the lockout interval b. How large a loading dose is required to relieve pain c. The client's indicating that pain is a 1 on a scale of 1 to 10 d. When the client is sleeping

the clients indicating that the pain is a 1 on a scale of 1 to 10

No protective; serves no purpose. Lasts longer than 6 months & is constant or recurring with a mild-to-severe intensity: A. Acute pain B. Chronic pain C. Chronic episodic pain D. Idiopathic pain

B

A terminally ill patient is experiencing chronic pain due to spinal cord tumor and has been admitted on several occasions for pain crises. Which intervention can produce positive outcome for the individual with uncontrolled pain and a short life expectancy?

Analgesic Nerve Blocks Analgesic blocks using neurolytic agents block nerve conductivity and destroys the nerves. Topical anesthesia, local anesthetic agents, and nonnarcotics are not effective for a patient experiencing pain due to cord compression.

Pain that occurs toward the end of the usual dosing interval of a regularly scheduled analgesic: A. Incident pain B. End-of-dose pain C. Spontaneous pain D. Acute pain

B

Sensory peripheral pain nerve fiber: A. Perception B. Nociceptor C. Modulation D. Prostaglandins

B

The reticular activating system inhibits painful stimuli if an person receives sufficient or excessive sensory input: A. Relaxation B. Distraction C. Music D. Cutaneous Stimulation

B

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.

B. The patient rates pain at an acceptable level of 3 on a 0 to 10 scale.

Arises from organs such as the gastrointestinal tract & pancreas; is sometimes subdivided: A. Nociceptive pain B. Somatic pain C. Visceral pain D. Neuropathic pain

C

Wrenda states that she has also been applying a cold pack an hour at a time to help heal her back as quickly as possible. Which instruction is most important for the RN to provide?

Excessive exposure to cold can damage the skin. Should only be 20-30 min max

The nurse administers codeine sulfate 30 mg orally to a patient who underwent craniotomy 3 days ago for a brain tumor. How soon after administration should the nurse reassess the patient's pain? a. Immediately b. In 10 minutes c. In 15 minutes d. In 60 minutes

In 60 mins

_____ is the physiologic process by which information about tissue damage is communicated to the central nervous system (CNS).

Nociception

Where do primary afferent fibers terminate?

Primary afferent fibers terminate within the dorsal horn of the spinal cord, which contains the cell bodies for afferent nerve fibers.

When is the best time to teach Wrenda about use of the PCA?

The day before the surgery is scheduled.

Which factor regarding older adults and medication is important for the nurse to understand?

The older adult is more likely to experience drug interactions than the general public

What are examples of a chemical stimulus?

Toxic substances or a blockage in a coronary artery

The nurse knows that which technique is best for assessing pain in a child who is 4 years of age? • Ask the parents if they think their child is in pain. • Use the FACES scale. • Ask the child to rate the level of pain on a 0 to 10 pain scale. • Check to see what previous nurses have charted.

Use the FACES scale.

How should the nurse position the head of the bed for a client receiving epidural opioids? a) Elevated 30 degrees b) Reverse trendelenberg c) Flat d) Trendelenberg

a) Elevated 30 degrees

A patient with osteoarthritis has been taking ibuprofen (Motrin) 400 mg every 8 hours. The patient states that the drug does not seem to work as well as it used to in controlling the pain. The most appropriate response to the patient is based on knowledge of which of the following? a. Another NSAID may be indicated because of individual variations in response to drug therapy. b. The patient is probably not compliant with the drug therapy and therefore the nurse must initially assess the patient's knowledge base and initiate appropriate teaching. c. If NSAIDs are not effective in controlling symptoms, systemic corticosteroids are the next line of therapy. d. It may take several months for NSAIDs to reach therapeutic levels in the blood and thus be effective.

a. Another NSAID may be indicated because of individual variations in response to drug therapy. Patients vary in their response to medications so when one NSAID does not provide relief, another should be tried. There is no evidence in the stem of the question to ascertain any noncompliance to drug therapy.

A patient with chronic arthritic pain reports using several nonpharmacologic interventions. Which of the following would be examples of this type of intervention? Select all that apply: a. Cold compresses b. Massage c. Over-the-counter menthol ointment d. Lidocaine patches

a. Cold compresses b. Massage

A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system? a) Thorough client education is necessary to prevent overdoses. b) The dose that is delivered when the client activates the machine is preset. c) An antidote is automatically delivered if the client exceeds the recommended dose. d) Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression.

b) The dose that is delivered when the client activates the machine is preset.

All the following medications are included in the admission orders for an 86-year-old patient with moderate degenerative arthritis in both hips. Which medication will the nurse use as an initial therapy? a. Aspirin (Bayer) 650 mg orally b. Oxycodone (Roxicodone) 5 mg orally c. Acetaminophen (Tylenol) 650 mg orally d. Naproxen (Aleve) 200 mg orally

c. Acetaminophen

Which of the following assessments is of highest priority for you to complete before administration of morphine? a. Pain rating b. Blood pressure c. Respiratory rate d. Level of consciousness

c. Respiratory rate Decreased respirations below a rate of 12/min are a sign of opioid toxicity. Using the ABC approach in prioritization of care, a patent airway is always the first priority and is important to assess as a baseline before and during the administration of morphine.

The nurse is caring for a diabetic patient who has chronic burning leg pain even when taking oxycodone (OxyContin) twice daily. Which of these prescribed medications is the best choice for the nurse to administer as an adjuvant to decrease the patient's pain? a. aspirin (Ecotrin) b. celecoxib (Celebrex) c. amitriptyline (Elavil) d. acetaminophen (Tylenol)

c. amitriptyline (Elavil) The patient's pain symptoms are consistent with neuropathic pain and the tricyclic antidepressants are effective for treating this type of pain. The other medications are more effective for nociceptive pain.

Which medication would the nurse most likely see on the medication administration record (MAR) of a client with diabetic neuropathy? a) Lorazepam b) Hydromorphone c) Morphine d) Gabapentin

d) Gabapentin Gabapentin is used to treat nerve pain.

The patient is receiving fentanyl (Duragesic) for control of chronic cancer pain. Which of the following should you observe for as a potential adverse effect of this medication? a. Pupillary dilation b. Hypertension c. Urinary incontinence d. Decreased respiratory rate

d. Decreased respiratory rate Respiratory depression is a potentially life-threatening adverse effect of fentanyl (Duragesic), which is an opioid analgesic.

Which of the following instructions for use of a patient-controlled analgesia (PCA) pump is most important when educating the patient and family before implementation? a. Notify the nurse when you need to push the button on the pump. b. Only the patient should push the button for more medication. c. A spouse can push the button when the patient is asleep. d. Wait for the pain to become at least a 7 on the pain scale before pushing the button.

only the patient should push the button for more medication

The _____ of pain will influence the ways in which a person responds to pain and must be incorporated into a comprehensive treatment plan.

perception or meaning Examples: A woman who is in labor and is experiencing pain but views the pain as "with a purpose" and self-limiting versus a patient who is experiencing unrelieved pain for an unknown reason but fears she may have done something to cause.it.

Both clients and nurses have misconceptions about pain. Which statement reflects a misconception? a. People can adapt to severe pain. b. Minor injuries can cause intense pain. c. The client is the authority about pain. d. Regular administration of analgesics leads to addiction.

regular administration of analgesics leads to addiction

client has a blocked bowl. How would you describe the pain a) Cutaneous b) Visceral c) Superficial d) Somatic

visceral

A patient with cancer is experiencing increased pain issues. A plan is developed for adding ibuprofen 600mg BID to the medication regimen of narcotics. The patient asks the nurse why he is now expected to take ibuprofen because he does not have arthritis. What is the most appropriate reply by the nurse?

"Ibuprofen increases the effects of your narcotic, providing better pain relief" Nonsteroidal anti-inflammatory drugs potentiate the effects of opiates and, when in combination, are of particular use in cancer patients because of major contributing factor of pain is cell destruction. Narcotic doses may still need to be increased as the disease is progressive. NSAIDS have an anti-inflammatory effect, but the ability to block prostaglandin synthesis promotes their pain-relieving properties. There is no information to support that they act more slowly or extend pain relief.

Wrenda returns to the pain clinic in a week and reports that her pain has worsened. The pain management physician recommends the use of a transcutaneous electrical nerve stimulator (TENS) unit and prescribes a schedule IV opioid analgesic. Wrenda states to the RN that she is familiar with the TENS Unit, calling it a biofeedback treatment. 12) What is the best response by the RN?

"Pain relief is actually provided by delivery of small electrical currents to the skin."

Wrenda tells the RN that she has an electric heating pad at home that she used when she sprained her ankle.

"The dry heat provided by your heating pad will help relieve your pain by promoting muscle relaxation."

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? • "To prevent overdose, you need to wait to ask for pain medication until you begin to experience pain." • "You should take your medication after you walk to make sure you do not fall while you are walking." • "We should work together to create a regular schedule of medications that does not allow for breakthrough pain." • "You need to take oral pain medications when you experience severe pain."

"We should work together to create a regular schedule of medications that does not allow for breakthrough pain."

Margo McCaffery, a nurse and pioneer in pain management, defined pain as

"whatever the person experiencing the pain says it is, existing whenever the person says it does."

The biopsychosocial model of pain acknowledges the multidimensional nature of pain. The five dimensions are:

(1) physiologic, (2) affective, (3) cognitive, (4) behavioral), and (5) sociocultural.

Nociception includes four processes:

(1) transduction, (2) transmission, (3) perception, and (4) modulation.

Three segments are involved in nociceptive signal transmission:

(1) transmission along the peripheral nerve fibers to the spinal cord, (2) dorsal horn processing, and (3) transmission to the thalamus and the cerebral cortex.

After delivering a healthy baby boy with epidural anesthesia, a woman on the postpartum unit complains of a severe headache. The nurse should anticipate which actions in the patient's plan of care? (Select all that apply.) A) Keeping the head of bed elevated at all times B) Administration of oral analgesics C) Avoid caffeine D) Assisting with a blood patch procedure E) Frequent monitoring of vital signs

*B) Administration of oral analgesics* *D) Assisting with a blood patch procedure* *E) Frequent monitoring of vital signs* Rationale: The nurse should suspect the patient is suffering from a postdural puncture headache (PDPH). Characteristically, assuming an upright position triggers or intensifies the headache, whereas assuming a supine position achieves relief (Hawkins and Bucklin, 2012). Conservative management for a PDPH includes administration of oral analgesics and methylxanthines (e.g., caffeine or theophylline). Methylxanthines cause constriction of cerebral blood vessels and may provide symptomatic relief. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH. Close monitoring of vital signs is essential.

When monitoring a woman in labor who has just received spinal analgesia, the nurse should report which assessment findings to the health care provider? (Select all that apply.) A) Maternal blood pressure of 108/79 B) Maternal heart rate of 98 C) Respiratory rate of 14 breaths/min D) Fetal heart rate of 100 beats/min E) Minimal variability on a fetal heart monitor

*D) Fetal heart rate of 100 beats/min* *E) Minimal variability on a fetal heart monitor* Rationale: After induction of the anesthetic, maternal blood pressure, pulse, and respirations and fetal heart rate and pattern must be checked and documented every 5 to 10 minutes. If signs of serious maternal hypotension (e.g., the systolic blood pressure drops to 100 mm Hg or less or the blood pressure falls 20% or more below the baseline) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given.

The RN explains the use of the TENS unit and demonstrates how to apply it. 13) Which instruction(s) should the RN include?

-Be sure to use conducting gel or conductor pads when applying the electrodes to the skin. -Clean the skin where the electrodes will be placed and dry thoroughly.

The primary health care provider prescribes intravenous (IV) opioid medication for flank pain associated with a kidney stone in the ureter. On the follow-up visit, the patient reports thigh pain to the nurse. What does the nurse infer from patient's report? 1 The patient is experiencing referred pain. 2 The patient is experiencing neuropathic pain. 3 The patient has acute pain progressing to chronic pain. 4 The patient has pain perception due to previous opioid medication.

1 Flank pain is associated with kidney stones in the ureter. The spread of pain to uninjured tissue is referred pain. Here, the pain spreads to the uninjured thigh tissue. Neuropathic pain refers to pain caused by nerve damage rather than by tissue injury or damage. When pain is short term and associated with an acute event such as a kidney stone, it is acute pain, not chronic pain. IV opioid administration would decrease the perception of pain intensity of the kidney stone but would be unrelated to the new complaint of thigh pain.

The nurse has given one unit of transmucosal fentanyl to an opioid-tolerant patient with breakthrough pain. The patient is still not feeling pain relief. How many more units of the drug can the nurse administer before notifying the primary health care provider? Record your answer using a whole number. ___ unit(s)

1 One transmucosal fentanyl unit is given to patients with breakthrough pain. It is swabbed over the buccal mucosa and gums to be dissolved in the mouth. It should not be chewed. The nurse has given one unit of fentanyl already; if the pain persists, the nurse can administer one more unit of fentanyl. A patient can be given a total of 2 units of transmucosal fentanyl per episode of breakthrough pain. If the patient's pain is not relieved, then the nurse should notify the primary health care provider.

A patient complains of nausea after receiving the first dose of morphine for pain. What should the nurse do? 1 Treat nausea with an anti-nausea medication and continue to use morphine 2 Request an order for a nonsteroidal anti-inflammatory drug (NSAID) instead of morphine. 3 Encourage the patient to wait as long as possible for the next dose. 4 Withhold the next dose of morphine until reevaluated by the health care provider.

1 Opioids can cause nausea and vomiting because of the action on the brainstem centers. This side effect decreases with repeated use, but until then, treatment for nausea should be instituted. Decreasing the dose may be ineffective for pain relief. Asking the patient to wait for pain relief is unethical. Withholding the dose may increase the pain.

A registered nurse is teaching a nursing student about using nonsteroidal antiinflammatory drugs (NSAIDs) for pain management. Which of the nursing student's statements indicates a need for further teaching? 1 "NSAIDs work by depressing the central nervous system." 2 "NSAIDs act by inhibiting the synthesis of prostaglandins." 3 "Patients allergic to aspirin are more likely to be allergic to other NSAIDs." 4 "Use of NSAIDS in older adults may result in increased risk of adverse events."

1 Opioids, not nonsteroidal antiinflammatory drugs (NSAIDs), depress the central nervous system. The other statements indicate effective teaching: NSAIDs inhibit prostaglandin synthesis, which inhibits cellular responses to inflammation; this helps relieve pain. An allergy to aspirin may be indicative of an allergy to other NSAIDs, and NSAIDs may put older adults at an increased risk for gastrointestinal bleeding.

A patient has had arthritic pain for 8 years and has surgery to remove a buildup of septic fluid. Postoperative, the patient received morphine through a patient-controlled analgesia (PCA) device for the management of pain. What is the advantage of PCA that the nurse should teach the patient? 1 PCA allows self-administration of analgesics. 2 PCA is associated with a risk of overdose. 3 PCA does not allow administration of opioids. 4 PCA allows intramuscular administration of medications.

1 PCA allows the patient to self-administer analgesic medication whenever needed. There is no risk of overdosage due to the programming. Opioids can be safely administered using PCA. It allows intravenous or subcutaneous administration of medications.

The nursing instructor asks the student nurse to differentiate between A and C peripheral nerve fibers. Which statement made by the student nurse indicates effective learning? 1 "The A fibers are myelinated and the C fibers are unmyelinated." 2 "The A fibers are smaller in diameter and the C fibers are larger in diameter." 3 "The A fibers transmit signals slowly and the C fibers transmit signals rapidly." 4 "The A fibers cause diffuse sensation and the C fibers cause localized sensations."

1 The A fibers are myelinated, whereas the B fibers are unmyelinated. The A fibers are larger in diameter, whereas the B fibers are smaller in diameter. Because A fibers are larger in diameter, they transmit signals to the central nervous system (CNS) more rapidly than the smaller C fibers. The sensations caused by the stimulation of the A fibers are localized, whereas the sensations caused by the stimulation of the B fibers are diffuse.

When performing pain assessment, the nurse shows a series of photographs to a child and asks the child to point to the face that shows how he or she feels. Which pain-rating scale is the nurse using for pain assessment? 1 Oucher scale 2 Numeric rating scale (NRS) 3 Visual analogue scale (VAS) 4 Verbal descriptor scale

1 The Oucher scale consists of six cartoon faces of a child ranging from a smiling face to less happy faces, to a final sad, tearful face. The child is asked to point to the face that best matches his or her pain. With the NRS, the nurse asks the child to choose a number to rate the level of pain. The VAS has the patient assess the pain on a 10-centimeter line, ranging from no pain to severe pain. With the verbal descriptor scale, the nurse asks the child to describe his or her feelings about the intensity of pain.

What is recommended on the World Health Organization (WHO) analgesic ladder while caring for a patient with cancer pain? 1 Transitioning use of adjuvants with nonsteroidal anti-inflammatory drugs (NSAIDs) to opioids 2 Using acetaminophen for refractory pain 3 Limiting the use of opioids because of the likelihood of side effects 4 Avoiding total sedation regardless of how severe the pain is

1 The WHO analgesic ladder transitions from the use of nonopioids (NSAIDs) with or without adjuvants to opioids with or without adjuvants. Acetaminophen is recommended for lesser levels of pain. Side effects related to the use of opioids may be unavoidable but are treatable. Treatment for severe pain may result in some level of sedation.

A patient is on a lidocaine patch for neuropathic pain. How should the lidocaine be given to the patient to achieve adequate pain control and avoid lidocaine toxicity? 1 12-hours-on, 12 hours-off schedule 2 12-hours on, 6 hours-off schedule 3 48-hours -on, 12 hours-off schedule 4 24-hours-on, 12 hours-off schedule

1 The lidocaine patch is a topical analgesic and is used for cutaneous neuropathic pain control in adults. Three patches of the appropriate size are placed over and around the pain site. To avoid lidocaine toxicity, the 12-hours-on, 12-hours-off schedule is used. All the other schedules such as the 12-hours-on, 6-hours-off schedule; 48-hours-on, 12-hours-off schedule; and the 24-hours-on, 12-hours-off schedule may cause toxicity.

During the subjective data collection for pain assessment, the nurse asks the patient, "Can you tell me what your discomfort feels like?" What is the reason for this question? 1 The nurse wants the patient to identify the quality of pain. 2 The nurse wants the patient to identify the severity of pain. 3 The nurse wants the patient to identify the duration of pain. 4 The nurse wants the patient to indentify the intensity of pain.

1 The nurse asks questions such as, "Can you tell me what your discomfort feels like?" to assess the quality of pain. To identify the severity of pain, the nurse can ask, "On a scale of 0 to 10, how bad is your pain now?" To identify the onset and duration of pain the nurse can ask, "When did your pain start?" To identify the intensity of pain the nurse can ask, "How much pain do you have now?"

The nurse explains patient-controlled analgesia to a patient. If the patient has understood this information, what would be the patient's most appropriate statement? 1 The device reduces the risk of an overdose of medication. 2 The caregivers can operate the device if the patient is unable to do so. 3 The patient will be lying in a prone position during the procedure. 4 The patient will decide about the loading dose of the analgesic drug.

1 The nurse should teach about the use of patient-controlled analgesia (PCA) to a patient before any procedure. It is important to tell the patient that PCA reduces any risk of overdose. It should be emphasized to the patient that the patient-controlled analgesia device (PCA device) should not be operated by the caregivers. The caregivers are not able to perceive the patient's pain and thus cannot decide the amount of drug required. The patient should be placed in a comfortable position in which the IV line is accessible. The prone position is not likely to be a comfortable position for the patient. The patient does not decide the loading dose of the drug; the loading dose is prescribed before use.

Which pain management task can the nurse safely delegate to nursing assistive personnel? 1) Asking about pain during vital signs 2) Evaluating the effectiveness of pain medication 3) Developing a plan of care involving nonpharmacological interventions 4) Administering over-the-counter pain medications

1) Asking about pain during vital signs

When using ice massage for pain relief, which procedures are correct? Select all that apply. 1 Apply ice using firm pressure over the skin. 2 Apply ice until numbness occurs and remove the ice for 5 to 10 minutes. 3 Apply ice until numbness occurs and discontinue application. 4 Apply ice for no longer than 10 minutes. 5 The ice is applied directly to the surface of the skin.

1, 2 Cold therapies are particularly effective for pain relief. Ice massage involves applying a frozen cup of ice firmly over the skin, which is covered with a lightweight cloth. When numbness occurs, remove the ice for usually 5 to 10 minutes.

The nurse has to administer opioids to a female patient after a surgical procedure. Which conditions may require special consideration before administration of opioids? Select all that apply. 1 Breastfeeding 2 Dialysis 3 Respiratory disease 4 History of orthopedic surgery 5 Chronic headache

1, 2, 3 Special considerations such as a breastfeeding mother, a patient on dialysis, and any respiratory conditions should be assessed carefully before administering opioids. Opioids may pass into the breast milk. It is excreted through the kidneys, and a patient on dialysis may require adjustment of the dose. Opioids tend to depress the respiratory system. Therefore, a preexisting respiratory disease may become aggravated. A history of orthopedic surgery and chronic headaches do not affect opioid administration.

The nurse is planning effective pain management for a patient. What patient barriers prevent pain management? Select all that apply. 1 Lack of money 2 Fear of legal repercussions 3 Difficulty in filling prescriptions 4 Extensive documentation requirements 5 Belief that patients need to learn to live with pain

1, 3, 4 Lack of money prevents access to appropriate resources for pain medications. Difficulty in filling prescriptions can prevent the patient from using pain medications. A requirement of extensive documentation makes the process tedious, interfering with the prescriber's directions for effective pain management. The fear of legal repercussions and a belief that patients need to learn to live with pain are barriers erected by health care providers.

The nurse is caring for a patient on pain management therapy. Which types of therapy cause a release of endorphins that can block the transmission of painful stimuli? Select all that apply. 1 Massage 2 Opioid analgesics 3 Cold application 4 Nonsteroidal antiinflammatory drugs (NSAIDs) 5 Transcutaneous electrical nerve stimulation (TENS)

1, 3, 5 Cutaneous stimulation releases endorphins, which block the transmission of painful stimuli. Massage, cold application, or transcutaneous electrical nerve stimulation (TENS) all stimulate the skin, which may be helpful in reducing pain perception via endorphin release. Opioid analgesics reduce pain by binding with opiate receptors to modify pain perception, not by releasing endorphins. Nonsteroidal antiinflammatory drugs (NSAIDs) reduce pain by inhibiting prostaglandin synthesis, which inhibits the body's cellular response to inflammation.

The nurse is teaching a group of caregivers about the concept of pain in older adults. What should the nurse include in the teachings? Select all that apply. 1 Older patients underreport pain. 2 Sleeping indicates pain relief. 3 Opioids are safe to use in older patients. 4 Older adults tend to perceive more pain. 5 Older adults with cognitive impairment do not experience less pain.

1, 3, 5 Older patients underreport pain with the fear of losing their independence, and do not want to alarm loved ones. Opioids are safe to use with proper monitoring of the patient to note any side effects. There is no evidence that cognitively impaired older adults experience less pain compared to individuals with intact cognitive function. Sleeping does not indicate pain relief. It indicates exhaustion, and in fact, pain may prevent the patient from having a good sleep. Age does not dull the sensitivity to pain. Older adults perceive pain as much as young adults.

The nurse is caring for a patient who is on opioid therapy. For which findings is the nurse carefully observing the patient? Select all that apply. 1 Decreased pulse rate 2 Increased respiratory rate 3 Decreased blood pressure 4 Pupil dilatation 5 Peripheral edema

1, 3, 5 Potential adverse effects of opioids include bradycardia (decreased pulse rate), hypotension (decreased blood pressure), and peripheral edema due to the accumulation of fluids. Decreased, not increased, respiratory rate may occur with opioid administration. Pupil constriction may occur with the use of opioids, but pupil dilatation is an effect of opioid withdrawal.

The nurse is learning about the effects of pain on the sympathetic system. What are the manifestations of sympathetic stimulation in response to the pain? Select all that apply. 1 Increased heart rate 2 Rapid, irregular breathing 3 Increased glucose level 4 Decreased blood pressure 5 Decreased gastrointestinal motility

1, 3, 5 The stimulation of the sympathetic branch of the autonomous nervous system causes an increased heart rate, an increased glucose level, and decreased gastrointestinal motility. Stimulation of the parasympathetic branch results in rapid, irregular breathing and decreased blood pressure.

Which statements about opioid analgesics for pain management are correct? Select all that apply. 1 Opioid analgesics act on higher centers of the brain. 2 Use of opioid analgesics will increase libido in male patients. 3 Opioid analgesics are prescribed for relieving mild forms of pain. 4 The short-acting forms of opioids provide pain relief for approximately 4 hours. 5 Prolonged use of opioid analgesics will increase patient tolerance to depression of the central nervous system

1, 4 Opioid analgesics act on higher centers of the brain and spinal cord by binding with opiate receptors. The short-acting forms of opioid analgesics provide pain relief for approximately 4 hours. Opioid analgesics will decrease the testosterone levels in male patients, decreasing, not increasing, libido. Opioid analgesics are prescribed to relieve moderate to severe levels of pain; other drugs are more appropriate for mild pain. Prolonged use of opioid analgesics will increase patient tolerance to most opioid side effects except central nervous system depression.

Which drugs may provide relief from bone pain? Select all that apply. 1 Calcitonin 2 Gabapentin 3 Nortriptyline 4 Bisphosphonates 5 Infusional lidocaine

1, 4 Calcitonin and biphosphates are effective in relieving bone pain. Gabapentin, nortriptyline, and infusional lidocaine are typically used to treat neuropathic pain, not bone pain.

The human body has a mechanism to reduce pain perception by inhibitory neurotransmitters. What are the inhibitory neurotransmitters of pain in the brain? Select all that apply. 1 Serotonin 2 Histamine 3 Substance P 4 Norepinephrine 5 Gamma aminobutyric acid

1, 4, 5 During the process of pain modulation, endogenous opioids, serotonin, norepinephrine, and gamma aminobutyric acid (GABA) are some of the inhibitory neurotransmitters released to inhibit the pain impulse. This happens in the fourth and final phase of the nociceptive process. Histamine and substance P have no role in pain modulation. Histamine is released by mast cells and plays a major role in the inflammatory process. Substance P transmits pain impulses from the periphery to higher brain centers.

The nurse works in a postsurgical ward. Which statements by the nurse indicate common misconceptions about pain? Select all that apply. 1 Psychogenic pain is not real. 2 Chronic pain is not psychological. 3 Patients who cannot speak can feel pain. 4 Administering analgesics regularly leads to drug addiction. 5 Patients who abuse substances overreact to discomfort.

1, 4, 5 Psychogenic pain is real and requires intervention. Regular administration of analgesics does not lead to drug addiction. However, some analgesics such as morphine should not be overused. The patients who abuse substances do not overreact to discomfort; their discomfort may be real. Chronic pain is not psychological; it may be real and can have an impact on daily activities. Patients who do not speak can still feel pain and need intervention.

The electrocardiogram of an elderly male patient who had chest pain shows signs of myocardial infarction. What are the likely sites for referred pain for a male patient with myocardial infection? Select all that apply. 1 Jaw 2 Groin 3 Left ear 4 Left arm 5 Left shoulder

1, 4, 5 When pathological changes in one part cause pain at a distant site on the body, then the pain is called referred pain. Pathological changes in the heart often cause referred pain in the jaw, left arm, and left shoulder, but they do not usually cause pain in the groin or left ear.

Which statement represents the best rationale for using noninvasive and non-pharmacologic pain-control measures in conjunction with other measures? A. These measures are more effective than analgesics. B. These measures decrease input to large fibers. C. These measures potentiate the effects of analgesics. D. These measures block transmission of type C fiber impulses.

19. Answer: C. These measures potentiate the effects of analgesics. Noninvasive measures may result in release of endogenous molecular neuropeptides with analgesics properties. They potentiate the effect of analgesics. No evidence indicates that noninvasive and nonpharmacologic measures are more effective than analgesics in relieving pain. Decreased input over large fibers allows more pain impulses to reach the central nervous system. There is no connection between type C fiber impulses and noninvasive and nonpharmacologic pain-control measures.

The nurse is assessing a patient who had been administered morphine for pain relief. The nurse finds that the patient's respiratory rate is 5 breaths/minute. Which drug would be the most helpful in reversing this adverse effect? 1 Meperidine 2 Naloxone 3 Flumazenil 4 Metoclopramide

2

The primary health care provider (PHP) administers epidural anesthesia to a patient with chronic cancer pain. The PHP instructs the nurse to monitor the patient every 15 minutes. Which intervention does the nurse implement to prevent complications? 1 Inspect the catheter for breaks. 2 Administer antiemetics as ordered. 3 Change the infusion tubing every 24 hours. 4 Assess for bladder and bowel distention.

2 A patient with chronic cancer pain is usually administered epidural anesthesia for pain management. This patient has to be monitored for side effects every 15 minutes. Nausea and vomiting are common side effects associated with epidural anesthesia. To prevent such undesirable complications, the nurse administers antiemetics as ordered. To maintain catheter function, the nurse inspects the catheter for breaks. The nurse changes the infusion tubing every 24 hours to prevent infection. To maintain urinary and bowel function, the nurse assesses for bladder and bowel distension.

A postoperative patient reports pain at the site of surgery. On examination, the nurse finds that the incision is healing well and there are no signs of infection. The nurse instructs a student nurse to give a placebo drug to the patient. Which action would be the most appropriate action for the student nurse to take? 1 Follow the instructions given by the nurse. 2 Question the action of the placebo prescription. 3 Administer another analgesic drug. 4 Administer the placebo and inform the primary health care provider immediately.

2 A placebo for pain does not have any analgesic properties. If a placebo is ordered, it must be questioned. The student should not blindly follow the instructions without knowing the purpose of administering the placebo. The student cannot directly administer another analgesic drug without an appropriate order to do so.

The nurse is caring for a patient who has severe pain due to muscle cramps. How does the nurse interpret this pain? 1 Visceral pain 2 Somatic pain 3 Referred pain 4 Cutaneous pain

2 Muscle cramps indicate that the patient has initiation of pain from musculoskeletal tissues. Therefore, the patient has somatic pain. If the pain arises from internal organs such as the gastrointestinal (GI) tract or pancreas, it indicates visceral pain. If the patient has pain at a particular site and injury at a different site, it indicates referred pain. If the patient has pain due to damage to the skin's surface, it indicates cutaneous pain.

During emotional pain assessment, the patient reports numbness and tingling sensations interspersed with shooting or electric-like pain. What does the nurse infer from the patient's report? 1 The patient is experiencing idiopathic pain. 2 The patient is experiencing neuropathic pain. 3 The patient is experiencing nociceptive visceral pain. 4 The patient is experiencing nociceptive somatic pain.

2 Neuropathic pain is characterized by burning, shooting, or electric-like pain accompanied by a tingling sensation. Idiopathic pain is chronic pain in the absence of an identifiable physical or psychological cause. When idiopathic pain is present, it is generally more than what would be expected for the organic pathological condition. Nociceptive pain originating from visceral sites is described as aching or cramping, or as aching or throbbing when it originates from somatic sites.

Which statement is true regarding nonpharmacological pain interventions? 1 Nonpharmacological interventions should only be used alone. 2 Nonpharmacological interventions are useful for patients who cannot tolerate pain medications. 3 Nonpharmacological interventions have a clear set of guidelines regarding intensity and duration. 4 Nonpharmacological interventions should be used in place of pharmacological therapies for acute pain.

2 Nonpharmacological pain relief can be useful for patients who cannot tolerate pain medications. The remaining statements, however, are false. Nonpharmacological interventions may be used alone, but they can also be used in combination with pharmacological therapies. Depending on the nonpharmacological therapy, research is still in progress to determine clear guidelines for intensity and duration. For acute pain, nonpharmacological therapy should never replace pharmacological therapy.

Which class of pain management drugs may interfere with bowel or bladder function? 1 Anticonvulsants 2 Opioid analgesics 3 Nonopioid analgesics 4 Nonsteroidal antiinflammatory drugs

2 Opioid analgesics are effective when used for pain management, but a common side effect is disruption of bowel or bladder function. Anticonvulsants are more commonly associated with side effects like dizziness, fatigue, and confusion than with disrupted bowel and bladder function. Nonopioid analgesics and nonsteroidal antiinflammatory drugs more commonly result in gastric bleeding, hypertension, and nausea than in disruption of bowel and bladder function.

Which signs or symptoms in an opioid-naïve patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid? 1 Oxygen saturation of 95% 2 Difficulty arousing the patient 3 Respiratory rate of 10 breaths/minute 4 Pain intensity rating of 5 on a scale of 0 to 10

2 Opioid-naïve patients may develop a rare adverse effect of respiratory depression. Sedation always occurs before respiratory depression. The change in the level of consciousness supersedes oxygen saturation of 95% and moderate pain.

The nurse concludes that a patient has radiating pain. Which assessment findings support the nurse's conclusion? 1 The patient has pain from a small cut or laceration. 2 The patient has pain in the back accompanied by pain in the leg. 3 The patient has a crushing sensation with pain in the chest. 4 The patient has a burning sensation with severe stomach pain.

2 Pain extending from the initial site of injury to another body part is radiating pain. Therefore, because the patient has pain in the back accompanied by pain in the leg, it indicates radiating pain. Pain resulting from stimulation of the skin is cutaneous pain. A patient with pain from a small cut or laceration has cutaneous pain. If the patient has pain at one site but injury at a different site, it indicates referred pain. A patient experiencing a crushing sensation with pain in chest and a burning sensation with severe stomach pain indicates referred pain.

A patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication? 1 Stool softener 2 Stimulant laxative 3 H2 receptor blocker 4 Proton pump inhibitor

2 Patients usually become tolerant to the side effects of opioids, with the exception of constipation. Routinely administering stimulant laxatives, not simple stool softeners, will prevent and treat constipation in these patients.

While treating a patient, the primary health care provider encourages the patient to watch funny videos. This is an example of which pain management technique? 1 Relaxation 2 Distraction 3 Acupressure 4 Music therapy

2 Patients who are bored or in isolation may think more frequently about their pain, thus perceiving it more acutely. Watching videos may direct the patient's attention to something other than pain, reducing awareness of it. This is an example of using distraction to manage pain. Relaxation techniques include meditation, yoga, guided imagery, and progressive relaxation exercises. Acupressure is applying pressure to specific points on the body in order to influence nerve pathways to decrease pain perception. Like distraction, music therapy works by taking the patient's attention away from the pain, but this is done with music, not videos.

A patient with a history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The health care provider's order reads, "Hydrocodone/acetaminophen 1 tab, per tube, q4 hours, prn." Which action by the nurse is most appropriate? 1 No action is required by the nurse because the order is appropriate. 2 Request to have the ordered changed to ATC (around the clock) for the first 48 hours. 3 Ask for a change of medication to meperidine 50 mg IVP, q3 hours, prn. 4 Begin the hydrocodone/acetaminophen when the patient shows nonverbal symptoms of pain.

2 The American Pain Society (2003) states that if you anticipate pain for most of the day, you should consider ATC administration. Insertion of a gastrostomy tube is painful. This patient will most likely experience pain for at least the next 48 hours.

An opioid-naïve patient is on naloxone for respiratory depression caused by methadone overdose. The nurse is instructed to reassess the patient every 15 minutes for 2 hours following drug administration. What is the reason behind the schedule of reassessment of the patient? 1 The half-life of naloxone is greater than that of methadone. 2 Duration of the action of naloxone is less than that of methadone. 3 Naloxone acts as an agonist to methadone after 2 hours of administration. 4 Naloxone can cause methadone withdrawal symptoms in an opioid-naïve patient.

2 The duration of action or half-life of naloxone is less than that of methadone. Therefore, recurrence of respiratory depression by the relatively long action of methadone can be prevented by reassessing the patient every 15 minutes for 2 hours after naloxone administration. Methadone has a greater half-life than naloxone. Therefore, the effect of methadone is more prolonged than that of naloxone. Naloxone is an opioid-antagonist drug. Naloxone does not act as an agonist to morphine after 2 hours. Opioid-naïve patients are patients who have not taken opioid medications for at least a week. Naloxone causes morphine withdrawal symptoms only in patients who are physically dependent on morphine, not the patients who are opioid naïve.

A patient with rheumatoid arthritis reports acute joint pain in the hand. Which intervention is inappropriate for providing pain relief? 1 Encouraging the patient to listen to music or watch television 2 Collaborating with an occupational therapist to provide assistive devices for grooming 3 Administering ordered analgesics around the clock for 24 to 48 hours 4 Applying cool compresses to the patient's joints with the prescriber's approval

2 The nurse may collaborate with an occupational therapist to provide assistive devices to the patient for grooming, but this is not done to relieve pain; rather, this is an intervention to help the patient dress and prepare for the day if the joint pain is making this difficult. The remaining interventions are appropriate for pain relief. Music and television can help relieve pain by taking the patient's attention away from it. Analgesic administration is a pharmacological therapy method to provide pain relief. Cool compresses may also help soothe the pain caused by rheumatoid arthritis.

A patient who is on aspirin therapy for pain relief reports that there has been no change in the pain even after taking the drug. On assessment, the nurse finds that the patient had a history of a bleeding gastric ulcer and obstructive sleep apnea. What immediate action should the nurse take? 1 Add an opioid analgesic. 2 Stop the aspirin administration. 3 Increase the dose of aspirin. 4 Stop the aspirin and give ibuprofen.

2 The nurse should be aware of some of the common contraindications of analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) should not be given to a patient with a history of gastrointestinal bleeding or renal insufficiency. Therefore, administration of aspirin should be stopped for this patient. Opioids should not be given to a patient with a history of obstructive sleep apnea, because they cause respiratory depression. Increasing the dose of aspirin would further worsen the gastrointestinal bleeding. Ibuprofen is also an NSAID and, therefore, should be avoided in this patient.

Which statement about transcutaneous electrical nerve stimulation (TENS) is incorrect? 1 TENS is helpful in reducing pain perception. 2 TENS is effective for chronic and postsurgical pain control. 3 A TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. 4 TENS requires a health care provider's order that identifies the site(s) for electrode placement.

2 Transcutaneous electrical nerve stimulation (TENS) is effective for acute, emergent, and postsurgical and procedural pain control but not for chronic pain. The remaining statements are correct. TENS is helpful in reducing pain perception. A TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. TENS requires a health care provider's order that identifies the site(s) for electrode placement.

While taking a patient's medical history, a nurse records that the patient has asthma. Which medications for pain management might the physician avoid prescribing? Select all that apply. 1 Tramadol 2 Naproxen 3 Ibuprofen 4 Oxycodone 5 Hydromorphone

2, 3 Some patients who have asthma or an allergy to aspirin are also allergic to other nonsteroidal antiinflammatory drugs (NSAIDs). Naproxen and ibuprofen are NSAIDs, so the physician may avoid prescribing these medicines to the patient for pain management. Tramadol, oxycodone, and hydromorphone are opioid analgesics, which may be less risky for allergic reaction in this patient.

The nurse advises a patient with neuropathic pain to undergo guided imagery therapy to alleviate pain. Which pharmacological treatment interventions would be beneficial to the patient for pain management? Select all that apply. 1 Corticosteroids 2 Anticonvulsants 3 Antidepressants 4 Muscle relaxants 5 Bisphosphonates

2, 3 The nonpharmacological interventions that are usually recommended for pain relief in a patient with neuropathic pain include relaxation and guided imagery. This allows patients to alter affective-motivational and cognitive pain perception. The pharmacological pain management therapies that would be beneficial to a patient with neuropathic pain include anticonvulsants such as gabapentin and antidepressants such as nortriptyline. Gabapentin acts on the supraspinal region to stimulate noradrenaline-mediated descending inhibition to reduce neuropathic pain. Nortriptyline alleviates neuropathic pain by altering neurotransmitter levels. Corticosteroids relieve pain associated with inflammation and bone metastasis. Muscle relaxants have no analgesic effect. Bisphosphonates are prescribed for bone pain.

The nurse is attending to a postsurgical patient who underwent a nephrectomy. What observations would tell the nurse the patient is in severe pain? Select all that apply. 1 The patient is motionless. 2 The patient has a reduced attention span. 3 The patient is constantly asking for pain relief medication. 4 The patient has clenched teeth and is biting his or her lips. 5 The patient is talking incessantly for a long time.

2, 3, 4 A patient in acute pain may not be able to concentrate on anything. The patient may have a reduced attention span and may focus only on pain relief. The nurse may observe the patient clenching teeth or biting his or her lips to tolerate or suppress the pain. These patients are usually physically restless due to pain and they do not interact or talk incessantly.

The nurse is assessing a patient with acute pain. Which statements are true about acute pain? Select all that apply. 1 Acute pain is not protective. 2 Acute pain has an identifiable cause. 3 Acute pain has limited tissue damage. 4 Acute pain results in prolonged hospitalization. 5 Patients with acute pain seek numerous health care providers.

2, 3, 4 Acute pain has an identifiable cause, limited tissue damage, and an emotional response. Acute pain results in prolonged hospitalization as it seriously threatens a patient's recovery, so the health team members treat it aggressively. Acute pain is protective, unlike chronic pain, which is not protective. A patient with chronic pain may seek numerous health care providers because of its unknown cause.

The nurse is assessing a hospitalized patient with acute pain. Which questions should the nurse ask the patient for an appropriate assessment? Select all that apply. 1 "How bad is your pain now?" 2 "What makes your pain worse?" 3 "Describe your pain." 4 "What is the worst pain you have had in past 24 hours?" 5 "Show me where you are hurt. Does it stay there or does it spread?"

2, 3, 5 When assessing a patient with acute pain, the questions should be specific. The questions should aim to determine the intensity, location, and quality of pain. Ask provocative questions such as, "What makes the pain worse?" Ask about the region of the pain and the radiation of pain. Asking how bad the pain is may not yield specific details. Instead, the patient should be asked to rate the pain on a scale of 0 to 10. Other details can be asked once the patient is comfortable.

The nurse is teaching a group of nursing students about concepts of pain in infants. Which information should the nurse include in the teaching? Select all that apply. 1 Infants cannot express pain. 2 Absorption of drugs is faster than expected. 3 Infants are less sensitive to pain than adults are. 4 Preterm neonates have greater sensitivity to pain than older children do. 5 Assessment of pain involves behavioral cues and physiological indicators.

2, 4, 5 Absorption of drugs in infants is faster than expected. The drugs that are excreted by the kidneys should be administered in a lower dosage. Preterm neonates have greater sensitivity than term neonates or older children. Using behavioral cues such as facial expression and physiological indicators such as changes in vital signs provide proper assessment of pain. Infants cannot verbalize pain but respond with behavioral changes. Term neonates have the same sensitivity to pain as older children.

The registered nurse is teaching a nursing student about applying transcutaneous electrical nerve stimulation (TENS) to a patient. Which of the nursing student's statements indicate a need for further teaching? Select all that apply. 1 "I should set the frequency to no more than 50 Hz." 2 "I should use TENS on patients who have chronic cancer pain." 3 "I should place TENS electrodes directly over or near the site of pain." 4 "I should apply hair or skin preparations before placing TENS electrodes." 5 "I should remove TENS electrodes if the patient feels a buzzing or tingling sensation."

2, 4, 5 Transcutaneous electrical nerve stimulation (TENS) is effective in treating acute, emergent, and postsurgical and procedural pain control, but not chronic conditions, like cancer pain. The nurse should not apply any hair or skin preparations before attaching the TENS electrodes. Buzzing or tingling sensations are normal, and do not require the nurse to remove electrodes. The other statements indicate understanding. The range of frequency of TENS is 10 Hz to 50 Hz. The TENS electrodes should be placed directly over or near the site of pain.

Which adjuvant drugs are preferred for treating neuropathic pain? Select all that apply. 1 Corticosteroids 2 Anticonvulsants 3 Opioid analgesics 4 Nonopioid analgesics 5 Tricyclic antidepressants

2, 5 Anticonvulsants and tricyclic antidepressants can be effective for treating chronic pain, especially neuropathic pain. Corticosteroids are typically used to relieve pain from inflammation and bone metastasis. Opioid and nonopioid analgesics are not adjuvant drugs.

A primary health care provider recommends ibuprofen to a patient in pain. Which statements about this medication are correct? Select all that apply. 1 It depresses the central nervous system in order to relieve pain. 2 It acts by inhibiting the synthesis of prostaglandins. 3 It is highly recommended for older adults experiencing pain. 4 It is the most effective prescription drug available for pain relief. 5 One of its serious side effects is gastrointestinal bleeding.

2, 5 Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, act by inhibiting prostaglandin synthesis, thereby inhibiting cellular response to inflammation and thus reducing pain. Gastrointestinal bleeding is a major adverse effect of NSAIDs. The remaining statements are incorrect. Opiates, not NSAIDs, depress the central nervous system to relieve pain. Because of the risk for gastrointestinal bleeding, ibuprofen and other NSAIDs are not frequently the first choice for treating pain in older adults. Ibuprofen is not a prescription drug; it is widely available over the counter.

When evaluating a client's adaptation to pain, which behavior indicates appropriate adaptation? A. The client distracts himself during pain episodes. B. The client denies the existence of any pain. C. The client reports no need for family support. D. The client reports pain reduction with decreased activity.

20. Answer: A. The client distracts himself during pain episodes. Distraction is an appropriate method of reducing pain. Denying the existence of any pain is inappropriate and not indicative of coping. Exclusion of family members and other sources of support represents a maladaptive response. Range-of-motion exercises and at least mild activity, not decreased activity, can help reduce pain and are important to prevent complications of immobility.

21. In planning pain reduction interventions, which pain theory provides information most useful to nurses? A. Specificity theory B. Pattern theory C. Gate-control theory D. Central-control theory

21. Answer: D. Central-control theory No one theory explains all the factors underlying the pain experience, but the central-control theory discusses brain opiates with analgesic properties and how their release can be affected by actions initiated by the client and caregivers. The gate-control, specificity, and patter theories do not address pain control to the depth included in the central-control theory.

Ryan underwent an open reduction and internal fixation of the left hip. One day after the operation, the client is complaining of pain. Which data would cause the nurse to refrain from administering the pain medication and to notify the health care provider instead? A. Left hip dressing dry and intact B. Blood pressure of 114/78 mm Hg; pulse rate of 82 beats per minute C. Left leg in functional anatomic position D. Left foot cold to touch; no palpable pedal pulse

22. Answer: D. Left foot cold to touch; no palpable pedal pulse A left foot cold to touch without palpable pedal pulse represents an abnormal finding on neurovascular assessment of the left leg. The client is most likely experiencing some complication from surgery, which requires immediate medical intervention. The nurse should notify the health care provider of these findings. A dry and intact hip dressing, blood pressure of 114/78 mm Hg, pulse rate of 82 beats per minute, and a left foot in functional anatomic position are all normal assessment findings that do not require medical intervention.

Which term would the nurse use to document pain at one site that is perceived in other site? A. Referred pain B. Phantom pain C. Intractable pain D. Aftermath of pain

23. Answer: A. Referred pain Referred pain is pain occurring at one site that is perceived in another site. Referred pain follows dermatome and nerve root patterns. Phantom pain refers to pain in a part of the body that is no longer there, such as in amputation. Intractable pain refers to moderate to severe pain that cannot be relieved by any known treatment. Aftermath of pain, a phase of the pain experience and the most neglected phase, addresses the client's response to the pain experience.

Chuck, who is in the hospital, complains of abdominal pain that ranks 9 on a scale of 1 (no pain) to 10 (worst pain). Which interventions should the nurse implement? (Select all that apply.) A. Assessing the client's bowel sounds B. Taking the client's blood pressure and apical pulse C. Obtaining a pulse oximeter reading D. Notifying the health care provider E. Determining the last time the client received pain medication F. Encouraging the client to turn, cough, and deep breathe

24. Answer: A, B, and E The nurse must rule out complications prior to administering pain medication, so her interventions would include assessing to make sure the client has bowel sounds and determining if the client is hemorrhaging by checking the client's blood pressure and pulse. The nurse must also make sure the pain medication is due according to the health care provider's orders. Obtaining a pulse oximeter reading and turning, coughing, and deep breathing will not help the client's pain. There is no need to notify the health care provider in this situation.

Albert who suffered severe burns 6 months ago is expressing concern about the possible loss of job-performance abilities and physical disfigurement. Which intervention is the most appropriate for him? A. Referring the client for counseling and occupational therapy B. Staying with the client as much as possible and building trust C. Providing cutaneous stimulation and pharmacologic therapy D. Providing distraction and guided imagery techniques

25. Answer: A. Referring the client for counseling and occupational therapy Because it has been 6 months, the client needs professional help to get on with life and handle the limitations imposed by the current problems. Staying with the client, building trust, and providing method of pain relief, such as cutaneous stimulation, medications, distraction, and guided imagery interventions, would have been more appropriate in earlier stages of postburn injury, when physical pain was most severe and fewer psychologic factors needed to be addressed.

Mrs. Bagapayo who had abdominal surgery 3 days earlier complains of sharp, throbbing abdominal pain that ranks 8 on a scale of 1 (no pain) to 10 (worst pain). Which intervention should the nurse implement first? A. Assessing the client to rule out possible complications secondary to surgery B. Checking the client's chart to determine when pain medication was last administered C. Explaining to the client that the pain should not be this severe 3 days postoperatively D. Obtaining an order for a stronger pain medication because the client's pain has increased

26. Answer: A. Assessing the client to rule out possible complications secondary to surgery The nurse immediate action should be assess the client in an attempt to exclude possible complications that may be causing the client's complaints. The health care provider ordered the pain medication for routine postoperative pain that is expected after abdominal surgery, not for such complications as hemorrhage, infection, or dehiscence. The nurse should never administer pain medication without assessing the client first. Obtaining an order for a strong medication may be appropriate after the nurse assesses the client and checks the chart to see whether the current analgesic is infective. Checking the client's chart is appropriate after the nurse determines that the client is not experiencing complications from surgery. Pain is subjective, and each person has his own level of pain tolerance. The nurse must always believe the client's complaint of pain.

A 50-year-old widower has arthritis and remains in bed too long because it hurts to get started. Which intervention should the nurse plan? A. Telling the client to strictly limit the amount of movement of his inflamed joints B. Teaching the client's family how to transfer the client into a wheelchair C. Teaching the client the proper method for massaging inflamed, sore joints D. Encouraging gentle range-of-motion exercises after administering aspirin and before rising

28. Answer: D. Encouraging gentle range-of-motion exercises after administering aspirin and before rising Aspirin raises the pain threshold and, although range-of-motion exercises hurt, mild exercise can relieve pain on rising. Strict limitation of motion only increases the client's pain. Having others transfer the client into a wheelchair does not increase his feelings of dependency. Massage increases inflammation and should be avoided with this client.

Which intervention should the nurse include as a nonpharmacologic pain-relief intervention for chronic pain? A. Referring the client for hypnosis B. Administering pain medication as prescribed C. Removing all glaring lights and excessive noise D. Using transcutaneous electric nerve stimulation

29. Answer: D. Using transcutaneous electric nerve stimulation Nonpharmacologic pain relief interventions include cutaneous stimulation, back rubs, biofeedback, acupuncture, transcutaneous electric nerve stimulation, and more. Hypnosis is considered an alternative therapy. Medications are pharmacologic measures. Although removing glaring lights and excessive noise help to reduce or remove noxious stimuli, it is not specific to pain relief.

The nursing instructor is teaching a student nurse about using a patient-controlled analgesia (PCA) pump. Which intervention does the student nurse follow to establish the route of medication and rapid administration of the medication? 1 Administer the loading dose of analgesia as prescribed. 2 Attach the drug reservoir to the infusion device and prime the tubing. 3 Insert and secure a needleless adapter into the injection port nearest the patient. 4 Attach a needleless adapter to the tubing adapter of the patient-controlled module.

3 A needleless adapter is inserted into the injection port nearest the patient to establish the route of medication and facilitate continuous delivery of the medication. The nurse administers the loading dose of analgesia as prescribed by giving one-time doses manually or programming it into the PCA pump. Attaching the drug reservoir to the infusion device and prime tubing locks the system and prevents air from infusing into the intravenous (IV) tubing. Attaching a needleless adapter to the tubing adapter of a patient-controlled module is done to connect with the IV line. It does not facilitate continuous delivery of the medication.

A patient is in the first postoperative day following a nephrectomy. The patient is receiving morphine through a patient-controlled analgesia (PCA) device for management of pain. The patient complains of pain in the shoulders. The nurse understands that it is a referred pain. What explanation should the nurse give to the patient regarding the referred pain? 1 It is a pain that occurs sporadically over time. 2 It is a moderate pain that occurs for more than 6 months constantly. 3 It is a pain that is sensed at a site away from its actual origin or pathology. 4 It is neuropathic pain that is caused generally after cancer or a tumor.

3 A pain that is sensed at a site away from its actual origin or pathology is known as referred pain. A pain that occurs sporadically over time is known as chronic episodic pain. A moderate pain that occurs constantly for more than 6 months is known as chronic or persistent noncancerous pain. A cancer pain is neuropathic pain that is caused generally after cancer or a tumor.

Which type of pain management is cold application? 1 Relaxation 2 Distraction 3 Cutaneous stimulation 4 Acupressure

3 Cold application stimulates the skin, which helps reduce pain perception, perhaps by releasing endorphins or activating large, fast-transmitting A-beta sensory nerve fibers. Relaxation techniques include meditation, yoga, guided imagery, and progressive relaxation exercises. Distraction works by diverting the patient's attention to something other than pain, thus reducing awareness of it. Acupressure involves the application of pressure, not cold.

A patient who is in the terminal stages of liver cancer reports continuous vomiting after taking oral opioid analgesics. The patient's weight is 85 pounds. The nurse applies a transdermal fentanyl patch to the patient. The next day, the patient informs the nurse that the pain is not alleviated. What could be the possible reason for this? 1 The dose of pain medication is not enough. 2 The number of patches used is not enough. 3 The route of administration of the analgesic is not correct. 4 The patient needs to wait longer for the medication to act.

3 Fentanyl is an opioid analgesic and is available for intravenous or transdermal administration. It is 100 times more potent than morphine. However, transdermal patches are not effective in patients weighing less than 100 pounds, because these patients have very little subcutaneous tissue for absorption. Therefore, the nurse should discuss a more appropriate analgesic drug with the primary health care provider. The dose and the number of patches for the therapeutic action are predetermined. The duration of drug action is about 48 to 72 hours.

The patient complains of intermittent back pain that travels down the left leg. What is this type of pain called? 1 Visceral 2 Referred 3 Radiating 4 Superficial

3 Intermittent or constant pain that travels down or along a body part is called radiating pain. Deep or visceral pain results from the stimulation of internal organs. It is diffuse and radiates in several directions. Referred pain is in a part of the body separate from the source of pain. Superficial pain is of short duration and is localized.

A student nurse is reading about the mode of action of nonsteroidal anti-inflammatory drugs (NSAIDS). The NSAID drug decreases the level of a chemical that is known to increase pain sensitivity. With which chemical does the NSAID react? 1 Renin 2 Serotonin 3 Prostaglandin 4 Diclofenac sodium

3 Prostaglandins are generated from the breakdown of phospholipids of the cell membrane and are known to increase pain sensitivity. NSAIDs act by decreasing the levels of such compounds in the blood. Renin is involved in balancing water and electrolytes in the body. Neurotransmitters such as serotonin inhibit the transmission of pain. Diclofenac sodium is a painkiller that reduces pain sensitivity.

Which topical analgesic is effective for relieving postherpetic neuralgia in adults? 1 Capsaicin 2 ELA-Max/LMX 3 Lidoderm patch 4 Eutectic mixture of local anesthetics (EMLA)

3 The Lidoderm patch is effective for treating postherpetic neuralgia, a cutaneous neuropathic pain. Capsaicin is more appropriate for relieving minor aches and pains of the muscles and joints. ELA-Max/LMX and a eutectic mixture of local anesthetics (EMLA) are more often used to treat children.

The nurse asks a patient to rate his pain from no pain to unbearable pain. Which pain rating scale is the nurse using for pain assessment? 1 Oucher scale t2 Numeric rating scale (NRS) 3 Visual analogue scale (VAS) 4 Verbal descriptor scale

3 The VAS assesses the pain level in the patient by rating the pain along a 10-centimeter line in 1-centimeter increments from no pain to unbearable pain. The Oucher scale requires the patient to look at six faces with different expressions and point at the face that best matches the pain he or she is experiencing. With the NRS, the nurse asks the patient to choose a number to rate the level of pain. With the verbal descriptor scale, the nurse asks the patient to describe his or her feelings about the intensity of pain.

The primary health care provider (PHP) prescribes a patient-controlled analgesia (PCA) pump to a postoperative patient for pain relief. The nurse reviews the PHP's order for the patient's name, the name of the medication, dose, frequency of medication, and lockout period. Why does the nurse perform this review? 1 To prevent medication errors 2 To ensure that the patient receives the correct medications 3 To ensure that the medication is administered safely 4 To avoid placing the patient at risk for allergic reactions

3 The nurse checks the computer printout with the PHP's order for the patient's name, the name of medication, dose, frequency of medication, and lockout period to ensure that the medication is administered safely. A second registered nurse confirms the PHP's order and correct setup of the PCA pump to prevent medication errors. To ensure that the patient receives the correct medications, the nurse checks the patient's prescription. The nurse checks the patient's history for drug allergies to avoid placing the patient at risk for allergic reactions.

A physician put a postoperative patient on a patient-controlled opioid analgesic pump to be used around the clock for a week. Which assessment should the nurse make at regular intervals? 1 Liver enzymes 2 Blood pressure 3 Respiratory rate 4 Body temperature

3 While there is little risk for overdose with patient-controlled analgesic pumps, respiratory depression is a side effect associated with opioids, so while the patient is on opioid pain management, the nurse should regularly check respiratory rate. A nurse may check liver enzymes in a patient who is taking acetaminophen, not opioids, because acetaminophen can adversely affect the liver. Whereas blood pressure and body temperature may be checked regularly, it is unlikely that the nurse is doing this to monitor for side effects of opioid pain management.

Which action should the nurse take before administering morphine 4.0 mg intravenously to a patient complaining of incision pain? 1) Assess the patient's incision. 2) Clarify the order with the prescriber. 3) Assess the patient's respiratory status. 4) Monitor the patient's heart rate.

3) Assess the patient's respiratory status.

Which nonpharmacological techniques pose a risk of injury to the patient if the patient has a history of diabetic neuropathy? Select all that apply. 1 Yoga 2 Massage 3 Hot bath 4 Cold application 5 Relaxation exercises

3, 4 A patient who has diabetic neuropathy may not be able to adequately monitor temperature in areas affected by nerve damage, so application of any heat or cold may place this patient at a higher risk for injury. If done safely and properly, yoga, massage, and relaxation exercises should not place a patient with diabetic neuropathy at a higher risk for injury than any other patient.

The nurse is assessing the touch, pain, and temperature sensation of a patient who is diagnosed with diabetic neuropathy. Arrange in ascending order the parts of the central nervous system through which pain sensation is carried. 1. Cerebrum 2. Thalamus 3. Spinal cord 4. Medulla, pons, midbrain

3, 4, 2, 1 Spinal cord, Medulla, pons, midbrain, Thalamus, Cerebrum Pain sensation is transmitted from afferent fibers to the spinal cord. From the spinal cord, the pain sensation is carried to medulla, pons, and midbrain. From here it continues through the spinothalamic tract to the thalamus and then to the cerebrum.

The nurse attending to a postoperative patient finds that the patient's pain medications have been changed from morphine to ibuprofen. What are the possible reasons for the change in medication by the health care provider? Select all that apply. 1 The patient's pain has increased. 2 Morphine is known to cause seizures. 3 The patient experienced clinical respiratory depression. 4 Ibuprofen does not affect the central nervous system the way morphine does. 5 Ibuprofen does not interfere with bowel and bladder function.

3, 4, 5 Opioids (morphine) can cause respiratory depression in some patients who are not used to them. Secondly, unlike nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, opioids interfere with the activity of the central nervous system and affect the bowel and the bladder function. Opioids are generally prescribed when pain is severe. NSAIDs are useful for mild to moderate pain. Morphine is not known to cause seizures.

A 12-year-old student fall off the stairs, grabs his wrist, and cries, "Oh, my wrist! Help! The pain is so sharp, I think I broke it." Based on this data, the pain the student is experiencing is caused by impulses traveling from receptors to the spinal cord along which type of nerve fibers? A. Type A-delta fibers B. Autonomic nerve fibers C. Type C fibers D. Somatic efferent fibers

30. Answer: A. Type A-delta fibers Type A-delta fibers conduct impulses at a very rapid rate and are responsible for transmitting acute sharp pain signals from the peripheral nerves to the spinal cord. Only type A-delta fibers transmit sharp, piercing pain. Somatic efferent fibers affect the voluntary movement of skeletal muscles and joints. Type C fibers transmit sensory input at a much slower rate and produce a slow, chronic type of pain. The autonomic system regulates involuntary vital functions and organ control such as breathing.

A 65-year-old patient is experiencing mild musculoskeletal pain. Which drug is the primary health care provider most likely to prescribe? 1 Aspirin 2 Naproxen 3 Ibuprofen 4 Acetaminophen

4 A physician may first recommend acetaminophen to this patient because the pain is mild, and acetaminophen is relatively safe and widely available over the counter for musculoskeletal pain. The physician may prescribe aspirin, naproxen, or ibuprofen, but these may be second-choice drugs because they are nonsteroidal antiinflammatory drugs which carry a risk for bleeding, especially in older adults, and may not be necessary if the pain is mild.

The physician tells the nurse to administer a second drug to a patient already on oxycodone. Which drug would be safe for this patient? 1 Fentanyl 2 Morphine 3 Codeine 4 Acetaminophen

4 Acetaminophen is safe to use in combination with opioids like oxycodone for pain relief. A health care provider may do so to lower the opioid dose. Fentanyl, morphine, and codeine are also opioids, so combining them with another opioid would have potentially dangerous synergistic effects.

The nurse is assessing a patient who complains of back pain. After taking the patient's history, the nurse does not expect the physician to recommend acetaminophen. Which of the patient's statements led the nurse to this conclusion? 1 "I drink alcohol occasionally." 2 "I have been constipated for 3 days." 3 "I am allergic to penicillin." 4 "Two months ago, I was diagnosed with hepatitis B."

4 Because acetaminophen can cause hepatotoxicity, and a patient who has hepatitis B has a compromised liver, the nurse may expect the physician to avoid recommending acetaminophen to this patient. Acetaminophen is safe for a patient who consumes alcohol occasionally, but it should be used with caution for a patient who frequently drinks alcohol. Occasional alcohol intake might not affect the administration of acetaminophen. Nonsteroidal antiinflammatory drugs, not acetaminophen, may aggravate constipation. An allergy to penicillin will not necessarily predispose a patient to an allergy to acetaminophen.

Which drug is unsafe for the central nervous system as a supplement to epidural anesthesia? 1 Aspirin 2 Naproxen 3 Ibuprofen 4 Oxycodone

4 Because opioid analgesics like oxycodone depress the central nervous system, they are not safe in combination with epidural anesthesia because of possible additive central nervous system adverse effects. Aspirin, naproxen, and ibuprofen are nonsteroidal antiinflammatory drugs (NSAIDs) which do not affect the central nervous system.

The registered nurse is teaching a patient about the use of cold therapy in acute pain management. Which of the patient's statements indicates a need for further teaching? 1 "I will apply ice two to five times a day." 2 "I will apply ice with a lightweight cover, with firm pressure to my skin." 3 "I will apply ice within a 6-inch circular area near where I have pain." 4 "I will place ice between my thumb and index finger if I have shoulder pain."

4 Cold is effective for tooth or mouth pain, not shoulder pain, when the ice is placed on the web of the hand between the thumb and index finger. This is an acupressure point that influences nerve pathways to the face and head. The remaining statements indicate understanding: Ice can be applied two to five times a day with firm pressure to the skin, covered with a lightweight cloth. Ice should also be applied within a 6-inch circular area near the site of pain.

A new medical resident writes an order for oxycodone SR 10 mg PO q12 hours prn. Which part of the order does the nurse question? 1 The drug 2 The time interval 3 The dose 4 Prn

4 Controlled- or extended-release opioid formulations such as oxycodone are available for administration every 8 to 12 hours around the clock (ATC). Health care providers should not order these long-acting formulations prn.

Why would a primary health care provider prescribe acetylcysteine to a patient who is on pharmacological pain management therapy? 1 Overdose of aspirin 2 Overdose of fentanyl 3 Overdose of morphine 4 Overdose of acetaminophen

4 Dangerous hepatotoxic overdoses of acetaminophen are treated with acetylcysteine. Antiulcer drugs may be prescribed to treat gastric bleeding caused by overdose of aspirin. Overdoses of fentanyl and morphine may be treated with naloxone.

After having received 0.2 mg of naloxone intravenous push (IVP), a patient's respiratory rate and depth are within normal limits. The nurse now plans to implement which actions? 1 Discontinue all ordered opioids. 2 Close the room door to allow the patient to recover. 3 Administer the remaining naloxone over 4 minutes. 4 Assess patient's vital signs every 15 minutes for 2 hours.

4 Every 15 minutes for 2 hours following drug administration reassess patients who receive naloxone because the duration of the opioid may be longer than the duration of the naloxone, and respiratory depression may return.

A patient returning to the nursing unit after knee surgery is verbalizing pain at the surgical site. What is the nurse's first action? 1 Call the patient's health care provider. 2 Administer pain medication as ordered. 3 Check the patient's vital signs. 4 Assess the characteristics of the pain.

4 It is necessary to monitor pain on a regular basis along with other vital signs. It is important for the nurse to understand that pain assessment is not simply a number.

Which pain characteristics might the nurse suspect in a patient with kidney stones? 1 The pain is of short duration and localized. 2 The pain is diffuse and radiates in several directions. 3 The pain radiates from the site of the injury to another body part. 4 The pain is in a part of the body separate from the source of pain.

4 Kidney stones cause groin pain, an example of referred pain, which occurs in a part of the body separate from the source of pain. Superficial or cutaneous pain, for example from a needle stick or small cuts, is of short duration and is localized. Deep or visceral pain, for example from angina pectoris, is diffuse and radiates in several directions. Radiating pain travels down from the site of injury to another body part, for example in sciatica.

A patient has had arthritic pain for 8 years and has surgery to remove a buildup of septic fluid. Postoperative, the patient received morphine through a patient-controlled analgesia (PCA) device for the management of pain. After a while, the patient starts getting drowsy and symptoms of respiratory depression begin to appear. The nurse is ordered to administer naloxone. What is the rate of administering naloxone? 1 Intravenous push at the rate of 1 mL every 1 minute 2 Intravenous push at the rate of 1 mL every 2 minutes 3 Intravenous push at the rate of 0.5 mL every 1 minute 4 Intravenous push at the rate of 0.5 mL every 2 minutes

4 Naloxone is an antidote for respiratory depression caused by opioids. The dosage of naloxone is 0.4 mg diluted by 9 mL saline. This is administered by intravenous push at the rate of 0.5 mL every 2 minutes. This dosage is optimal for reversal of respiratory depression. Doses larger than this can cause severe pain and other serious complications.

A patient took more than the prescribed amount of acetaminophen and is experiencing hepatotoxicity. Which drug might the nurse anticipate the health care provider to use to treat this patient? 1 Naloxone 2 Tramadol 3 Oxycodone 4 Acetylcysteine

4 Overdose of acetaminophen may lead to hepatotoxicity, which is treated with acetylcysteine. Naloxone is used to reverse the adverse effects of opioids, not acetaminophen. Tramadol and oxycodone are used to manage pain, not to treat acetaminophen overdose.

A patient with chronic low back pain who took an opioid around-the-clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking, chills, abdominal cramps, and joint pain. What does the nurse recognize as these symptoms? 1 Addiction 2 Tolerance 3 Pseudoaddiction 4 Physical dependence

4 Physical dependence is a state of adaptation that is manifested by a drug-class specific withdrawal syndrome produced by abrupt cessation of the drug, rapid dose reduction, decreasing blood levels of the drug, and/or the administration of an antagonist.

The nurse is teaching a group of nursing students about pain sensations in infants. Which information should be included in the teaching about pain sensation in infants? 1 Infants do not perceive pain sensation immediately after birth. 2 Nurses cannot accurately assess pain in infants. 3 Infants cannot express pain sensation in the first month of life. 4 Infants learn to perceive pain by experiencing the first unpleasant stimulus.

4 Some common misconceptions about pain sensation in infants exist, of which the nurse should be aware. Infants immediately respond to pain on experiencing the first noxious stimulus. Infants feel pain from birth; a functional processing of pain is developed by mid to late gestation. Nurses can use behavioral changes and alterations in vital signs to assess pain in infants. Although infants cannot verbalize pain, they can express pain by crying.

The nurse is assessing a patient who has sustained severe injuries in a motor vehicle accident. The patient is in severe pain and is diaphoretic. On assessment, the patient's heart rate is increased, pupils are dilated, and blood pressure is decreased. Which finding is caused by the stimulation of the parasympathetic nervous system? 1 Diaphoresis 2 Dilation of pupils 3 Increased heart rate 4 Decrease in blood pressure

4 Superficial pain or mild-to-moderate pain stimulates the sympathetic nervous system. The parasympathetic nervous system is stimulated by continuous, deep, or severe pain involving visceral organs. Stimulation of the parasympathetic nervous system has an inhibitory effect on the body systems and causes a decrease in blood pressure. The sympathetic nervous system prepares the body for a fight-or-flight response. Diaphoresis, dilation of pupils, and increased heart rate are caused by the stimulation of the sympathetic system.

When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information should the nurse include? 1 TENS works by causing distraction. 2 TENS therapy does not require a health care provider's order. 3 A TENS unit must remain plugged in at all times 4 TENS electrodes are applied near or directly on the site of pain.

4 TENS involves stimulation of the skin with a mild electrical current passed through external electrodes. The therapy requires a health care provider order. The TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. Place the electrodes directly over or near the site of pain.

The registered nurse is evaluating the performance of a student nurse who is performing a back massage for a patient with back pain. Which action by the student nurse needs correction? 1 Using long, gliding strokes along the muscles of the spine 2 Beginning at the sacral area and massaging in a circular motion 3 Kneading the skin by gently grasping tissue between the thumb and fingers 4 Kneading downward along one side of the spine from the shoulders to the buttocks

4 The nurse should knead upward along one side of the spine from buttocks to shoulders, not downward from the shoulders to the buttocks. The nurse should massage each body part for at least 10 minutes and use long, gliding strokes along the muscles of the spine. The massage should begin at the sacral area and progress in a circular motion while moving upward from the buttocks to the shoulders. The nurse should knead the skin by gently grasping tissue between the thumb and fingers.

A nurse administers epidural anesthesia to a patient in the terminal stages of cancer for pain relief. Which nursing intervention is then necessary? 1 Administering supplemental doses of opioid 2 Assessing vitals once every hour after administering the first dose 3 Administering anticoagulant medications with the epidural 4 Notifying the health care provider if the patient develops pain at the epidural insertion site

4 The nurse should notify the health care provider if the patient develops pain at the epidural insertion site, because it may indicate development of an epidural hematoma. Administering supplemental opioids could lead to dangerous additive central nervous system adverse effects. The nurse should monitor vital signs and respiratory rate once every 15 minutes after the administration of epidural anesthesia to ensure stable vitals; once every hour is not enough. Anticoagulants and antiplatelet drugs should not be administered to the patient, because they may increase the risk of hematoma formation.

A patient with diabetes who is on metformin has been taking morphine and nortriptyline for the past week to treat neuropathic pain. The patient is diagnosed with an upper respiratory tract infection and is prescribed antibiotics. Which drug taken by the patient is an adjuvant pain medication? 1 Antibiotic 2 Morphine 3 Metformin 4 Nortriptyline

4 The primary purpose of an adjuvant drug such as an antiepileptic, muscle relaxant, sedative, or anxiolytic is to treat conditions other than pain. Some of these drugs have analgesic properties and reduce pain effectively when used with or without pain medications. The diabetic patient takes nortriptyline, which is an antidepressant. It is also used as an adjuvant analgesic to morphine, which is an opioid analgesic in pain management. Morphine is the primary drug that provides pain relief. Antibiotics and metformin do not have an analgesic affect. Antibiotics are used to treat infections and do not have an analgesic effect. Metformin is an oral hypoglycemic drug and does not have any effect on pain relief.

Which pain management method is considered a nonpharmacological complementary and alternative intervention? 1 Distraction 2 Biofeedback 3 Guided imagery 4 Therapeutic touch

4 Therapeutic touch is a nonpharmacological complementary and alternate pain management intervention. Distraction, biofeedback, and guided imagery, music are nonpharmacological, but considered cognitive-behavioral, not alternative and complementary, interventions.

The nurse has conducted an informative session on discouraging pseudoaddiction to a group of people in a community. Which group of patients should be the main target for the nurse's teachings? 1 Patients with a history of taking over-the-counter medicines 2 Patients with a history of drinking coffee for more than 5 years 3 Patients who say that heroin increases concentration 4 Patients who repeatedly seek multiple medical opinions for chronic pain relief

4 When a patient with chronic pain seeks pain medication from multiple primary health care providers, the patient is called a drug seeker but not an illicit drug abuser. This kind of addiction is called pseudoaddiction. Such drug seekers should be referred to pain specialists. Pseudoaddiction is not related to a history of taking over-the-counter medicines or the history of drinking coffee for more than 5 years. The patients who say that heroin increases concentration do not have pseudoaddiction.

The nurse is teaching pain management to a group of caregivers. Which information should be included? Select all that apply. 1 Chronic pain is often psychological. 2 Only hospitalized patients experience severe pain. 3 Psychogenic pain is not real. 4 Regular administration of analgesics will not lead to addiction. 5 Patients with minor illnesses may also experience severe pain.

4, 5 Misconceptions about pain often lead to poor nursing care. Therefore, it is important to know these misconceptions in order to promote appropriate pain management in patients. Regular administration of analgesics does not lead to addiction. Therefore, analgesics should be administered whenever the need arises. Although a patient may suffer from minor illness, he or she may experience severe pain that should not be ignored. A common misconception is that chronic pain is often psychological. However, chronic pain may have a pathological origin. Another misconception is that only hospitalized patients experience pain. Patients who are not hospitalized may also experience pain that needs to be addressed. Another misconception is that psychogenic pain is not real.

A substance that can cause analgesia when it attaches to opiate receptors in the brain is: A. Endorphin B. Bradykinin C. Substance P D. Prostaglandin

A

Body's natural supply of morphinelike substances: A. Neuromodulators B. Serotonin C. Pain Threshold D. Pain Experience

A

Identify the ABCDE clinical approach to pain assessment and management. A. Ask about pain, Believe patient, Choose pain control options, Deliver interventions & Empower patient B. Assess, Balance, Calculate, Diagnose, Evaluate C. Ability, Balance, Circulation, Diagnostics, Exercise D. Ambulate, Balance, Care, Delayed, Empathy

A

Mental & physical freedom from tension or stress that provides the patient a sense of self control: A. Relaxation B. Distraction C. Music D. Cutaneous Stimulation

A

Normal processing of stimuli that damages normal tissues or has the potential to do so if prolonged. Usually responsive to nonopiods and or opiods. A. Nociceptive pain B. Somatic pain C. Visceral pain D. Neuropathic pain

A

Protective; has identifiable cause, is of short duration, and has limited tissue damage & emotional response: A. Acute pain B. Chronic pain C. Chronic episodic pain D. Idiopathic pain

A

Severe cancer pain is most effectively treated with analgesics given: A. Around the clock, with extra doses available as needed B. Around the clock, in titrated doses C. As needed by the client D. Sparingly, to avoid side effects

A

While caring for a patient with cancer pain, the nurse knows that the World Health Organization (WHO) analgesic ladder recommends: A. Transitioning use of adjuvants with nonsteroidal anti-inflammatory drugs (NSAIDs) to opioids. B. Using acetaminophen for refractory pain. C. Limiting the use of opioids because of the likelihood of side effects. D. Avoiding total sedation, regardless of how severe the pain is.

A

A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain? A) Amitriptyline (Elavil) B) Corticosteroids C) Methylphenidate (Ritalin) D) Lorazepam (Ativan)

A) Amitriptyline (Elavil) Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract sedation if the client is on opioids. Lorazepam is an anxiolytic.

Identify the psychological factors that can influence pain. (Select all that apply). A. Anxiety B. Age C. Coping Style D. Neurological function

A, C

Identify the social factors that can influence pain. (Select all that apply). A. Attention B. Culture C. Previous experience D. Ethnicity E. Family & social support F. Spiritual factors

A, C, E, F

The nurse is assessing a patient for opioid tolerance. Which finding supports the nurse's 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.

A. Increasingly higher doses of opioid are needed to control pain.

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

A. Past medical history of gastric ulcer C. Stated allergy to aspirin

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 patient's 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.

A. Patient drinks 1 to 2 glasses of wine every night. Alcohol and Tylenol both affect the liver.

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 patient's pain during dressing changes? A. The patient's 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 patient's facial expressions are stoic during the procedure. D. The patient can tolerate more pain, so dressing changes can be performed more frequently.

A. The patient's need for analgesic medication decreases during the dressing changes.

When titrating an analgesic to manage pain, what is the priority goal? A. administer smallest dose that provides relief with the fewest side effects B. titrate upward until the client is pain free C. tirate downwards to prevent toxicity D. ensure that the drug is adequate to meet the clients subjective needs

A. administer smallest does that provides relief with the fewest side effects the goal is to control pain while minimizing side effects. For severe pain, the medication can be titrated upward until pain is controlled. Downward titration occurs when the pain begins to subside. Adequate dosing is important; however, the concept of controlled dosing applies more to potent vasoactive drugs.

In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant? A. assist the client with preparation of a sits bath B. monitor the client for signs of discomfort while ambulating C. coach the client to deep breathing during painful procedures D. evaluate relief after applying a cold application

A. assist the client with preparation of aa sits bath The nursing assistant is able to assist the client with hygiene issues and knows the principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and evaluating outcomes are nursing responsibilities.

A client appears upset and tearful, but denies pain and refuses pain medication, because "my sibling is a drug addict and has ruined our lives." what is the priority intervention for this client? A. encourage expression of fears on past experiences B. provide accurate information about use of pain meds C. explain that addiction is unlikely among acute care clients D. Seek family assistance in resolving this problem

A. encourage expression of fears on past experiences This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.

Nonpharmacologic strategies for pain management: A. may reduce pain perception. B. make pharmacologic strategies unnecessary. C. usually take too long to implement. D. trick children into believing that they do not have pain.

A. may reduce pain perception. R: A. Nonpharmacologic techniques for pain management may help the child with associated fears and stress related to pain. The strategies may provide assistance with coping that may reduce the perception of pain, decrease anxiety, and increase effectiveness of medications. B. The child with moderate or severe pain will require pharmacologic intervention. C. The child should be taught nonpharmacologic pain management strategies before pain occurs, thus reducing the implementation time. D. The child will still have the pain, but the perception may be altered.

A nurse is treating a Japanese man with cancer and spinal metastases resulting in severe back pain. She frequently asks him to state his pain level, and he responds with a 2/10. Which statement best explains this patient's response? a.) The patient has a high pain tolerance. b.) The patient's culture determines stoicism, particularly from men. c.) The patient currently does not have pain. d.) The patient does not understand the pain scale

Answer: B

Causes vasodilation and edema: A. Bradykinin B. Substance P C. Pain Experience D. Pain Tolerance

B

Comes from bone, joint, muscle, skin or connective tissue; is usually aching or throbbing in quality & well localized: A. Nociceptive pain B. Somatic pain C. Visceral pain D. Neuropathic pain

B

Inhibits pain transmission: A. Neuromodulators B. Serotonin C. Pain Threshold D. Pain Experience

B

Pain is a protective mechanism warning of tissue injury and is largely a(n): A. Objective experience B. Subjective experience C. Acute symptom of short duration D. Symptom of a severe illness or disease

B

The patient rates his pain as a 6 on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. The patient's wife says that he can't be in that much pain since he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain? A. The patient's wife is the best resource for determining the level of pain since she has been with him continually for the entire day. B. The patient's report of pain is the best method for assessing the pain. C. The patient's health care provider has the best knowledge of the level of pain that the patient that should be experiencing. D. The nurse is the most experienced at assessing pain.

B

The use of patient disctraction in pain control is based on the principle that: A. Small C fibers transmit impulses via the spinothalamic tract B. The reticular formation can send inhibitory signals to gating mechanisms C. Large A fibers compete with pain impulses to close gates to painful stimuli D. Transmission of pain impulses from the spinal cord to the cerebral cortex can be inhibited

B

To adequately assess the quality of a patient's pain, which question would be appropriate? A. "Is it a sharp pain or a dull pain?" B. "Tell me what your pain feels like." C. "Is your pain a crushing sensation?" D. "How long have you had this pain?"

B

Which is not a physiological factor that influences pain? A. Age B. Culture C. Fatigue D. Genes E. Neurological Function

B

Which of the following is most important when assessing a client's pain? A. The physical location of the pain B. The client's perception of the pain C. The client's vital signs D. The client appears uncomfortable

B

Which of the following is not a type of analgesic used for pain relief? A. Acetaminophen B. Herbals C. Opioids D. Adjuvants

B

Which statement made by a nursing educator best explains why it is important for nurses to determine a patient's 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."

B. "This information is useful in determining what type of pain interventions will most likely be effective in providing pain relief."

The nurse is assessing how a patient's 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?"

B. "What activities, if any, has your pain prevented you from doing?"

Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? Choose all that apply. A. An anxious, chronic pain client who frequently uses the call button B. A client second day post-op who needs pain medication prior to dressing changes C. A client with HIV who reports headache and abdominal and pleuritic chest pain D. A client who is being discharged with a surgically implanted catheter

B. A client second day post-op who needs pain medication prior to dressing changes A second day postoperative client who needs medication prior to dressing changes has predictable and routine care that a new nurse can manage. Although clients with chronic pain can be relatively stable, the interaction with this client will be time consuming and may cause the new nurse to fall behind. The client with HIV has complex complaints that require expert assessment skills. The client pending discharge will need special and detailed instructions.

Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.) A. A client who needs pre-op teaching for use of a PCA pump B. A client with a leg cast who needs neurologic checks and PRN hydrocodone C. A client post-op toe amputation with diabetic neuropathic pain D. A client with terminal cancer and severe pain who is refusing medication

B. A client with a leg cast who needs neurologic checks and PRN hydrocodone C. A client post-op toe amputation with diabetic neuropathic pain The clients with the cast and the toe amputation are stable clients and need ongoing assessment and pain management that are within the scope of practice for an LPN/LVN under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and the terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication.

The nurse recognizes that which of the following is a modifiable contributor to a patient's perception of pain? A. Age and gender B. Anxiety and fear C. Culture D. Previous pain experience

B. Anxiety and fear

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 nurse's 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.

B. Ask the health care provider to verify the dosage and frequency of the medication. Max Tylenol should be 1000 mg per dose. 2 tabs of this med would be too much Tylenol, if given every 6 hours, 4 doses X 2 tabs of 750 mg each is 6000 mg of Tylenol in 24 hours which exceed max of 4000 mg in 24 hours.

The nurse is caring for a patient who suddenly experiences chest pain. What is the nurse's 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.

B. Ask the patient to rate and describe the pain.

Which assessment data should the nurse include when obtaining a review of body systems A. Brief statement about what brought the client to the health care provider B. Client complaints of chest pain, dyspnea, or abdominal pain C. Information about the client's sexual performance and preference D. The client's name, address, age, and phone number

B. Client complaints of chest pain, dyspnea, or abdominal pain Client complaints about chest pain, dyspnea, or abdominal pain are considered part of the review of body systems. This portion of the assessment elicits subjective information on the client's perceptions of major body system functions, including cardiac, respiratory, and abdominal. The client's name, address, age, and phone number are biographical data. A brief statement about what brought the client to the health care provider is the chief complaint. Information about the client's sexual performance and preference addresses past health status.

For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take? A. Closely assess for nonverbal signs such as grimacing or rocking. B. Obtain baseline behavioral indicators from family members. C. Look at the MAR and chart, to note the time of the last dose and response. D.Give the maximum PRS dose within the minimum time frame for relief

B. Obtain baseline behavioral indicators from family members. Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.

Ann is about to take her NCLEX examination next week and is currently reviewing the concept of pain. Which scientific rationale would indicate that she understands the topic? A. Pain is an objective sign of a more serious problem B. Pain sensation is affected by a client's anticipation of pain C. Intractable pain may be relieved by treatment D. Psychological factors rarely contribute to a client's pain perception

B. Pain sensation is affected by a client's anticipation of pain Phases of pain experience include the anticipation of pain. Fear and anxiety affect a person's response to sensation and typically intensify the pain. Intractable pain is moderate to severe pain that cannot be relieved by any known treatment. Pain is a subjective sensation that cannot be quantified by anyone except the person experiencing it. Psychological factors contribute to a client's pain perception. In many cases, pain results from emotions, such as hostility, guilt, or depression.

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

B. Somatic pain

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 patient's behavior and response to surgery? A. The surgery successfully cured the patient's pain. B. The patient's culture is possibly influencing the patient's 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.

B. The patient's culture is possibly influencing the patient's experience of pain.

An important consideration when using the FACES pain rating scale with children is: A. that children color the face with the color they choose to best describe their pain. B. the scale can be used with most children, including those as young as 3 years old. C. the scale is not appropriate for use with adolescents. D. the scale is useful in pain assessment but is not as accurate when assessing physiologic responses.

B. the scale can be used with most children, including those as young as 3 years old. R: A. The child points at the face that best describes the pain being experienced. B. The FACES scale has been validated for children as young as 3 years old to rate pain. C. The scale is useful for all ages above 3 years, including adults. D. The scale does not have a means of assessing physiologic data.

In educating clients about non-pharmaceutical alternatives, which topic could you delegate to an experienced LPN/LVN, who will function under your continued support and supervision? A. therapeutic touch B. use of heat and cold applications C. meditation D. transcutaneous electrical nerve stimulation (TENS)

B. use of heat and cold applications Use of heat and cold applications is a standard therapy with guidelines for safe use and predictable outcomes, and an LPN/LVN will be implementing this therapy in the hospital, under the supervision of an RN. Therapeutic touch requires additional training and practice. Meditation is not acceptable to all clients and an assessment of spiritual beliefs should be conducted. Transcutaneous electrical stimulation is usually applied by a physical therapist.

Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b. NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine

BCA 1. NSAIDs and corticosteroids 2. codeine, oxycodone and diphenhydramine 3.morphine, hydromorphone, acetaminophen and lorazepam Step 1 includes non-opioids and adjuvant drugs. Step 2 includes opioids for mild pain plus Step 1 drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain (replacing Step 2 opioids) and continuing Step 1 drugs and adjuvant drugs as needed.

Inhibition of the pain impulse of the nociceptive process: A. Perception B. Nociceptor C. Modulation D. Prostaglandins

C

Involves physical, emotional, and cognitive components: A. Bradykinin B. Substance P C. Pain Experience D. Pain Tolerance

C

Pain that is unpredictable and not associated with any activity or event: A. Incident pain B. End-of-dose pain C. Spontaneous pain D. Acute pain

C

Pain that occurs sporadically over an extended period of time: A. Acute pain B. Chronic pain C. Chronic episodic pain D. Idiopathic pain

C

Teaching a child about painful procedures is best achieved by: A. Early warnings of the anticipated pain B. Storytelling about the upcoming procedure C. Relevent play directed toward procedure activities D. Avoiding explanations until the pain is experienced

C

The point at which a person feels pain: A. Neuromodulators B. Serotonin C. Pain Threshold D. Pain Experience

C

Treats acute or chronic pain, stress, anxiety & depression: A. Relaxation B. Distraction C. Music D. Cutaneous Stimulation

C

Which client is most likely to receive opioids for extended periods of time? A) A client with fibromyalgia B) A client with phantom limb pain C) A client with progressive pancreatic cancer D) A client with trigeminal neuralgia

C) A client with progressive pancreatic cancer Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioid and adjuvant medications. Trigeminal neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.

Identify the cultural factors that can influence pain. (Select all that apply). A. Coping style B. Spiritual factors C. Meaning of pain D. Ethnicity

C, D

which route of administration is preferable for administration of daily analgesics? A. IV B. IM or subcutaneous C. Oral D. Transdermal E. PCA

C. oral If the gastrointestinal system is function, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms.

Miggy, a 6-year-old boy, received a small paper cut on his finger, his mother let him wash it and apply small amount of antibacterial ointment and bandage. Then she let him watch TV and eat an apple. This is an example of which type of pain intervention? A. Pharmacologic therapy B. Environmental alteration C. Control and distraction D. Cutaneous stimulation

C. Control and distraction The mothers actions are example of control and distraction. Involving the child in care and providing distraction took his mind off the pain. Pharmacologic agents for pain analgesics -- were not used. The home environment was not changed, and cutaneous stimulation, such as massage, vibration, or pressure, was not used.

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."

C. "I feel less anxiety about the possibility of overdosing."

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 patient's pain 1 hour after administering oral pain medication." D. "It wasn't time for the patient's medication, so when she requested it, I gave her a placebo."

C. "I need to reassess the patient's pain 1 hour after administering oral pain medication."

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."

C. "Ibuprofen helps to decrease the production of prostaglandins."

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 don't need pain medication, they aren't in pain." C. "Pain assessment scales determine the quality of a patient's pain." D. "A patient's behavior is more reliable than the patient's report of pain."

C. "Pain assessment scales determine the quality of a patient's pain."

A family member asks you, "Why can't you give more medicine? He is still having a lot of pain." What is your best response? A. "The doctor ordered the medicine to be given every 4 hours." B. "If the medication is given too frequently he could suffer ill effects." C. "Please tell him that I will be right there to check on him." D. "Let's wait about 30-40 minutes. If there is no relief I'll call the doctor."

C. "Please tell him that I will be right there to check of him." directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next.

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 can't adjust the time for you. I'm sorry, but you must take your pill right now."

C. "Would you like medication to be given for dressing changes on top of your regularly scheduled medication?"

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."

C. "You need to drink plenty of fluids and eat a diet high in fiber."

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.

C. Give medications around-the-clock.

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 patient's 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

C. Softly plays music that the patient finds relaxing

Mr. Lim, who has chronic pain, loss of self-esteem, no job, and bodily disfigurement from severe burns over the trunk and arms, is admitted to a pain center. Which evaluation criteria would indicate the client's successful rehabilitation? A. The client remains free of the aftermath phase of the pain experience. B. The client experiences decreased frequency of acute pain episodes. C. The client continues normal growth and development with intact support systems. D. The client develops increased tolerance for severe pain in the future.

C. The client continues normal growth and development with intact support systems. Even though the client may experience an aftermath phase, progress is still possible, as is effective rehabilitation. Aftermath reactions may occur but need not interfere with rehabilitation. Acute pain is not expected at this stage of recovery. Conditioning probably would produce less pain tolerance.

A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal? A. fever B. nausea C. diaphoresis D. abdominal cramps

C. diaphoresis Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.

In caring for a young child with pain, which assessment tool is the most useful? A. simple description pain intensity scale B. 0-10 numeric pain scale C. faces pain-rating scale D. McGill-Melzack pain questionnaire

C. faces pain-rating scale The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is appropriate for young children who may have difficulty describing pain or understanding the correlation of pain to numerical or verbal descriptors. The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary.

Which non-pharmacological measure is particularly useful for a client with acute pancreatitis A. Diversional therapy, such as playing cards or board games B. Massage of back and neck with warmed lotion C. Side-lying position with knees to chest and pillow against abdomen D. Transcutaneous electrical nerve stimulation (TENS)

C. side lying position with knees to chest and pillow against abdomen The side-lying, knee-chest position opens retroperitoneal space and provides relief. The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain, especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain. The additional stimulation of massage may be distressing to the client.

For a client who is taking aspirin, which laboratory value should be reported to the physician? A. Potassium 3.6 mEq/L B. Hematocrit 41% C.PT 14 seconds D. BUN 20 mg/dL

C.PT 14 seconds When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%, female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).

When admitting a postop patient to the surgical unit, which nursing action is a priority?

Conduct Pain Assessment Assessment is a constant ongoing task for the postop patient

A postoperative patient has an order to receive morphine sulfate 4 mg IM every 3 to 4 hours prn for pain. On hand are prefilled syringes labeled morphine sulfate 10 mg/ml. How many milliliters should you administer? a. 0.4 ml b. 0.55 ml c. 0.6 ml d. 0.75 ml

Correct: A Dose (mg) ÷ availability (mg/ml) = ml to administer. Therefore, 4 mg ÷ 10 mg/ml = 0.4 ml.

You are caring for a patient who is receiving morphine sulfate via PCA. Which of the following patient assessment data demonstrate the most therapeutic effect of this medication? a. Pain rating 1/10, drowsy but arousable, respirations 16 b. Pain rating 2/10, awake and alert, respirations 18 c. Pain rating 3/10, awake and alert, respirations 20 d. Pain rating 2/10, drowsy but arousable, respirations 18

Correct: B Effective pain management is achieved when there is adequate pain control (rating of 3 or less on a scale of 1 to 10) with normal respirations and an absence of sedation. These data exhibit the best effectiveness of the pain medication in all of these areas.

You should teach a patient to avoid which of the following medications while taking ibuprofen? a. Morphine sulfate (generic) b. Nitroglycerin (Nitro-Bid) c. Aspirin d. Furosemide (Lasix)

Correct: C The patient should not take aspirin while taking ibuprofen because the combination could increase the risk of GI bleeding.

When assessing a patient receiving morphine sulfate 2 mg every 10 minutes via PCA pump, the nurse should take action as soon as the patient's respiratory rate would drop down to or below which of the following parameters? a. 16 Breaths/min b. 14 Breaths/min c. 12 Breaths/min d. 10 Breaths/min

Correct: C To protect the patient from adverse effects of respiratory depression from this medication, the nurse should alert the physician as soon as the respiratory rate drops down to or below 12 breaths/min.

A nurse is treating a patient in acute pain. What is an outcome appropriate for this patient? A. Able to self medicate B. Use of alternative therapies C. Able to tolerate high levels of pain D. Reports pain of 3 or less on a scale of 0 to 10

D

A postoperative client is prescribed acetaminophen (Tylenol) with codeine at discharge. When performing discharge teaching, the nurse: A. Warns of signs of addiction B. Recommends that the client decrease the number of tablets taken each day C. Warns that some clients experience temporary stress incontinence D. Recommends that the client take milk of magnesia at bedtime

D

A variety of meds that enhance analgesics or have analgesic properties: A. Acetaminophen B. Herbals C. Opioids D. Adjuvants

D

Abnormal processing of sensory input by the peripheral or central nervous system; treatment usually includes adjuvant & analgesics: A. Nociceptive pain B. Somatic pain C. Visceral pain D. Neuropathic pain

D

An 8-year-old client is crying with pain after a tonsillectomy. Which nursing intervention is most appropriate for this client? A. Tell him he is too big to cry. B. Tell him he may have a Popsicle when he stops crying. C. Tell him you will put him in his bed if he continues to cry. D. Hold him and provide comfort.

D

Increase sensitivity to pain: A. Perception B. Nociceptor C. Modulation D. Prostaglandins

D

Level of pain a person is willing to put up with: A. Bradykinin B. Substance P C. Pain Experience D. Pain Tolerance

D

Pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition: A. Acute pain B. Chronic pain C. Chronic episodic pain D. Idiopathic pain

D

Stimulation of skin helps relieve pain: A. Relaxation B. Distraction C. Music D. Cutaneous Stimulation

D

When asked about pain, a client complains of having severe discomfort from arthritis. Vital signs are unchanged, and the client is calmly watching television. Which of the following nursing diagnoses is most appropriate? A. Acute pain B. Altered sensory perception C. Impaired mobility D. Chronic pain

D

A postoperative patient who has undergone extensive bowel surgery moves as little as possible and does not use the incentive spirometer unless specifically reminded. The patient rates the pain severity as an 8 on a 10-point scale but tells the nurse, "I can tough it out." In encouraging the patient to use pain medication, the best explanation by the nurse is that a. very few patients become addicted to opioids when using them for acute pain control. b. there is little need to worry about side effects because these problems decrease over time. c. there are many pain medications and if one drug is ineffective, other drugs may be tried. d. unrelieved pain can be harmful due to the effect on respiratory function

D.

A first day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take? A. Deliver the bolus dose per standing order. B. Contact the physician to increase the dose. C. Try non-pharmacological comfort measures. D. Assess the pain for location, quality, and intensity

D. Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps.

The nurse is caring for a patient who recently had surgery to repair a hernia. The patient's 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 isn't receiving more pain medication. Which is the nurse's 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 doesn't 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. Let's try boosting you up in bed and putting an ice pack on the incision to see if that helps."

D. "It can take 2 hours for oral pain medication to work, and your pain is going down. Let's try boosting you up in bed and putting an ice pack on the incision to see if that helps."

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."

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."

For which time period would the nurse notify the health care provider that the client had no bowel sounds? A. 2 minutes B. 3 minutes C. 4 minutes D. 5 minutes

D. 5 minutes To completely determine that bowel sounds are absent, the nurse must auscultate each of the four quadrants for at least 5 minutes; 2, 3, or 4 minutes is too short a period to arrive at this conclusion.

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.

D. Infants respond behaviorally and physiologically to painful stimuli.

Newly hired nurse Liza is excited to perform her very first physical assessment with a 19-year-old client. Which assessment examination requires Liza to wear gloves? A. Breast B. Integumentary C. Ophthalmic D. Oral

D. Oral Gloves should be worn any time there is a risk of exposure to the client's blood or body fluids. Oral, rectal, and genital examinations require gloves because they involve contact with body fluids. Ophthalmic, breast, or integumentary examinations normally do not involve contact with the client's body fluids and do not require the nurse to wear gloves for protection. However, if there are areas of skin breakdown or drainage, gloves should be used.

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

D. The patient who is experiencing 8/10 pain and has a STAT order for pain medication

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

D. Visceral pain

What is the best way to schedule medication for a client with constant pain? A. PRN at the client's request B. Prior to painful procedures C. IV bolus after pain assessment D. Around-the-clock

D. around the clock IF the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control

The nurse is starting an intravenous (IV) line on a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on the knowledge that: A. children tolerate pain better than adults. B. children become accustomed to painful procedures. C. children often lie about experiencing pain. D. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.

D. children often demonstrate increased behavioral signs of discomfort with repeated painful procedures. R: A. There are no data to support the theory that children tolerate pain better than adults. B. The child has increasing difficulty with numerous and repeated painful procedures rather than becoming accustomed to them. C. Pain is whatever the experiencing person defines it to be. D. Children with chronic illnesses are more likely to identify invasive procedures as stressful compared with children with acute illnesses.

The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take? A. prepare the medication and hand it to the physician B. check the hospital policy regarding use of the placebo C. follow a personal code of ethics and refuse to give it D. contact the charge nurse for advice

D. contact the charge nurse for advice the charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following one's own ethical code is correct, you must ensure that the client is not abandoned and that care continues.

The most consistent indicator of pain in infants is: A. increased respirations. B. increased heart rate. C. clenching the teeth and lips. D. facial expression of discomfort.

D. facial expression of discomfort. R: A. Respiratory pattern may be markedly variable in an infant in pain and thus is not a consistent indicator of pain. B. Heart rate may initially decrease in some infants with pain and then increase; thus it is not a consistent indicator of pain. C. Clenching the teeth and lips are signs of pain often assessed in the toddler, not the infant. D. Facial expression of discomfort is the most consistent behavioral manifestation of pain in infants.

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on knowledge that: A. children tend to be overmedicated for pain. B. giving large doses of opioids causes euthanasia. C. narcotic addiction is common in terminally ill children. D. large doses of opioids are justified when there are no other treatment options.

D. large doses of opioids are justified when there are no other treatment options. R: A. Continuing studies report that children are consistently undermedicated for pain. B. The dosage of opioids is titrated to relieve pain, not cause death. C. Addiction refers to a psychologic dependence on the narcotic medication, which does not occur in terminal care. D. Large doses of opioids may be needed because the child has become physiologically tolerant to the drug, requiring higher doses to achieve the same degree of pain control. Pain is considered the fifth vital sign, and management of pain is critical to treatment of a child with bone cancer.

A 72 year old patient is hospitalized after a fall at home, is restless, has elevated blood pressure, and moans with turns. When the nurse asks, the patient denies being in pain. What initial interventions should the nurse employ?

Discuss the symptoms and explain how medication will increase comfort and increase healing Older adults are hesitant to express pain becasue they may fear being labeled as a complainer

Explain the difference between fibers that an action potential can travel across.

Each fiber is responsible for a different pain sensation. A-delta fibers are myelinated and rapidly conducting and are responsible for the initial, sharp pain associated with an injury. C fibers are unmyelinated and slow conducting and are responsible for transmitting sensation that is aching and throbbing in quality.

True or False: A patient who has a history of chronic pain is in danger of experiencing respiratory depression when taking opioids as long-term therapy. True False

False Answer: B (False) Rationale: Respiratory depression rarely occurs in patients taking opioids for chronic pain. The pain, stress, and anxiety experienced by the patient are potent respiratory stimulants that may override or negate the respiratory depression resulting from the drugs. In addition, McCaffery (1999) states that patients develop tolerance to respiratory depression at the same time that they become tolerant to the analgesic effect of an opioid.

The nurse is called to a patients room who complains of pain 9/10 and requests pain medication. He is laughing, watching football, and is in conversation with a visitor. Based on the assessment, what intervention should the nurse employ?

Give the total dose of pain medication Pain is a multidimensional phenomenon that is difficult to define. It is personal and subjective and is whatever the patient says it is.

The hospice RN obtains the following information about a 72-year-old terminally ill patient with cancer of the colon. The patient takes oxycodone (OxyContin) 100 mg twice daily for level 6 abdomen pain on a 10-point scale. The pain has made it difficult to continue with favorite activities such as playing cards with friends twice a week. The patient's children are supportive of the patient's wish to stop chemotherapy but express sadness that the patient does not have long to live. Based on this information, which nursing diagnosis has priority in planning the patient's care? a. Impaired social interaction related to disabling pain b. Anxiety related to poor patient coping skills c. Disabled family coping related to patient-family conflict d. Risk for aspiration related to opioid use

Impaired social interaction related to disabling pain

Which order would the nurse question when caring for a postop patient receiving epidural morphine infusion?

Lovenox 40mg SC BID Molecular weight heparins have been linked to spinal hematoma in clients with epidurals.

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? • Neurological factors • Competency of the surgeon • Meaning of pain • Postoperative support personnel

Meaning of pain

A patient with a history of chronic cancer pain is admitted to the hospital. When reviewing the patient's home medications, which of these will be of most concern to the admitting nurse? a. Oxycodone (OxyContin) 80 mg twice daily b. Ibuprofen (Advil) 800 mg three times daily c. Amitriptyline (Elavil) 50 mg at bedtime d. Meperidine (Demerol) 25 mg every 4 hours

Meperidine. Response Feedback: Rationale: Meperidine is contraindicated for chronic pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods. The ibuprofen, amitriptyline, and oxycodone are all appropriate medications for long-term pain management

Two days after undergoing surgery, a patient refuses to get out of bed. What information can the nurse provide that may increase compliance with the treatment plan?

Movement can cause breakthrough pain. We can give you medication to control the pain and help you to increase your activity

A 28 year old quadriplegic complains of burning pain in his lower legs. What type of pain should the nurse suspect?

Neuropathic Pain Nociceptive/neuropathic pain is due to damage to nerve cells or changes in the processing of pain

What are nociceptors?

Nociceptors are neurons that respond to pain and are stimulated by a mechanical, thermal, or chemical stimuli.

What information about pain must the nurse understand when designing a plan of care to manage pain?

Past experience with pain effects the way current pain is perceived Past experience affects the way current pain is perceived, the impact of pain experiences is not predictable, anxiety influences an individuals response to pain, and no matter what the experience is, one never becomes accustomed to pain.

How should the RN explain the mechanism that causes the skin to become reddened from prolonged exposure to cold?

Reflex vasodilation occurs following the initial vasoconstricting effects of cold.

The clinic stocks a small number of scheduled medications, so the RN obtains a dose of the prescribed medication for Wrenda. At the end of the shift,the RN counts the remaining medications with the oncoming RN and notes that the count is not accurate. What action should the RN implement?

Review prescriptions for any scheduled drugs with all nurses with access to the medications to determine why the count is inaccurate.

Once generated, an action potential travels all the way to the spinal cord unless it is blocked by a _____ inhibitor or disrupted by a lesion at the _____.

Sodium channel inhibitor (e.g., local anesthetic), terminal of the fiber (e.g., by a dorsal root entry zone [DREZ] lesion)

What is an example of a thermal stimulus?

Sunburn

What is an example of a mechanical stimulus?

Surgical incision

The action potential potential travels from the nociceptors to the spinal cord primarily by what?

The A-delta fibers within primary afferent fibers (action potential can also be transferred along the C fibers of the primary afferent fibers).

A patient is in the first postoperative day following a nephrectomy. The patient is receiving morphine through a patient-controlled analgesia (PCA) device for management of pain. The nurse decides to use the ABCDE approach while assessing and managing pain for this patient. What are the correct components of the ABCDE approach?

The ABCDE approach helps in accurately assessing pain and its management. A stands for "Ask regularly about the pain." B stands for "Believe the patient and family in the report of pain." C stands for "Choose pain control options appropriate for the patient." D stands for "Deliver interventions in an orderly and coordinated fashion." E stands for "Empower patients and their families."

What is a realistic outcome for the patient who is terminally ill with bone cancer and is experiencing uncontrolled pain?

The patient experiences improved quality of life

When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication? a. The patient complains of a "pounding" headache. b. The patient becomes restless and agitated. c. The patient has not voided for over 10 hours. d. The patient has cramping abdominal pain.

The patient has not voided for over 10 hours

You are caring for a 72 year old patient with advanced cancer who complains of increased pain and tactile sensitivity over the last several weeks. Which non pharmacological alternative could be added to her plan of care to enhance her comfort?

Therapeutic Touch Therapeutic touch is thought to realign aberrant energy fields through passing hands over the energy fields without actually touching the body and promoting comfort.

In addition to the TENS unit, Wrenda has a prescription for a Schedule IV analgesic. The RN recognizes that specific protocols are followed when a client is receiving scheduled (controlled) medications. What characteristic of scheduled drugs results in the need for these specific protocols?

There is a high potential abuse.

Describe transduction.

Transduction involves the conversion of a noxious (tissue-damaging) mechanical, thermal, or chemical stimulus into an electrical signal called an action potential.

Describe transmission.

Transmission is the process by which pain signals are relayed from the periphery to the spinal cord and then to the brain.

A patient with colon cancer is being managed with OxyContin 30mg PO BID and Oxycodone 5mg PO q4h PRN for breakthrough pain. The patiens wife voices her concern that the patient is becoming addicted to the medication and questions whether milder nonnarcotic medications could be used. What is the most appropriate response by the nurse?

With the diagnosis of cancer, there is a need to use regular and strong mediaction for pain control to provide a better quality of life Persistent pain can be managed using long acting medications and narcotics when the condition warrants their use. Addiction is not an issue for the patien with chronic cancer pain. Amount and types of meds are adjusted according to patient status

Mr. Wright is recovering from abdominal surgery. When the nurse assists him to walk, she observes that he grimaces, moves stiffly, and becomes pale. She is aware that he has consistently refused his pain medication. What would be a priority nursing diagnosis for this patient? a) Acute Pain related to fear of taking prescribed postoperative medications b) Impaired Physical Mobility related to surgical procedure c) Anxiety related to outcome of surgery d) Risk for Infection related to surgical incision

a) Acute Pain related to fear of taking prescribed postoperative medications Mr. Wright's immediate problem is his pain that is unrelieved because he refuses to take his pain medication for an unknown reason. The other nursing diagnoses are plausible, but not a priority in this situation.

The nurse is assessing the pain of a neonate who is admitted to the NICU with a heart defect. Which pain assessment scale would be the best tool to use with this patient? a) CRIES scale b) COMFORT scale c) FLACC scale d) FACES scale

a) CRIES scale The CRIES Pain Scale is a tool intended for use with neonates and infants from 0 to 6 months. The COMFORT Scale, used to assess pain and distress in critically ill pediatric patients, relies on six behavioral and two physiologic factors that determine the level of analgesia needed to adequately relieve pain in these children. The FLACC scale (F—Faces, L—Legs, A—Activity, C—Cry, C—Consolability) was designed for infants and children from age 2 months to 7 years who are unable to validate the presence or severity of pain. The FACES scale is used for children who can compare their pain to the faces depicted on the scale.

In providing care to a client with chronic pain, which of the following characteristics or client responses should the nurse expect? a) Heart rate, blood pressure, and pulse rate may be normal while the client is experiencing pain. b) Opioid-based analgesics may have little if any effect on reducing the quality of chronic pain. c) The client may have adapted so successfully to the presence of chronic pain that measures for relief are unnecessary. d) The actual intensity of chronic pain is difficult to assess because the client may complain constantly

a) Heart rate, blood pressure, and pulse rate may be normal while the client is experiencing pain. Adaptation to the presence of chronic pain is physiologic. Thus, the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain.

A postoperative client who has been receiving morphine for pain management is exhibiting a depressed respiratory rate and is not responsive to stimuli. Which drug has the potential to reverse the respiratory-depressant effect of an opioid? a) Naloxone b) Epinephrine c) Diphenhydramine d) Atropine

a) Naloxone

The nurse caring for a client receiving opioid therapy notes that the client's respirations are 7. What is the first action by the nurse? a) Physically stimulate client. b) Take the client's blood pressure. c) Begin cardiac compressions. d) Administer Narcan.

a) Physically stimulate client. The first action by the nurse is to physically stimulate the client by shaking the client or using a loud sound, followed by reminders every few minutes to breathe deeply. If this is ineffective, Narcan can be used to reverse the respiratory depressant effect of the opioid.

Which circumstance may preclude the use of cutaneous stimulation to relieve a client's pain? a) The client has difficulty localizing his pain. b) The client has a history of heart disease. c) The client is receiving both scheduled and breakthrough analgesia. d) The client's pain is chronic rather than acute.

a) The client has difficulty localizing his pain.

A nurse is caring for a client who complains of an aching pain in the abdomen. The nurse also noted that the client is guarding the area. What kind of pain is the client experiencing? a) Visceral pain b) Somatic pain c) Cutaneous pain d) Neuropathic pain

a) Visceral pain

A patient is receiving morphine sulfate intravenously (IV) for right flank pain associated with a kidney stone in the right ureter. The patient also complains of right inner thigh pain and asks the nurse whether something is wrong with the right leg. In responding to the question, the nurse understands that the patient a. is experiencing referred pain from the kidney stone. b. has neuropathic pain from nerve damage caused by inflammation. c. has acute pain that may be progressing into chronic pain. d. is experiencing pain perception that has been affected by the morphine received earlier.

a.

You have been assigned to care for a postoperative patient who has been switched from patient-controlled analgesia with meperidine (Demerol) to morphine sulfate after experiencing restlessness and agitation. The caregiver asks why the change has been made. Which of the following replies is most appropriate? a. "Restlessness and agitation are symptoms of meperidine toxicity." b. "Meperidine is not controlling the surgical pain effectively." c. "Meperidine has caused the respiratory rate to drop too low." d. "Meperidine can only be used for 24 hours postoperatively."

a. "Restlessness and agitation are symptoms of meperidine toxicity." Confusion, restlessness, and agitation are signs of toxicity from normeperidine, a toxic metabolite of meperidine.

A patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first? a. Administer the prescribed PRN immediate-acting morphine. b. Suggest the use of alternative therapies such as heat or cold. c. Utilize distraction by talking about things the patient enjoys. d. Consult with the doctor about increasing the MS Contin dose.

a. Administer the prescribed PRN immediate-acting morphine. The patient's pain requires rapid treatment and the nurse should administer the immediate-acting morphine. Increasing the MS Contin dose and use of alternative therapies also may be needed, but the initial action should be to use the prescribed analgesic medications.

A patient admitted with metastatic lung cancer is ordered to receive morphine sulfate for pain. You should assess for which of the following common adverse reactions to this medication? a. Constipation b. Agitation c. Diarrhea d. Urinary incontinence

a. Constipation Morphine sulfate is an opioid analgesic that can lead to constipation as a side effect. It is very important to use countermeasures, such as increased fiber and fluids in the diet, whenever possible, to prevent this side effect.

A 45-year-old patient has breast cancer that has spread to the liver and spine. The patient has been taking oxycodone (OxyContin) and amitriptyline (Elavil) for pain control at home but now has constant severe pain and is hospitalized for pain control and development of a pain-management program. When doing the initial assessment, which question will be most appropriate to ask first? a. How would you describe your pain? b. How much medication do you take for the pain? c. How long have you had this pain? d. How many times a day do you medicate for pain?

a. How would you describe your pain?

You are caring for a patient receiving morphine sulfate 10 mg IV push prn for pain. Upon assessment, the nurse finds the patient obtunded with a respiratory rate of 8. Which of the following medications would you prepare to administer to treat these symptoms? a. Naloxone (Narcan) b. Atropine sulfate c. Protamine sulfate d. Neostigmine bromide (Prostigmin)

a. Naloxone (Narcan) Naloxone is the antidote or reversal agent for opioid analgesics, such as morphine. Excessive sedation and respiratory depression are symptoms of overdose and/or severe adverse effects that must be reversed for patient safety.

You are caring for a postoperative patient receiving epidural fentanyl for pain relief. For which of the following common side effects will you monitor the patient (select all that apply)? a. Nausea b. Itching c. Urinary retention d. Ataxia

a. Nausea, and b. Itching Common side effects of intraspinal opioids include nausea, itching, and urinary retention. Ataxia is a common side effect of intraspinal clonidine.

A patient who is using a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first? a. Remove the fentanyl patch. b. Notify the health care provider. c. Continue to monitor the patient's status. d.Give the prescribed PRN naloxone (Narcan).

a. Remove the fentanyl patch. The assessment data indicate possible overdose of opioid. The first action should be to remove the patch. Naloxone administration in a patient who has been chronically using opioids can precipitate withdrawal and would not be the first action. Notification of the health care provider and continued monitoring also are needed, but the patient's data indicate that more rapid action is needed.

You would question an order written for Percocet for a patient exhibiting which of the following clinical manifestations? a. Severe jaundice b. Oral candidiasis c. Increased urine output d. Elevated blood glucose

a. Severe jaundice Acetaminophen and oxycodone are the ingredients in Percocet. Because acetaminophen is metabolized in the liver, the patient could develop acetaminophen toxicity in the presence of severe liver disease (evidenced by jaundice). The prudent nurse would question the order before administration.

To reduce the risk of adverse effects, you should do which of the following when caring for a patient receiving morphine sulfate via patient-controlled analgesia (PCA)? a. Teach the caregiver not to push the button for the patient. b. Instruct the patient not to push the button too frequently. c. Ask the patient to do deep breathing exercises every hour. d. Administer medications to prevent the occurrence of diarrhea.

a. Teach the caregiver not to push the button for the patient. It is important to teach the caregiver not to push the button for the patient because it is only the patient who can determine the need for the medication. If the caregiver pushes the button, the patient could receive more of a dose than is actually needed, and this increases the risk of adverse effects.

A patient who uses extended-release morphine sulfate (MS Contin) for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone (Vicodin) tablets, but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take? a. Wake the patient and administer the hydrocodone. b. Wait until the patient wakes up and reassess the pain. c. Consult with the health care provider about changing the MS Contin dose. d. Suggest the use of nondrug therapies for pain relief instead of additional opioids.

a. Wake the patient and administer the hydrocodone. Since patients with chronic pain frequently use withdrawal and decreased activity as coping mechanisms for pain, the patient's sleep is not an indicator that she is pain free. The nurse should wake the patient and administer the hydrocodone.

Morphine 10 mg IV every 4 to 6 hours prn is ordered for a patient with a pancreatic tumor who has a distant history of opioid abuse. After 3 days of receiving the morphine every 6 hours, the patient tells the nurse that the medication is needed more frequently to control the pain. The best initial action by the nurse is to a. administer the morphine every 4 hours as needed. b. consult with the doctor about initiating an appropriate weaning protocol for the morphine c. remind the patient that the previous substance abuse increases the risk for addiction. d. use alternative therapies such as heat or cold.

a. administer the morphine every 4 hours as needed Rationale: These patient data indicate that tolerance for the morphine is developing and more frequent administration is needed to maintain pain control. A weaning protocol is not indicated, since the patient still has the pancreatic tumor and there is no indication that the physiologic basis of the pain has changed. Although the patient may be at risk for addiction, adequate pain management is the priority at present. Alternative therapies may be a useful adjuvant to the morphine but should not be the first nursing action.

A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic pain complains of nausea and abdominal fullness. The best initial action by the nurse is to a. administer the ordered antiemetic medication. b. tell the patient that the nausea will subside in about a week. c. order the patient a clear liquid diet until the nausea decreases. d. consult with the health care provider about using a different opioid

a. administer the ordered antiemetic medication. Nausea is frequently experienced with the initiation of opioid therapy, and antiemetics usually are prescribed to treat this expected side effect. There is no indication that a different opioid is needed, although if the nausea persists, the health care provider may order a change of opioid. Although tolerance develops and the nausea will subside in about a week, it is not appropriate to allow the patient to continue to be nauseated. A clear liquid diet may decrease the nausea, but the best choice would be to administer the antiemetic medication and allow the patient to eat.

A primary health care provider prescribes 10 mg of codeine every 4 hours to a patient who has chronic pain from cancer. However, after taking a second dose of the prescribed drug, the nurse notices that the patient is very drowsy and nauseous. Which dose alteration may provide effective pain relief while improving the drowsiness and nausea? a. 5 mg codeine every 4 hours b. 10 mg codeine every 8 hours c. 20 mg codeine every 8 hours d. 5 mg codeine every 12 hours

a. lower dose every 4 hrs Because codeine is short-acting, relief is likely only attainable with administration every 4 hours. If 5 mg is not enough, or the side effects remain, the patient may require a different opioid. Even at every 8 hours, 10-mg and 20-mg doses are too much for the patient to tolerate without adverse side effects. A 5-mg dose every 12 hours is probably too long of an interval for this patient to obtain relief from the pain.

The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emptional experience associated with _____ or _____ tissue damage, or described in terms of such damage."

actual, potential

A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic pain complains of nausea and abdominal fullness. The most appropriate initial action by the nurse is to a. consult with the health care provider about using a different opioid. b. administer the ordered metoclopramide (Reglan) 10 mg IV. c. tell the patient that the nausea will subside in about a week. d. order the patient a clear liquid diet until the nausea decreases.

administer the ordered metoclopramide (Reglan) 10 mg IV

A home health patient has a prescription for pentazocine (Talwin,) a mixed opioid agonist-antagonist. When teaching the patient and family about adverse effects, the nurse will plan to focus on how to monitor for a. agitation. b. respiratory depression. c. hypotension. d. physical dependence.

agitation

While waiting to perform x-rays on an injured right hand according to non-pharmacological pain management practice, pain can be modulated or reduced if the nurse: a. Performs frequent pain assessment b. Administers a placebo c. Applies ice to the right elbow d. Turns off the light and shuts the door

applies ice to the right elbow

When assessing a patient receiving a continuous opioid infusion, the nurse immediately notifies the physician when the patient has: a) A respiratory rate of 10/min with normal depth b) A sedation level of 4 c) Mild confusion d) Reported constipation

b) A sedation level of 4 Sedation level is more indicative of respiratory depression because a drop in level usually precedes it. A sedation level of 4 calls for immediate action because the patient has minimal or no response to stimuli. A respiratory level of 10 with normal depth of breathing is usually not a cause for alarm. Mild confusion may be evident with the initial dose and then disappear; additional observation is necessary. Constipation should be reported to the physician, but is not the priority in this situation.

Applying the gate control theory of pain, what would be an effective nursing intervention for a patient with lower back pain? a) Encouraging regular use of analgesics b) Applying a moist heating pad to the area at prescribed intervals c) Reviewing the pain experience with the patient d) Ambulating the patient after administering medication

b) Applying a moist heating pad to the area at prescribed intervals Nursing measures such as applying warmth to the lower back stimulate the large nerve fibers to close the gate and block the pain. The other choices do not involve attempts to stimulate large nerve fibers that interfere with pain transmission as explained by the gate control theory.

A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the nurse's best intervention in this situation? a) Medicate the boy with analgesics to reduce the anxiety of experiencing pain. b) Ask the boy to draw a cartoon about the color or shape of his pain. c) Ignore the boy's pain if he is not complaining about it. d) Distract the boy so he does not notice his pain.

b) Ask the boy to draw a cartoon about the color or shape of his pain.

The nurse is preparing to initiate PCA therapy for a client with sleep apnea. What is the correct action by the nurse? a) Increase the lock out time. b) Contact the physician. c) Initiate the therapy. d) Decrease the loading dose.

b) Contact the physician. The nurse should contact the physician, as PCA therapy for pain management is contraindicated for clients with sleep apnea. This is due to the fact that oversedation in clients with sleep apnea poses a significant health risk. PCA therapy is also contraindicated in confused clients, infants and very young children, cognitively impaired clients, and clients with asthma.

A client is experiencing acute pain following the amputation of a limb. What nursing interventions would be most appropriate when treating this client? a) Increase and decrease the serum level of the analgesic as needed. b) Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. c) Treat the pain only as it occurs to prevent drug addiction. d) Do not provide analgesia if there is any doubt about the likelihood of pain occurring.

b) Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. The client would benefit from the use of nonpharmacologic complementary therapies as adjuncts to the medical regimen. The phantom pain is real pain and should be treated as such. The nurse would not increase and decrease the serum level of the analgesic as needed. The nurse would not doubt the client's report of pain and would not withhold analgesia if she doubted the likelihood of the pain occurring.

When assessing pain in a child, the nurse needs to be aware of what considerations? a) Immature neurologic development results in reduced sensation of pain. b) Inadequate or inconsistent relief of pain is widespread. c) Reliable assessment tools are currently unavailable. d) Narcotic analgesic use should be avoided.

b) Inadequate or inconsistent relief of pain is widespread. Health care personnel are only now becoming aware of pain relief as a priority for children in pain. The evidence supports the fact that children do indeed feel pain and reliable assessment tools are available specifically for use with children. Opioid analgesics may be safely used with children as long as they are carefully monitored.

The nurse preparing to admit a client receiving epidural opioids should make sure that which of the following medications is readily available on the unit? a) Lasix b) Narcan c) Digoxin d) Lopressor

b) Narcan

A postoperative client has not voided for 8 hours (since surgery). He is restless and reports abdominal pain. How and what would the nurse assess before administering pain medications? a) Check database for last bowel movement. b) Palpate abdomen for distended bladder. c) Percuss abdomen for sounds of tympany. d) Auscultate abdomen for bowel sounds.

b) Palpate abdomen for distended bladder. Nurses can provide interventions to alter or relieve pain. A client who has not voided for 8 hours after surgery, is restless, and is having abdominal pain probably has pain from a distended bladder and needs to be catheterized.

Which of the following is the priority assessment for a nurse caring for a client with a Patient Controlled Analgesia (PCA) pump? a) Cardiovascular b) Respiratory c) Peripheral Vascular d) Nueromuscular

b) Respiratory

Which clients would be the best candidate to receive epidural analgesia for pain management? a) a client who is experiencing chest pains b) a child undergoing hip surgery c) a cliient with a strained back d) a client with an inoperable brain tumor

b) a child undergoing hip surgery Epidural analgesia is being used more commonly to provide pain relief during the immediate postoperative phase and for chronic pain situations. Epidural pain management is also being used in children with terminal cancer and children undergoing hip, spinal, or lower extremity surgery.

A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a p.r.n. drug regimen as an effective method of pain control would be the client: a) experiencing chronic pain. b) in the postoperative stage with occasional pain. c) experiencing acute pain. d) in the early postoperative period.

b) in the postoperative stage with occasional pain. A p.r.n. (as needed) medication would be most appropriate for a client in the postoperative stage with occasional pain. A client in the early postoperative period would benefit from the dosage of pain medication with around the clock dosing. A client experiencing chronic pain would benefit from the dosage of pain medication with around the clock dosing. A client experiencing acute pain would benefit from the dosage of pain medication with around the clock dosing.

A nurse is performing pain assessments on clients in a physician's office. Which clients would the nurse document as having acute pain? Select all that apply. a) A client who has diabetic neuropathy b) A client who fell and broke an ankle c) a client who is having a myocardial infarction d) A client who presents with the signs and symptoms of appendicitis e) A client who has bladder cancer f) A client who has rheumatoid arthritis

b, c, d

The nurse instructs the client taking ibuprofen that the drug is effective for pain relief because it acts to a- slow painful stimuli through type A-delta pain fibers. b- reduce inflammation and block prostaglandins. c- interrupt the transmission of pain impulses. d- interfere with the relay of pain information through the dorsal horn.

b- reduce inflammation and block prostaglandins. The site of action of nonsteroidal anti-inflammatory drugs (NSAIDs) is primarily the periphery at the receptor site, where NSAIDs serve an anti-inflammatory function and prevent the production of prostaglandins.

Which action should the nurse take when preparing patient-controlled analgesia for a postoperative patient? a. Caution the patient to limit the number of times he presses the dosing button. b. Ask another nurse to double-check the setup before patient use. c. Instruct the patient to administer a dose only when experiencing pain. d. Provide clear, simple instructions for dosing if the patient is cognitively impaired.

b. Ask another nurse to double-check the setup before patient use

Which nursing action should the nurse delegate to nursing assistive personnel (NAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain? a. Assess the skin under the heating pad. b. Check the respiratory rate every 2 hours. c. Monitor sedation using the sedation assessment scale. d. Ask the patient about whether pain control is effective.

b. Check the respiratory rate every 2 hours. Obtaining the respiratory rate is included in NAP education and scope of practice. Assessment for sedation, pain control, and skin integrity requires more education and scope of practice.

A nurse is caring for a nonverbal patient when she begins to suspect that the patient is in pain. Which nonverbal manifestations would indicate pain? Select all that apply: a. Decreased respiratory rate b. Increased blood pressure c. Facial grimacing d. Decreased urinary output

b. Increased blood pressure c. Facial grimacing

A nurse is considering her options for pain relief for a patient with 10/10 pain in the lower extremities related to fibromyalgia. The physician has prescribed several pain interventions. Which would be the most immediately effective? a. Oxycodone 5-10 mg tablets b. Morphine 1-2 mg IV push c. Acetaminophen 650 mg tablets d. Extended-release oxycodone 20 mg tablet

b. Morphine 1-2 mg IV push

Applying the gate control theory of pain, what would be an effective nursing intervention for a patient with lower back pain? a. Encouraging regular use of analgesics b. Applying a moist heating pad to the area at prescribed intervals c. Reviewing the pain experience with the patient d. Ambulating the patient after administering medication

b. Nursing measures such as applying warmth to the lower back stimulate the large nerve fibers to close the gate and block the pain. The other choices do not involve attempts to stimulate large nerve fibers that interfere with pain transmission as explained by the gate control theory.

The nurse assesses a postoperative patient who is receiving morphine through patient-controlled analgesia (PCA). Which information is most important to report to the health care provider? a. The patient complains of nausea after eating. b. The patient's respiratory rate is 10 breaths/minute. c. The patient has not had a bowel movement for 3 days. d. The patient has a distended bladder and has not voided.

b. The patient's respiratory rate is 10 breaths/minute. The patient's respiratory rate indicates a need to decrease the PCA dose or change the medication in order to avoid further respiratory depression. The other information also may require intervention, but is not as urgent to report as the respiratory rate.

Pain is best described as a. a creation of a person's imagination. b. an unpleasant, subjective experience. c. a maladaptive response to a stimuls. d. a neurologic event resulting from activation of nociceptors.

b. an unpleasant, subjective experience. The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage."

An appropriate nonopioid analgesic for mild pain is (select all that apply) a. oxycodone. b. ibuprofen (Advil). c. lorazepam (Ativan). d. acetaminophen (Tylenol). e. codeine with acetaminophen (Tylenol #3).

b. ibuprofen (Advil, and d. acetaminophen (Tylenol). Nonopioid analgesics include acetaminophen, aspirin and other salicylates, and nonsteroidal antiinflammatory drugs (NSAIDs).

These medications are prescribed by the health care provider for a patient who uses long-acting morphine (MS Contin) for chronic back pain, but still has ongoing pain. Which medication should the nurse question? a. morphine (Roxanol) b. pentazocine (Talwin) c. celecoxib (Celebrex) d. dexamethasone (Decadron)

b. pentazocine (Talwin) Opioid agonist-antagonists can precipitate withdrawal if used in a patient who is physically dependent on mu agonist drugs such as morphine. The other medications are appropriate for the patient.

After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client? a) 2 b) 1 c) 3 d) 4

c) 3 The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows: 1 = awake and alert; no action necessary 2 = occasionally drowsy but easy to arouse; requires no action 3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose 4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

When developing the plan of care for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain is most effectively relieved when analgesics are administered in what matter? a) On a PRN (as needed) basis b) Conservatively c) Around the clock (ATC) d) Intramuscularly

c) Around the clock (ATC) The PRN protocol is totally inadequate for patients experiencing chronic pain. ATC doses of analgesics are more effective, whereas conservative pain management for whatever reason may also prove ineffective. Intramuscular administration is not practical on a long-range basis for a patient with chronic pain.

A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a client being discharged. What process is involved in this pain relief measure? a) Biofeedback mechanism b) Transcutaneous electrical nerve stimulation c) Cutaneous stimulation d) Client-controlled analgesia

c) Cutaneous stimulation Cutaneous stimulation techniques include acupressure, massage, application of heat and cold, and transcutaneous electrical nerve stimulation (TENS).

A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort? a) Melatonin b) Dopamine c) Endorphins d) Serotonin

c) Endorphins Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals, which have prolonged analgesic effects and produce euphoria. It is thought that certain measures, such as skin stimulation and relaxation techniques, release endorphins.

A client comes to the emergency department complaining of a shooting pain in his chest. When assessing the client's pain, which behavioral response would the nurse expect to find? a) Decreased heart rate b) High blood pressure c) Guarding of the chest area d) Increased respiratory rate

c) Guarding of the chest area

The nurse recognizes which of the following statements is true of chronic pain? a) It can be easily described by the client. b) It disappears with treatment. c) It may cause depression in clients. d) It is always present and intense.

c) It may cause depression in clients.

Three days after surgery, a patient continues to have moderate to severe incisional pain. Based on the gate control theory, what action should the nurse take? a) Decrease external stimuli in the room during painful episodes. b) Advise the patient to try to sleep following administration of pain medication. c) Reposition the patient and gently massage the patient's back. d) Administer pain medications in smaller doses but more frequently.

c) Reposition the patient and gently massage the patient's back. The nurse would reposition the client and gently massage the client's back using the gate control theory of pain. The gate control theory provides the most practical model regarding the concept of pain. It describes the transmission of painful stimuli and recognizes a relation between pain and emotions. Nursing measures, such as massage or a warm compress to a painful lower back area, stimulate large nerve fibers to close the gate, thus blocking pain impulses from that area.

A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0 to 10 scale) and requests "something for pain that will work quickly." The nurse will document this as a) somatic pain. b) referred pain. c) breakthrough pain. d) neuropathic pain.

c) breakthrough pain. Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.

Endogenous opioids such as endorphins: a) release neurotensin. b) excite neural pathways. c) contribute to analgesia. d) cause muscle spasms.

c) contribute to analgesia. 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.

Which physiologic or behavioral manifestation is more commonly associated with acute pain rather than chronic pain? a- Reduced tendency to touch or move the affected area b- Psychosocial withdrawal c- Inability to concentrate d-Dry skin and moist oral mucous membranes

c- Inability to concentrate The characteristic most common to chronic pain is psychosocial withdrawal. Dry skin and moist mucous membranes indicate an absence of or physiologic adaptation to the stress response associated with chronic pain. Clients experiencing either acute or chronic pain tend to protect the painful area. The inability to concentrate is associated much more with acute pain before any physiologic or behavioral adaptation has occurred.

A postoperative client that recently returned from surgery has a morphine PCA pump. The basal rate is ordered to be 1 mg/hour and the patient can have a 1-mg bolus every 15 minutes. When the nurse assesses the client, the nurse finds the client stuporous, hard to arouse, with a respiratory rate of 6 breaths/minute. After successfully treating the client, which action by the nurse takes priority? The nurse should a- request the physician order different basal and bolus rates. b- question the client about how he/she has been using the button on the pump. c- check the IV pump to ensure the basal rate is set correctly. d- Ask the physician to discontinue the PCA pump and revert to prn opioids for pain.

c- check the IV pump to ensure the basal rate is set correctly. The patient exhibited manifestations of opioid toxicity. The ordered dose was well within a safe range for a postoperative client. On a PCA pump, the demand feature has a lock-out device limiting the amount of opioid the client can administer. This could have been set incorrectly, allowing the client to overdose him/herself; however, a sleepy postoperative client often cannot use the demand feature without reminders. This leaves the basal rate as the most likely source of error and the nurse should check to see that it was set correctly. Giving prn pain medications often results in undertreatment of pain and should not be used on a postoperative client. If the pump was set incorrectly, there is no need to adjust the rates. Questioning the client and re-educating him/her if needed are always appropriate, but it is not the priority since the pump most likely was set incorrectly.

A 73-year-old patient who sustained a right hip fracture in a fall requests pain medication from the nurse. Based on his injury, which type of pain is this patient most likely experiencing? a. Phantom b. Visceral c. Deep somatic d. Referred

c. Deep somatic

Following surgery, a client has great difficulty getting out of bed, walking, and coughing and deep breathing. Although patient-controlled analgesia (PCA) is in place, it is rarely used, even when suggested by the nurse. This concerns the nurse. Which statement is the best way to address this concern with the client? a. "I noticed you use very little pain medication. You must be very brave and strong. But without pain medication, you will get weaker, not stronger." b. "I noticed you don't use much pain medication. If you don't push that button, I will. You need that medicine. Don't worry about getting addicted. It won't happen." c. "I noticed you haven't used your pain medication as often as you could, even though it is painful for you to get out of bed and to walk. Many people are reluctant to take pain medication. Tell me what makes you reluctant." d. "I can understand why you are reluctant to use pain medication. Many people feel the same way. Yet without pain relief, you can get atelectasis, pneumonia, and blood clots, and maybe even develop an ileus."

c. I noticed you haven't used your pain meds as often as you could, even though it is painful for you to get out of bed and walk. many people are reluctant to take pain meds. Tell me what makes you reluctant

A patient asks you why a dose of morphine sulfate by IV push is given before starting the medication via PCA. Which of the following responses is most appropriate? a. "PCA takes at least 2 hours to begin working, so the IV push dose will provide pain relief in the interim." b. "The IV push dose will enhance the effects of the PCA for the next 8 hours." c. "The IV push dose will provide for immediate pain relief, which can be maintained by using the PCA." d. "PCA will never be effective unless a loading dose is given first."

c. "The IV push dose will provide for immediate pain relief, which can be maintained by using the PCA." An IV push loading dose of an opioid analgesic provides an effective opioid level in the body, which results in immediate pain control. The PCA medication doses may be smaller and can be used more frequently to maintain pain control when the loading dose begins to wear off.

When assessing a patient receiving morphine sulfate 2 mg every 10 minutes via PCA pump, the nurse should take action as soon as the patient's respiratory rate would drop down to or below which of the following parameters? a. 16 Breaths/min b. 14 Breaths/min c. 12 Breaths/min d. 10 Breaths/min

c. 12 breaths/min To protect the patient from adverse effects of respiratory depression from this medication, the nurse should alert the physician as soon as the respiratory rate drops down to or below 12 breaths/min.

What should you monitor in a patient taking high doses of acetaminophen over a prolonged period? a. Prothrombin time b. GI irritation c. Liver function d. Kidney function

c. Liver function Prolonged use of high doses of acetaminophen increases the risk of liver damage.

When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication? a. The patient has cramping abdominal pain. b. The patient becomes restless and agitated. c. The patient has not voided for over 10 hours. d. The patient complains of a "pounding" headache.

c. The patient has not voided for over 10 hours. Urinary retention is a common side effect of epidural opioids. Headache is not an anticipated side effect of morphine, although if there is a cerebrospinal fluid leak, the patient may develop a "spinal" headache. Sedation (rather than restlessness or agitation) would be a possible side effect. Hypotonic bowel sounds and constipation (rather than abdominal cramping) are concerns.

The nurse is evaluating the effectiveness of imipramine (Tofranil), a tricyclic antidepressant, for a patient who is receiving the medication to help relieve chronic cancer pain. Which information is the best indicator that the imipramine is effective? a. The patient states, "I feel much less depressed since I've been taking the imipramine." b. The patient sleeps 8 hours every night. c. The patient says that the pain is manageable and that he or she can accomplish desired activities. d. The patient has no symptoms of anxiety.

c. The patient says that the pain is manageable and that he or she can accomplish desired activities

An important nursing responsibility related to pain is a. leave the patient alone to rest. b. help the patient appear to not be in pain. c. believe what the patient says about the pain. d. assume responsibility for eliminating the patient's pain.

c. believe what the patient says about the pain. Pain is a subjective experience, and patients need to feel confident the nurse will believe their reports of pain.

A patient is receiving a PCA infusion following surgery to repair a hip fracture. She is sleeping soundly but awakens when the nurse speaks to her in a normal tone of voice. Her respirations are 8 breaths per minute. The most appropriate nursing action in this situation is to a. stop the PCA infusion. b. obtain an oxygen saturation level. c. continue to closely monitor the patient. d. administer naloxone and contact the physician.

c. continue to closely monitor the patient. Close monitoring is indicated for this patient with a sedation score of 3 and respiratory rate of 8 breaths/minute. If the respirations fall below 8 breaths/minute and the sedation level is 5 or greater, the nurse should vigorously stimulate the patient and try to keep the patient awake.

Unrelieved pain is a. expected after major surgery. b. expected in a person with cancer. c. dangerous and can lead to many physical and psychologic care needs. d. an annoying sensation, but it is not as important as other physical care needs.

c. dangerous and can lead to many physical and psychologic care needs. Consequences of untreated pain include unnecessary suffering, physical and psychosocial dysfunction, impaired recovery from acute illness and surgery, immunosuppression, and sleep disturbances. In the acutely ill patient, unrelieved pain can result in increased morbidity as a result of respiratory dysfunction, increased heart rate and cardiac workload, increased muscular contraction and spasm, decreased gastrointestinal motility and transit, and increased breakdown of body energy stores (i.e., catabolism).

Which of these prescribed therapies should the nurse use first when caring for a patient with cancer pain that the patient describes as at "level 8 (0 to 10 scale), deep, and aching." a. fentanyl (Duragesic) patch b. ketorolac (Toradol) tablets c. hydromorphone (Dilaudid) IV d. acetaminophen (Tylenol) suppository

c. hydromorphone (Dilaudid) IV The patient's pain level indicates that a rapidly-acting medication such as an IV opioid is needed. The other medications also may be appropriate to use, but will not work as rapidly or as effectively as the IV hydromorphone.

Providing opioids to a dying patient who is experiencing moderate to sever pain a. may cause addiction. b. will probably be ineffective. c. is an appropriate nursing action. d. will likely hasten the person's death.

c. is an appropriate nursing action. Opioids are an appropriate intervention for moderate to severe pain experienced by a dying patient, and they may be titrated upward many times over the course of therapy to maintain adequate pain control.

A cancer patient who reports ongoing, constant moderate pain with short periods of severe pain during dressing changes a. is probably exaggerating pain. b. should be referred for surgical treatment of his pain. c. should be receiving both a long-acting and a short-acting opioid. d. should receive regularly scheduled short-acting opioids plus acetaminophen.

c. should be receiving both a long-acting and a short-acting opioid. Moderate to severe pain usually requires an opioid analgesic. Constant, moderate pain is treated with a long-acting opioid; procedural severe pain is treated with a short-acting opioid.

Pain is a. subjective. b. objective. c. usually subjective, but may be primarily objective in some circumstances.

c. usually subjective, but may be primarily objective in some circumstances. Although understanding the patient's experience and relying on his or her self-report is essential, this view is problematic in many patients. For example, patients who are comatose or who suffer from dementia, patients who are mentally disabled, and patients with expressive aphasia (disturbance in formulation and comprehension of language) possess varying ability to report pain. In these instances, you must incorporate nonverbal information such as behaviours into your pain assessment.

A patient with extensive second-degree burns on the legs and trunk is using patient-controlled analgesia (PCA) with IV morphine to be delivered at 1 mg every 10 minutes to control the pain. Several times during the night, the patient awakens in severe pain, and it takes more than an hour to regain pain relief. The most appropriate action by the nurse is to a. request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain. b. consult with the patient's health care provider about adding a continuous morphine infusion to the PCA regimen at night. c. teach the patient to push the button every 10 minutes for an hour before going to sleep even if the pain is minimal. d. administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.

consult with there patient's health care provider about adding a continuous morphine infusion to the PCA regimen at night. Response Feedback: Rationale: Adding a continuous dose of the morphine at night will allow the patient to sleep without being awakened by the pain. Administering a dose of morphine when the patient awakens would not address the problem. Teaching the patient to administer unneeded medication before going to sleep might result in oversedation and respiratory depression. It is inappropriate for the nurse to administer the morphine while the patient sleeps because the nurse could not assess the pain level.

After the nurse has instructed a client with low-back pain about the use of a transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what? a) "I may need fewer pain medications with the TENS unit in place." b) "Wearing the TENS unit should not interfere with my daily activities." c) "One advantage of the TENS unit is it increases blood flow." d) "I could use the TENS unit if I feel pain somewhere else on my body."

d) "I could use the TENS unit if I feel pain somewhere else on my body." The client needs further instruction when she says she can use the TENS unit on other areas of the body. Such a statement would indicate that the client does not understand that the unit should be used as prescribed by the physician in the location defined by the physician.

A middle-age client tells the nurse that her neck pain reduced considerably after she underwent a treatment in which thin needles were inserted into her skin. What kind of pain relief treatment did the client undergo? a) Transcutaneous electrical nerve stimulation b) Biofeedback c) Rhizotomy d) Acupuncture

d) Acupuncture

Which of the following means of pain control is based on the gate control theory? a) Distraction b) Hypnosis c) Biofeedback d) Acupuncture

d) Acupuncture Acupuncture is a means of pain control that is based on the gate control theory. Biofeedback, distraction, and hypnosis are alternative and complementary therapies that are nonpharmacological means of pain control. They are not based on the gate control theory.

When performing an assessment on a client with chronic pain, the nurse notes that the client frequently shifts conversational topics. The nurse determines that this may be an indicator for which of the following? a) Boredom b) Depression c) Moodiness d) Anxiety

d) Anxiety Clients in pain may experience anxiety, and the anxiety may also increase the perception of pain. Signs of anxiety include decreased attention span or ability to follow directions, asking frequent questions, shifting topics of conversation, and avoidance of discussion of feelings.

The nurse is preparing to administer an NSAID to a client for pain relief. The nurse notices that the client is diagnosed with a bleeding disorder. What should the nurse do? a) Administer the medication. b) Ask the client if they want the medication. c) Administer the medication with food. d) Contact the physician.

d) Contact the physician. The nurse should contact the physician regarding the diagnosis of a bleeding disorder and the order for the NSAID. NSAIDs are contraindicated in clients with bleeding disorders, as the action of the NSAID can interfere with the client's platelet function.

While assessing an infant, the nurse notes that the infant displays an occasional grimace and is withdrawn; legs are kicking, body is arched, and the infant is moaning during sleep. When awakened, the infant is inconsolable. What scale should the nurse use while assessing pain in this infant? a) BRADEN SCALE b) APGAR SCORE c) FACES SCALE d) FLACC SCALE

d) FLACC SCALE

A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing? a) Visceral pain b) Chronic pain c) Cutaneous pain d) Neuropathic pain

d) Neuropathic pain

Which guideline regarding pain should be included in the nurse's education plan for a group of parents with infants and toddlers? a) Toddlers often try to be brave and not cry. b) Toddlers are often reluctant to express pain. c) Infants cannot express pain until 8 months of age. d) Pain can be a source of fear and threat to the toddler's security.

d) Pain can be a source of fear and threat to the toddler's security.

Based on your knowledge of pain and the body's response, when assessing a client in pain, you would anticipate the a) Pulse rate is decreased b) Blood pressure is normal c) Respirations are shallow d) Pupils are dilated

d) Pupils are dilated Acute pain stimulates the sympathetic nervous system and produces the following objective symptoms: increased blood pressure, increased pulse, increased respiratory rate, dilated pupils, and diaphoresis.

A pregnant woman is receiving an epidural analgesic prior to delivery. The nurse provides vigilant monitoring of this patient to prevent the occurrence of: a) Pruritus b) Urinary retention c) Vomiting d) Respiratory depression

d) Respiratory depression Too much of an opioid drug given by way of an epidural catheter or a displaced catheter may result in the occurrence of respiratory depression. Pruritus, urinary retention, and vomiting may occur but are not life threatening.

A client has required frequent scheduled and breakthrough doses of opioid analgesics in the 6 days since admission to the hospital. The client's medication regimen may necessitate which intervention? a) Supplementary oxygen and chest physiotherapy b) Calorie restriction and dietary supplements c) Frequent turns and application of skin emollients d) Stool softeners and increased fluid intake

d) Stool softeners and increased fluid intake The most common side effect of opioid use is constipation. Consequently, stool softeners and increased fluid intake may be indicated. Opioids may cause respiratory depression, but this fact in and of itself does not create a need for oxygen supplementation or chest physiotherapy. The use of opioids does not create a need for calorie restriction, supplements, frequent turns, or the use of skin emollients.

The nurse is providing education to a client about the role of endogenous opioids in the transmission of pain. Which information about the release of endogenous opioids is most accurate? a) They block glutamate receptors and peptides. b) They occupy cell receptors for neurotransmitters. c) They react with acetylcholine and serotonin. d) They bind to opioid receptor sites throughout the CNS.

d) They bind to opioid receptor sites throughout the CNS.

A patient with chronic back pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask? a. "Can you describe the quality of your pain?" b. "Has there been a change in the pain location?" c. "How would you rate your pain on a 0 to 10 scale?" d. "Does the pain keep you from doing things you enjoy?"

d. "Does the pain keep you from doing things you enjoy?" The goal for the treatment of chronic pain usually is to enhance function and quality of life. The other questions also are appropriate to ask, but information about patient function is more useful in evaluating effectiveness.

Which of the following words is most likely to be used to describe neuropathic pain? a. Dull b. Mild c. Aching d. Burning

d. Burning Neuropathic pain is caused by damage to peripheral nerves or structures in the central nervous system (CNS). Typically described as numbing, hot or burning, shooting, stabbing, sharp, or electric shock-like in nature, neuropathic pain can be sudden, intense, short lived, or lingering.

Which of the following clinical manifestations would you attribute to adverse effects of morphine sulfate administered via PCA? a. Urinary incontinence b. Increased blood pressure c. Diarrhea d. Nausea and vomiting

d. Nausea and vomiting Morphine sulfate promotes nausea and vomiting by directly stimulating the chemoreceptor trigger zone in the medulla. Other common side effects include constipation, sedation, respiratory depression, and pruritus.

A patient who has chronic musculoskeletal pain tells the nurse, "I feel depressed because I ache too much to play golf." The patient says the pain is usually at a level 7 (0 to 10 scale). Which patient goal has the highest priority when the nurse is developing the treatment plan? a. The patient will exhibit fewer signs of depression. b. The patient will say that the aching has decreased. c. The patient will state that pain is at a level 2 of 10. d. The patient will be able to play 1 to 2 rounds of golf.

d. The patient will be able to play 1 to 2 rounds of golf. For chronic pain, patients are encouraged to set functional goals such as being able to perform daily activities and hobbies. The patient has identified playing golf as the desired activity, so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment. The nurse also should assess for depression, but the patient has identified the depression as being due to the inability to play golf, so the goal of being able to play 1 or 2 rounds of golf is the most appropriate.

When the nurse visits a hospice patient, the patient has a respiratory rate of 8 breaths/minute and complains of severe pain. Which action is best for the nurse to take? a Inform the patient that increasing the morphine will cause the respiratory drive to fail. b. Administer a nonopioid analgesic, such as a nonsteroidal anti-inflammatory drug (NSAID), to improve patient pain control. c. Tell the patient that additional morphine can be administered when the respirations are 12. d. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.

d. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief. The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's respiratory rate.

A nurse believes that patients with the same type of tissue injury should have the same amount of pain. This statement reflects a. a belief that will contribute to appropriate pain management. b. an accurate statement about pain mechanisms and an expected goal of pain therapy. c. a premise that this belief will have no effect on the type of care provided to people in pain. d. a lack of knowledge about pain mechanisms, which is likely to contribute to poor pain management.

d. a lack of knowledge about pain mechanisms, which is likely to contribute to poor pain management. Genetic makeup and variability among individuals affects the plasticity of the central nervous system; this phenomenon helps to explain individual differences in responses to pain. Poor knowledge of pain mechanisms often leads to poor pain management.

These medications are ordered for an 86-year-old patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy? a. aspirin (Bayer) 650 mg orally b. naproxen (Aleve) 200 mg orally c. oxycodone (Roxicodone) 5 mg orally d. acetaminophen (Tylenol) 650 mg orally

d. acetaminophen (Tylenol) 650 mg orally Acetaminophen is the best first-choice medication. The principle of "start low, go slow" is used to guide therapy when treating elderly adults because the ability to metabolize medications is decreased and the likelihood of medication interactions is increased. Nonopioid analgesics are used first for mild to moderate pain, although opioids may be used later. Aspirin and the NSAIDs are associated with a high incidence of gastrointestinal bleeding in elderly patients.

To obtain the most complete assessment data about a patient's chronic pain pattern, the nurse asks the patient a. "Can you describe where your pain is the worst?" b. "What is the intensity of your pain on a scale of 0 to 10?" c. "Would you describe your pain as aching, throbbing, or sharp?" d. "Can you describe your daily activities in relation to your pain?"

d. can you describe your daily activities in relation to your pain? Response Feedback: Rationale: The assessment of chronic pain should focus on the impact of the pain on patient function and daily activities. The other questions are also appropriate to ask, but will not give as complete information.

Noxious stimuli cause the release of numerous chemicals, which make up a "biologic soup," into the damaged tissues, and includes:

hydrogen ions, substance P, adenosine triphosphate (ATP); chemicals released from mast cells (serotonin, histamine, bradykinin, and prostaglandins); and chemicals released from macrophages (bradykinin, interleukins, and tumor necrosis factor [TNF]). Hydrogen ions Substance P Adenosine triphosphate (ATP) Serotonin Histamine Bradykinin Prostaglandins Bradykinin Interleukin Tumor necrosis factor (TNF)

A patient with chronic cancer pain experiences breakthrough pain (level 9 of 10) and anxiety while receiving sustained-release morphine sulfate (MS Contin) 160 mg every 12 hours. All these medications are ordered for the patient. Which one will be most appropriate for the nurse to administer first? a. Ibuprofen (Motrin) 400-800 mg orally b. Immediate-release morphine 30 mg orally c. Amitriptyline (Elavil) 10 mg orally. d. Lorazepam (Ativan) 1 mg orally

immediate release morphine 30 mg orally

our patient is recovering from knee surgery and states that her pain level is 7 on a 0-10 pain scale. She received a dose of medication 15 minutes ago. Which interventions may be beneficial for this patient at this time? (Select all that apply.) a. Massage her back. b. Help her to reposition on her side. c. Tell her that she cannot have any more pain medication at this time as she may become addicted d. Take a few minutes and talk to her about the pictures of her family that she brought with her from home.

massage her back Help her to reposition on her side

The health care provider tells a patient to use ibuprofen (Motrin, Advil) to relieve pain after treating a laceration on the patient's forearm from a dog bite. The patient asks the nurse how ibuprofen will control the pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing the a. production of pain-sensitizing chemicals. b. spinal cord transmission of pain impulses. c. sensitivity of the brain to painful stimuli. d. modulating effect of descending nerves.

production of pain-sensitizing chemicals

A person who is suffering may experience _____ distress

spiritual

Deep somatic pain comes from/examples

stimulation of receptors in blood vessels, joints, tendons, nerves, ligaments, fascia, muscles and bone

The emotional distress of pain can cause _____, which is the state of distress associated with loss.

suffering Suffering can result in a profound sense of insecurity and lack of self control. Suffering is not the same as pain.

A hospice patient is in continuous pain, and the health care provider has left orders to administer morphine at a rate that controls the pain. When the nurse visits the patient, the patient is awake but moaning with severe pain and asks for an increase in the morphine dosage. The respiratory rate is 10 breaths per minute. The most appropriate action by the nurse is to a. titrate the morphine dose upward until the patient states there is adequate pain relief. b. administer a nonopioid analgesic, such as ibuprofen, to improve patient pain control. c. tell the patient that additional morphine can be administered when the respirations are 12. d. inform the patient that increasing the morphine will cause the respiratory drive to fail

titrate the morphine dose upward until the patient states there is adequate pain relief. Response Feedback: Rationale: The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's respiratory rate.

To assess the quality of a patient's pain, the RN asks which question?

"What word best describes the pain you are experiencing?"

A patient has had arthritic pain for 8 years. Which questions should the nurse ask to assess the patient's pain? Select all that apply. 1 "Which factors relieve your pain?" 2 "How would you describe the pain?" 3 "Are you having any trouble passing stools?" 4 "Are you allergic to any food item or medication?" 5 "On a scale of 0 to 10, how high would you rate the pain?"

1, 2, 5 To assess the pain completely and accurately, the nurse needs to assess its onset, palliative factors, quality, radiation, severity, and time factors related to the pain. Asking about palliative factors helps to determine the factors that influence the pain. A description of the pain helps to understand the nature and location of the pain. Asking a patient to rate the pain on a pain scale helps to assess the intensity of the pain. Asking questions regarding elimination and allergies does not help in pain assessment.

A patient is in the first postoperative day following a nephrectomy. The patient is receiving morphine through a patient-controlled analgesia (PCA) device for management of pain. The patient is apprehensive about being given opioid drugs and is afraid of becoming addicted to the drug. The patient is also afraid of chronic side effects. What explanation should the nurse give the patient? Select all that apply. 1 Opioids can be used safely in cases of moderate to severe pain. 2 Opioids can be given only after surgery or for postsurgical pain. 3 Slow titration prevents potentially dangerous opioid-induced side effects. 4 The drug is administered carefully, because its action cannot be reversed. 5 In case of any adverse effects, opioid antagonist drugs can be given to reverse the effects.

1, 3, 5 There are many misconceptions about the use of opioid drugs. Opioids can be safely given to people for management of moderate to severe pain. Opioids are given in slow titration to prevent the appearance or development of any side effects. In rare cases, there may be respiratory depression as an adverse effect of opioid drugs. In such cases, an opioid antagonist drug can be administered to the patient to reverse the effects of opioids. It is not mandatory to give opioids only after surgery. They can be administered to relieve pain of any origin. The action of opioids can be reversed with the proper antagonist drug.

A registered nurse is teaching a nursing student about various nonpharmacological pain management interventions. Which of the nursing student's statements indicates a need for further teaching? 1 "Biofeedback can help change a patient's perception of pain." 2 "Music therapy can be used in combination with pharmacological measures." 3 "Guided imagery provides effective pain relief for a patient who has acute appendicitis." 4 "Therapeutic touch is a complementary and alternative medicine pain relief method."

3 Acute pain cannot be effectively managed by nonpharmacological pain management interventions alone, so the nursing student requires further teaching to understand that guided imagery alone will be inadequate for a patient experiencing acute appendicitis. The remaining statements indicate understanding. Cognitive-behavioral interventions like biofeedback can change a patient's perception of pain. Any nonpharmacological intervention like music therapy can be used in combination with pharmacological interventions to provide pain relief. Therapeutic touch is a complementary and alternative pain relief method.

A client who is receiving epidural analgesia complains of nausea and loss of motor function in his legs. The nurse obtains his blood pressure and notes a drop in his blood pressure from the previous reading. Which complication is the patient most likely experiencing? 1) Infection at the catheter insertion site 2) Side effect of the epidural analgesic 3) Epidural catheter migration 4) Spinal cord damage

3) Epidural catheter migration

Which pain management drug is considered the best tolerated and safest analgesic? 1 Fentanyl 2 Tramadol 3 Acetylcysteine 4 Acetaminophen

4 Acetaminophen is considered the best tolerated and safest analgesic used in pain management. Fentanyl and tramadol are opioids, which have the potential for significant side effects and often result in patients building a tolerance to them. Acetylcysteine is not an analgesic; rather, it is used to treat acetaminophen overdose.

What is the immediate intervention if a patient on oxycodone 10 mg/mL infusion therapy experiences respiratory depression? 1 Administering acetylcysteine 2 Reducing the dose of oxycodone to 5 mg/mL 3 Decreasing the rate of infusion 4 Administering 0.4 mg of naloxone

4 Respiratory depression is a serious side effect of opioid administration. Naloxone counters the effects of opioids, so this drug would be used to treat respiratory depression resulting from oxycodone administration. Acetylcysteine is used to counter acetaminophen, not opioid, overdose. Decreasing the dose or rate of infusion may be done to decrease less serious side effects like drowsiness or nausea.

When assessing the lower extremities for arterial function, which intervention should the nurse perform? A. Assessing the medial malleoli for pitting edema B. Performing Allen's test C. Assessing the Homans' sign D. Palpating the pedal pulses

7. Answer: D. Palpating the pedal pulses Palpating the client's pedal pulses assists in determining if arterial blood supply to the lower extremities is sufficient. Assessing the medial malleoli for pitting edema is appropriate for assessing venous function of the lower extremity. Allen's test is used to evaluate arterial blood flow before inserting an arterial line in an upper extremity or obtaining arterial blood gases. Homans' sign is used to evaluate the possibility of deep vein thrombosis.

A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain? A. amitriptyline B. corticosteroids C. methylphenidate D. lorazepam

A. amitriptyline Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract sedation if the client is on opioids. Lorazepam is an anxiolytic

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

C. A 50-year-old patient with prostate cancer

At 7 months after back injury and lumbar laminectomy, a patient complains of tenderness at the operative site and appears depressed and unwell. Other symptoms include depression, fatigue, and sleep disturbances. Which nursing diagnosis is a priority for this patient?

Chronic Pain Chronic pain has vague symptoms and few other physical findings and occurs beyond

The nurse should instruct a patient receiving NSAIDs to report which of the following adverse effects? a. Blurred vision b. Nasal stuffiness c. Urinary retention d. Black or tarry stools

Correct: D Black, tarry stools could indicate GI bleeding, which is a risk associated with NSAIDs. For this reason, the patient should be taught to report this sign and other signs of bleeding immediately.

Before administering celecoxib (Celebrex), the nurse will assess the patient's medical record for which of the following medications that would increase the risk of adverse effects? a. Aspirin b. Scopolamine c. Theophylline d. Acetaminophen

Correct: A Rationale: Celecoxib is a nonsteroidal antiinflammatory drug (NSAID) of the cyclooxygenase-2 (COX-2) inhibitor type. Although celecoxib does not inhibit COX-1 and thus has a decreased risk of bleeding, bleeding is still of concern as an adverse effect. For this reason, the drug should not be taken with other drugs that increase risk of bleeding, such as aspirin.

While reviewing the medication list for an older client with a history of heart failure, diabetes, and hypertension, which medication might cause concern?

Dolobid 250mg Salicylate salts containing mg or na should be avoided in clients whom excessive amounts of these electrolytes might be harmful

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? • Relaxation and guided imagery • Transcutaneous electrical nerve stimulation (TENS) • Herbal supplements with analgesic effects • Pudendal block

Relaxation and guided imagery

A patient with trigeminal nerve pain describes severe pain on her cheek when wind blows against her face or with the slightest touch of clothing. Which word best describes this phenomena? a. Hyperalgesia b. Neural plasticity c. Nociception d. Allodynia

d. Allodynia

A 24-year old patient is admitted to the trauma unit with a diagnosis of a fractured femur after a motor vehicle accident. He states that he has pain in the injured leg. What should be the first action taken by the nurse? a. Administer the lowest dose of pain medication b. Assess the characteristics of the pain c. Call the orthopedic surgeon d. Complete the admission assessment

assess the characteristics of the pain

Which of the following nursing interventions is most appropriate when preparing to administer an opioid analgesic agent? a. Give the medication on an empty stomach. b. Count the number of doses on hand before administration. c. Give the medication with a glass of juice or other cold beverage. d. Assess the patient for allergies to aspirin before administration.

b. Count the number of doses on hand before administration. Because opioid analgesics are controlled substances, the nurse needs to count the number of doses and check that it matches the number recorded before removing and administering the medication.

After administering acetaminophen and oxycodone (Percocet) for complaints of pain, which of the following interventions would be of highest priority for the nurse to complete before leaving the patient's room? a. Leave the overbed light on at low setting. b. Ensure that the upper two side rails are raised. c. Offer to turn on the television to provide distraction. d. Ensure that documentation of intake and output is accurate.

b. Ensure that the upper two side rails are raised. Percocet has acetaminophen and oxycodone (a class III controlled substance) as ingredients. Since the medication contains an opioid analgesic with sedative properties, the nurse must ensure patient safety before leaving the room, such as leaving the top two bedrails raised. This will help prevent the patient from falling from bed, while not restraining the patient (as four side rails would do).

A nurse uses a whirlpool to relax a patient following intense physical therapy to restore movement in her legs. What is a potent pain-blocking neuromodulator, released through relaxation techniques? a) Prostaglandins b) Substance P c) Endorphins d) Serotonin

c) Endorphins Endorphins are produced at neural synapses at various points along the CNS pathway. They are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that endorphins are released through pain relief measures, such as relaxation techniques. Prostaglandins, substance P, and serotonin (a hormone that can act to stimulate smooth muscles, inhibit gastric secretion, and produce vasoconstriction) are neurotransmitters or substances that either excite or inhibit target nerve cells.

A patient with a history of stroke 4 years ago resulting in aphasia (inability to verbally express thoughts) returns to the surgical unit after a cholecystectomy. The surgeon ordered an intravenous pain medication every 4 hours as needed (PRN) for postoperative pain. The best nursing intervention related to pain control after surgery would be to: a. Administer the pain medication when the patient becomes restless b. Wait until the patient verbalizes that he is experiencing pain to administer the pain medication. c. Assess the patient's level of pain using a Faces Pain Scale and administer pain medication as ordered d. Administer the pain medication every 4 hours as the client can't express pain.

c. Assess the patients level of pain using a Faces pain scale and administer pain medication as ordered

Your patient developed respirator depression after her first dose of intravenous (IV) morphine. After giving 0.2mg of nalozone (Narcan) IV push, the patient's respiratory rate and depth are within normal limits. Which action do you take now? a. Leave the patient alone to sleep now. b. Discontinue all pain medications ordered c. Administer another dose of naloxone in 1 hours d. Assess the patient's vital signs every 15 minutes for 2 hours

d. Asses the patients vital signs every 15 mins for 2 hours

our patient is being discharged home on an around-the-clock opioid for chronic rheumatoid arthritis pain. You would expect an order for which of the following classes of medications to accompany this order? a. Laxative b. Antibiotic c. Stool softener d. Proton pump inhibitor

laxative

A nurse is caring for a patient who recently had an abdominal hysterectomy and states that she is experiencing severe pain. The patient's 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? • "Your vitals do not show that you are having pain; can you describe your pain?" • "You do not look like you are in pain." • "OK, I will go get you some narcotic pain relievers immediately." • "What would you like to try to alleviate your pain?"

"What would you like to try to alleviate your pain?"

Three days after undergoing exploratory laparotomy and lysis of adhesions, a patient tells the nurse that his pain is no better than on the first day postop and he fears that he will be unable to return to his work withing the allotted time frame. Which response by the nurse is the most appropriate for the situation?

"You have undergone a major surgery, which is a major stressor to your body. As your body heals, your pain should resolve" Acute pain occurs after surgury and is usually limited and of predictable duration. Increased activity is needed to maintain function, promote healing, and prevent complications of surgery.

Reasons for untreated pain by health care providers include:

(1) inadequate knowledge and skills to assess pain; (2) unwillingness to believe patients' reports of pain; (3) lack of time, expertise, and perceived importance of regular pain assessments; (4) inaccurate and inadequate information about addiction, tolerance, respiratory depression, and other side effects of opioids; and (5) the fear that aggressive pain management may hasten nor cause death.

A woman is experiencing back labor and complains of constant, intense pain in her lower back. An effective relief measure is to use: A) counterpressure against the sacrum. B) pant-blow (breaths and puffs) breathing techniques. C) effleurage. D) biofeedback.

*A) counterpressure against the sacrum.* Rationale: Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. Pant-blow breathing techniques are usually helpful during contractions per the gate-control theory. Effleurage is light stroking, usually of the abdomen, in rhythm with breathing during contractions. It is used as a distraction from contraction pain; however, it is unlikely to be effective for back labor. Biofeedback-assisted relaxation techniques are not always successful in reducing labor pain. Using this technique effectively requires strong caregiver support.

A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse's MOST appropriate analgesic for pain control is: A) fentanyl (Sublimaze). B) promethazine (Phenergan). C) butorphanol tartrate (Stadol). D) nalbuphine (Nubain).

*A) fentanyl (Sublimaze).* Rationale: fenanyl IV push is the answer. This is not a fentanyl patch which would be a wrong answer. Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Phenergan is not an analgesic. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs' undesirable effects. *Stadol and Nubain are opioid agonist-antagonist analgesics. Their use may precipitate withdrawals in a patient with a history of opiate use.*

Nurses should be aware of the difference experience can make in labor pain, such as: A) sensory pain for nulliparous women often is greater than for multiparous women during early labor. B) affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. C) women with a history of substance abuse experience more pain during labor. D) multiparous women have more fatigue from labor and therefore experience more pain.

*A) sensory pain for nulliparous women often is greater than for multiparous women during early labor.* Rationale: Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

With regard to systemic analgesics administered during labor, nurses should be aware that: A) systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B) effects on the fetus and newborn can include decreased alertness and delayed sucking. C) IM administration is preferred over IV administration. D) IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

*B) effects on the fetus and newborn can include decreased alertness and delayed sucking.* Rationale: Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. Effects depend on the specific drug given, the dosage, and the timing. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: A) visceral. B) referred. C) somatic. D) afterpain.

*B) referred.* Rationale: *Visceral pain* is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. As labor progresses the woman often experiences *referred pain*. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. *Somatic pain* is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take? A) Encourage her to empty her bladder. B) Decrease her intravenous (IV) rate to a keep vein-open rate. C) Turn the woman to the left lateral position or place a pillow under her hip. D) No action is necessary since a decrease in the woman's blood pressure is expected.

*C) Turn the woman to the left lateral position or place a pillow under her hip.* Rationale: Encouraging the woman to empty her bladder will not help the hypotensive state and may cause her to faint if she ambulates to the bathroom. The IV rate should be kept at the current rate or increased to maintain the appropriate perfusion. Turning the woman to her left side is the best action to take in this situation since this will increase placental perfusion to the infant while waiting for the doctor's or nurse midwife's instruction. Hypotension indicated by a 20% drop from preblock level is an emergency situation and action must be taken.

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: A) either hot or cold applications may provide relief, but they should never be used together in the same treatment. B) acupuncture can be performed by a skilled nurse with just a little training. C) hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. D) therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

*C) hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited.* Rationale: Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. The woman and her partner should experiment with massage before labor to see what might work best. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

Which factor in the patient's past medical history dictates that the nurse exercise caution when administering acetaminophen (Tylenol)? 1) Hepatitis B 2) Occasional alcohol use 3) Allergy to aspirin 4) Gastric irritation with bleeding

1) Hepatitis B Hepatitis is a liver disease. Tylenol affects the Liver; NSAIDs affect the kidneys

The registered nurse and a nursing student are discussing opioid pain management therapy and naloxone (Narcan). Which of the nursing student's statements indicate a need for further teaching? Select all that apply. 1 "The infusion rate of an intravenous push of naloxone should be 0.5 mL for 1 minute." 2 "0.4 mg of naloxone should be diluted with 15 mL saline." 3 "Opioid-naïve patients should be closely monitored for sedation." 4 "Administering naloxone faster than the recommended rate may cause severe pain." 5 "If an adult patient experiences respiratory depression, naloxone should be administered."

1, 2 Naloxone (Narcan) is used to reverse the effects of opioids, especially in cases of overdose. While administering naloxone, the intravenous (IV) push should be at a rate of 0.5 mL every 2 minutes, not for 1 minute, until the respiratory rate is greater than eight breaths/min. Generally, 0.4 mg of naloxone is diluted with 9 mL, not 15 mL, saline. The remaining statements are correct. Opioid-naïve patients should be closely monitored for sedation, which occurs before respiratory depression. If naloxone is administered too quickly, the patient may experience severe pain and other serious complications. If an adult patient who is on pain management therapy with opioid analgesics experiences respiratory depression, naloxone should be administered.

A group of nursing students is learning about nociceptive and neuropathic pain. What are examples of neuropathic pain? Select all that apply. 1 Aching muscles 2 Diabetic neuropathy 3 Trigeminal neuralgia 4 Nerve root compression 5 Throbbing pain at knee joint

2, 3, 4 Neuropathic pain arises when there is abnormal processing of sensory input by the peripheral or central nervous system. Pain felt along the distribution of many peripheral nerves as in diabetic neuropathy is a neuropathic pain. Pain felt partly along the distribution of a damaged nerve such as in nerve root compression is also an example of neuropathic pain. Pain associated with trigeminal neuralgia is also a neuropathic pain. Aching muscles and a throbbing pain at the knee joint are examples of nociceptive pain.

Which one of the following instructions is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine? A. Only the patient should push the button. B. Do not use the PCA until the pain is severe. C. The PCA prevents overdoses from occurring. D. Notify the nurse when the button is pushed.

A

A health care provider writes the following order for an opioid naive patient who returned from the operating room following a total hip replacement. "Fentanyl patch 100 mcg, change every 3 days." Based on this order, the nurse takes the following action: A. Calls the health care provider, and questions the order B. Applies the patch the third postoperative day C. Applies the patch as soon as the patient reports pain D. Places the patch as close to the hip dressing as possible

A Fentanyl is 100X more potent than morphine and not recommended for acute postoperative pain. opioid naive patients should never be started on a fentanyl patch. First she should try a low dose of morphine to see how see reacts to morphine which is in same medication family as fentanyl. Fentanyl is a strong opioid and can cause a patient to stop breathing.

The nurses caring for a child are concerned about the child's frequent requests for pain medication. During a team conference, a nurse suggests that they consider administering a placebo instead of the usual pain medication. This decision should be based on knowledge that: A. this practice is unjustified and unethical. B. this practice is effective in determining whether a child's pain is real. C. the absence of a response to a placebo means the child's D. pain has an organic basis. Incorrect E. a positive response to a placebo will not occur if the child's pain has an organic basis.

A. this practice is unjustified and unethical. R: A. Placebos should never be given by any route in the assessment or management of pain. B. Placebos should never be given as a means to determine whether pain is real. Individuals respond differently to placebos; thus the patient's response may not be an accurate measure of pain. C. Response to a placebo is not a measure of the origin of pain and should never be used as a means of assessing pain. D. Response to a placebo is not a measure of the origin of pain and should never be used as a means of assessing pain.

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."

A."Meditation controls pain by blocking pain impulses from coming through the gate."

Wrenda decides to purchase buffered aspirin and asks if this medication is also safe to give her 4-year-old son since he occasionally experiences viral infections and becomes feverish.

All aspirin products should be avoided in children unless specifically prescribed.

A nurse is working with a woman during the transition stage of labor. She asks the woman if she would like to change position and the woman retorts, "I didn't ask for any help, I'm fine where I am!" Which is the most appropriate reason for this behavior? a.) Pain may evoke a wide range of responses, including anger b.) The patient may be disoriented or confused c.) There may be a psychiatric history involved with this patient d.) The patient's pain is well controlled

Answer: A

A nurse is conducting a pain assessment on a patient with a spinal tumor and lower extremity pain. What questions would be important to characterize the pain? Select all that apply: a.) "What is your current level of pain on a scale of 0 to 10?" b.) "How would you describe your pain: sharp, shooting, radiating, stabbing, throbbing, etc.?" c.) "How long have you had this pain, and is it constant?" d.) "What do you usually take for pain at home?"

Answer: A, B, C

What is a priority intervention for an older female patient with a history of hyperparathyroidism? A. Encourage small frequent meals. B. Implement fall precautions. C. Provide pain medications as prescribed. D. Encourage oral fluid hydration.

Answer: B Rationale: Manifestations of hyperparathyroidism may present as bone lesions, pathologic fractures, bone cysts, and osteoporosis. Preventing falls is a priority nursing intervention. Fluid hydration may be used to treat hypercalcemia. Small frequent meals can assist with nutritional need.

The patient is receiving his first dose of an opioid analgesic for pain. The nurse expects that another medication that will probably be ordered concurrently for this patient will be a(n): A. Antacid agent B. Laxative or stool softener C. Anti-anxiety agent D. Breakthrough pain reliever

Answer: B Rationale: Opioids inhibit peristalsis in the GI tract. Patients who take regular doses of opioids frequently become constipated. Interventions such as diet modifications and laxative agents may be needed to prevent or minimize the problem of constipation. Other common side effects of opioid administration include nausea and vomiting, sedation, and respiratory depression (see Table 3-9).

Which patient would benefit most from the use of a patient-controlled analgesia pump? A. 75-year-old woman in the last stages of the dying process who is experiencing occasional episodes of confusion B. 60-year-old man who is mentally alert and is experiencing left-sided weakness after a stroke C. 42-year-old man who is mentally alert and is recovering from a fractured femur D. 15-year-old girl who is recovering from a head injury from an automobile accident

Answer: C Rationale: The mentally alert, physically able patient is the best candidate to receive PCA. When a patient is cognitively impaired or unable to push the PCA button, another method of administration should be considered.

When caring for a patient with a suspected viral infection, which medication order would the nurse question?

Aspirin ASA may pose a risk for people of any age when administered to those with viral infections. Adults have experienced Reye's syndrome-like manifestations.

Which of the following signs or symptoms in an opioid-naïve patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid? A. Oxygen saturation of 95% B. Difficulty arousing the patient C. Respiratory rate of 10 breaths/min D. Pain intensity rating of 5 on a scale of 0 to 10

B

A new medical resident writes an order for OxyContin SR 10 mg PO q12 hours prn. Which part of the order does the nurse question? A. The drug B. The time interval C. The dose D. The route

B 12 hours is a long time to have to wait for a prn pain medication. SR means slow release and slow release meds are not used for prn meds. PRN meds should be fast acting and short acting. Oxycontin SR 10 mg lasts about 12 hours but should not be given for breakthrough pain. It should be given on a regular 12 hour schedule.

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 student's 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 patient's 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."

B. "It is safe to administer opioids to older adults as long as you start with small doses and frequently assess the patient's response to the medication."

A 6-year-old is hospitalized with a fractured femur. Based on the nurse's knowledge of opioid side effects, the nurse should include which actions in the patient's plan of care to prevent constipation? (Select all that apply.) A. Instruct the child to remain supine while in bed. B. Administer docusate sodium (Colace). C. Encourage fluid intake. D. Encourage the child to eat fruit. E. Administer diphenhydramine (Benadryl).

B. Administer docusate sodium (Colace). C. Encourage fluid intake. D. Encourage the child to eat fruit. R: Administration of Colace, a stool softener, can help prevent constipation. Increased fluid and fruit intake (high fiber content) can help prevent constipation. Increased activity helps stimulate peristalsis. Diphenhydramine would not increase peristalsis or prevent constipation.

Transdermal fentanyl (Duragesic) is being used for an adolescent with cancer who is in hospice care. The adolescent has been comfortable for several hours but now complains of severe pain. The most appropriate nursing action is to: A. administer meperidine (Demerol) intramuscularly (IM). B. administer morphine sulfate immediate release (MSIR) intravenously (IV). C. use a nonpharmacologic strategy. D. place another fentanyl patch on the adolescent.

B. administer morphine sulfate immediate release (MSIR) intravenously (IV). R: A. Intramuscular injections should be avoided in cancer patients because of increased risk of bleeding and the fact that they do not act immediately. B. The nurse should administer an immediate-release opioid such as MSIR IV for the breakthrough pain. C. Nonpharmacologic strategies are not effective in severe pain. D. Transdermal fentanyl will take up to 24 hours to reach peak effect and thus is not effective for severe breakthrough pain.

A child who has been receiving morphine intravenously will now start receiving it orally. The nurse should anticipate that, to achieve equianalgesia (equal analgesic effect), the oral dose will be: A. the same as the intravenous (IV) dose. B. greater than the IV dose. C. one half of the IV dose. D. one fourth of the IV dose.

B. greater than the IV dose. R: A. Oral morphine is not as effective at the same dose as IV morphine. B. When the route of morphine administration is changed from IV to PO (by mouth), it is essential that the dosage be increased to achieve an equianalgesic effect. C. The dosage of morphine is increased, not decreased, when the administration route changes from IV to PO. D. The dosage of morphine is increased, not decreased, when the administration route changes from IV to PO.

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

C. Ask the patient to rate the level of pain.

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 patient's 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

C. Labeling the tubing that leads to the epidural catheter

When changing a dressing on the leg of a 16-year-old patient who suffered second degree burn injuries, the nurse expects to observe which characteristics of pain expression? (Select all that apply.) A. Stomping feet on the ground and screaming, "No" B. Attempting to move leg out of reach of the nurse. C. Repeatedly stating, "You're hurting me." D. Clinching fists and tensing arms in anticipation. E. Scooting away and asking parents to stop the nurse.

C. Repeatedly stating, "You're hurting me." D. Clinching fists and tensing arms in anticipation. R: Developmental characteristics of the adolescent's response to pain include: less vocal protest; less motor activity; more verbal expressions, such as "It hurts" or "You're hurting me"; and increased muscle tension and body control. Stating "You're hurting me" and muscle tension are expected responses to pain for the adolescent.

Family members are encouraging your client to "tough it out" rather than run the risk of becoming addicted to narcotics. The client is stoically abiding by the family's wishes. Priority nursing interventions for this client should target which dimension of pain? A.Sensory B.Affective C.Sociocultural D.Behavioral E.Cognitive

C. Sociocultural The family is part of the sociocultural dimension of pain. They are influencing the client and should be included in the teaching sessions about the appropriate use of narcotics and about the adverse effects of pain on the healing process. The other dimensions should be included to help the client/family understand overall treatment plan and pain mechanism

Which route of administration is preferred if immediate analgesia and rapid titration are necessary A. intraspinal B.patient-controlled analgesia (PCA) C. intravenous D. sublingual

C. intravenous the IV route is preferred as the fastest and most amenable to titration. A PCA bolus can be delivered; however, the pump will limit the dosage that can be delivered unless the parameters are changed. Intraspinal administration requires special catheter placement and there are more potential complications with this route. Sublingual is reasonably fast, but not a good route for titration, medication variety in this form is limited.

The nurse is caring postoperatively for an 8-year-old child with multiple fractures and other trauma resulting from a motor vehicle injury. The child is experiencing severe pain. An important consideration in managing the child's pain is to: A. give only an opioid analgesic at this time. B. increase the dosage of analgesic until the child is adequately sedated. C. plan a preventive schedule of pain medication around the clock. D. give the child a clock and explain when he or she can have pain medications.

C. plan a preventive schedule of pain medication around the clock. R: A. This is appropriate for the immediate pain but will not facilitate the more long-term plan of pain management. B. The dosage of analgesic is increased until pain is controlled, not until sedation is adequate. C. An around-the-clock administration strategy should be used for a child recovering from trauma and surgery. This schedule will help prevent low plasma levels of the drug, leading to breakthrough pain. D. The child should be frequently assessed for pain, and medication doses titrated accordingly. It is inappropriate to give a child a clock with instructions as to when pain medication can be given, especially a child who has experienced a traumatic event.

The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain: A. cannot occur if a child is comatose. B. may occur if a child regains consciousness. C. requires astute nursing assessment and management. D. is best assessed by family members who are familiar with the child.

C. requires astute nursing assessment and management. R: Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess pain. Pain can occur in the comatose child. The child can be in pain while comatose. The family can provide insight into the child's different responses, but the nurse should be monitoring physiologic and behavioral manifestations.

In applying the principles of pain treatment, what is the first consideration? A.treatment is based on client goals B. a multidisciplinary approach is needed C. the client must be believed about perceptions of own pain D. drug side effects must be prevented and managed

C. the client must be believed about perceptions of own pain The client must be believed and his or her experience of pain must be acknowledged as valid. The data gathered via client reports can then be applied to other options in developing the treatment plan.

What is the best goal for the RN to include in the plan of care related to the problem statement of "Acute pain related to strain on muscles with movement?"

Client reports pain of 1 on a 1-10 scale scale. 3 or under pain level is also a good goal.

A client with chronic pain reports to you, the charge nurse, that the nurse have not been responding to requests for pain medication. What is your initial action? A.Check the MARs and nurses' notes for the past several days. B. Ask the nurse educator to give an in-service about pain management. C. Perform a complete pain assessment and history on the client. D. Have a conference with the nurses responsible for the care of this client

D. Have a conference with the nurses responsible for the care of this client As charge nurse, you must assess for the performance and attitude of the staff in relation to this client. After gathering data from the nurses, additional information from the records and the client can be obtained as necessary. The educator may be of assistance if knowledge deficit or need for performance improvement is the problem.

as the charge nurse, you are reviewing the charts of clients who were assigned to a newly graduated RN. The Rn correctly charted dose and time of medication, but there is no documentation regarding non-pharmaceutical measures. what action should you take first? A. make a note in the nurse's file and continue to observe clinical performance B. refer the new nurse to the in-service education department C. quiz the nurse about knowledge of pain management D. give praise for the correct dose and time and discuss the deficits in charting

D. give praise for the correct dose and time and discuss the deficits in charting In supervising the new RN, good performance should be reinforced first and then areas of improvement can be addressed. Asking the nurse about knowledge of pain management is also an option; however, it would be a more indirect and time-consuming approach. Making a note and watching do not help the nurse to correct the immediate problem. In-service might be considered if the problem persists.

A child is being seen in the emergency department with multiple facial abrasions and lacerations. The combination agent lidocaine, adrenaline, and tetracaine (LAT) is applied topically to the wounds. The purpose of this combination therapy is to: A. cleanse the wound. B. promote scab formation. C. prevent infection of the wound. D. provide anesthesia to the wound.

D. provide anesthesia to the wound. R: The combination of lidocaine, adrenaline, and tetracaine provides anesthesia within 10 to 15 minutes of application. LAT does not have a cleansing effect. LAT has no effect on scab formation. LAT has no antibacterial effect.

6) Before implementing any interventions, what action is most important for the RN to take?

Discuss the plan of care with the client.

An 80 year old patient who is recovering from a hip fracture with surgical nailing is becoming increasingly confused and unable to participate in care, and has experienced several periods of urinary incontinence. Which orders might the nurse suspect of contributing to the patient's sypmptoms?

Meperidine 25mg Meperidine causes confusion and delerium in the older adult and should be used caustiously in patients with altered renal function.

One hour after administering the first dose of an intravenous opioid to your postoperative patient, about which of the following assessments should you be most concerned? a. Respiratory rate of 6 breaths per minute b. Oxygen saturation of 95% on room air c. Heart rate of 70 regular d. Blood pressure of 140/72

Resp rate 6 breaths per min

The three types of responses to pain are physiologic, behavioral, and affective. Which are examples of behavioral responses to pain? Select all that apply. a) A patient cradles a wrist that was injured in a car accident. b) A child is moaning and crying due to a stomachache. c) A patient's pulse is increased following a myocardial infarction. d) A patient in pain strikes out at a nurse who attempts to bathe him. e) A patient who has chronic cancer pain is depressed and withdrawn. f) A child pulls away from a nurse trying to give him an injection.

a, b, f Protecting or guarding a painful area, moaning and crying, and moving away from painful stimuli are behavioral responses. Examples of a physiologic or involuntary response would be increased blood pressure or dilation of the pupils. Affective responses, such as anger, withdrawal, and depression, are psychological in nature.

One of the most common distinctions of pain is whether it is acute or chronic. Which examples describe chronic pain? Select all that apply. a) A patient is receiving chemotherapy for bladder cancer. b) An adolescent is admitted to the hospital for an appendectomy. c) A patient is experiencing a ruptured aneurysm. d) A patient who has fibromyalgia requests pain medication. e) A patient has back pain related to an accident that occurred last year. f) A patient is experiencing pain from second-degree burns.

a, d, e Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the normal healing period. Examples are cancer pain, fibromyalgia pain, and back pain. Acute pain is generally rapid in onset and varies in intensity from mild to severe, as occurs with an emergency appendectomy, a ruptured aneurysm, and pain from burns.

An elderly patient is confined to bedrest following cervical spine surgery to treat nerve pinching. The nurse is vigilant about turning the patient and assessing the patient regularly to prevent the formation of pressure ulcers. What type of agent is the stimulus for pressure ulcers? a. Mechanical b. Thermal c. Chemical d. Electrical

a. Receptors in the skin and superficial organs may be stimulated by mechanical, thermal, chemical, and electrical agents. Friction from bed linens causing pressure sores and pressure from a cast are mechanical stimulants. Sunburn is a thermal stimulant. An acid burn is the result of a chemical stimulant. The jolt from a lightening bolt is an electrical stimulant.

A patient returns from the postanesthesia care unit following surgery with a PCA containing morphine. What assessment findings would be abnormal? a. Respiratory rate of 8 breaths per minute b. Pain scale rating of 3/10 c. Blood pressure 106/76 d. Patient is lethargic

a. Respiratory rate of 8 breaths per minute

A 7-year old pediatric patient tells you that he is in pain. The patient rates the pain as 4 on the Faces Pain Scale of 0-10. His mother, who is in the room, states that her son is having pain at a level of 8 on the 0-10 scale. Which is the most accurate assessment of the patient's pain? a. The patient is the best resource for assessing the pain and should receive the appropriate pain medication b. The patient is the best resource for assessing the pain, but should not receive any pain medication because his level is only 4 out of 10. c. The nurse is the best resource for assessing the pediatric patient's pain level and gives the dose of pain medication that matches the nurses' judgment. d. The mother is the best resource for assessing the pain in this case, and the patient should receive the maximum dose of pain medication ordered.

a. The patient is the best resource for assessing the pain and should receive the appropriate pain medication

A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. The nurse's reply is based on the information that these strategies a. impact the cognitive and affective components of pain. b. increase the modulating effect of the efferent pathways. c. prevent transmission of nociceptive stimuli to the cortex. d. slow the release of transmitter chemicals in the dorsal horn.

a. impact the cognitive and affective components of pain. Cognitive therapies impact on the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.

A patient complains of abdominal pain that is difficult to localize. The nurse documents this as which type of pain? a) Cutaneous b) Visceral c) Superficial d) Somatic

b) Visceral The patient's pain would be categorized as visceral pain, which is poorly localized and can originate in body organs in the abdomen. Cutaneous pain (superficial pain) usually involves the skin or subcutaneous tissue. A paper cut that produces sharp pain with a burning sensation is an example of cutaneous pain. Deep somatic pain is diffuse or scattered and originates in tendons, ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that occurs with a sprain causes deep somatic pain.

A nurse instructor is teaching a class of student nurses about the nature of pain. Which statements accurately describe this phenomenon? Select all that apply. a. Pain is whatever the physician treating the pain says it is. b. Pain exists whenever the person experiencing it says it exists. c. Pain is an emotional and sensory reaction to tissue damage. d. Pain is a simple, universal, and easy-to-describe phenomenon. e. Pain that occurs without a known cause is psychological in nature. f. Pain is classified by duration, location, source, transmission, and etiology.

b, c, f. Margo McCaffery (1979, p. 11) offers the classic definition of pain that is probably of greatest benefit to nurses and their patients: "Pain is whatever the experiencing person says it is, existing whenever he (or she) says it does." The International Association for the Study of Pain (IASP) further defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (IASP, 1994). Pain is an elusive and complex phenomenon, and despite its universality, its exact nature remains a mystery. Pain is present whenever a person says it is, even when no specific cause of the pain can be found. Pain may be classified according to its duration, its location or source, its mode of transmission, or its etiology.

When doing a pain assessment for a patient who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the patient's pain? a. "How long have you had this pain?" b. "How would you describe your pain?" c. "How much medication do you take for the pain?" d."How many times a day do you medicate for pain?"

b. "How would you describe your pain?" Because pain is a multidimensional experience, asking a question that addresses the patient's experience with the pain is likely to elicit more information than the more specific information asked in the other three responses. All of these questions are appropriate, but the response beginning "How would you describe your pain?" is the best initial question.

A patient at the end of life is receiving comfort care. He is grimacing, and the family at the bedside are concerned that he is experiencing pain. They ask the nurse for pain medications. Which response by the nurse is most appropriate? a. "I am concerned about further depressing his respirations and cannot give him any opioid medications at this time." b. "It is important that he is comfortable. I will give him some oral morphine to help with his pain." c. "I am against euthanasia and will not be able to care for this patient any longer." d. "The patient has not verbalized his pain rating, and I am hesitant to give pain medication."

b. "It is important that he is comfortable. I will give him some oral morphine to help with his pain."

The health care provider plans to titrate a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time (select all that apply)? a. Assessing for signs that the patient is becoming addicted to the opioid b. Monitoring for therapeutic and adverse effects of opioid administration c. Emphasizing that the risk of some opioid side effects increases over time d. Educating the patient about how analgesics improve postoperative activity level e. Teaching about the need to decrease opioid doses by the second postoperative day

b. Monitoring for therapeutic and adverse effects of opioid administration d. Educating the patient about how analgesics improve postoperative activity level Monitoring for pain relief and teaching the patient about how opioid use will improve postoperative outcomes are appropriate actions when administering opioids for acute pain. Although postoperative patients usually need decreasing amount of opioids by the second postoperative day, each patient's response is individual. Tolerance may occur, but addiction to opioids will not develop in the acute postoperative period. The patient should use the opioids to achieve adequate pain control, and so the nurse should not emphasize the adverse effects.

A postoperative patient asks the nurse how the prescribed ibuprofen (Motrin) will control the incisional pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing the a. modulating effect of descending nerves. b. sensitivity of the brain to painful stimuli. c. production of pain-sensitizing chemicals. d. spinal cord transmission of pain impulses.

c. production of pain-sensitizing chemicals. Nonsteroidal anti-inflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by the NSAIDs.

A patient is postoperative following an emergency cesarean section birth. The patient asks the nurse about the use of pain medications following surgery. What would be a correct response by the nurse? a) "It's not a good idea to ask for pain medication regularly as it can be addictive." b) "It is better to wait until the pain gets unbearable before asking for pain medication." c) "It's natural to have to put up with pain after surgery and it will lessen in intensity in a few days." d) "Your doctor has ordered pain medications for you, which you should not be afraid to request any time you have pain."

d) "Your doctor has ordered pain medications for you, which you should not be afraid to request any time you have pain." Many pain medications are ordered on a PRN (as needed) basis. Therefore, nurses must be diligent to assess patients for pain and administer medications as needed. A patient should not be afraid to request these medications and should not wait until the pain is unbearable. Few people become addicted to the medications if used for a short period of time. Pain following surgery can be controlled and should not be considered a natural part of the experience that will lessen in time.

A female patient who is having a myocardial infarction complains of pain that is situated in her jaw. The nurse documents this as what type of pain? a) Transient pain b) Superficial pain c) Phantom pain d) Referred pain

d) Referred pain Referred pain is perceived in an area distant from its point of origin, whereas transient pain is brief and passes quickly. Superficial pain originates in the skin or subcutaneous tissue. Phantom pain may occur in a person who has had a body part amputated, either surgically or traumatically.

A postoperative patient is hesitant to receive opioid pain medication for fear of becoming addicted.Which nursing statement is most appropriate in encouraging correct use of opioid medications? a. "If you are taking opioids for pain relief and no other reason you will not become addicted." b. "You deserve to be pain free, and the medications will help this." c. "It is important to take all of your medications as prescribed by the physicians." d. "You need to take the medications when you feel your pain level increasing, not once it is already at a high level."

d. "You need to take the medications when you feel your pain level increasing, not once it is already at a high level."

A patient with chronic cancer pain is receiving imipramine (Tofranil) in addition to long-acting morphine for pain control. Which information is the best indicator that the imipramine is effective? a. The patient sleeps 8 hours every night. b. The patient has no symptoms of anxiety. c. The patient states, "I feel much less depressed since I've been taking the imipramine." d. The patient states, "The pain is manageable, and I can accomplish my desired activities.

d. The patient states, "The pain is manageable, and I can accomplish my desired activities. Imipramine is being used in this patient to manage chronic pain and improve functional ability. Although the medication also is prescribed for patients with depression, insomnia, and anxiety, the evaluation for this patient is based on improved pain control and activity level.

A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which of these prescribed medications will be best for the nurse to administer? a. lorazepam (Ativan) 1 mg orally b. amitriptyline (Elavil) 10 mg orally c. ibuprofen (Motrin) 400 to 800 mg orally d. immediate-release morphine 30 mg orally

d. immediate-release morphine 30 mg orally The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid, such as the immediate-release morphine. The Motrin and Elavil may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of anti-anxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.

In the acutely ill patient, unrelieved pain can cause increased morbidity due to:

respiratory dysfunction, increased heart rate and cardiac workload, increased muscular contraction and spasm, decreased gastric motility and transit, and increased breakdown of energy stores (catabolism).