Pain test

A client is crying and grimacing but denies pain and refuses pain medication because "my brother is a drug addict and has ruined our lives." What is the priority intervention for this client? 1. Encourage expression of fears and past experiences. 2. Provide accurate information about the use of pain medication. 3. Explain that addiction is unlikely among acute care clients. 4. Seek family assistance in resolving this problem.

1

A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal anti-inflammatory drugs. Which medication will the nurse advocate for first? 1. Gabapentin 2. Corticosteriods 3. Hydromorphone 4. Lorazepam

1

After reviewing Ms. J's (end-stage multiple myeloma) medication list, the nurse is most likely to question schedule doses of which medication? 1. Naltrexone 2. Fentanyl 3. Morphone 4. Acetaminophen

1

For Ms. R (rheumatoid arthritis), which discharge topic is the most important to emphasize to prevent a major postsurgical complication? 1. Activity and movement limitations for the affected shoulder 2. Continuation of pain medication as prescribed 3. Possibility of repeat surgery for ongoing disease changes 4. expected post surgical symptoms, such as localized pain

1

In the care of clients with pain and discomfort, which task is most appropriate to delegate to unlicensed assistive personnel (UAP)? 1. Assisting the client with preparation of a sitz bath 2. Monitoring the client for signs of discomfort while ambulating 3. Coaching the client to deep breathe during painful procedures 4. Evaluating relief after applying a cold compress

1

Mr. O (tibia-fibula fracture) is at risk for compartment syndrome because of the cast. Which pain assessment finding most strongly suggests compartment syndrome? 1. Pain on passive motion 2. Sudden increase in pain 3. Intense discomfort related to an itching sensation 4. Absence of pain despite no recent medication

1

Ms. J is receiving opiates to control her pain caused by end-stage multiple myeloma. Which side effect is the major concern for this patient? 1. Constipation 2. Respiratory depression 3. Nausea and vomiting 4. Sedation

1

The client is prescribed a fentanyl patch for persistent severe pain. Which client behavior most urgently requires correction? 1. Frequently likes to sit in the hot tub to reduce joint stiffness 2. Prefers to place the patch only on the upper anterior chest wall 3. Saves and reuses the old patches when he can't afford new ones 4. Changes the patch every 4 days rather than the prescribed 72 hours

1

The nurse is caring for a postoperative client who reports pain. Based on recent evidence-based guidelines, which approach would be best? 1.Multimodal strategies 2.Standing orders by protocol 3. Intravenous patient controlled analgesia 4. opioid dosage based on valid numerical scale

1

The nurse is considering seeking clarification for several prescriptions of pain medication. Which client circumstance is the priority concern? 1. A 35-year-old opioid-naïve adult will receive a basal dose of morphine via IV patient-controlled analgesia (PCA). 2. A 65-year-old adult will be discharged with a prescription for nonsteroidal anti-inflammatory drugs (NSAIDS). 3. A 25-year-old adult is prescribed as needed IM analgesic for pain 4. A 45 year old adult is taking oral fluids and foods has ordered for IV morphine.

1

The nurse is working with a health care provider who prescribes opioid doses based on a specific pain intensity rating (dosing to the numbers). Which client circumstance is cause for greatest concern? 1. A 73-year-old frail female client with a history of chronic obstructive pulmonary disease is prescribed 4 mg IV morphine for pain of 1 to 3 on a scale of 0 to 10 2. A 25-year-old postoperative male client with a history of opioid addiction is prescribed one tablet of oxycodone and acetaminophen for pain of 4 to 5 on a scale of 0 to 10. 3. A 33-year-old opioid-naïve female client who has a severe migraine headache is prescribed 5 mg IV morphine for pain of 7 to 8 on a scale of 0 to 10. 4. A 60 year old male with a history of rheumatoid arthritis is prescribed one tablet of hydromorphone for pain of 5 to 6 on a scale of 0 to 10.

1

The nurse recognizes that there are ethical considerations in helping clients to achieve relief from pain. Which nursing action is the best example of the principle of nonmaleficence? 1. Client seems excessively sedated but continues to ask for morphine, so the nurse conducts further assessment and seeks alternatives to opioid medication. 2. Client has no known disease disorders and no objective signs of poor health or injury, but reports severe pain, so nurse advocates for pain medicine. 3. Client is older, but he is mentally alert and demonstrates good judgment, so the nurse encourages the client to verbalize personal goals for pain management. 4. Client repeatedly refuses pain medication but shows grimacing and reluctance to move, so the nurse explains the benefits of taking pain medication

1

When an analgesic is titrated to manage pain, what is the priority goal? 1. Titrate to the smallest dose that provides relief with he fewest side effects 2. Titrate upward until the client is pain free or acceptable level is reached 3. Titrate downward to prevent toxicity over-dose, and adverse effects 4. Titrate to a dosage that is adequate to meet the clients subjective needs

1

Which nonpharmacologic intervention for pain management is the most appropriate for Mr. L (kidney stone)? 1. Avoid overhydration or underhydration. 2. Gently massage the lower back. 3. Darken the room to encourage rest and sleep. 4. apply and ice pack to kidney area

1

According to recent guidelines from the American Pain Society I collaboration with the American Society of Anesthesiologist, what are the priority pain management strategies that the nurse would expect to see in the pain management for post surgical clients? Select All that Apply 1. Acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for management of postoperative pain in adults and children without contraindications 2. Surgical site-specific peripheral regional anesthetic techniques in adults and children for procedures 3. Neuraxial (epidural) analgesia for major thoracic and abdominal procedures if the client has risk for cardiac complications or prolonged ileus 4. Multimodal therapy that could include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies 5. Long-acting oral opioids, especially in the immediate postoperative period, for continuous around-the-clock relief 6. Neuraxial administration of magnesium, benzodiazepines, neostigmine, tramadol, or ketamine is recommended for postoperative pain

1, 2, 3, 4

Which morning tasks can be delegated to the UAP? Select all that apply. 1. Assisting Ms. R, who has rheumatoid arthritis, with morning care 2. Reinforcing to Mr. L, who has a kidney stone, the need to save urine for straining 3. Preparing Mr. H's room for his return from the OR for hernia repair 4. Reporting on the condition of Mr. O's skin resulting from his motorcycle accident 5. Getting coffee for Ms. J's (end-stage multiple myeloma) family 6. Checking on the pulse oximeter reading for Mr. A, who has bacterial pneumonia

1, 2, 3, 5,

which of the six patients can be assigned to the new RN? 1. Ms.R with rheumatoid arthritis 2. Mr.L with kidney stones 3. Mr. O with MVA 4. Mr. H with inguinal hernia repair 5. Ms. J with end stage multiple myeloma 6. Mr. A with bacterial pneumonia and HIV positive

1, 2, 4

Which end-of-shift tasks can be delegated to the UAP? Select all that apply. 1. Emptying Ms. J's (end-stage multiple myeloma) trash can and placing personal items within reach 2. Checking Mr. A's (bacterial pneumonia) linens for moisture and soiling and changing as needed 3. Asking Mr. L (kidney stone) if he needs a dose of pain medication before shift change 4. Assisting Ms. R (rheumatoid arthritis) to change position in bed to relieve pressure on joints 5. Ensuring Mr. O's (tibia-fibula fracture) leg is elevated and evaluating comfort 6. Emptying Mr. A's (bacterial pneumonia) urinal and recording the output

1, 2, 4, 6

Which tasks related to pain management can be delegated to the UAP? Select all that apply. 1. Reporting on grimacing seen in unresponsive patients 2. Asking about the location, quality, and radiation of pain 3. Reminding patients to report pain as necessary 4. Observing for relief after medication is given 5. Asking patients directly, "Are you having pain?" 6. Determining if position change relieves pain

1, 3, 5

which clients must be assigned to an experience RN? Select all that apply? 1. client who was in an automobile crash and sustained multiple injuries 2.Client with chronic back pain related to a workplace injury 3. client who has returned from surgery and has a chest tube in place 4. Client with abdominal cramps related to food poisoning 5. Client with a severe headache of unknown origin 6. Client with chest pain who has a history of arteriosclerosis

1, 3, 5, 6

A client received as needed (PRN) morphine, lorazepam, and cyclobenzaprine. The unlicensed assistive personnel (UAP) reports that the client has a respiratory rate of 10 breaths/min. What is the priority action? 1. Call the health care provider to obtain an order for naloxone. 2. Assess the client's responsiveness and respiratory status. 3. Obtain a bag-valve mask and deliver breaths at 20 breaths/min. 4. Double-check the prescription to see which drugs were ordered.

2

Based on the information that the nurse received during hand-off report for Mr. A (who has bacterial pneumonia and is HIV positive), what is the priority concept to consider in planning care for this patient? 1. Pain 2. Gas exchange 3.immunity 4. cellular regulation

2

Based on the information that the nurse received during hand-off report for Mr. L (kidney stone), what is the priority concept to consider in planning interventions for this patient? 1. Elimination 2. Pain 3. Fluid balance 4. Infection

2

For a cognitively impaired client who cannot accurately report pain, what is the first action that the nurse should take? 1. Closely assess for nonverbal signs such as grimacing or rocking. 2. Obtain baseline behavioral indicators from family members. 3. Note the time of and client's response to the last dose of analgesic. 4. Give the maximum as needed (PRN) dose within the minimum time frame for relief.

2

Mr. A (bacterial pneumonia) has a single-lumen peripherally inserted central catheter, and he has the following scheduled medications and IV solutions that need to be given now: vancomycin 1.5 g in 250 mL of 5% dextrose over 90 minutes, levofloxacin 750 mg in 150 mL of normal saline over 90 minutes, 5% dextrose and 0.45% saline 1000 mL with 20 mEq (20 mmol) of potassium at 125 mL/hr, and an IV bolus dose of morphine 3 mg. What is the priority action? 1. Call the HCP and ask if the medication times can be staggered. 2. Call the pharmacy and inquire about the compatibility of medications and solutions. 3. Give the bolus dose of morphine because it will take the least amount of time. 4. obtain an order to establish an additional peripheral IV site

2

Mr. H (hernia repair) is asking for pain medication, and the HCP has ordered 10 mg of immediate-release oxycodone as needed. The pharmacy has stocked 5-mg tablets of controlled-release oxycodone in the medication cabinet. What is the priority action? 1. Call the HCP for clarification of the original prescription. 2. Call the pharmacy and obtain the immediate-release form of the drug. 3. Ask the patient if the immediate- or controlled-release action is preferred. 4. Give two of the 5-mg tablets to achieve the correct dose.

2

Mr. H (hernia repair) says, "I have several friends who became addicted to drugs, and it totally ruined their lives. I'm afraid to take any kind of addictive drugs." What is the nurse's best response? 1. "Your HCP prescribes types of opioids that do not cause addiction." 2. "You will be given opioids for a very short time, and addiction is unlikely." 3. "Your friends probably had addictive personalities; you don't need to worry." 4. "If you become addicted, the HCP will refer you to a drug rehabilitation program."

2

Mr. H returns from the OR after a hernia repair. He says that he is "afraid to walk because it will make the pain really bad." What does the nurse explain as being the best option? 1. Pain medication every 4 hours if he needs or wants it 2. Medication 30 to 40 minutes before ambulation or dressing changes 3. Around-the-clock pain medication even if he has no report of pain 4. Talking to the HCP for reassurance about the treatment plan

2

Ms. J's (end-stage multiple myeloma) son tells the nurse, "My mom is having trouble breathing, and she is having a lot of pain!" On assessment, Ms. J demonstrates rapid shallow breathing and reports pain over the right lateral ribs that increases with movement and breathing. What is the priority action? 1. Take vital signs with pulse oximeter reading and inform the HCP. 2. Apply oxygen and raise the head of the bed if patient is not hypotensive. 3. Obtain an order to start an IV and to give a bolus dose of morphine. 4. Be calm, stay with the patient, and encourage pursed-lip breathing.

2

Ms. R (rheumatoid arthritis) tells the nurse, "I really dread doing the postoperative exercises." She seems fearful and grimaces when the nurse suggests that pain medication can be given before the exercises begin. Which member of the health care team would the nurse consult first? 1. Psychiatric clinical nurse specialist to evaluate fears 2. Occupational therapy to review the exercise therapy 3. Pharmacist to verify efficacy of prescribed pain medication 4. Surgeon to review the expected progress of healing

2

Pain disorder and depression have been diagnosed for a client. He reports chronic low back pain and states, "None of these doctors has done anything to help." Which client statement is cause for greatest concern? 1. "I twisted my back last night, and now the pain is a lot worse." 2. "I'm so sick of this pain. I think I'm going to find a way to end it." 3. "Occasionally, I buy pain killers from a guy in my neighborhood." 4. "I'm going to sue you and the doctor; you aren't doing anything for me."

2

The UAP reports that the new nurse is undermedicating the patients. What is the best way for the team leader to handle this situation? 1. Ignore her; the UAP is not qualified to judge an RN. 2. Ask the UAP to give specific examples. 3. Go to the new nurse and question her. 4. Do an assessment on all of the nurse's patients.

2

The client is diagnosed by the emergency department health care provider (HCP) with an acute migraine. For which situation is it most important to have a discussion with the HCP before medication is prescribed? 1. The HCP is considering dexamethasone to prevent reoccurrence, and the client has type 2 diabetes. 2. The HCP is considering subcutaneous sumatriptan, and the client took ergotamine 3 hours ago. 3. The HCP is considering metoclopramide, and this is a first-time migraine for the client. 4. The HCP is considering prochlorperazine, and the client drove himself to the hospital.

2

The new nurse tells the team leader that she cannot find any documentation that shows the time of Mr. L's (kidney stone) last dose of pain medication. What action should occur first? 1. Help the new nurse look at the chart and medication administration record. 2. Tell the new nurse to ask the night nurse before she leaves 3. Speak to the night shift nurse about the documentation 4. Have the new nurse ask Mr. L when he last had his medication

2

The nurse is caring for a young client with type 1 diabetes who has sustained injuries when she tried to commit suicide by crashing her car. Her blood glucose (BG) level is 550 mg/dL (30.5 mmol/L), but she refuses insulin; however, she wants the pain medication. What is the best action? 1. Notify the charge nurse and make arrangements to transfer to intensive care. 2. Explain significance of BG and insulin and then call the health care provider. 3. Withhold the pain medication until she agrees to accept the insulin 4. Give her the pain medication and document the refusal of the insulin

2

Which postoperative client is manifesting the MOST serious negative effect of inadequate pain management? 1.Demonstrates continuous use of call bell related to unsatisfied needs and discomfort 2. Develops venous thromboembolism r/t immobility caused by pain and discomfort 3. Refuses to participate in physical therapy because of fear of pain caused by exercises 4.feels depressed about loss of function and hopeless about getting relief from pain

2

the nurse is assessing a client who has been receiving opioid medication via patient-controlled analgesia. What is an EARLY sign that alerts the nurse to a possible adverse opioid reaction? 1. client reports SOB 2. client is more difficult to arouse 3. client is more anxious and nervous 4. client reports pain is worsening

2

During the shift, the following events occur at the same time. Prioritize the order for addressing these problems. 1. Mr. L is calling out loudly about right-sided flank pain caused by his kidney stone 2. Mr. O, who was in a motorcycle accident, is calling, "The pump tipped over, and it's broken." 3. Another nurse needs opioid wastage witnessed. 4. Mr. A, with bacterial pneumonia, is urinating in the corner of his room.

2, 1, 4, 3

Which clients can be appropriately assigned to an LPN/LVN who will function under the supervision of an RN or team leader? Select all that apply. 1. Client who needs preoperative teaching about the patient-controlled analgesia pump 2. Client with a leg cast who needs neuro-circ checks and as needed (PRN) hydrocodone 3. Client who underwent a toe amputation and has diabetic neuropathic pain 4. Client with terminal cancer and severe pain who is refusing medication 5. Client who reports abdominal pain after being kicked, punched, and beaten 6. Client with arthritis who needs scheduled pain medications and heat applications

2, 3, 6

Which tasks related to Mr. A's (bacterial pneumonia) pain management can be delegated to the UAP? Select all that apply. 1. Clean the transcutaneous electrical nerve stimulation (TENS) unit. 2. Notify the nurse about the patient's request for pain medication. 3. Reinforce the use of a pillow to splint when coughing. 4. Observe for actions that increase fatigue or anxiety 5. Suggest that relatives bring personal comfort items 6. Assist the patient to change position every 2 hours

2, 3, 6

At the end of the shift, the opioid count shows that two tablets of oxycodone are unaccounted for. The team leader has spoken to all of the nurses and pharmacists who had access to the medication cabinet during the shift, but no one will admit to removing those two tablets. What should the team leader do? Select all that apply. 1. Inform the staff that no one can leave until the matter is resolved. 2. Fill out an incident report and include facts about findings and actions. 3. Interview all of the patients who have orders for oxycodone. 4. Discuss the matter with the unit manager and review potential problems of the current system. 5. Review available records of access and medication retrieval for the past 24 hours. 6. Ask the staff if they saw any other people (e.g., students, HCPs, instructors) who may have accessed the cabinet during the shift.

2, 4, 5, 6

Which clients can be appropriately assigned to a newly graduated RN who has recently completed orientation? Select all that apply. 1. Anxious client with chronic pain who frequently uses the call button 2. Client on the second postoperative day who needs pain medication before dressing changes 3. Client with acquired immune deficiency syndrome who reports headache and abdominal and pleuritic chest pain 4. Client with chronic pain who is to be discharged with a new surgically implanted catheter 5. Client who is reporting pain at the site of a peripheral IV line 6. Client with a kidney stone who needs frequent as needed (PRN) pain medication

2, 5, 6

13. Which client has the most immediate need for IV access to deliver immediate analgesia with rapid titration? 1. Client who has sharp chest pain that increases with cough and shortness of breath 2. Client who reports excruciating lower back pain with hematuria 3. Client who is having an acute myocardial infarction with severe chest pain 4. Client who is having a severe migraine with an elevated blood pressure

3

A client's family member comes to the nurse's station and says, "He needs more pain medicine. He is still having a lot of pain." What is the nurse's best response? 1. "The health care provider (HCP) ordered the medicine to be given every 4 hours." 2. "If medication is given too frequently, there are ill effects." 3. "Please tell him that I will be right there to check on him." 4. "Let's wait about 40 minutes. If there he still hurts, I'll call the HCP."

3

A client's opioid therapy is being tapered off, and the nurse is watchful for signs of withdrawal. What is one of the 1st signs of withdrawal? 1. Fever 2. Nausea 3. Diaphoresis 4. Abdominal cramps

3

Family members are encouraging the client to "tough out the pain" rather than risk drug addiction to opioids. The client is stoically abiding. The nurse recognizes that the sociocultural dimension of pain is the current priority for the client. Which questions will the nurse ask? 1. "Where is the pain located, and does it radiate to other parts of your body?" 2. "How would you describe the pain, and how is it affecting you?" 3. "What do you believe about pain medication and drug addiction?" 4. "How is the pain affecting your activity level and your ability to function?"

3

For Mr. O, in addition to pain medication, which action will help the most to relieve pain associated with the tibia-fibula fracture caused by his motorcycle accident? 1. Instruct him to periodically move his toes. 2. Use diversional therapy. 3. Elevate the injured leg above the heart. 4. Place the patient in a high Fowler position.

3

For a postoperative client, the HCP prescribed multimodal therapy, which includes acetaminophen, nonsteroidal anti-inflammatory drugs, as needed (PRN) opioids, and nonpharmaceutical interventions. The client continuously asks for the PRN opioid, and the nurse suspects that the client may have a drug abuse problem. Which action by the nurse is best? 1. Administer acetaminophen and spend extra time with the client. 2. Explain that opioid medication is reserved for moderate to severe pain. 3. Give the opioid because client deserves relief and drug abuse is unconfirmed. 4. Ask the HCP to validate suspicions of drug abuse and alter the opioid prescription.

3

For which of these clients is IV morphine the first-line choice for pain management? 1. A 33-year-old intrapartum client needs pain relief for labor contractions. 2. A 24-year-old client reports severe headache related to being hit in the head. 3. A 56-year-old client reports breakthrough bone pain related to multiple myeloma. 4. A 73-year-old client reports chronic pain associated with hip replacement surgery.

3

In application of the principles of pain treatment, what is the first consideration? 1. Treatment is based on client goals 2. A multidisciplinary approach is needed 3. Client's perception of pain must be accepted 4. Drug side effects must be prevented and managed

3

It is the end of the shift, and the new nurse is trying to give pain medication to one patient, provide comfort measures for another patient, and redo pain assessments on all her patients. Her documentation is incomplete. What should the team leader do? 1. Offer to help her by performing the comfort measures. 2. Let her struggle through so she can find her own way. 3. Help her to prioritize and delegate the tasks. 4. Ask someone from the oncoming shift to help her.

3

Later in the shift, Mr. A (bacterial pneumonia) reports, "The chest pain is gone, but my back really hurts a lot. I need more morphine." Based on the ethical principle of nonmaleficence, what is the nurse's priority action? 1. Believe Mr. A's subjective report of pain and give pain medication as ordered. 2. Contact the HCP for an increase in dosage because Mr. A appears to need higher doses. 3. Consider history of addiction and chronic pain, respiratory status, and time of last dose. 4. Offer nonpharmaceutical measures, such as position change or distraction.

3

Mr. H is given a dose of pain medication. One hour later, he is anxious and appears uncomfortable, and he asks, "What's the matter? Is something wrong? I'm still hurting." What action should be taken first? 1. Call the HCP for a change in medication or dose. 2. Initiate NPO in case surgery is needed. 3. Check for bladder distention and last voiding. 4. Reassure the patient that the hernia is not recurring.

3

Mr. L (kidney stone) calls for pain medication. He describes the pain caused by his kidney stone as excruciating. He is crying, diaphoretic, and pacing around the room. What is the priority action? 1. Instruct Mr. L to do deep breathing exercises. 2. Remind Mr. L to use the PCA pump when he has pain. 3. Give Mr. L an as needed (PRN) IV bolus dose as ordered. 4. Call the HCP immediately to report pain and other symptoms.

3

Mr. L (kidney stone) reports that the pain has decreased compared with earlier, but now he is having other symptoms. Which symptom is of greatest concern? 1. Painless hematuria with small clots 2. Dull pain that radiates into the genitalia 3. Absence of pain but scant urine output 4. Sensation of urinary urgency

3

Mr. O (tibia-fibula fracture) reports an increasing pain in the right abdomen. On physical examination, there are hyperactive bowel sounds, a tense abdomen with guarding, and exquisite tenderness with gentle palpation. What is the priority action? 1. Give a PRN pain medication. 2. Notify the HCP of findings. 3. Take a complete set of vital signs. 4. Assist him to change positions.

3

Ms. J (end-stage multiple myeloma) is having severe pain and admits to it; however, she becomes very anxious when certain family members come and go and refuses to take the pain medication. Which adjunct medication would be most useful to Ms. J to help her manage these episodes? 1. Naproxen 2. Doxepin 3. Lorazepam 4. Dicyclomine

3

The charge nurse of a long-term care facility is reviewing the methods and assessment tools that the staff nurses are using to assess pain. Which nurse is using the best method to assess pain? 1. Nurse A uses a behavioral assessment tool when the client is engaged in activities. 2. Nurse B asks a client who doesn't speak English to point to the location of pain. 3. Nurse C uses the same numerical rating scale every day for the same client. 4. Nurse D asks the daughter of a confused client to describe the clients pain

3

The health care provider prescribes 7 mg morphine IV as needed (PRN). The nursing student prepares the medication and shows the syringe (see figures below) to the nursing instructor. What should the nursing instructor do first? she did it wrong lol 1. Tell the student to review the provider's prescription before administering medication. 2. Waste the medication and tell the student that remediation is required for serious error. 3. Ask the student to demonstrate the calculations and steps required to prepare the dose. 4. Accompany the student to the client's room and observe as the medication is administered.

3

The home health nurse discovers that an older adult client has been sharing his pain medication with his daughter. Despite the nurse's warnings about the dangers of sharing, he states, "My daughter can't afford to see a doctor or to buy medicine, so I must give her a few of my pain pills." Which member of the health care team is the nurse most likely to consult first? 1. Health care provider to renew the prescription so that client has enough medicine 2. Pharmacist to monitor the frequency of the prescription refills 3. Social worker to help the family locate resources for health care 4. Home health aide to watch for inappropriate medication usage by family

3

The nurse is caring for a young man with a history of substance abuse who had exploratory abdominal surgery 4 days ago for a knife wound. There is a prescription to discontinue the morphine via patient-controlled analgesia and to start oral pain medication. The client begs, "Please don't stop the morphine. My pain is really a lot worse today than it was yesterday."What is the best response? 1. "Let me stop the pump, and we can try oral pain medication to see if it relieves the pain." 2. "I realize that you are scared of the pain, but we must try to wean you off the pump." 3. "Show me where your pain is and describe how it feels compared with yesterday." 4. "Let's take your vital signs; then I will discuss your concerns with the health care provider."

3

Which client is most likely to receive opioids for extended periods of time? 1. A client with fibromyalgia 2. A client with phantom limb pain in the leg 3. A client with progressive pancreatic cancer 4. A client with trigeminal neuralgia

3

Which nonpharmacologic pain measure to help Ms. R (rheumatoid arthritis) relieve her early morning stiffness should be delegated to the UAP? 1. Assisting Ms. R to get in a bathtub full of warm water 2. Sharing some relaxation techniques with Ms. R 3. Assisting Ms. R to take a warm shower 4. Evaluating the effectiveness of paraffin therapy

3

The team leader is giving the end-of-shift report about Ms. R (rheumatoid arthritis) to the oncoming nurse. Place the following information in the correct order. 1. "She had shoulder pain (4 of 10) and was reluctant to move around." 2. "Do you have any questions for me?" 3. "Ms. R is a 55-year-old woman." 4. "She had shoulder arthroplasty 3 days ago." 5. "She received a PRN dose of acetaminophen with codeine, and her pain is now 1 of 10." 6. "The physical therapist must speak to Ms. R's daughter, so page him when she arrives"

3, 4, 1, 5, 6, 2

4. The home health nurse is interviewing an older client with a history of mild heart failure and rheumatoid arthritis. The client reports "feeling pretty good, except for the pain and stiffness in my joints when I first get out of bed." Which member of the health care team would be the most appropriate to aid in the client's report of pain? 1. Health care provider to review the dosage and frequency of pain medication 2. Physical therapist for evaluation of function and possible exercise therapy 3. Social worker to locate community resources for complementary therapy 4. Unlicensed assistive personnel to help client with a warm shower in the morning

4

A client has severe pain and bladder distention related to urinary retention and possible obstruction. An experienced unlicensed assistive personnel (UAP) states that she received training in indwelling catheter insertion at a previous job. What task can be delegated to this UAP? 1. Assessing the bladder distention and the pain associated with urinary retention 2. Inserting the indwelling catheter after verifying her knowledge of sterile technique 3. Evaluating the relief of pain and bladder distention after the catheter is inserted 4. Measuring the urine output after the catheter is inserted and obtaining a specimen

4

A client with chronic pain reports to the charge nurse that the other nurses have not been responding to requests for pain medication. What is the charge nurse's initial reaction? 1. Check the medication administration records for the past several days. 2. Ask the nurse educator to provide in-service training about pain management. 3. Perform a complete pain assessment on the client and take a pain history. 4. Have a conference with the staff nurses to assess their care of this client.

4

An inexperienced graduate nurse is reviewing the medication administration record (MAR) for a client who has a patient-controlled analgesia (PCA) pump for pain management. The new nurse compares the MAR and the health care provider's (HCP's) prescription, and both indicate that larger doses are prescribed at night compared with doses throughout the day. Which member of the health care team should the new nurse consult first? 1. Ask the client if he typically needs extra medication in the evening. 2. Ask the HCP to verify that the larger amount is the correct dose 3. Ask the pharmacist to confirm the dosage on the original prescription. 4. Ask the charge nurse if this is a typical dosage for nighttime PCA.

4

Mr. A (bacterial pneumonia) reports left-sided anterior chest pain. What is the priority action? 1. Obtain an order for an electrocardiogram and continuous telemetry monitoring. 2. Auscultate the lung fields and compare to baseline assessments. 3. Give a PRN pain medication and reevaluate after 30 minutes. 4. Ask him to describe the pain and measure all vital signs.

4

Ms. J's (end-stage multiple myeloma) son repeatedly insists that Ms. J is not getting enough pain medication. He threatens to sue. The team leader has used therapeutic communication skills with the son and advocated for the patient with the HCP. The HCP says, "I'll be in tomorrow. Just tell the son to chill out." What is the best action? 1. Call another HCP 2. Continue to use current orders 3. Adivse the son to call the HCP 4. Notify the unit manager

4

On the first day after surgery, a client receiving an analgesic via patient-controlled analgesia pump reports that the pain control is inadequate. What is the first action that the nurse should take? 1. Deliver the bolus dose per standing order. 2. Contact the health care provider (HCP) to increase the dose. 3. Try nonpharmacologic comfort measures. 4. Assess the pain for location, quality, and intensity.

4

One of the staff members is talking about Mr. A,who has bacterial pneumonia, saying, "He complains all the time about pain everywhere. Well, he is going to have pain. He's a drug addict, so what does he expect?" What is the best response to this comment? 1. "All patients have a right to care regardless of race or creed." 2. "I'll take Mr. A; I don't mind taking care of him." 3. "You should think about how he really feels." 4. "What can we do to help Mr. A cope with his pain?"

4

The charge nurse is reviewing the records of clients who were assigned to a newly graduated RN. The RN has correctly documented dose and time of medication, but there is no documentation regarding nonpharmaceutical measures. What action should the charge nurse take first? 1. Make a note in the nurse's file and continue to observe clinical performance. 2. Refer the new nurse to the in-service education department. 3. Quiz the nurse about knowledge of pain management and pharmacology. 4. Give praise for documenting dose and time and discuss documentation deficits.

4

The health care provider (HCP) has ordered a placebo for a client with chronic pain. The newly hired nurse feels very uncomfortable administering the medication. What is the first action that the new nurse should take? 1. Prepare the medication and hand it to the HCP 2. Check the hospital policy regarding the use of placebo 3. Follow a personal code of ethics and refuse to participate 4. Contact the charge nurse for advise and suggestion

4

The nurse reinforces teaching about the purpose and correct use of the PCA with Mr. O (tibia-fibula fracture) and his mother. Both express an understanding and willingness to comply. When is the best time for Mr. O to activate the PCA to receive a dose of pain medication? 1. Whenever pain is a 5 on scale of 0 to 10, with 10 being the worst pain imaginable 2. 30 minutes after waking up in the morning and 30 minutes before bedtime 3. As soon as the lockout time expires; if pain is still present, even if it is mild 4. 10 minutes before a painful procedure such as a dressing change or physical therapy

4

The oncoming team leader asks the night shift nurse if anyone spoke to the mother about pushing the PCA button for Mr. O. The night nurse states, "The mother is just concerned about her son and wants him to have pain relief. Besides, the prescribed dose is controlled by the pump." What is the team leader's best action? 1. Report the night nurse to the unit manager for failure to safeguard the patient. 2. Explain the purpose and function of the PCA delivery system to the mother. 3. Give the night nurse written information about the dangers of possible overdose. 4. First talk to the night nurse about the PCA procedure; then talk to the mother.

4

The team is providing emergency care to a client who received an excessive dose of opioid pain medication. Which task is best to assign to the LPN/LVN? THE DOERS 1. Calling the HCP to report SBAR 2. Giving naloxone and evaluating status for the 1st 30 minutes 3. Monitoring the respiratory status for the 1st 30 minutes 4. Applying oxygen per nasal cannula as ordered

4

The team leader is preparing to give Mr. L (kidney stone) pain medication, but the IV site is infiltrated, so the nurse informs him that the IV catheter will have to be reinserted. He yells, "What's wrong with you people?! Can't you do anything right?!" What is the best response? 1. "Let me call the HCP, and I can get an order for an oral medication." 2. "This is not my fault, but if you will just give me a couple of minutes, I can fix it." 3. "Let me call the nursing supervisor, and you can talk to her about the situation." 4. "I know you are having pain. Let me restart your IV line right now."

4

The team leader is talking to Ms. R (rheumatoid arthritis) about discharge plans a follow up appointments. She begins to cry and says "I was so active and athletic when I was younger." Whats the most therapeutic response? 1."Your shoulder will get progressively better with time and patience. Don't cry." 2. "I can see that you are really upset. Is your shoulder hurting a lot right now?" 3. "I know what you mean. I used to be able to do a lot more when I was younger, too." 4. "It is difficult to deal with changes. What types of activities did you used to do?"

4

What is the best way to schedule medication for a client with constant pain? 1. PRN at the clients request 2. before painful procedures 3. IV bolus after pain assessment 4. Around the clock

4

Which client is at greatest risk for respiratory depression while receiving opioids for analgesia? 1. Older adult client with chronic pain related to joint immobility 2. Client with a heroin addiction and back pain 3. Young female client with advanced multiple myeloma 4. Opioid-naive adolescent with an arm fracture and cystic fibrosis

4

The oncoming day shift nurse has received the shift report from the night nurse. The day shift nurse has done a quick check on all of the clients and has determined that all are stable and not in acute distress. Prioritize the order in which the oncoming nurse will care for the following clients. 1 being first and 5 being last. 1. Adolescent who is alert and oriented. He was admitted 2 days ago for treatment of meningitis. He reports a continuous headache that is partially relieved by medication. 2. Older man who underwent total knee replacement surgery 2 days ago. He is using the patient-controlled analgesia (PCA) pump frequently with good relief and occasionally asks for bolus doses. 3. Middle-aged woman who is demanding and frequently calls for assistance. She was admitted for investigation of functional abdominal pain and is scheduled for diagnostic testing this morning. 4. Older woman with advanced Alzheimer disease who requires total care for all activities of daily living. She struggles during any type of nursing care, and it is difficult to assess her subjective symptoms. She is awaiting transfer to a long term care facility 5. Young man who was admitted with chest pain secondary to a spontaneous pneumothorax. Today the chest tube will be removed and the PCA pump with be discontinued.

5, 3, 1, 2, 4

SBAR

situation background assessment recommendations