NURS 309 Quiz 4 Pain

A client with diabetic neuropathy reports a burning, electrical-type of pain in the lower extremities that is worse at night and not responding to non-steroidal anti-inflammatory drugs. Which medication will the nurse advocate for first? A. Gabapentin B. Corticosteroids C. Hydromorphone D. Lorazepam

A. Gabapentin

In assessing pain in an older adult patient, what is the major barrier to accurate assessment? A. Many older adults are reluctant to report pain B. Pain sensation decreases with age C. Pain scales are inaccurate for older adults D. Most older adults have some cognitive impairment

A. Many older adults are reluctant to report pain

A patient with chronic cancer pain has been taking opioids for several months and now reports needing increasing doses to achieve pain relief. What is the most likely explanation of the need for increasing amounts of medication for this patient? A. Patient is addicted to opioids B. Disease is progressing C. A different opioid is needed D. Patient has a tolerance for opioids

B. Disease is progressing

The patient has a severe burn on the hand and forearm and reports pain that is severe and escalating. The nurse anticipates that pain medication will be administered via which route? A. Oral B. Intravenous C. Intranasal D. Subcutaneous

B. Intravenous

A patient develops a physical dependence after taking an opioid as prescribed for post-surgical pain. What is the recommended approach for dealing with the dependence? A. Immediate discontinuation of the opioid B. Administering an antagonist, such as naloxone C. Gradual reduction of the opioid as pain decreases D. Referral to a substance specialist for treatment

C. Gradual reduction of the opioid as pain decreases

The patient has a history of rheumatoid arthritis and is also being treated for acute pain from a wrist fracture. Which medication is most likely to be prescribed to reduce the pain and discomfort caused by inflammation? A. Morphine B. Acetaminophen C. Ibuprofen D. Bupivacaine

C. Ibuprofen

The patient reports that he has chronic lower back pain that is not relieved by the prescribed medication and that the primary care provider is unwilling to prescribe anything stronger. Who should the nurse consult first? A. Pharamcist B. Physical therapist C. Pain resource nurse D. Alternate health care provider

C. Pain resource nurse

An older patient requires an NSAID for inflammatory pain. The nurse would seek an order for what type of additional medication to accompany the NSAID therapy? A. Anxiolytic, such as alprazolam B. Nonopioid analgesic, such as acetaminophen C. Proton pump inhibitory, such as lansoprazole D. Anticonvulsant, such as pregabalin

C. Proton pump inhibitory, such as lansoprazole

Which assessment would the nurse perform to determine if a patient would be an appropriate candidate for using imagery as a distraction therapy? A. Determine if touch and physical proximity are culturally accepatable B. Ensure that the patient can speak, read, and write English C. Assess environmental factors that contribute to discomfort or annoyance D. Confirm that the patient can follow logical and sustained conversation

D. Confirm that the patient can follow logical and sustained conversation

Using the concept of comfort, which application creates the greatest concern related to the use of the patient-controlled analgesia (PCA) infusion device? A. Pendant B. Demand C. Lockout D. Proxy

D. Proxy

A patient needs morphine 2 mg IV push. The drug is available as 5 mg/mL. How many mL would the nurse administer? ______ mL of morphine

0.4 mL of morphine

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

C. Client's perception of pain must be accepted

Which behavior exemplifies the nurse's primary role in assessing and managing the patient's pain? A. Administers pain medications as ordered if pain is sufficient to warrant therapy B. Listens to the patient's self-report and forms an opinion about the veracity of the description C. Observes for concurrent verbal reports and nonverbal signs to substantiate presence of pain D. Listens to and accepts the self-report of pain and assesses patient's preferences and values

D. Listens to and accepts the self-report of pain and assesses patient's preferences and values

A nurse is caring for a client after a total knee replacement who is requesting Vicodin in addition to the patient-controlled analgesia (PCA). The client reports having taken 2 Vicodin tablets every 4 hours for several weeks before surgery. If each tablet contains 500 mg of acetaminophen, how much acetaminophen had the client been ingesting per day? __________ mg

6,000 mg

The nurse is interviewing a patient who frequently comes to the clinic to obtain medication for chronic back pain. The patient states, "I know you guys think I am faking, but I hurt and I am really sick of your attitude." What is the best response? A. "Sir, tell me about your pain and how it is affecting your life." B. "Sir, you can speak to a pain specialist if you would prefer." C. "Sir, I see you are frustrated, but you are unfairly judging me." D. "Sir, we are trying our best; let's just continue the interview."

A. "Sir, tell me about your pain and how it is affecting your life."

Which patient is having pain that is unlikely to respond to first-line opioid and nonopioid medication? A. 62-year-old woman who fractured her wrist B. 70-year-old woman with postherpetic neuralgia C. 50-year-old man with a recently inserted chest tube D. 45-year-old man who sustained burns to the hands

B. 70-year-old woman with postherpetic neuralgia

Which patient has the highest risk for inadequate pain management? A. 56-year-old man who had major abdominal surgery for a stab wound B. 78-year-old woman who was transferred to a nursing home after hip surgery C. 10-year-old child who had a tonsillectomy and whose parents can't speak English D. 24-year-old postpartum woman with a history of drug abuse

B. 78-year-old woman who was transferred to a nursing home after hip surgery

The nurse is assisting a surgical patient with pain management. Which outcome statement best demonstrates that the short-term goal is being met 45 minutes after receiving pain medication? A. Patient reports that the pain level is 6/10 B. Patient tolerates the dressing change without grimacing C. Patient declines a prn anxiolytic medication D. Patient asks for assistance to go to the bathroom

B. Patient tolerates the dressing change without grimacing

The nurse is assessing a patient who is receiving opioid medication via a patient-controlled analgesia device. The patient is very drowsy and difficult to arouse. What should the nurse do first? A. Wake the patient and tell the patient to stop pushing the button so frequently B. Stay with the patient and discontinue the basal rate C. Let the patient sleep but increase the frequency of assessment D. Obtain an order for exclusive use of nonopioid medication

B. Stay with the patient and discontinue the basal rate

Which nursing action indicates that the nurse is performing the first step of the Hierarchy of Pain Measures? A. Premedicates before a dressing change B. Uses a standard pain assessment tool C. Compares vital signs before and after pain medications D. Starts with a low dose and observes for behavioral changes

B. Uses a standard pain assessment tool

The health care provider informs the nurse that a young patient should receive morphine for severe pain but that caution is needed because the patient is opioid naive. Which consideration is the most important in caring for an observing this patient? A. Decreased analgesia may occur because the patient is opioid naive B. Respiratory depression is a problem only for elderly adults with respiratory disorders C. Excessive sedation can progress to clinically significant respiratory depression D. A standing order for a prn one-time dose of naloxone is needed for adverse effects

C. Excessive sedation can progress to clinically significant respiratory depression

The nurse is reviewing the medication list for a patient who had open heart surgery. The nurse is likely to query the prescription for which medication because prostaglandin inhibition is associated adverse cardiovascular effects? A. Duloxetine B. Acetaminophen C. Naproxen D. Morphine

C. Naproxen

A client who had a total hip replacement asks the nurse about the continuous regional analgesia being used. What information should the nurse include when explaining the benefits of this treatment over conventional methods to control pain? A. Adjusting the dose is easily done B. Neuropathic pain can be relieved C. Systemic side effects are minimal D. The need for parenteral medication is avoided

C. Systemic side effects are minimal

The nurse is assessing the patient for chronic pain or discomfort. Which is the best question to use to elicit the quality of the pain? A. "Am I correct in assuming that you are having pain?" B. "Would you describe the pain as sharp?" C. "Is the pain really bad right now?" D. "How would you describe your pain?"

D. "How would you describe your pain?"

The nurse asks the patient with cancer, "Sir, where is your pain?" The patient repeatedly responds, "It hurts all over." What is the best rationale for taking the extra time to help the patient to identify specific areas that hurt? A. Documentation is incomplete as a legal document if the nurse charts "hurts all over" B. Formulating an achievable therapeutic goal is very difficult for a vague complaint C. Health care provider cannot prescribe appropriate medication for relief of generalized pain D. Patient understands the origin, and new or increasing pain raises the suspicion of metastasis

D. Patient understands the origin, and new or increasing pain raises the suspicion of metastasis

Despite the nurse's best efforts, the patient's wife continuously asks the nurse to reassess her husband's pain and to give him additional medication. What is the best rationale for using the concept of "self-report?" A. The wife's behavior indicates that she is overly anxious B. The concerns of the wife make accurate pain assessment very difficult C. The patient's relationship with his wife is interfering with the plan of care D. The patient is the only one who can describe his experience of pain

D. The patient is the only one who can describe his experience of pain

What is a nurse's responsibility when administering prescribed opioid analgesics? SATA A. Count the client's respirations B. Document the intensity of the client's pain C. Withhold the medication if the client reports pruritus D. Verify the number of doses in the locked cabinet before administering the prescribed dose E. Discard the medication in the client's toilet before leaving the room if the medication is refused

A. Count the client's respirations B. Document the intensity of the client's pain D. Verify the number of doses in the locked cabinet before administering the prescribed dose

Which patient is most likely to report pain that would be considered acute? A. Has a history of peripheral vascular disease; foot is suddenly cold and blue B. Has a history of diabetic neuropathy; reports burning sensation in lower leg C. Has a history of old ankle fracture; reports recent diagnosis of osteoarthritis D. Has a history of osteosarcoma in the femur with amputation above tumor site

A. Has a history of peripheral vascular disease; foot is suddenly cold and blue

The nurse knows that acute pain serves a biologic purpose. How does the nurse apply this knowledge in caring for a patient with a history of cardiac problems who now reports severe chest pain? A. Immediately administers supplemental oxygen B. Calmly reassures that acute pain is usually temporary C. Efficiently assesses for anxiety or panic attack D. Quickly obtains an order for prn pain medication

A. Immediately administers supplemental oxygen

Acetaminophen is the first-line medication for which patient? A. Needs relief from pain related to a minor surgical procedure B. Has chronic pain and discomfort due to rheumatoid arthritis C. Experiences burning and tingling in legs due to diabetes D. Has intermittent abdominal cramping due to Crohn's disease

A. Needs relief from pain related to a minor surgical procedure

The nurse is working at a walk-in clinic and has interviewed several patients. Which patient has the most common reason for seeking medical care? A. Has a family history of angina B. Has a personal history of chronic pain C. Has drug addiction and is seeking pain medication D. Has a desire to avoid pain or injury during exercise

B. Has a personal history of chronic pain

Based on the client's reported pain level, the nurse administers 8 mg of the prescribed morphine. The medication is available in a 10 mg syringe. Wasting of the remaining 2 mg of morphine should be done by the nurse and a witness. Who should be the witness? A. Nursing supervisor B. Licensed practical nurse C. Client's health care provider D. Designated nursing assistant

B. Licensed practical nurse

In the postanesthesia care unit, it is reported that the client received intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as part of the client's initial 24-hour postoperative care? A. Assessing the client for tachycardua B. Monitoring of respiratory rate hourly C. Administering naloxone every 3 to 4 hours D. Observing the client for signs of CNS excitement

B. Monitoring of respiratory rate hourly

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

B. Obtain baseline behavioral indicators from family members

A client reports severe pain 2 days after surgery. Which initial action should the nurse take after assessing the character of the pain? A. Encourage rest B. Obtain the vital signs C. Administer the prn analgesic D. Document the client's pain response

B. Obtain the vital signs

What are the desired outcomes that the nurse expects when administering a non-steroidal anti-inflammatory drug (NSAID)? SATA A. Diuresis B. Pain relief C. Antipyresis D. Bronchodilation E. Anticouagulation F. Reduced inflammation

B. Pain relief C. Antipyresis F. Reduced inflammation

The nurse is caring for several patients who will receive pain medication. Which patient is most likely to receive around-the-clock oral opioids? A. Patient with fibromyalgia B. Patient with chronic cancer pain C. Patient with Crohn's disease D. Patient who had a stroke

B. Patient with chronic cancer pain

The nurse is performing a pain assessment on a patient who had abdominal surgery. He was just transferred from the Intensive care unit to the medical surgical unit. Which question would the nurse ask? A. "You are probably having pain at the incision site. Right?" B. "How bad is your pain? Is it better compared to before?" C. "Can you tell me about any pain or discomfort you are having?" D. "Do you think you can walk, or would you like pain medication first?"

C. "Can you tell me about any pain or discomfort you are having?"

Which patient has chronic noncancer pain? A. A 17-year-old male after an appendectomy B. A 64-year-old male with back pain related to tumor growth C. A 48-year-old female who has persistent pain related to interstitial cystitis D. A 5-year-old female with stomach cramps related to food posioning

C. A 48-year-old female who has persistent pain related to interstitial cystitis

A client with an inflamed sciatic nerve is to have a conventional transcutaneous electrical stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit, which nursing action is appropriate? A. Maintain the settings programmed by the health care provider B. Turn the machine on several times a day for ten to twenty minutes C. Adjust the dial on the unit until the client states the pain is relieved D. Apply the color-coded electrodes on the client where they are most comfortable

C. Adjust the dial on the unit until the client states the pain is relieved

The health care provider prescribes 7 mg morphine IV as needed (PRN). The nursing student prepares the medication and shows the syringe to the nursing instructor. What should the nursing instructor do first? A. Tell the student to review the provider's prescription before administering the medication B. Waste the medication and tell the student that remediation is required for serious error C. Ask the student to demonstrate the calculations and steps required to prepare the dose D. Accompany the student to the client's room and observe as the medication is administer

C. Ask the student to demonstrate the calculations and steps required to prepare the dose

The older patients tells the home health nurse that he took two tablets of arthritis-strength extended release acetaminophen at 6:00 am and two tablets of hydrocodone at 2:00 pm and that he plans to take one dose of an over-the-counter product that contains acetaminophen, doxylamine succinate, and dextromethorphan to sleep at night. What would the nurse do first? A. Call poison control because the patient has exceeded the recommended dose of acetaminophen B. Tell the patient to call the health care provider and report all medications that he takes C. Educate the patient about the acetaminophen in each product and the maximum dosage/day D. Record the medications, frequency, and dosage in the medication reconciliation record

C. Educate the patient about the acetaminophen in each product and the maximum dosage/day

A patient with chronic leg pain reports pain level at 7/10, so the nurse administers a prn medication. Which observation best suggests that the funcitonal goal of therapy is being met? A. Patient appears relaxed while talking with family members B. Pulse, blood pressure, and respirations are not elevated C. Patient ambulates independently down the hall without distress D. Patient asks for additional food between lunch and dinner

C. Patient ambulates independently down the hall without distress

Nociception involves the normal function of physiologic systems and four processes. When the nurse suggests listening to music as a distraction, which process is the target of the intervention? A. Transduction B. Transmission C. Perception D. Modulation

C. Perception

Which patient is most likely to receive a prescription for gabapentin? A. A patient who has persistent burning and tingling sensation in the lower extremities B. A patient who reports a gnawing and burning discomfort in the epigastric area between meals C. A patient who expresses fear, anxiety, and uncertainty related to episodes of angina D. A patient who has intractable pain related to malignant spread of cancer

A. A patient who has persistent burning and tingling sensation in the lower extremities

The nurse is caring for a postoperative client who reports pain. Based on recent evidenced-based practice guidelines, which approach would be best? A. Multimodal strategies B. Standing orders by protocol C. Intravenous patient-controlled analgesia (PCA) D. Opioid dosage based on valid numerical scale

A. Multimodal strategies

When an analgesic is titrated to manage pain, what is the priority goal? A. Titrate to the smallest dose that provides relief with the fewest side effects B. Titrate upward until the client is pain free or acceptable level is reached C. Titrate downward to prevent toxicity, overdose, and adverse effects D. Titrate to a dosage that is adequate to meet the client's subjective needs

A. Titrate to the smallest dose that provides relief with the fewest side effects

The patient with chronic cancer pain has been taking oral morphine for several months. The health care provider suggests a very low dose of nalbuphine for relief of opioid-induced pruritus. What would the nurse frequently assess for? A. Higher risk for respiratory depression B. Severe pain or withdrawal symptoms C. Hemodynamic adverse effects D. Bleeding and increased clotting time

B. Severe pain or withdrawal symptoms

Which drug can cause adverse effects, particularly in an older adult because of an accumulation of toxic metabolites? A. Ibuprofen B. Morphine C. Meperidine D. Acetaminophen

C. Meperidine

What is the best type of pain scale to use for children or for adult patient who have language barriers or reading problems? A. 0 to 10 numeric rating scale B. FACES (smile to frown) C. Vertical presentation scale D. Pasero Opioid-Induced Sedation Scale

B. FACES (smile to frown)

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? A. Call the health care provider to obtain an order for naloxone B. Assess the client's responsiveness and respiratory status C. Obtain a bag-value mask and deliver breaths at 20 breaths/min D. Double-check the prescription to see which drugs were ordered

B. Assess the client's responsiveness and respiratory status

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? A. Client reports shortness of breath B. Client is more difficult to arouse C. Client is more anxious and nervous D. Client reports pain is worsening

B. Client is more difficult to arouse

A modified-release opioid is ordered for a patient who is currently NPO and receiving nutrition and fluids through a small-bore nasogastric tube. What should the nurse do? A. Crush the medication and mix it with water to instill through the NG tube B. Contact the health care provider for an order to administer the medication rectally C. Have the patient swallow the medication with a very small amount of water D. Hold the medication and document that the patient is NPO for foods and fluids

B. Contact the health care provider for an order to administer the medication rectally

A patient is prescribed morphine sulfate. Which nursing interventions decrease the risk of constipation? SATA A. Give foods that are soft, such as white bread or white rice B. Encourage an increase in water and fluid intake C. Administer a stool softener every morning D. Obtain an order for a bulk laxative E. Encourage movement, activity, and walking F. Teach to keep a record of bowel movements

B. Encourage an increase in water and fluid intake C. Administer a stool softener every morning E. Encourage movement, activity, and walking F. Teach to keep a record of bowel movements

A nurse is taking the health history of a client who is to have surgery in 1 week. The nurse identifies that the client is taking ibuprofen (Advil) for discomfort associated with osteoarthritis and notifies the health care provider. Which drug dose the nurse expect will most likely be prescribed instead of Advil? A. Naproxen (Aleve) B. Ibuprofen (Motrin) C. Ketorolac (Toradol) D. Acetaminophen (Tylenol)

D. Acetaminophen (Tylenol)

The nurse is giving discharge instructions about multimodal analgesia to a daughter who will care for her elderly father at home while he recovers from surgery. The daughter suggests that the single best medication should be recommended for convenience and to save money. What is the best response? A. "The doctor always prescribes this combination of medications as the best therapy." B. "Elderly people frequently do better with fewer medications; let me call the doctor." C. "Just see how it goes for your dad. It is likely that you can gradually decrease the medication." D. "Combing different analgesics gives greater relief with lower doses and fewer side effects."

D. "Combing different analgesics gives greater relief with lower doses and fewer side effects."

Which patient is least likely to be a good candidate for patient-controlled analgesia? A. 32-year-old male with severe burns and a history of drug abuse B. 16-year-old male with multiple injuries sustained during an accident C. 34-year-old female with functional blindness who had abdominal surgery D. 25-year-old female with intermittent lucidity after a severe head injury

D. 25-year-old female with intermittent lucidity after a severe head injury

The patient is receiving the first dose transdermal fentanyl, and the health care provider informs the nurse that the dosage will be titrated until the patient experiences adequate pain control. How much time does the nurse expect will pass between dosage changes? A. Between 5-15 minutes if the patient has severe pain B. At least 24 hours before the next dose C. Approximately 2-3 days for transdermal applications D. Depends on the ordered frequency of the patch change

B. At least 24 hours before the next dose

Based on evidence-based practice, what is the best choice for managing chronic pain for a 73-year-old female with osteoarthritis? A. Acetaminophen is the primary drug of choice B. Tramadol is the first-line choice for this patient C. Long-term use of an oral NSAID, such as ibuprofen, is the best D. Topical NSAIDs and nonpharmacologic measures should be tried first

A. Acetaminophen is the primary drug of choice

Based on the concept of comfort, what is the expected physiologic consequence of taking a mu opioid agonist? A. An increase in dosage yields an increase in pain relief B. There is a dose ceiling effect, so comfort is readily achieved C. Analgesia is reversed at the peak effect D. Peak comfort is typically 15-20 minutes after administration

A. An increase in dosage yields an increase in pain relief

The home health nurse is visiting a 73-year-old diabetic patient who was recently discharged after surgery. While reviewing a list of the patient's medications, the nurse sees that there are several different classes of analgesics listed. Which action is the nurse most likely to take? A. Assess the patient's understanding of the multimodal treatment plan and ability to comply B. Contacts the health care provider to discontinue medications that contribute to polypharmacy C. Emphasizes that medications with more side effects are the last choice for pain D. Advises the patient not to take any NSAIDs because of irritation of gastric mucosa

A. Assess the patient's understanding of the multimodal treatment plan and ability to comply

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

A. Assisting the client with preparation of a sitz bath

What are physiologic responses that indicate a patient is experiencing acute pain? SATA A. Diaphoresis B. Somnolence C. Bradypnea D. Hypotension E. Tachycardia F. Dilated pupils

A. Diaphoresis E. Tachycardia F. Dilated pupils

A client with arthritis increases the dose of ibuprofen (Motrin, Advil) to abate joint discomfort. After several weeks, the client becomes increasingly weak. The health care provider determines that the client is severely anemic and admits the client to the hospital. What clinical indicators does the nurse expect to identify when performing an admission assessment? SATA A. Melena B. Tachycardia C. Constipation D. Clay-colored stools E. Painful bowel movements

A. Melena B. Tachycardia

The patient reports pruritus related to taking an opioid medication. What medication prescription would the nurse obtain to help the patient to manage this side effect? A. Reduced opioid dose B. Over-the-counter antihistamine C. Topical steroid D. Anti-anxiety medication

A. Reduced opioid dose

A client who had abdominal surgery is receiving patient-controlled analgesia (PCA) intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is still experiencing pain. What should the nurse do first? A. Monitor the client's pain level for another hour B. Determine the integrity of the intravenous delivery system C. Reprogram the pump to deliver a bolus dose every 8 minutes D. Arrange for the client to be evaluated by the health care provider

B. Determine the integrity of the intravenous delivery system

The nurse is assessing an elderly patient who has "pain all over." Which strategy would the nurse use to help the patient identify which areas of the body are painful? A. Start with gentle palpation on the abdomen and chest B. Focus on the hand and fingers of one extremity C. Direct the patient to find one area that does not hurt D. Provide examples and comparisons of severe pain

B. Focus on the hand and fingers of one extremity

The nurse is caring for a patient who has an epidural catheter for pain management. Which information is appropriate in the care of this patient? A. Pain assessments are performed less frequently if epidural catheters are used for pain management B. Morphine and hydromorphone may be used with a local anesthetic such as bupivacaine C. Epidural catheters are used exclusively to deliver single bolus doses during surgical procedures D. The patient will be confined to bed during the therapy because of lower extremity weakness

B. Morphine and hydromorphone may be used with a local anesthetic such as bupivacaine

Which concept is most closely aligned with how a a transcutaneous electrical nerve stimulation (TENS) unit works to decrease pain? A. Comfort B. Sensory perception C. Cognition D. Cellular regulation

B. Sensory perception

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? A. "The health care provider ordered the medicine to be given every 4 hours." B. "If medication is given too frequently, there are ill effects." C. "Please tell him that I will be right there to check on him." D. "Let's wait about 40 minutes. If there he still hurts, I'll call the health care provider."

C. "Please tell him that I will be right there to check on him."

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 dimensions of pain is the current priority for the client. Which question will the nurse ask? A. "Where is the pain located, and does it radiate to other parts of the body?" B. "How would you describe the pain, and how is it affecting you?" C. "What do you believe about pain medications and drug addiction?" D. "How is the pain affecting your activity level and your ability to function?"

C. "What do you believe about pain medications and drug addiction?"

A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do? A. Add a placebo to the morphine to appease the spouse B. Discuss with the spouse the risk for morphine addiction C. Assess the client's pain before increasing the dose or the morphine D. Check the client's heart rate before increasing the morphine to the next level

C. Assess the client's pain before increasing the dose or the morphine

The nurse is caring for a patient on the first postoperative day. The patient denies pain, but his blood pressure and pulse are elevated and he is diaphoretic and anxious. What should the nurse do first? A. Believe and document the patient's self-report of "denies pain" B. Call the health care provider and report the vital signs, diaphoresis, and anxiety C. Assess the patient for postoperative complications or barriers to reporting pain D. Ask a family member if the patient would typically be stoic during pain or discomfort

C. Assess the patient for postoperative complications or barriers to reporting pain

The nurse is assessing a patient with severe dementia who resides in a long-term care facility. A score of 9 is obtained using the Pain Assessment in Advanced Dementia Scale. Based on assessment findings, which action will the nurse take? A. Speak calmly to the patient and explain that repositioning will make him more comfortable B. Gently reassure the patient and continue routine observation for discomfort or pain C. Assess the patient for the source of the pain and immediately inform the health care provider D. Contact the family and ask how the patient would typically respond to discomfort

C. Assess the patient for the source of the pain and immediately inform the health care provider

A client is receiving morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate? A. Nasotracheal suction B. Mechanical ventilation C. Naloxone adminstration D. Cardiopulmonary resuscitation

C. Naloxone adminstration

The nurse is assessing the patient's use of transdermal fentanyl and discovers that the patient is making several errors. Which behavior is most likely to result in fentanyl-induced respiratory depression? A. Patient is folding the patch in half B. Patient is saving the old patches C. Patient is placing a heating pad over the patch D. Patient is using adhesive tape over the patch

C. Patient is placing a heating pad over the patch

A patient with rheumatoid arthritis reports having chronic pain for years with an exacerbation that started in the morning. Which observation indicates the patient has a physiologic adaptation to pain? A. Pupils are dilated B. Breathing is shallow C. Pulse rate is 70/min D. Temperature is 98.6

C. Pulse rate is 70/min

The patient reports a vivid childhood memory of having severe pain during and after a dental procedure and expresses reluctance to visit the dentist even for routine cleanings. What should the nurse do? A. Refer the patient for psychological counseling before seeking dental care B. Obtain an order for anti-anxiety medication and suggest relaxation techniques C. Suggest talking to a dentist about current pain management techniques D. Advise the patient that past fears should not interfere with good health practices

C. Suggest talking to a dentist about current pain management techniques

The nurse sees that during the night the patient received lorazepam for anxiety, promethazine for nausea, and hydromorphone for pain. Which assessment is the most important to conduct? A. Closely monitor liver enzymes to identify early indicators of adverse effects B. Watch for symptoms of cardiotoxicity, such as tingling and cardiac dysrhythmias C. Use the Pasero Opioid-Induced Sedation Scale and check respiratory status D. Watch for gastrointestinal distress, decreased platelet count, and bleeding

C. Use the Pasero Opioid-Induced Sedation Scale and check respiratory status

The postanesthesia care unit reports to the nurse in the medical-surgical unit that the patient received 2 mg of intravenous morphine with relief. When is the patient likely to be transitioned to oral analgesics? A. Upon arrival to the medical-surgical unit B. When the health care provider writes postoperative orders C. When the patient is able to tolerate oral intake D. When the intravenous access is discontinued

C. When the patient is able to tolerate oral intake

The home health nurse is reviewing the older adult's medications and sees that naproxen is prescribed. Which question is the nurse most likely to ask in order to assess for adverse effects? A. "Have you noticed unusual fatigue, restlessness, or feelings of depression?" B. "Do you notice dry mouth, dizziness, mental clouding, or weight gain?" C. "Are you experiencing constipation, itching, or excessive sleepiness?" D. "Have you had gastric discomfort, vomiting, bleeding, or bruising?"

D. "Have you had gastric discomfort, vomiting, bleeding, or bruising?"

The nurse is reviewing the patient's medication list and sees that acetaminophen and celecoxib are scheduled to be administered at the same time. What should the nurse do? A. Call the health care provider for an order to stagger the administration of these two pain medications B. Ask the patient which one he prefers to take; administer the preferred drug and assess for relief C. Give the acetaminophen because it is less likely to cause gastric irritation and bleeding D. Administer the medications as ordered because they can be given together without ill effects

D. Administer the medications as ordered because they can be given together without ill effects

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

D. Around-the-clock

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? A. Deliver the bolus dose per standing order B. Contact the health care provider (HCP) to increase the dose C. Try nonpharmacologic comfort measures D. Assess the pain for location, quality, and intensity

D. Assess the pain for location, quality, and intensity

A new, inexperienced nurse sees that a patient is receiving around-the-clock medication but also has orders for a prn analgesic every 4-6 hours. How will the new nurse determine when a prn dose is given? A. Administer a dose every 6 hours to ensure adequate relief B. Call the health care provider and ask for specific parameters for prn dosing C. Look at the medication administration record to see what the previous night nurse gave D. Assess the patient for breakthrough pain and anticipate painful procedures

D. Assess the patient for breakthrough pain and anticipate painful procedures

The patient reports that he has been taking hydrocodone as prescribed by his provider and uses over-the-counter acetaminophen whenever he needs additional pain relief. Which laboratory test indicates the adverse and additive effects of these two medications? A. Decreased clotting times B. Decreased hematocrit C. Elevated white blood cell count D. Elevated liver enzymes

D. Elevated liver enzymes

The nursing student is using the Wong-Baker FACES pain rating scale to assess the pain of a 4-year-old child. The nurse would intervene if the student performed which action? A. Points to the smiling face and tells the child that this face has "no pain" B. Tells the child that FACES helps nurses understand how he is feeling C. Points to the tearful face and tells the child that the picture means "worst pain" D. Observes the child's facial expression and matches it to a face on the scale

D. Observes the child's facial expression and matches it to a face on the scale