NURS 309 Quiz #4 Questions
9. 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 c. Titrate downward to prevent toxicity d. Titrate to a dosage that is adequate to meet the client's subjective needs
a
19.) which team members(RN, UAP, pHysical therap) should preform the following tasks? a. Instruct in and supervise use of a transcutaneous electrical nerve stimulation unit. b. Administer non-opioid medication. c. Answer questions about medication side effects. d. Identify contributing factors such as fatigue or anxiety. e. Suggest that the relatives bring personal comfort items. f. Assist the patient to change position every 2 hours. g. Reinforce the use of a pillow to splint when coughing.
PT, RN, RN, RN, RN, UAP, UAP
9. In assessing pain in an older adult PT, what is a major barrier to accurate assessment? a. Many older adults are reluctant to report pain b. Pain perception increases with age c. Pain scales are inaccurate for older adults d. Most older adults have some cognitive impairment
a
15. A PT reports a constant "achy: type of pain after abdominal surgery. This is an indication of which type of pain? a. Somatic b. Visceral c. Neuropathic d. Psychosomatic
a
(#189) A client reports sever pain 2 days after surgery. Which intial action should the nurse take after assessing the character of the pain? a. Encourage rest b. Obtain VS c. Admin. Prn analgesics d. document the client's pain response
b
14. The nurse is caring for several PT's who will receive pain medication. Which PT is most likely to receive around the clock oral opiods? a. PT with fibromyalgia b. PT with chronic cancer pain c. PT with Crohn's d. PT who had a stroke
b
8.) During of the shift the following events occur at the same time. Prioritize the order for addressing these problems. a. Mr. L is callin out loudly about right sided flank pain caused by his kidney stone. b. Mr. O, who was in a motorcycle accident is calling "the pump tipped over and it's broken" c. Another nurse needs opioids wastage witness. d. Mr. A, with bacterial pneumonia is urinating in the corner of his room.
b, a, d, c
39. A pt is prescribed morphine sulfate, and opioid analgesic, for pain. Which nursing interventions decrease the risk for constipation? SATA a. Give foods low in bulk and roughage b. Instruct the pt to increase water consumption c. Administer a stool softener every morning d. Change the dose of the opioid e. Encourage activity
b, c, e
1.) You decide to do a brief round of all the patients before shift report, to ensure safety and to help determine acuity and assignments. List the order in which you should briefly check in on these patients: a. Ms. R b. Mr. L c. Mr. O d. Mr. H e. Ms. J f. Mr. A
f, c, b, a, e
13. Mr. O is at risk for compartment syndrome because of the cast. Which pain assessment finding would alert you to 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
13.) A client is crying and grimacing but denies pain and refuses pain medication because "my sibling is a drug addict and it ruined our lives" what is the primary nursing diagnosis? 1.) encourage expression of fears in the 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
11.) A client receive as needed morphine lorazapam and cyclobenzaprine. The UAP reports that the client has a respiratory rate of 10 per minute what is the priority action? 1.)Call the physician to obtain in order for naloxone 2.) assess the clients responsiveness in respiratory status 3.) obtain a bag valve mask and deliver breaths at 20 per minute 4.) Double check the drug cooler to see what the client should have received.
2
15. Mr. H returns from the OR following a hernia repair. He says that he is "afraid to walk because it will make the pain really bad." What will you explain as being the best option? 1. Pain medication every 4 hours if he needs it 2. Medication 45 minutes before ambulation or dressing changes 3. Around-the-clock pain medication even if he has no report of pain 4. Talking to the physician for reassurance about the treatment plan
2
16. Mr. H is asking for pain medication, and the health care provider has ordered 10 mg of oxycodone controlled- release (OxyContin) as needed. The pharmacy has stocked 5-mg tablets of oxycodone immediate-release in the medication cabinet. What is your first action? 1. Call the health care provider for clarification of the order. 2. Call the pharmacy and obtain the controlled-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
20. Mr. A has a single—lumen peripherally inserted central catheter, and he has the following scheduled medica— tions and IV solutions that need to be given now: vancomycin (Vancocin) 1.5 g in 250 mL of dextrose 5% over 90 minutes; levofloxacin (Levaquin) 750 mg in 150 mL of normal saline over 90 minutes; dextrose 5% and 0.45% saline 1000 mL with 20 mEq of potassium at 125 mL/hr; and an IV bolus dose of morphine 3 mg. What is your priority action? 1. Call the physician and ask if the medication times can be staggered. 2. Call the pharmacy and enquire about the compat- ibility of medications and solutions. 3. Give the bolus dose of morphine, because it will take the least amount of time. 4. Establish an additional peripheral IV site.
2
A nurse is caring for a client after a total knee replacement who is requesting Vicodin in addition to the PCA. The client reports having taken 2 Vicodin tabs q4hrs for several weeks before surgery. If each tablet contains 500mg of acetaminophen, how much acetaminophen had the client been ingesting per day? (Round your answer using a whole #)
2 (Vicodin) Tabs x 500mg = 1,000mg (There are x6 "q4hr" intervals in 24 hours/per day) 6 intervals x 1,000 mg (amount of acetaminophen - per interval/dose) = 6,000mg/day **This is more than the recommended maximum dose of 4,000mg/day for short term use**
14. Mr. 0 reports an increasing pain in the right abdomen. On physical examination, you note hyperactive bowel sounds, a tense abdomen with guarding, and exquisite tenderness with gentle palpation. What is your priority action? 1. Give a PRN pain medication. 2. Notify the physician of your findings. 3. Take the complete set of vital signs. 4. Assist him to change positions
3
14.) A client's opioid therapy is being tapered off, and the nurse is watching for signs of withdrawal. what is one of the first signs of withdrawal? 1.) Fever 2.) Nasuea 3.) Diaphoresis 4.) Abdominal cramps.
3
17, Mr. H is given a dose of pain medication. One hour later he is anxious and appears uncomfortable and asks, "What's the matter? Is something wrong? I'm still hurting." What action should you take first? 1. Call the physician for a change in medication or dose. 2. Initiate "nothing by mouth" status in case surgery is needed. 3. Check for bladder distention and last voiding. 4. Reassure the patient that the hernia is not recurring.
3
12.) Which client is at greatest risk for respiratory depression while receiving opioids for analgesia? 1.) elderly client with chronic pain who has a hip fracture 2.) client with a heron addiction and back pain 3.) Young female client with advance multiple myeloma 4.) Child with an arm fracture in cystic fibrosis
4
18. One of the staff members is talking about Mr. A, who has bacterial pneumonia, in the medication room. "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 your best response to this comment? 1. 'All' patients have a right to care regardless of race, creed, or other traits." 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
12. The nurse knows that acute pain serves a biologic purpose. How does the nurse apply this knowledge in caring for a PT with a Hx of cardiac problems, who now reports sever chest pain? a. Immediately administers supplemental O2 b. Reassures that acute pain is usually temporary c. Assesses for anxiety, restlessness, or apprehension d. Obtains prn pain meds
a
13. A client is crying and grimacing but denies pain in refuses pain medication because "my sibling is a drug addict and ruin our lives" what is the priority intervention for this client? a. Encourage expression of fears in the past Experiences. b. Provide accurate information about the use of pain medication c. Explain that addiction is unlikely among acute-care clients d. Seek family assistance in resolving this problem
a
22. Which therapy is first in line choice for severe acute pain? a. Opiods b. NSAIDS c. Adjuvants d. Cutaneous stimulation
a
3. 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 you advocate for first? a. Gabapentin (Neurontin) b. Corticosteroids c. Hydropmophone (DIlaudid) d. Lorazepam (Ativan)
a
30. The nurse is interviewing a PT who frequently comes to the clinic to obtain medication for chronic back pain. The PT states, "I know you guys think I'm faking, but I hurt and 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
34. 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 nurses sees that there are several different classes of analgesics listen. Which action if the nurse most likely to take? a. Assess pt's understanding of the multimodal tx plan and ability to comply b. Contacts the health care provider (HCP) to discontinue medication that contribute to polypharmacy c. Emphasizes that medications with more side effects are the last choice for pain d. Advise that patient not to take any NSAIDS because of irritation of gastric mucosa.
a
8. Which PT is most likely to report pain that would be considered acute? a. Has a Hx of PVD, foot is suddenly cold and blue b. Has a Hx of diabetic neuropathy, reports burning sensation in lower leg. c. Has a Hx of old ankle Fx, reports recent Dx of osteoarthritis d. Has a Hx of osteosarcoma in the femurs with tumor growth and expansion
a
Acetaminophen (Tylenol) is the first-line-medication for which patient? Needs relief from pain related to osteoarthritis Has chronic pain and discomfort due to rheumatoid arthritis Experiences burning and tingling in legs due to diabetes Has intermittent abdominal cramping due to Crohn's disease
a
What is the drug category of choice for the pain treatment of mild to moderate bone pain? NSAIDS Opioids Anticonvulsants Antianxiety agents
a
he nurse is teaching a patient about acupuncture as an alternative therapy for pain relief. Which statement by the patient indicates the nurse's teaching is effective? "Acupuncture is used for pain control and anesthesia purposes" "Acupuncture is commonly used to relieve pain and inflammation" "A local anesthetic is injected which decreases pain perception" "Needles are inserted into the body to temporarily deaden the nerve"
a
19. What are the physiologic responses that indicate the PT is experiencing pain? a. Diaphoresis b. Restlessness c. Bradycardia d. Hypotension e. Bradypnea
a, b
A client with arthritis increases the dose of ibuprofen 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 Melena Tachycardia Constipation Clay-colored stools Painful BM's
a, b
2. Which factors affect pain and its management? SATA a. Age b. Disease process c. Gender d. Sociocultural background e. Absence of physiologic response f. Genetics
a, b, c, d, e
32. Which are advantages of the PCA method of med admin? SATA a. It allows a predetermined bolus b. It maintains a constant lvl of pain relief c. It diminishes the patient anxiety by allowing the PT control over administration d. It eliminates the need for repeated injections e. The PT needs no education for effectiveness.
a, b, c, d, e
6. Which morning tasks can be delegated to the UAP? (select all that apply) a. Assisting Ms. R, who has rheumatoid arthritis, with morning care b. Reinforcing to Mr. L, who has a kidney stone, the need to save urine for straining c. Preparing Mr. H's room for his return from the OR for hernia repair d. Reporting on the condition of Mr. O's skin resulting from his motorcycle accident e. Getting coffee for Ms. J's (end-stage multiple myeloma) family f. Checking on the pule oximeter reading for Mr. A, who has bacterial pneumonia
a, b, c, e
(#32) What is the nurse's responsibility when administering prescribed opioid analgesics? SATA a. Count the client's resp. b. Document the intensity of the client's pain c. withhold the meds if the client reports pruritis d. Verify the # of doses in the locked cabinet before administering the prescribed dose e. Discard the med in the client's toilet before leaving the room if the med is refused.
a, b, d
2.)Which of the six patients can be assigned to the new RN? (select all that apply) a. Ms. R b. Mr. L c. Mr. O d. Mr. H e. Ms. J f. Mr. A
a, b, d
What is the nurse's responsibility when administering prescribed opioid analgesics? SATA Count the client's resp. Document the intensity of the client's pain withhold the meds if the client reports pruritis Verify the # of doses in the locked cabinet before administering the prescribed dose Discard the med in the client's toilet before leaving the room if the med is refused.
a, b, d
27. A PT w/ chronic bone pain as a result of rheumatoid arthritis may be prescribed which agents? SATA a. Aspirin b. COX-2 inhibitor such as celecoxib (Celebrex) c. Opioid such as morphine d. Acetaminophen (Tylenol) e. NSAID such as ibuprofen (Motrin, Advil)
a, b, e
Which nonpharmacologic therapies stimulate the skin and subcutaneous tissue to produce pain relief? SATA Massage Imagery Vibration Heat Application Therapeutic touch
a, c, d, e
7. Which tasks related to pain management can you delegate to the UAP? (select all that apply) a. Reporting on grimacing seen in unresponsive patients b. Asking about the location, quality, and radiation of pain c. Reminding patients to report pain as necessary d. Observing for relief after medication is given e. Asking patients directly, "are you having pain?" f. Determining if position changes relieves pain
a, c, e
6. Which clients must be assigned to an experienced RN? Select all a. Client who was in an automobile crash and sustained multiple injuries b. Client with chronic back pain related to a workplace injury c. Client who has returned from surgery and has a chest tube in place d. Client with abdominal cramps related to food poisoning e. Client with a severe headache of unknown origin f. Client with chest pain who has a history of arteriosclerosis
a, c, e, f
24. The nurse monitors for gastric irritation, signs of bleeding, and bruising as side effects of which pain meds? SATA a. Aspirin (nonopiod analgesic, NSAID) b. Acetaminophen (nonopioid analgesic) c. Ibuprofen (nonopioid analgesic, NSAID) d. Morphine (opioid analgesic) e. Demerol (Opioid analgesic)
a,c
(#172) A client with arthritis increases the dose of ibuprofen 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 BM's
b
(#55) Based on the client's reported pain lvl, the nurse admin. 8 mg of the prescribed morphine. The med is available in a 10 mL 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. LPN c. Client's health care provider d. Designated nursing assistant
b
) In the PACU it is reported that client received intrathecal morphine intra-op to control pain. Considering the administration of this medication, what should the nurse include as part of the client's initial 24-hour post-op care? Assessing the client for tachycardia Monitoring of respiratory rate hourly Administering naloxone every 3 to 4 hours Observing the client for signs of CNS excitement
b
1. The nurse is working at a walk-in clinic and has just interviewed several PTs. Which patient represents the most common reason for seeking medical care? a. Has a family Hx of cardiac disease b. Has a personal Hx of chronic pain c. Has annual appointment for cancer screening d. Has a desire to lose weight and improve health
b
10. For client education about nonpharmaceutical alternatives, which topic could you delegate to an experienced LPN/LVN, who will function with your continued support and supervision? a. Therapeutic touch b. Application of heat and cold c. Meditation d. TENS
b
11. A client receives as needed morphine, lorazapam, and cyclobenzaprine. The UAP reports that the client has a respiratory rate of 10 per minute what is the priority action? a. Call the physician to obtain in order for naloxone b. Assess the clients responsiveness in respiratory status c. Obtain a bag valve mask and deliver breaths at 20 per minute d. Double check the drug cooler to see what the client should have received
b
17. Which PT is having pain that is unlikely to respond to first-line-analgesics? a. 62 yo woman who Fxed he wrist b. 70 yo woman with posttherpetic neuralgia c. 50 yo man with a recently inserted chest tube d. 45 yo man who sustained burn to hands
b
20. What is the best type of pain scale to use for PT's who have language barriers or reading problems, or children? a. 0-10 numeric rating scale b. FACES (smile to frown) c. Verbal description scales d. Pasero Opiod-induced sedation scale
b
23. The nurse is assessing an elderly PT who has "pain all over." Which strategy would the nurse use to help the PT 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 PT to find one area that does not hurt d. Provide examples and comparisons of severe pain.
b
28. The nurse is assisting a surgical PT with pain management. Which outcome statement best demonstrates that the short-term functional goal is being met 45 minutes after receiving pain meds? a. Patient reports that pain lvl is 4/10 b. PT ambulates in hallway with PT c. PT declines a prn anxiolytic med d. PT does not demonstrate facial grimacing.
b
31. Which nursing action indicate that the nurse is performing the first step of McCaffrey and Pasero's hierarchy of Pain measures? a. Premedicates before dressing change b. Uses a standard pain assessment tool c. Compares VS before and after pain meds
b
37. For early postoperative pain or pain that is severe and escalating, what is the preferred route? a. Oral b. Intravenous c. Intranasal d. Subcutaneous
b
4. Which PT has the highest risk for inadequate pain management? a. 56 yo man who had a major abdominal surgery for a stab wound b. 78 yo woman who was txed to a nursing home after hip surgery c. 10 yo child who had a tonsillectomy and his parents can't speak English d. 24 yo postpartum woman with a hx of drug abuse
b
5. The new nurse tells you that she can't find any documentation that shows the time of Mr. L's (kidney stone) last dose of pain medication. What actions should occur first? a. Help the new nurse look at the chart and medication administration record b. Tell the new nurse to ask the night nurse before she leaves c. Speak to the night shift nurse about the documentation d. Have the new nurse ask Mr. L when he last had medication
b
A client reports severe pain 2 days after surgery. Which initial action should the nurse take after assessing the character of the pain? Encourage rest Obtain VS Admin. Prn analgesics document the client's pain response
b
A client who had abdominal surgery is receiving PCA IV 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? Monitor the client's pain level for another hour Determine the integrity of the IV delivery system Reprogram the pump to deliver a bolus dose every 8 minutes Arrange for the client to be evaluated by the HCP
b
A modified-release opioid is ordered for a patient who is currently NPO and receiving nutrition and fluids through a small more NG tube. What should the nurse do? Crush the medication and mix it with water to instill through the NG tube Contact the health care provider for an order to administer the medication rectally. Have the patient swallow the medication with very small amount of water Hold the medication and document that the patient is NPO for foods and fluids
b
A patient using a transcutaneous nerve stimulation (TENS) unit asks the nurse how it works to decrease pain. What is the best response? "It deserves an electric shock to relieve muscle tension" "Low-Voltage electrical currents are delivered to the painful area" "Endorphins are blocked, which inhibits pain transmission" "The nerves causing pain will swell, raising the pain threshold"
b
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 rationale that explains that need for increasing amounts of medication for this patient? Patient is addicted to opioids Disease is progressing A different opioid is needed Patient has developed a tolerance for opioids
b
Based on the client's reported pain level, the nurse admin. 8 mg of the prescribed morphine. The med is available in a 10 mL syringe. Wasting of the remaining 2 mg of morphine should be done by the nurse and a witness. Who should be the witness? Nursing supervisor LPN Client's health care provider Designated nursing assistant
b
The nurse is assessing a patient who is receiving pain medication via a PCA device. The patient is very drowsy and difficult to arouse. What should the nurse do first? Wake the patient and tell him to stop pushing the button so frequently Stay with the patient and discontinue the basal rate Let the patient sleep, but increase the frequency of assessment Obtain an order for exclusive use of nonopioid mediation
b
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 assessment are preformed less frequently if epidural catheters are used for pain management b.Morphine and hydromorphine (Dilaudid) 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
The pt with chronic cancer pain has been taking oral morphine for several months. The HCP suggests a very low dose of nalbuphine (Nubain) for relief of opioid induced pruritus. The nurse recognizes that frequent assessment is required for: Higher risk for respiratory depression Severe pain or withdrawal symptoms Hemodynamic adverse effects Bleeding and increase clotting time
b
(#59) What are the desired outcomes that the nurse expects when administering an NSAID? SATA a. Diuresis b. Pain relief c. Antipyresis d. Bronchodilation e. Anticoagulation f. Reduced inflammation
b, c, f
What are the desired outcomes that the nurse expects when administering an NSAID? SATA Diuresis Pain relief Antipyresis Bronchodilation Anticoagulation Reduced inflammation
b, c, f
(#775) A client receiving morphine by PCA has a respiratory rate of 6 breaths/min. What interventions should the nurse anticipate? a. Nasotracheal suction b. Mechanical ventilation c. Naloxone administration d. CPR
c
(#789) A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended doseage. 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 about the risk for morphine addiction c. Assess the client's pain before increasing the dose of morphine d. Check the client's heart rate before increasing the morphine to the next level
c
10. The nurse is caring for a PT in on the first post op day. The PT denies pain, but his BP and pulse are elevated and he is diaphoretic and anxious. What should the nurse do first? a. Believe and document the PT's self-report of "denies pain" b. Call the health care provider and report the VS, diaphoresis, and anxiety c. Assess the PT for postop. Complications or barriers to reporting pain d. Ask a family member if the PT would typically be stoic during pain or discomfort.
c
11.) Mr. Al reports that the pain has decrease compared with earlier, but now he is having other symptoms. What symptom is of greatest concern? a. Painless hematuria with small clots. b. Dull pain that radiates into the genitalia c. Absence of pain but scant urine output. d. Sensation of urinary urgancy.
c
12. 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? A. instruct him to periodically move his toes. B. Use diversional therapy. C. Elevate the injured leg above the heart. D. Place the patient in high Fowler position
c
13. A PT with rheumatoid arthtitis reports having chronic pain for years with an exacerbation that started in the morning. Which observation indicates the PT has a physiologic adaption to pain? a. Pupils are dilated b. Breathing is shallow c. Pulse rate is 70 bpm d. Temp is 98.6 f
c
14. A client's opioid therapy is being tapered off, and the nurse is watching for signs of withdrawal. what is one of the first signs of withdrawal? a. Fever b. Nasuea c. Diaphoresis d. Abdominal cramps.
c
16. 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. Sensory perception d. Modulation
c
2. Family members are encouraging your client to "tough out the pain: rather than risk drug addiction to narcotics. The client is stoically abiding. You recognize that the sociocultural dimension of pain is the current priority for the client. Which question will you ask? a. "where is the pain located, and does it radiate to other parts of your body?" b. "How would you describe the pain, and how is it affecting you?" c. "what do you believe about pain medication and drug addiction?" d. "How is the pain affecting your activity level and your ability to function?" e. "What information do you need about pain, healing, and addiction?"
c
29. The PT reports a vivid childhood memory of having severe pain during and after a dental procedure. The PT confides a reluctance to visit the dentist even for routine cleanings. What should the nurse do? a. Refer the PT for Psychological counseling before seeking dental care. b. Obtain an order for antianxiety meds and suggest relaxation techniques c. Suggest talking to a dentist about current pain management techniques d. Advise PT that past fears should not interfere with good health practices.
c
3. The PT 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. Pharmicist b. PT c. Pain resource nurse d. An alternate health care provider
c
33. The nurse is assessing a PT with sever dementia who resides in a long-term care facility. A score of 8 is obtained by using the pain assessment in advanced dementia scale. Based on assessment finding, which action will the nurse take? a. Speak calmly and explain that repositioning will make him more comfortable b. Gently reassure the PT and continue routine observation for discomfort and pain c. Assess the PT for the source of the pain and immediately inform the health care provider d. Contact the family and ask how the PT would typically respond to discomfort
c
38. The PACU 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 HCP writes post-op orders c. When the pt is able to tolerate oral intake d. When the IV access is discontinued
c
4. 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 in the leg c. A client with progressive pancreatic cancer d. A client with trigeminal neuralgia
c
4. Which nonpharmacologic pain measure to help Ms. R relieve her early morning stiffness should be delegated to the UAP? a. Assisting Ms. R to get in a bath tub full of warm water b. Sharing some relaxation techniques with Ms. R c. Assisting Ms. R to take a warm shower d. Evaluating the effectiveness of paraffin therapy
c
5. The nurse is taking a health Hx of a PT who has persistent pain related to interstitial cystitis. How does the nurse categorize this pain? a. Acute b. Chronic c. Chronic noncancer d. Somatic
c
6. A PT with chronic leg pain reports pain level at 7/10, so the nurse administers a prn med. Which observation best suggests the goal of the therapy has been met? a. PT appears relaxed while talking with family members. b. Pulse, BP, and resp. are not elevated. c. PT ambulates ind. Down the hall without distress d. PT asks for additional food between lunch and dinner
c
7. In application of the principles of pain treatment, what is the first consideration? a. Treatment is base on client goals b. A multidisciplinary approach is needed c. The client's perception of pain must be accepted d. Drug side effects must be prevented and managed
c
8. Which client has the most immediate need for IV access to deliver immediate analgesia with rapid titration? a. Client who has sharp chest pain that increases with cough and SOB b. Client who reports excruciating lower back pain with hematuria c. Client who is having an acute myocardial infarction with sever chest pain d. Client who is having a sever migraine with an elevated BP
c
9.) Mr. L calls for pain medication he describes the pain caused by his kidney stone as excruciating he is crying by Frederick in pacing around the room. what is your priority action? a. Instruct Mr. L to do deep breathing exercises b. Remind Mr. L to use the PCA pump c. Get Mr. L an as needed IV bolus dose as ordered d. Call the physician immediately.
c
A client who had a total hip replacement asks the nurse about the continuous regional anesthesia being used. What information should the nurse include when explaining the benefits of this treatment over controversial methods to control pain? Adjusting the dose is easily done Neuropathic pain can be relieved Systemic side effects are minimal The need for parenteral medication is avoided
c
A client with an inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit, which nursing action is appropriate? Maintain the settings programmed by the health care provider Turn the machine on several times a day for 10-20 minutes Adjust the dial on the unit until the client states the pain is relieved Apply the color-coded electrodes on the client where they are most comfortable
c
A patient develops a physical dependence after taking an opioid as prescribed for postsurgical pain. What is the recommended approach for dealing with the dependence? Immediate discontinuation of the opioid Administration an antagonist, such as naloxone (Narcan) Gradual reduction of the opioid as pain decreases Referral to a substance specialist for treatment
c
In applying the concept of titration, which route is likely to have the shortest intervals between the increases in dosage? Transdermal Oral Intravenous Intramuscular
c
The nurse is receiving 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 with adverse cardiovascular effects? Duloxetine (Cymbalta) Acetaminophen (Tylenol) Naproxen (Naprosyn) Morphine (MS Contin)
c
The patient has a history of rheumatoid arthritis and is also being treated for acute pain from a hip fracture. Which medication is likely to be prescribed to reduce the pain and discomfort caused by inflammation? Morphine (MS Contin) Acetaminophen (Tylenol) Ibuprofen (Advil/Motrin) Bupivacaine (Marcaine)
c
35. Which drugs can cause adverse effects, particularly in an older adult, because of an accumulation of toxic metabolites? SATA a. Ibuprofen (Advil, Motrin) b. Morphine c. Meperidine (Demerol) d. Acetaminophen (Tylenol) e. Codeine
c, e
Which statements are rue regarding the side effects of respiratory depression as a result of administering an opioid analgesic? SATA Respiratory depression develops when opioid tolerance occurs Respiratory depression is less of a problem in the older adult The drug used to reverse respiratory depression is naloxone (Narcan) A one-time dose of naloxone (Narcan) is all that is needed to reverse the effects of the opioid Sedation will occur before opioid-induced respiratory depression
c, e
1. You are the charge RN. A client with chronic pain reports to you that the nurses have not been responding to requests for pain medication. What is your initial action? a. Check the med. Admin. Records (MARs) for the past several days. b. Ask the nurse educator to provide in-service training about pain management c. Perform a complete pain assessment on the client and take a pain history d. Have a conference with the nurses responsible for the care of this client
d
10.) You are preparing to give Mr. Al pain medication but you know that the IV site is infiltrated so you inform him that the IV catheter will have to be reinserted he tells you "what's wrong with you people can't you do anything right what is the best response?" a. Let me call the position and I can get an an order for an oral medication. b. This is not my fault but if you will just give me a couple minutes I can fix it. c. Let me call the nursing supervisor and you can talk to her about the situation. d. I know you are having pain let me restart your IV line right now.
d
11. A PT reports a deep, poorly localized cramping type of pain. These assessment findings indicate which type of pain? a. Somatic b. Psychosomatic c. Neuropathic d. Visceral
d
12. Which client is at greatest risk for respiratory depression while receiving opioids for analgesia? a. elderly client with chronic pain who has a hip fracture b. client with a heron addiction and back pain c. Young female client with advance multiple myeloma d. Child with an arm fracture and cystic fibrosis
d
18. Which behavior exemplifies the nurse's primary role in assessing and managing the PT's pain? a. Administers pain meds as ordered if pain is sufficient to warrant therapy. b. Listens to the PT'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 PT's preferences and values.
d
21. The nurse asks the PT, "Sir, where is your pain?" The PT repeatedly responds, "It hurts all over." What is the best rationale for taking extra time to help the PT to identify specific areas that hurt? a. Documentation is incomplete as a legal document if the nurse charts "It hurts all over" b. Formulation an achievable therapeutic goal is very difficult for a vague complaint c. The Health care provider cannot prescribe appropriate meds for relief of generalized pain d. Differentiating between painful and non-painful areas helps the PT understand the origin
d
25. The nursing student is using the Wong-baker FACES pain rating scale to assess the pain of a 4 yo 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
26. The nurse is assessing the PT for pain or discomfort. Which is the best question to use to elicit the quality of pain? a. So you are not having any pain or discomfort right? b. Would you describe the pain as sharp? c. Choose two or three words to describe your pain d. How would you describe your pain?
d
3. You are talking to Ms. R (rheumatoid arthritis) about discharge plans and follow-up appointments. She begins to cry and says, "I was so active and athletic when I was younger." What is the most therapeutic response? a. 'Your shoulder will get rogressively better with time and patience. Don't cry." b. "I can see that you are really upset. Is your shoulder hurting a lot right now?" c. "I know what you mean. I used to be able to do a lot more when I was younger, too." d. "It is difficult to deal with changes. What types of activities did you used to do?"
d
36. The nurse is giving discharge instructions about multimodal analgesia to a daughter who will care form 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 frequency 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. "Combining different analgesics give greater relief with lower doses and fewer side effects"
d
5. As the charge nurse, you are reviewing the charts of clients who were assigned to the care of a newly graduated RN. The RN has correctly charted does and time of medication, but there is no documentation regarding nonpharmaceutical 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 dept. c. Quiz the nurse about knowledge of pain management and pharmacology d. Give praise for correctly charting the dose and time and discuss the deficits in charting.
d
7. Despite the nurse's best efforts, the PT's wife continuously asks the nurse to reassess her husband's pain and to give him additional meds. 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 health care provider needs to be contacted for a dosage increase d. The PT is the only one who can describe his experience of pain.
d
A new inexperienced nurse sees that the patient is receiving around-the-clock medication, but also has orders for prn analgesic every 4-6 hours as needed. How will the new nurse determine when a PRN dose in given? Admin a dose q6hrs to ensure adequate relief Call the health care provider and ask for specific parameters for PRN dosing Look at the medication administration record to see what the previous nurse gave Assess the patient for breakthrough pain and anticipate painful procedures
d
A nurse is taking the health history of the 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 that health care provider. Which drug does the nurse expect will most likely be prescribed instead of the Advil? Naproxen (Aleve) Ibuprofen (Motrin) Ketorolac (Toradol) Acetaminophen (Tylenol)
d
Which assessment would the nurse perform to determine if a patient would be an appropriate candidate for using imagery as a distraction therapy? Determine if touch and physical proximity are culturally acceptable Ensure that the patient can speak, read, and write English Assess environmental factors that contribute to discomfort or annoyance Confirm that the patient can follow a logical and sustained conversation
d
Which patient is least likely to be a good candidate for PCA? 32-year-old male with severe burns and a history of drug abuse 16-year-old male with multiple injuries sustained during an accident 34-year-old female with functional blindness who had abdominal surgery 25-year-old female with intermittent lucidity after a severe head injury
d
Which statement about the strategy of the distraction is true? Distraction is most effective for acute pain relief Distraction directly influences the cause of pain Distraction is tried when medication ineffective Distraction alters the perception of pain
d
he nurse is reviewing the patient's medication list and sees that acetaminophen (Tylenol) and celecoxib (Celebrex) are scheduled to be administered at the same time. What should the nurse do? Call the HCP for an order to stagger the administration of these two pain medications Ask the patient which one he prefers to take; administer the preferred drug and assess for relief. Give the acetaminophen (Tylenol) because it is less likely to cause gastric irritation and bleeding Administer the medication as ordered, because they can be given together without ill effects
d
the patient reports that he has been taking hydrocodone (Vicodin) as prescribed by his HCP and uses OTC acetaminophen (Tylenol) whenever he needs additional pain relief. Which laboratory test indicates that the patient is having adverse effects because of the additive effects of these two medications? Decrease clotting times Decrease hematocrit Elevated white blood cell count Elevated liver enzymes
d
