Pain

1. Pain has been defined as "whatever the person experiencing the pain says it is, existing whenever the patient says it does." This definition is problematic for the nurse when caring for which type of patient? a. A patient placed on a ventilator b. A patient with a history of opioid addiction c. A patient with decreased cognitive function d. A patient with pain resulting from severe trauma Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 29). Elsevier Health Sciences. Kindle Edition.

1. c. Because the patient's self-report is the most valid means of pain assessment, patients who have decreased cognitive function, such as those who are comatose, have dementia, or are mentally disabled, might not be able to report pain. In these cases, nonverbal information and behaviors are necessary considerations in pain assessment. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 326). Elsevier Health Sciences. Kindle Edition.

10. A patient with trigeminal neuralgia has moderate to severe burning and shooting pain. In helping the patient to manage the pain, the nurse recognizes what about this type of pain? a. Treatment includes the use of adjuvant analgesics b. Will be chronic in nature and require long-term treatment c. Responds to small to moderate around-the-clock doses of oral opioids d. Can be well controlled with salicylates or nonsteroidal antiinflammatory drugs (NSAIDs) Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

10. a. Damage to peripheral or cranial nerves causes neuropathic pain that is not well controlled by opioid analgesics alone and often includes the adjuvant use of tricyclic antidepressants or antiseizure drugs to help inhibit pain transmission. Salicylates and NSAIDs are not effective for the intensity of neuropathic pain. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

11. In the following scenario, identify the elements of a pain assessment that are present. A 62-year-old male patient is admitted to the medical unit from the emergency department. On arrival he is trembling and nearly doubled over with severe, cramping abdominal pain. He indicates that he has severe right upper quadrant pain that radiates to his back and he is more comfortable walking bent forward than lying in bed. He notes that he has had several similar bouts of abdominal pain in the last month but "not as bad as this. This is the worst pain I can imagine." The other episodes lasted only about 2 hours. Today he experienced an acute onset of pain and nausea after eating fish and chips at a fast-food restaurant about 4 hours ago. a. b. c. d. e. f. g. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

11. a. Onset: About 4 hours ago b. Duration and pattern of the pain: Continuously for about 4 hours. Similar episodes in the past month but lasted only 2 hours. c. Location: Right upper quadrant d. Intensity: Severe, 10 on a scale of 0 to 10 e. Quality: Severe cramping, radiates to back f. Associated symptoms: Nausea g. Management strategies: Pain better walking bent forward, more intense lying in bed Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

17. Which measures or drugs may be effective in controlling pain in the physiologic pain process stage of transduction (select all that apply)? a. Distraction d. Local anesthetics b. Corticosteroids e. Antiseizure medications c. Epidural opioids f. Nonsteroidal antiinflammatory drugs (NSAIDs) Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 31). Elsevier Health Sciences. Kindle Edition.

17. b, d, e, f. Distraction is effective in the perception stage. Epidural opioids are effective in the transmission stage. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

12. List the 10 basic principles that should guide the treatment of all pain. a. b. c. d. e. f. g. h. i. j. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 31). Elsevier Health Sciences. Kindle Edition.

12. a. Follow the principles of pain assessment. b. Use a holistic approach to pain management. c. Every patient deserves adequate pain management. d. Base treatment on the patient's goals. e. Use both drug and nondrug therapies. f. When appropriate, use a multimodal approach to analgesic therapy. g. Address pain using an interdisciplinary approach. h. Evaluate the effectiveness of all therapies to ensure that they are meeting the patient's goals. i. Prevent or manage medication side effects. j. Incorporate patient and caregiver teaching throughout assessment and teaching. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

13. A patient with colorectal cancer has continuous, poorly localized abdominal pain at an intensity of 5 on a scale of 0 to 10. How does the nurse teach the patient to use pain medications? a. On an around-the-clock schedule b. As often as necessary to keep the pain controlled c. By alternating two different types of drugs to prevent tolerance d. When the pain cannot be controlled with distraction or relaxation Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 31). Elsevier Health Sciences. Kindle Edition.

13. a. Analgesics should be scheduled around the clock for patients with constant pain to prevent pain from escalating and becoming difficult to relieve. If pain control is not adequate, the analgesic dose may be increased or an adjunctive drug may be added to the treatment plan. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

14. A patient who has been taking ibuprofen (Motrin) and imipramine (Tofranil) for control of cancer pain is having increased pain. What would the health care provider recommend as an appropriate change in the medication plan? a. Add PO oxycodone (Oxycontin) to the other medications b. Substitute PO propoxyphene (Darvon), a mild opioid, for imipramine c. Add transdermal fentanyl (Duragesic) to the use of the other medications d. Substitute PO hydrocodone with acetaminophen (Lortab, Vicodin) for the other medications Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 31). Elsevier Health Sciences. Kindle Edition.

14. a. As cancer pain increases, stronger drugs are added to the regimen. This patient is using a nonsteroidal antiinflammatory drug (NSAID) and an antidepressant. A stronger preparation would be an opioid but because an NSAID is already being used, a combination NSAID/opioid is not indicated. An appropriate stronger drug would be an oral opioid, in this case oral oxycodone, and this still leaves stronger drugs for expected increasing pain. Propoxyphene is not recommended in analgesic guidelines because of its limited efficacy and toxicities. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

15. A patient with chronic cancer-related pain has started using MS Contin for pain control and has developed common side effects of the drug. The nurse reassures the patient that tolerance will develop to most of these side effects but that continued treatment will most likely be required for what? a. Pruritus c. Constipation b. Dizziness d. Nausea and vomiting Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 31). Elsevier Health Sciences. Kindle Edition.

15. c. Although tolerance to many of the side effects of opioids (nausea, sedation, respiratory depression, pruritus) develops within days, tolerance to opioid-induced constipation does not occur. A bowel regimen that includes a gentle-stimulant laxative and a stool softener should be started at the beginning of opioid therapy and continue for as long as the drug is taken. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

16. A postoperative 68-year-old opioid-naive patient is receiving morphine by patient-controlled analgesia (PCA) for postoperative pain. What is the rationale for not initiating the PCA analgesic with a basal dose of analgesic as well? a. Opioid overdose c. Lack of pain control b. Nausea and itching d. Adverse respiratory outcomes Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 31). Elsevier Health Sciences. Kindle Edition.

16. d. Use of a basal dose may increase the risk of serious respiratory events in opioid-naive patients and those at risk for respiratory difficulties (older age, existing pulmonary disease, etc.). Overdose is not expected, as the dosages are calculated and the PCA pump is programmed to prevent this. Nausea and itching are common side effects but not related to a basal dose of analgesic. A lack of pain control would not be expected with or without a basal dose. The nurse would be assessing the patient and notify the physician if a lack of pain control occurs but, again, this is not related to receiving a basal dose of analgesic via PCA pump. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

18. A patient is receiving a continuous infusion of morphine via an epidural catheter following major abdominal surgery. Which actions should the nurse include in the plan of care (select all that apply)? a. Label the catheter as an epidural access. b. Assess the patient's pain relief frequently. c. Use sterile technique when caring for the catheter. d. Monitor the patient's level of consciousness (LOC). e. Monitor patient vital signs (blood pressure, heart rate, respirations). f. Assess the motor and sensory function of the patient's lower extremities. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 31). Elsevier Health Sciences. Kindle Edition.

18. a, b, c, d, e, f. The major complications of epidural analgesia are catheter displacement and migration, accidental infusions of neurotoxic agents, and infection. These actions will help to reduce those risks. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

19. A patient with multiple injuries resulting from an automobile accident tells the nurse that he has "bad" pain but that he can "tough it out" and does not require pain medication. To gain the patient's participation in pain management, what should the nurse explain to the patient? a. Patients have a responsibility to keep the nurse informed about their pain. b. Unrelieved pain has many harmful effects on the body that can impair recovery. c. Using pain medications rarely leads to addiction when they are used for actual pain. d. Nonpharmacologic therapies can be used to relieve his pain if he is afraid to use pain medications. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 32). Elsevier Health Sciences. Kindle Edition.

19. b. When a patient wants to be stoic about pain, it is important that he or she understand that pain itself can have harmful physiologic effects and that failure to report pain and participate in its control can result in severe unrelieved pain. No evidence that indicates fear of taking the medication is present in this situation. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

2. On the first postoperative day following a bowel resection, the patient complains of abdominal and incisional pain rated 9 on a scale of 0 to 10. Postoperative orders include morphine, 4 mg IV q2 hr, for pain and may repeat morphine, 4 mg IV, for breakthrough pain. The nurse determines that it has been only 2 hours since the last dose of morphine and wants to wait a little longer. What effect does the nurse's action have on the patient? a. Protects the patient from addiction and toxic effects of the drug b. Prevents hastening or causing a patient's death from respiratory dysfunction c. Contributes to unnecessary suffering and physical and psychosocial dysfunction d. Indicates that the nurse understands the adage of "start low and go slow" in administering analgesics Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 29). Elsevier Health Sciences. Kindle Edition.

2. c. Administering the smallest prescribed analgesic dose when given a choice is not consistent with current pain management guidelines and leads to undertreatment of pain and inadequate pain control. Without reassessing the pain within 30 minutes of the IV analgesic the nurse is unsure how well the previous dose of medication worked for the patient to determine the current dose needed. Unnecessary suffering, impaired recovery from acute illness, increased morbidity as a result of respiratory dysfunction, increased heart rate and cardiac Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

20. The patient has chronic pain that is no longer relieved with oral morphine. Which medication would the nurse expect to be ordered to provide better pain relief for this patient? a. Duragesic b. Oramorph SR c. Hydrocodone d. Intranasal butorphanol (Stadol) Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 32). Elsevier Health Sciences. Kindle Edition.

20. a. Duragesic is frequently used for chronic pain in patients who are not opiate-naive. Oramorph SR given buccally will have the same absorption as morphine, so it would not be expected to be more effective than oral morphine. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

25. The nurse is assessing a client diagnosed with chronic pain. Which characteristics would the nurse observe? 1. The client's blood pressure is elevated. 2. The client has rapid shallow respirations. 3. The client has facial grimacing. 4. The client is lying quietly in bed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

25. 1. Blood pressure elevates in acute pain. Chronic pain, by definition, lasts more than six (6) months, lasts far beyond the expected time for the pain to resolve, and may have an unclear onset. Changes in vital signs result from the fight-or-flight response by the body. The body cannot maintain this response and must adjust. 2. Rapid shallow respirations might be attributed to acute pain if it was painful to breathe. The client with a chest injury or pain will splint the area and slow the respirations or attempt to breathe shallowly and rapidly. 3. Facial grimacing will occur in acute pain and is an objective sign the nurse can identify. Clients with chronic pain may be laughing and still be in pain. Remember, pain is whatever the client says it is and occurs whenever the client says it does. 4. The client in chronic pain will have adapted to living with the pain, and lying quietly may be the best way for the client to limit the feeling of pain. TEST-TAKING HINT: The test taker must be able to differentiate between acute and chronic pain. Options "1," "2," and "3" are objective symptoms of acute pain. If the test taker were aware of this, then choosing the only option left would be a good choice. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 681). F.A. Davis Company. Kindle Edition. 4

26. The client had a mastectomy and lymph node dissection three (3) years ago and has experienced postmastectomy pain (PMP) since. Which intervention should the nurse implement? 1. Have the client see a psychologist because the pain is not real. 2. Tell the client the pain is the cancer coming back. 3. Refer the client to a physical therapist to prevent a frozen shoulder. 4. Discuss changing the client to a more potent narcotic medication. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

26. 1. Pain is whatever the client says it is and occurs whenever the client says it does. The nurse should never deny the client's pain exists. 2. This has been occurring for the past three (3) years and does not mean the cancer has come back. Many clients will fear the cancer has recurred and delay treatment; denial is a potent coping mechanism. 3. PMP is characterized as a constriction accompanied by a burning sensation or prickling in the chest wall, axilla, or posterior arm resulting from movement of the arm. Because of this, the client limits movement of the arm and the shoulder becomes frozen. 4. There are many problems associated with long-term narcotic use. Other strategies should be attempted prior to resigning the client to a lifetime of taking narcotic medications. TEST-TAKING HINT: The test taker could eliminate option "1" because it violates all principles of pain management. Option "2" is not in the realm of the nurse's responsibility. . Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 681). F.A. Davis Company. Kindle Edition. 3

27. The male client diagnosed with chronic pain since a construction accident which broke several vertebrae tells the nurse he has been referred to a pain clinic and asks, "What good will it do? I will never be free of this pain." Which statement is the nurse's best response? 1. "Are you afraid of the pain never going away?" 2. "The pain clinic will give you medication to cure the pain." 3. "Pain clinics work to help you achieve relief from pain." 4. "I am not sure. You should discuss this with your HCP." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

27. 1. This is a therapeutic response and the client is requesting information. 2. Pain clinics do not cure pain; they do help identify measures to relieve pain. 3. Pain clinics use a variety of methods to help the client to achieve relief from pain. Some measures include guided imagery, transcutaneous electrical nerve stimulation (TENS) units, nerve block surgery or injections, or medications. 4. This is not an appropriate answer, even if the nurse is not sure. The nurse should attempt to discover the information for the client and then give factual information. TEST-TAKING HINT: The test taker should answer a question with factual information. If the stem asks for a therapeutic response, then the test taker should choose one which addresses feelings. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 682). F.A. Davis Company. Kindle Edition. 3

28. The client diagnosed with cancer is experiencing severe pain. Which regimen would the nurse teach the client about to control the pain? 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) around the clock with narcotics used for severe pain. 2. Morphine sustained release, a narcotic, routinely with a liquid morphine preparation for breakthrough pain. 3. Extra-Strength Tylenol, a nonnarcotic analgesic, plus therapy to learn alternative methods of pain control. 4. Demerol, an opioid narcotic, every six (6) hours orally with a suppository when the pain is not controlled. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

28. 1. NSAIDs around the clock are dangerous because of the potential for gastrointestinal ulceration. NSAIDs are not the drug of choice for cancer pain. 2. Morphine is the drug of choice for cancer pain. There is no ceiling effect, it metabolizes without harmful by-products, and it is relatively inexpensive. A sustainedrelease formulation, such as MS Contin, is administered every six (6) to eight (8) hours, and a liquid fast-acting form is administered sublingually for any pain which is not controlled. 3. Tylenol is not strong enough for this client's pain. The maximum adult dose within a 24-hour period is four (4) g. Tylenol is toxic to the liver in higher amounts. 4. Meperidine (Demerol) metabolizes into normeperidine and is not cleared by the body rapidly. A buildup of normeperidine can cause the client to seize. TEST-TAKING HINT: The test taker must be aware of medications and their uses. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 682). F.A. Davis Company. Kindle Edition. 2

29. The client is being discharged from the hospital for intractable pain secondary to cancer and is prescribed morphine, a narcotic. Which statement indicates the client understands the discharge instructions? 1. "I will be sure to have my prescriptions filled before any holiday." 2. "There should not be a problem having the prescriptions filled anytime." 3. "If I run out of medications, I can call the HCP to phone in a prescription." 4. "There are no side effects to morphine I should be concerned about." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

29. 1. Narcotic medications require handwritten prescription forms (Drug Enforcement Agency rules) which must be filled within a limited time frame from the time the prescription is written. Many local pharmacies will not have the medication available or may not have it in the quantities needed. The client should anticipate the needs prior to any time when the HCP may not be available or the pharmacy may be closed. 2. There can be several reasons a legitimate prescription is not filled. 3. Morphine needs a handwritten prescription on a triplicate form. 4. All medications have side effects; most notably, narcotics slow peristalsis and cause constipation. TEST-TAKING HINT: The test taker could eliminate both options "1" and "2" because they are opposites. Option "4" is untrue of all medications. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 682). F.A. Davis Company. Kindle Edition. 1

3. List and briefly describe the five dimensions of pain. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 29). Elsevier Health Sciences. Kindle Edition.

3. a. Physiologic—the anatomic and physical determinants of pain b. Affective—the emotional response to pain c. Cognitive—the beliefs, attitudes, and meanings attributed to pain d. Behavioral—observable actions that express or control pain e. Sociocultural—age and gender, family and caregiver influence, and culture that influences the pain experience Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

30. The client diagnosed with intractable pain is receiving an IV constant infusion of morphine, a narcotic opioid. The concentration is 50 mg of morphine in 250 mL of normal saline. The IV is infusing at 10 mL/hr. The client has required bolus administration of two (2) mg IVP × two (2) during the 12-hour shift. How much morphine has the client received during the shift? _________ Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

30. 28 mg of morphine. First, determine how many milligrams of morphine are in each milliliter of saline: 50 ÷ 250 mL = 0.2 mg/mL Then determine how many milliliters are given in a shift: 10 mL/hr × 12 hour = 120 mL infused 1 shift = 120 mL infused If each milliliter contains 0.2 milligram of morphine, then 0.2 mg × 120 mL = 24 mg by constant infusion Then determine the amount given IVP: 2 × 2 = 4 mg given IVP Finally, add the bolus amount to the amount constantly infused: 24 + 4 = 28 mg TEST-TAKING HINT: The nurse is responsible for being knowledgeable of all medications and the amount the client is receiving. The test taker can use the drop-down calculator on the NCLEX-RN examination or ask the examiner for scratch paper. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 682). F.A. Davis Company. Kindle Edition.

35. The nurse is caring for clients on a medical floor. Which client should the nurse assess first after the shift report? 1. The client with arterial blood gases of pH 7.36, Paco2 40, HCO3 26, Pao2 90. 2. The client with vital signs of T 99˚F, P 101, R 28, and BP 120/80. 3. The client complaining of pain at a "10" on a 1-to-10 scale who can't localize it. 4. The client who is postappendectomy with pain at a "3" on a 1-to-10 scale. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

35. 1. These are normal arterial blood gases. 2. These temperature, pulse, and respiration rates are only slightly elevated, and the blood pressure is normal. 3. This is typical of clients with chronic pain. They cannot localize the pain and frequently describe the pain as always being there, as disturbing rest, and as demoralizing. This client should be seen, and appropriate pain-control measures should be taken. 4. This is considered mild pain, and this client can be seen after the client in chronic pain. TEST-TAKING HINT: Options "1" and "2" could be eliminated because the values are within normal limits or only slightly above normal. Option "4" could be eliminated because three (3) is low on the 1-to-10 pain scale. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 3

31. The male client who has made himself a do not resuscitate (DNR) order is in pain. The client's vital signs are P 88, R 8, and BP 108/70. Which intervention should be the nurse's priority action? 1. Refuse to give the medication because it could kill the client. 2. Administer the medication as ordered and assess for relief from pain. 3. Wait until the client' respirations improve and then administer the medication. 4. Notify the HCP the client is unstable and pain medication is being held. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

31. 1. The client is in pain and has the right to have pain-control measures taken. 2. The client is in pain. The American Nurses Association Code of Ethics states clients have the right to die as comfortably as possible even if the measures used to control the pain indirectly hasten the impending death. The Dying Client's Bill of Rights reiterates this position. The client should be allowed to die with dignity and with as much comfort as the nurse can provide. 3. The client may be splinting to prevent the pain from being too severe. The client's respirations actually may improve when the nurse administers the pain medication. 4. The HCP is aware the client is unstable because the HCP must write the DNR order on the chart. There is no reason to withhold needed medication. TEST-TAKING HINT: The position of administering medication which could hasten a client's death is a difficult one and requires the nurse to be aware of ethical position statements. Nurses never administer medications for the purpose of hastening death but sometimes must administer medications to provide what nurses do best, comfort. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 2

32. The charge nurse is making assignments on an oncology floor. Which client should be assigned to the most experienced nurse? 1. The client diagnosed with leukemia who has a hemoglobin of 6 g/dL. 2. The client diagnosed with lung cancer with a pulse oximeter reading of 89%. 3. The client diagnosed with colon cancer who needs the colostomy irrigated. 4. The client diagnosed with Kaposi's sarcoma who is yelling at the staff. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

32. 1. This hemoglobin is low but would be expected for a client diagnosed with leukemia. A less experienced nurse could care for this client. Leukemia affects production of all cells produced by the bone marrow—either there is too much production of immature cells overpowering the ability of the bone marrow to use the pluripotent cells to produce other needed blood cells or because the bone marrow is not producing enough cells as needed. It effectively produces a pancytopenia. 2. This represents an arterial blood gas of less than 60%; this client should be assigned to the most experienced nurse. 3. A client who needs a colostomy irrigated could be assigned to a less experienced nurse. 4. Psychological problems come second to physiological ones. TEST-TAKING HINT: This is a priority question. The test taker should realize option "1" is expected and may even be good for this client; option "3" is expected and not life threatening; and option "4," although not expected, is not life threatening. By doing this, the test taker could then look at what was determined for each option and realize option "2" needs the most experienced nurse. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 2

33. The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients in a pain clinic. Which intervention would be inappropriate to delegate to the UAP? 1. Assist the client diagnosed with intractable pain to the bathroom. 2. Elevate the head of the bed for a client diagnosed with back pain. 3. Perform passive range of motion for a client who is bedfast. 4. Monitor the potassium levels on a client about to receive medication. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

33. 1. The UAP could perform this function. 2. The UAP could perform this function. 3. The UAP could perform this function. 4. The nurse should monitor any laboratory work needed to administer a medication safely. TEST-TAKING HINT: The rules for delegation state assessment, teaching, evaluating, or anything requiring nursing judgment cannot be delegated. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 4

34. The client diagnosed with chronic back pain is being placed on a transcutaneous electrical nerve stimulation (TENS) unit. Which information should the nurse teach? 1. The TENS unit will deaden the nerve endings, and the client will not feel pain. 2. The TENS unit could cause paralysis if the client gets the unit wet. 3. The TENS unit stimulates the nerves in the area, blocking the pain sensation. 4. The TENS unit should be left on for an hour, and then taken off for an hour. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

34. 1. The TENS unit does not deaden nerve endings; this would be accomplished through local anesthesia. 2. The unit could stop functioning if it got wet, but this would not cause paralysis. 3. The TENS unit works on the gate control theory of pain control and works by flooding the area with stimulation and blocking the pain impulses from reaching the brain. 4. The TENS unit should be applied and left in place unless the client is showering. TEST-TAKING HINT: A medical device which causes paralysis so easily would not be approved for use by the general population, so option "2" could be eliminated. The test taker would need to be aware of the gate control theory of pain control to eliminate the other options. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 3

36. The female client in the oncology clinic tells the nurse she has a great deal of pain but does not like to take pain medication. Which action should the nurse implement first? 1. Tell the client it is important for her to take her medication. 2. Find out how the client has been dealing with the pain. 3. Have the HCP tell the client to take the pain medications. 4. Instruct the client not to worry—the pain will resolve itself. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

36. 1. This could be appropriate once the nurse assesses the situation further. 2. The nurse should assess the situation fully. The client may be afraid of becoming addicted or may have been using alternative forms of treatment, such as music therapy, distraction techniques, acupuncture, or guided imagery. 3. This is not appropriate. It is in the nurse's realm of responsibility to investigate the client's reasons for not wanting to take pain medication. 4. Chronic cancer pain does not resolve on its own. TEST-TAKING HINT: Option "1" is advising without assessing. Assessment is the first step of the nursing process and should be implemented first in most situations unless a direct intervention treats the client in an emergency. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 684). F.A. Davis Company. Kindle Edition. 2

37. The client is complaining of left shoulder pain. Which intervention should the nurse implement first? 1. Assess the neurovascular status of the left hand. 2. Check the medication administration record (MAR). 3. Ask if the client wants pain medication. 4. Administer the client's pain medication. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 619). F.A. Davis Company. Kindle Edition.

37. 1. The nurse should first assess the client for potential complications to determine if this is expected pain or pain requiring notifying the health-care provider. 2. The nurse must check the MAR to determine when the last pain medication was administered, but it is not the first intervention. 3. The nurse must rule out complications which require medical intervention prior to medicating the client. 4. The nurse should not administer any pain medication prior to ruling out complications and checking the MAR. TEST-TAKING HINT: The test taker should apply the nursing process when answering the question and select an option that addresses assessment. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 630). F.A. Davis Company. Kindle Edition. 1

38. The nurse is caring for a client in acute pain as a result of surgery. Which intervention should the nurse implement? 1. Administer pain medication as soon as the time frame allows. 2. Use nonpharmacological methods to replace medications. 3. Use cryotherapy after heat therapy because it works faster. 4. Instruct family members to administer medication with the PCA. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 619). F.A. Davis Company. Kindle Edition.

38. 1. Pain medications should be administered at the frequency ordered by the HCP, not just when the client requests them, especially for acute pain. 2. Nonpharmacological methods should never replace medications, but they should be used in combination to help keep the client comfortable. 3. Cryotherapy (cold) is used immediately postoperative or postinjury. Heat applications are applied at a later time. 4. Only clients should activate the PCA to prevent overdosing. TEST-TAKING HINT: Option "4" should be eliminated because a basic concept is the client should be the person in control of the pain, not a family member; pain is subjective. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 631). F.A. Davis Company. Kindle Edition. 1.

39. Which situation is an example of the nurse fulfilling the role of client advocate? 1. The nurse brings the client pain medication when it is due. 2. The nurse collaborates with other disciplines during the care conference. 3. The nurse contacts the health-care provider when pain relief is not obtained. 4. The nurse teaches the client to ask for medication before the pain gets to a "5." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 619). F.A. Davis Company. Kindle Edition.

39. 1. This exemplifies the role of provider of care, and it does not address client advocacy. 2. This action is addressing the role of collaborator. 3. When the nurse contacts the HCP about unrelieved pain, the nurse is speaking when the client cannot, which is the definition of a client advocate. 4. This action is providing care to the client and does not address client advocacy. TEST-TAKING HINT: One (1) of the most important roles of the nurse is to be a client advocate. The nurse must always identify problems and follow through to their resolution. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 631). F.A. Davis Company. Kindle Edition. 3

4. Once generated, what may block the transmission of an action potential along a peripheral nerve fiber to the dorsal root of the spinal cord? a. The transmission may be interrupted by drugs such as local anesthetics. b. Nothing can stop the action potential along an intact nerve until it reaches the spinal cord. c. The action potential must cross several synapses, points at which the impulse may be blocked by drugs. d. The nerve fiber produces neurotransmitters that may activate nearby nerve fibers to transmit pain impulses. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 29). Elsevier Health Sciences. Kindle Edition.

4. a. Although a peripheral nerve is one cell that carries an impulse directly from the periphery to the dorsal horn of the spinal cord with no synapses, transmission of the impulse can be interrupted by drugs known as membrane stabilizers or sodium-channel inhibitors, such as local anesthetics and some antiseizure drugs. The nerve fiber produces neurotransmitters only at synapses, not during transmission of the action potential. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

40. Which statement should the nurse identify as the expected outcome for a client experiencing acute pain? 1. The client will have decreased use of medication. 2. The client will participate in self-care activities. 3. The client will use relaxation techniques. 4. The client will repeat instructions about medications. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 619). F.A. Davis Company. Kindle Edition.

40. 1. A decrease in use of pain medication does not mean the client's pain is managed; the client may be concerned about possible addiction to the pain medication. 2. Clients experiencing acute pain will not be involved in self-care because of their reluctance to move, which increases the pain; therefore, participation indicates the client's pain is tolerable. 3. Using relaxation techniques does not indicate the client's pain is under control. 4. This would be an expected outcome of a knowledge-deficit problem. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 631). F.A. Davis Company. Kindle Edition. 2

41. Which nursing intervention is the highest priority when administering pain medication to a client experiencing acute pain? 1. Monitor the client's vital signs. 2. Verify the time of the last dose. 3. Check for the client's allergies. 4. Discuss the pain with the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 620). F.A. Davis Company. Kindle Edition.

41. 1. It is important to monitor vital signs, but it is not the priority intervention prior to administering the medication. 2. The nurse should verify the time the last dose was administered to determine the time the next dose could be administered, but this is not the priority intervention. 3. Prior to giving any medication, the nurse should assess any allergies, but it is not the priority intervention. 4. The nurse should question the client to rule out complications and to determine which medication and amount would be most appropriate for the client. This is assessment. TEST-TAKING HINT: When questions require a priority answer, the test taker should look for an option which addresses assessment, but the test taker should remember there are many words which reflect assessment, such as "discuss," "determine," "monitor," or "obtain," to name a few. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 631). F.A. Davis Company. Kindle Edition. 4

42. Which intervention is appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP) when caring for the female client experiencing acute pain? 1. Take the pain medication to the room. 2. Apply an ice pack to the site of pain. 3. Check on the client 30 minutes after she takes the pain medication. 4. Observe the client's ability to use the PCA. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 620). F.A. Davis Company. Kindle Edition.

42. 1. Medication administration cannot be delegated to a UAP. 2. This task does not require teaching, evaluating, or nursing judgment and therefore can be delegated. 3. Assessment cannot be delegated to a UAP. 4. Evaluation of teaching cannot be delegated to a UAP. TEST-TAKING HINT: The terms "observe" and "check" in options "3" and "4" are different from the term "evaluate," but reading the options, the tasks are clearly addressing the evaluation step of the nursing process. Evaluation cannot be delegated to the UAP. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 631). F.A. Davis Company. Kindle Edition. 2

43. The nurse is administering an opioid narcotic to the client. Which interventions should the nurse implement for client safety? Select all that apply. 1. Compare the hospital number on the MAR to the client's bracelet. 2. Have a witness verify the wasted portion of the narcotic. 3. Assess the client's vital signs prior to administration. 4. Determine if the client has any allergies to medications. 5. Clarify all pain medication orders with the health-care provider. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 620). F.A. Davis Company. Kindle Edition.

43. 1. This procedure ensures client safety by preventing medication from being given to the wrong client. 2. This is a legal requirement, not a safety issue. 3. This intervention would prevent giving a narcotic to a client who is unstable or compromised. 4. Determining allergies addresses client safety. 5. It would not be realistic to recheck all orders. TEST-TAKING HINT: This question specifically asks the test taker to identify interventions for safely administering medication to the client. Therefore, options "2" and "5" could be eliminated because they do not address the client's safety. This is an alternate-type question requiring the test taker to select more than one (1) option as the correct answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 631). F.A. Davis Company. Kindle Edition. 1,3,4

44. Which technique would be most appropriate for the nurse to implement when assessing a four (4)-year-old client in acute pain? 1. Use words a four (4)-year-old child can remember. 2. Explain the 0-to-10 pain scale to the child's parent. 3. Have the child point to the face which describes the pain. 4. Administer the medication every four (4) hours. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 620). F.A. Davis Company. Kindle Edition.

44. 1. The nurse should use words a four (4)-yearold child understands and remembers, but this is not the best way to assess pain. 2. A four (4)-year-old child cannot be expected to use the numeric pain scale because of lack of cognitive abilities, and explaining it to the parents does not address the child's pain. 3. The Faces Scale is the best way to assess pain in a four (4)-year-old child. 4. This does not assess the child's pain, and administering the pain medication every four (4) hours may compromise the child's safety. TEST-TAKING HINT: When age is listed, it is an indication the question is asking for agespecific information. The test taker should consider developmental levels for that particular age. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 632). F.A. Davis Company. Kindle Edition. 3

T or F ? Predictable physiologic changes occur in the presence of acute pain. These may include muscle tension; tachycardia; rapid, shallow respirations; increased blood pressure; dilated pupils; sweating; and pallor. Equal pupillary response, respiratory changes, and normal skin assessment are not predictable physiological changes with acute pain

True

45. Which nursing intervention is priority for the client experiencing acute pain? 1. Assess the client's verbal and nonverbal behavior. 2. Wait for the client to request pain medication. 3. Administer the pain medication on a scheduled basis. 4. Teach the client to use only imagery every hour for the pain. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 620). F.A. Davis Company. Kindle Edition.

45. 1. Assessing verbal and nonverbal cues is the priority intervention because pain is subjective. 2. Some clients are hesitant to ask for medication or believe it is a sign of weakness to ask. 3. There are times when pain medications are given on a routine basis, but it is not the best answer because assessment takes priority. 4. Alternative therapies, such as imagery, are used in combination with medications, but they never replace medications. TEST-TAKING HINT: Options such as option "4" which have absolute words such as "only" usually can be eliminated as a correct answer. The test taker should remember to apply the nursing process, and the first step is assessment. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 632). F.A. Davis Company. Kindle Edition. 1

46. The nurse is conducting an interview with a 75-year-old client admitted with acute pain. Which question would have priority when assisting with pain management? 1. "Have you ever had difficulty getting your pain controlled?" 2. "What types of surgery have you had in the last 10 years?" 3. "Have you ever been addicted to narcotics?" 4. "Do you have a list of your prescription medications?" Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 620). F.A. Davis Company. Kindle Edition.

46. 1. The answer to this request would indicate if the client has had a negative experience which may influence the client's pain management. 2. Previous surgeries would be pertinent information but not for pain management.3. Before asking this question, the nurse should have specific information to suspect drug use. 4. Discussing the client's prescription medications is necessary, but asking for a list of medications will not address the client's pain management. TEST-TAKING HINT: Assessment, the first step of the nursing process, of pain perception is indicated when caring for a client with acute pain. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 632). F.A. Davis Company. Kindle Edition. 1

47. The nurse clears the PCA pump and discovers the client has used only a small amount of medication during the shift. Which intervention should the nurse implement? 1. Determine why the client is not using the PCA pump. 2. Document the amount and take no action. 3. Chart the client is not having pain. 4. Contact the HCP and request oral medication. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 620). F.A. Davis Company. Kindle Edition.

47. 1. Assessing why the client is not using the medication is a priority and then, based on the client's response, a plan of care can be determined. 2. The fact a client is not using pain medication warrants the nurse determining the cause so appropriate action can be taken. 3. This may or may not be why the client is not using the PCA pump. The nurse must first determine why the client is not using pain medication. 4. This may or may not be indicated, but until the nurse determines why the client is not taking the medication, this action should not be implemented. TEST-TAKING HINT: Assessment is priority when caring for a client. It is the first step of the nursing process, and if the test taker is unsure of the correct answer, it is the best choice to select. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 632). F.A. Davis Company. Kindle Edition. 1

48. Which problem would be most appropriate for the nurse to identify for the client experiencing acute pain? 1. Ineffective coping. 2. Potential for injury. 3. Alteration in comfort. 4. Altered sensory input. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 620). F.A. Davis Company. Kindle Edition.

48. 1. This is a psychosocial problem, which is not appropriate for an acute physiological problem. 2. A potential problem is not priority for a client in acute pain. 3. Alteration in comfort is addressing the client's acute pain. 4. Altered sensory input does not address the client's acute physical pain. TEST-TAKING HINT: The test taker should be familiar with NANDA's list of client problems and nursing diagnoses, which includes alteration in comfort for pain. Potential problems do not have priority over actual problems. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 632). F.A. Davis Company. Kindle Edition. 3

5. A patient comes to the clinic with a complaint of a dull pain in the anterior and posterior neck. On examination, the nurse notes that the patient has full range of motion (ROM) of the neck and no throat redness or enlarged head or neck lymph nodes. What will be the nurse's next appropriate assessment indicated by these findings? a. Palpation of the liver b. Auscultation of bowel sounds c. Inspection of the patient's ears d. Palpation for the presence of left flank pain Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 29). Elsevier Health Sciences. Kindle Edition.

5. a. The right neck and flank are common areas of referred pain from liver damage and examination of the liver should be considered when pain occurs without other findings in these areas. Other common referred areas are midscapular and left arm for cardiac pain, inner legs for bladder pain, and shoulders for gallbladder pain. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

54. The nurse is receiving a client from the postanesthesia care unit (PACU). Which interventions should the nurse implement? Select all that apply. 1. Ambulate the client to the bathroom to void. 2. Take the client's vital signs to compare with PACU data. 3. Monitor all lines into and out of the client's body. 4. Assess the client's surgical site. 5. Push the client's PCA button to treat for pain during movement. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 622). F.A. Davis Company. Kindle Edition.

54. 1. The client should not be ambulated until the nurse has a chance to assess for the client's ability to ambulate safely. 2. The nurse should assess the vital signs from PACU with the current vital signs to be sure that the client is stable. 3. The nurse should assess the intravenous lines, indwelling catheters, and tubes upon receiving the client. 4. The nurse must assess the surgical site for bleeding to know if the client is actually stable or not. 5. Only the client should push the PCA pump's button; otherwise the client may receive an overdose of medication. TEST-TAKING HINT: The client is "returning" from PACU. This client may still be groggy from anesthesia and should not be ambulating until the nurse has assessed the client and is aware the client is awake enough to ambulate safely. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 634). F.A. Davis Company. Kindle Edition. 2,3,4

55. The three (3)-day postoperative client is complaining of unrelieved pain at the incision site one (1) hour after the administration of narcotic pain medication. Which action should the nurse implement first? 1. Check the MAR for another medication to administer. 2. Teach the client to use guided imagery to relieve the pain. 3. Assess the client for complications. 4. Elevate the head of the client's bed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 622). F.A. Davis Company. Kindle Edition.

55. 1. This may be an appropriate intervention, but unrelieved pain three (3) days after the surgery may indicate a problem. The nurse should assess the client first. 2. A client in pain is not ready to learn. If narcotic medication is not successful, something else may be occurring. 3. The first step of the nursing process is to assess. Pain unrelieved three (3) days postoperative needs to be investigated. 4. Repositioning the client may or may not help, but the nurse should assess the client. TEST-TAKING HINT: The first step of the nursing process is ASSESS. The test taker must have some systematic method of problem solving. The test taker must also remember "if in stress—do not assess." In other words, the test taker has been given enough information to implement an intervention immediately. Content - Surgical: Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 634). F.A. Davis Company. Kindle Edition. 3

6. While caring for an unconscious patient, the nurse discovers a stage 2 pressure ulcer on the patient's heel. During care of the ulcer, what is the nurse's understanding of the patient's perception of pain? a. The patient will have a behavioral response if pain is perceived. b. The area should be treated as a painful lesion, using gentle cleansing and dressing. c. The area can be thoroughly scrubbed because the patient is not able to perceive pain. d. All nociceptive stimuli that are transmitted to the brain result in the perception of pain. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 29). Elsevier Health Sciences. Kindle Edition.

6. b. It is known that the brain is necessary for pain perception but because it is not clearly understood where in the brain pain is perceived, pain may be perceived even in a comatose patient who may not respond behaviorally to noxious stimuli. Any noxious stimulus should be treated as potentially painful. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

7. List in order the nociceptive processes that occur to communicate tissue damage to the CNS. No. 1 is the first process and No. 4 is the last process. a. Perception b. Modulation c. Transmission d. Transduction Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

7. a. 3; b. 4; c. 2; d. 1 Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

9. Amitriptyline (Elavil) is prescribed for a patient with chronic pain from fibromyalgia. When the nurse explains that this drug is an antidepressant, the patient states that she is in pain, not depressed. What is the nurse's best response to the patient? a. Antidepressants will improve the patient's attitude and prevent a negative emotional response to the pain. b. Chronic pain almost always leads to depression, and the use of this drug will prevent depression from occurring. c. Some antidepressant drugs relieve pain by releasing neurotransmitters that prevent pain impulses from reaching the brain. d. Certain antidepressant drugs are metabolized in the liver to substances that numb the ends of nerve fibers, preventing the onset of pain. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

9. c. Several antidepressants affect the modulatory systems by inhibiting the reuptake of serotonin and norepinephrine in descending modulatory fibers, thereby increasing their availability to inhibit afferent transmission of pain impulses. Although chronic pain is often accompanied by anxiety and depression, the antidepressants that affect the physiologic process of pain modulation are used for pain control whether depression is present or not. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

A patient asks the nurse why he felt pain prior to a myocardial infarction primarily in his left arm. How should the nurse respond? 1. "Pain in the arm related to cardiac tissue damage is a type of referred pain." 2. "Cardiac pain is generally unexplainable." 3. "Were you doing some physical activity with your arm just prior to the event?" 4. "What you are describing relates to psychogenic pain."

Correct Answer: 1 Rationale 1: Referred pain is pain perceived in an area distant from the stimulus. Visceral sensory fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue areas of the body. Rationale 2: Cardiac pain is explainable. Rationale 3: Physical activity did not trigger the pain. Rationale 4: Psychogenic pain occurs in the absence of a diagnosed physiological cause or event. Global Rationale: Referred pain is pain perceived in an area distant from the stimulus. Visceral sensory fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue areas of the body. Cardiac pain is explainable. Physical activity did not trigger the pain. Psychogenic pain occurs in the absence of a diagnosed physiological cause or event.

A patient with chronic orthopedic pain is considering the use of a transcutaneous electrical nerve stimulator to reduce the pain. What advantages of using this device should the nurse review with the patient? 1. avoiding the adverse effects of pain medication 2. low cost 3. can be used by all patients 4. can relieve all types of pain

Correct Answer: 1 Rationale 1: A transcutaneous electrical nerve stimulator has the advantages of avoidance of adverse drug effects, patient control, and good interaction with other therapies. Rationale 2: Disadvantages of this device are the cost and the need for expert training. Rationale 3: This device is not effective at relieving pain for all patients. Patients with pacemakers should not use this device. Rationale 4: This device is not effective at relieving all types of pain. Global Rationale: A transcutaneous electrical nerve stimulator has the advantages of avoidance of adverse drug effects, patient control, and good interaction with other therapies. Disadvantages of this device are the cost and the need for expert training. This device is not effective at relieving all types of pain or for all patients. Patients with pacemakers should not use this device.

The nurse is managing care for a group of patients with pain. For which health problem should the nurse expect the patient to experience acute pain? 1. cholecystectomy 2. phantom limb pain 3. complex regional pain syndrome 4. degenerative joint disease

Correct Answer: 1 Rationale 1: Acute pain has a sudden onset, is usually self-limited, and is localized. The cause of acute pain generally can be identified. It generally results from tissue injury from trauma, surgery, or inflammation. Surgical pain such as after gallbladder removal is considered acute pain. Rationale 2: The neuropathic pain associated with amputation, phantom limb pain, may not begin immediately and may become a chronic problem. Rationale 3: Complex regional pain syndrome is a chronic exaggerated response to a painful stimulus. Rationale 4: Degenerative joint disease is chronic; the accompanying joint pain is also chronic. Global Rationale: Acute pain has a sudden onset, is usually self-limited, and is localized. The cause of acute pain generally can be identified. It generally results from tissue injury from trauma, surgery, or inflammation. Surgical pain such as after gallbladder removal is considered acute pain. The neuropathic pain associated with amputation, phantom limb pain, may not begin immediately and may become a chronic problem. Complex regional pain syndrome is a chronic exaggerated response to a painful stimulus. Degenerative joint disease is chronic; the accompanying joint pain is also chronic.

The nurse is caring for a patient recovering from surgery. Which intervention will provide the most pain relief for the patient? 1. Offer pain relief before the patient complains of pain. 2. Wait until the patient can describe the pain specifically. 3. Assess the pain level every 4 hours around the clock. 4. Allow the patient to "sleep off" the anesthesia, then offer pain medication.

Correct Answer: 1 Rationale 1: Anticipating a patient's pain will ensure a more manageable pain experience than will waiting until the patient complains of pain. Rationale 2: Pain management needs to be implemented before the patient describes specific postoperative pain. Rationale 3: The patient should not be awakened to assess pain unless there are other significant nonverbal signs during sleep that indicate the patient is in pain. These can include grimacing, moaning, thrashing, or guarding of a surgical site. Rationale 4: Pain management needs to be implemented before the patient "sleeps off" anesthesia. Global Rationale: Anticipating a patient's pain will ensure a more manageable pain experience than will waiting until the patient complains of pain. Pain management needs to be implemented before the patient describes specific postoperative pain or "sleeps off" anesthesia. The patient should not be awakened to assess pain unless there are other significant nonverbal signs during sleep that indicate the patient is in pain. These can include grimacing, moaning, thrashing, or guarding of a surgical site.

A patient who is receiving around-the-clock pain medication complains of an acute exacerbation of pain. What should the nurse do to help this patient? 1. Provide the medication ordered for breakthrough pain. 2. Talk the patient through the pain. 3. Encourage the patient to ignore the pain. 4. Give the patient a nonsteroidal anti-inflammatory drug (NSAID).

Correct Answer: 1 Rationale 1: Breakthrough pain (BTP) occurs in patients who are receiving long-acting analgesics for chronic pain. It is a transitory experience of moderate to severe pain that is often precipitated by coughing or movement but may occur spontaneously. Short-acting opioids for this type of pain should be administered as needed in addition to the ATC dose for chronic, persistent pain. Rationale 2: The pain must be addressed; it is not appropriate to talk the patient through the pain. Rationale 3: The pain must be addressed; it is not appropriate to encourage the patient to ignore the pain. Rationale 4: NSAIDs can only be given with the physician's order. Global Rationale: Breakthrough pain (BTP) occurs in patients who are receiving long-acting analgesics for chronic pain. It is a transitory experience of moderate to severe pain that is often precipitated by coughing or movement but may occur spontaneously. Short-acting opioids for this type of pain should be administered as needed in addition to the ATC dose for chronic, persistent pain. The pain must be addressed; it is not appropriate to talk the patient through the pain or encourage the patient to ignore the pain. NSAIDs can only be given with the physician's order.

A patient with a history of lumbar spinal cord nerve compression continues to complain of burning pain. Which type of pain should the nurse realize this patient is experiencing? 1. complex regional pain syndrome 2. myofascial pain syndrome 3. chronic postoperative pain 4. phantom limb pain

Correct Answer: 1 Rationale 1: Complex regional pain syndrome is a neuropathic pain that results from nerve damage. It is characterized by continuous severe, burning pain. These conditions follow peripheral nerve damage and present the symptoms of pain, vasospasm, muscle wasting, and vasomotor changes. Rationale 2: Myofascial pain syndrome is a condition marked by injury to or disease of muscle and fascial tissue. Rationale 3: This pain was not described as chronic. Rationale 4: No amputation has been performed that might explain phantom limb pain. Global Rationale: Complex regional pain syndrome is a neuropathic pain that results from nerve damage. It is characterized by continuous severe, burning pain. These conditions follow peripheral nerve damage and present the symptoms of pain, vasospasm, muscle wasting, and vasomotor changes. This pain was not described as chronic. No amputation has been performed that might explain phantom limb pain. Myofascial pain syndrome is a condition marked by injury to or disease of muscle and fascial tissue.

A patient diagnosed with depression tells the nurse that his pain has been "unrelenting" over the last several weeks. What should the nurse consider as contributing to this patient's amount of pain? 1. Depression can cause an increase in pain sensations. 2. The pain medication has not been working. 3. Medication to treat the depression is interfering with the control of pain. 4. The patient is exaggerating the amount of pain.

Correct Answer: 1 Rationale 1: Depression is clearly linked to pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, leading to an increase in pain sensations. Rationale 2: The nurse has no way of knowing if the patient's pain medication is not controlling the pain. Rationale 3: There is also no way of knowing if the medication used to treat the patient's depression is interfering with the control of pain. Rationale 4: The nurse cannot make the assumption that the patient is exaggerating the amount of pain. Global Rationale: Depression is clearly linked to pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, leading to an increase in pain sensations. The nurse has no way of knowing if the patient's pain medication is not controlling the pain. There is also no way of knowing if the medication used to treat the patient's depression is interfering with the control of pain. The nurse cannot make the assumption that the patient is exaggerating the amount of pain.

A patient is watching a comedy on the television and has not requested pain medication for over 6 hours. The nurse realizes that the patient is utilizing what as a form of pain control? 1. distraction 2. meditation 3. guided imagery 4. biofeedback

Correct Answer: 1 Rationale 1: Distraction involves redirecting attention away from the pain and onto something the patient finds more pleasant. Participating in an activity that promotes laughter has been found to be highly effective in pain relief. Laughing for 20 minutes or more is known to produce an increase in endorphins that may continue to relieve pain even after the patient stops laughing. Rationale 2: Meditation is a process of emptying the mind of all sensory data and, typically, concentrating on a single object, word, or idea. This activity produces a deeply relaxed state in which oxygen consumption decreases, muscles relax, and endorphins are produced. Rationale 3: Guided imagery is use of the mind to create a scene or sensory experience that relaxes the muscles and moves the attention away from the pain experience. Rationale 4: In biofeedback, electrodes placed on the skin transform data into visual cues so the patient learns to recognize stress-related responses and replace them with relaxation responses. Global Rationale: Distraction involves redirecting attention away from the pain and onto something the patient finds more pleasant. Participating in an activity that promotes laughter has been found to be highly effective in pain relief. Laughing for 20 minutes or more is known to produce an increase in endorphins that may continue to relieve pain even after the patient stops laughing. Meditation is a process of emptying the mind of all sensory data and, typically, concentrating on a single object, word, or idea. This activity produces a deeply relaxed state in which oxygen consumption decreases, muscles relax, and endorphins are produced. Guided imagery is use of the mind to create a scene or sensory experience that relaxes the muscles and moves the attention away from the pain experience. In biofeedback, electrodes placed on the skin transform data into visual cues so the patient learns to recognize stress-related responses and replace them with relaxation responses.

The nurse is assessing a patient's response to pain. Why should the nurse do this for every patient situation? 1. Everyone has a unique tolerance to pain. 2. Everyone has the same pain threshold. 3. Everyone perceives painful stimuli at the same intensity. 4. Most people have the same the pain response to surgery.

Correct Answer: 1 Rationale 1: Each person's pain tolerance is different and will need to be assessed on an individual basis. Rationale 2: Everyone does not have the same pain threshold. Rationale 3: Everyone perceives pain at a different intensity. Rationale 4: Different people have a different pain response to surgery. Global Rationale: Each person's pain tolerance is different and will need to be assessed on an individual basis. Everyone does not have the same pain threshold or perceive pain at the same intensity. Different people have a different pain response to surgery.

The patient complaining of pain has been waiting for medication to relieve the pain. What should the nurse understand about this patient? 1. The patient's pain is real. 2. The patient just wants medication. 3. The patient wants attention. 4. The patient is demanding

Correct Answer: 1 Rationale 1: If the patient says he or she has pain, the patient is in pain. All pain is real. Rationale 2: Nurses should not be judgmental when responding to a patient's report of pain. This is a common bias and is a barrier to effective pain management. Rationale 3: This is the nurse's interpretation. Rationale 4: This is the nurse's interpretation. Global Rationale: If the patient says he or she has pain, the patient is in pain. All pain is real. Nurses should not be judgmental when responding to a patient's report of pain. This is a common bias and is a barrier to effective pain management. Concluding that the patient is demanding or just wants attention reflects a biased interpretation.

After assessing a patient for pain, the nurse concludes that the pain is caused by a mechanical stimulus. What should the nurse consider as a possible cause of this patient's pain? 1. muscle tear 2. burn 3. frostbite 4. myocardial infarction

Correct Answer: 1 Rationale 1: Mechanical causes of pain include spasm, compression, or extreme muscle stretch or contraction. A muscle tear creates pain from a mechanical source. Rationale 2: A burn involves pain from a thermal source. Rationale 3: Frostbite involves pain from a thermal source. Rationale 4: Myocardial infarction involves pain from a chemical source. Global Rationale: There are three types of painful stimuli: mechanical, chemical, and thermal. Mechanical causes of pain include spasm, compression, or extreme muscle stretch or contraction. A muscle tear creates pain from a mechanical source. Myocardial infarction involves pain from a chemical source. Burn and frostbite involve pain from a thermal source.

A patient with severe nerve pain from spinal cord compression is considering surgery to sever the nerves and relieve the pain. What should the nurse encourage the patient to consider prior to having this surgery? 1. There may be loss of motor function associated with the nerves that will be severed. 2. The surgery will need to be repeated when the nerves regenerate. 3. Pain medication will still be needed after the surgery. 4. The patient will be a paraplegic after the surgery

Correct Answer: 1 Rationale 1: Motor function loss is an unwelcome side effect of some surgeries, so the patient needs to consider the amount and degree of potential motor loss. Rationale 2: The nerves will not regenerate, so surgery will not need to be repeated. Rationale 3: Pain medication may or may not be needed after the surgery. Rationale 4: Not all surgeries to sever nerves to control pain result in paraplegia. Global Rationale: Motor function loss is an unwelcome side effect of some surgeries, so the patient needs to consider the amount and degree of potential motor loss. The nerves will not regenerate, so surgery will not need to be repeated. Pain medication may or may not be needed after the surgery. Not all surgeries to sever nerves to control pain result in paraplegia.

A patient tells the nurse that she is unable to sleep through the night because of leg pain. What will the nurse most likely assess in this patient? 1. an increase in pain 2. a decrease in pain 3. a decrease in anxiety 4. an increase in concentration

Correct Answer: 1 Rationale 1: Pain interferes with a person's ability to fall asleep and stay asleep and can induce fatigue. Fatigue can lower pain tolerance. The nurse will most likely assess an increase in pain in the patient who is unable to sleep. Rationale 2: There will not be a decrease in pain. Rationale 3: Anxiety may increase the perception of pain, and pain may cause more anxiety. Rationale 4: The patient in pain often has difficulty concentrating. Global Rationale: Pain interferes with a person's ability to fall asleep and stay asleep and can induce fatigue. Fatigue can lower pain tolerance. The nurse will most likely assess an increase in pain in the patient who is unable to sleep. There will not be a decrease in pain. Anxiety may increase the perception of pain and pain may cause more anxiety. The patient in pain often has difficulty concentrating.

A patient scheduled for knee surgery tells the nurse, "I know I won't feel as much pain with this knee surgery as I did with the other one when I was 20 years younger." What should the nurse respond to this patient? 1. "There might be more pain, because the pain response can get worse with aging." 2. "You are most likely correct." 3. "It should not be quite as bad with the newer technology." 4. "Pain responses diminish with age."

Correct Answer: 1 Rationale 1: Pain tolerance decreases with aging, perhaps related to the prevalence of chronic pain in this population. Rationale 2: The nurse should not agree that the patient will have less pain because this may not occur. Rationale 3: The amount of pain may or may not be impacted by the use of newer technology. Rationale 4: The pain response does not diminish with age. Global Rationale: Pain tolerance decreases with aging, perhaps related to the prevalence of chronic pain in this population. The nurse should not agree that the patient will have less pain because this may not occur. The amount of pain may or may not be impacted by the use of newer technology. The pain response does not diminish with age.

The nurse is planning to administer a pain medication to a patient who is 2 hours postoperative following bowel resection surgery. The patient has four standing orders for pain medication. Which medication should the nurse consider providing to the patient at this time? 1. The one that is to be administered intravenously by the patient and is under patient control 2. The one that will be given intramuscularly to work quickly 3. The one that is ordered on a prn basis 4. The one to be administered orally

Correct Answer: 1 Rationale 1: Patient-controlled analgesia allows self-management of pain and is a common method of administering postoperative pain medication. The advantages to this method are dose precision, timeliness, and convenience. Rationale 2: The medication that is administered intramuscularly is not typically recommended for moderate-to-severe pain that will require more than one dose. Rationale 3: A prn medication administered 2 hours after a major surgery would not be the most effective. Rationale 4: An oral medication administered 2 hours after a major surgery would not be the most effective. Global Rationale: Patient-controlled analgesia allows self-management of pain and is a common method of administering postoperative pain medication. The advantages to this method are dose precision, timeliness, and convenience. An oral medication or a prn medication administered 2 hours after a major surgery would not be the most effective. The medication that is administered intramuscularly is not typically recommended for moderate-to-severe pain that will require more than one dose.

A patient is receiving a narcotic for severe acute pain. What should the nurse encourage the patient to consume in greater quantities due to the pain medication? 1. fiber 2. vitamin D 3. protein 4. carbohydrates

Correct Answer: 1 Rationale 1: Patients receiving narcotics are at risk for constipation. Increasing fiber in the diet will help to reduce this effect. Rationale 2: Increasing vitamin D is not specifically related to the effects of a narcotic medication. Rationale 3: Increasing protein is not specifically related to the effects of a narcotic medication. Rationale 4: Increasing carbohydrates is not specifically related to the effects of a narcotic medication. Global Rationale: Patients receiving narcotics are at risk for constipation. Increasing fiber in the diet will help to reduce this effect. Increasing vitamin D, protein, or carbohydrates is not specifically related to the effects of a narcotic medication.

A patient is refusing to take pain medication for chronic back pain. The nurse asks the patient to rate the pain on a scale from 0 to 10. What is the nurse attempting to do with this patient? 1. Assess the patient's level of pain 2. Determine if the patient should remain in the hospital 3. Decide if the patient is being argumentative 4. Figure out if the patient should leave the hospital against medical advice

Correct Answer: 1 Rationale 1: The most reliable indicator of the presence and degree of pain is the patient's own statements about the pain. Pain rating scales ensure consistent communication about the pain level. Rationale 2: The nurse is not attempting to question the patient's admission or stay in the hospital. Rationale 3: The nurse is not attempting to decide if the patient is being argumentative. Rationale 4: The nurse is not attempting to decide whether the patient should leave the hospital against medical advice. Global Rationale: The most reliable indicator of the presence and degree of pain is the patient's own statements about the pain. Pain rating scales ensure consistent communication about the pain level. The nurse is not attempting to question the patient's admission or stay in the hospital, to decide if the patient is being argumentative, or decide whether the patient should leave the hospital against medical advice.

The nurse is using the neuromatrix theory when determining a patient's pain. What should the nurse consider when assessing a patient's pain? 1. cultural and genetic factors 2. specificity 3. pattern 4. previous sensitization

Correct Answer: 1 Rationale 1: The neuromatrix theory of pain integrates cultural and genetic factors with basic neurophysiological function. According to this theory, the brain contains a body-self neuromatrix, a widely distributed network of neurons that are affected by both genetic factors and sensory experiences. The neuromatrix integrates multiple sources of input in addition to the stimuli of pain and touch. Other sensory systems that help interpret the input, such as attention, expectation, personality, culture, innate pain modulation systems, and components of stress-regulation systems, all contribute to the pain experience for the individual. Rationale 2: Specificity theories describe nerve impulses of varying intensity terminating in pain centers in the forebrain. Rationale 3: Pattern theories describe nerve impulses of varying intensity terminating in pain centers in the forebrain. Rationale 4: According to the pain sensitization theory, painful signals create a cascade of changes in the nervous system, which increases the responsiveness of the peripheral and central neurons. These changes increase the response to future signals and amplify pain. Global Rationale: The neuromatrix theory of pain integrates cultural and genetic factors with basic neurophysiological function. According to this theory, the brain contains a body-self neuromatrix, a widely distributed network of neurons that are affected by both genetic factors and sensory experiences. The neuromatrix integrates multiple sources of input in addition to the stimuli of pain and touch. Other sensory systems that help interpret the input, such as attention, expectation, personality, and culture, innate pain modulation systems, and components of stress-regulation systems, all contribute to the pain experience for the individual. Specificity and pattern theories describe nerve impulses of varying intensity terminating in pain centers in the forebrain. According to the pain sensitization theory, painful signals create a cascade of changes in the nervous system, which increases the responsiveness of the peripheral and central neurons. These changes increase the response to future signals and amplify pain.

A patient tells the nurse that he has had deep, burning muscle pain for most of his adult life. What does this information tell the nurse about how the patient's pain is being transmitted in the body? 1. C fibers 2. A-delta fibers 3. endorphins 4. dynorphins

Correct Answer: 1 Rationale 1: The pain from deep body structures, such as muscles and viscera, is primarily transmitted by C fibers, producing diffuse burning or aching sensations. Rationale 2: A-delta fibers are myelinated and transmit impulses rapidly. They produce what is called fast pain or first pain, which is sharp, well-defined pain typically accompanying cuts, electric shocks, or the impact of a blow. Rationale 3: Endorphins are endogenous opioids that block the transmission of painful impulses. Rationale 4: Dynorphins are endogenous opioids that block the transmission of painful impulses. Global Rationale: The pain from deep body structures, such as muscles and viscera, is primarily transmitted by C fibers, producing diffuse burning or aching sensations. A-delta fibers are myelinated and transmit impulses rapidly. They produce what is called fast pain or first pain, which is sharp, well-defined pain typically accompanying cuts, electric shocks, or the impact of a blow. Endorphins and dynorphins are endogenous opioids that block the transmission of painful impulses.

A female patient tells the nurse that at times the pain she has is so severe that she cannot move or get out of bed at home. What should the nurse realize is contributing to this patient's pain? 1. gender 2. overuse of alcohol 3. overuse of pain medication 4. too much sleep and rest

Correct Answer: 1 Rationale 1: The pain threshold is the point at which a stimulus elicits a response. Clinical and animal studies show that women have a lower pain threshold and experience a higher intensity of pain than men. Rationale 2: Alcohol may raise pain tolerance. Rationale 3: Medications may raise pain tolerance. Rationale 4: Sleep and rest may raise pain tolerance. Global Rationale: The pain threshold is the point at which a stimulus elicits a response. Clinical and animal studies show that women have a lower pain threshold and experience a higher intensity of pain than men. Medications, alcohol, sleep, and rest may raise pain tolerance.

A patient is being treated for chronic pain. What should the nurse keep in mind when assessing this patient's level of pain? 1. The pain rating may be inconsistent with the underlying pathology. 2. There is usually a clear, physiologic cause. 3. Pain typically lasts 2 months or less. 4. The pain reported is usually less severe than acute pain.

Correct Answer: 1 Rationale 1: The patient might not exhibit signs of pain such as elevations in vital signs, grimacing, writhing, or moaning. Rationale 2: There may not be an identified physiologic cause. Rationale 3: Chronic pain may persist for longer than 2 months. Rationale 4: There is no indication that chronic pain is less severe than acute pain, although in some instances it may be more diffuse. Global Rationale: The patient might not exhibit signs of pain such as elevations in vital signs, grimacing, writhing, or moaning. Chronic pain may persist for longer than 2 months and may not have an identified physiologic cause. There is no indication that chronic pain is less severe than acute pain, although in some instances it may be more diffuse.

The nurse is planning care for a patient with chronic pain. Which pain control goal would be most appropriate for this patient? 1. Reduce the focus on pain. 2. Reduce the sympathetic stress response. 3. Be completely pain free. 4. Improve patient outcomes

Correct Answer: 1 Rationale 1: With chronic pain, the pain itself becomes the problem, creating physical, psychosocial, and economic stresses on the affected individual and the family. Furthermore, emotional and psychologic factors can cause the pain itself or make it worse. Rationale 2: Reducing the sympathetic pain response would be an appropriate acute pain management goal. Rationale 3: Being completely pain free might be an unattainable goal for a patient with chronic pain. Rationale 4: Improving patient outcomes would be an appropriate acute pain management goal. Global Rationale: With chronic pain the pain itself becomes the problem, creating physical, psychosocial, and economic stresses on the affected individual and the family. Furthermore, emotional and psychologic factors can cause the pain itself or make it worse. Reducing the sympathetic pain response and improving patient outcomes would be appropriate acute pain management goals. Being completely pain free might be an unattainable goal for a patient with chronic pain.

A nurse is teaching pain management to a homebound hospice patient, already being treated with opioids. This patient has been diagnosed with metastatic breast cancer and expresses anxiety about keeping her pain under control. In which nonpharmacologic complementary methods might the nurse instruct the patient? Standard Text: Select all that apply. 1. guided imagery 2. progressive muscle relaxation 3. distraction 4. acupuncture 5. regional pain management

Correct Answer: 1, 2, 3 Rationale 1: Guided imagery can be taught to the patient by the nurse. Rationale 2: Progressive muscle relaxation can be taught to the patient by the nurse. Rationale 3: Distraction can be taught to the patient by the nurse. Rationale 4: Acupuncture cannot be taught to the patient by the nurse. Acupuncture can only be provided by persons with special training. Rationale 5: Regional pain management is not an alternative complementary therapy. Global Rationale: Guided imagery, progressive muscle relaxation, and distraction can be taught by the nurse. Acupuncture can only be provided by persons with special training. Regional pain management is not an alternative complementary therapy.

The nurse is preparing to apply a transdermal analgesic patch to a patient. In what order should the nurse administer this medication? Standard Text: Click and drag the options below to move them up or down. Choice 1. Choose a new site and cleanse and dry an upper torso location. Choice 2. Clip chest hair and open the medication package. Choice 3. Keep the patch intact for 72 hours. Choice 4. Place the patch, making sure all edges are in contact with the skin

Correct Answer: 1, 2, 4, 3 Rationale 1: A transdermal patch is applied to a clean, dry area on the upper torso. Rationale 2: If hair is present, it should be clipped before applying the patch. Rationale 3: The patch is effective for about 72 hours. Rationale 4: Apply the patch immediately after opening the package, ensuring complete contact with the skin, especially around the edges. Global Rationale: A transdermal patch is applied to a clean, dry area on the upper torso. If hair is present, it should be clipped before applying the patch. Apply the patch immediately after opening the package, ensuring complete contact with the skin, especially around the edges. The patch is effective for about 72 hours

After completing an assessment, the nurse determines that a patient experiencing pain should avoid taking NSAIDs. What information caused the nurse to make this determination? Standard Text: Select all that apply. 1. The patient takes medication for peptic ulcer disease. 2. The patient has a pacemaker inserted for atrial fibrillation. 3. The patient had a total hip and total knee replacement a year ago. 4. The patient takes medication and vitamin K for a clotting disorder. 5. The patient performs peritoneal self-dialysis for chronic kidney failure.

Correct Answer: 1, 4, 5 Rationale 1: NSAIDs are not recommended for use in people with peptic ulcer disease. Rationale 2: A pacemaker would not be a contraindication for using NSAIDs. Rationale 3: Total joint replacements are not a reason to contraindicate NSAIDs. Rationale 4: NSAIDs are not recommended for use in people with bleeding disorders. Rationale 5: NSAIDs are not recommended for use in people with kidney or liver disease. Global Rationale: NSAIDs are not recommended for use in people with kidney or liver disease, bleeding disorders, or peptic ulcer disease. A pacemaker would not be a contraindication for using NSAIDs. Total joint replacements are not a reason to contraindicate NSAIDs.

A patient recovering from abdominal surgery is refusing hydromorphone (Dilaudid) because she has heard that it may be addictive. She is crying and rates her pain at 10 out of 10. What statements should the nurse include as part of the patient's education? Standard Text: Select all that apply. 1. There is little to no risk of addiction when taking narcotics for pain. 2. Untreated pain can result in poor wound healing. 3. Patients with uncontrolled pain have an increased risk of blood clots. 4. Dehydration can result from poorly managed pain. 5. Family members will not want to visit patients showing visible signs of pain.

Correct Answer: 1,2,3 Rationale 1: A common myth among healthcare professionals is that using opioids for pain treatment poses a real threat of addiction. Actually, when the medications are used as recommended, there is little to no risk of addiction. Rationale 2: Pain causes physiological consequences, including poor wound healing. Rationale 3: Pain causes physiological consequences, including coagulation leading to DVT or PE. Rationale 4: There is no evidence that poor pain relief causes dehydration. Rationale 5: There is no evidence that poor pain relief causes family members to refuse to visit. Global Rationale: A common myth among healthcare professionals is that using opioids for pain treatment poses a real threat of addiction. Actually, when the medications are used as recommended, there is little to no risk of addiction. Pain causes physiological consequences, including poor wound healing and coagulation leading to DVT or PE. There is no evidence that poor pain relief causes dehydration or refusal by family members to visit.

A patient with bone pain complains that the pain is more intense when the patient is being repositioned in bed. For which type of pain should the nurse plan care? 1. Central 2. Incident 3. Nociceptive 4. Neuropathic

Correct Answer: 2 Rationale 1: Central pain is caused by a lesion or damage in the brain or spinal cord. Rationale 2: Incident or episodic pain is predictable, precipitated by an event or activity such as coughing, changing position, or being touched. Rationale 3: Nociceptive pain is caused by stimulation of peripheral or visceral pain receptors. Rationale 4: Neuropathic pain arises as a consequence of a lesion or disease affecting the somatosensory system. Global Rationale: Incident or episodic pain is predictable, precipitated by an event or activity such as coughing, changing position, or being touched. Central pain is caused by a lesion or damage in the brain or spinal cord. Nociceptive pain is caused by stimulation of peripheral or visceral pain receptors. Neuropathic pain arises as a consequence of a lesion or disease affecting the somatosensory system.

The nurse is assessing a patient's vital signs. What should the nurse include in this assessment? 1. peripheral pulses 2. pain level 3. ability to ambulate 4. urine output

Correct Answer: 2 Rationale 1: Assessment of peripheral pulses is done to check for presence and strength; it is not routinely done to assess a pulse rate. Rationale 2: Pain is increasingly being referred to as the "fifth vital sign," with recommendations to include pain assessment in every vital signs assessment. Rationale 3: Ambulation is not a vital sign. Rationale 4: Urine output is not a vital sign. Global Rationale: Pain is increasingly being referred to as the "fifth vital sign," with recommendations to include assess pain assessment in every vital signs assessment. Assessment of peripheral pulses is done to check for presence and strength; it is not routinely done to assess a pulse rate. Ambulation and urine output are not vital signs.

A patient with chronic pain is being started on a "patch." What should the nurse instruct the patient about this pain-relieving delivery system? 1. It will not work as well as oral pain medications. 2. The dosage will be lower in the beginning. 3. The patient will never experience breakthrough pain. 4. The patient will never overdose with this delivery method

Correct Answer: 2 Rationale 1: The transdermal, or patch, form of medication is increasingly being used because it is simple, painless, and delivers a continuous level of medication. The continuous dosage is an advantage over oral medications. Transdermal medications are easy to store and apply, and reapplying every 72 hours enhances compliance. Rationale 2: Dosages for the "patch" start low and are increased as deemed necessary by the physician. Rationale 3: Additional short-acting medication is often needed for breakthrough pain. Rationale 4: Overdosage can occur with this route. Global Rationale: Dosages for the "patch" start low and are increased as deemed necessary by the physician. The transdermal, or patch, form of medication is increasingly being used because it is simple, painless, and delivers a continuous level of medication. The continuous dosage is an advantage over oral medications. Transdermal medications are easy to store and apply, and reapplying every 72 hours enhances compliance. Additional short-acting medication is often needed for breakthrough pain. Overdosage can occur with this route.

A patient with chronic pain tells the nurse that she "rarely sleeps more than 3 hours a night." The nurse recognizes that this patient is at risk for developing which health problem? 1. chronic insomnia 2. depression 3. high pain tolerance 4. adult attention deficit disorder

Correct Answer: 2 Rationale 1: There is no evidence to support the risk of chronic insomnia, although insomnia is associated with chronic pain. Rationale 2: Depression is clearly linked to pain, and insomnia is an associated symptom of chronic pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, which leads to an increase in pain sensations. Rationale 3: There is no evidence to support inferences concerning pain tolerance. Rationale 4: There is no evidence to support the risk of adult attention deficit disorder. Global Rationale: Depression is clearly linked to pain, and insomnia is an associated symptom of chronic pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, which leads to an increase in pain sensations. There is no evidence to support the risk of chronic insomnia or adult attention deficit disorder, or inferences concerning pain tolerance.

A patient with chronic pain is prescribed an anticonvulsant medication. What should the nurse instruct the patient to expect when taking this medication? Standard Text: Select all that apply. 1. Less nausea 2. Reduced pain 3. Improved sleep 4. Improved mobility 5. Reduced urine output

Correct Answer: 2, 3 Rationale 1: Anticonvulsants are not prescribed to reduce nausea. Rationale 2: Anticonvulsants are frequently used with opioids in pain control because these drugs reduce pain. Rationale 3: Anticonvulsants are frequently used with opioids in pain control because these drugs reduce sleep disruption. Rationale 4: Anticonvulsants are not prescribed to improve mobility. Rationale 5: Anticonvulsants should not adversely affect renal functioning. Global Rationale: Anticonvulsants are frequently used with opioids in pain control because these drugs reduce pain and sleep disruption. Anticonvulsants are not prescribed to reduce nausea or improve mobility. They should not adversely affect renal functioning

The nurse is caring for older patients in a long-term-care facility. The nurse understands that which factors influence pain management in these patients? Standard Text: Select all that apply. 1. Increased A fiber transmission increases the potential for addiction in older adults. 2. An increased risk of depression in older adults is related to chronic pain. 3. Less reporting of referred pain may mask myocardial infarction in older adults. 4. Assessment of pain in the cognitively impaired older adult is not possible. 5. Delirium should be evaluated as pain.

Correct Answer: 2, 3, 5 Rationale 1: There is actually decreased fiber transmission and no greater risk of dependence with older adults. Rationale 2: There is an increased risk of depression in the older patient experiencing chronic pain. Rationale 3: Older adults are less likely to report referred pain, meaning they may present in a different manner than younger adults. This may lead to problems diagnosing patients appropriately. Rationale 4: Research has shown the numeric rating, verbal descriptor, and FACES rating scales to be effective with older adults. These scales are also effective with cognitively impaired older adults, although the FACES scale is the preferred tool. Rationale 5: The older adult may present with manifestations such as delirium rather than subjective reports of pain. Global Rationale: In older adults there are decreased fiber transmission, no greater risk for addiction, and an increased risk of depression related to chronic pain. There is also a lower level of reported referred pain, so that the patient may not exhibit classic symptoms of myocardial infarction. Research has shown the numeric rating, verbal descriptor, and FACES rating scales to be effective with older adults. These scales are also effective with cognitively impaired older adults, although the FACES scale is the preferred tool. The older adult may present with manifestations such as delirium rather than subjective reports of pain.

The nurse is assessing a patient's pain perception. What should the nurse use to make this assessment? 1. FACES scale 2. psychological evaluation tool 3. PQRST guide 4. biofeedback rating

Correct Answer: 3 Rationale 1: The FACES scale is a pain rating tool. Rationale 2: Use of a psychological evaluation tool is not indicated. Rationale 3: A patient's pain perception can be assessed by using the PQRST technique: P = What precipitated (triggered, stimulated) the pain? Has anything relieved the pain? What is the pattern of the pain? Q = What is the quality and quantity of the pain? Is it sharp, stabbing, aching, burning, stinging, deep, crushing, viselike, or gnawing? R = What is the region (location) of the pain? Does the pain radiate to other areas of the body? S = What is the severity of the pain? And T = What is the timing of the pain? When does it begin, how long does it last, and how is it related to other events in the patient's life? Rationale 4: A biofeedback rating would not address all areas of a pain assessment. Global Rationale: A patient's pain perception can be assessed by using the PQRST technique: P = What precipitated (triggered, stimulated) the pain? Has anything relieved the pain? What is the pattern of the pain? Q = What is the quality and quantity of the pain? Is it sharp, stabbing, aching, burning, stinging, deep, crushing, viselike, or gnawing? R = What is the region (location) of the pain? Does the pain radiate to other areas of the body? S = What is the severity of the pain? And T = What is the timing of the pain? When does it begin, how long does it last, and how is it related to other events in the patient's life? The FACES scale is a pain rating tool. Use of a psychological evaluation tool is not indicated. A biofeedback rating would not address all areas of a pain assessment.

A patient has periodic severe nerve pain that is not well controlled with pain medication. The nurse thinks that this patient might benefit from which pain management approach? 1. a nonsteroidal anti-inflammatory drug (NSAID) 2. a narcotic 3. an antidepressant 4. a local anesthetic

Correct Answer: 3 Rationale 1: The NSAID group can have serious side effects, including bleeding tendencies, and would not be appropriate in a long-term situation. Rationale 2: Other medications are prescribed before introducing narcotics. Rationale 3: Antidepressants within the tricyclic and related chemical groups act on the production and retention of serotonin in the CNS, thus inhibiting pain sensation. They also promote normal sleeping patterns, which further alleviates the suffering of the patient in pain. They are useful with neuropathic pain. Rationale 4: A local anesthetic would not be appropriate for long-term pain management. Global Rationale: Antidepressants within the tricyclic and related chemical groups act on the production and retention of serotonin in the CNS, thus inhibiting pain sensation. They also promote normal sleeping patterns, which further alleviates the suffering of the patient in pain. They are useful with neuropathic pain. Other medications are prescribed before introducing narcotics. The NSAID group can have serious side effects, including bleeding tendencies, and would not be appropriate in a long-term situation. A local anesthetic would not be appropriate for long-term pain management.

A patient recovering from a broken leg asks why the pain is so sharp. What should the nurse explain about acute pain? Standard Text: Select all that apply. 1. The pain signal releases catecholamines. 2. The pain signal reduces blood flow to the gut. 3. The pain signal travels along nerve fibers to the spinal cord. 4. The pain signal travels up to the brain portion called the thalamus. 5. The pain signal spreads throughout the cortex, limbic system, and brainstem.

Correct Answer: 3, 4, 5 Rationale 1: The release of catecholamines explains the cardiovascular response to pain. Rationale 2: The reduction of blood flow to the gut explains why nausea and vomiting occur with pain. Rationale 3: With sharp local pain, nociceptors transmit pain stimuli along myelinated fibers to the spinal cord. Rationale 4: With sharp local pain, nociceptors transmit pain stimuli along myelinated fibers to the spinal cord, where it travels via the neospinothalamic tract to the thalamus. Rationale 5: With sharp local pain, the stimulus is distributed from the thalamus to the somatosensory cortex (perception and interpretation), the limbic system (emotional responses to pain), and brainstem centers (autonomic nervous system responses). Global Rationale: With sharp local pain, nociceptors transmit pain stimuli along myelinated fibers to the spinal cord, where it travels via the neospinothalamic tract to the thalamus. From the thalamus, the stimulus is distributed to the somatosensory cortex (perception and interpretation), the limbic system (emotional responses to pain), and brainstem centers (autonomic nervous system responses). The release of catecholamines explains the cardiovascular response to pain. The reduction of blood flow to the gut explains why nausea and vomiting occur with pain.

A patient has been receiving morphine sulfate 10 mg intramuscularly every 4 hours for the past few days. The nurse is anticipating discharge and wants to calculate the oral dose necessary for this patient. Calculate the oral dosage range using the equianalgesic dosing formula: __________ mg.

Correct Answer: 30-60 Rationale: The PO dose is 3 to 6 times the IM dose.

A patient is prescribed a fentanyl patch to administer 100 mcg/hour. The patient uses one patch for 72 hours and then is changed to an intravenous infusion of morphine 8 hours into the second patch. If the patient had been receiving the morphine intravenously, how many mg of the medication would the patient have received from wearing the patch?

Correct Answer: 320 mg Rationale: Fentanyl 100 mcg/hr is equivalent to 4 mg/hr morphine IV. If the first patch was for 72 hours and the second patch was for 8 hours, the patient wore the patch for a total of 80 hours. Multiply the equivalent dose of 4 mg × 80 = 320 mg.

A patient is seen talking and laughing in the clinic's waiting room yet complains of excruciating pain. What should the nurse realize this patient is demonstrating? 1. the desire for narcotics 2. denial 3. fake pain 4. inconsistent behavioral response to pain

Correct Answer: 4 Rationale 1: No mention is made of the patient requesting narcotics. Rationale 2: Behavioral responses to pain may or may not coincide with the patient's report of pain and are not very reliable cues to the pain experience. Rationale 3: The nurse cannot decide if the patient's pain is real. Rationale 4: Behavioral responses to pain may or may not coincide with the patient's report of pain and are not very reliable cues to the pain experience. The nurse needs to manage the pain if the patient verbalizes that it is present, even if the nonverbal signs are not congruent. Global Rationale: Behavioral responses to pain may or may not coincide with the patient's report of pain and are not very reliable cues to the pain experience. The nurse needs to manage the pain if the patient verbalizes that it is present, even if the nonverbal signs are not congruent. The nurse cannot decide if the patient's pain is real. No mention is made of the patient requesting narcotics.

A 47-year-old female patient has a history of scoliosis and back pain. Which type of pain should the nurse realize this patient most likely is experiencing? 1. recurrent acute pain 2. ongoing time-limited pain 3. chronic malignant pain 4. chronic nonmalignant pain

Correct Answer: 4 Rationale 1: Recurrent acute pain is characterized by relatively well-defined episodes of pain interspersed with pain-free episodes. Rationale 2: Ongoing time-limited pain is not a commonly used term for pain. Rationale 3: Malignancy is not mentioned as a cause of the pain. Rationale 4: Chronic nonmalignant pain is non-life-threatening pain that nevertheless persists beyond the expected time for healing. Chronic lower back pain falls into this category. Global Rationale: Chronic nonmalignant pain is non-life-threatening pain that nevertheless persists beyond the expected time for healing. Chronic lower back pain falls into this category. Malignancy is not mentioned as a cause of the pain. Recurrent acute pain is characterized by relatively well-defined episodes of pain interspersed with pain-free episodes. Ongoing time-limited pain is not a commonly used term for pain.

A patient with chronic pain is desperately searching for something to relieve the pain. What should the nurse recommend for this patient? 1. A thorough analysis of the pain to determine if it is truly pain 2. Avoiding the use of narcotics 3. Evaluation by a psychiatrist to determine if the patient is depressed 4. A pain medication schedule to help avoid the onset of pain

Correct Answer: 4 Rationale 1: The pain has already been identified as being real and chronic in nature. Rationale 2: Avoidance of narcotics may not meet the patient's immediate needs. Rationale 3: There is no mention of a depressed state, only the patient's need to address the pain. Rationale 4: It is now widely accepted that anticipating pain has a noticeable effect on the amount of pain a patient experiences. Offering pain relief before a pain event is well on its way can lessen the pain. Global Rationale: It is now widely accepted that anticipating pain has a noticeable effect on the amount of pain a patient experiences. Offering pain relief before a pain event is well on its way can lessen the pain. The pain has already been identified as being real and chronic in nature. There is no mention of a depressed state, only the patient's need to address the pain. Avoidance of narcotics may not meet the patient's immediate needs.

A patient with a history of chronic pain tells the nurse, "I do a variety of things to make my body produce its own pain reliever." What should the nurse realize this patient is describing? 1. a theory of denial 2. a belief in alternative methods 3. a reason to reduce the amount of pain medication prescribed 4. the body's ability to make endorphins

Correct Answer: 4 Rationale 1: The patient is not denying the pain. Rationale 2: Alternative methods have not been employed. Rationale 3: There was no discussion of pain medication amounts. Rationale 4: There is a pain inhibitory center within the dorsal horns of the spinal cord. The exact nature of this inhibitory mechanism is unknown. However, the most clearly defined chemical inhibitory mechanism is fueled by endorphins (endogenous morphines), which are naturally occurring opioid peptides that are present in neurons in the brain, spinal cord, and gastrointestinal tract. Endorphins work by binding with opiate receptors on the neurons to inhibit pain impulse transmission. Global Rationale: There is a pain inhibitory center within the dorsal horns of the spinal cord. The exact nature of this inhibitory mechanism is unknown. However, the most clearly defined chemical inhibitory mechanism is fueled by endorphins (endogenous morphines), which are naturally occurring opioid peptides that are present in neurons in the brain, spinal cord, and gastrointestinal tract. Endorphins work by binding with opiate receptors on the neurons to inhibit pain impulse transmission. The patient is not denying the pain. Alternative methods have not been employed. There was no discussion of pain medication amounts

The nurse is helping a patient in pain by gently massaging the painful area. The nurse is utilizing which form of pain control with the patient? 1. acupuncture 2. biofeedback 3. guided imagery 4. cutaneous stimulation

Correct Answer: 4 Rationale 1: There is no mention of the use of acupuncture needles. Rationale 2: Biofeedback does not involve massage. Rationale 3: Guided imagery does not involve massage. Rationale 4: It is believed that stimulation of the skin is effective in relieving pain because it prompts closure of the gate in the substantia gelatinosa. Cutaneous stimulation may be accomplished by massage, vibration, applying heat and cold, and therapeutic touch. Global Rationale: It is believed that stimulation of the skin is effective in relieving pain because it prompts closure of the gate in the substantia gelatinosa. Cutaneous stimulation may be accomplished by massage, vibration, applying of heat and cold, and therapeutic touch. Touch was used, so biofeedback and guided imagery are not correct. There is no mention of the use of acupuncture needles.

The nurse is ranking a patient's prescribed pain medications according to their strengths. Using the WHO analgesic ladder, in what order, from weakest to strongest, should the nurse rank the medications? Standard Text: Click and drag the options below to move them up or down. Choice 1. Morphine sulfate 5 mg IV Choice 2. Ibuprofen 400 mg PO with the anticonvulsant gabapentin (Neurontin) 300 mg PO Choice 3. Propoxyphene HCL (Darvon) 250 mg. PO Choice 4. Acetaminophen (Tylenol) 325 mg PO

Correct Answer: 4, 2, 3, 1 Rationale 1: Morphine is the strongest of these pain medications. It is an opioid. Rationale 2: Ibuprofen is a nonopioid and is the second weakest of these medications. Rationale 3: Propoxyphene is the second strongest of these medications. Rationale 4: Tylenol is the weakest of these medications. Global Rationale: The nonopioid analgesics acetaminophen and ibuprofen are the least invasive, followed by the mild opioid analgesics with adjuvant therapy, and finally the opioids.

The nurse is explaining the pain response process to a patient experiencing chronic pain. In which order should the nurse identify the steps in the neural pain pathway? Standard Text: Click and drag the options below to move them up or down. Choice 1. In the thalamus and cerebral cortex, the pain impulse becomes pain when the sensation reaches conscious levels and is perceived and evaluated by the person experiencing the sensation. Choice 2. Dorsal horn synapses relay impulses up the spinal cord. Spinal neurons transmit the impulses via axons that cross over to the spinothalamic tract. Choice 3. The impulses ascend the spinothalamic tracts and pass through the medulla and midbrain to the thalamus. Choice 4. A noxious stimulus is perceived by cutaneous nociceptors and then transmitted through A-delta (AΔ) and even smaller C nerve fibers to the spinal cord dorsal horn.

Correct Answer: 4,2,3,1 Rationale 1: This is the final step in the neural pain pathway. Rationale 2: This is the second step in the neural pain pathway. Rationale 3: This is the third step in the neural pain pathway. Rationale 4: This is the first step in the neural pain pathway. Global Rationale: The neural pain pathway physiology follows this order: A noxious stimulus is perceived by cutaneous nociceptors and then transmitted through A-delta (AΔ) and even smaller C nerve fibers to the spinal cord dorsal horn. Dorsal horn synapses relay impulses up the spinal cord. Spinal neurons transmit the impulses via axons that cross over to the spinothalamic tract. The impulses ascend the spinothalamic tracts and pass through the medulla and midbrain to the thalamus. In the thalamus and cerebral cortex, the pain impulse becomes pain when the sensation reaches conscious levels and is perceived and evaluated by the person experiencing the sensation.

A patient with a long history of pain rarely appears to be in pain and often forgoes the use of pain medication. What does the nurse realize about this patient? 1. The patient has a high pain tolerance. 2. The patient has a low pain tolerance. 3. The patient is addicted to pain medication. 4. The patient does not really have pain.

Rationale 1: Pain tolerance describes the amount of pain a person can tolerate before outwardly responding to it. A patient with a high tolerance to pain would rarely report pain or need analgesic management. Rationale 2: With a low tolerance, the patient would be verbalizing pain and requesting medication. Rationale 3: If addicted, the patient would eventually need more medication, not less, to manage the pain. Rationale 4: There is no evidence that the patient is not in pain. Global Rationale: Pain tolerance describes the amount of pain a person can tolerate before outwardly responding to it. A patient with a high tolerance to pain would rarely report pain or need analgesic management. With a low tolerance, the patient would be verbalizing pain and requesting medication. If addicted, the patient would eventually need more medication, not less, to manage the pain. There no evidence that the patient is not in pain.

A patient is hospitalized with suspected gallstones and inflammatory gallbladder disease. Place an "X" over the area of the body where the nurse would expect the patient to locate the pain.

Right upper back Referred pain is pain that is perceived in an area distant from the site of the stimuli. It commonly occurs with pain that originates in thoracic or abdominal viscera. Visceral sensory fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue areas of the body.

________ a. Pain from loss of afferent input choose from the following: Categories of Pain 1. Nociceptive pain 2. Neuropathic pain Sources of Pain 3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

a. 2, 7/9 Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 327). Elsevier Health Sciences. Kindle Edition.

________ b. Pain persisting from sympathetic nervous system (SNS) activity choose from the following: Categories of Pain 1. Nociceptive pain 2. Neuropathic pain Sources of Pain 3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

b. 2, 7;

________ c. Pain caused by dysfunction in the central nervous system (CNS) choose from the following: Categories of Pain 1. Nociceptive pain 2. Neuropathic pain Sources of Pain 3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

c. 2, 6;

________ d. Pain arising from skin and subcutaneous tissue; well localized choose from the following: Categories of Pain 1. Nociceptive pain 2. Neuropathic pain Sources of Pain 3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

d. 1, 3;

________ e. Pain arising from muscles and bones; localized or diffuse and radiating choose from the following: Categories of Pain 1. Nociceptive pain 2. Neuropathic pain Sources of Pain 3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

e. 1, 5;

________ f. Pain felt along the distribution of peripheral nerve(s) from nerve damage choose from the following: Categories of Pain 1. Nociceptive pain 2. Neuropathic pain Sources of Pain 3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

f. 2, 8;

________ g. Pain arising from visceral organs; well or poorly localized; referred cutaneously choose from the following: Categories of Pain 1. Nociceptive pain 2. Neuropathic pain Sources of Pain 3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 30). Elsevier Health Sciences. Kindle Edition.

g. 1, 4

A patient with a history of high blood pressure and cardiac arrhythmias is admitted after having EKG changes consistent with a myocardial infarction. Place an "X" over the area of the body where the nurse would expect the patient to locate the pain

left side of jaw, over heart, left arm Referred pain is pain that is perceived in an area distant from the site of the stimuli. It commonly occurs with pain that originates in thoracic or abdominal viscera. Visceral sensory fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue areas of the body.