CEN PAIN QUESTIONS

describes the timing or onset of the pain

"It came on suddenly"

Which statement describes the quality of pain?

"It feels like it's burning." Quality describes the type of pain, such as burning, sharp, or dull.

describes the location of the pain

"It hurts right here"

describes the severity of the pain

"It is an 8 out of 10" .

Before wound cleaning and repair, use a

(LET) or a topical numbing skin spray pharmacy-prepared mixture of lidocaine, epinephrine, and tetracaine

Otherwise healthy patients, should not exceed how much of tylenol

4,000 mg of acetaminophen (Tylenol) in 24 hours

What is the definition of neuropathy?

A disturbance of function or a pathologic change in a nerve Neuropathy is a disturbance of function or a pathologic change in a nerve.

fracture is most likely to cause which type of pain? A. Acute B. Neuropathic C. Visceral D. Somatic

A fracture, trauma, surgery, procedure, illness, or infection may cause acute pain. A primary lesion may cause neuropathic pain. owel obstruction, venous occlusion, or ischemia may cause visceral pain. Bone metastasis or degenerative joint disease may cause somatic pain.

What is bradykinin?

A mediator Damaged tissue releases powerful mediators, such as bradykinins, potassium, leukotrienes, serotonin, histamines, arachidonic acid, thromboxanes, substance P, and a platelet activating factor, which play a role in pain.

Nociceptors (pain receptors)

A nociceptor is a pain receptor.

A patient with a bowel obstruction is likely to experience which type of pain? A. Visceral B. Somatic C. Neuropathic D. Hyperesthesia

A patient with a bowel obstruction is likely to experience visceral pain. Patients with degenerative joint disease typically experience somatic pain. Patients with dysfunctions in the peripheral or central nervous system experience neuropathic pain. Hyperesthesia is not a type of pain but is an unusual or pathologic sensitivity of the skin or of a particular sense to stimulation.

According to the World Health Organization pain ladder, which medication is indicated for a patient with mild pain? A. Morphine sulfate B. Codeine C. Hydromorphone (Dilaudid) D. Acetaminophen (Tylenol)

A patient with mild pain should receive nonopioids, such as aspirin (Ecotrin), acetaminophen (Tylenol), or a nonsteroidal anti-inflammatory drug.

According to the World Health Organization pain ladder, which medication is indicated for a patient with moderate to severe pain pain? A. Morphine sulfate B. Codeine C. Hydromorphone (Dilaudid) D. Acetaminophen (Tylenol)

A patient with moderate to severe pain should receive strong opioids, such as morphine sulfate or hydromorphone (Dilaudid).

neuropathic pain MAY BE CAUSED BY

A primary lesion.

Which structure can decrease the number of pain impulses received from afferent pain fibers?

A-beta fibers Large A-beta fibers in the dorsal horn can decrease the number of pain impulses received from afferent pain fibers. This explains how acupuncture and topical medications can relieve pain. Afferent fibers stimulate the periaqueductal gray area, the magnus raphe nucleus, and the pain-inhibitory complex in the anterior horn, which allows the body to manage debilitating pain and still survive.

According to the World Health Organization pain ladder, which medication is indicated for a patient with mild to moderate pain? A. Morphine sulfate B. Codeine C. Hydromorphone (Dilaudid) D. Acetaminophen (Tylenol)

According to the World Health Organization pain ladder, a patient with mild to moderate pain should receive short-acting opioids, such as codeine, with or without a nonopioid.

Using the five-level triage system of the Emergency Severity Index, which acuity level is appropriate for a patient in severe acute pain from sickle cell disease? A. Level 1 B. Level 2 C. Level 3 D. Level 4

According to the five-level triage system of the Emergency Severity Index, a patient in acute pain from sickle cell disease is level 2 because of severe pain.

Which medication is indicated for a patient with mild to moderate pain? A. Acetaminophen and oxycodone (Percocet) B. Acetaminophen and hydrocodone (Vicodin) C. Hydromorphone (Dilaudid) D. Propoxyphene (Darvon)

Acetaminophen and hydrocodone (Vicodin), acetaminophen and oxycodone (Percocet), propoxyphene (Darvon) are short-acting opioids that would be indicated for mild to moderate pain.

A fracture is most likely to cause which type of pain?

Acute fracture, trauma, surgery, procedure, illness, or infection may cause acute pain.

Which description applies to acute pain? A. It is transient. B. It is harder to differentiate than chronic pain. C. It increases over time. D. It may increase with treatment.

Acute pain is transient because it occurs suddenly and usually subsides as healing occurs. It is easier to differentiate than chronic pain. Acute pain usually decreases over time. Cancer pain, not acute pain, may increase with treatment.

what is characters evidence a neurobiological disease

Addiction is a primary, chronic, neurobiological disease characterized by behaviors that include impaired control over drug use, compulsive drug use, continued use despite harm, craving, or any combination of these.

Blowing bubbles is an appropriate nonpharmacologic intervention for patients in which age group? A. Infants B. Preschoolers C. School-age children D. Adolescents

Blowing bubbles is an appropriate nonpharmacologic intervention for preschoolers. Blowing bubbles is not appropriate for infants, school-age children, or adolescents.

what may cause somatic pain

Bone metastasis or degenerative joint disease

What is bradykinin? A prostaglandin B. A stimulus C. A nociceptor D. A mediator

Damaged tissue releases powerful mediators, such as bradykinins, potassium, leukotrienes, serotonin, histamines, arachidonic acid, thromboxanes, substance P, and a platelet activating factor, which play a role in pain. Damaged tissue also releases prostaglandins, which make the nerve endings more sensitive. Examples of stimuli may include a laceration, heat that causes tissue damage, or the stretching of an abdominal muscle from inflammation or blood in the abdomen. A nociceptor is a pain receptor.

Which substance causes a pain response? A. Norepinephrine B. Gamma-aminobutyric acid C. Glycine D. Substance P

Damaged tissue releases powerful mediators, such as substance P, potassium, leukotrienes, bradykinins, serotonin, histamines, arachidonic acid, thromboxanes, and platelet activating factor, which play a role in acute pain and possibly in chronic pain. Substance P is the main neurotransmitter associated with slow pain sensations. Norepinephrine and serotonin inhibit pain impulses in the medulla and pons. Gamma-aminobutyric acid and glycine are neurotransmitters that contribute to pain modulation, inhibiting pain impulses in the brain and spinal cord.

Which substance causes a pain response? A. Norepinephrine B. Gamma-aminobutyric acid C. Glycine D. Substance P

Damaged tissue releases powerful mediators, such as substance P, potassium, leukotrienes, bradykinins, serotonin, histamines, arachidonic acid, thromboxanes, and platelet activating factor, which play a role in acute pain and possibly in chronic pain. Substance P is the main neurotransmitter associated with slow pain sensations. Norepinephrine and serotonin inhibit pain impulses in the medulla and pons. Gamma-aminobutyric acid and glycine are neurotransmitters that contribute to pain modulation, inhibiting pain impulses in the brain and spinal cord.

A patient who received procedural sedation is not easily aroused but responds purposefully to repeated or painful stimulation. Which level of sedation does this represent?

Deep sedation In deep sedation or analgesia, the patient is not easily aroused but responds purposefully to repeated or painful stimulation.

Which disorder is most likely to cause somatic pain? A. Tumor B. Venous occlusion C. Degenerative joint disease D. Arthritis

Degenerative joint disease or bone metastasis may cause somatic pain, which is described as aching or throbbing. A tumor, chemotherapy, or radiation therapy can cause cancer pain. Bowel obstruction, venous occlusion, or ischemia may cause visceral pain. Arthritis, migraines, and low back disorders may cause chronic pain.

Which procedural sedation medication lowers the seizure threshold?

Etomidate (Amidate) lowers the seizure threshold. Propofol (Diprivan) has anticonvulsant properties. Midazolam (Versed) and fentanyl (Duragesic) have no known effects on the seizure threshold

What is the most consistent behavioral indicator of pain in infants?

Facial expression is the most consistent behavioral indicator of pain in infants.

What is the most consistent behavioral indicator of pain in infants? A. Consolability B. Quality of cry C. Level of activit D. Facial expression

Facial expression is the most consistent behavioral indicator of pain in infants. Quality of cry, level of activity, and consolability are assessment parameters of the FLACC pain scale.

Which drug produces the fewest cardiac effects?

Fentanyl (Duragesic) Administrating analgesics to patients with respiratory depression, hemodynamic instability, or a coma requires care. Manage respiratory depression with airway adjuncts so the patient can receive adequate analgesia. Minimize hypotension by using a drug with fewer negative cardiac effects, such as fentanyl (Duragesic). Morphine sulfate, hydromorphone (Dilaudid), and meperidine (Demerol) produce more cardiac effects than fentanyl.

Which medication has a rapid onset and a short duration of action?

Fentanyl (Duragesic) Fentanyl has a rapid onset (1 to 2 minutes) and a short duration of action (up to 60 minutes).

Which nonpharmacologic intervention is most effective for an adolescent?

For adolescents, effective nonpharmacologic interventions include 1. guided imagery, 2. distraction, video games, trivia, 3. deep breathing, usic, praise, 4. ice or heat application, and having a choice about parental involvement.

Which nonpharmacologic intervention is most effective for an adolescent? A. Rewards B. Parental selection of the appropriate intervention C. Guided imagery D. Play

For adolescents, effective nonpharmacologic interventions include guided imagery, distraction, video games, trivia, deep breathing, music, praise, ice or heat application, and having a choice about parental involvement.

Which medication is the drug of choice for a patient who presents with an acute pain episode from sickle cell disease? A. Methadone (Dolophine) B. Codeine C. Hydromorphone (Dilaudid) D. Oxycodone (OxyContin)

For patients with acute pain episodes from sickle cell disease, evidence-based guidelines from the American Pain Society recommend administering intravenous morphine sulfate or hydromorphone (Dilaudid) within 15 minutes of arrival. Methadone (Dolophine), codeine, and oxycodone (OxyContin) are not appropriate drug choices for sickle cell acute pain episodes.

which neurotransmitters contribute to pain modulation, inhibiting pain impulses in the brain and spinal cord.

Gamma-aminobutyric acid and glycine

Which agent is used to manage mild to moderate pain? A. Morphine sulfate B. Oxycodone (OxyContin) C. Hydromorphone (Dilaudid) D. Ibuprofen (Motrin)

Ibuprofen (Motrin) is a nonsteroidal anti-inflammatory drug, which is used to manage mild to moderate pain, including pain with an inflammatory component. Morphine sulfate, oxycodone (OxyContin), and hydromorphone (Dilaudid) are all opioids, which are indicated for managing more severe pain.

Which administration method increases the risk of abscess development? A. Intravenous injection B. Subcutaneous injection C. Intramuscular injection D. Patient-controlled analgesia (PCA)

Intramuscular injection increases the risk of abscess development and is associated with erratic absorption and tissue damage. Intravenous injection, subcutaneous injection, and patient-controlled analgesia do not cause an increased risk of abscess development.

Which description applies to acute pain?

It is transient. Acute pain is transient because it occurs suddenly and usually subsides as healing occurs. It is easier to differentiate than chronic pain. Acute pain usually decreases over time. Cancer pain, not acute pain, may increase with treatment.

Which medication has an analgesic ceiling effect?

Ketorolac (Toradol)) Nonsteroidal anti-inflammatory drugs, such as ketorolac (Toradol), have an analgesic ceiling effect. This means that doses beyond a certain level do not produce any increase in analgesic effects.

which medication has a slower onset and how long does it last

Meperidine (Demerol) lasts 2 to 4 hours. Morphine sulfate has a duration of 3 to 7 hours. Hydromorphone (Dilaudid) has a duration of 4 to 5 hours.

Which medication is indicated for a patient with severe pain? A. Acetaminophen and oxycodone (Percocet) B. Acetaminophen and hydrocodone (Vicodin) C. Hydromorphone (Dilaudid) D. Propoxyphene (Darvon)

Morphine sulfate and hydromorphone (Dilaudid) are the primary options for managing severe pain.

Which medication is indicated for a patient with severe pain? A. Acetaminophen and oxycodone (Percocet) B. Acetaminophen and hydrocodone (Vicodin) C. Hydromorphone (Dilaudid) D. Propoxyphene (Darvon)

Morphine sulfate and hydromorphone (Dilaudid) are the primary options for managing severe pain. Acetaminophen and hydrocodone (Vicodin), acetaminophen and oxycodone (Percocet), and propoxyphene (Darvon) are short-acting opioids that would be indicated for mild to moderate pain.

Atomized lidocaine may be used to reduce the pain of which procedure?

Nasogastric tube insertion Before inserting a nasogastric tube, consider using lidocaine (Xylocaine) gel, atomized nasopharyngeal lidocaine, or lidocaine and phenylephrine.

Which of these is a nociceptor? A. A mediator B. A stimulus C. A pain receptor D. A prostaglandin

Nociceptors (pain receptors) are located in the skin, muscles, joints, arteries, and viscera. They may be stimulated by a chemical, thermal, or mechanical stimulus. Damaged tissue releases powerful mediators that play a role in acute and chronic pain. Damaged tissue also releases prostaglandins, which makes the nerve endings more sensitive.

which neurotransmitters inhibit pain impulses in the medulla and pons

Norepinephrine and serotonin

Which medication do not have an analgesic ceiling effect

Opioids, such as codeine, oxycodone (OxyContin), and hydrocodone (Dilaudid), do not have an analgesic ceiling effect.

Pharmacologic intervention is the only way to treat a patient's pain. A. True B. False

Pain management should include pharmacologic and nonpharmacologic interventions.

Which area of the brain may be involved in the discrimination and cognition of pain?

Parietal lobe The sensory homunculus, located on the postcentral gyrus of the parietal lobe, may be involved in the discriminative and cognitive components of pain.

When administering opioids to a pediatric patient, which complication should you stay alert for? A. Hypertension B. Emergence delirium C. Respiratory depression D. Myoclonus

Pediatric patients who receive opioids have the same risks of respiratory depression and apnea as adults. Emergence delirium is a complication seen in patients over age 15 after the administration of a procedural sedation drug, such as ketamine (Ketalar) and propofol (Diprivan). Hypertension is not an adverse effect of opioids. Etomidate (Amidate), an intravenous induction agent, may cause myoclonus.

Which term defines what can result from an abrupt drug cessation, a rapid dose reduction, a decreased blood level of the drug, or an antagonist administration.

Physical dependence is a state of adaptation manifested by a withdrawal syndrome

A patient states. "If I stand up straight, it hurts." This statement reflects which aspect of the pain assessment?

Precipitating factor The patient's statement reflects what precipitates or aggravates the pain. By using the PQRST mnemonic, you can gather information about the patient's pain. PQRST stands for palliative, provoking, or precipitating factors; quality; radiation; severity; and timing of pain.

assessment parameters of the FLACC pain scale are:

Quality of cry, level of activity, and consolability

Which part of the body has the highest concentration of nociceptors?

Skin Concentrated at various levels throughout the body, the skin has the highest concentration of nociceptors.

For a patient with a repeat visit for a migraine, what should the triage nurse do first? A. Perform a thorough pain assessment. B. Suggest taking a nonopioid analgesic. C. Immediately administer a strong opioid, as prescribed. D. Triage the patient as nonurgent.

Some patients with back problems, migraines, and abdominal disorders make frequent ED visits. These disorders can cause chronic pain. However, you must perform a thorough pain assessment to determine if the patient's pain is acute or chronic. This information helps determine if treatment with opioids is appropriate. Because patients with a headache should receive a medical screening to rule out acute causes of the pain, they should not be triaged as nonurgent.

what is is the main neurotransmitter associated with slow pain sensations

Substance P

Which substance causes a pain response?

Substance P Damaged tissue releases powerful mediators, such as substance P, potassium, leukotrienes, bradykinins, serotonin, histamines, arachidonic acid, thromboxanes, and platelet activating factor, which play a role in acute pain and possibly in chronic pain.

What does the A in the FLACC pain scale stands for? A. Analgesia B. Anxiety C. Agitation D. Activity

The A in the FLACC pain scale stands for activity. FLACC stands for face, legs, activity, cry, and consolability. This scale does not assess anxiety, agitation, or analgesia.

Which pain scale is the most appropriate for a school-age pediatric patient? A. FLACC B. FACES C. Self-report D. Numeric

The FACES Pain Scale, Oucher Scale, visual analog scale, color analog scale, and poker chip tool are appropriate scales for assessing pain in school-age pediatric patients.

Which pain scale is the most appropriate to use in an infant, age 6 months? A. FACES B. FLACC C. Numeric D. Oucher

The FLACC pain scale is a behavioral observation tool, appropriate for use in a nonverbal patient from ages 3 months to 7 years. It assesses the face, legs, activity, cry, and consolability.

Flumzenil (Romazicon) can reverse which procedural sedation medication? A. Fentanyl (Duragesic) B. Midazolam (Versed) C. Etomidate (Amidate) D. Propofol (Diprivan)

The effects of midazolam (Versed) are reversed with flumazenil (Romazicon). no reversal for propofol or etomidate

Which sensation results from the stimulation of myelinated A-delta fibers? A. Sharp pain B. Burning pain C. Aching pain D. Throbbing pain

The myelinated A-delta fibers rapidly transmit the pain impulse (fast pain), producing a sharp pain sensation.

Which pain theory best explains the concept of chronic pain? A. Gate control theory B. Specificity theory C. Neuromatrix theory D. Nociceptor response theory

The neuromatrix theory expands on the gate control theory and explains that chronic pain is a multidimensional experience caused by nerve impulse patterns known as signatures, which the brain generates through a widely distributed network called the body-self neuromatrix. The gate control and specificity theories do not explain the concept of chronic pain. The nociceptor response theory does not exist.

Which patient factor is appropriate to consider when selecting a pain assessment scale? A. Occupation B. Verbal skills C. Injury or illness D. Ability to draw

The pain scale should be developmentally appropriate and understandable by the patient. Observable scales that measure physical behavior may be selected if the patient cannot verbalize or understand the question. The patient's occupation, illness or injury, and ability to draw do not affect the selection of an appropriate pain scale.

Which factor is involved in the pathophysiology of pain? A. Conditional B. Somatic C. Behavioral D. Chronic

The pathophysiology of pain is complex, involving sensory, emotional, behavioral, and spiritual factors.

Which structure is the final step in the pain pathway and results in pain perception and interpretation?

Third-order neurons Third-order neurons in the thalamus, brainstem, and midbrain project to the central nervous system, which allows pain perception and interpretation. Also, the limbic and reticular tracts are activated by third-order neurons, resulting in arousal and emotional responses to pain. When stimulated, nociceptors (first-order neurons) in the skin, muscles, joints, arteries, and viscera transmit pain impulses to the spinal cord. Second-order neurons in the dorsal horn of the spinal cord transmit the pain impulse to higher brain areas via spinal pathways. The thalamus is the primary relay station for pain impulses.

which part of the brain allow the patient to perceive the location, quality, and intensity of the pain.

Third-order neurons in the thalamus, brainstem, and midbrain project to portions of the central nervous system

Which term defines the state of adaptation in which drug exposure results in a reduction of one or more of the drug's effects over time?

Tolerance Tolerance is defined as the state of adaptation in which exposure to a drug results in a reduction of one or more of the drug's effects over time.

Which term defines the state of adaptation in which drug exposure results in a reduction of one or more of the drug's effects over time? A. Tolerance B. Physical dependence C. Addiction D. Pseudoaddiction

Tolerance is defined as the state of adaptation in which exposure to a drug results in a reduction of one or more of the drug's effects over time. Physical dependence is a state of adaptation manifested by a withdrawal syndrome that can result from an abrupt drug cessation, a rapid dose reduction, a decreased blood level of the drug, or an antagonist administration. Addiction is a primary, chronic, neurobiological disease characterized by behaviors that include impaired control over drug use, compulsive drug use, continued use despite harm, craving, or any combination of these. Pseudoaddiction is the exhibition of behaviors of addiction that resolve when the pain is adequately treated.

In the emergency department, which intervention is not appropriate for managing a trauma patient? A. Withhold pain medication until diagnostic tests are complete. B. Continuously assess respiratory and neurologic status. C. Provide fluid resuscitation based on hemodynamic status. D. Protect the cervical spine until a cervical spine injury is ruled out.

Trauma patients should receive prompt, effective pain management. However, use caution in a patient with respiratory depression, hemodynamic instability, or coma.

Which is when burning, aching, or throbbing.

Unmyelinated C fibers transmit pain impulses more slowly (slow pain) causing this type of pain

The Oucher scale is appropriate for patients

between ages 3 and 13.

A noxious stimulus is one that is

damaging to normal tissues.

Using the five-level triage system of the Emergency Severity Index, Levels 3 and 4 , the patient requires

do not provide high priority

A patient who takes more than the maximum daily dose of acetaminophen (Tylenol) is at risk for injury to which organ? A. Liver B. Kidney C. Stomach D. Heart

hepatotoxicity.

Using the five-level triage system of the Emergency Severity Index, level 1, the patient requires

immediate life-saving intervention

Hyperalgesia

is an increased response to a stimulus that is normally painful.

Neuritis

is an inflammation of a nerve or nerves

The effects of fentanyl (Duragesic) are reversed by

naloxone (Narcan).

The FLACC scale is appropriate for assessing pain in

neonates, infants, or preschool (nonverbal) children.

In general anesthesia, the patient is

not aroused even by painful stimulation.

PQRST stands for

palliative, provoking, or precipitating factors; quality; radiation; severity; and timing of pain.

The FACES scale is appropriate for

pediatric patients, age 3 or older

The numeric scale is appropriate for

pediatric patients, age 5 or older

play and rewards are appropriate nonpharmacological methods for pain for which group of pts

preschoolers

Damaged tissue also releases which hormone which make the nerve endings more sensitive

prostaglandins xamples of stimuli may include a laceration, heat that causes tissue damage, or the stretching of an abdominal muscle from inflammation or blood in the abdomen.

Otherwise healthy patients, who take nonsteroidal anti-inflammatory drugs have an increased risk of

renal impairment, gastrointestinal bleeding, and cardiovascular risks.

Pseudoaddiction is

the exhibition of behaviors of addiction that resolve when the pain is adequately treated.

Before catheterizing a male patient, consider the use of

topical lidocaine.

Before performing a venipuncture, consider using

topical vapocoolants, intradermal lidocaine, or lidocaine 4% (LMX 4) cream.

In minimal and moderate sedation, the patient responds to

verbal commands

Bowel obstruction, venous occlusion, or ischemia may cause PAIN that is

visceral pain.

Parental involvement is appropriate for

younger pediatric patients.