deWit Medical Surgical Nursing Chapter 7 Questions
Packs or compresses for heat therapy are usually left in place for ___
15 to 20 minutes
The LPN/LVN is teaching a patient from another culture about managing pain in the early postoperative period. Which patient statement indicates a need for further teaching? 1 "At this time, I should try to maintain my usual aversion to using analgesics." 2 "If I feel like moaning and groaning a bit, it's okay." 3 "I can expect the methods used to relieve my pain to help me from getting fatigued." 4 "If I take a pain medication, I'm likely to have fewer complications from immobility."
ANS 1 Avoiding the use of analgesics will hamper the patient's ability to recover from the surgery in a timely manner.
A patient with terminal cancer says to the LPN/LVN, "I'm so afraid that they won't be able to control my pain." In order to give the best care, what should the nurse understand about the patient's fear? 1 The fear of uncontrollable pain may increase the intensity of pain. 2 The fear of uncontrollable pain may be a sign of not accepting the inevitability of pain. 3 The fear of the uncontrollable pain may be related to unresolved attitudes toward death. 4 The fear of the uncontrollable of pain may be an expression of manipulative behavior.
ANS 1 Based on the gate control theory of pain, anxiety seems to open the gate, which causes increased pain.
The nurse is preparing to administer a narcotic pain medication to a patient. Which assessment is most critical prior to administration of the medication? 1 Respiratory rate. 2 Heart rate. 3 Blood pressure. 4 Pulse pressure.
ANS 1 Narcotic analgesia produces respiratory depression as an additional effect, especially in larger doses. Less that 8 respirations per minute is the general standard for decreasing the dosage or increasing time between doses. Although respiratory status is the priority, BP can decrease following narcotic analgesia, particularly if it was low originally. BP needs to be monitored.
The nursing student is studying the gate control theory of pain. The student correctly identifies the gate control theory of pain as having what characteristic? 1 The gate control theory suggests that when a large volume of nonpainful stimuli are competing for the gate, pain impulses may be blocked. 2 The gate control theory suggests that all pain impulses are transmitted up the spinal cord. 3 The gate control theory states that pain impulses can be transmitted only if the spinal cord "gate" is open at all times. 4 The gate control theory states that pain will not be perceived when there is no observable tissue damage.
ANS 1 Other nonpainful stimuli may treat pain by blocking the pain impulse according to the gate control theory. Examples include massage and electrical nerve stimulation. Pain impulses must be of sufficient number and strength to be transmitted. Chronic pain, for example, has no clear explanation. It may result from the "gate" remaining open at all times.
The nurse is assessing the patient's pain level. Which physiologic sign would indicate the patient is experiencing pain? 1 Increased respiratory rate 2 Anxiety 3 Blood pressure within normal limits (WNL) for patient 4 Increased temperature
ANS 1 Rapid breathing may indicate the patient is sensing discomfort or pain. Anxiety may increase the intensity of perceived pain, but it does not cause pain. Blood pressure changes are a common physiologic response to pain. Body temperature does not correlate with pain sensation.
The nurse has just administered pain medication to a patient. To prevent complications, the LPN/LVN should take which action when administering analgesic medications? (Select all that apply.) 1 Document reactions to medications after they are given. 2 Record the patient's use of adjunctive measures (e.g., massage). 3 Promptly notify the physician if any problems occur. 4 Remind the patient to ambulate only in his room after pain medication has been given. 5 Ask the patient to rate his pain on a pain scale before and after the medication has been given.
ANS 1,2,3,5 It is important for the nurse to document reactions and effectiveness of the pain medication, as well as the amount of pain experienced prior to the medication. Adjunctive measures that are effective are important to record so these measures can be used in the future. The patient should only ambulate with assistance after receiving pain medication
The nurse gives the patient a 4mg IM dose of morphine at 10:00AM. When should the nurse next evaluate the effectiveness of the pain control medication: 1 10:15am 2 10:45am 3 11:00am 4 2:00pm
ANS 2
The nurse understands that the choice of a pain scale to use for a patient depends on: 1 Pain scales available on the unit 2 Age and physical and cognitive ability of the patient 3 Nurse's preference for a pain scale 4 World Health Organization recommendation
ANS 2
The patient is experiencing pain in a limb after amputation. What type of pain is this patient experiencing: 1 Chronic pain 2 Phantom pain 3 Referred pain 4 Nociceptive pain
ANS 2
A newborn infant is to have a surgical procedure. The LPN/LVN should understand which concept as a basis for the newborn's pain management? 1 Newborns are not mature enough to experience pain. 2 Newborns perceive pain. 3 Newborns do not remember painful experiences. 4 Newborns who are breastfed receive antibodies to deal with pain.
ANS 2 It was once thought that newborns do not perceive pain, but studies have shown that it is likely that newborns do perceive pain. Therefore, analgesia for neonates is appropriate during procedures or situations that would be known to cause pain in more mature patients.
unit (PACU) following right total knee replacement surgery. The best time to administer pain medication to the patient is: 1 when he requests it. 2 on a regularly scheduled basis. 3 after he exhibits objective signs of pain. 4 4 hours after he is transferred to his room.
ANS 2 The best pain management is to prevent its occurrence. Also, patients often do not request pain medication early enough to prevent or minimize its effects. Administration time of previous pain medication must be ascertained. Waiting an additional 4 hours is most likely too long between doses of analgesic to effectively manage the patient's pain.
A patient who has gallbladder problems complains of pain under her right scapula. Which of these conclusions about the patient's complaints is accurate? 1 The patient is misinterpreting the pain. 2 The patient is experiencing referred pain. 3 The patient has a neurologic condition that causes improper interpretation of pain. 4 The patient's pain is not related to her gallbladder problems.
ANS 2 When a patient experiences pain felt in a different part of the body from where it actually originates, it is considered referred pain. Referred pain can be difficult when diagnosing a problem since the site of origin might be overlooked.
The nurse is caring for a patient receiving a strong narcotic for pain control. During the assessment the nurse notes the patient's respiratory rate to be 8 respirations per minute. Which medication may be necessary for this patient? 1 Potassium sulfate 2 Naloxone (Narcan) 3 Sodium chloride 4 Ipecac
ANS 2 Naloxone (Narcan) is a narcotic antagonist medication that is given to combat respiratory depression caused by narcotics. It may be given IM or IV.
A patient receives an analgesic. Several hours later, the patient develops hives and itching. Which of these actions is essential for the LPN/LVN to take immediately? 1 Find out if the medication relieved the pain. 2 Report the finding. 3 Ask the patient to remain in bed. 4 Tell the patient to refrain from eating.
ANS 2 The health care provider should be notified immediately of the reaction so that proper treatment can be initiated. It is irrelevant at this time to determine if the pain medication has been effective. The nurse will want to keep the patient in bed and withhold foods and fluid, as well as monitor them closely, but these are not the priority actions.
A patient is undergoing rehabilitative therapy. When would be the best time to give analgesic medication: 1 Give PRN medications every 4-6 hours 2 Give early in the morning before performing ADLs 3 Give on a schedule to minimize pain during therapy sessions 4 Give whenever the pain is greater than 4/10
ANS 3
Gabapentin(Neurontin) is given to relieve which type of pain: 1 Acute pain 2 Chronic pain 3 Neuropathic pain 4 Nociceptive pain
ANS 3
The patient is unable to verbalize pain. Which patient behavior is the best indicator that pain medication is successfully addressing the patient's pain: 1 Patient sleeps unless aroused by nurse 2 Patient watches TV without grimacing 3 Patient actively participates in physical therapy 4 Patient smiles at friends and family when they visit
ANS 3
The nurse is caring for a patient who is debilitated from rheumatoid arthritis. The nurse is aware that pain in debilitated patients has which characteristic? 1 Debilitated patients are often not aware of the pain. 2 Debilitated patients are usually more tolerant of the pain. 3 Debilitated patients tend to be less able to withstand the pain. 4 Debilitated patients are as able as well individuals to withstand the pain.
ANS 3 Coping with a chronic illness or chronic pain expends a great deal of energy, so debilitated patients are often less able to withstand pain. Fatigue also increases the perception of pain.
A patient is brought to the emergency department after experiencing excruciating pain for the past 36 hours. The patient says the pain is still intense. The patient is to have an examination, has not had any medications, and falls asleep while waiting for the physician. Which of these interpretations of the patient's behavior is most accurate? 1 The patient's pain was an attention-getting device. 2 The patient is no longer in pain. 3 The patient may have become exhausted by the pain. 4 The patient is attempting to get drugs.
ANS 3 Intense pain, especially over an extended period of time, is very exhausting and may have led to the patient falling asleep. The nurse should not assume that the patient was seeking attention or drugs, or that the patient is no longer in pain.
Two days after surgery, a 64-year-old patient with insulin-dependent diabetes who has had a left below-the-knee amputation tells the nurse she has pain in her left great toe. What kind of pain is the patient experiencing? 1 Referred 2 Radiating 3 Phantom 4 Psychogenic
ANS 3 Phantom limb sensation is a commonly occurring phenomenon following amputation and should be evaluated as acute pain. It may spontaneously resolve or persist for several months. Referred pain originates in an area anatomically distant from the area it is perceived; this is due to types and distribution of pain fibers in body areas. Radiating pain spreads out from the source of the pain. Psychogenic pain is thought to be of psychological origin.
The nurse is caring for a patient receiving epidural analgesia. The patient should be monitored for which side effect? 1 Hypertension 2 Increased respiratory rate 3 Urinary retention 4 Tachycardia
ANS 3 Possible side effects from epidural analgesia include delayed respiratory suppression or apnea, bradycardia, hypotension, urinary retention, nausea and vomiting, and allergic reactions such as itching or hives.
When considering factors that may be contributing to a patient's pain, the nurse correctly identifies which factor as being the least likely to affect a patient's perception of pain? 1 Cultural background 2 Anxiety level 3 Socioeconomic status 4 Belief of what the pain could mean
ANS 3 Socioeconomic status has no effect on pain perception. A significant amount of data exist correlating cultural background, anxiety level, and beliefs regarding pain with pain perception and intensity experienced.
When assessing a patient who is experiencing acute pain and comparing the findings to the patient's normal database, what can the LPN/LVN can expect to find? 1 Decrease in respiratory rate 2 Loss of muscle tone 3 Increase in blood pressure 4 Decrease in pulse pressure
ANS 3 The patient experiencing acute pain may have physiologic symptoms such as increased pulse and respiratory rates, increased blood pressure, diaphoresis, and increased muscle tension.
An 84-year-old man is admitted to the hospital because of kidney stones. He is in acute pain. Which of these statements about administering analgesics to the elderly is accurate? 1 The patient should not be given drugs that have respiratory effects. 2 The patient may require larger doses of medication to achieve relief. 3 The patient will require careful monitoring for side effects. 4 The patient can easily become addicted to narcotics.
ANS 3 When administering analgesics to elderly patients, the nurse must carefully monitor for side effects. The elderly patient may have reduced tolerance to analgesics for a number of reasons, including slower metabolism of medications. Elderly patients often require a lower dose of pain medication.
Intramuscular analgesic injections are not recommended for the elderly because: 1 Kidney function is decreased and the drug is excreted more slowly 2 Circulation is sluggish and the medication is not packed up quickly 3 Skin and tissue are more fragile and bruising is likely 4 Muscle and fat tissue are diminished which may affect bioavailability
ANS 4
When evaluating the effectiveness of pain medication, in addition to assessing physical body language, the nurse should rely on: 1 The length of time between requests for pain medication 2 How sedated the patient becomes after receiving the medication 3 Whether the patient experiences nausea from the medication 4 What the patient says about his pain relief
ANS 4
Which pain scale would be appropriate for a patient who is cognitively impaired: 1 Visual scale 2 Color scale 3 Pieces of pain scale 4 Behavioral pain scale
ANS 4
A patient is asking the nurse how endorphins work. The LPN/LVN explains to the patient that endorphins aid in which way? 1 Preventing pain and discomfort 2 Inducing unpleasant sensations 2 Producing depression and an "I don't care" attitude 4 Reducing anxiety and relieving pain
ANS 4 Endorphins (endogenous morphine) attach to pain receptors and block pain.
A patient is receiving a pain medication that contains codeine. Which side effect side effect is the patient most likely to experience? 1 Excessive perspiration 2 Tingling of the fingers and toes 3 Diplopia 4 Constipation
ANS 4 Narcotics slow peristalsis, causing water to be absorbed from the stool while in the colon. These two factors lead to constipation. The other options are not typical side effects of narcotics.
A postoperative patient is to receive patient-controlled analgesia (PCA). The LPN/LVN explains the method to the patient. Which of these statements, if made by the patient, indicates a need for further instruction? 1 "I will be able to tell when I need medication by how I feel." 2 "I will be able to give myself medication at any time within certain parameters." 3 "I will be able to control the amount of medication I give myself within certain parameters." 4 "I will have set times at which I can give certain quantities of medications."
ANS 4 PCA allows the patient to self-administer pain medication based on his or her needs, within preset parameters. There are usually no set times for medication administration via PCA.
The nurse is caring for a cancer patient. The nurse notices that the patient always refuses the offer for pain medication. What might be the cause of his refusal of pain medication? 1 Low pain threshold 2 High pain threshold 3 Low pain tolerance 4 High pain tolerance
ANS 4 Pain tolerance indicates the level of pain that must be present before an individual is significantly affected by it. Pain threshold is the level of pain that must be present before an individual perceives its presence.
On the first day following bowel resection, the nurse's assessment notes the patient to be awake, alert, and moving all extremities. To keep him comfortable, the nurse wants to assess his pain level. What intervention will most accurately reveal his pain level? 1 Measuring the patient's vital signs. 2 Reviewing his chart to see how much pain medication he has had. 3 Assessing his discomfort when you assist him to turn and deep-breathe. 4 Asking him how he feels and to rate his pain.
ANS 4 The most significant data regarding a patient's level of pain can be obtained by asking the patient to rate his pain on a scale of 0 to 10 (no pain to worst pain ever experienced). The other options will aid in assessing his pain, but the patient's description is the most accurate way to assess pain level.
Which is an understanding the LPN/LVN should have concerning pain? 1 If pain is present, there is a demonstrable cause. 2 A patient with low pain tolerance has no self-control. 3 A patient with high pain tolerance is emotionally mature. 4 The person who has pain is the one to decide if he or she is willing to tolerate it.
ANS 4 The nurse should understand that there does not have to be an obvious reason for the patient to experience pain. In addition, pain tolerance is very individualized and may even vary within an individual at different times. The person experiencing pain is the only one who may ultimately decide if he or she is willing to tolerate pain.
A patient tells the LPN/LVN that it helps his muscle pain to use a mentholated rub, which he buys as an over-the-counter product. Which of these instructions should the nurse give the patient? 1 "Take a shower right after you apply the rub." 2 "Try not to breathe in the menthol from the rub." 3 "Be sure to lie down for at least 30 minutes after applying the rub." 4 "Wash your hands well after applying the menthol rub."
ANS 4 Menthol should not be placed near or in the eyes or on mucous membranes; therefore, it is important for the patient to wash his hands after applying the product. Showering immediately after application would not allow the menthol to penetrate the skin. Breathing the menthol from the application should not disturb the patient. Lying down is not necessary.