NURS 211 - NCLEX Style Questions (Pain)
An older adult patient is discharged from the hospital with nortriptyline (Pamelor) for neuropathic pain. Which statement indicates the patient's need for additional education? a. "I will chew sugarless gum and mints." b. "I will drink carbonated beverages." c. "I will take my medication at breakfast." d. "I will use a humidifier at bedtime."
"I will take my medication at breakfast."
Chuck, who is in the hospital, complains of abdominal pain that ranks 9 on a scale of 1 (no pain) to 10 (worst pain). Which interventions should the nurse implement? (Select all that apply.) A. Assessing the client's bowel sounds B. Taking the client's blood pressure and apical pulse C. Obtaining a pulse oximeter reading D. Notifying the health care provider E. Determining the last time the client received pain medication F. Encouraging the client to turn, cough, and deep breathe
A, B, E The nurse must rule out complications prior to administering pain medication, so her interventions would include assessing to make sure the client has bowel sounds and determining if the client is hemorrhaging by checking the client's blood pressure and pulse. The nurse must also make sure the pain medication is due according to the health care provider's orders. Obtaining a pulse oximeter reading and turning, coughing, and deep breathing will not help the client's pain. There is no need to notify the health care provider in this situation.
Which term would the nurse use to document pain at one site that is perceived in other site? A. Referred pain B. Phantom pain C. Intractable pain D. Aftermath of pain
A. Referred pain Referred pain is pain occurring at one site that is perceived in another site. Referred pain follows dermatome and nerve root patterns. Phantom pain refers to pain in a part of the body that is no longer there, such as in amputation. Intractable pain refers to moderate to severe pain that cannot be relieved by any known treatment. Aftermath of pain, a phase of the pain experience and the most neglected phase, addresses the client's response to the pain experience.
When evaluating a client's adaptation to pain, which behavior indicates appropriate adaptation? A. The client distracts himself during pain episodes. B. The client denies the existence of any pain. C. The client reports no need for family support. D. The client reports pain reduction with decreased activity.
A. The client distracts himself during pain episodes. Distraction is an appropriate method of reducing pain. Denying the existence of any pain is inappropriate and not indicative of coping. Exclusion of family members and other sources of support represents a maladaptive response. Range-of-motion exercises and at least mild activity, not decreased activity, can help reduce pain and are important to prevent complications of immobility.
A 12-year-old student fall off the stairs, grabs his wrist, and cries, "Oh, my wrist! Help! The pain is so sharp, I think I broke it." Based on this data, the pain the student is experiencing is caused by impulses traveling from receptors to the spinal cord along which type of nerve fibers? A. Type A-delta fibers B. Autonomic nerve fibers C. Type C fibers D. Somatic efferent fibers
A. Type A-delta fibers Type A-delta fibers conduct impulses at a very rapid rate and are responsible for transmitting acute sharp pain signals from the peripheral nerves to the spinal cord. Only type A-delta fibers transmit sharp, piercing pain. Somatic efferent fibers affect the voluntary movement of skeletal muscles and joints. Type C fibers transmit sensory input at a much slower rate and produce a slow, chronic type of pain. The autonomic system regulates involuntary vital functions and organ control such as breathing.
Morphine 10 mg IV every 4 to 6 hours prn is ordered for a patient with a pancreatic tumor who has a distant history of opioid abuse. After 3 days of receiving the morphine every 6 hours, the patient tells the nurse that the medication is needed more frequently to control the pain. The best initial action by the nurse is to: a. administer the morphine every 4 hours as needed. b. consult with the doctor about initiating an appropriate weaning protocol for the morphine. c. remind the patient that the previous substance abuse increases the risk for addiction. d. use alternative therapies such as heat or cold
A: administer the morphine every 4 hours as needed
A client experiencing pain has been prescribed aspirin. The nurse realizes that this medication will affect which pain process? 1. Transduction. 2. Transmission. 3. Perception. 4. Modulation.
ANS: 1 Transduction During the transduction phase, noxious stimuli trigger the release of biochemical mediators, such as prostaglandins, bradykinin, serotonin, histamine, and substance P, that sensitize nociceptors. Noxious or painful stimulation also causes movement of ions across cell membranes, which excites nociceptors. Pain medications such as ibuprofen or aspirin can work during this phase by blocking the production of prostaglandin or by decreasing the movement of ions across the cell membrane
A pt who uses a fentanyl patch for chronic abdominal pain caused by ovarian CA asks the nurse for the prescribed Vicodin, but the pt is asleep when the nurse returns with the med. Which action is best for the nurse to take? a. Wake the pt & administer the hydrocodone. b. Wait until the pt wakes up & reassess the pain. c. Suggest the use of nondrug therapies for pain relief instead of additional opioids. d. Consult w/HCP about changing the fentanyl (Duragesic) dose.
ANS: A Because patients with chronic pain frequently use withdrawal and decreased activity as coping mechanisms for pain, sleep is not an indicator that the patient is pain free. The nurse should wake the patient and administer the hydrocodone.
A patient with chronic back pain has learned to control the pain with the use of imagery and hypnosis. The patient's spouse asks the nurse how these techniques work. Which response by the nurse is best? a. "The strategies work by affecting the perception of pain." b. "These techniques block the pain pathways of the nerves." c. "Both strategies prevent transmission of painful stimuli to the brain." d. "The therapies slow the release of chemicals in the spinal cord that cause pain."
ANS: A Cognitive therapies affect the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.
A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic arthritic joint pain following a traumatic injury complains of nausea and abdominal fullness. Which action should the nurse take initially? a. Administer the ordered antiemetic medication. b. Tell the patient that the nausea will subside in about a week. c. Order the pt a clear liquid diet until the nausea decreases. d. Consult with the HCP about using a different opioid.
ANS: A Nausea is frequently experienced w/the initiation of opioid therapy, & antiemetics usually are prescribed to treat this expected S/E. There is no indication that a different opioid is needed, although if the nausea persists, the HCP may order a change of opioid. A clear liquid diet may decrease the nausea, but the best choice would be to administer the antiemetic medication & allow the pt to eat.
The nurse is caring for a 1-day postoperative patient who is receiving morphine through patient-controlled analgesia (PCA). What action by the nurse is a priority? a. Check the respiratory rate. b. Assess for nausea after eating. c. Inspect the abdomen and auscultate bowel sounds. d. Evaluate the sacral and heel areas for signs of redness.
ANS: A The patient's respiratory rate is the highest priority of care while using PCA medication because of the possible respiratory depression. The other information may also require intervention but is not as urgent to report as the respiratory rate.
A nurse assesses a postoperative patient 2 days after chest surgery. What findings indicate that the patient requires better pain management (select all that apply)? a. Confusion b. Hypoglycemia c. Poor cough effort d. Shallow breathing e. Elevated temperature
ANS: A, C, D, E Inadequate pain control can decrease tidal volume and cough effort, leading to complications such as pneumonia with increases in temperature. Poor pain control may lead to confusion through a variety of mechanism, including hypoventilation and poor sleep quality. Stressors such as pain cause increased release of corticosteroids that can result in hyperglycemia.
Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain? a. Check the skin under the heating pad. b. Take the respiratory rate every 2 hours. c. Monitor sedation using the sedation assessment scale. d. Ask the patient about whether pain control is effective.
ANS: B Obtaining the respiratory rate is included in UAP education and scope of practice. Assessment for sedation, pain control, and skin integrity requires more education and scope of practice.
A patient who is using a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first? a. Obtain vital signs. b. Remove the fentanyl patch. c. Notify the health care provider. d. Administer the prescribed PRN naloxone (Narcan).
ANS: B The assessment data indicate a possible overdose of opioid. The first action should be to remove the patch. Naloxone administration in a pt who has been chronically using opioids can precipitate withdrawal & wouldn't be the first action. Notification of the HCP & continued monitoring are also needed, but the pt's data indicate that more rapid action is needed. The RR alone is an indicator for immediate action before obtaining BP, pulse, & temperature.
A pt w/terminal cancer-related pain & a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first? a. Use distraction by talking about things the pt enjoys. b. Administer the prescribed PRN immediate-acting morphine. c. Suggest the use of alternative therapies such as heat or cold. d. Consult with the doctor about increasing the MS Contin dose.
ANS: B The patient's pain requires rapid treatment and the nurse should administer the immediate-acting morphine. Increasing the MS Contin dose and use of alternative therapies may also be needed, but the initial action should be to use the prescribed analgesic medications
The nurse reviews the medication orders for an older patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy? a. Naproxen (Aleve) 200 mg orally b. Oxycodone (Roxicodone) 5 mg orally c. Acetaminophen (Tylenol) 650 mg orally d. Aspirin (acetylsalicylic acid, ASA) 650 mg orally
ANS: C Acetaminophen is the best first-choice medication. The principle of "start low, go slow" is used to guide therapy when treating older adults because the ability to metabolize medications is decreased & the likelihood of medication interactions is increased. Nonopioid analgesics are used first for mild to moderate pain, although opioids may be used later. Aspirin and the NSAIDs are associated with a high incidence of GI bleeding in older patients.
The nurse teaches a student nurse about the action of ibuprofen. Which statement, if made by the student, indicates that teaching was effective? a. "The drug decreases pain impulses in the spinal cord." b. "The drug decreases sensitivity of the brain to painful stimuli." c. "The drug decreases production of pain-sensitizing chemicals." d. "The drug decreases the modulating effect of descending nerves."
ANS: C Nonsteroidal antiinflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by NSAIDs.
When visiting a hospice pt, the nurse assesses that the pt has a RR of 11 bpm & complains of severe pain. Which action is best for the nurse to take? a. Inform the pt that increasing the morphine will cause the respiratory drive to fail. b. Tell the pt that additional morphine can be administered when the RR is 12. c. Titrate the prescribed morphine dose upward until the pt indicates adequate pain relief. d. Administer a nonopioid analgesic, such as a NSAID, to improve pt pain control
ANS: C The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's RR.
The nurse reviews the medication administration record in order to choose the most appropriate pain medication for a pt w/cancer who describes the pain as "deep, aching and at a level 8 on a 0 to 10 scale". Which medication should the nurse administer? a. Fentanyl (Duragesic) patch b. Ketorolac (Toradol) tablets c. Hydromorphone (Dilaudid) IV d. Acetaminophen (Tylenol) suppository
ANS: C The patient's pain level indicates that a rapidly acting medication such as an IV opioid is needed. The other medications also may be appropriate to use, but will not work as rapidly or as effectively as the IV hydromorphone.
The nurse assesses that a patient receiving epidural morphine has not voided for over 10 hours. What action should the nurse take initially? a. Monitor for withdrawal symptoms. b. Place an indwelling urinary catheter. c. Ask if the patient feels the need to void. d. Document this allergic reaction in the patient's chart.
ANS: C Urinary retention is a common S/E of epidural opioids. Assess if the pt feels the need to void. Since urinary retention is a possible S/E, there is no reason for concern of withdrawal symptoms. Usually an in and out catheter is performed to empty the bladder if the pt is unable to void because of the risk of infection with an indwelling catheter. Urinary retention does not indicate that this reaction is an allergic reaction.
A patient who has fibromyalgia tells the nurse, "I feel depressed because I ache too much to play golf." The patient says the pain is usually at a level 7 (0 to 10 scale). Which patient goal has the highest priority when the nurse is developing the treatment plan? a. The patient will exhibit fewer signs of depression. b. The patient will say that the aching has decreased. c. The patient will state that pain is at a level 2 of 10. d. The patient will be able to play 1 to 2 rounds of golf.
ANS: D For chronic pain, pts are encouraged to set functional goals such as being able to perform ADLs & hobbies. Playing golf as the desired activity, so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment. The nurse should also assess for depression, but the pt has identified the depression as being due to the inability to play golf, so the goal of being able to play 1-2 rounds of golf is the most appropriate.
A nurse assesses a patient with chronic cancer pain who is receiving imipramine (Tofranil) in addition to long-acting morphine. Which statement, if made by the patient, indicates to the nurse that the patient is receiving adequate pain control? a. "I'm not anxious at all." b. "I sleep 8 hours every night." c. "I feel much less depressed since I've been taking the Tofranil." d. "The pain is manageable and I can accomplish my desired activities.
ANS: D Imipramine is being used in this patient to manage chronic pain and improve functional ability. Although the medication is also prescribed for patients with depression, insomnia, and anxiety, the evaluation for this patient is based on improved pain control and activity level.
A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain suddenly complains of rapid onset pain at a level 9 (0 to 10 scale) and requests "something for pain that will work now." How will the nurse document the type of pain reported by this patient? a. Somatic pain b. Referred pain c. Neuropathic pain d. Breakthrough pain
ANS: D Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.
A patient with chronic neck pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask? a. "Can you describe the quality of your pain?" b. "Has there been a change in the pain location?" c. "How would you rate your pain on a 0 to 10 scale?" d. "Does the pain keep you from doing things you enjoy?"
ANS: D The goal for the treatment of chronic pain usually is to enhance function and quality of life. The other questions are also appropriate to ask, but information about patient function is more useful in evaluating effectiveness
A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which action by the nurse is best? a. Provide amitriptyline (Elavil) 10 mg orally. b. Administer lorazepam (Ativan) 1 mg orally. c. Offer ibuprofen (Motrin) 400 to 800 mg orally. d. Give immediate-release morphine 30 mg orally
ANS: D The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid, such as the immediate-release morphine. Lorazepam and amitriptyline may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of antianxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.
Which patient with pain should the nurse assess first? a. Patient with postoperative pain who received morphine sulfate IV 15 minutes ago b. Patient with neuropathic pain who has a dose of hydrocodone (Lortab) scheduled now c. Patient who received hydromorphone (Dilaudid) 1 hour ago and currently has a sedation scale of 2 d. Patient who returned from the postanesthesia care unit 2 hours ago and has a respiratory rate of 10
ANS: D This patient's respiratory rate indicates possible respiratory depression. The risk for oversedation is greatest in the first 4 hours after transfer from the postanesthesia care unit. Patients should be reassessed 30 minutes after receiving IV opioids for pain. A scheduled oral mediation does not need to be administered exactly at the scheduled time. A sedation scale of 2 indicates adequate pain control from hydromorphone.
The nurse administers IV morphine at 0830. At what time will the nurse ask the pt if pain relief was obtained? a. 1000 b. 1030 c. 0900 d 0930
After administering IV medication, check the pt in 15 to 30 minutes for relief from pain. IV medication is injected directly into the bloodstream and bypasses the gastric system metabolism.
A patient is utilizing a heating pad at home for the treatment of a muscle spasm. The pain management nurse notes the patient is on a transdermal fentanyl (Duragesic) patch. What will the nurse include in the patient's education? a. Avoid using the heating pad directly over the patch. b. Cover the patch with a cloth while using the heating pad. c. Remove the patch while using the heating pad. d. Stop the use of the heating pad until the patch is discontinued.
Avoid using the heating pad directly over the patch
Christine Ann is about to take her NCLEX examination next week and is currently reviewing the concept of pain. Which scientific rationale would indicate that she understands the topic? A. Pain is an objective sign of a more serious problem B. Pain sensation is affected by a client's anticipation of pain C. Intractable pain may be relieved by treatment D. Psychological factors rarely contribute to a client's pain perception
B. Pain sensation is affected by a client's anticipation of pain Phases of pain experience include the anticipation of pain. Fear and anxiety affect a person's response to sensation and typically intensify the pain. Intractable pain is moderate to severe pain that cannot be relieved by any known treatment. Pain is a subjective sensation that cannot be quantified by anyone except the person experiencing it. Psychological factors contribute to a client's pain perception. In many cases, pain results from emotions, such as hostility, guilt, or depression.
A patient with extensive second-degree burns on the legs and trunk is using patient-controlled analgesia (PCA) with IV morphine to be delivered at 1 mg every 10 minutes to control the pain. Several times during the night, the patient awakens in severe pain, and it takes more than an hour to regain pain relief. The most appropriate action by the nurse is to a. request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain. b. consult with the patient's health care provider about adding a continuous morphine infusion to the PCA regimen at night. c. teach the patient to push the button every 10 minutes for an hour before going to sleep even if the pain is minimal. d. administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.
B: consult with the patient's health care provider about adding a continuous morphine infusion to the PCA regimen at night
Miggy, a 6-year-old boy, received a small paper cut on his finger, his mother let him wash it and apply small amount of antibacterial ointment and bandage. Then she let him watch TV and eat an apple. This is an example of which type of pain intervention? A. Pharmacologic therapy B. Environmental alteration C. Control and distraction D. Cutaneous stimulation
C. Control and distraction The mothers actions are example of control and distraction. Involving the child in care and providing distraction took his mind off the pain. Pharmacologic agents for pain analgesics — were not used. The home environment was not changed, and cutaneous stimulation, such as massage, vibration, or pressure, was not used.
Which statement represents the best rationale for using noninvasive and non-pharmacologic pain-control measures in conjunction with other measures? A. These measures are more effective than analgesics. B. These measures decrease input to large fibers. C. These measures potentiate the effects of analgesics. D. These measures block transmission of type C fiber impulses.
C. These measures potentiate the effects of analgesics. Noninvasive measures may result in release of endogenous molecular neuropeptides with analgesics properties. They potentiate the effect of analgesics. No evidence indicates that noninvasive and nonpharmacologic measures are more effective than analgesics in relieving pain. Decreased input over large fibers allows more pain impulses to reach the central nervous system. There is no connection between type C fiber impulses and noninvasive and nonpharmacologic pain-control measures.
A client is surprised to learn of the diagnosis of a heart attack when there was no chest pain experienced but only some left shoulder pain. What should the nurse explain to the client about the type of pain experienced? 1. Phantom pain 2. Referred pain 3. Visceral pain 4. Chronic pain
Correct Answer: 2 Referred Pain Referred pain appears to arise in different areas of the body, as may occur with cardiac pain.
An older client who refuses medication for pain is irritable and unable to sleep. What should the nurse explain to the client to encourage the use of pain medication? Standard Text: Select all that apply. 1. There are high-dose medications that will eradicate the pain. 2. The lack of pain control is causing the inability to sleep. 3. The lack of pain control is causing irritability. 4. The risks of taking pain medication are low in the older population. 5. The lack of pain control will affect mobility and activity tolerance.
Correct Answer: 2,3,5
A client is complaining of having the same type of pain that he experienced prior to being diagnosed with cancer. The nurse realizes that which process will influence this client's perception of pain? 1. Transmission. 2. Modulation. 3. Perception. 4. Transduction.
Correct Answer: 3 Perception Perception is when the client becomes conscious of the pain. Pain perception is the sum of complex activities in the CNS that can shape the character and intensity of pain perceived and ascribes meaning to the pain. The psychosocial context of the situation and the meaning of the pain based on past experiences and future hopes and dreams help to shape the behavioral response that follows.
A client rates pain as being 7 on a scale from 0 to 10. What will the nurse document as this client's pain intensity? 1. Mild pain 2. Moderate pain 3. Severe pain 4. Physiological pain
Correct Answer: 3 Severe Severe pain is rated a 7-10 on a scale of 0 to 10.
A client is experiencing pain after spraining an ankle. The nurse realizes the type of pain the client is most likely experiencing would be: 1. Mild pain 2. Severe pain 3. Somatic pain 4. Visceral pain
Correct Answer: 3 Somatic Pain Somatic pain originates in the skin, muscles, bone, or connective tissue. The sharp sensation of a paper cut or aching of a sprained ankle are common examples of somatic pain.
The client is admitted to the emergency department with complaints of abdominal pain. The client denies any nausea or vomiting. When asked, the client states the pain started 2 hours ago and describes the pain as "cramping." The client is most likely experiencing what type of pain? 1. Chronic pain 2. Phantom pain 3. Visceral pain 4. Acute pain
Correct Answer: 4 Acute Pain Acute pain is pain that is directly related to tissue injury and resolves when tissue heals.
A client tells the nurse that an ice pack works well to reduce the intensity of back pain. The nurse realizes that the client is implementing: 1. A placebo. 2. Distraction. 3. Guided imagery. 4. The gate control theory of pain.
Correct Answer: 4 The Gate Control Theory In the gate control theory, signals of noxious stimuli are carried to the dorsal horn, where they are modified according to the balance of the substantia gelatinosa. By using ice, the substantia gelatinosa is calmed, reducing the pain.
A 50-year-old widower has arthritis and remains in bed too long because it hurts to get started. Which intervention should the nurse plan? A. Telling the client to strictly limit the amount of movement of his inflamed joints B. Teaching the client's family how to transfer the client into a wheelchair C. Teaching the client the proper method for massaging inflamed, sore joints D. Encouraging gentle range-of-motion exercises after administering aspirin and before rising
D. Encouraging gentle range-of-motion exercises after administering aspirin and before rising Aspirin raises the pain threshold and, although range-of-motion exercises hurt, mild exercise can relieve pain on rising. Strict limitation of motion only increases the client's pain. Having others transfer the client into a wheelchair does not increase his feelings of dependency. Massage increases inflammation and should be avoided with this client.
Ryan underwent an open reduction and internal fixation of the left hip. One day after the operation, the client is complaining of pain. Which data would cause the nurse to refrain from administering the pain medication and to notify the health care provider instead? A. Left hip dressing dry and intact B. Blood pressure of 114/78 mm Hg; pulse rate of 82 beats per minute C. Left leg in functional anatomic position D. Left foot cold to touch; no palpable pedal pulse
D. Left foot cold to touch; no palpable pedal pulse A left foot cold to touch without palpable pedal pulse represents an abnormal finding on neurovascular assessment of the left leg. The client is most likely experiencing some complication from surgery, which requires immediate medical intervention. The nurse should notify the health care provider of these findings. A dry and intact hip dressing, blood pressure of 114/78 mm Hg, pulse rate of 82 beats per minute, and a left foot in functional anatomic position are all normal assessment findings that do not require medical intervention.
Which nonpharmacologic intervention is difficult to use with older adults who are cognitively impaired? a. Aromatherapy. b. Distraction. c. Guided imagery. d. Heat application
Guided imagery
Which statement indicates the development of opioid tolerance? a. Larger doses of opioids are needed to control pain, as compared to several weeks earlier. b. Stimulants are needed to counteract the sedating effects of opioids. c. The patient becomes anxious about knowing the exact time of the next dose of opioid. d. The patient no longer experiences constipation from the usual dose of opioid.
Larger doses of opioids are needed to control pain, as compared to several weeks earlier.
A 45-year-old patient who reports pain in the foot that moves up along the calf says: "My right foot feels like it is on fire." The patient reports that the pain started yesterday, and he or she has no prior history of injury or falls. Which components of pain assessment has the patient reported? a. Aggravating and alleviating factors. b. Exacerbation, with associated signs and symptoms. c. Intensity, temporal characteristics, and functional impact. d. Location, quality, and onset
Location, quality, and onset
Which behavioral therapy works best to relieve pain with muscle tension and spasms in patients who are anxious about their pain? a. Distraction. b. Hypnosis. c. Relaxation. d. Stress management
Relaxation
The pt who had a below the knee amputation 3 days ago complains of pain from the amputated extremity. Which statement by the nurse best explains what the pt is experiencing? a. "The phantom pain will subside when the brain realizes the lower extremity is no longer there" b. "The radiating pain will continue for months because the lower extremity is no longer there" c. "You are suffering from referred pain, which you will always have, but it will lessen with time" d. "You are experiencing psychogenic pain because loss of an extremity is an emotional loss"
a Feeling an extremity after amputation is phantom pain. This type of pain decreases over time as the brain adjusts to the missing extremity. Radiating, referred, and psychogenic pain are not the source of this pt's discomfort.
A pt who has a serious back injury received IV medication for pain approx 1 hour earlier. The pt practices relaxation techniques but still is reporting pain at a level of 9 of 10. What intervention should the nurse implement next? a. report the lack of pain relief to the PCP b. tell the pt to give the medication more time c. reposition the pt, and try diversion activities d. document in the nurse's notes that the pt has a low pain tolerance
a If the pt with a serious injury is not obtaining pain relief from pharmacologic and nonpharmacologic interventions, the PCP should be notified. Waiting longer and using more nonpharmacologic interventions are not likely to relieve pain in this situation.
The endocrine system releases excessive hormones during episodes of acute pain. The nurse should monitor pt's experiencing acute pain for which potential problem? a. hyperclycemia b. migraine headache c. hyperkalemia d. diarrhea
a Release of hormones causes the blood glucose level to increase, causing hyperglycemia. Hypokalemia may result from the metabolic effect of genitourinary injury. Constipation results from decreased intestinal motility. Migraine headaches are not a result of hormone release during acute pain.
Which symptoms does the nurse recognize as physiologic response to acute pain? a. increased BP b. decreased pulse c. increased temp d. restlessness
a acute pain can increase BP and pulse but may not affect temp. Restlessness is a psychological response, not physiologic
When administering medications to elderly pts, what information does the nurse need to understand? a. start with a low dosage, and increase the dosage as needed for pain relief b. start with a high dosage, and decrease the dosage as pain is relieved c. start with a mid-range dosage, and increase or decrease the dosage as needed for pain. d. start with a low dosage, and decrease dosage as indicated for pain
a due to decreased metabolism and clearance of medications, start with a lower dose and increase as indicated for pain relief. A high dose may result in drug toxicity. Too low of a dose will not relieve pain.
Following surgery to the left elbow, a patient is receiving a continuous, upper-extremity, peripheral nerve block. The pain management nurse immediately notifies the anesthesia provider of: a. a change in level of sensory or motor function to the left hand. b. a new complaint of left great-toe pain with a reported history of gout. c. new orders written by the surgeon to increase frequency of oral oxycodone from every six hours as needed, to every four hours as needed. d. patient refusal to participate in physical therapy
a change in level of sensory or motor function to the left hand
When assessing the pt for pain, which factors should the nurse consider? (Select all that apply) a. previous medical history b. physical appearance c. age, gender, and culture d. lifestyle and loss of appetite e. hair color and style
a, b. c. d Medical history, physical appearance, age, gender, culture, lifestyle, and loss of appetite should be considered when conducting a pain assessment. Hair color and style are not necessary components of pain assessment.
A patient with fibromyalgia experiences chronic pain in certain joints which adjunct therapy will most likely relieve her pain a. Ibuprofen (Motrin) 400-800 mg orally b. Immediate-release morphine 30 mg orally c. Amitriptyline (Elavil) 10 mg orally. d. Lorazepam (Ativan) 1 mg orally
a. Ibuprofen (Motrin) 400-800 mg orally
.6. The hospice RN obtains the following information about a 72-year-old terminally ill patient with cancer of the colon. The patient takes oxycodone (OxyContin) 100 mg twice daily for level 6 abdomen pain on a 10-point scale. The pain has made it difficult to continue with favorite activities such as playing cards with friends twice a week. The patient's children are supportive of the patient's wish to stop chemotherapy but express sadness that the patient does not have long to live. Based on this information, which nursing diagnosis has priority in planning the patient's care? a. Impaired social interaction related to disabling pain b. Anxiety related to poor patient coping skills c. Disabled family coping related to patient-family conflict d. Risk for aspiration related to opioid use
a. Impaired social interaction related to disabling pain
The health care provider plans to titrate a patient-controlled opioid infusion (PCA) to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time? (Select all that apply.) a. Monitoring for therapeutic and adverse effects of opioid administration b. Teaching about the need to decrease opioid doses by the second postoperative day c. Assessing for signs that the patient is becoming addicted to the opioid d. Educating the patient about how analgesics improve postoperative activity level e. Emphasizing that the risk of opioid side effects increases over time
a. Monitoring for therapeutic and adverse effects of opioid administration AND d. Educating the patient about how analgesics improve postoperative activity level
Which of the following is a priority for a nurse to include in a teaching plan for a pt who desires self-management and alternative strategies? a. body alignment and superficial heat and cooling b. patient controlled analgesia (PCA) pump c. neurostimulation d. peripheral nerve blocks
a. body alignment and superficial heat and cooling Body alignment and thermal management are examples of nonpharmacologic measures to manage pain. They can be used individually or in combination with other nondrug therapies. Proper body alignment achieved through proper positioning can help prevent or relieve pain. Thermal measures such as the application of localized, superficial heat and cooling may relieve pain and provide comfort. PCA, neurostimulation, and peripheral nerve blocks are not totally self-managed or alternate therapies, because they are used under the direction of medical professionals.
Following the initiation of a pain management plan, pain should be reassessed and documented on a regular basis as a way to evaluate the effectiveness of treatments. Pain should be reassessed at which minimum interval? a. with each new report of pain b. Before and after administration of narcotic analgesics c. every 10 minutes d. every shift
a. with each new report of pain Following the initiation of a pain management plan, pain should be reassessed and documented on a regular basis as a way to evaluate the effectiveness of treatments. At a minimum, pain should be reassessed with each new report of pain and before and after administration of analgesics.
The pain management nurse observes a patient with complex regional pain syndrome who is not wearing the right-side jacket sleeve. The patient reports intense, right arm pain upon light touch. The nurse recognizes this pain as: a. allodynia. b. hypoalgesia. c. neuritis. d. paresthesia.
allodynia
A pt with a fractured femur thinks about vacationing on the beach to relieve pain. What nonpharmacologic pain relief technique should the nurse document the pt is using? a. distraction b. imagery c. relaxation d. biofeedback
b imagery is the use of visual concentration to change the perception of pain. Distraction is the use of music or TV to occupy the mind to decrease concentration on pain. Relaxation is muscle relaxation to decrease anxiety created by pain. Biofeedback enables voluntary control over the body to decrease pain.
Stephanie is a 70-year-old retired schoolteacher who is interested in nondrug, mind-body therapies, self-management, and alternative strategies to deal with joint discomfort from rheumatoid arthritis. Which of the following options should you suggest for her plan of care, considering her expressed wishes? A. Using a stationary exercise bicycle and free weights and attending a spinning class. B. Using mind-body therapies such as music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy. C. Drinking chamomile tea and applying icy/hot gel. D. Receiving acupuncture and attending church services.
b. Using mind body therapies Mind-body therapies are designed to enhance the mind's capacity to affect bodily functions and symptoms and include music therapy, distraction techniques, and pet therapy, among many others. Although getting exercise, drinking chamomile tea and applying gels, and receiving acupuncture and attending church services may be beneficial, they are not classified as mind-body therapies in combination as specified in these answer choices.
A 65-year-old woman has fallen while sweeping her driveway, sustaining a tissue injury. She describes her condition as an aching, throbbing back. Which type of pain are these complaints most indicative of? a. neuropathic pain b. nociceptive pain c. chronic pain d. mixed pain syndrom
b. nociceptive pain Nociceptive pain refers to the normal functioning of physiological systems that leads to the perception of noxious stimuli (tissue injury) as being painful. Pt's describe this type of pain as dull or aching, and is poorly localized. Neuropathic pain is described as shooting, tingling, burning, or numbness that is constant in the extremities, as in diabetic neuropathy. Chronic pain lasts longer than 30 days and is characterized by a disease affecting brain structure and function, such as chronic headaches or open wounds. Mixed pain syndromes are caused by different pathophysiological mechanisms such as a combination of neuropathic and nociceptive pain; this occurs in syndromes such as sciatica, spinal cord injuries, and cervical or lumbar spinal stenosis.
Which statement best describes the dosage of pain medication that a nurse should administer given pharmacologic treatment considerations? a. The smallest dose possible to avoid opioid addiction. b. the smallest dose possible to decrease adverse effects c. a dose that best manages pain with fewest side effects d. a large dose initially to decrease the initial level of pain.
c Based on the pt's report of pain, the nurse administers the dose of medication that is effective in relieving pain without causing adverse side effects. administering too small of a dose does not relieve pain. Administering a large dose may result in unwanted side effects. Addiction to narcotics is rare
A patient receiving prn intermittent IV administration of opiates following gastric surgery watches a favorite television program every morning. The patient does not request pain medication during this time and when questioned denies the need for medication. The nurse's evaluation of this situation is that: a. lying quietly in bed is the best method of controlling the patient's incisional pain. b. encouraging the patient to watch other television programs will decrease the pain. c. the distraction of the television enables the patient to decrease the perception of pain d. the patient's dose of opiates needs to be decreased because her pain is well controlled
c. the distraction of the television enables the patient to decrease the perception of pain
The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse's response is to: a. clarify the patient's report by reviewing the patient's nonverbal behavior. b. confronting the patient's denial of pain. c. obtaining an order for pain medication. d. supporting the patient's stoic behavior.
clarify the patient's report by reviewing the patient's nonverbal behavior
Which method is the most accurate way to determine the pain level of a pt who is alert and oriented? a. evaluate whether the pt is crying and grimacing b. assess the pt heat rate and BP c. consider the seriousness of the pt's condition d. use a pain assessment tool and ask the pt to rate the pain level
d. Because pain is defined as what a patient says it is, a pt's report based on the pain scale is currently the most accurate way to determine the pain level of a cognitively alert pt. Crying or grimacing may be considered on a noncognitive scale for a nonverbal pt. Vital signs as the pt's condition contribute to a pain assessment, but they may not be the most accurate determinants.
To obtain the most complete assessment data about a patient's chronic pain pattern, the nurse asks the patient: a. "Can you describe where your pain is the worst? "b. "What is the intensity of your pain on a scale of 0 to 10?" c. "Would you describe your pain as aching, throbbing, or sharp?" d. "Can you describe your daily activities in relation to your pain?"
d. "Can you describe your daily activities in relation to your pain?"
Postoperative surgical patients should be given alternating doses of acetaminophen and which medication throughout the postoperative course, unless contraindicated? a. antihistamine b. local anasthetic c. opioids d. nonsteroidal anti-inflammatory drug (NSAID)
d. nonsteroidal anti-inflammatory drug (NSAID) Unless contraindicated, all surgical pt's should routinely be given acetaminophen and an NSAID in scheduled doses throughout the postoperative course. Opioid analgesics are added to the treatment plan to manage moderate-to-severe postoperative pain. A local anasthetic is sometimes administered epidurally or by continuous peripheral nerve block
A 53-year-old patient who is receiving ibuprofen 400 mg twice a day, for chronic, low back pain develops lower-extremity edema. The pain management nurse suspects that the edema is caused by: a. a decrease in renal function. b. a low creatinine level. c. an increase in glomerular filtration rate. d. an increase in plasma proteins.
decrease in renal function
Biofeedback is a therapy used to: a. develop psycho-physiologic self-regulation. b. enhance drug delivery. c. increase release of serotonin. d. promote neuronal regeneration
develop psycho-physiologic self-regulation
The pain management nurse, concerned with metabolite accumulation in a patient with decreased creatinine clearance, decides to utilize: a. fentanyl transdermal patch (Duragesic). b. methadone (Dolophine). c. morphine (MS-IR). d. oxycodone (Roxicodone)
fentanyl transdermal patch (Duragesic)
The pain management nurse is assessing a trauma patient's readiness for discharge, by determining the level of comfort the patient prefers. The nurse completes this portion of the pain assessment by asking about the patient's: a. aggravating and alleviating factors. b. functional pain goal. c. intensity of pain. d. onset of pain.
functional pain goal
When assessing an infant for pain, the pain management nurse recognizes that: a. a lack of a physiologic or behavioral response means a lack of pain. b. if something causes pain in an adult, it can cause pain in an infant. c. the parent's observations should not be included in the patient's assessment of pain. d. Wong-Baker FACES Scale is an appropriate assessment tool.
if something causes pain in an adult, it can cause pain in an infant
A patient with fibromyalgia reports symptoms of unrelieved pain. To determine whether the patient is also experiencing other conditions, the pain management nurse will ask the patient about: a. constipation, dizziness, and pruritus. b. evening pain and stiffness. c. hyperactivity, followed by periods of heavy sleep. d. loss of appetite and increased feelings of anxiety.
loss of appetite and increased feelings of anxiety
A 35-year-old, male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a 7 on a Numeric Rating Scale of 0 to 10. The nurse concludes that the patient's behavior: a. is an emotional reaction to having cancer. b. is in anticipation of future pain. c. is more indicative of the need for pain medication than the pain rating. d. may be in conflict with the pain rating, and accepts the report of pain.
may be in conflict with the pain rating, and accepts the report of pain
A 12-year-old oncology patient who is receiving in-home care without IV access needs medication for breakthrough pain. The pain management nurse's most effective route of administration to recommend is: a. intranasal. b. nebulized. c. oral transmucosal. d. transdermal
oral transmucosal
A 73-year-old patient with cancer is in the hospital for pain control and rates pain as a "12" on the Numeric Rating Scale of 0 to 10. Thirty minutes after receiving IV pain medication, the patient reports no pain relief. The pain management nurse calls the physician for additional orders for pain medication. The nurse's actions demonstrate: a. analgesic titration. b. empathy. c. independence. d. patient advocacy.
patient advocacy
The main responsibilities of the nurse on the interdisciplinary, chronic pain management team are to: a. assess level of function; design a therapeutic exercise plan; and monitor functional progress. b. provide a comprehensive, psychosocial evaluation; implement cognitive behavior interventions; and teach problem-solving techniques. c. provide ergonomic training; develop pain management strategies to apply in the workplace; and facilitate the return to work. d. review the medical history; monitor medications; and provide education for the patient and family
review the medical history; monitor medications; and provide education for the patient and family
The pain management nurse assesses a patient with complex regional pain syndrome. The nurse is concerned about the patient's depressed mood, because she or he has said: "I can't live with this pain." The nurse further assesses for suicide risk, because: a. decreased pain thresholds lead to suicidal thoughts. b. suicidal thoughts are common in patients with chronic pain. c. suicidal thoughts are often expressed by patients with acute pain. d. verbalization of suicidal thoughts is a way for patients to get attention
suicidal thoughts are common in patients with chronic pain
An 85-year-old, male patient with a history of prostate cancer and metastasis to the lumbar spine, is receiving methadone (Dolophine), 10 mg, three times a day. The patient's spouse tells the pain management nurse that the patient exhibits a lack of motivation, loss of appetite, and an inability to get out of bed. The nurse initially focuses on: a. need for antidepressants. b. physical therapy evaluation. c. psychological evaluation. d. the patient's pain assessment.
the patient's pain assessment
A distinguishing feature of a cluster headache is that it occurs: a. bilaterally. b. globally. c. occipitally. d. unilaterally.
unilaterally
The pain management nurse follows the recommended protocol for preventing constipation when starting a patient on opioids by: a. adding bulk fiber to the diet. b. giving the patient enemas as needed. c. increasing fluids and exercise. d. using a bowel stimulant and stool softener
using a bowel stimulant and stool softener