NURS 309 Quiz 4 Pain
A postoperative client reports, "I have pain from a mild headache." Which PRN medication does the nurse administer? A. Acetaminophen (Tylenol) B. Hydromorphone (Dilaudid) C. Midazolam (Versed) D. Oxycodone hydrochloride/acetaminophen (Tylox)
A. Acetaminophen (Tylenol)
The home health nurse is visiting a 73-year-old diabetic patient who was recently discharged after surgery. While reviewing a list of the patient's medications, the nurse sees that there are several different classes of analgesics listed. Which action is the nurse most likely to take? A. Assess the patient's understanding of the multimodal treatment plan and ability to comply B. Contacts the health care provider to discontinue medications that contribute to polypharmacy C. Emphasizes that medications with more side effects are the last choice for pain D. Advises the patient not to take any NSAIDs because of irritation of gastric mucosa
A. Assess the patient's understanding of the multimodal treatment plan and ability to comply
What are physiologic responses that indicate a patient is experiencing acute pain? SATA A. Diaphoresis B. Somnolence C. Bradypnea D. Hypotension E. Tachycardia F. Dilated pupils
A. Diaphoresis E. Tachycardia F. Dilated pupils
Which patient is most likely to report pain that would be considered acute? A. Has a history of peripheral vascular disease; foot is suddenly cold and blue B. Has a history of diabetic neuropathy; reports burning sensation in lower leg C. Has a history of old ankle fracture; reports recent diagnosis of osteoarthritis D. Has a history of osteosarcoma in the femur with amputation above tumor site
A. Has a history of peripheral vascular disease; foot is suddenly cold and blue
The nurse knows that acute pain serves a biologic purpose. How does the nurse apply this knowledge in caring for a patient with a history of cardiac problems who now reports severe chest pain? A. Immediately administers supplemental oxygen B. Calmly reassures that acute pain is usually temporary C. Efficiently assesses for anxiety or panic attack D. Quickly obtains an order for prn pain medication
A. Immediately administers supplemental oxygen
Acetaminophen is the first-line medication for which patient? A. Needs relief from pain related to a minor surgical procedure B. Has chronic pain and discomfort due to rheumatoid arthritis C. Experiences burning and tingling in legs due to diabetes D. Has intermittent abdominal cramping due to Crohn's disease
A. Needs relief from pain related to a minor surgical procedure
The patient reports pruritus related to taking an opioid medication. What medication prescription would the nurse obtain to help the patient to manage this side effect? A. Reduced opioid dose B. Over-the-counter antihistamine C. Topical steroid D. Anti-anxiety medication
A. Reduced opioid dose
The nurse is performing a pain assessment on a patient who had abdominal surgery. He was just transferred from the Intensive care unit to the medical surgical unit. Which question would the nurse ask? A. "You are probably having pain at the incision site. Right?" B. "How bad is your pain? Is it better compared to before?" C. "Can you tell me about any pain or discomfort you are having?" D. "Do you think you can walk, or would you like pain medication first?"
C. "Can you tell me about any pain or discomfort you are having?"
Which drug can cause adverse effects, particularly in an older adult because of an accumulation of toxic metabolites? A. Ibuprofen B. Morphine C. Meperidine D. Acetaminophen
C. Meperidine
The nurse is reviewing the medication list for a patient who had open heart surgery. The nurse is likely to query the prescription for which medication because prostaglandin inhibition is associated adverse cardiovascular effects? A. Duloxetine B. Acetaminophen C. Naproxen D. Morphine
C. Naproxen
A patient with rheumatoid arthritis reports having chronic pain for years with an exacerbation that started in the morning. Which observation indicates the patient has a physiologic adaptation to pain? A. Pupils are dilated B. Breathing is shallow C. Pulse rate is 70/min D. Temperature is 98.6
C. Pulse rate is 70/min
A client has a one-time prescription for morphine 1 mg IV push. The drug is available as 5 mg/mL. The nurse administers ________ mL of morphine for one dose.
0.2 mL
A patient needs morphine 2 mg IV push. The drug is available as 5 mg/mL. How many mL would the nurse administer? ______ mL of morphine
0.4 mL of morphine
An older client takes ibuprofen 1600 mg daily for osteoarthritis. Which health teaching will the nurse provide for the client related to this medication? SATA A. "Be sure and take your medication with food to prevent stomach ulcers." B. "Take your medication only when you need it for chronic pain." C. "Avoid any over-the-counter medications that may contain ibuprofen." D. "Take your blood pressure often because ibuprofen can cause it to go up." E. "You might want to take acetaminophen because it has fewer side effects than ibuprofen."
A. "Be sure and take your medication with food to prevent stomach ulcers." C. "Avoid any over-the-counter medications that may contain ibuprofen." D. "Take your blood pressure often because ibuprofen can cause it to go up." E. "You might want to take acetaminophen because it has fewer side effects than ibuprofen."
A client who is using patient-controlled analgesia (PCA) is asleep. The nurse observes a family member pushing the PCA button for the sleeping client. What does the nurse say to the visitor? A. "Please allow the client to push the button when needed." B. "Please don't touch any equipment in the client's room." C. "Thank you. I am sure the client appreciated that." D. "The client is asleep and is not in pain."
A. "Please allow the client to push the button when needed."
A client who had a total knee replacement 2 weeks ago reports severe pain at the surgical site. Which response by the nurse are most appropriate for the client at this time? SATA A. "Please rate your pain on a 0-10 scale, with 10 being the worst possible pain." B. "Could you describe the pain in your knee?" C. "By now, your pain should be a lot less than it was 2 weeks ago." D. "Which positions make the pain feel worse or better?" E. "Having your joint replaced should have decreased your knee pain."
A. "Please rate your pain on a 0-10 scale, with 10 being the worst possible pain." B. "Could you describe the pain in your knee?" D. "Which positions make the pain feel worse or better?"
The nurse is interviewing a patient who frequently comes to the clinic to obtain medication for chronic back pain. The patient states, "I know you guys think I am faking, but I hurt and I am really sick of your attitude." What is the best response? A. "Sir, tell me about your pain and how it is affecting your life." B. "Sir, you can speak to a pain specialist if you would prefer." C. "Sir, I see you are frustrated, but you are unfairly judging me." D. "Sir, we are trying our best; let's just continue the interview."
A. "Sir, tell me about your pain and how it is affecting your life."
Which patient is most likely to receive a prescription for gabapentin? A. A patient who has persistent burning and tingling sensation in the lower extremities B. A patient who reports a gnawing and burning discomfort in the epigastric area between meals C. A patient who expresses fear, anxiety, and uncertainty related to episodes of angina D. A patient who has intractable pain related to malignant spread of cancer
A. A patient who has persistent burning and tingling sensation in the lower extremities
Based on evidence-based practice, what is the best choice for managing chronic pain for a 73-year-old female with osteoarthritis? A. Acetaminophen is the primary drug of choice B. Tramadol is the first-line choice for this patient C. Long-term use of an oral NSAID, such as ibuprofen, is the best D. Topical NSAIDs and nonpharmacologic measures should be tried first
A. Acetaminophen is the primary drug of choice
A client with cancer is receiving low-dose oral morphine but is reporting both "sharp, tingly" pain and constipation. What intervention does the nurse implement first? A. Administers ordered docusate sodium (Colace) and gabapentin (Neurontin) B. Decreases the morphine (morphine sulfate) dosage for the client C. Gives the client a Fleet's (sodium biphosphate) enema D. Records the client's bowel movements
A. Administers ordered docusate sodium (Colace)
Based on the concept of comfort, what is the expected physiologic consequence of taking a mu opioid agonist? A. An increase in dosage yields an increase in pain relief B. There is a dose ceiling effect, so comfort is readily achieved C. Analgesia is reversed at the peak effect D. Peak comfort is typically 15-20 minutes after administration
A. An increase in dosage yields an increase in pain relief
A postoperative client is vomiting and states, "I am having a lot of pain—about a 7 on a scale of 0 to 10." Which route of administration does the nurse choose to administer an analgesic to the client? A. Intravenous B. Oral C. Rectal D. Transdermal
A. Intravenous
In assessing pain in an older adult patient, what is the major barrier to accurate assessment? A. Many older adults are reluctant to report pain B. Pain sensation decreases with age C. Pain scales are inaccurate for older adults D. Most older adults have some cognitive impairment
A. Many older adults are reluctant to report pain
A postoperative client is receiving epidural analgesia and reports itching. What does the nurse do next? A. Reduces the analgesic dose B. Gives diphenhydramine (Benadryl) C. Gives an antiemetic D. Calls the surgeon
A. Reduces the analgesic dose
A nursing technician reports that a client who is receiving IV PCA morphine is very drowsy, unable to complete a sentence without falling asleep, and has a respiratory rate of 10 breaths per minute. What is the nurse's priority action at this time? A. Wake the client and raise the head of the bed to a 90-degree angle B. Promptly call the primary health care provider to reduce the opioid dose C. Document the assessment findings and take vital signs in an hour D. Give naloxone according to agency protocol
A. Wake the client and raise the head of the bed to a 90-degree angle
The family of a client with chronic cancer pain says to the nurse, "Can you please reduce Dad's pain medication so that we can spend more quality time with him?" How does the nurse respond? A. "I will ask his oncologist about your question." B. "Let's ask your father about your request." C. "No, his pain relief is more important than your concerns." D. "Yes, this is a valuable way for all of you to make needed adjustments."
B. "Let's ask your father about your request."
A client being discharged after hip replacement says, "I am going to use hypnosis instead of medication to manage my pain. I believe in mind over body." How does the nurse respond? A. "I will discuss cancelling your medication order with your provider." B. "That sounds like a great plan; can you tell me more about it?" C. "That sounds like a wonderful idea; and I think it will definitely work!" D. "Your plan will not work; people with your type of pain need narcotics."
B. "That sounds like a great plan; can you tell me more about it?"
Which patient is having pain that is unlikely to respond to first-line opioid and nonopioid medication? A. 62-year-old woman who fractured her wrist B. 70-year-old woman with postherpetic neuralgia C. 50-year-old man with a recently inserted chest tube D. 45-year-old man who sustained burns to the hands
B. 70-year-old woman with postherpetic neuralgia
Which patient has the highest risk for inadequate pain management? A. 56-year-old man who had major abdominal surgery for a stab wound B. 78-year-old woman who was transferred to a nursing home after hip surgery C. 10-year-old child who had a tonsillectomy and whose parents can't speak English D. 24-year-old postpartum woman with a history of drug abuse
B. 78-year-old woman who was transferred to a nursing home after hip surgery
A client with chronic pain feels no relief with high-dose opioids and says, "I just can't manage living right now." What intervention does the nurse anticipate the health care provider will order for this client? A. Adding acetaminophen (Tylenol) B. Adding duloxetine (Cymbalta) as adjuvant therapy C. Increasing the opioid dose to control the pain D. Replacing the opioid with desipramine (Norpramin) for depression
B. Adding duloxetine (Cymbalta) as adjuvant therapy
The patient is receiving the first dose transdermal fentanyl, and the health care provider informs the nurse that the dosage will be titrated until the patient experiences adequate pain control. How much time does the nurse expect will pass between dosage changes? A. Between 5-15 minutes if the patient has severe pain B. At least 24 hours before the next dose C. Approximately 2-3 days for transdermal applications D. Depends on the ordered frequency of the patch change
B. At least 24 hours before the next dose
A modified-release opioid is ordered for a patient who is currently NPO and receiving nutrition and fluids through a small-bore nasogastric tube. What should the nurse do? A. Crush the medication and mix it with water to instill through the NG tube B. Contact the health care provider for an order to administer the medication rectally C. Have the patient swallow the medication with a very small amount of water D. Hold the medication and document that the patient is NPO for foods and fluids
B. Contact the health care provider for an order to administer the medication rectally
A patient with chronic cancer pain has been taking opioids for several months and now reports needing increasing doses to achieve pain relief. What is the most likely explanation of the need for increasing amounts of medication for this patient? A. Patient is addicted to opioids B. Disease is progressing C. A different opioid is needed D. Patient has a tolerance for opioids
B. Disease is progressing
A client reports increasing pain during dressing changes. Which interventions are recommended for the client? SATA A. Assistance by the client with the dressing change B. Distraction C. Epidural analgesic D. Music therapy E. Premedication F. Transcutaneous electrical nerve stimulation (TENS)
B. Distraction D. Music therapy E. Premedication
A patient is prescribed morphine sulfate. Which nursing interventions decrease the risk of constipation? SATA A. Give foods that are soft, such as white bread or white rice B. Encourage an increase in water and fluid intake C. Administer a stool softener every morning D. Obtain an order for a bulk laxative E. Encourage movement, activity, and walking F. Teach to keep a record of bowel movements
B. Encourage an increase in water and fluid intake C. Administer a stool softener every morning E. Encourage movement, activity, and walking F. Teach to keep a record of bowel movements
What is the best type of pain scale to use for children or for adult patient who have language barriers or reading problems? A. 0 to 10 numeric rating scale B. FACES (smile to frown) C. Vertical presentation scale D. Pasero Opioid-Induced Sedation Scale
B. FACES (smile to frown)
The nurse is assessing an elderly patient who has "pain all over." Which strategy would the nurse use to help the patient identify which areas of the body are painful? A. Start with gentle palpation on the abdomen and chest B. Focus on the hand and fingers of one extremity C. Direct the patient to find one area that does not hurt D. Provide examples and comparisons of severe pain
B. Focus on the hand and fingers of one extremity
The nurse is working at a walk-in clinic and has interviewed several patients. Which patient has the most common reason for seeking medical care? A. Has a family history of angina B. Has a personal history of chronic pain C. Has drug addiction and is seeking pain medication D. Has a desire to avoid pain or injury during exercise
B. Has a personal history of chronic pain
The patient has a severe burn on the hand and forearm and reports pain that is severe and escalating. The nurse anticipates that pain medication will be administered via which route? A. Oral B. Intravenous C. Intranasal D. Subcutaneous
B. Intravenous
The nurse is caring for a patient who has an epidural catheter for pain management. Which information is appropriate in the care of this patient? A. Pain assessments are performed less frequently if epidural catheters are used for pain management B. Morphine and hydromorphone may be used with a local anesthetic such as bupivacaine C. Epidural catheters are used exclusively to deliver single bolus doses during surgical procedures D. The patient will be confined to bed during the therapy because of lower extremity weakness
B. Morphine and hydromorphone may be used with a local anesthetic such as bupivacaine
The nurse is assisting a surgical patient with pain management. Which outcome statement best demonstrates that the short-term goal is being met 45 minutes after receiving pain medication? A. Patient reports that the pain level is 6/10 B. Patient tolerates the dressing change without grimacing C. Patient declines a prn anxiolytic medication D. Patient asks for assistance to go to the bathroom
B. Patient tolerates the dressing change without grimacing
The nurse is caring for several patients who will receive pain medication. Which patient is most likely to receive around-the-clock oral opioids? A. Patient with fibromyalgia B. Patient with chronic cancer pain C. Patient with Crohn's disease D. Patient who had a stroke
B. Patient with chronic cancer pain
Which concept is most closely aligned with how a a transcutaneous electrical nerve stimulation (TENS) unit works to decrease pain? A. Comfort B. Sensory perception C. Cognition D. Cellular regulation
B. Sensory perception
The patient with chronic cancer pain has been taking oral morphine for several months. The health care provider suggests a very low dose of nalbuphine for relief of opioid-induced pruritus. What would the nurse frequently assess for? A. Higher risk for respiratory depression B. Severe pain or withdrawal symptoms C. Hemodynamic adverse effects D. Bleeding and increased clotting time
B. Severe pain or withdrawal symptoms
The nurse is assessing a patient who is receiving opioid medication via a patient-controlled analgesia device. The patient is very drowsy and difficult to arouse. What should the nurse do first? A. Wake the patient and tell the patient to stop pushing the button so frequently B. Stay with the patient and discontinue the basal rate C. Let the patient sleep but increase the frequency of assessment D. Obtain an order for exclusive use of nonopioid medication
B. Stay with the patient and discontinue the basal rate
Which nursing action indicates that the nurse is performing the first step of the Hierarchy of Pain Measures? A. Premedicates before a dressing change B. Uses a standard pain assessment tool C. Compares vital signs before and after pain medications D. Starts with a low dose and observes for behavioral changes
B. Uses a standard pain assessment tool
A postoperative client is requesting medication for pain every 4 hours. In planning effective pain management, what assessment question does the nurse ask the client before administering the medication? A. "Are you bleeding?" B. "Are you able to last more than 4 hours?" C. "Is your pain controlled between doses?" D. "What do you do for pain when you're at home?"
C. "Is your pain controlled between doses?"
The nurse is planning a dressing change on a postoperative mastectomy client. The client is receiving acetaminophen and oxycodone (Percocet) orally for pain every 4 hours and is due to receive them at 4:00 p.m. When will the nurse change the dressing? A. 3:30 p.m. B. 4:00 p.m. C. 4:30 p.m. D. 7:00 p.m.
C. 4:30 p.m.
Which patient has chronic noncancer pain? A. A 17-year-old male after an appendectomy B. A 64-year-old male with back pain related to tumor growth C. A 48-year-old female who has persistent pain related to interstitial cystitis D. A 5-year-old female with stomach cramps related to food posioning
C. A 48-year-old female who has persistent pain related to interstitial cystitis
Which client does the RN arriving for duty assess first? A. A 27-year-old who has chronic severe back pain with movement B. A 51-year-old with lung cancer who reports pain "whenever I cough" C. A 56-year-old with acute pancreatitis who reports increasing abdominal pain D. A 63-year-old who reports ongoing pain associated with rheumatoid arthritis
C. A 56-year-old with acute pancreatitis who reports increasing abdominal pain
The nurse is caring for a patient on the first postoperative day. The patient denies pain, but his blood pressure and pulse are elevated and he is diaphoretic and anxious. What should the nurse do first? A. Believe and document the patient's self-report of "denies pain" B. Call the health care provider and report the vital signs, diaphoresis, and anxiety C. Assess the patient for postoperative complications or barriers to reporting pain D. Ask a family member if the patient would typically be stoic during pain or discomfort
C. Assess the patient for postoperative complications or barriers to reporting pain
The nurse is assessing a patient with severe dementia who resides in a long-term care facility. A score of 9 is obtained using the Pain Assessment in Advanced Dementia Scale. Based on assessment findings, which action will the nurse take? A. Speak calmly to the patient and explain that repositioning will make him more comfortable B. Gently reassure the patient and continue routine observation for discomfort or pain C. Assess the patient for the source of the pain and immediately inform the health care provider D. Contact the family and ask how the patient would typically respond to discomfort
C. Assess the patient for the source of the pain and immediately inform the health care provider
In the role of client advocate, what does the nurse do first for a client who reports pain? A. Administers pain medication B. Assesses the level of pain C. Believes the client's report of pain D. Calls the provider for a medication order
C. Believes the client's report of pain
Which activity does the RN team leader on a large medical-surgical unit assign to the LPN/LVN? A. Assessment of a client scheduled for surgery who is crying and expressing fear that the pain will be intolerable B. Assessment of a client using a transcutaneous electrical nerve stimulation unit to relieve chronic pain C. Complex dressing changes for a sacral wound for a client with type 2 diabetes who was given prescriptions for pain medication before wound care D. Instructions to a postoperative hip replacement client who has just been placed on patient-controlled analgesia for pain relief
C. Complex dressing changes for a sacral wound for a client with type 2 diabetes who was given prescriptions for pain medication before wound care
The older patients tells the home health nurse that he took two tablets of arthritis-strength extended release acetaminophen at 6:00 am and two tablets of hydrocodone at 2:00 pm and that he plans to take one dose of an over-the-counter product that contains acetaminophen, doxylamine succinate, and dextromethorphan to sleep at night. What would the nurse do first? A. Call poison control because the patient has exceeded the recommended dose of acetaminophen B. Tell the patient to call the health care provider and report all medications that he takes C. Educate the patient about the acetaminophen in each product and the maximum dosage/day D. Record the medications, frequency, and dosage in the medication reconciliation record
C. Educate the patient about the acetaminophen in each product and the maximum dosage/day
The health care provider informs the nurse that a young patient should receive morphine for severe pain but that caution is needed because the patient is opioid naive. Which consideration is the most important in caring for an observing this patient? A. Decreased analgesia may occur because the patient is opioid naive B. Respiratory depression is a problem only for elderly adults with respiratory disorders C. Excessive sedation can progress to clinically significant respiratory depression D. A standing order for a prn one-time dose of naloxone is needed for adverse effects
C. Excessive sedation can progress to clinically significant respiratory depression
The nurse is caring for a client who had a fractured ankle repaired. Twenty minutes after receiving 1.5 mg of hydromorphone (Dilaudid) IV push, the client is slow to respond and has constricted pupils and a respiratory rate of 6 breaths/min. What action does the nurse take initially? A. Calls the care provider for a change in the medication order B. Changes the order to every 6 hours rather than every 4 hours C. Gives the client a dose of naloxone (Narcan) 0.4 mg IV D. Performs a cognitive assessment on the client
C. Gives the client a dose of naloxone (Narcan) 0.4 mg IV
A client with cancer who is taking pain medication states, "I am still having pain." During the assessment, the client does not exhibit any physical manifestations of pain. What does the nurse do next? A. Decreases the client's standard pain medication dose B. Gives the client a placebo and monitors the outcome C. Gives the pain medication as requested D. Withholds the pain medication
C. Gives the pain medication as requested
A patient develops a physical dependence after taking an opioid as prescribed for post-surgical pain. What is the recommended approach for dealing with the dependence? A. Immediate discontinuation of the opioid B. Administering an antagonist, such as naloxone C. Gradual reduction of the opioid as pain decreases D. Referral to a substance specialist for treatment
C. Gradual reduction of the opioid as pain decreases
The patient has a history of rheumatoid arthritis and is also being treated for acute pain from a wrist fracture. Which medication is most likely to be prescribed to reduce the pain and discomfort caused by inflammation? A. Morphine B. Acetaminophen C. Ibuprofen D. Bupivacaine
C. Ibuprofen
A hospitalized client anticipates a daily painful dressing change. Which complementary and alternative medicine therapy might the nurse offer before the procedure? A. Animal-assisted therapy B. Hydrotherapy C. Imagery D. Acupuncture
C. Imagery
A hospitalized client expresses satisfaction after using a recommended complementary and alternative medicine (CAM) therapy, saying that pain was diminished and anxiety reduced. Which CAM did the client most likely use? A. Herbs B. Homeopathy C. Imagery D. Tai chi
C. Imagery
The nurse is preparing a client for home care pain management following discharge. Which intervention does the nurse implement? A. Discuss pain-relieving strategies on the day of discharge. B. Discuss home care with only the client's family, not with the client. C. Offer flexibility in home management of the client's current regimen. D. Offer information about end-of-life pain control management.
C. Offer flexibility in home management of the client's current regimen.
Which statement is true about assessing pain in an older adult client? A. The nurse should assess for present and past pain. B. Older adults typically believe that expressing pain is acceptable. C. Older adults are at great risk for undertreated pain. D. Older adults usually believe that pain signifies a minor illness.
C. Older adults are at great risk for undertreated pain.
The patient reports that he has chronic lower back pain that is not relieved by the prescribed medication and that the primary care provider is unwilling to prescribe anything stronger. Who should the nurse consult first? A. Pharamcist B. Physical therapist C. Pain resource nurse D. Alternate health care provider
C. Pain resource nurse
A patient with chronic leg pain reports pain level at 7/10, so the nurse administers a prn medication. Which observation best suggests that the funcitonal goal of therapy is being met? A. Patient appears relaxed while talking with family members B. Pulse, blood pressure, and respirations are not elevated C. Patient ambulates independently down the hall without distress D. Patient asks for additional food between lunch and dinner
C. Patient ambulates independently down the hall without distress
The nurse is assessing the patient's use of transdermal fentanyl and discovers that the patient is making several errors. Which behavior is most likely to result in fentanyl-induced respiratory depression? A. Patient is folding the patch in half B. Patient is saving the old patches C. Patient is placing a heating pad over the patch D. Patient is using adhesive tape over the patch
C. Patient is placing a heating pad over the patch
Nociception involves the normal function of physiologic systems and four processes. When the nurse suggests listening to music as a distraction, which process is the target of the intervention? A. Transduction B. Transmission C. Perception D. Modulation
C. Perception
A client with extensive burn injuries is to be weaned from long-term opioid use. What type of opioid dependence does the nurse expect this client to have? A. Addiction B. Tolerance C. Physical dependence D. Pseudoaddiction
C. Physical dependence
The nurse manager for an oncology unit is evaluating a newly hired staff nurse. Which action by the nurse is of greatest concern to the nurse manager? A. Asking a client with chest pain if the pain is sharp and stabbing B. Instructing a confused postoperative client about how to use patient-controlled analgesia C. Preparing to administer a placebo to a client with chronic back pain D. Requesting that a client with chronic pain describe the specific location of the pain
C. Preparing to administer a placebo to a client with chronic back pain
An older patient requires an NSAID for inflammatory pain. The nurse would seek an order for what type of additional medication to accompany the NSAID therapy? A. Anxiolytic, such as alprazolam B. Nonopioid analgesic, such as acetaminophen C. Proton pump inhibitory, such as lansoprazole D. Anticonvulsant, such as pregabalin
C. Proton pump inhibitory, such as lansoprazole
During change-of-shift report, the day shift staff learns that a client who had back surgery has been reporting increasing lower back pain during the night. It is most appropriate for which day staff member to assess the client's pain? A. LPN/LVN who is responsible for administering medications to the client B. RN nurse manager who is in charge of coordinating care for several units C. RN team leader who is responsible for updating the care plan for the client D. RN who has floated to the unit from the emergency department
C. RN team leader who is responsible for updating the care plan for the client
The patient reports a vivid childhood memory of having severe pain during and after a dental procedure and expresses reluctance to visit the dentist even for routine cleanings. What should the nurse do? A. Refer the patient for psychological counseling before seeking dental care B. Obtain an order for anti-anxiety medication and suggest relaxation techniques C. Suggest talking to a dentist about current pain management techniques D. Advise the patient that past fears should not interfere with good health practices
C. Suggest talking to a dentist about current pain management techniques
A newly admitted client who was in an automobile accident has a concussion and is reporting pain from a fractured femur and broken fingers. Which staff member does the charge nurse on the orthopedic unit assign to care for this client? A. An experienced RN travel nurse who arrived on the unit this morning B. An LPN/LVN who has worked on the orthopedic unit for 6 years C. The neurology unit RN who has floated to the orthopedic unit D. The RN orthopedic case manager who is responsible for discharge planning
C. The neurology unit RN who has floated to the orthopedic unit
The nurse sees that during the night the patient received lorazepam for anxiety, promethazine for nausea, and hydromorphone for pain. Which assessment is the most important to conduct? A. Closely monitor liver enzymes to identify early indicators of adverse effects B. Watch for symptoms of cardiotoxicity, such as tingling and cardiac dysrhythmias C. Use the Pasero Opioid-Induced Sedation Scale and check respiratory status D. Watch for gastrointestinal distress, decreased platelet count, and bleeding
C. Use the Pasero Opioid-Induced Sedation Scale and check respiratory status
The postanesthesia care unit reports to the nurse in the medical-surgical unit that the patient received 2 mg of intravenous morphine with relief. When is the patient likely to be transitioned to oral analgesics? A. Upon arrival to the medical-surgical unit B. When the health care provider writes postoperative orders C. When the patient is able to tolerate oral intake D. When the intravenous access is discontinued
C. When the patient is able to tolerate oral intake
The nurse is giving discharge instructions about multimodal analgesia to a daughter who will care for her elderly father at home while he recovers from surgery. The daughter suggests that the single best medication should be recommended for convenience and to save money. What is the best response? A. "The doctor always prescribes this combination of medications as the best therapy." B. "Elderly people frequently do better with fewer medications; let me call the doctor." C. "Just see how it goes for your dad. It is likely that you can gradually decrease the medication." D. "Combing different analgesics gives greater relief with lower doses and fewer side effects."
D. "Combing different analgesics gives greater relief with lower doses and fewer side effects."
The home health nurse is reviewing the older adult's medications and sees that naproxen is prescribed. Which question is the nurse most likely to ask in order to assess for adverse effects? A. "Have you noticed unusual fatigue, restlessness, or feelings of depression?" B. "Do you notice dry mouth, dizziness, mental clouding, or weight gain?" C. "Are you experiencing constipation, itching, or excessive sleepiness?" D. "Have you had gastric discomfort, vomiting, bleeding, or bruising?"
D. "Have you had gastric discomfort, vomiting, bleeding, or bruising?"
The nurse is assessing the patient for chronic pain or discomfort. Which is the best question to use to elicit the quality of the pain? A. "Am I correct in assuming that you are having pain?" B. "Would you describe the pain as sharp?" C. "Is the pain really bad right now?" D. "How would you describe your pain?"
D. "How would you describe your pain?"
When assessing a client for acute or chronic pain, what question does the nurse ask the client to obtain the most data? A. "Did someone do this to you?" B. "Does it hurt badly?" C. "Is the pain really that bad?" D. "When does it hurt?"
D. "When does it hurt?"
A client with osteoarthritis pain tells the nurse, "I take two arthritis-strength Tylenol (650 mg) every 8 hours." How does the nurse respond? A. "Aspirin would be a better, more effective choice for your pain relief." B. "More Tylenol is needed to provide effective pain relief for you." C. "That is the appropriate dose of Tylenol for your pain." D. "You will need to have routine liver and kidney function laboratory tests."
D. "You will need to have routine liver and kidney function laboratory tests."
Which patient is least likely to be a good candidate for patient-controlled analgesia? A. 32-year-old male with severe burns and a history of drug abuse B. 16-year-old male with multiple injuries sustained during an accident C. 34-year-old female with functional blindness who had abdominal surgery D. 25-year-old female with intermittent lucidity after a severe head injury
D. 25-year-old female with intermittent lucidity after a severe head injury
The nurse is reviewing the patient's medication list and sees that acetaminophen and celecoxib are scheduled to be administered at the same time. What should the nurse do? A. Call the health care provider for an order to stagger the administration of these two pain medications B. Ask the patient which one he prefers to take; administer the preferred drug and assess for relief C. Give the acetaminophen because it is less likely to cause gastric irritation and bleeding D. Administer the medications as ordered because they can be given together without ill effects
D. Administer the medications as ordered because they can be given together without ill effects
A new, inexperienced nurse sees that a patient is receiving around-the-clock medication but also has orders for a prn analgesic every 4-6 hours. How will the new nurse determine when a prn dose is given? A. Administer a dose every 6 hours to ensure adequate relief B. Call the health care provider and ask for specific parameters for prn dosing C. Look at the medication administration record to see what the previous night nurse gave D. Assess the patient for breakthrough pain and anticipate painful procedures
D. Assess the patient for breakthrough pain and anticipate painful procedures
Which assessment would the nurse perform to determine if a patient would be an appropriate candidate for using imagery as a distraction therapy? A. Determine if touch and physical proximity are culturally accepatable B. Ensure that the patient can speak, read, and write English C. Assess environmental factors that contribute to discomfort or annoyance D. Confirm that the patient can follow logical and sustained conversation
D. Confirm that the patient can follow logical and sustained conversation
The patient reports that he has been taking hydrocodone as prescribed by his provider and uses over-the-counter acetaminophen whenever he needs additional pain relief. Which laboratory test indicates the adverse and additive effects of these two medications? A. Decreased clotting times B. Decreased hematocrit C. Elevated white blood cell count D. Elevated liver enzymes
D. Elevated liver enzymes
The nurse is establishing a plan of care for a hospitalized client with chronic pain caused by fibromyalgia. Which nursing action does the nurse delegate to a nursing assistant? A. Application of a transcutaneous electrical nerve stimulation (TENS) device B. Education about nonpharmacologic interventions for pain control C. Referral to available community resources for pain management D. Engagement in conversation about the client's family to distract the client
D. Engagement in conversation about the client's family to distract the client
Which behavior exemplifies the nurse's primary role in assessing and managing the patient's pain? A. Administers pain medications as ordered if pain is sufficient to warrant therapy B. Listens to the patient's self-report and forms an opinion about the veracity of the description C. Observes for concurrent verbal reports and nonverbal signs to substantiate presence of pain D. Listens to and accepts the self-report of pain and assesses patient's preferences and values
D. Listens to and accepts the self-report of pain and assesses patient's preferences and values
The nursing student is using the Wong-Baker FACES pain rating scale to assess the pain of a 4-year-old child. The nurse would intervene if the student performed which action? A. Points to the smiling face and tells the child that this face has "no pain" B. Tells the child that FACES helps nurses understand how he is feeling C. Points to the tearful face and tells the child that the picture means "worst pain" D. Observes the child's facial expression and matches it to a face on the scale
D. Observes the child's facial expression and matches it to a face on the scale
The nurse asks the patient with cancer, "Sir, where is your pain?" The patient repeatedly responds, "It hurts all over." What is the best rationale for taking the extra time to help the patient to identify specific areas that hurt? A. Documentation is incomplete as a legal document if the nurse charts "hurts all over" B. Formulating an achievable therapeutic goal is very difficult for a vague complaint C. Health care provider cannot prescribe appropriate medication for relief of generalized pain D. Patient understands the origin, and new or increasing pain raises the suspicion of metastasis
D. Patient understands the origin, and new or increasing pain raises the suspicion of metastasis
Using the concept of comfort, which application creates the greatest concern related to the use of the patient-controlled analgesia (PCA) infusion device? A. Pendant B. Demand C. Lockout D. Proxy
D. Proxy
Despite the nurse's best efforts, the patient's wife continuously asks the nurse to reassess her husband's pain and to give him additional medication. What is the best rationale for using the concept of "self-report?" A. The wife's behavior indicates that she is overly anxious B. The concerns of the wife make accurate pain assessment very difficult C. The patient's relationship with his wife is interfering with the plan of care D. The patient is the only one who can describe his experience of pain
D. The patient is the only one who can describe his experience of pain
The nurse manager on the surgical unit is making assignments for the day. Who is assigned to check and program the patient-controlled analgesia (PCA) pumps on the unit? A. A pharmacy technician B. One registered nurse (RN) and a licensed practical/vocational nurse (OPN/LVN)(LPN/LVN) C. One registered nurse (RN) and a certified nursing assistant (CNA) D. Two registered nurses (RNs)
D. Two registered nurses (RNs)
A client had a hip replacement 2 days ago and reports having a moderate amount of pain, stating that it is "a 7 on a 0-to-10 scale" of intensity. What intervention has the highest priority in the client's nursing care plan? A. Encouraging diversional activities B. Incorporating activities of daily living as soon as possible C. Teaching key points of the relaxation response D. Using preemptive analgesia
D. Using preemptive analgesia