NURS 3200 Unit 2 Test

A client who is experiencing no symptoms of a low calcium level asks why calcium is important. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Calcium is needed to keep the nervous system working properly." 2. "Calcium is used by the body to make the muscles move." 3. "Calcium is used in the blood to help with clotting." 4. "Calcium maintains the normal respiratory rate." 5. "Calcium is needed to control blood glucose levels."

1. "Calcium is needed to keep the nervous system working properly." 2. "Calcium is used by the body to make the muscles move." 3. "Calcium is used in the blood to help with clotting."

The nurse determines that teaching about gout has been effective when the client makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I should increase my fluid intake to 2 to 4 liters every day." 2. "I should avoid eating salmon, sardines, organ meats, alcohol, mushrooms, legumes, and oatmeal." 3. "I should notify my healthcare provider if my pain gets worse." 4. "I should weigh myself every day and notify my healthcare provider if I gain over 2 pounds in a day." 5. "I will expect to experience flank pain when taking this medication."

1. "I should increase my fluid intake to 2 to 4 liters every day." 2. "I should avoid eating salmon, sardines, organ meats, alcohol, mushrooms, legumes, and oatmeal." 3. "I should notify my healthcare provider if my pain gets worse." 4. "I should weigh myself every day and notify my healthcare provider if I gain over 2 pounds in a day."

A client has been treated for a migraine headache, been given a prescription for sumatriptan (Imitrex), and is being dismissed from the clinic. Which client statements would the nurse evaluate as meeting the goal that, prior to dismissal, the client will verbalize symptoms that indicate the need to contact the healthcare professional? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I should report any tightness in my chest." 2. "I should expect some dizziness and blurred vision until I get acclimated to this drug, so that should not be reported." 3. "If I get a headache after drinking alcoholic beverages, I should notify my healthcare provider." 4. "If I get a really bad headache, I should report it." 5. "If I notice a rash when I have a headache, I should report it."

1. "I should report any tightness in my chest." 4. "If I get a really bad headache, I should report it." 5. "If I notice a rash when I have a headache, I should report it."

The nurse and the client have established this goal: "The client will verbalize safety considerations for use of tramadol (Ultram) before being dismissed from the hospital." Which client statements would support evaluation that this goal has been achieved? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I will not drive until I know how I am going to react to the tramadol." 2. "I will limit my alcohol intake to a couple of glasses of wine with dinner." 3. "I will avoid taking my regular dose of kava while I am on this drug." 4. "I will not eat aged cheese while taking tramadol." 5. "I will work with my healthcare provider to taper off the dose of this medication when it is no longer needed."

1. "I will not drive until I know how I am going to react to the tramadol." 3. "I will avoid taking my regular dose of kava while I am on this drug." 5. "I will work with my healthcare provider to taper off the dose of this medication when it is no longer needed."

The client is being treated for severe pain with opioid analgesics. The pain has neuropathic qualities. The nurse chooses a prn order for which type of analgesic to aid the client's pain management? 1. Adjuvant analgesics 2. Nonopioid analgesics 3. Parenteral opioids 4. Patient-controlled analgesics

1. Adjuvant analgesics

The client rings the nurse call button and requests pain medication. Upon assessment, the nurse finds the client sitting up in a chair, watching television with a friend. Vital signs are normal and the client's skin is warm and dry. Which nursing actions are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ask the client to rate his pain on the pain scale. 2. Tell the client that he does not look as if he is in pain. 3. Have the client go back to bed and ask the visitor to leave. 4. Check to see when the client last received pain medication. 5. Have another nurse assess the client.

1. Ask the client to rate his pain on the pain scale. 4. Check to see when the client last received pain medication.

The nurse is teaching a client who is prescribed sumatriptan therapy for treatment of migraine headaches. The nurse instructs the client to take the drug at which time? 1. At the first sign of aura or headache 2. First thing in the morning if expecting a headache 3. When the client can lie down for 1 hour after taking the drug 4. About 30 minutes after the start of the headache

1. At the first sign of aura or headache

A client with osteoarthritis does not want to use medication for pain control. What can the nurse suggest to improve the symptoms of this disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Begin a walking program. 2. Perform exercises to strengthen the quadriceps muscle. 3. Discuss the use of a brace with the healthcare provider. 4. Consider losing weight. 5. Schedule joint replacement surgery as soon as possible.

1. Begin a walking program. 2. Perform exercises to strengthen the quadriceps muscle. 3. Discuss the use of a brace with the healthcare provider. 4. Consider losing weight.

Which clients would the nurse identify as needing 1,300 mg of calcium per day? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Client age 15 2. Pregnant client age 17 3. Client age 30 4. Client age 53 5. Client age 83

1. Client age 15 2. Pregnant client age 17

A client is being treated for type 2 diabetes mellitus, tuberculosis, and rheumatoid arthritis. The nurse would be most concerned about this patient being treated with which medication? 1. Etanercept (Enbrel) 2. Hydroxychloroquine (Plaquenil) 3. Methotrexate (Rheumatrex) 4. Sulfasalazine (Azulfidine)

1. Etanercept (Enbrel)

While conducting a physical assessment, the nurse is concerned that the client, who is taking a bisphosphonate, is showing signs of osteonecrosis of the jaw. What did the nurse assess in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Jaw pain and swelling 2. Several loose teeth 3. Elevated blood pressure 4. Oral lesions 5. Difficulty swallowing

1. Jaw pain and swelling 2. Several loose teeth

The nurse is concerned that a client is at risk for the development of hypocalcemia because of which health problem? 1. Renal disease 2. Osteoporosis 3. Osteoarthritis 4. Cardiac damage

1. Renal disease

A client is prescribed colchicine (Colcrys) for gout. The nurse discusses possible adverse effects of this therapy, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. nausea and vomiting. 2. abdominal pain. 3. diarrhea. 4. constipation. 5. muscle pain.

1. nausea and vomiting. 2. abdominal pain. 3. diarrhea.

A client with rheumatoid arthritis is prescribed hydroxychloroquine (Plaquenil). The nurse should caution the client to: 1. report blurred vision or decreased reading ability immediately. 2. continue taking a glass of red wine before dinner to reduce cardiovascular risk. 3. take this drug with an antacid to decrease stomach distress. 4. expose skin to sunlight for at least 20 minutes every day to help with bone formation.

1. report blurred vision or decreased reading ability immediately.

A client is diagnosed with a vitamin D deficiency. To aid in the correction of this deficiency, the nurse instructs the client to: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. spend 15 minutes a day in the sun without sunscreen. 2. increase the intake of milk. 3. increase intake of vitamin-enriched foods. 4. increase intake of red meat. 5. increase intake of leafy greens.

1. spend 15 minutes a day in the sun without sunscreen. 2. increase the intake of milk. 3. increase intake of vitamin-enriched foods.

When planning care for a client, the nurse will include interventions to address factors that predispose the client to developing gout, including: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. taking a prescribed thiazide diuretic. 2. taking aspirin every day. 3. drinking four beers every night. 4. receiving treatment for polycythemia. 5. being diagnosed with heart failure.

1. taking a prescribed thiazide diuretic. 2. taking aspirin every day. 3. drinking four beers every night. 4. receiving treatment for polycythemia.

How is acute pain defined? 1. Pain associated with chronic illness 2. Pain associated with an injury or surgery 3. Pain associated with malignant pain 4. Pain associated with nerve injury

2

Which question is most important for the nurse to ask the client who has been diagnosed with osteoporosis? 1. "How much weight have you gained in the last year?" 2. "How many dairy products do you consume per day?" 3. "Does someone in your household smoke?" 4. "What would you estimate your cholesterol intake to be?"

2. "How many dairy products do you consume per day?"

The recommended dietary allowance for calcium in the normal healthy adult is: 1. 1,600 to 2,000 mg/day. 2. 1,000 to 1,200 mg/day. 3. 200 to 600 mg/day. 4. 2,400 to 2,800 mg/day.

2. 1,000 to 1,200 mg/day.

The nurse has just taken a job in a hospital that cares for an ethnically diverse population and is concerned about being culturally sensitive. How should the nurse plan to manage caring for clients in pain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Treat all clients alike. 2. Listen carefully as the client's comments about pain are translated. 3. Show respect for the client's preferences even if they are very different from the nurse's. 4. Ask questions about the client's beliefs and customs regarding pain management. 5. Watch how other nurses provide care to their clients.

2. Listen carefully as the client's comments about pain are translated. 3. Show respect for the client's preferences even if they are very different from the nurse's. 4. Ask questions about the client's beliefs and customs regarding pain management.

The nurse is teaching a group of student nurses the role of naloxone in treating opioid toxicity. How should the nurse explain the mechanism of action? 1. Naloxone blocks the pain transmission sites. 2. Naloxone competes with the opioid at the receptor sites. 3. Naloxone binds with the opioid to prevent the action of the opioid. 4. Naloxone blocks the pain perception of the client.

2. Naloxone competes with the opioid at the receptor sites.

The client has advanced cancer and is experiencing malignant pain. How should the nurse plan to manage this pain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use the intravenous route for pain medication administration. 2. Set up a dosing schedule that provides for round-the-clock doses. 3. Encourage the client to wait 10 minutes after pain medication is required to ask for a dose. 4. Augment the client's regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain. 5. Counsel the client that it is not possible to eliminate all the pain of cancer and that some must be tolerated.

2. Set up a dosing schedule that provides for round-the-clock doses. 4. Augment the client's regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain.

For which symptom is it critical for the nurse to monitor when caring for a client with hypoparathyroidism? 1. Decreased peristalsis 2. Tetany 3. Weakness 4. Vomiting

2. Tetany

When clients are aware that healthcare providers are actively engaged in pain management, research shows that the clients often respond in which manner? 1. They report a decrease in chronic pain. 2. They experience less anxiety. 3. There is no change in pain levels. 4. They report less acute pain.

2. They experience less anxiety.

The nurse is instructing a mother to encourage her school-age children to play out of doors because it will help reduce the risk of osteomalacia by: 1. increasing renal perfusion, which helps to activate vitamin D. 2. increasing the level of an inactive form of vitamin D in the blood. 3. increasing osteoblastic activity to maintain calcium in the bone. 4. enhancing activation of the parathyroid hormone.

2. increasing the level of an inactive form of vitamin D in the blood.

A client has a serum calcium level of 12.0 mg/dL. The nurse suspects that the client is experiencing a pathophysiologic process such as: 1. osteomalacia. 2. metastatic bone tumor. 3. hypoparathyroidism. 4. chronic kidney disease.

2. metastatic bone tumor.

A client has been prescribed allopurinol (Zyloprim) for gout. The purpose of this medication is to: 1. relieve the inflammation caused by this disease process. 2. reduce the formation of uric acid. 3. help the body excrete excess uric acid. 4. prevent the joint damage associated with this disease.

2. reduce the formation of uric acid.

A client with osteoporosis has been prescribed raloxifene (Evista). Which question should the nurse ask to determine the client's risks for complications with this drug? 1. "Have you ever had esophageal or ulcer disease?" 2. "Do you have a history of abnormal breast biopsies?" 3. "Have you ever had or been treated for blood clots?" 4. "Have you ever had any broken bones?"

3. "Have you ever had or been treated for blood clots?"

The nurse is teaching a client about taking risedronate (Actonel) for osteoporosis. Which statement by the client indicates a need for further teaching? 1. "I will wait at least 30 minutes before eating." 2. "I will take the medication first thing in the morning, with water." 3. "I can return to bed while I wait for the medication to work." 4. "I will report difficulties with heartburn."

3. "I can return to bed while I wait for the medication to work."

The nurse is teaching a client who is being discharged from the hospital. The client will be going home on morphine sulfate therapy. The client tells the nurse that at home, the client was using St. John's wort as a natural treatment for depression, and asks if it is all right to continue taking this herb. What is the nurse's best response? 1. "If it is a natural substance, it should be OK, and you should not have to worry about any drug interactions." 2. "Why are you using an herb? You could treat your depression better with conventional medication." 3. "St. John's wort can decrease the analgesic effect of morphine sulfate. You might want to wait until you no longer need pain management." 4. "As long as you don't take them at the same time, you should be OK. Just space them about 2 hours apart."

3. "St. John's wort can decrease the analgesic effect of morphine sulfate. You might want to wait until you no longer need pain management."

The nurse should question an order for tramadol (Ultram) for which client? 1. An 18-year-old female with a femur fracture 2. A 65-year-old male with prostate cancer 3. A 59-year-old male with COPD 4. A 60-year-old female with hypertension

3. A 59-year-old male with COPD

The nurse receives a medication order for fentanyl patches (Duragesic) for a new home health client. What should the nurse check before ordering these patches from the pharmacy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Is the client allergic to amitriptyline (Elavil)? 2. Was the client's morphine discontinued? 3. Has the client ever taken opioids? 4. Can the client manage changing the patch every morning? 5. Has the client had adverse reactions to morphine?

3. Has the client ever taken opioids? 5. Has the client had adverse reactions to morphine?

When administering opioid drugs, the nurse should have an opioid antagonist readily available in case the client experiences which effects? 1. Nausea and vomiting 2. Hyperventilation 3. Hypoventilation 4. Hypovolemia

3. Hypoventilation

Pain transduction begins when which event occurs? 1. Pain travels on the nociceptor to the spinal cord. 2. The pain impulse reaches the spinal cord to pass messages to neurons. 3. Local tissue injury causes release of chemical mediators of inflammation. 4. The pain impulse reaches the brain, which responds with a variety of actions.

3. Local tissue injury causes release of chemical mediators of inflammation.

Somatic pain is a type of nociceptor pain that is usually experienced in which area? 1. Internal organs 2. Cancer or tumors 3. Muscles and joints 4. The nerves

3. Muscles and joints

A client is prescribed a disease-modifying antirheumatic agent. What will the nurse explain as the mechanism of action for this medication? 1. Provides rapid relief of symptoms. 2. Prevents the need for orthopedic surgery. 3. Reduces damage and delays disease progression. 4. Allows the client to be more active.

3. Reduces damage and delays disease progression.

An adult client with a history of migraine headaches tells the nurse that in the past 6 months, she has needed to use her medication to abort headaches on the average of five to six times a month, despite avoiding her migraine triggers. The nurse explains that the next step in her therapy might be to take which action? 1. Review her migraine triggers and look for new ones. 2. Try a different drug to abort the headaches. 3. Try a drug to prevent the headaches. 4. Take a drug holiday to clear out her system.

3. Try a drug to prevent the headaches.

The nurse should instruct a client with the initial stages of osteoarthritis to engage in low-impact exercise and take: 1. opioid analgesics. 2. glucosamine and chondroitin agents. 3. acetaminophen. 4. high anti-inflammatory doses of aspirin.

3. acetaminophen.

A calcium supplement has been added to a client's drug regimen. The nurse should advise the client to: 1. decrease intake of dairy products to prevent hypercalcemia. 2. increase consumption of fruits and vegetables high in vitamin C. 3. avoid taking calcium supplements with bran or whole-grain cereal. 4. increase consumption of lean meats for additional protein intake.

3. avoid taking calcium supplements with bran or whole-grain cereal.

A client with rheumatoid arthritis is prescribed hydroxychloroquine (Plaquenil). To encourage compliance, the nurse should advise the client to expect the effects of this drug to begin within: 1. 3 to 6 days. 2. 6 to 9 months. 3. 7 days. 4. 4 to 6 weeks.

4. 4 to 6 weeks.

The nurse is teaching an older adult client about morphine sulfate drug therapy. Important safety teaching for this client should include which instruction? 1. Do not take the drug with food or milk. 2. Take the drug only when absolutely necessary. 3. Always have someone stand by while using the toilet. 4. Change positions slowly to avoid dizziness and fainting.

4. Change positions slowly to avoid dizziness and fainting.

A client with a calcium imbalance has an elevated calcitonin level. The nurse recognizes that the secretion of calcitonin is increased when the client experiences: 1. hypocalcemia. 2. hypothyroidism. 3. hyperthyroidism. 4. hypercalcemia.

4. hypercalcemia.

The nurse is planning an educational program for a group of senior citizens on the importance of calcium intake. The nurse will explain that approximately 50% of the calcium in the body participates in intracellular functions and is: 1. nonionized. 2. bound to albumin. 3. complexed. 4. ionized.

4. ionized.

The nurse, instructing a client on the prevention of osteoporosis, includes the importance of maintaining a normal serum calcium level because: 1. calcium influences the contraction of skeletal muscle. 2. calcium ions assist in blood clotting. 3. appropriate nerve conduction depends on an adequate calcium level. 4. the support provided by bones is important for the structural integrity of the body.

4. the support provided by bones is important for the structural integrity of the body.

Normally, serum calcium level is maintained by: 1. folic acid and thyroxine. 2. vitamin C and prolactin. 3. vitamin B12 and aldosterone. 4. vitamin D and parathyroid hormone.

4. vitamin D and parathyroid hormone.

Which finding should the nurse expect when assessing a patient with osteoarthritis? A) Pain that worsens with activity, relieved at rest B) Warm swollen joints C) Anorexia and weight loss D) Low grade fever

A) Pain that worsens with activity, relieved at rest

Which assessment finding indicates to the nurse that a client is experiencing breakthrough pain? A. A sudden flare-up of continuous, stable pain B. Pain severe enough to require opioids C. Pain a client cannot control any longer D. Pain breaking through analgesics prescribed for pain

A. A sudden flare-up of continuous, stable pain

Which is the most common clinical manifestation in a client with osteoporosis? A. Loss of height B. Dowager's hump C. Difficulty bending and lifting D. Episodes of vertebral pain

A. Loss of height

Which statement by a patient with Paget disease indicates that the nurse needs to reinforce teaching? A) "Bisphosphonates and calcitonin will help strengthen the bone." B) "Exercise may cause fractures." C) "I will need to take calcium and vitamin D supplements." D) "I need to maintain a healthy body weight.

B) "Exercise may cause fractures."

The nurse would expect to assess which finding in a patient with allodynia? A) A diminished response to pain B) A hypersensitive response to an innocuous stimulus such as light touch C) An increased sensitivity to thermal stimulation D) A decreased sensitivity to tactile stimulation

B) A hypersensitive response to an innocuous stimulus such as light touch

Which laboratory values would the nurse expect to find in a patient with rheumatoid arthritis (RA)? A) Negative rheumatoid factor B) Low C-reactive protein C) Low erythrocyte sedimentation rate D) Antibodies to cyclic citrullinated peptide (anti-CCP)

D) Antibodies to cyclic citrullinated peptide (anti-CCP)

Which is the correct accepted standard to assess pain level? A. Parental assessment B. Nerve conduction studies C. Healthcare provider assessment D. Self-reporting by the client

D. Self-reporting by the client

Adalimumab (Humira)

Disease-modifying antirheumatic drug (DMARD). Interrupts complex immune responses, preventing disease progression. Uses: slow joint degeneration and progression of rheumatoid arthritis.

Alendronate (Fosamax)

Osteoporosis Agent; Bisphosphonate, bone resorption inhibitor; Inhibits osteoclast-mediated bone resorption to minimize loss of bone density

Calcium Salts - therapeutic v. pharmacologic classificaiton

therapeutic - calcium supplement pharmacologic - drugs for hypocalcemia

Calcium is necessary for proper functioning of what body systems?

◦Nervous ◦Muscular ◦Skeletal ◦Cardiovascular

Which statement by a female patient with osteopenia indicates that more teaching about risk factors is needed? A) "I need to take calcium and vitamin D." B) "Because exercise is good for me, I will try swimming." C) "I need to stop smoking." D) "I should stop drinking cola beverages."

B) "Because exercise is good for me, I will try swimming."

Which finding would the nurse expect when assessing a patient with a tension type headache (TTH)? A) A throbbing unilateral headache B) A constant, bilateral, dull bandlike pain around the head with vomiting C) A sudden onset of severe unilateral piercing or burning pain, located behind or around the eye D) Premonitory or prodromic symptoms

B) A constant, bilateral, dull bandlike pain around the head with vomiting

The nursing plan of care for a 4-year-old following a tonsillectomy should include which of the following concepts? A) Analgesic dosing is based on year in school and weight. B) Administer analgesics by the least painful route. C) Administer analgesics only when the Wong-Baker FACES scale indicates a pain rating of 6 or higher. D) Administer analgesics rectally.

B) Administer analgesics by the least painful route.

The nursing plan of care for a patient in pain should include which strategy? A) Administer pain medication when the patient reports pain of at least a level of 4 out of 10. B) Administer pain medications around the clock. C) Administer pain medication when the nurse perceives the patient to be in pain. D) Administer pain medication only when patient states a need for pain relief.

B) Administer pain medications around the clock.

Which drug of choice should the nurse anticipate administering to a patient with severe new onset pain due to trigeminal neuralgia? A) Gabapentin B) Carbamazepine C) Baclofen D) Phenytoin

B) Carbamazepine

When a patient complains of intense throbbing hip pain with ambulation, the nurse categorizes this as which type of pain? A) Nociceptive pain B) Central pain C) Visceral pain D) Somatic pain

D) Somatic pain

Which scale would be most appropriate for the nurse to use when assessing pain in a 5-year-old? A) Visual Analog Scale B) Verbal Numeric Scale C) McGill Pain Questionnaire D) Wong-Baker FACES Scale

D) Wong-Baker FACES Scale

When assessing a patient with a herniated disc in the lumbar region, the nurse would expect to find: A) lower extremity paralysis. B) urinary incontinence. C) neck and shoulder pain radiating to hands. D) burning pain that radiates from the buttocks to the leg.

D) burning pain that radiates from the buttocks to the leg.

The nurse monitoring a client receiving morphine therapy would be watchful for which common adverse side effects? 1. Hypertension, diarrhea, and sedation 2. Hypertension, respiratory depression, and constipation 3. Hypotension, diarrhea, and insomnia 4. Hypotension, respiratory depression, and constipation

4. Hypotension, respiratory depression, and constipation

A client with a history of migraine headache has decided to augment drug therapy with lifestyle changes to prevent migraine attacks. Which information should the nurse include in teaching for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You should consider wearing sunglasses when in bright light." 2. "In some people, pickles will trigger migraines." 3. "Some people find it is helpful to drink hot coffee, tea, or chocolate when they first experience a migraine aura." 4. "Try drinking a glass of wine before bed each evening." 5. "Try to modify the way you deal with the stress in your life."

. "You should consider wearing sunglasses when in bright light." 2. "In some people, pickles will trigger migraines." 5. "Try to modify the way you deal with the stress in your life."

How should the nurse respond when a 28-weeks-pregnant woman asks if she will need surgery after her baby is born to relieve the constant back pain she has been experiencing? A) "That depends, did you have a herniated disc before pregnancy?" B) "It's a possibility, have you seen a surgeon?" C) "Most often, back pain goes away after delivery." D) "Stay off your feet as much as possible and rest in bed."

C) "Most often, back pain goes away after delivery."

The home hospice nurse is completing the initial assessment of a client who has terminal heart failure. The client frequently has pain with breathing. Which questions should the nurse ask? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "How much pain are you willing to tolerate?" 2. "What do you like to do throughout the day?" 3. "Have you ever been addicted to a pain medication?" 4. "Are there any pain medications you would like to avoid?" 5. "What things besides drugs help with your pain?"

1. "How much pain are you willing to tolerate?" 2. "What do you like to do throughout the day?" 4. "Are there any pain medications you would like to avoid?" 5. "What things besides drugs help with your pain?"

To increase the awareness of pain treatment among healthcare professionals, the American Pain Society coined which phrase? 1. "Pain: Assess daily" 2. "Pain: Optimum pain relief" 3. "Pain: The fifth vital sign" 4. "Pain: Obtain relief"

1. "Pain: Assess daily"

The client has been prescribed duloxetine (Cymbalta) for the treatment of diabetic neuropathic pain. What information should the nurse provide to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "The prescription is for a small number of capsules because the medication will be discontinued if it doesn't work in a week." 2. "This is a corticosteroid, so you may notice an increased thirst." 3. "Your dose is lower than your wife's because her prescription is for a different reason." 4. "You may feel relief in as few as 5 days." 5. "This drug is a narcotic, so be certain to keep it in a safe place."

1. "The prescription is for a small number of capsules because the medication will be discontinued if it doesn't work in a week." 3. "Your dose is lower than your wife's because her prescription is for a different reason." 4. "You may feel relief in as few as 5 days."

A client who has neuropathy of the lower extremities is prescribed an opioid analgesic for pain. The provider adds a tricyclic antidepressant (TCA) medication for pain management. The client asks the nurse, "Why am I getting this new drug? I am not depressed, my feet just burn." What is the best response from the nurse? 1. "This drug will also help with the nerve pain you are having in your feet." 2. "It is to help you sleep at night instead of using the opioid." 3. "Sometimes people get depressed with chronic pain." 4. "Maybe this is a mistake if you are not depressed."

1. "This drug will also help with the nerve pain you are having in your feet."

An adult client with a history of obesity, asthma, peripheral vascular disease, and migraine headaches tells the nurse she saw an advertisement in a magazine for a drug for migraine headaches: "The drug was Imitrex; it looked very effective, and I wonder why my provider hasn't talked to me about using it for my headaches." What is the nurse's best response to this question about sumatriptan (Imitrex)? 1. "Your peripheral vascular disease is a contraindication for the drug." 2. "You have asthma, so you cannot use the drug." 3. "I think it will be good for you. Bring in the ad." 4. "Once you lose some weight, the drug will be perfect for you."

1. "Your peripheral vascular disease is a contraindication for the drug."

Nociceptor pain responds well to which type of drug therapy? 1. Analgesic drugs 2. Serotonin receptor blockers 3. Antidepressant medications 4. Nonanalgesic drugs

1. Analgesic drugs

The nurse is teaching the client how to use sumatriptan (Imitrex) to treat migraine headaches. Which common side effects should the nurse include in this teaching? 1. Dizziness and nausea 2. Hypotension and irritability 3. Constipation and sedation 4. Anxiety and agitation

1. Dizziness and nausea

The client has been keeping a "headache diary" of her migraines. Upon review of this diary, the nurse notes that the headaches are described as mild and have happened four times in the last 3 months. The client reports that she "generally just lies down until they pass" but that her new job will not allow that time. She is requesting information about pain medication. What medications would the nurse expect to be prescribed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ibuprofen 2. Acetaminophen and caffeine 3. Sumatriptan (Imitrex) 4. Ergotamine (Ergostat) 5. Amitriptyline (Elavil)

1. Ibuprofen 2. Acetaminophen and caffeine

The nurse plans care for the client receiving nonopioid analgesic drugs based on which benefit these drugs have over opioids? 1. Lower risk of dependency 2. Few or no GI side effects 3. Cost effectiveness 4. No risk of dizziness or hallucinations

1. Lower risk of dependency

The client is experiencing mild pain secondary to a minor ankle sprain. Which is the drug class of choice for the client's pain? 1. Nonopioid analgesics 2. Opioid analgesics 3. Adjuvant analgesics 4. Patient-controlled analgesics

1. Nonopioid analgesics

The client is prescribed morphine sulfate (MS Contin) for chronic back pain resulting from inoperable disk degeneration. What nursing actions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use the prn order of docusate (Dulcolax) routinely every night. 2. Ask the dietary department to add bran cereal to the client's breakfast trays. 3. Ask the healthcare provider to write an order for an indwelling urinary catheter. 4. Review the trending of the client's hemoglobin and hematocrit levels. 5. Check the medical record for a prn order for an antiemetic.

1. Use the prn order of docusate (Dulcolax) routinely every night. 2. Ask the dietary department to add bran cereal to the client's breakfast trays. 4. Review the trending of the client's hemoglobin and hematocrit levels. 5. Check the medical record for a prn order for an antiemetic.

The client is experiencing pain after orthopedic surgery, and is prescribed opioid analgesic medication. The client complains to the nurse that the surgical joint is still uncomfortable, despite around-the-clock medication. What is the nurse's best response? 1. "You just had your medication; you will have to tolerate the pain for a little while." 2. "Let's try a cold pack on the area to help control the pain." 3. "I will call your provider to increase your dose of medication." 4. "I wonder if you are starting to get addicted to your medication."

2. "Let's try a cold pack on the area to help control the pain."

A client who is being treated for cancer tells the nurse that she is still having trouble getting to the toilet without experiencing significant pain. The nurse plans care for this client based on which goal? 1. Eliminating all pain in clients with chronic pain 2. Allowing the client to perform activities of daily living 3. Preventing the client from becoming addicted to the medication 4. Allowing the nurse to assess if the treatment is successful

2. Allowing the client to perform activities of daily living

What is the mechanism of action that differentiates opioid agonists from opioid agonist-antagonists? 1. Opioid agonists block two receptors; opioid agonist-antagonists have no effect on any receptors. 2. Opioid agonists activate two receptors; opioid agonist-antagonists occupy only one receptor. 3. Opioid agonists activate one receptor; opioid agonist-antagonists activate both receptors. 4. Opioid agonists block one receptor; opioid agonist-antagonists block both receptors.

2. Opioid agonists activate two receptors; opioid agonist-antagonists occupy only one receptor.

How is pain perception best defined? 1. Pain perception is based on the client's culture and previous experience with pain. 2. Pain perception is the conscious experience of pain that occurs in the brain. 3. Pain perception is the unconscious experience of pain that occurs in the brain. 4. Pain perception is the pain score rating for a client before drug therapy begins.

2. Pain perception is the conscious experience of pain that occurs in the brain.

Gate control therapy proposes a mechanism to explain which phenomenon? 1. Pain modulation 2. Pain transmission 3. Pain perception 4. Pain transduction

2. Pain transmission

A client arrives unconscious in the emergency department in respiratory depression from an unknown drug overdose. To help diagnose the overdose, the client is given small doses of naloxone (Narcan). What is the purpose of this action? 1. To help wake up the client to obtain the name of the drug 2. To help diagnose if the overdose was an opioid drug 3. To prevent vomiting while the client is unconscious 4. To reduce the psychoactive effects of the drug overdose

2. To help diagnose if the overdose was an opioid drug

The client asks the nurse why he is receiving combination therapy of opioid and nonopioid drugs to manage his pain. The nurse should explain which benefit of combination therapy? 1. Combination therapy prevents addiction to the opioid drug. 2. Using combination therapy helps to relieve pain synergistically and decreases the risk of side effects. 3. Combination therapy eliminates the need for follow-up laboratory monitoring. 4. Combination therapy is standard therapy for all pain management clients.

2. Using combination therapy helps to relieve pain synergistically and decreases the risk of side effects.

Which statement indicates to the nurse that the patient with lower back pain due to intervertebral disc degeneration does not understand the goal of physical therapy? A) "Physical therapy will help strengthen my core muscles." B) "Electrical stimulation may be used to relieve my back pain." C) "Physical therapy can reverse the disc degeneration." D) "Physical therapy will help strengthen back muscles weakened by bedrest."

C) "Physical therapy can reverse the disc degeneration."

The nurse is performing medication teaching for a client after surgery. The nurse explains that the client will go home on tramadol, a nonopioid analgesic, for pain management. The client states, "I can't take that, I'm allergic to NSAIDs." How should the nurse respond? 1. "Tramadol is an NSAID that doesn't cause GI bleeds, so you should be OK." 2. "Are you sure? I don't see that allergy listed." 3. "Not all nonopioids are NSAIDs. Tramadol is not an NSAID." 4. "Then you will probably have to stay on a low dose of your opioid analgesic."

3. "Not all nonopioids are NSAIDs. Tramadol is not an NSAID."

A client is being switched from abortive therapy for migraines to preventive therapy. The client asks the nurse to explain the difference between the two types of therapy. What is the nurse's best response? 1. "Preventive therapy will allow you to get pregnant while on medication." 2. "Preventive therapy will help you have less pain with each headache." 3. "Preventive therapy will help prevent headaches, rather than treating them when you get them." 4. "Preventive therapy will prevent drug side effects, which are worse with abortive therapy."

3. "Preventive therapy will help prevent headaches, rather than treating them when you get them."

The nurse is interviewing the client before minor surgery. The client is worried about pain management: "I have a history of addiction; I have to be careful what I get for pain." What is the best response from the nurse? 1. "Maybe you should put off having surgery until you don't have the urge to abuse drugs." 2. "We will have to use only complementary therapies for you. I am afraid you may still have some pain." 3. "We can use nonopioid drugs, which have a very low risk of dependency." 4. "How long have you been drug-free? If it has been more than 2 years, we can use opioids."

3. "We can use nonopioid drugs, which have a very low risk of dependency."

Clients and healthcare providers often have beliefs about pain that can interfere with successful pain management. What is a common myth related to pain? 1. Clients in pain do not necessarily look and act as if they are in pain. 2. Clients can sleep even when experiencing pain. 3. Vital signs are reliable indicators of pain. 4. Clients rarely become addicted to pain medication.

3. Vital signs are reliable indicators of pain.

A client is prescribed an opioid—nonopioid drug combination. The nurse explains that the drug is composed of hydrocodone and acetaminophen. The client says, "Why am I getting this? I don't have a fever, and I don't think that will be enough for my pain." Which is the best response from the nurse? 1. "I am not really sure; it really can't hurt you." 2. "You still might run a fever; this will prevent it." 3. "Why, are you allergic to acetaminophen?" 4. "The two drugs work together to relieve your pain."

4. "The two drugs work together to relieve your pain."

For which client should the nurse question an order for tramadol? 1. A 35-year-old female with migraine headaches 2. A 60-year-old female with osteoarthritis 3. A 55-year-old male with a history of anxiety disorder 4. A 50-year-old male with a seizure disorder

4. A 50-year-old male with a seizure disorder

A client who is allergic to morphine has been receiving meperidine (Demerol) 75 to 100 mg IM every 6 hours for the last 3 days. Five hours after the last dose, the client calls the nursing desk and says, "I need some pain medication. I am hurting so badly that I am shaking." What should the nurse do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administer the 100-mg dose. 2. Administer the 75-mg dose. 3. Administer 50 mg of meperidine. 4. Collaborate with the client's healthcare provider regarding the medication and schedule. 5. Ask the client when the shaking first began.

4. Collaborate with the client's healthcare provider regarding the medication and schedule. 5. Ask the client when the shaking first began.

What is one of the benefits of the use of nonpharmacologic interventions in pain management? 1. Nonpharmacologic interventions allow for pain medication to be given on an as-needed basis only. 2. Nonpharmacologic interventions provide adequate pain relief without the use of medication. 3. Nonpharmacologic interventions do not require additional training of the healthcare team. 4. Nonpharmacologic interventions allow for lower doses and fewer drug-related adverse effects of pain medications.

4. Nonpharmacologic interventions allow for lower doses and fewer drug-related adverse effects of pain medications.

Which objective method should the nurse use to assess the client's pain level? 1. Ask the client to describe the pain sensation. 2. Assess pain only when the client complains of pain. 3. Observe whether the client appears to be in pain or appears comfortable. 4. Use a pain rating scale such as the numeric rating scale.

4. Use a pain rating scale such as the numeric rating scale.

Which statement is typical of data collected on a patient with mild spinal stenosis? A) "Flexing my lower back relieves the pain." B) "Twisting side to side relieves the pain." C) "I sometimes experience loss of bladder control." D) "I have difficulty wiggling my toes."

A) "Flexing my lower back relieves the pain."

Which patient statement indicates to the nurse that more teaching about the diagnostic process of fibromyalgia is needed? A) "Pain needs to be present in 7 of 18 trigger points." B) "Diagnosis is made if I have widespread pain for 6 months or more." C) "There is no definitive test for fibromyalgia." D) "We need to rule out other causes for my pain."

A) "Pain needs to be present in 7 of 18 trigger points."

Which information should the nurse keep in mind when assessing pain in an older adult client? A. Pain in older adult clients tends to be overtreated. B. Older adult clients are less sensitive to drugs. C. McGill Pain Questionnaire is effective to assess pain in older adults. D. Older adults have a decreased pain threshold.

C. McGill Pain Questionnaire is effective to assess pain in older adults.

To reduce the incidence of migraine headaches, the nurse is teaching the patient to avoid foods high in tyramine. Which foods should the nurse tell the patient to avoid? A) Cheddar cheese B) White wine C) Cottage cheese D) Smoked fish

A) Cheddar cheese

A client is being treated for chronic pain. Which should the nurse expect to assess in this client? A. Elevated temperature B. Elevated blood pressure C. Present for more than 12 weeks D. Rapid heart rate

C. Present for more than 12 weeks

Which manifestation would the nurse expect to find in a patient with diabetic neuropathy? A) Pain and paresthesia starting in both feet and progressing up the leg B) Pain and paresthesia in one foot that eventually progresses up the leg C) A dull cramping pain in both calves D) Leg pain that is more severe in the morning

A) Pain and paresthesia starting in both feet and progressing up the leg

Which priority intervention should the nurse anticipate in the patient admitted with cauda equine syndrome? A) Prepare patient for urgent surgery. B) Place the patient on complete bedrest. C) Obtain equipment for skin traction. D) Obtain a physical therapy consult.

A) Prepare patient for urgent surgery.

Using the WHO pain ladder, the nursing plan of care for a patient with chronic lower back pain should include which strategy? A) Start with the first step and advance slowly up the ladder. B) Treat breakthrough pain with a long-acting analgesic. C) Administer an opioid and then slowly move back down the ladder. D) Aim for complete pain control as the goal of therapy.

A) Start with the first step and advance slowly up the ladder.

To perform scoliosis screening using the Adam forward bend test, what action does the nurse take? A) The nurse asks the child to bend forward at the waist. B) The nurse asks the child to cross arms over the chest. C) The nurse stands at the child's side to exam the spine. D) The nurse stands at the child's head to examine the spine.

A) The nurse asks the child to bend forward at the waist.

When preparing a community program on joint disease, the nurse recognizes that which group is most at risk for rheumatoid arthritis? A) Women between 40 and 60 years of age B) Men between 40 and 60 years of age C) Women between 20 and 40 years of age D) Men between 20 and 40 years of age

A) Women between 40 and 60 years of age

Which client statement should indicate to the nurse that teaching about non-modifiable risk factors for osteoporosis has been effective? A. "European Americans and Asian Americans are at a higher risk for osteoporosis than African Americans." B. "Lack of activity with a sedentary lifestyle decreases blood flow to the bones, limiting osteoblast activity and growth." C. "Nicotine from cigarette smoking slows the production of osteoblasts and impairs the absorption of calcium." D. "Alcohol has a direct toxic effect on osteoblast activity, suppressing bone formation during periods of alcohol intoxication."

A. "European Americans and Asian Americans are at a higher risk for osteoporosis than African Americans."

The nurse reviews the causes of osteoporosis with a group of new nurses. Which statement by a new nurse indicates understanding? A. "Osteoporosis is characterized by increased bone resorption and increased risk for fractures." B. "Women less than 50 years of age are at risk for an osteoporosis-related fracture." C. "Osteoporosis can occur only in older women." D. "More bone loss occurs after peak bone mass is achieved, around age 35."

A. "Osteoporosis is characterized by increased bone resorption and increased risk for fractures"

A nurse is caring for a client with a history of osteoarthritis. When reviewing the client's health assessment findings, which information should the nurse consider to guide the client's plan of care? (Select all that apply.) A. Medical history of bursitis B. Client age between 20 and 40 C. History of staphylococcal infection D. Joint stiffness of the hips E. Client age 65 or older

A. Medical history of bursitis D. Joint stiffness of the hips E. Client age 65 or older

The nurse is providing care for a client with spinal stenosis. Which nonsurgical treatment for this disorder should the nurse anticipate being ordered? (Select all that apply.) A. Nerve block B. Physical therapy C. Acupuncture D. Narcotic pain medication E. Nonsteroidal anti-inflammatory medications

A. Nerve block B. Physical therapy C. Acupuncture E. Nonsteroidal anti-inflammatory medications

The nurse is providing care for a client diagnosed with osteoarthritis (OA). Which nonsurgical therapy should the nurse anticipate being ordered? (Select all that apply.) A. Nonsteroidal anti-inflammatory medication B. Biophosphate C. Cortisone injection D. Topical analgesic E. Calcitonin

A. Nonsteroidal anti-inflammatory medication C. Cortisone injection D. Topical analgesic

The nurse evaluates a 54-year-old client experiencing pain. Which mnemonic should the nurse use for this assessment? A. OPQRST (Onset, provocative and palliative factors, quality, region or radiation, severity, timing) B. OQRST (Onset, quality, region or radiation, severity, timing) C. FLACC (Face, Legs, Activity, Cry, Consolability) D. OPQRS (Onset, provocative and palliative factors, quality, region or radiation, severity)

A. OPQRST (Onset, provocative and palliative factors, quality, region or radiation, severity, timing)

To assess a patient's quality of pain, which question would the nurse ask the patient? A) When did the pain start? B) How would you describe the pain? C) Can you point the site of your pain? D) On a scale of 0 to 10, how bad is your pain?

B) How would you describe the pain?

The nurse should expect to assess which finding in a patient with intervertebral disc degeneration? A) Back and leg pain relieved by sitting B) Pain in the back that spreads to the buttocks C) Back pain that spreads to the neck D) Back pain with numbness and tingling of the fingers

B) Pain in the back that spreads to the buttocks

Which assessment findings in a 7-year-old child suggests a diagnosis of psoriatic arthritis? A) Pain that started in the hips, knees, heels, or great toe followed later on by spine pain B) Red, scaly skin; pitted and yellowed toenails; joint pain C) Arthritis symptoms, intestinal inflammation D) Pain in the lower legs

B) Red, scaly skin; pitted and yellowed toenails; joint pain

The nurse notices that a pregnant woman has an exaggerated concavity of her spine. The nurse documents this as: A) kyphosis. B) lordosis. C) scoliosis. D) rotoscoliosis.

B) lordosis.

The school nurse is screening middle-school students for scoliosis and notes that one student has a curve of 15 degrees. The nurse tells the parents that their child has: A) prescoliosis. B) mild scoliosis. C) moderate scoliosis. D) severe scoliosis.

B) mild scoliosis.

When preparing a patient for a discectomy, the nurse explains that this procedure: A) removes the lamina to enlarge the spinal canal. B) removes all or part of the herniated disc. C) joins vertebrae together to prevent motion between the vertebra. D) vaporizes the tissue in the disc.

B) removes all or part of the herniated disc.

A client is experiencing acute pain. Which intervention should the nurse consider to improve pain control? A. Encourage to delay taking pain medication. B. Administer around-the-clock pain medication. C. Ask the healthcare provider to explain the pain management regimen. D. Assess for pain every shift.

B. Administer around-the-clock pain medication.

The nurse is teaching the parents of a child with scoliosis about the disorder. What would the nurse explain is the recommended treatment for a 15-degree curve of the spine? A) "Spinal fusion will be needed after the child has stopped growing to correct the curve." B) "A brace will need to be worn to straighten the spine." C) "All that is needed for this degree of curvature is physical therapy." D) "Surgery for placement of a rod may be needed if the spinal curvature worsens."

C) "All that is needed for this degree of curvature is physical therapy."

Which is the most appropriate pain scale for the nurse to use when assessing pain in a 7-year-old developmentally disabled child? A) Neonatal Infants Pain Scale (NIPS) B) Faces, Legs, Activity, Crying, Consolability Scale (FLACC) C) CRIES observational assessment tool D) Wong-Baker FACES scale

C) CRIES observational assessment tool

What sign(s) should alert the nurse to a potential problem in a patient taking a non-steroidal anti-inflammatory drug (NSAID) for diabetic polyneuropathy? A) Elevated liver function tests B) Elevated white blood cell count C) Elevated blood urea nitrogen (BUN) and serum creatinine levels D) Elevated prothrombin time

C) Elevated blood urea nitrogen (BUN) and serum creatinine levels

A patient with rheumatoid arthritis tells the nurse that the physician told him he has Felty syndrome and asks the nurse what it means. Which of the following conditions does the nurse include in her description of this syndrome? A) Low grade fever, weight loss, anorexia B) Vasculitis, pericarditis, pneumonitis C) Enlarged spleen, neutropenia, anemia D) Symmetric polyarticular joint swelling, joint redness, joint tenderness

C) Enlarged spleen, neutropenia, anemia

When a baby is born with congenital scoliosis, the nurse should also assess for problems with which other organs? A) Heart and lungs B) Liver and kidneys C) Heart and kidneys D) Lungs and liver

C) Heart and kidneys

Using the Pain Assessment in Advanced Dementia (PAINAD) tool, the nurse assesses a patient with Alzheimer disease to have a score of 5. The nurse prepares to treat this patient for which level of pain? A) No pain B) Mild pain C) Moderate pain D) Severe pain

C) Moderate pain

The nurse is discussing the pathophysiology of osteoporosis with a client. Which statement about bone mass is accurate? A. "Bone spurs causes the damage and degeneration associated with osteoporosis." B. "Bone mass is not affected by diet and nutrition." C. "Bone mass peaks between ages 30 and 35 years of age." D. "Bone loss slows down and stops around 60 years of age."

C. "Bone mass peaks between ages 30 and 35 years of age."

The nurse anticipates that a patient experiencing neuropathic pain caused by lumbar disc herniation may be treated with: A) Nonsteroidal anti-inflammatory drugs, which are specific for neuropathic pain B) Opioids for moderate pain C) Tramadol (Ultram) for mild pain D) Gabapentin (Neurontin), which is specific for neuropathic pain

D

Which patient statement indicates to the nurse that more teaching is needed about multimodal pain management? A) "This method will provide better pain control." B) "I will need a lower dose of each drug." C) "It reduces the need for opioid drugs." D) "It may increase the severity of the side effects I experience."

D) "It may increase the severity of the side effects I experience."

Which medication should the nurse anticipate administering to a patient in severe acute pain who is being treated using the WHO analgesic ladder? A) Ibuprofen B) Tramadol C) Codeine D) Morphine

D) Morphine

Which concept should the nurse use when assessing a patient's level of pain? A) Pain is defined by the nurse based on the type of injury. B) Consider the source of the pain when assessing for pain. C) A family member can determine the patient's level of pain if the patient is nonverbal. D) Pain is subjective experience of the patient.

D) Pain is subjective experience of the patient.

A nursing assessment on a patient experiencing myofascial pain is most likely to reveal: A) a feeling of pins and needles. B) constant pain. C) pain aggravated by cold. D) taut muscle band.

D) taut muscle band.

A patient who has had a right leg amputation below the knee describes a feeling that his toes are getting closer to his knee. The nurse explains to the patient that this sensation is known as: A) stump pain. B) phantom sensations. C) phantom limb pain. D) telescoping.

D) telescoping.

Which description accurately applies to acute pain? A. Not aggravated by activity B. Does not diminish as tissue healing occurs C. Decreases respirations D. Arises from injury or inflammation

D. Arises from injury or inflammation

Which pain scale should the nurse use to assess pain in an 18-month-old client? A. NRS B. VAS C. Bieri modified scale D. CRIES

D. CRIES