Pain NCLEX Questions

CASE STUDY - Pain Patient Profile R.D. is a 62-year-old man being evaluated for a change in his pain therapy for chronic malignant pain from metastatic cancer. Subjective Data • Patient desires zero pain but will accept pain level of 3 to 4 on a scale of 0 to 10. • He has been taking two Percocet tablets q4hr while awake but his pain is now usually at 4 to 5 with the medication. • Patient reports that pain varies over 24 hours from 5 to 10. • He always awakens in the morning with pain at 10 with nervousness, nausea, and a runny nose. • When pain becomes severe he stays in bed and concentrates on blocking the pain by emptying his mind. • He is worried that increased pain means his disease is worsening. • He is afraid to take additional doses or other opioids because he fears addiction. Objective Data • Height: 6 ft, 0 in (183 cm) • Weight: 150 lb (68 kg) • Rigid posturing, slow gait Discussion Questions 1. What additional assessment data should the nurse obtain from R.D. before making any decisions about his problem? 2. What data from the nursing assessment are characteristic of the affective, behavioral, and cognitive dimensions of the pain experience? 3. Based on R.D.'s lack of pain control with his current dosage of opioid and his symptoms on arising in the morning, what changes are indicated in his medication regimen? 4. Priority Decision: What are the priority teaching needs that should be included in a teaching plan for R.D. to titrate his analgesic dose effectively?

1. Assess the location, quality, and specific pattern of the pain. Also assess R.D.'s prior medication use, experience with opioids, and any addictions. 2. Affective: Worried about worsening of disease, afraid of opioids Behavioral: Posturing, slow gait, stays in bed with severe pain Cognitive: Uses emptying mind to block pain 3. The symptoms that R.D. has in the mornings are related to withdrawal because of physical dependence and the long interval during the night when the opioid is not used. An adjuvant drug should be added to his regimen and it and the Percocet should be taken around the clock. If the pain is not controlled with this measure, a stronger, sustained-release opioid such as MS Contin should be substituted for the Percocet. 4. Teach R.D. to evaluate the dose required to control his pain and the range and frequency of his dose

CASE STUDY CONTINUED 5. How could the nurse best help R.D. overcome his fear of addiction to opioid drugs? 6. What additional pain therapies could the nurse plan to help R.D. manage his pain? 7. Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses? Are there any collaborative problems?

5. Explain that tolerance and physical dependence are expected with long-term opiate use and should not be confused with addiction. Addiction is a psychologic condition characterized by a drive to obtain and compulsively take substances other than for their prescribed therapeutic value and despite risk of harm. 6. There are several physical techniques that could be used, depending on the location of R.D.'s pain, including dermal stimulation, such as massage and pressure. Additional cognitive-behavioral therapies, such as distraction or relaxation (imagery, meditation), could be taught. R.D. has a potential for using cognitive-behavioral therapies successfully because he can already mentally block the pain somewhat. 7. Nursing diagnoses: • Chronic pain related to ineffective pain management • Anxiety related to effects of disease process and inadequate relief from pain-relief measures • Activity intolerance related to pain, fatigue Collaborative problems: Potential complications: drug-induced constipation, respiratory depression, negative nitrogen balance, opioid toxicity

28. The nurse is assessing a patient for opioid tolerance. Which finding supports the nurse's assessment? A. Increasingly higher doses of opioid are needed to control pain. B. The patient needed a substantial dose of naloxone (Narcan). C. The patient asks for pain medication close to the time it is due around the clock. D. The patient no longer experiences sedation from the usual dose of opioid.

A. Increasingly higher doses of opioid are needed to control pain.

35. The nurse is administering ibuprofen (Advil) to an older patient. Which of the following assessment data causes the nurse to hold the medication? (Select all that apply.) A. Past medical history of gastric ulcer B. Patient states last bowel movement was 4 days ago C. Stated allergy to aspirin D. Patient states has 2/10 intermittent joint pain E. Patient experienced respiratory depression after administration of an opioid medication

A. Past medical history of gastric ulcer C. Stated allergy to aspirin

29.A nurse is caring for a patient with rheumatoid arthritis who is now going to be taking 2 acetaminophen (Tylenol) tablets every 6 hours to control pain. Which part of the patient's social history is the nurse most concerned about? A. Patient drinks 1 to 2 glasses of wine every night. B. Patient smokes 2 packs of cigarettes a day. C. Patient occasionally smokes marijuana. D. Patient takes antianxiety medications.

A. Patient drinks 1 to 2 glasses of wine every night.

8.A 24-year-old Asian woman is in labor and refuses to receive any sort of anesthesia medication. Which alternative treatment is best for this patient? A. Relaxation and guided imagery B. Transcutaneous electrical nerve stimulation (TENS) C. Herbal supplements with analgesic effects D. Pudendal block

A. Relaxation and guided imagery

18.The nurse is evaluating the effectiveness of guided imagery for pain management as used for a patient who has second- and third-degree burns and needs extensive dressing changes. Which statement best describes that guided imagery is effectively controlling the patient's pain during dressing changes? A. The patient's need for analgesic medication decreases during the dressing changes. B. The patient rates pain during the dressing change as a 6 on a scale of 0 to 10. C. The patient's facial expressions are stoic during the procedure. D. The patient can tolerate more pain, so dressing changes can be performed more frequently.

A. The patient's need for analgesic medication decreases during the dressing changes.

3.Which of the following statements made by a patient reflects that the patient understands the relationship between the gate control theory of pain and the use of meditation to relieve pain? A."Meditation controls pain by blocking pain impulses from coming through the gate." B. "Meditation will help me sleep through the pain because it opens the gate." C."Meditation stops the occurrence of pain stimuli." D."Meditation alters the chemical composition of pain neuroregulators, which closes the gate."

A."Meditation controls pain by blocking pain impulses from coming through the gate."

All the following medications are included in the admission orders for an 86-year-old patient with moderate degenerative arthritis in both hips. Which medication will the nurse use as an initial therapy? a. Aspirin (Bayer) 650 mg orally b. Oxycodone (Roxicodone) 5 mg orally c. Acetaminophen (Tylenol) 650 mg orally d. Naproxen (Aleve) 200 mg orally

Acetaminophen

Which action should the nurse take when preparing patient-controlled analgesia for a postoperative patient? a. Caution the patient to limit the number of times he presses the dosing button. b. Ask another nurse to double-check the setup before patient use. c. Instruct the patient to administer a dose only when experiencing pain. d. Provide clear, simple instructions for dosing if the patient is cognitively impaired.

Ask another nurse to double-check the setup before patient use

Your patient developed respirator depression after her first dose of intravenous (IV) morphine. After giving 0.2mg of nalozone (Narcan) IV push, the patient's respiratory rate and depth are within normal limits. Which action do you take now? a. Leave the patient alone to sleep now. b. Discontinue all pain medications ordered c. Administer another dose of naloxone in 1 hours d. Assess the patient's vital signs every 15 minutes for 2 hours

Asses the patients vital signs every 15 mins for 2 hours

A patient with a history of stroke 4 years ago resulting in aphasia (inability to verbally express thoughts) returns to the surgical unit after a cholecystectomy. The surgeon ordered an intravenous pain medication every 4 hours as needed (PRN) for postoperative pain. The best nursing intervention related to pain control after surgery would be to: a. Administer the pain medication when the patient becomes restless b. Wait until the patient verbalizes that hse is experiencing pain to administer the pain medication. c. Assess the patient's level of pain using a Faces Pain Scale and administer pain medication as ordered d. Administer the pain medication every 4 hours as the client can't express pain.

Assess the patients level of pain using a Faces pain scale and administer pain medication as orderd

4. A nursing student is planning care for an elderly patient who is experiencing pain. Which of the following statements made by the nursing student indicates the need for the nursing professor to clarify the nursing student's knowledge? A Older patients often have difficulty determining what is causing their pain." B. "It is safe to administer opioids to older adults as long as you start with small doses and frequently assess the patient's response to the medication." C. "As adults age, their ability to perceive pain decreases." D. "Patients who have dementia probably experience pain, and their pain is not always well controlled."

B. "It is safe to administer opioids to older adults as long as you start with small doses and frequently assess the patient's response to the medication."

23.Which statement made by a nursing educator best explains why it is important for nurses to determine a patient's medical history and recent drug use? A. "Health care providers have a responsibility to prevent drug seekers from gaining access to drugs." B. "This information is useful in determining what type of pain interventions will most likely be effective in providing pain relief." C. "Some recreational drugs have pharmaceutical counterparts that may be more effective in managing pain." D. "Getting this information gives the nurse an opportunity to provide patient teaching about drug abstinence."

B. "This information is useful in determining what type of pain interventions will most likely be effective in providing pain relief."

25.The nurse is assessing how a patient's pain is affecting mobility. Which assessment question is most appropriate? A. "Have you considered working with a physical therapist?" B. "What activities, if any, has your pain prevented you from doing?" C. "Would you please rate your pain on a scale from 1 to 10 for me?" D. "What effect does your pain medication typically have on your pain?"

B. "What activities, if any, has your pain prevented you from doing?"

17.The nurse recognizes that which of the following is a modifiable contributor to a patient's perception of pain? A. Age and gender B. Anxiety and fear C. Culture D. Previous pain experience

B. Anxiety and fear

21.A nurse receives an order from a health care provider to administer Vicodin ES, which contains 750 mg acetaminophen and 7.5 mg hydrocodone, to a patient who is experiencing 8/10 postsurgical pain. The order is to give 2 tablets every 6 hours by mouth as needed for pain. What is the nurse's best next action? A. Give the Vicodin ES to the patient immediately because the patient is experiencing severe pain. B. Ask the health care provider to verify the dosage and frequency of the medication. C. Ask the health care provider for an order for a nonsteroidal antiinflammatory drug (NSAID). D. Ask the health care provider for an order to play music for the patient, in addition to providing the pain medication.

B. Ask the health care provider to verify the dosage and frequency of the medication.

30.The nurse is caring for a patient who suddenly experiences chest pain. What is the nurse's first priority? A. Call the rapid response team. B. Ask the patient to rate and describe the pain. C. Raise the head of the bed. D. Administer pain relief medications.

B. Ask the patient to rate and describe the pain.

33. A nurse is caring for a patient who fell on the ice and has connective tissue damage in the wrist and hand. What does type of pain does the nurse document that the patient has? A. Visceral pain B. Somatic pain C. Peripherally generated pain D. Centrally generated pain

B. Somatic pain

11.A nurse is caring for a patient who recently had spinal surgery. The nurse knows that patients usually experience acute pain following this type of surgery. The patient refuses to get up and walk and is not moving around in the bed. However, the patient is stoic and denies experiencing pain at this time. What most likely explains this patient's behavior and response to surgery? A. The surgery successfully cured the patient's pain. B. The patient's culture is possibly influencing the patient's experience of pain. C. The patient is experiencing urinary retention because of manipulation of the spine during surgery; this is preventing the patient from experiencing pain. D. The nurse is allowing personal beliefs about pain to influence pain management at this time.

B. The patient's culture is possibly influencing the patient's experience of pain.

22.The nurse knows that which technique is best for assessing pain in a child who is 4 years of age? A. Ask the parents if they think their child is in pain. B. Use the FACES scale. C. Ask the child to rate the level of pain on a 0 to 10 pain scale. D. Check to see what previous nurses have charted.

B. Use the FACES scale.

16. A patient who had a motor vehicle accident 2 days ago is experiencing pain and is receiving patient-controlled analgesia (PCA). How does the nurse know that the patient is experiencing effective pain management with the PCA? A. The patient is sleeping and is difficult to arouse. B.The patient rates pain at an acceptable level of 3 on a 0 to 10 scale. C. Sufficient medication is left in the PCA syringe. D. The patient presses the control button to deliver pain medication.

B.The patient rates pain at an acceptable level of 3 on a 0 to 10 scale.

A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (of a 0-10 scale) and requests "something for pain that will work quickly." The best way for the nurse to document this information is as a. breakthrough pain. b. neuropathic pain. c. somatic pain. d. referred pain

Breakthrough pain

9.Which of the following statements made by the patient indicates to the nurse that teaching on a patient-controlled analgesia (PCA) device has been effective? A. "This is the only pain medication I will need to be on." B. "I can administer the pain medication as frequently as I need to" C. "I feel less anxiety about the possibility of overdosing." D. "I will need the nurse to notify me when it is time for another dose."

C. "I feel less anxiety about the possibility of overdosing."

24.A nurse is supervising a student who is caring for a patient with chronic pain. Which statement by the student indicates an understanding of pain management? A. "This patient says her pain is a 5, but she is not acting like it. I am not going to give her any pain medication." B. "The patient is sleeping, so I pushed her PCA button for her." C. "I need to reassess the patient's pain 1 hour after administering oral pain medication." D. "It wasn't time for the patient's medication, so when she requested it, I gave her a placebo."

C. "I need to reassess the patient's pain 1 hour after administering oral pain medication."

19. A nurse is providing medication education to a patient who just started taking ibuprofen, a nonselective nonsteroidal antiinflammatory drug (NSAID). Which statement made by the nurse best indicates how ibuprofen works? A. "Ibuprofen helps to remove factors that cause or stimulate pain." B. "Ibuprofen reduces anxiety, which will help you better cope with your pain." C. "Ibuprofen helps to decrease the production of prostaglandins." D. "Ibuprofen binds with opiate receptors to reduce your pain."

C. "Ibuprofen helps to decrease the production of prostaglandins."

26.The nurse is teaching a student nurse about pain assessment scales. Which statement by the student indicates correct understanding? A. "You cannot use a pain scale to compare the pain of my patient with the pain of your patient." B. "When patients say they don't need pain medication, they aren't in pain." C. "Pain assessment scales determine the quality of a patient's pain." D. "A patient's behavior is more reliable than the patient's report of pain."

C. "Pain assessment scales determine the quality of a patient's pain."

10.A nurse is caring for a patient who is experiencing pain following abdominal surgery. What information is important for the nurse to tell the patient when providing patient education about effective pain management? A. "To prevent overdose, you need to wait to ask for pain medication until you begin to experience pain." B. "You should take your medication after you walk to make sure you do not fall while you are walking." C. "We should work together to create a regular schedule of medications that does not allow for breakthrough pain." D "You need to take oral pain medications when you experience severe pain."

C. "We should work together to create a regular schedule of medications that does not allow for breakthrough pain."

20.A nurse has brought the patient his scheduled pain medication. The patient asks the nurse to wait to give pain medication until the time for the dressing change, which is 2 hours away. Which response by the nurse is most therapeutic? A. "This medication will still be providing you relief at the time of your dressing change." B. "OK, swallow this pain pill, and I will return in a minute to fill your wound." C. "Would you like medication to be given for dressing changes on top of your regularly scheduled medication?" D. "Your medication is scheduled for this time, and I can't adjust the time for you. I'm sorry, but you must take your pill right now."

C. "Would you like medication to be given for dressing changes on top of your regularly scheduled medication?"

12. A nurse is providing discharge teaching for a patient with a fractured humerus. The patient is going home with Vicodin (5/325). What important patient education does the nurse provide? A. "Be sure to eat a meal high in fat before taking the medication, to avoid a stomach ulcer." B. "Narcotics can be addictive, so do not take them unless you are in severe pain." C. "You need to drink plenty of fluids and eat a diet high in fiber." D. "As your pain severity lessens, you will begin to give yourself once-daily intramuscular injections."

C. "You need to drink plenty of fluids and eat a diet high in fiber."

6.The nurse anticipates administering an opioid fentanyl patch to which patient? A.A 15-year-old adolescent with a broken femur B.A 30-year-old adult with cellulitis C. A 50-year-old patient with prostate cancer D. An 80-year-old patient with a broken hip

C. A 50-year-old patient with prostate cancer

1. What is the most appropriate way to assess the pain of a patient who is oriented and has recently had surgery? A. Assess the patient's body language. B. Observe cardiac monitor for increased heart rate. C. Ask the patient to rate the level of pain. D. Ask the patient to describe the effect of pain on the ability to cope.

C. Ask the patient to rate the level of pain.

32.Which of the following is the best way for the nurse to manage pain for a patient with chronic pain from arthritis? A.Administer pain medication before any activity. B. Provide intravascular bolus as needed for breakthrough pain. C. Give medications around-the-clock. D. Administer pain medication only when nonpharmacological measures have failed.

C. Give medications around-the-clock.

7.What nursing intervention is most effective in preventing injury to a patient following administration of epidural anesthesia? A Keeping the reversal agent in a syringe in the patient's bedside table B. Applying a gauze dressing to the epidural catheter insertion site C. Labeling the tubing that leads to the epidural catheter D. Asking the nursing assistive personnel to check on the patient at least once every 2 hours

C. Labeling the tubing that leads to the epidural catheter

5. The nurse is caring for two patients; both are having a hysterectomy. The first patient is having the hysterectomy after a complicated birth. The second patient has uterine cancer. What will most likely influence the experience of pain for these two patients? A. Neurological factors B.Competency of the surgeon C.Meaning of pain D. Postoperative support personnel

C. Meaning of pain

13.A patient arrives at the emergency department experiencing a headache and rates the pain as 7 on a 0 to 10 pain scale. What nonpharmacological intervention does the nurse implement for this patient while awaiting orders for pain medication from the health care provider? A. Frequently reassesses the patient's pain scores B. Reassures the patient that the provider will come to the emergency department soon C. Softly plays music that the patient finds relaxing D. Teaches the patient how to do yoga

C. Softly plays music that the patient finds relaxing

31.The nurse is caring for a patient who recently had surgery to repair a hernia. The patient's pain was 7 out of 10 before receiving pain medication. One hour after receiving an oral opioid, the patient ranks his pain at 3 out of 10. The patient asks the nurse why he isn't receiving more pain medication. Which is the nurse's best response? A. "This medication can be given only every 4 hours. It is not time for you to have any other pain medication right now." B. "I will notify the health care provider to come perform an assessment if your pain doesn't improve in 30 minutes." C. "If the pain becomes severe, we may need to transfer you to an intensive care unit." D. "It can take 2 hours for oral pain medication to work, and your pain is going down. Let's try boosting you up in bed and putting an ice pack on the incision to see if that helps."

D. "It can take 2 hours for oral pain medication to work, and your pain is going down. Let's try boosting you up in bed and putting an ice pack on the incision to see if that helps."

A nurse is caring for a patient who recently had an abdominal hysterectomy and states that she is experiencing severe pain. The patient's blood pressure is 110/60, and her heart rate is 60. Additionally, the patient does not appear to be in any distress. Which response by the nurse is most therapeutic? A. "Your vitals do not show that you are having pain; can you describe your pain?" B."You do not look like you are in pain." C. "OK, I will go get you some narcotic pain relievers immediately." D. "What would you like to try to alleviate your pain?"

D. "What would you like to try to alleviate your pain?"

14.A patient who has had type 2 diabetes for 26 years is beginning to experience peripheral neuropathy in the feet and lower legs, which is causing the patient to have a decreased ability to feel pain in the lower extremities. The nurse is providing education to the patient to prevent injury to the feet. The nurse tells the patient to always wear shoes or slippers when walking. Which of the following statements made by the nurse best explains the rationale for this instruction? A. "Wearing shoes blocks pain perception and helps you adapt to pain, which ends up protecting your feet." B. "Shoes provide nonpharmacological pain relief to people with diabetes and peripheral neuropathy." C. "Since you cannot feel pain as much in your feet, you need to open your neurological gates to allow pain sensations to come through. Wearing shoes helps to open those gates, which protects your feet." D. "You have lost the ability to withdraw from pain because of your peripheral neuropathy. If you step on something and are not wearing shoes, you will not feel it; this could possibly cause injury to your foot."

D. "You have lost the ability to withdraw from pain because of your peripheral neuropathy. If you step on something and are not wearing shoes, you will not feel it; this could possibly cause injury to your foot."

34.The nurse is caring for an infant in the intensive care unit. Which of the following is the most accurate description of factors that will influence the perception and management of pain for this patient? A. Infants cannot tolerate analgesics owing to an underdeveloped metabolism. B. Infants have an increased sensitivity to pain when compared with older children. C. Pain cannot be accurately assessed in infants. D. Infants respond behaviorally and physiologically to painful stimuli.

D. Infants respond behaviorally and physiologically to painful stimuli.

27.The nurse is administering pain medication for several patients. Which patient does the nurse administer medication to first? A. The patient who needs to take a scheduled dose of maintenance pain medication B. The patient who needs to be premedicated before walking C. The patient with a PCA running who needs to have the syringe replaced D. The patient who is experiencing 8/10 pain and has a STAT order for pain medication

D. The patient who is experiencing 8/10 pain and has a STAT order for pain medication

15.A nurse is assessing a patient who started to have severe pain 3 days ago. When the nurse asks the patient to describe the pain, the patient states, "The pain feels like it is in my stomach. It is a burning pain, and it spreads out in a circle around the spot where it hurts the most." What type of pain does the nurse document that the patient is having at this time? A. Superficial pain B. Idiopathic pain C. Chronic pain D. Visceral pain

D. Visceral pain

A 73-year-old patient who sustained a right hip fracture in a fall requests pain medication from the nurse. Based on his injury, which type of pain is this patient most likely experiencing? a. Phantom b. Visceral c. Deep somatic d. Referred

Deep somatic

A client who is receiving epidural analgesia complains of nausea and loss of motor function in his legs. The nurse obtains his blood pressure and notes a drop in his blood pressure from the previous reading. Which complication is the patient most likely experiencing? a. Infection at the catheter insertion site b. Side effect of the epidural analgesic c. Epidural catheter migration d. Spinal cord damage

Epidural catheter mgration

A 45-year-old patient has breast cancer that has spread to the liver and spine. The patient has been taking oxycodone (OxyContin) and amitriptyline (Elavil) for pain control at home but now has constant severe pain and is hospitalized for pain control and development of a pain-management program. When doing the initial assessment, which question will be most appropriate to ask first? a. How would you describe your pain? b. How much medication do you take for the pain? c. How long have you had this pain? d. How many times a day do you medicate for pain?

How would you describe your pain?

Following surgery, a client has great difficulty getting out of bed, walking, and coughing and deep breathing. Although patient-controlled analgesia (PCA) is in place, it is rarely used, even when suggested by the nurse. This concerns the nurse. Which statement is the best way to address this concern with the client? a. "I noticed you use very little pain medication. You must be very brave and strong. But without pain medication, you will get weaker, not stronger." b. "I noticed you don't use much pain medication. If you don't push that button, I will. You need that medicine. Don't worry about getting addicted. It won't happen." c. "I noticed you haven't used your pain medication as often as you could, even though it is painful for you to get out of bed and to walk. Many people are reluctant to take pain medication. Tell me what makes you reluctant." d. "I can understand why you are reluctant to use pain medication. Many people feel the same way. Yet without pain relief, you can get atelectasis, pneumonia, and blood clots, and maybe even develop an ileus."

I noticed you haven't used your pain meds as often as you could, even though it is painful for you to get out of bed and walk. many people are reluctant to take pain meds. Tell me what makes you reluctant

The hospice RN obtains the following information about a 72-year-old terminally ill patient with cancer of the colon. The patient takes oxycodone (OxyContin) 100 mg twice daily for level 6 abdomen pain on a 10-point scale. The pain has made it difficult to continue with favorite activities such as playing cards with friends twice a week. The patient's children are supportive of the patient's wish to stop chemotherapy but express sadness that the patient does not have long to live. Based on this information, which nursing diagnosis has priority in planning the patient's care? a. Impaired social interaction related to disabling pain b. Anxiety related to poor patient coping skills c. Disabled family coping related to patient-family conflict d. Risk for aspiration related to opioid use

Impaired social interaction related to disabling pain

The nurse administers codeine sulfate 30 mg orally to a patient who underwent craniotomy 3 days ago for a brain tumor. How soon after administration should the nurse reassess the patient's pain? a. Immediately b. In 10 minutes c. In 15 minutes d. In 60 minutes

In 60 mins

A patient with a history of chronic cancer pain is admitted to the hospital. When reviewing the patient's home medications, which of these will be of most concern to the admitting nurse? a. Oxycodone (OxyContin) 80 mg twice daily b. Ibuprofen (Advil) 800 mg three times daily c. Amitriptyline (Elavil) 50 mg at bedtime d. Meperidine (Demerol) 25 mg every 4 hours

Meperidine. Response Feedback: Rationale: Meperidine is contraindicated for chronic pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods. The ibuprofen, amitriptyline, and oxycodone are all appropriate medications for long-term pain management

One hour after administering the first dose of an intravenous opioid to your postoperative patient, about which of the following assessments should you be most concerned? a. Respiratory rate of 6 breaths per minute b. Oxygen saturation of 95% on room air c. Heart rate of 70 regular d. Blood pressure of 140/72

Resp rate 6 breaths per min

When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication? a. The patient complains of a "pounding" headache. b. The patient becomes restless and agitated. c. The patient has not voided for over 10 hours. d. The patient has cramping abdominal pain.

The patient has not voided for over 10 hours

A 7-year old pediatric patient tells you that he is in pain. The patient rates the pain as 4 on the Faces Pain Scale of 0-10. His mother, who is in the room, states that her son is having pain at a level of 8 on the 0-10 scale. Which is the most accurate assessment of the patient's pain? a. The patient is the best resource for assessing the pain and should receive the appropriate pain medication b. The patient is the best resource for assessing the pain, but should not receive any pain medication because his level is only 4 out of 10. c. The nurse is the best resource for assessing the pediatric patient's pain level and gives the dose of pain medication that matches the nurses' judgment. d. The mother is the best resource for assessing the pain in this case, and the patient should receive the maximum dose of pain medication ordered.

The patient is the best resource for assessing the pain and should receive the appropriate pain medication

The nurse is evaluating the effectiveness of imipramine (Tofranil), a tricyclic antidepressant, for a patient who is receiving the medication to help relieve chronic cancer pain. Which information is the best indicator that the imipramine is effective? a. The patient states, "I feel much less depressed since I've been taking the imipramine." b. The patient sleeps 8 hours every night. c. The patient says that the pain is manageable and that he or she can accomplish desired activities. d. The patient has no symptoms of anxiety.

The patient says that the pain is manageable and that he or she can accomplish desired activities

A patient is receiving a continuous infusion of morphine via an epidural catheter following major abdominal surgery.Which actions should the nurse include in the plan of care (select all that apply)? a. Label the catheter as an epidural access. b. Assess the patient's pain relief frequently. c. Use sterile technique when caring for the catheter. d. Monitor the patient's level of consciousness (LOC). e. Monitor patient vital signs (blood pressure, heart rate, respirations). f. Assess the motor and sensory function of the patient's lower extremities

a, b, c, d, e, f. The major complications of epidural analgesia are catheter displacement and migration, accidental infusions of neurotoxic agents, and infection. These actions will help to reduce those risks.

Match the following types of pain in the left column with a category of pain from the upper right column and an example of the source of the pain from the lower right column. Types of Pain ___a. Pain from loss of afferent input ___b. Pain persisting from sympathetic nervous system (SNS) activity ___c. Pain caused by dysfunction in the central nervous system (CNS) ___d. Pain arising from skin and subcutaneous tissue; well localized ___e. Pain arising from muscles and bones; localized or diffuse and radiating ___f. Pain felt along the distribution of peripheral nerve(s) from nerve damage ___g. Pain arising from visceral organs; well or poorly localized; referred cutaneously Categories of Pain 1. Nociceptive pain 2. Neuropathic pain Sources of Pain 3. Sunburn 4. Pancreatitis 5. Osteoarthritis 6. Poststroke pain 7. Phantom limb pain 8. Trigeminal neuralgia 9. Postmastectomy pain

a. 2, 7/9; b. 2, 7; c. 2, 6; d. 1, 3; e. 1, 5; f. 2, 8; g. 1, 4

List in order the nociceptive processes that occur to communicate tissue damage to the CNS. No. 1 is the first process and No. 4 is the last process. a. Perception b. Modulation c. Transmission d. Transduction

a. 3; b. 4; c. 2; d. 1

19. A patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first? a. Administer the prescribed PRN immediate-acting morphine. b. Suggest the use of alternative therapies such as heat or cold. c. Utilize distraction by talking about things the patient enjoys. d. Consult with the doctor about increasing the MS Contin dose.

a. Administer the prescribed PRN immediate-acting morphine. The patient's pain requires rapid treatment and the nurse should administer the immediate-acting morphine. Increasing the MS Contin dose and use of alternative therapies also may be needed, but the initial action should be to use the prescribed analgesic medications.

Once generated, what may block the transmission of an action potential along a peripheral nerve fiber to the dorsal root of the spinal cord? a. The transmission may be interrupted by drugs such as local anesthetics. b. Nothing can stop the action potential along an intact nerve until it reaches the spinal cord. c. The action potential must cross several synapses, points at which the impulse may be blocked by drugs. d. The nerve fiber produces neurotransmitters that may activate nearby nerve fibers to transmit pain impulses.

a. Although a peripheral nerve is one cell that carries an impulse directly from the periphery to the dorsal horn of the spinal cord with no synapses, transmission of the impulse can be interrupted by drugs known as membrane stabilizers or sodium-channel inhibitors, such as local anesthetics and some antiseizure drugs. The nerve fiber produces neurotransmitters only at synapses, not during transmission of the action potential.

A patient with colorectal cancer has continuous, poorly localized abdominal pain at an intensity of 5 on a scale of 0 to 10. How does the nurse teach the patient to use pain medications? a. On an around-the-clock schedule b. As often as necessary to keep the pain controlled c. By alternating two different types of drugs to prevent tolerance d. When the pain cannot be controlled with distraction or relaxation

a. Analgesics should be scheduled around the clock for patients with constant pain to prevent pain from escalating and becoming difficult to relieve. If pain control is not adequate, the analgesic dose may be increased or an adjunctive drug may be added to the treatment plan

A patient who has been taking ibuprofen (Motrin) and imipramine (Tofranil) for control of cancer pain is having increased pain. What would the health care provider recommend as an appropriate change in the medication plan? a. Add PO oxycodone (Oxycontin) to the other medications b. Substitute PO propoxyphene (Darvon), a mild opioid, for imipramine c. Add transdermal fentanyl (Duragesic) to the use of the other medications d. Substitute PO hydrocodone with acetaminophen (Lortab, Vicodin) for the other medications

a. As cancer pain increases, stronger drugs are added to the regimen. This patient is using a nonsteroidal antiinflammatory drug (NSAID) and an antidepressant. A stronger preparation would be an opioid but because an NSAID is already being used, a combination NSAID/opioid is not indicated. An appropriate stronger drug would be an oral opioid, in this case oral oxycodone, and this still leaves stronger drugs for expected increasing pain. Propoxyphene is not recommended in analgesic guidelines because of its limited efficacy and toxicities.

A patient with trigeminal neuralgia has moderate to severe burning and shooting pain. In helping the patient to manage the pain, the nurse recognizes what about this type of pain? a. Treatment includes the use of adjuvant analgesics b. Will be chronic in nature and require long-term treatment c. Responds to small to moderate around-the-clock doses of oral opioids d. Can be well controlled with salicylates or nonsteroidal antiinflammatory drugs (NSAIDs)

a. Damage to peripheral or cranial nerves causes neuropathic pain that is not well controlled by opioid analgesics alone and often includes the adjuvant use of tricyclic antidepressants or antiseizure drugs to help inhibit pain transmission. Salicylates and NSAIDs are not effective for the intensity of neuropathic pain.

The patient has chronic pain that is no longer relieved with oral morphine. Which medication would the nurse expect to be ordered to provide better pain relief for this patient? a. Duragesic b. Oramorph SR c. Hydrocodone d. Intranasal butorphanol (Stadol)

a. Duragesic is frequently used for chronic pain in patients who are not opiate-naive. Oramorph SR given buccally will have the same absorption as morphine, so it would not be expected to be more effective than oral morphine. Hydrocodone is used for acute and short-term pain, not chronic pain. Intranasal butorphanol (Stadol) is used for acute headaches and recurrent, not chronic pain. The route used will depend on the swallowing ability of the patient.

List the 10 basic principles that should guide the treatment of all pain

a. Follow the principles of pain assessment. b. Use a holistic approach to pain management. c. Every patient deserves adequate pain management. d. Base treatment on the patient's goals. e. Use both drug and nondrug therapies. f. When appropriate, use a multimodal approach to analgesic therapy. g. Address pain using an interdisciplinary approach. h. Evaluate the effectiveness of all therapies to ensure that they are meeting the patient's goals. i. Prevent or manage medication side effects. j. Incorporate patient and caregiver teaching throughout assessment and teaching.

In the following scenario, identify the elements of a pain assessment that are present. A 62-year-old male patient is admitted to the medical unit from the emergency department. On arrival he is trembling and nearly doubled over with severe, cramping abdominal pain. He indicates that he has severe right upper quadrant pain that radiates to his back and he is more comfortable walking bent forward than lying in bed. He notes that he has had several similar bouts of abdominal pain in the last month but "not as bad as this. This is the worst pain I can imagine." The other episodes lasted only about 2 hours. Today he experienced an acute onset of pain and nausea after eating fish and chips at a fast-food restaurant about 4 hours ago. a. b. c. d. e. f. g.

a. Onset: About 4 hours ago b. Duration and pattern of the pain: Continuously for about 4 hours. Similar episodes in the past month but lasted only 2 hours. c. Location: Right upper quadrant d. Intensity: Severe, 10 on a scale of 0 to 10 e. Quality: Severe cramping, radiates to back f. Associated symptoms: Nausea g. Management strategies: Pain better walking bent forward, more intense lying in bed

List and briefly describe the five dimensions of pain.

a. Physiologic—the anatomic and physical determinants of pain b. Affective—the emotional response to pain c. Cognitive—the beliefs, attitudes, and meanings attributed to pain d. Behavioral—observable actions that express or control pain e. Sociocultural—age and gender, family and caregiver influence, and culture that influences the pain experience

21. A patient who is using a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first? a. Remove the fentanyl patch. b. Notify the health care provider. c. Continue to monitor the patient's status. d.Give the prescribed PRN naloxone (Narcan).

a. Remove the fentanyl patch. The assessment data indicate possible overdose of opioid. The first action should be to remove the patch. Naloxone administration in a patient who has been chronically using opioids can precipitate withdrawal and would not be the first action. Notification of the health care provider and continued monitoring also are needed, but the patient's data indicate that more rapid action is needed.

A patient comes to the clinic with a complaint of a dull pain in the anterior and posterior neck. On examination, the nurse notes that the patient has full range of motion (ROM) of the neck and no throat redness or enlarged head or neck lymph nodes. What will be the nurse's next appropriate assessment indicated by these findings? a. Palpation of the liver b. Auscultation of bowel sounds c. Inspection of the patient's ears d. Palpation for the presence of left flank pain

a. The right neck and flank are common areas of referred pain from liver damage and examination of the liver should be considered when pain occurs without other findings in these areas. Other common referred areas are midscapular and left arm for cardiac pain, inner legs for bladder pain, and shoulders for gallbladder pain.

14. A patient who uses extended-release morphine sulfate (MS Contin) for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone (Vicodin) tablets, but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take? a. Wake the patient and administer the hydrocodone. b. Wait until the patient wakes up and reassess the pain. c. Consult with the health care provider about changing the MS Contin dose. d. Suggest the use of nondrug therapies for pain relief instead of additional opioids.

a. Wake the patient and administer the hydrocodone. Since patients with chronic pain frequently use withdrawal and decreased activity as coping mechanisms for pain, the patient's sleep is not an indicator that she is pain free. The nurse should wake the patient and administer the hydrocodone.

18. A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic pain complains of nausea and abdominal fullness. The best initial action by the nurse is to a. administer the ordered antiemetic medication. b. tell the patient that the nausea will subside in about a week. c. order the patient a clear liquid diet until the nausea decreases. d. consult with the health care provider about using a different opioid

a. administer the ordered antiemetic medication. Nausea is frequently experienced with the initiation of opioid therapy, and antiemetics usually are prescribed to treat this expected side effect. There is no indication that a different opioid is needed, although if the nausea persists, the health care provider may order a change of opioid. Although tolerance develops and the nausea will subside in about a week, it is not appropriate to allow the patient to continue to be nauseated. A clear liquid diet may decrease the nausea, but the best choice would be to administer the antiemetic medication and allow the patient to eat.

5. A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. The nurse's reply is based on the information that these strategies a. impact the cognitive and affective components of pain. b. increase the modulating effect of the efferent pathways. c. prevent transmission of nociceptive stimuli to the cortex. d. slow the release of transmitter chemicals in the dorsal horn.

a. impact the cognitive and affective components of pain. Cognitive therapies impact on the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.

Morphine 10 mg IV every 4 to 6 hours prn is ordered for a patient with a pancreatic tumor who has a distant history of opioid abuse. After 3 days of receiving the morphine every 6 hours, the patient tells the nurse that the medication is needed more frequently to control the pain. The best initial action by the nurse is to a. administer the morphine every 4 hours as needed. b. consult with the doctor about initiating an appropriate weaning protocol for the morphine c. remind the patient that the previous substance abuse increases the risk for addiction. d. use alternative therapies such as heat or cold.

administer the morphine every 4 hours as needed Response Feedback: Rationale: These patient data indicate that tolerance for the morphine is developing and more frequent administration is needed to maintain pain control. A weaning protocol is not indicated, since the patient still has the pancreatic tumor and there is no indication that the physiologic basis of the pain has changed. Although the patient may be at risk for addiction, adequate pain management is the priority at present. Alternative therapies may be a useful adjuvant to the morphine but should not be the first nursing action.

A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic pain complains of nausea and abdominal fullness. The most appropriate initial action by the nurse is to a. consult with the health care provider about using a different opioid. b. administer the ordered metoclopramide (Reglan) 10 mg IV. c. tell the patient that the nausea will subside in about a week. d. order the patient a clear liquid diet until the nausea decreases.

administer the ordered metoclopramide (Reglan) 10 mg IV

A home health patient has a prescription for pentazocine (Talwin,) a mixed opioid agonist-antagonist. When teaching the patient and family about adverse effects, the nurse will plan to focus on how to monitor for a. agitation. b. respiratory depression. c. hypotension. d. physical dependence.

agitation

While waiting to perform x-rays on an injured right hand according to non-pharmacological pain management practice, pain can be modulated or reduced if the nurse: a. Performs frequent pain assessment b. Administers a placebo c. Applies ice to the right elbow d. Turns off the light and shuts the door

applies ice to the right elbow

Severe cancer pain is most effectively treated with analgesics given: a. Around the clock, with extra doses available as needed b. Around the clock, in titrated doses c. As needed by the client d. Sparingly, to avoid side effects

around the clock, with an extra dose available as needed

A 24-year old patient is admitted to the trauma unit with a diagnosis of a fractured femur after a motor vehicle accident. He states that he has pain in the injured leg. What should be the first action taken by the nurse? a. Administer the lowest dose of pain medication b. Assess the characteristics of the pain c. Call the orthopedic surgeon d. Complete the admission assessment

assess the characteristics of the pain

Which measures or drugs may be effective in controlling pain in the physiologic pain process stage of transduction (select all that apply)? a. Distraction d. Local anesthetics b. Corticosteroids e. Antiseizure medications c. Epidural opioids f. Nonsteroidal antiinflammatory drugs (NSAIDs)

b, d, e, f. Distraction is effective in the perception stage. Epidural opioids are effective in the transmission stage

1. When doing a pain assessment for a patient who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the patient's pain? a. "How long have you had this pain?" b. "How would you describe your pain?" c. "How much medication do you take for the pain?" d."How many times a day do you medicate for pain?"

b. "How would you describe your pain?" Because pain is a multidimensional experience, asking a question that addresses the patient's experience with the pain is likely to elicit more information than the more specific information asked in the other three responses. All of these questions are appropriate, but the response beginning "How would you describe your pain?" is the best initial question.

20. Which nursing action should the nurse delegate to nursing assistive personnel (NAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain? a. Assess the skin under the heating pad. b. Check the respiratory rate every 2 hours. c. Monitor sedation using the sedation assessment scale. d. Ask the patient about whether pain control is effective.

b. Check the respiratory rate every 2 hours. Obtaining the respiratory rate is included in NAP education and scope of practice. Assessment for sedation, pain control, and skin integrity requires more education and scope of practice.

While caring for an unconscious patient, the nurse discovers a stage 2 pressure ulcer on the patient's heel. During care of the ulcer, what is the nurse's understanding of the patient's perception of pain? a. The patient will have a behavioral response if pain is perceived. b. The area should be treated as a painful lesion, using gentle cleansing and dressing. c. The area can be thoroughly scrubbed because the patient is not able to perceive pain. d. All nociceptive stimuli that are transmitted to the brain result in the perception of pain

b. It is known that the brain is necessary for pain perception but because it is not clearly understood where in the brain pain is perceived, pain may be perceived even in a comatose patient who may not respond behaviorally to noxious stimuli. Any noxious stimulus should be treated as potentially painful.

1. The health care provider plans to titrate a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time (select all that apply)? a. Assessing for signs that the patient is becoming addicted to the opioid b. Monitoring for therapeutic and adverse effects of opioid administration c. Emphasizing that the risk of some opioid side effects increases over time d. Educating the patient about how analgesics improve postoperative activity level e. Teaching about the need to decrease opioid doses by the second postoperative day

b. Monitoring for therapeutic and adverse effects of opioid administration d. Educating the patient about how analgesics improve postoperative activity level Monitoring for pain relief and teaching the patient about how opioid use will improve postoperative outcomes are appropriate actions when administering opioids for acute pain. Although postoperative patients usually need decreasing amount of opioids by the second postoperative day, each patient's response is individual. Tolerance may occur, but addiction to opioids will not develop in the acute postoperative period. The patient should use the opioids to achieve adequate pain control, and so the nurse should not emphasize the adverse effects.

16. The nurse assesses a postoperative patient who is receiving morphine through patient-controlled analgesia (PCA). Which information is most important to report to the health care provider? a. The patient complains of nausea after eating. b. The patient's respiratory rate is 10 breaths/minute. c. The patient has not had a bowel movement for 3 days. d. The patient has a distended bladder and has not voided.

b. The patient's respiratory rate is 10 breaths/minute. The patient's respiratory rate indicates a need to decrease the PCA dose or change the medication in order to avoid further respiratory depression. The other information also may require intervention, but is not as urgent to report as the respiratory rate.

A patient with multiple injuries resulting from an automobile accident tells the nurse that he has "bad" pain but that he can "tough it out" and does not require pain medication. To gain the patient's participation in pain management, what should the nurse explain to the patient? a. Patients have a responsibility to keep the nurse informed about their pain. b. Unrelieved pain has many harmful effects on the body that can impair recovery. c. Using pain medications rarely leads to addiction when they are used for actual pain. d. Nonpharmacologic therapies can be used to relieve his pain if he is afraid to use pain medications.

b. When a patient wants to be stoic about pain, it is important that he or she understand that pain itself can have harmful physiologic effects and that failure to report pain and participate in its control can result in severe unrelieved pain. No evidence that indicates fear of taking the medication is present in this situation.

8. A patient with second-degree burns has been receiving morphine through patient-controlled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. The most appropriate action by the nurse is to a. administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping. b. consult with the health care provider about using a different treatment protocol to control the patient's pain. c. request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain. d. teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.

b. consult with the health care provider about using a different treatment protocol to control the patient's pain. PCAs are best for controlling acute pain; this patient's history indicates chronic pain and a need for a pain management plan that will provide adequate analgesia while the patient is sleeping. Administering a dose of morphine when the patient already has severe pain will not address the problem. Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a patient through PCA.

15. These medications are prescribed by the health care provider for a patient who uses long-acting morphine (MS Contin) for chronic back pain, but still has ongoing pain. Which medication should the nurse question? a. morphine (Roxanol) b. pentazocine (Talwin) c. celecoxib (Celebrex) d. dexamethasone (Decadron)

b. pentazocine (Talwin) Opioid agonist-antagonists can precipitate withdrawal if used in a patient who is physically dependent on mu agonist drugs such as morphine. The other medications are appropriate for the patient.

A postoperative patient who has undergone extensive bowel surgery moves as little as possible and does not use the incentive spirometer unless specifically reminded. The patient rates the pain severity as an 8 on a 10-point scale but tells the nurse, "I can tough it out." In encouraging the patient to use pain medication, the best explanation by the nurse is that a. very few patients become addicted to opioids when using them for acute pain control. b. there is little need to worry about side effects because these problems decrease over time. c. there are many pain medications and if one drug is ineffective, other drugs may be tried. d. unrelieved pain can be harmful due to the effect on respiratory function and

be able to play 1 to 2 rounds of golf

On the first postoperative day following a bowel resection, the patient complains of abdominal and incisionalpain rated 9 on a scale of 0 to 10. Postoperative orders include morphine, 4 mg IV q2 hr, for pain and may repeat morphine, 4 mg IV, for breakthrough pain. The nurse determines that it has been only 2 hours since the last dose of morphine and wants to wait a little longer. What effect does the nurse's action have on the patient? a. Protects the patient from addiction and toxic effects of the drug b. Prevents hastening or causing a patient's death from respiratory dysfunction c. Contributes to unnecessary suffering and physical and psychosocial dysfunction d. Indicates that the nurse understands the adage of "start low and go slow" in administering analgesics

c. Administering the smallest prescribed analgesic dose when given a choice is not consistent with current pain management guidelines and leads to undertreatment of pain and inadequate pain control. Without reassessing the pain within 30 minutes of the IV analgesic the nurse is unsure how well the previous dose of medication worked for the patient to determine the current dose needed. Unnecessary suffering, impaired recovery from acute illness, increased morbidity as a result of respiratory dysfunction, increased heart rate and cardiac workload, and other physical dysfunction can occur.

A patient with chronic cancer-related pain has started using MS Contin for pain control and has developed common side effects of the drug. The nurse reassures the patient that tolerance will develop to most of these side effects but that continued treatment will most likely be required for what? a. Pruritus c. Constipation b. Dizziness d. Nausea and vomiting

c. Although tolerance to many of the side effects of opioids (nausea, sedation, respiratory depression, pruritus) develops within days, tolerance to opioid-induced constipation does not occur. A bowel regimen that includes a gentle-stimulant laxative and a stool softener should be started at the beginning of opioid therapy and continue for as long as the drug is taken.

Pain has been defined as "whatever the person experiencing the pain says it is, existing whenever the patient says it does." This definition is problematic for the nurse when caring for which type of patient? a. A patient placed on a ventilator b. A patient with a history of opioid addiction c. A patient with decreased cognitive function d. A patient with pain resulting from severe trauma

c. Because the patient's self-report is the most valid means of pain assessment, patients who have decreased cognitive function, such as those who are comatose, have dementia, or are mentally disabled, might not be able to report pain. In these cases, nonverbal information and behaviors are necessary considerations in pain assessment.

9. When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication? a. The patient has cramping abdominal pain. b. The patient becomes restless and agitated. c. The patient has not voided for over 10 hours. d. The patient complains of a "pounding" headache.

c. The patient has not voided for over 10 hours. Urinary retention is a common side effect of epidural opioids. Headache is not an anticipated side effect of morphine, although if there is a cerebrospinal fluid leak, the patient may develop a "spinal" headache. Sedation (rather than restlessness or agitation) would be a possible side effect. Hypotonic bowel sounds and constipation (rather than abdominal cramping) are concerns.

13. The nurse is caring for a diabetic patient who has chronic burning leg pain even when taking oxycodone (OxyContin) twice daily. Which of these prescribed medications is the best choice for the nurse to administer as an adjuvant to decrease the patient's pain? a. aspirin (Ecotrin) b. celecoxib (Celebrex) c. amitriptyline (Elavil) d. acetaminophen (Tylenol)

c. amitriptyline (Elavil) The patient's pain symptoms are consistent with neuropathic pain and the tricyclic antidepressants are effective for treating this type of pain. The other medications are more effective for nociceptive pain.

12. Which of these prescribed therapies should the nurse use first when caring for a patient with cancer pain that the patient describes as at "level 8 (0 to 10 scale), deep, and aching." a. fentanyl (Duragesic) patch b. ketorolac (Toradol) tablets c. hydromorphone (Dilaudid) IV d. acetaminophen (Tylenol) suppository

c. hydromorphone (Dilaudid) IV The patient's pain level indicates that a rapidly-acting medication such as an IV opioid is needed. The other medications also may be appropriate to use, but will not work as rapidly or as effectively as the IV hydromorphone.

3. A postoperative patient asks the nurse how the prescribed ibuprofen (Motrin) will control the incisional pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing the a. modulating effect of descending nerves. b. sensitivity of the brain to painful stimuli. c. production of pain-sensitizing chemicals. d. spinal cord transmission of pain impulses.

c. production of pain-sensitizing chemicals. Nonsteroidal anti-inflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by the NSAIDs.

To obtain the most complete assessment data about a patient's chronic pain pattern, the nurse asks the patient a. "Can you describe where your pain is the worst?" b. "What is the intensity of your pain on a scale of 0 to 10?" c. "Would you describe your pain as aching, throbbing, or sharp?" d. "Can you describe your daily activities in relation to your pain?"

can you describe your daily activities in relation to your pain? Response Feedback: Rationale: The assessment of chronic pain should focus on the impact of the pain on patient function and daily activities. The other questions are also appropriate to ask, but will not give as complete information.

When asked about pain, a client complains of having severe discomfort from arthritis. Vital signs are unchanged, and the client is calmly watching television. Which of the following nursing diagnoses is most appropriate? a. Acute pain b. Altered sensory perception c. Impaired mobility d. Chronic pain

chronic pain

A patient with extensive second-degree burns on the legs and trunk is using patient-controlled analgesia (PCA) with IV morphine to be delivered at 1 mg every 10 minutes to control the pain. Several times during the night, the patient awakens in severe pain, and it takes more than an hour to regain pain relief. The most appropriate action by the nurse is to a. request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain. b. consult with the patient's health care provider about adding a continuous morphine infusion to the PCA regimen at night. c. teach the patient to push the button every 10 minutes for an hour before going to sleep even if the pain is minimal. d. administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.

consult with there patient's health care provider about adding a continuous morphine infusion to the PCA regimen at night. Response Feedback: Rationale: Adding a continuous dose of the morphine at night will allow the patient to sleep without being awakened by the pain. Administering a dose of morphine when the patient awakens would not address the problem. Teaching the patient to administer unneeded medication before going to sleep might result in oversedation and respiratory depression. It is inappropriate for the nurse to administer the morphine while the patient sleeps because the nurse could not assess the pain level.

7. A patient with chronic back pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask? a. "Can you describe the quality of your pain?" b. "Has there been a change in the pain location?" c. "How would you rate your pain on a 0 to 10 scale?" d. "Does the pain keep you from doing things you enjoy?"

d. "Does the pain keep you from doing things you enjoy?" The goal for the treatment of chronic pain usually is to enhance function and quality of life. The other questions also are appropriate to ask, but information about patient function is more useful in evaluating effectiveness.

4. A patient with chronic cancer pain is receiving imipramine (Tofranil) in addition to long-acting morphine for pain control. Which information is the best indicator that the imipramine is effective? a. The patient sleeps 8 hours every night. b. The patient has no symptoms of anxiety. c. The patient states, "I feel much less depressed since I've been taking the imipramine." d. The patient states, "The pain is manageable, and I can accomplish my desired activities.

d. The patient states, "The pain is manageable, and I can accomplish my desired activities. Imipramine is being used in this patient to manage chronic pain and improve functional ability. Although the medication also is prescribed for patients with depression, insomnia, and anxiety, the evaluation for this patient is based on improved pain control and activity level.

17. A patient who has chronic musculoskeletal pain tells the nurse, "I feel depressed because I ache too much to play golf." The patient says the pain is usually at a level 7 (0 to 10 scale). Which patient goal has the highest priority when the nurse is developing the treatment plan? a. The patient will exhibit fewer signs of depression. b. The patient will say that the aching has decreased. c. The patient will state that pain is at a level 2 of 10. d. The patient will be able to play 1 to 2 rounds of golf.

d. The patient will be able to play 1 to 2 rounds of golf. For chronic pain, patients are encouraged to set functional goals such as being able to perform daily activities and hobbies. The patient has identified playing golf as the desired activity, so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment. The nurse also should assess for depression, but the patient has identified the depression as being due to the inability to play golf, so the goal of being able to play 1 or 2 rounds of golf is the most appropriate.

10. When the nurse visits a hospice patient, the patient has a respiratory rate of 8 breaths/minute and complains of severe pain. Which action is best for the nurse to take? a Inform the patient that increasing the morphine will cause the respiratory drive to fail. b. Administer a nonopioid analgesic, such as a nonsteroidal anti-inflammatory drug (NSAID), to improve patient pain control. c. Tell the patient that additional morphine can be administered when the respirations are 12. d. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.

d. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief. The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's respiratory rate.

A postoperative 68-year-old opioid-naive patient is receiving morphine by patient-controlled analgesia (PCA) for postoperative pain. What is the rationale for not initiating the PCA analgesic with a basal dose of analgesic as well? a. Opioid overdose c. Lack of pain control b. Nausea and itching d. Adverse respiratory outcomes

d. Use of a basal dose may increase the risk of serious respiratory events in opioid-naive patients and those at risk for respiratory difficulties (older age, existing pulmonary disease, etc.). Overdose is not expected, as the dosages are calculated and the PCA pump is programmed to prevent this. Nausea and itching are common side effects but not related to a basal dose of analgesic. A lack of pain control would not be expected with or without a basal dose. The nurse would be assessing the patient and notify the physician if a lack of pain control occurs but, again, this is not related to receiving a basal dose of analgesic via PCA pump

22. These medications are ordered for an 86-year-old patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy? a. aspirin (Bayer) 650 mg orally b. naproxen (Aleve) 200 mg orally c. oxycodone (Roxicodone) 5 mg orally d. acetaminophen (Tylenol) 650 mg orally

d. acetaminophen (Tylenol) 650 mg orally Acetaminophen is the best first-choice medication. The principle of "start low, go slow" is used to guide therapy when treating elderly adults because the ability to metabolize medications is decreased and the likelihood of medication interactions is increased. Nonopioid analgesics are used first for mild to moderate pain, although opioids may be used later. Aspirin and the NSAIDs are associated with a high incidence of gastrointestinal bleeding in elderly patients.

6. A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which of these prescribed medications will be best for the nurse to administer? a. lorazepam (Ativan) 1 mg orally b. amitriptyline (Elavil) 10 mg orally c. ibuprofen (Motrin) 400 to 800 mg orally d. immediate-release morphine 30 mg orally

d. immediate-release morphine 30 mg orally The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid, such as the immediate-release morphine. The Motrin and Elavil may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of anti-anxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.

11. A patient with a history of chronic cancer pain is admitted to the hospital. When reviewing the patient's home medications, which of these will be of most concern to the admitting nurse? a. amitriptyline (Elavil) 50 mg at bedtime b. oxycodone (OxyContin) 80 mg twice daily c. ibuprofen (Advil) 800 mg 3 times daily d. meperidine (Demerol) 25 mg every 4 hours

d. meperidine (Demerol) 25 mg every 4 hours Meperidine is contraindicated for chronic pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods. The ibuprofen, amitriptyline, and oxycodone are all appropriate medications for long-term pain management.

2. A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0 to 10 scale) and requests "something for pain that will work quickly." The nurse will document this as a. somatic pain. b. referred pain. c. neuropathic pain. d.breakthrough pain.

d.breakthrough pain. Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.

A patient with chronic cancer pain experiences breakthrough pain (level 9 of 10) and anxiety while receiving sustained-release morphine sulfate (MS Contin) 160 mg every 12 hours. All these medications are ordered for the patient. Which one will be most appropriate for the nurse to administer first? a. Ibuprofen (Motrin) 400-800 mg orally b. Immediate-release morphine 30 mg orally c. Amitriptyline (Elavil) 10 mg orally. d. Lorazepam (Ativan) 1 mg orally

immediate release morphine 30 mg orally

A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. The nurse's reply will be based on the information that these strategies. a. impact the cognitive and affective components of pain. b. prevent transmission of nociceptive stimuli to the cortex. c. increase the modulating effect of the efferent pathways. d. slow the release of transmitter chemicals in the dorsal horn.

impact the cognitive and affective components of pain

Amitriptyline (Elavil) is prescribed for a patient with chronic pain from fibromyalgia. When the nurse explains that this drug is an antidepressant, the patient states that she is in pain, not depressed. What is the nurse's best response to the patient? a. Antidepressants will improve the patient's attitude and prevent a negative emotional response to the pain. b. Chronic pain almost always leads to depression, and the use of this drug will prevent depression from occurring. c. Some antidepressant drugs relieve pain by releasing neurotransmitters that prevent pain impulses from reaching the brain. d. Certain antidepressant drugs are metabolized in the liver to substances that numb the ends of nerve fibers, preventing the onset of pain.

l antidepressants affect the modulatory systems by inhibiting the reuptake of serotonin and norepinephrine in descending modulatory fibers, thereby increasing their availability to inhibit afferent transmission of pain impulses. Although chronic pain is often accompanied by anxiety and depression, the antidepressants that affect the physiologic process of pain modulation are used for pain control whether depression is present or not.

our patient is being discharged home on an around-the-clock opioid for chronic rheumatoid arthritis pain. You would expect an order for which of the following classes of medications to accompany this order? a. Laxative b. Antibiotic c. Stool softener d. Proton pump inhibitor

laxative

our patient is recovering from knee surgery and states that her pain level is 7 on a 0-10 pain scale. She received a dose of medication 15 minutes ago. Which interventions may be beneficial for this patient at this time? (Select all that apply.) a. Massage her back. b. Help her to reposition on her side. c. Tell her that she cannot have any more pain medication at this time as she may become addicted d. Take a few minutes and talk to her about the pictures of her family that she brought with her from home.

massage her back Help her to reposition on her side

The health care provider plans to titrate a patient-controlled opioid infusion (PCA) to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time? (Select all that apply.) a. Monitoring for therapeutic and adverse effects of opioid administration b. Teaching about the need to decrease opioid doses by the second postoperative day c. Assessing for signs that the patient is becoming addicted to the opioid d. Educating the patient about how analgesics improve postoperative activity level e. Emphasizing that the risk of opioid side effects increases over time

monitoring for therapeutic and adverse effects of opioid admin educating the patient about how analgesics improve postoperative activity level

Which of the following instructions for use of a patient-controlled analgesia (PCA) pump is most important when educating the patient and family before implementation? a. Notify the nurse when you need to push the button on the pump. b. Only the patient should push the button for more medication. c. A spouse can push the button when the patient is asleep. d. Wait for the pain to become at least a 7 on the pain scale before pushing the button.

only the patient should push the button for more medication

The health care provider tells a patient to use ibuprofen (Motrin, Advil) to relieve pain after treating a laceration on the patient's forearm from a dog bite. The patient asks the nurse how ibuprofen will control the pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing the a. production of pain-sensitizing chemicals. b. spinal cord transmission of pain impulses. c. sensitivity of the brain to painful stimuli. d. modulating effect of descending nerves.

production of pain-sensitizing chemicals

A patient is receiving morphine sulfate intravenously (IV) for right flank pain associated with a kidney stone in the right ureter. The patient also complains of right inner thigh pain and asks the nurse whether something is wrong with the right leg. In responding to the question, the nurse understands that the patient

referred pain from the kidney stone

Both clients and nurses have misconceptions about pain. Which statement reflects a misconception? a. People can adapt to severe pain. b. Minor injuries can cause intense pain. c. The client is the authority about pain. d. Regular administration of analgesics leads to addiction.

regular administration of analgesics leads to addiction

Patient-controlled analgesia (PCA) effectiveness is evaluated by: a. The number of minutes on the lockout interval b. How large a loading dose is required to relieve pain c. The client's indicating that pain is a 1 on a scale of 1 to 10 d. When the client is sleeping

the clients indicating that the pain is a 1 on a scale of 1 to 10

A hospice patient is in continuous pain, and the health care provider has left orders to administer morphine at a rate that controls the pain. When the nurse visits the patient, the patient is awake but moaning with severe pain and asks for an increase in the morphine dosage. The respiratory rate is 10 breaths per minute. The most appropriate action by the nurse is to a. titrate the morphine dose upward until the patient states there is adequate pain relief. b. administer a nonopioid analgesic, such as ibuprofen, to improve patient pain control. c. tell the patient that additional morphine can be administered when the respirations are 12. d. inform the patient that increasing the morphine will cause the respiratory drive to fail

titrate the morphine dose upward until the patient states there is adequate pain relief. Response Feedback: Rationale: The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's respiratory rate.

A patient is receiving morphine sulfate intravenously (IV) for right flank pain associated with a kidney stone in the right ureter. The patient also complains of right inner thigh pain and asks the nurse whether something is wrong with the right leg. In responding to the question, the nurse understands that the patient a. is experiencing referred pain from the kidney stone. b. has neuropathic pain from nerve damage caused by inflammation. c. has acute pain that may be progressing into chronic pain. d. is experiencing pain perception that has been affected by the morphine received earlier.

unrelieved pain can be harmful due to the effect on respiratory function.

client has a blocked bowl. How would you describe the pain

visceral