Prep U: Pain Management
A client being treated for rheumatoid arthritis has been prescribed a glucocorticosteroid. How should the nurse best ensure this client's safety during treatment? A. Ensure the client knows to taper down the dose if it is discontinued by the care provider. B. Educate the client about the need to avoid grapefruit and grapefruit juice during treatment. C. Teach the client the signs and symptoms of gastrointestinal bleeding. D. Educate the client about the difference between tolerance and dependence.
A
A client has been given a patient-controlled analgesia (PCA) device to control postoperative pain. The client expresses concern about administering too much of the analgesic and accidentally overdosing. What topic should the nurse teach the client about? A. the limits on dose and frequency that are programmed into the PCA B. the fact that naloxone will be kept readily available at all times C. the use of non-pharmacologic pain interventions to minimize use of the PCA D. the importance of limiting the use of the PCA to no more than twice per hour
A
A client has been taking opioid analgesics for more than 2 weeks to control post-surgical pain. Although pleased with the client's progress, the surgeon decides to change the analgesic to a non-opioid drug. The surgeon prescribes a gradually lower opioid dose and increasingly larger non-opioid doses. The surgeon is changing medications in this manner to avoid: A. withdrawal symptoms. B. addiction. C. tolerance. D. respiratory depression.
A
A client recovering from hip surgery is receiving morphine through a patient-controlled analgesia (PCA) infusion pump with a set basal rate. What action is most important for the nurse to implement? A. Assess the client's respiratory status B. Instruct the client about bolus doses C. Ask the client about pain status D. Obtain consent for PCA by proxy
A
A clinic nurse assesses a client with diabetes who reports taking naproxen (Aleve) and the herb bilberry for osteoarthritis. To assess for an adverse reaction between naproxen and bilberry, the nurse asks the client A. "Do you bleed easily?" B. "Have you been constipated?" C. "Has your blood sugar been elevated more than usual?" D. "Have you noticed an increase in your pain levels?"
A
A female client with sickle-cell disease is hospitalized for pain management. The client's BUN is 24 mg/dL and creatinine is 1.6 mg/dL. To assist with management of the pain, the nurse A. Applies warm soaks to the extremities B. Administers meperidine (Demerol) intravenously C. Obtains cold packs to place on the joints D. Places the lower extremities in a dependent position
A
A patient is complaining of a headache during epidural administration of an anesthetic agent. Which of the following nursing interventions should be completed? A. Keep the head of the bed flat. B. Maintain a dehydrated state. C. Place patient in semi-Fowler's position. D. No intervention is necessary.
A
Prostaglandins are chemical substances with what property? A. Increase the sensitivity of pain receptors B. Reduce the perception of pain C. Inhibit the transmission of pain D. Inhibit the transmission of noxious stimuli
A
The nurse is obtaining data regarding medications the client is taking on a regular basis. The client states he is taking duloxetine, an antidepressant for the treatment of neuropathic pain. What type of therapy does the nurse understand the client is receiving? A. Adjuvant drug therapy B. Replacement drug therapy C. Alternate drug therapy D. Withdrawal therapy
A
When receiving epidural opioids, respiratory depression generally peaks within which time frame? A. 6 to 12 hours B. 1 to 3 hours C. 4 to 6 hours D. 18 to 24 hours
A
When the nurse is performing an assessment and finds no physical cause for a patient's pain, what should the nurse do when the patient continues to complain of pain? A. Believe a patient when he or she states that pain is present. B. Doubt that pain exists when no physical origin can be identified. C. Realize that patients frequently imagine and state that they have pain without actually feeling painful sensations. D. Assume that the patient may be a drug seeker and should be given other methods for pain control.
A
Which action by the nurse indicates understanding of one basic principle of providing effective pain management? A. Awakening a new postoperative client to take pain medication B. Administering pain medications on a PRN (as needed) basis C. Continuing to provide around-the-clock pain medications 72 hours after a surgical procedure D. Administering a dose of an analgesic agent via client-controlled analgesia (PCA) during rounds
A
Which of the following is a misconception about pain and analgesia? A. Chronic pain is due to a psychological disturbance. B. No evidence exists that stress causes pain. C. It is rare for chronic pain patients to misrepresent their symptoms. D. The stress of managing the chronic pain may lead to depression.
A
Which route of medication administration should the nurse consider first after IV removal in a postoperative client with an NPO (nothing by mouth) order? A. Rectal B. Topical C. Intrathecal D. Subcutaneous
A
Which statement made by a client with cancer who has moderate to severe pain and was prescribed oxymorphone indicates further instruction is required? A. "I will take this medication with breakfast for the best results." B. "I will stop drinking beer while I'm taking this medication." C. "The IR indicates I will get fast relief when I take the medication." D. "I can also have this medication in an extended-release tablet."
A
The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply. A. "How long have you experienced this pain?" B. "Please point to where you are experiencing pain." C. "You've never had this pain before, have you?" D. "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain." E. "What aggravates your chest pain?"
A,B,D,E
A nurse can administer analgesics through various routes. Which medication routes provide absorption into the systemic circulation? Select all that apply. A. rectal B. topical C. oral mucosa D. subcutaneous E. epidural space
A,C,D,E
When evaluating a patient's response to acute pain, the nurse assesses for the presence of physiologic responses associated with the pain experience. Select all that apply: A. Increased cardiac output B. Lowered production of cortisol C. Bradycardia and hypotension D. Increased metabolic rate E. Hyperglycemia F. Decreased urinary output
A,D,E,F
A 75-year-old client had surgery for a hip fracture yesterday. The client is under stress because of the pain, the medications, sleep deprivation, and hospital surroundings. Which nursing intervention to treat the client's pain should the nurse question when ordered by the doctor? A. Use of transcutaneous electrical nerve stimulator (TENS) B. Advil for pain management C. Morphine rather than Advil for pain management D. Acetaminophen for pain management
B
Choose the most likely reason why a nurse should question the use of Demerol for pain management in an elderly patient? There is (are): A. Increased susceptibility to nervous system depression. B. Decreased binding of meperidine by plasma protein. C. Changes in renal metabolism. D. Decreased metabolism of medications.
B
The nurse is assessing a client who has been taking up to 4 grams of acetaminophen every day for undiagnosed pain. What reaction due to ingestion of acetaminophen will the nurse assess for? A. Excessive clotting of blood B. Abrupt onset of rash and pruritus C. Shortness of breath D. Sensitivity to hot and cold temperatures
B
Which of the following nursing interventions contributes to achieving a client's goal for pain relief? A. Minimize the client's description of pain or need for pain relief. B. Collaborate with the client about his or her goal for a level of pain relief. C. Use all forms of available pain management techniques. D. Prevent the client from self-administering analgesics.
B
Which route of administration of medication is preferred in the most acute care situations? A. Epidural B. Intravenous C. Subcutaneous D. Intramuscular
B
The nurse administered an analgesic to a client who was reporting pain. The medication is ordered as needed every 3 hours. Forty minutes later the client states he has had little relief. The nurse does all of the following: A. states, "I can administer the medication to you in about 2 hours" B. evaluates the pain level using the established pain scale C. assesses respirations, pulse, and blood pressure D. consults with the healthcare provider about the client's report E. plans to place the client in a position of comfort when pain is relieved
B,C,D
A client is recovering from abdominal surgery and sleeping. The client had received an opioid medication 3 hours ago. The client's son requests pain medication for the client, stating "I do not want her to wake up in pain." The first nursing action is A. Refuse to administer the pain medication. B. Administer the prescribed medication. C. Instruct the son about lack of client consent. D. Wake the client and ask about her pain rating.
C
A patient comes into the clinic frequently with complaints of pain. What would the nurse recognize as chronic benign pain in a patient? A. A migraine headache B. An exacerbation of rheumatoid arthritis C. Low back pain D. Sickle cell crisis
C
Acute pain can be distinguished from chronic pain by assessing which characteristic? A. Acute pain responds poorly to drug therapy. B. Chronic pain diminishes with healing. C. Acute pain is specific and localized. D. Chronic pain is symptomatic of primary injury.
C
An older adult is being treated with opioids for pain relief. Which of the following should the nurse strongly recommend to this client? A. Exercise regularly. B. Avoid harsh sunlight. C. Follow a bowel regimen. D. Reduce fiber intake.
C
The client experienced abdominal surgery the previous day and has just received an opioid medication for report of pain. The client is sitting in a chair next to the bed. An additional activity that the nurse uses to relieve pain is A. apply ice to the incision site for 30 minutes B. assist the client to ambulate on the nursing unit C. encourage the client to watch television D. have the client deep breathe and hold
C
The client is postoperative for a right total-knee arthroplasty, and medications include lidocaine 5% (Lidoderm). Past history includes a left mastectomy and herpes zoster following treatment with chemotherapy. The best nursing action is to: A. Question the use of lidocaine 5%. B. Apply the patch to the right thigh. C. Remove the patch after 12 hours. D. Withhold opioids during lidocaine use.
C
The client, newly admitted to the hospital, is unsure of home medications and is wearing a transdermal fentanyl patch. What is most important for the nurse to do first? A. Remove the old patch B. Check the dose C. Teach about adverse reactions D. Ask about constipation
C
The nurse is administering an analgesic to an older adult patient. Why is it important for the nurse to assess the patient carefully? A. Older people metabolize drugs more rapidly. B. Older people have increased hepatic, renal, and gastrointestinal function. C. Older people are more sensitive to drugs. D. Older people have lower ratios of body fat and muscle mass.
C
The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient? A. Older people are expected to experience chronic pain. B. Older people have a decreased pain threshold. C. Older people experience reduced sensory perception. D. Older people have increased sensory perception.
C
The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for? A. Asystole B. Hypertension C. Bradypnea D. Tachycardia
C
The nurse needs to carefully monitor a client with traumatic injuries. Which action by the nurse demonstrates understanding of the most essential component of the client's pain assessment? A. The nurse administers ketorolac upon admission to the unit. B. The nurse validates the client's report of pain by assessing the client's blood pressure. C. The nurse administers pain medication based on the client's reported pain level. D. The nurse assesses the response to medication after every meal consumed by the client.
C
The patient develops respiratory depression after the nurse administers fentanyl for pain. What medication can the nurse anticipate administering to counteract the effects of the fentanyl? A. Nubain B. Morphine C. Narcan D. Lidocaine
C
When applying a fentanyl patch, the last dose of sustained-release morphine should be administered at what point? A. 1 hour before application B. 1 hour after application C. At the same time the first patch is applied D. There are no administration requirements
C
Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain? A. Avoid caffeine or other stimulants, such as decongestants B. Monitor weight, vital signs, and serum glucose concentration C. Do not administer if respirations are less than 12 breaths per minute D. Monitor blood counts and liver function tests
C
Which of the following is a physiologic response to pain? A. Bradycardia B. Dry skin C. Pallor D. Hypotension
C
Which of the following is a reliable source for quantifying pain? A. The client's vital signs B. The nature of the client's injury or condition C. The client's description of the pain D. The extent of the client's injury
C
What does the nurse understand is the advantage of using intraspinal infusion to deliver analgesics? (Select all that apply.) A. It is easily accessible by the nurse. B. Higher doses may be administered. C. Side effects of systemic analgesia are reduced. D. Effects on pulse, respirations, and blood pressure are reduced. E. The need for injections decreases in frequency.
C,D,E
The advance practice nurse is treating a client experiencing a neuropathic pain syndrome. Which statements by the client demonstrates an understanding of concepts related to neuropathic pain? A. "Neuropathic pain will only last a few days and is easily treated with COX-2 analgesic agents." B. "Neuropathic pain is the body's normal response to tissue damage that causes pain." C. "When the inflammation in my foot resolves, I will no longer have pain from neuropathy." D. "My phantom limb pain serves no purpose, and I may need to take antidepressants to help."
D
The nurse is administering a narcotic analgesic for the control of a newly postoperative client's pain. What medication will the nurse administer to this client? A. Midazolam (Versed) B. Ibuprofen (Motrin) C. Acetaminophen (Tylenol) D. Fentanyl (Duragesic)
D
The nurse is visiting a client at home with intractable cancer pain. The client has a transdermal fentanyl patch on her right chest area. It is most important for the nurse to A. Instruct the client to note fatigue or extreme sleepiness. B. Inform the client about use of alcohol with fentanyl. C. Assess for the date of the client's last bowel movement. D. Remove the heating pad present on the chest area.
D
Which intervention is appropriate for a nurse caring for a client in severe pain receiving a continuous I.V. infusion of morphine? A. Assisting with a naloxone challenge test before therapy begins B. Discontinuing the drug immediately if signs of dependence appear C. Changing the administration route to P.O. if the client can tolerate fluids D. Obtaining baseline vital signs before administering the first dose
D
Which of the following should the nurse recommend to a client with a bruised ankle to initially relieve pain associated with the injury and reduce localized swelling? A. Acupuncture B. Percutaneous electrical nerve stimulation (PENS) C. Transcutaneous electrical nerve stimulation (TENS) D. Applications of heat and cold
D
The client is taking oxycodone (Oxycontin) for chronic back pain and reports decreased pain relief when he began taking a herb to improve his physical stamina. The nurse asks if the herb is A. valerian B. kava-kava C. chamomile D. ginseng
D
When caring for a patient who is deaf, which of the following should be used to elicit information regarding the patient's level of pain? A. An outside interpreter should be used. B. Computer-generated speech C. Use of Braille D. Verbally asking the rate of pain
A
A nurse observes the anesthesiologist administer single-dose, extended-release morphine through an epidural catheter for a client undergoing a major surgical procedure. What is the duration the nurse should assess the client for drug effectiveness? A. 2 to 4 hours B. 8 to 10 hours C. 24 hours D. 48 hours
D
The client is postoperative for a total hip arthroplasty and denies pain when asked by the nurse. The client remains still in the bed and refuses to move. She finally reports feeling pressure at the site upon continued questioning by the nurse. The best nursing intervention is to A. Use the term "pressure" when asking the client about pain. B. Wait to medicate the client until the client reports pain. C. Use a 0 to 10 numeric pain intensity scale to measure pain. D. Re-educate the client to use the word pain instead of pressure.
A
The client takes naproxen for arthritic pain and is now prescribed warfarin for persistent atrial fibrillation. Due to the interactions of the medications, what is the nurse's best response? A. Assess the client's stool for color B. Teach the client to ingest foods high in vitamin K C. Administer both medications with food to increase absorption D. Inform the client to decrease alcohol to one glass each day
A
A 64-year-old client is experiencing joint pain on a regular basis and asks the nurse what the options are beyond heat and the yoga exercises the client has been doing. What does the nurse describe as the cornerstone treatment modality for pain? A. drug therapy B. physical therapy C. acupuncture D. psychological counseling
A
A client has a long history of diabetes mellitus and developed diabetic neuropathy more than 25 years ago. The client is without breakthrough pain at this point in time. How would this client's pain be classified? A. neuropathic and chronic B. nociceptive and chronic C. nociceptive and acute D. neuropathic and acute
A
A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing? A. visceral B. neuropathic C. deeper somatic D. chronic
A
A client is on a second round of radiation therapy for an inoperable tumor, and asks the nurse for medication to help with pain. The nurse suspects that the client's pain is the result of nerve damage from the radiation. Which type of pain is the client likely experiencing? A. neuropathic pain B. somatic pain C. visceral pain D. referred pain
A
A client is postoperative and has not taken her pain medication. The nurse is performing an assessment at the beginning of her shift and determines that sensitization has occurred. The first nursing intervention is to A. Administer the prescribed intravenous opioid. B. Educate the client about notifying the nurse about pain before the pain becomes intense. C. Provide alternative measures, such as a back rub, for pain relief. D. Medicate with naloxone (Narcan) for reversal of sensitization.
A
A client is reporting her pain as "8" on a 0-to-10 pain intensity scale. Then, the client states the pain is "3." Before the nurse leaves the room, the client states her pain is "6." The best action of the nurse is to A. Obtain a pain scale with faces for the client to measure her pain. B. Average the numbers and report that number as the client's level of pain. C. Medicate the client for pain based on the highest number of "8." D. Record each of the numbers the client stated for her pain.
A
A client sustained severe burns over both lower extremities 1 week ago. The client informs the nurse that he had to wait for 30 minutes last night to receive pain medication, which caused the pain not to be relieved after administration. What suggestions could the nurse make to the physician to provide adequate relief of pain? A. Provide the client with a patient-controlled analgesia (PCA) pump. B. If the nurse is going to be late with administration, have an extra dose of medication available. C. Increase the frequency of the medication so that the client will have less time to wait. D. Increase the dosage of the medication so the client will stay medicated longer.
A
A client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. The initial surgeries occurred more than 2 months ago, and the nurse is concerned about the repeated requests. What does the nurse suspect to be the cause of the client's frequent appeals for pain medication? A. tolerance B. addiction C. drug allergy D. poor quality control by the drug manufacturer
A
A new surgical patient has been prescribed an opioid analgesic intravenously for pain control. The nurse should be aware of which most serious adverse effect of this medication? A. Respiratory depression B. Nausea and vomiting C. Constipation D. Pruritus
A
A nurse is caring for a client with pain. What should the nurse monitor for when administering intravenous acetaminophen? A. hepatotoxicity B. renal toxicity C. bleeding D. gastrointestinal effects
A
According to The Joint Commission's pain assessment and management standards, which of the following are essential components of a comprehensive pain assessment? A. location, onset, alleviating factors, and aggravating factors B. quality, location, intensity, and family history C. nutritional deficiencies, onset, duration, and effects of pain D. intensity, variations, range of motion, and the client's goal for pain control
A
How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client? A. Administering the analgesics every three hours B. Administering the analgesics intravenously C. Administering the analgesics on an as-needed basis D. Administering analgesics with increased dosage
A
How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client? A. Administering the analgesics on a regular basis B. Administering the analgesics intravenously C. Administering the analgesics on an as-needed per client request D. Administering analgesics with increased dosage
A
Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission? A. A child quickly removing a hand when touching a hot object B. A surgeon making an incision to perform surgery C. A mother in labor utilizing imagery to reduce pain D. A patient taking tramadol to enhance pain management
A
The nurse applies a transdermal patch of fentanyl for a client with pain due to cancer of the pancreas. The client puts the call light on 1 hour later and tells the nurse that it has not helped. What is the best response by the nurse? A. "It will take approximately 12 to 18 hours for the medication to begin to work, so I will give you something else now to relieve the pain." B. "It should have begun working 30 minutes ago. I will call the doctor and let the doctor know you need something stronger." C. "You have probably developed a tolerance to the medication." D. "It will take about 24 hours for the medication to work. I can't give you anything else or you will overdose."
A
The nurse has assessed a client's pain subsequent to a broken ankle. How would the nurse categorize and document the client's pain? A. Acute B. Chronic C. Intermittent D. Visceral
A
The nurse is assessing a client's level of pain. How is the pain best described? A. An unpleasant sensation of physical hurt or discomfort that can be caused by disease, injury, or surgery. B. An unpleasant sensation created by emotional states such as fear, frustration, anger, or depression. C. A chronic, unpleasant sensation that occurs due to disease affecting one or more body systems. D. An unpleasant sensation that occurs due to malfunctioning of the nervous system.
A
The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain? A. Diaphoresis B. Bradycardia C. Hypotension D. Decreased respiratory rate
A
The nurse sees an order for a lidocaine 5% patch. What use is approved for by the US Food and Drug Administration for this patch? A. postherpetic neuralgia B. epidural anesthesia C. general anesthesia D. diabetic neuropathy
A
The nurse understands that which statement is true about tolerance and addiction? A. Although clients may need increasing levels of opioids, they are not addicted. B. Tolerance to opioids is uncommon. C. Addiction to opioids commonly develops. D. The nurse must be primarily concerned about development of addiction by a client in pain.
A
The nurse, as a member of the patient's health care team, obtains pain assessment information to identify goals for pain management. Select the most important factor that the nurse would use for goal setting: A. Severity of the pain as judged by the patient B. Anticipated harmful effects of the pain experience C. Anticipated duration of the pain D. Medical interventions for pain management
A
When completing a teaching plan for a client receiving patient-controlled analgesia (PCA), which component would be important for the nurse to stress? A. The pump will deliver a preset amount of medication. B. The client should wait until the pain is severe to push the button to prevent overdose. C. Teach the client to avoid pushing the button multiple times because additional doses will be given. D. Chance of sedation is rare when using a PCA pump.
A
When using transdermal Fentanyl, the nurse and patient should be aware of which sign or symptom of Fentanyl overdose? A. Confusion B. Hyperalertness C. Hyperventilation D. Insomnia
A
Which is a gastrointestinal route for administration of analgesics? A. Rectal B. Epidural space C. Oral mucosa D. Subcutaneous
A
Which of the following is a true statement with regards to the nursing process of pain control? A. The use of physiologic signs to indicate pain is unreliable. B. Formulate treatment plans based on behaviors. C. Usually all patients exhibit the same pain behaviors. D. Nonverbal expressions of pain are reliable indicators of the quality of pain.
A
Which of the following is a true statement with regards to the preventative approach to the use of analgesics? A. Smaller doses of medication are needed. B. It promotes tolerance to analgesic agents C. The use increases peaks and troughs in the serum level. D. Larger doses of medication are needed.
A
Which substance reduces the transmission of pain? A. Endorphins B. Acetylcholine C. Serotonin D. Substance P
A
The client has suffered an injury to his right leg and is reporting pain at the level of "5" on a scale of 0 to 10. The client has a history of peripheral arterial disease. The client requests nonpharmacologic interventions. What interventions are appropriate for the nurse to perform? Select all that apply. A. massages the client's back and shoulders B. applies ice to the injured site on the leg C. teaches the client to perform slow, rhythmic breathing D. turns on the television to a show the client asks to watch E. consults with the healthcare provider about a macrobiotic diet
A,C,D
For which reasons are nonpharmacologic pain management techniques used? Select all that apply. A. They help decrease the sensation of pain. B. They lower the risk of clients becoming addicted to pain medications. C. They help decrease the distress a client experiences as a result of pain. D. They can successfully replace pain medications for severe pain. E. They allow clients to match the technique to their own individual and cultural preferences.
A,C,E
An elderly client has a fractured hip and is in Buck's traction. The client is disoriented and cannot express herself. At 0730 the client was calm. Now, at 0930, the client is restless and agitated. The nurse reviews the medication administration record. The last dose of opioid was at 0330. The nurse assesses the client's agitation may be from A. Effects of the opioid medication B. Recurring pain C. Diminished pain perception D. Increased uptake of opioids
B
A client arrives in the orthopedic clinic with complaints of twisting the right ankle while playing softball. The nurse collects data including complaints of pain and swelling in the right ankle. What intervention will the nurse provide that will decrease vasodilation and reduce localized swelling? A. Warm compresses B. Ice bag C. Elevation of the extremity D. Injection of a steroid into the joint space
B
A client comes to the clinic and informs the nurse that he needs more analgesics for chronic pain. The client states that the medication is not as strong, and he requires more than the prescribed dose. What does the nurse suspect is occurring with the client? A. Addiction B. Tolerance C. Physical dependence D. Withdrawal symptoms
B
A client is prescribed methadone 10 mg three times a day for neuralgia following chemotherapy treatment. The client reports that he is experiencing constipation and asks the nurse for information about preventing constipation. The nurse recommends A. ingesting up to 6 glasses of fluids per day B. increasing the amount of bran and fresh fruits and vegetables C. using milk of magnesia 30 mL every day D. inserting a bisacodyl (Dulcolax) rectal suppository every morning
B
A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies A. "I will notify your physician." B. "What do you mean by the word sick?" C. "A lot of people have a similar problem with this medication." D. "A nausea medication has been prescribed that I will give you."
B
A client is receiving morphine sulfate intravenously (IV) every 4 hours as needed for the relief of pain related to a surgical procedure the client had 3 days previously. The physician is discontinuing the IV and will be starting the client on oral pain medication. What would provide the client with optimal pain relief when discontinuing the IV dose? A. Administer a lower dose so the client does not get addicted to the medication. B. Administer an equianalgesic dose. C. The client should be ordered the medication to be administered intramuscularly (IM) instead of by mouth. D. Administer a higher dose of the medication by mouth.
B
A client is receiving morphine through a patient-controlled analgesia (PCA) system following surgery. The nurse states to the client A. "Whenever you hurt, push the button." B. "Only you are to push the button for medication." C. "Wait until your pain is severe before pushing the button." D. "This will completely relieve your pain."
B
A client who fell at home is hospitalized for a hip fracture. The client is in Buck's traction, anticipating surgery, and reports pain as "2" on a pain intensity scale of 0 to 10. The client also exhibits moderate anxiety and moves restlessly in the bed. The best nursing intervention to address the client's anxiety is to A. Administer the prescribed alprazolam (Xanax). B. Assess the reason for the client's anxiety. C. Administer the prescribed dose of morphine. D. Assist the client out of bed and into a chair.
B
A client who is prescribed morphine for undiagnosed abdominal pain reports that he is allergic to morphine. The nurse questions the client about his allergic reaction; the client responds that when he took it in the past, he experienced itching. The nurse plans to A. Notify the physician that the client is allergic to morphine. B. Administer prescribed diphenhydramine (Benadryl). C. Obtain an order for a skin cream to minimize itching. D. Refuse to administer the morphine.
B
A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing? A. Breakthrough pain B. Neuropathic pain C. Visceral pain D. Referred pain
B
A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be: A. Attributed to a specific cause. B. Prolonged in duration. C. Rapidly occurring and subsiding with treatment. D. Separate from any central or peripheral pathology.
B
A preventative approach to pain relief with non-steroidal anti-inflammatory drugs (NSAIDs) means that the medication is given: A. Before pain becomes severe. B. Before pain is experienced. C. When pain is at its peak. D. When the level of pain tolerance has been exceeded.
B
About which issue should the nurse inform clients who use pain medications on a regular basis? A. Avoid harsh sunlight for 2 hours after administering analgesic agents or salicylates. B. Inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesics consistently without consulting a physician. C. Minimize fiber intake during the therapy. D. Consume the medications just before or along with meals.
B
In which case it is most likely that pain management may not be readily forthcoming to an adult client who is in pain? A. When analgesics are contraindicated for the client's condition B. When the client's expressions of pain are incongruent with the nurse's expectations C. When a numeric scale is used to assess pain intensity D. When the pain is chronic
B
The client is prescribed 2 mg of intravenous morphine every 2 hours as needed for pain. The nurse administers the medication. Thirty minutes later, the client reports the pain level remains at a "6" on a pain intensity scale of 0 to 10. The nurse first A. States that "You received the full dose. I can give you no more." B. Assesses the client's mental status and vital signs C. Contacts the physician to report the ineffectiveness of the medication D. Teaches the client about guided imagery and distraction
B
The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to A. Notify the surgeon of the client's goal of "0." B. Educate the client that this goal may not be achievable. C. Plan to use medication and nonpharmacologic interventions. D. Ensure the client is prescribed large doses of opioids postoperatively.
B
The client is taking continuous-release oxycodone for chronic pain and now reports constipation. What should be the first question the nurse asks the client? A. "What do you usually take for constipation?" B. "When was your last bowel movement?" C. "Can you take bisacodyl?" D. "Are you able to increase fluids and fiber in your diet?"
B
The nurse informs the patient that a preventive approach for pain relief will be used, involving nonsteroidal anti-inflammatory drugs. What will this mean for the patient? A. The pain medication will be administered before the pain becomes severe. B. The pain medication will be administered before the pain is experienced. C. The pain medication will be administered when the pain is at its peak. D. The pain medication will be administered when the level of pain tolerance has been exceeded.
B
The nurse is caring for a client with kidney stones who is complaining of severe pain. What type of pain does the nurse understand this client is experiencing? A. Somatic Pain B. Visceral Pain C. Neuropathic Pain D. Chronic Pain
B
When drafting a nursing care plan for a patient in pain, it is important for the nurse to determine if the pain is acute or chronic. Choose the best example of chronic pain. A. A migraine headache B. Intervertebral disk herniation C. Angina D. Appendicitis
B
When taking a client history, the nurse notes that the client is taking herbal remedies in addition to acetaminophen. Which herb, when taken in conjunction with acetaminophen, enhances the risk of bleeding? A. Echinacea B. Ginkgo C. Willow D. Kava
B
Which condition is a heightened response that occurs after exposure to a noxious stimulus? A. Pain tolerance B. Sensitization C. Pain threshold D. Dependence
B
Which is a true statement regarding placebos? A. A placebo effect is an indication that the client does not have pain. B. Placebos should never be used to test a client's truthfulness about pain. C. A placebo should be used as the first line of treatment for a client. D. A positive response to a placebo indicates that the client's pain is not real.
B
Which of the following is the most important potential nursing diagnosis for the client receiving opiate therapy? A. Risk for injury B. Risk for impaired gas exchange C. Diarrhea D. Altered mobility
B
A client is being taught to self-administer a narcotic analgesic by means of an intravenous PCA pump system. Which of the following would help prevent accidental overdosage? A. Reducing the dosage of the narcotic analgesic B. Reducing the frequency of administration of the narcotic analgesic C. Programming the dosage and time interval into the device D. Drawing up a schedule chart for the client
C
A client is recovering from abdominal surgery. The statement by the client that most indicates the nurse needs to educate the client about pain and pain control is A. "Pain medication can control pain." B. "I will report to you when I am experiencing pain." C. "I should expect to have pain." D. "Pain relief may promote a quicker recovery."
C
A nurse is caring for a client diagnosed with depression in the mental health unit. The nurse understands that therapeutic effects of tricyclic antidepressants occur at which time point? A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks
C
A teenage client is undergoing a dressing change to burns on the thigh. The client refuses pain medication and states, "I do not hurt, and I don't need it." He is withdrawn, grimaces, and turns away during the dressing change. He was last medicated 8 hours ago. What is the best statement by the nurse? A. "You are so brave to not take your pain medication when the dressing change will hurt." B. "If you need pain relief, I can give you some medication when I have completed the dressing change." C. "I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication." D. "You are so right to not take your pain medication. You can become dependent on the medication."
C
An adult with severe cognitive impairment has had a surgical procedure, and the nurse is having a difficult time assessing the level of pain the client is having postoperatively. What method can the nurse use to obtain data about the client's pain? A. Have the client point to a smiley face or a frown. B. Ask the client to point to a pain level between 0 and 10 on a chart. C. Use behavioral comparison of the client's current and previous behavior patterns. D. Ask the client loudly if he is having any pain and what level it is.
C
Prior to starting a peripheral intravenous line on a patient, what intervention can the nurse provide to decrease the pain from the needle puncture? A. Give an oral opioid analgesic 30 minutes before the procedure. B. Apply diclofenac gel over the site 1 hour before the procedure. C. Apply eutectic mixture of local anesthetic cream 30 minutes prior to the procedure. D. Inject lidocaine 2% with epinephrine locally around the potential procedure site.
C
The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe? A. Tramadol B. Ketamine C. Gabapentin D. Hydromorphone
C
The nurse has given an older adult an oral opioid for postoperative pain. What should the nurse do first to make the pain medication more effective? A. Consult with the health care prescriber to include hydroxyzine with the opioid. B. Provide the client with a fresh gown. C. Position the client for comfort. D. Encourage the client to eat crackers.
C
A client has been prescribed a fentanyl patch for pain control. The nurse understands that this patch should be replaced every A. 12-24 hours. B. 24-36 hours. C. 36-60 hours. D. 48-72 hours.
D
A client has been using NSAIDs daily over an extended period. Which of the following effects should the nurse carefully monitor for in this client? A. Cardiac disorders B. Urinary tract infection C. Hypothyroidism D. Gastrointestinal bleeding
D
A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect? A. Placebo B. Dependence C. Tolerance D. Addiction
D
A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client A. About activities that would distract him from pain B. That the nurse will notify the surgeon of his fear C. How anxiety could increase his pain perception D. That medication will be prescribed for pain relief
D
A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain? A. Administer oral opioids as needed. B. Provide patient-controlled analgesia. C. Administer pain medication through a transdermal patch. D. Administer analgesics around the clock.
D
A home health nurse is visiting a client who has been taking the same dose of acetaminophen/hydrocodone for 2 months. To monitor for the presence of expected side effects of this medication, what should the nurse include in the assessment of the client? A. Observe respiratory rate and depth. B. Assess level of consciousness. C. Take the client's blood pressure. D. Ask about the client's bowel pattern.
D
The nurse is caring for a client in the hospital who has been taking an analgesic for pain related to a chronic illness and has developed a tolerance to the medication. What is the most appropriate action by the nurse? A. Inform the client that he will not be able to receive more medication than the physician has ordered. B. Suggest a consultation with a psychiatrist to treat the client's addiction. C. Inform the client that you will ask the physician to order a non-narcotic analgesic. D. Consult with the prescriber regarding the need for an increased dose of the drug and not to reduce the frequency of administration.
D
The nurse's major area of assessment for a patient receiving patient-controlled analgesia is assessment of what system? A. Cardiovascular B. Integumentary C. Neurologic D. Respiratory
D
The physician has ordered a mu opioid analgesic for a patient with pain. What drug does the nurse anticipate administering? A. Nubain B. Stadol C. Buprenex D. Fentanyl
D
Which phase of pain transmission occurs when the brain experiences pain at a conscious level? A. Transmission B. Modulation C. Transduction D. Perception
D
Which phase of pain transmission occurs when the one is made aware of pain? A. Transmission B. Modulation C. Transduction D. Perception
D