Quiz 1 Pain 309

In the care of clients with pain and discomfort, which task is most appropriate to delegate to unlicensed assistive personnel (UAP)? 1. Assisting the client with preparation of sitz bath 2. Monitoring the client for signs of discomfort while ambulating 3. Coaching the client to deep breathe during painful procedures 4. Evaluating relief after applying a cold compress

1

A patient needs morphine 2 mg IV push. The drug is available as 5 mg/mL. How many mL would the nurse administer?

0.4 mL

The home health nurse is reviewing the older adult's medication and sees that naproxen is prescribed. Which question is the nurse most likely to ask in order to assess for adverse effects? 1. "Have you noticed unusual fatigue, restlessness, or feelings of depression?" 2. "Do you notice any dry mouth, dizziness, mental clouding, or weight gain?" 3. "Are you experiencing constipation, itching, or excessive sleepiness?" 4. "Have you had any gastric discomfort, vomiting, bleeding, or bruising?"

4

A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal anti-inflammatory drugs. Which medication will the nurse advocate first? 1. Gabapentin 2. Corticosteroids 3. Hydromorphone 4. Lorazepam

1

The nurse is caring for a postoperative client who reports pain. Based on recent evidence-based guidelines, which approach would be best? 1. Multimodal strategies 2. Standing orders by protocol 3. Intravenous patient-controlled analgesia (PCA) 4. Opioid dosage based on valid numerical scale

1

The nurse is interviewing a patient who frequently comes to the clinic to obtain medication for chronic back pain. The patient states, "I know you guys think I am faking, but I hurt and I am really sick of your attitude." What is the best response? 1. "Sir, tell me about your pain and how it is affecting your life" 2. "Sir, you can speak to a pain specialist if you would prefer." 3. "Sir, I see you are frustrated, but you are unfairly judging me." 4. "Sir, we are trying our best; let's just continue the interview."

1

When an analgesic is titrated to manage pain, what is the priority goal? 1. Titrate to the smallest does that provides relief with the fewest side effects 2. Titrate upward until the client is pain free or acceptable level is reached 3. Titrate downward to prevent toxicity, overdoes, and adverse effects 4. Titrate to a dosage that is adequate to meet the client's subjective needs

1

Which patient is most likely to receive a prescription for gabapentin? 1. A patient who has persistent burning and tingling sensation in the lower extremities 2. A patient who reports a gnawing and burning discomfort in the epigastric area between meals 3. A patient who expresses fear, anxiety, and uncertainty related to episodes of angina 4. A patient who has intractable pain related to malignant spread of cancer

1

A client with arthritis increases the does of ibuprofen (Motrin, Advil) to abate joint discomfort. After several weeks the client becomes increasingly weak. The health care provider determines that the client is severely anemic and admits the client to the hospital. What clinical indication does the nurse expect to identify when performing an admission assessment? Select all that apply. 1. Melena 2. Tachycardia 3. Constipation 4. Clay-colored stools 5. Painful bowel movements

1, 2

What is a nurse's responsibility when administering prescribed opioid analgesics? Select all that apply. 1. Count the clients respirations. 2. Document the intensity of the client's pain. 3. Withhold the medication if the client reports pruritis. 4. Verify the number of doses in the locked cabinet before administering the prescribed dose. 5. Discard the medication in the client's toilet before leaving the room if the medication is refused.

1, 2, 4

What are physiologic responses that indicate a patient is experiencing acute pain? Select all that apply. 1. Diaphoresis 2. Somnolence 3. Bradypnea 4. Hypotension 5. Tachycardia 6. Dilated pupils

1, 5, 6

A client received as needed (PRN) morphine, lorazepam, and cyclobenzaprine. The unlicensed assistive personnel (UAP) reports that the client has a respiratory rate of 10 breaths/min. What is the priority action? 1. Call the health provider to obtain an order for naloxone 2. Assess the client's responsiveness and respiratory status 3. Obtain a bag-valve mask and deliver breaths at 20 breaths/min 4. Double-check the prescription to see which drugs were ordered

2

A client reports sever pain 2 days after surgery. Which initial action should the nurse take after assessing the character of the pain? 1. Encourage rest 2. Obtain vital signs 3. Administer the prn analgesic 4. Document the client's pain response

2

A client who had abdominal surgery is receiving patient-controlled analgesia (PCA) intravenously to manage pain. The pump is programmed to deliver a basal does and bolus doses that can be accessed by the client with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is still experiencing pain. What should the nurse do first? 1. Monitor the client's pain level for another hour 2. Determine the integrity of the intravenous delivery system 3. Reprogram the pump to deliver a bolus dose every 8 minutes 4. Arrange for the client to be evaluated by the health care provider

2

For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take? 1. Closely assess for nonverbal signs such as grimacing or rocking 2. Obtain baseline behavioral indicators from family members 3. Note the time of and client's response to the last dose of analgesic 4. Give the maximum as needed (PRN) dose within the minimum time frame for relief

2

In the postanasthesia care unit it is reported that the client received intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as part of the client's initial 24-hour postoperative care? 1. Assessing the client for tachycardia 2. Monitoring the respiratory rate hourly 3. Administering naloxone every 3 to 4 hours 4. Observing the client for signs of CNS excitement

2

The nurse is assessing a client who has been receiving opioid medication via patient-controlled analgesia. What is an early sign that alerts the nurse to a possible adverse opioid reaction? 1. Client reports shortness of breath 2. Client is more difficult to arouse 3. Client is more anxious and nervous 4. Client reports pain is worsening

2

The nurse is assisting a surgical patient with pain management. Which outcome statement best demonstrates that the short-term goal is being met 45 minutes after receiving pain medication? 1. Patient reports that the pain level is 6/10 2. Patient tolerates the dressing changes without grimacing 3. Patient declines a prn anxiolytic medication 4. Patient asks for assistance to go to the bathroom

2

The nurse is caring for a patient who has an epidural catheter for pain management. Which information is appropriate in the care of this patient? 1. Pain assessments are performed less frequently if epidural catheters are used for pain management 2. Morphine and hydromorphone may be used with a local anestetic such as bupivacaine 3. Epidural catheters are used exclusively to deliver single bolus doses during surgical procedures 4. The patient will be confined to bed during the therapy because of lower extremity weakness

2

The nurse is working at a walk-in clinic and has interviewed several patients. Which is the most common reason for seeking medical care? 1. Has a family history of angina 2. Has a personal history of chronic pain 3. Has drug addiction and is seeking pain medication 4. Has a desire to avoid pain or injury during exercise

2

Which nursing action indicates that the nurse is performing the first step of the Hierarchy of Pain Measures? 1. Premedicates before a dressing change 2. Uses a standard pain assessment tool 3. Compares vital signs before and after pain medication 4. Starts with a low dose and observes for behavioral changes

2

Which patient has the highest risk for inadequate pain management? 1. 56-year-old man who had major abdominal surgery for a stab wound 2. 78-year-old woman who was transferred to a nursing home after hip surgery 3. 10-year-old child who had a tonsillectomy and whose parents can't speak English 4. 24-year-old postpartum woman with a history of drug abuse

2

A patient is prescribed morphine sulfate. Which nursing interventions decrease the risk of constipation? Select all that apply. 1. Give foods that are soft, such as white bread and white rice 2. Encourage an increase in water and fluid intake 3. Administer a stool softener every morning 4. Administer an order for a bulk laxative 5. Encourage movement, activity, and walking 6. Teach to keep a record of bowel movements

2, 3, 5, 6

A client receiving morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate? 1. Nasotracheal suction 2. Mechanical ventilation 3. Naloxone administration 4. Cardiopulmonary resuscitation

3

A client who had a total hip replacement asks the nurse about the continuous regional analgesia being used. What information should the nurse include when explaining the benefits of this treatment over conventional methods to control pain? 1. Adjusting the does is easily done 2. Neuropathic pain can be relieved 3. Systemic side effects are minimal 4. The need for parenteral medication is avoided

3

A client with an inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit, which nursing action is appropriate? 1. Maintain the settings programmed by the health care provider 2. Turn the machine on several times a day for ten to twenty minutes 3. Adjust the dial on the unit until the client states the pain is relieved 4. Apply the color-coded electrodes on the client where they are most comfortable

3

A client's family member comes to the nurse's station and says, "He needs more pain medicine. He is still having a lot of pain." What is the nurse's best response? 1. "The health care provider (HCP) ordered the medicine to be given every 4 hours." 2. "If medication is given too frequently, there are ill effects." 3. "Please tell him that I will be right there to check on him." 4. "Let's wait about 40 minutes. If he still hurts, I'll call the HCP."

3

A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do? 1. Add a placebo to the morphine to appease the spouse 2. Discuss with the spouse the risk for morphine addiction 3. Assess the client's pain before increasing the dose of morphine 4. Check the client's heart rate before increasing the morphine to the next level

3

Family members are encouraging the client to "tough out the pain" rather than risk drug addiction to opioids. The client is stoically abiding. The nurse recognizes that the sociocultural dimension of pain is the current priority for the patient. Which question will the nurse ask? 1. "Where is the pain located, and does it radiate to other parts of your body?" 2. "How would you describe the pain, and how is it affecting you?" 3. "What do you believe about pain medication and drug addiction?" 4. "How is the pain affecting your activity level and your ability to function?"

3

In application of the principles of pain treatment, what is the first consideration? 1. Treatment is based on client goals 2. A multidisciplinary approach is needed 3. Client's perception of pain must be accepted 4. Drug side effects must be prevented and managed

3

The health care provider prescribes 7 mg morphine IV as needed (PRN). The nursing student prepares the medication and shows the syringe (see figures below) to the nursing instructor. What should the nursing instructor do first? 1. Tell the student to review the provider's prescription before administering medication 2. Waste the medication and tell the student that remediation is required for serious error 3. Ask the student to demonstrate the calculations and steps required to prepare the dose 4. Accompany the student to the client's room and observe as the medication is administered

3

Which drug can cause adverse effects, particularly in an older adult, because of an accumulation of toxic metabolites? 1. Ibuprofen 2. Morphine 3. Meperidine 4. Acetaminophen

3

A nurse is instructing a group of volunteer nurses on the technique of administering the smallpox vaccine. What injection mthod should the nurse teach? 1. Z-track 2. Intravenous 3. Subcutaneous 4. Intradermal scratch

4

A nurse is taking the health history of a client who is to have surgery in 1 week. The nurse identifies that the client is taking ibuprofen (Advil) for discomfort associated with osteoarthritis and notifies the health care provider. Which drug does the nurse expect will most likely be prescribed instead of Advil? 1. Naproxen (Aleve) 2. Ibuprofen (Motrin) 3. Ketorolac (Toradol) 4. Acetaminophen (Tylenol)

4

On the first day after surgery, a client receiving an analgesic via patient-controlled analgesia pump reports that the pain control is inadequate. What is the first action that the nurse should take? 1. Deliver the bolus dose per standing order 2. Contact the health care provider (HCP) to increase the dose 3. Try nonpharmacologic comfort measures 4. Assess the pain for location, quality, and intensity

4

The nurse asks the patient with cancer, "Sir, where is your pain?" The patient repeatedly responds, "It hurts all over." What is the best rationale for taking the extra time to help the patient identify specific areas that hurt? 1. Documentation is incomplete as a legal document if the nurse charts "hurts all over" 2. Formulating an achievabe therapeutic goal is very difficult for a vague complaint 3. Health care provider cannot prescribe appropriate medication for relied of generalized pain 4. Patient understands the origin, and new or increasing pain raises the suspicion of metastasis

4

Using the concept of comfort, which application creates the greatest concern related to the use of the patient-controlled analgesia (PCA) infusion device? 1. Pendant 2. Demand 3. Lockout 4. Proxy

4

What is the best way to schedule medication for a client with constant pain? 1. As needed (PRN) at the client's request 2. Before painful procedures 3. IV bolus after pain assessment 4. Around-the-clock

4

A nurse is caring for a client after a total knee replacement who is requesting Vicodin in addition to the patient-controlled analgesia (PCA). The client reports having taken 2 Vicodin tablets every 4 hours for several weeks before surgery. If each tablet contains 500 mg of acetaminophen, how much acetaminophen had the client been ingesting per day? Round your answer using a whole number.

6000 mg