Pain Management Practice Questions and Answers

1. Which statement indicates the development of opioid tolerance? √ Larger doses of opioids are needed to control pain, as compared to several weeks earlier. Stimulants are needed to counteract the sedating effects of ...

1. Which statement indicates the development of opioid tolerance? √ Larger doses of opioids are needed to control pain, as compared to several weeks earlier. Stimulants are needed to counteract the sedating effects of opioids. The patient becomes anxious about knowing the exact time of the next dose of opioid. The patient no longer experiences constipation from the usual dose of opioid. 2. The pain management nurse observes a patient with complex regional pain syndrome who is not wearing the right-side jacket sleeve. The patient reports intense, right arm pain upon light touch. The nurse recognizes this pain as: √ allodynia. hypoalgesia. neuritis. paresthesia. 3. A 45-year-old patient who reports pain in the foot that moves up along the calf says: "My right foot feels like it is on fire." The patient reports that the pain started yesterday, and he or she has no prior history of injury or falls. Which components of pain assessment has the patient reported? Aggravating and alleviating factors. Exacerbation, with associated signs and symptoms. Intensity, temporal characteristics, and functional impact. √ Location, quality, and onset. 4. A 53-year-old patient who is receiving ibuprofen 400 mg twice a day, for chronic, low back pain develops lower-extremity edema. The pain management nurse suspects that the edema is caused by: √a decrease in renal function. a low creatinine level. an increase in glomerular filtration rate. an increase in plasma proteins. 5. A distinguishing feature of a cluster headache is that it occurs: bilaterally. globally. occipitally. √unilaterally. 6. A 73-year-old patient with cancer is in the hospital for pain control and rates pain as a "12" on the Numeric Rating Scale of 0 to 10. Thirty minutes after receiving IV pain medication, the patient reports no pain relief. The pain management nurse calls the physician for additional orders for pain medication. The nurse's actions demonstrate: analgesic titration. empathy. independence. √patient advocacy. 7. Which behavioral therapy works best to relieve pain with muscle tension and spasms in patients who are anxious about their pain? Distraction. Hypnosis. √ Relaxation. Stress management. 8. The pain management nurse follows the recommended protocol for preventing constipation when starting a patient on opioids by: adding bulk fiber to the diet. giving the patient enemas as needed. increasing fluids and exercise. √ using a bowel stimulant and stool softener. 9. A 35-year-old, male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a 7 on a Numeric Rating Scale of 0 to 10. The nurse concludes that the patient's behavior: is an emotional reaction to having cancer. is in anticipation of future pain. is more indicative of the need for pain medication than the pain rating. √ may be in conflict with the pain rating, and accepts the report of pain. 10. An older adult patient is discharged from the hospital with nortriptyline (Pamelor) for neuropathic pain. Which statement indicates the patient's need for additional education? "I will chew sugarless gum and mints." "I will drink carbonated beverages." √"I will take my medication at breakfast." "I will use a humidifier at bedtime." 11. Which nonpharmacologic intervention is difficult to use with older adults who are cognitively impaired? Aromatherapy. Distraction. √Guided imagery. Heat application. 12. An 85-year-old, male patient with a history of prostate cancer and metastasis to the lumbar spine, is receiving methadone (Dolophine), 10 mg, three times a day. The patient's spouse tells the pain management nurse that the patient exhibits a lack of motivation, loss of appetite, and an inability to get out of bed. The nurse initially focuses on: need for antidepressants. physical therapy evaluation. psychological evaluation. √ the patient's pain assessment. 13. The pain management nurse assesses a patient with complex regional pain syndrome. The nurse is concerned about the patient's depressed mood, because she or he has said: "I can't live with this pain." The nurse further assesses for suicide risk, because: decreased pain thresholds lead to suicidal thoughts. √suicidal thoughts are common in patients with chronic pain. suicidal thoughts are often expressed by patients with acute pain. verbalization of suicidal thoughts is a way for patients to get attention. 14. A 45-year-old patient is diagnosed with lumbar radiculopathy. The patient's pain is not well controlled by an opioid medication. Which medication class does the pain management nurse identify as being the first-line, adjuvant medication for this diagnosis? Acetaminophen-containing drugs. Nonsteroidal anti-inflammatory drugs. Serotonin reuptake inhibitor antidepressants. √Tricyclic antidepressants. 15. Biofeedback is a therapy used to: √develop psycho-physiologic self-regulation. enhance drug delivery. increase release of serotonin. promote neuronal regeneration. 16. The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse's response is to: √clarify the patient's report by reviewing the patient's nonverbal behavior. confronting the patient's denial of pain. obtaining an order for pain medication. supporting the patient's stoic behavior. 17. The pain management nurse assesses a 67-year-old patient for reports of episodic, sudden-onset, right-sided facial pain. The patient describes the pain as fleeting, electric-like and triggered by light touch and brushing of the teeth. The nurse suspects: facet syndrome. myofascial pain syndrome. temporomandibular disorder. √ trigeminal neuralgia. 18. When assessing an infant for pain, the pain management nurse recognizes that: a lack of a physiologic or behavioral response means a lack of pain. √ if something causes pain in an adult, it can cause pain in an infant. the parent's observations should not be included in the patient's assessment of pain. Wong-Baker FACES Scale is an appropriate assessment tool. 19. A patient is utilizing a heating pad at home for the treatment of a muscle spasm. The pain management nurse notes the patient is on a transdermal fentanyl (Duragesic) patch. What will the nurse include in the patient's education? √Avoid using the heating pad directly over the patch. Cover the patch with a cloth while using the heating pad. Remove the patch while using the heating pad. Stop the use of the heating pad until the patch is discontinued. 20. The main responsibilities of the nurse on the interdisciplinary, chronic pain management team are to: assess level of function; design a therapeutic exercise plan; and monitor functional progress. provide a comprehensive, psychosocial evaluation; implement cognitive behavior interventions; and teach problem-solving techniques. provide ergonomic training; develop pain management strategies to apply in the workplace; and facilitate the return to work. √ review the medical history; monitor medications; and provide education for the patient and family. 21. The pain management nurse is assessing a trauma patient's readiness for discharge, by determining the level of comfort the patient prefers. The nurse completes this portion of the pain assessment by asking about the patient's: aggravating and alleviating factors. √functional pain goal. intensity of pain. onset of pain. 22. A patient with fibromyalgia reports symptoms of unrelieved pain. To determine whether the patient is also experiencing other conditions, the pain management nurse will ask the patient about: constipation, dizziness, and pruritus. evening pain and stiffness. hyperactivity, followed by periods of heavy sleep. √loss of appetite and increased feelings of anxiety. 23. The pain management nurse, concerned with metabolite accumulation in a patient with decreased creatinine clearance, decides to utilize: √fentanyl transdermal patch (Duragesic). methadone (Dolophine). morphine (MS-IR). oxycodone (Roxicodone). 24. Following surgery to the left elbow, a patient is receiving a continuous, upper-extremity, peripheral nerve block. The pain management nurse immediately notifies the anesthesia provider of: √ a change in level of sensory or motor function to the left hand. a new complaint of left great-toe pain with a reported history of gout. new orders written by the surgeon to increase frequency of oral oxycodone from every six hours as needed, to every four hours as needed. patient refusal to participate in physical therapy. 25. A 12-year-old oncology patient who is receiving in-home care without IV access needs medication for breakthrough pain. The pain management nurse's most effective route of administration to recommend is: intranasal. nebulized. √oral transmucosal. transdermal. Question 1 The right answer was Larger doses of opioids are needed to control pain, as compared to several weeks earlier. Question 2 The right answer was allodynia. Question 3 The right answer was Location, quality, and onset. Question 4 The right answer was a decrease in renal function. Question 5 The right answer was unilaterally. Question 6 The right answer was patient advocacy. Question 7 The right answer was Relaxation. Question 8 The right answer was using a bowel stimulant and stool softener. Question 9 The right answer was may be in conflict with the pain rating, and accepts the report of pain. Question 10 The right answer was "I will take my medication at breakfast." Question 11 The right answer was Guided imagery. Question 12 The right answer was the patient's pain assessment. Question 13 The right answer was suicidal thoughts are common in patients with chronic pain. Question 14 The right answer was Tricyclic antidepressants. Question 15 The right answer was develop psycho-physiologic self-regulation. Question 16 The right answer was clarify the patient's report by reviewing the patient's nonverbal behavior. Question 17 The right answer was trigeminal neuralgia. Question 18 The right answer was if something causes pain in an adult, it can cause pain in an infant. Question 19 The right answer was Avoid using the heating pad directly over the patch. Question 20 The right answer was review the medical history; monitor medications; and provide education for the patient and family. Question 21 The right answer was functional pain goal. Question 22 The right answer was loss of appetite and increased feelings of anxiety. Question 23 The right answer was fentanyl transdermal patch (Duragesic). Question 24 The right answer was a change in level of sensory or motor function to the left hand. Question 25 The right answer was oral transmucosal. Thursday, January 14, 2016 NCLEX Pain Testbank Ignatavicius & Workman’s MEDICAL-SURGICAL NURSING, 8th Edition NCLEX EXAMINATION ASSESSMENT AND CARE OF PATIENT WITH PAIN 1. In the role of client advocate, what does the nurse do first for a client who reports pain? A. Administers pain medication B. Assesses the level of pain C. Believes the client’s report of pain D. Calls the provider for a medication order 2.The nurse is preparing a client for home care pain management following discharge. Which intervention does the nurse implement? A. Discuss pain-relieving strategies on the day of discharge. B. Discuss home care with only the client’s family, not with the client. C. Offer flexibility in home management of the client’s current regimen. D. Offer information about end-of-life pain control management. 3.A client being discharged after hip replacement says, “I am going to use hypnosis instead of medication to manage my pain. I believe in mind over body.” How does the nurse respond? A. “I will cancel your medication order.” B. “That sounds like a great plan; can you tell me more about it?” C. “That sounds like a wonderful idea; and I think it will definitely work!” D. “Your plan will not work; people with your type of pain need narcotics.” 4.When assessing a client for pain, acute or chronic, what question does the nurse ask the client to obtain the most data? A. “Did someone do this to you?” B. “Does it hurt badly?” C. “Is the pain really that bad?” D. “When does it hurt?” 5.A postoperative client is requesting medication for pain every 4 hours. In planning effective pain management, what assessment question does the nurse ask the client before administering the medication? A. “Are you bleeding?” B. “Are you really hurting every 4 hours?” C. “Is your pain controlled between doses?” D. “What do you do for pain when you’re at home?” 6.A client with extensive burn injuries is to be weaned from long-term opioid use. What type of opioid dependence does the nurse expect this client to have? A. Addiction B. Equianalgesia C. Physical dependence D. Pseudoaddiction 7.A client with cancer who is taking pain medication states, “I am still having pain.” During the assessment, the client does not exhibit any physical manifestations of pain. What does the nurse do next? A. Decreases the client’s standard pain medication dose B. Gives the client a placebo and monitors the outcome C. Gives the pain medication as requested D. Withholds the pain medication 8.A postoperative client reports, “I have pain from a mild headache.” Which PRN medication does the nurse administer? A. Acetaminophen (Tylenol) B. Hydromorphone (Dilaudid) C. Midazolam (Versed) D. Oxycodone hydrochloride/acetaminophen (Tylox) 9.A client had a hip replacement 2 days ago and reports having a moderate amount of pain, stating that it is “a 7 on a 0-to-10 scale” of intensity. What intervention has the highest priority in the client’s nursing care plan? A. Encouraging diversional activities B. Incorporating activities of daily living as soon as possible C. Teaching key points of the relaxation response D. Using pre-emptive analgesia 10.A client with cancer is receiving low-dose oral morphine but is reporting both “breakthrough” pain and constipation. What intervention does the nurse implement first? A. Administers ordered docusate sodium (Colace) and gabapentin (Neurontin) B. Decreases the morphine (morphine sulfate) dosage for the client C. Gives the client a Fleet’s (sodium biphosphate) enema D. Records the client’s bowel movements 11.A postoperative client is vomiting and states, “I am having a lot of pain—about a 7 on a scale of 0 to 10.” Which route of administration does the nurse choose to administer an analgesic to the client? A. Intravenous B. Oral C. Rectal D. Transdermal 12.A client with chronic pain feels no relief with high-dose opioids and says, “I just can’t manage living right now.” What intervention does the nurse anticipate the health care provider will order for this client? A. Adding acetaminophen (Tylenol) B. Adding duloxetine (Cymbalta) as adjuvant therapy C. Increasing the opioid dose to control the pain D. Replacing the opioid with duloxetine (Cymbalta) for depression 13.A client who is using patient-controlled analgesia (PCA) is asleep. The nurse observes a family member pushing the PCA button for the sleeping client. What does the nurse say to the visitor? A. “Please allow the client to push the button when needed.” B. “Please don’t touch any equipment in the client’s room.” C. “Thank you. I am sure the client appreciated that.” D. “The client is asleep and is not in pain.” 14.A postoperative client is receiving epidural analgesia and reports itching. What does the nurse do next? A. Reduces the analgesic dose B. Gives diphenhydramine (Benadryl) C. Gives an antiemetic D. Calls the surgeon 15.Which statement is true about assessing pain in an older adult client? A. The nurse should assess for present and past pain. B. Older adults typically believe that expressing pain is acceptable. C. Older adults are at great risk for undertreated pain. D. Older adults usually believe that pain signifies a minor illness. 16.A client with osteoarthritis pain tells the nurse, “I take two arthritis-strength Tylenol (650 mg) every 8 hours.” How does the nurse respond? A. “Aspirin would be a better, more effective choice for your pain relief.” B. “More Tylenol is needed to provide effective pain relief for you.” C. “That is the appropriate dose of Tylenol for your pain.” D. “You will need to have routine liver and kidney function laboratory tests.” 17.The nurse is planning a dressing change on a postoperative mastectomy client. The client is receiving acetaminophen and oxycodone (Percocet) orally for pain every 4 hours and is due to receive them at 4:00 p.m. When will the nurse change the dressing? A. 3:30 p.m. B. 4:00 p.m. C. 4:30 p.m. D. 7:00 p.m. 18.The nurse is caring for a client who had a fractured ankle repaired. Twenty minutes after receiving 1.5 mg of hydromorphone (Dilaudid) IV push, the client is slow to respond and has constricted pupils and a respiratory rate of 6 breaths/min. What action does the nurse take initially? A. Calls the care provider for a change in the medication order B. Changes the order to every 6 hours rather than every 4 hours C. Gives the client a dose of naloxone (Narcan) 0.4 mg IV D. Performs a cognitive assessment on the client 19.The family of a client with chronic cancer pain says to the nurse, “Can you please reduce Dad’s pain medication so that we can spend more quality time with him?” How does the nurse respond? A. “I will ask his oncologist about your question.” B. “Let’s ask your father about your request.” C. “No, his pain relief is more important than your concerns.” D. “Yes, this is a valuable way for all of you to make needed adjustments.” 20.A newly admitted client who was in an automobile accident has a concussion and is reporting pain from a fractured femur and broken fingers. Which staff member does the charge nurse on the orthopedic unit assign to care for this client? A. An experienced RN travel nurse who arrived on the unit this morning B. An LPN/LVN who has worked on the orthopedic unit for 6 years C. The neurology unit RN who has floated to the orthopedic unit D. The RN orthopedic case manager who is responsible for discharge planning 21.During change-of-shift report, the day shift staff learns that a client who had back surgery has been reporting increasing lower back pain during the night. It is most appropriate for which day staff member to assess the client’s pain? A. LPN/LVN who is responsible for administering medications to the client B. RN nurse manager who is in charge of coordinating care for several units C. RN team leader who is responsible for updating the care plan for the client D. RN who has floated to the unit from the emergency department 22.Which activity does the RN team leader on a large medical-surgical unit assign to the LPN/LVN? A. Assessment of a client scheduled for surgery who is crying and expressing fear that the pain will be intolerable B. Assessment of a client using a transcutaneous electrical nerve stimulation unit to relieve chronic pain C. Complex dressing changes for a sacral wound for a client with type 2 diabetes who was given prescriptions for pain medication before wound care D. Instructions to a postoperative hip replacement client who has just been placed on patient-controlled analgesia for pain relief 23.The nurse is establishing a plan of care for a hospitalized client with chronic pain caused by fibromyalgia. Which nursing action does the nurse delegate to a nursing assistant? A. Application of a transcutaneous electrical nerve stimulation (TENS) device B. Education about nonpharmacologic interventions for pain control C. Referral to available community resources for pain management D. Engagement in conversation about the client’s family to distract the client 24.Which client does the RN arriving for duty assess first? A. A 27-year-old who has chronic severe back pain with movement B. A 51-year-old with lung cancer who reports pain “whenever I cough” C. A 56-year-old with acute pancreatitis who reports increasing abdominal pain D. A 63-year-old who reports ongoing pain associated with rheumatoid arthritis 25.The nurse manager for an oncology unit is evaluating a newly hired staff nurse. Which action by the nurse is of greatest concern to the nurse manager? A. Asking a client with chest pain if the pain is sharp and stabbing B. Instructing a confused postoperative client about how to use patient-controlled analgesia C. Preparing to administer a placebo to a client with chronic back pain D. Requesting that a client with chronic pain describe the specific location of the pain 26.The nurse manager on the surgical unit is making assignments for the day. Who is assigned to check and program the patient-controlled analgesia (PCA) pumps on the unit? A. A pharmacy technician B. One registered nurse (RN) C. One registered nurse (RN) and a certified nursing assistant (CNA) D. Two registered nurses (RNs) 27.A hospitalized client anticipates a daily painful dressing change. Which complementary and alternative medicine therapy might the nurse offer before the procedure? A. Animal-assisted therapy B. Hydrotherapy C. Imagery D. Acupuncture 28.A hospitalized client expresses satisfaction after using a recommended complementary and alternative medicine (CAM) therapy, saying that pain was diminished and anxiety reduced. Which CAM did the client most likely use? A. Herbs B. Homeopathy C. Imagery D. Tai chi 29.A client reports increasing pain during dressing changes. Which interventions are recommended for the client? (Select all that apply.) A. Assistance by the client with the dressing change B. Distraction C. Epidural analgesic D. Music therapy E. Premedication F. Transcutaneous electrical nerve stimulation (TENS) ANSWER WITH RATIONALE 1. C. The nurse’s primary role in pain management is to advocate for the client by believing reports of pain. Administering pain medication, assessing the pain level, and calling the provider are not the first step to take. 2. C. Flexibility will be necessary to adapt to the client’s needs and allow for uninterrupted control of the client’s pain issues. Discussion of pain relief strategies should begin when the client is admitted, not at the time of discharge. The client and other necessary health care agencies should be included in the discussion about home care. End-of-life pain control management will not be needed for most clients. 3.B.Complementary and alternative therapies should supplement, not replace, medication management. The nurse needs to obtain more data about the client’s plan. Telling the client that his or her plan will not work is dismissive of the client. The client may not need to be prescribed narcotics for the pain. 4. D.Asking when the pain occurs helps determine precipitating factors to identify the source of pain. It is an open-ended question that requires a descriptive response. Asking if someone hurt the client may be appropriate in rare circumstances, but typically it is not an appropriately focused question; the question does not relate to the severity or character of the pain. The nurse should ask the client open-ended questions, not questions requiring a "yes-or-no" answer, such as “Does it hurt badly?” Asking “Is the pain really that bad?” minimizes the client’s perception of pain; it is also a closed-ended question requiring a "yes-or-no" answer. 5. C. Asking the client about the frequency of pain and how the pain is being controlled helps in formulating an effective pain management plan. Asking the client about the occurrence of bleeding does not address the pain issue; it is a separate problem. Indicating that the client isn’t really hurting sounds judgmental and places the client on defense. Asking what the client does for pain at home is helpful in assessing chronic pain, but not for assessing postoperative pain; it is not relevant in this scenario. 6.C. Physical dependence occurs in people who take opioids over a period of time. When it is necessary to discontinue opioid analgesia for the client who is opioid dependent, slow tapering (weaning) of the drug dosage lessens or alleviates physical withdrawal symptoms. Addiction is a condition influenced by genetic, psychosocial, and environmental factors and characterized by impaired control over drug use, compulsive use, craving, or continued use despite harm; this description does not accurately reflect the client’s situation.Equianalgesia refers to the dose and route of administration of one drug that produces about the same degree of analgesia as the given dose and route of another drug; this term is used when switching opioids or routes of opioids. Pseudoaddiction is a condition created by the undertreatment of pain, and is characterized by behaviors such as anger and escalating demands for more or different medications; this description does not accurately reflect the client’s situation. 7. C. Both types of chronic pain (chronic cancer pain and chronic non-cancer pain) do not cause sympathetic reactions. Therefore, some clients do not appear to be in pain, even when they are. Clients with cancer tend to know what medication works for them. The nurse needs to follow the protocol for the client regardless of the client’s responses when it is chronic cancer pain. The nurse should never decrease pain medication under the assumption that, because the client does not exhibit pain, the client must not have any pain. Unless the client is involved in a clinical research trial, giving a placebo in place of medication is never appropriate. It is never appropriate to withhold prescribed pain medication. 8.A. Non-opioid analgesics such as Tylenol are the first line of therapy for mild to moderate pain. Dilaudid is appropriate for acute pain, such as pain from surgery, but it is inappropriate to give it for headache pain, especially for a mild headache. Versed is not appropriate for routine postoperative pain or headache; it is often used as a preoperative sedative. Although Tylox contains acetaminophen, it is also a narcotic; this level of pain control is not needed for a mild headache. 9. D. Use of pre-emptive analgesia is a technique designed to decrease pain in the postoperative period, decrease the requirements for a postoperative analgesic, prevent morbidity, and decrease the duration of hospital stay. Use of diversion in treating pain is often effective, but it would not be appropriate for acute pain expected on the second postoperative day. Getting the client to perform activities of daily living is an important step in recovery; however, it is not related to pain relief, but rather to other postoperative complications, such as circulation and elimination problems. Use of the relaxation response in treating pain is often effective, but it would not be appropriate for acute pain expected on the second postoperative day. 10. A. Docusate is a stool softener, and gabapentin is an adjuvant for breakthrough pain. Constipation is a side effect of morphine, but decreasing the morphine dose will cause this client’s pain to become even worse. Giving an enema is not the first intervention that should be tried by the nurse. Recording bowel movements is helpful for assessment, but does nothing to relieve the client’s constipation. 11. A. The intravenous route is the best choice for fast relief of nausea and pain. Oral pain medication may exacerbate the client’s nausea and is not the best choice. The rectal route and the transdermal route are not the routes of choice for short-term pain control because their effect is not as rapid or controlled as that of other routes. 12. B. Both tricyclic and other antidepressants such as duloxetine (Cymbalta) help treat the depression that can accompany chronic pain. They also stimulate the activity of endogenous opiates (endorphins and enkephalins) by increasing levels of the neurotransmitter serotonin. Adding acetaminophen would not address the client’s depression. Increasing the opioid dose can cause respiratory depression. Discontinuing the opioid can cause relapse pain. 13. A. The “PC” in “PCA” means “patient-controlled,” so having someone else push the button and administer analgesia defeats the purpose. More important, this action could cause oversedation and possible serious safety issues. Telling the family member not to touch any equipment in the client’s room is not only nonspecific, it is also disrespectful. Expressing appreciation is inappropriate because the nurse is condoning an unauthorized and potentially unsafe action. The fact that the client is asleep does not mean that the client is pain-free. 14. A. Pruritus (itching) is a common side effect of epidural opioids and is first treated by reducing the analgesic dose. Because epidural-induced pruritus does not appear to be caused by histamine release, diphenhydramine (Benadryl) may not be effective in relieving itching and may work only via its sedating effects. Antiemetics are given to relieve nausea and vomiting. If a health care provider needs to be called, it would be the anesthesiologist, not the surgeon 15. C. Older adults are at great risk for undertreated pain because of outdated beliefs by some health care providers about older adults’ pain sensitivity, tolerance, and ability to take opioids. The nurse should assess only for present pain. Older adults often believe that expressing pain is unacceptable. Older adults often believe that pain signifies a major illness. 16. D. Clients taking Tylenol, especially high doses of it, should be reminded to have routine liver and kidney function laboratory testing done, because hepatotoxicity and nephrotoxicity are adverse effects associated with long-term use. Acetaminophen (Tylenol) is a better choice for pain relief than aspirin because it has fewer side effects on the gastrointestinal system, such as bleeding. The client is actually taking more than the recommended upper limit of Tylenol; no more than 3600 mg daily should be used, and no more than 2400 mg for older adults. 17. C. About 30 minutes after administration of an analgesic is an optimal time to perform a procedure on a client. At 4:30 p.m., the opioid has had time to take effect and provide relief for the client. It would be inappropriate to perform a painful procedure, such as a dressing change, just before a scheduled analgesic is received (i.e., 3:30 p.m.), because the pain medication will be at its lowest concentrations in the client’s system. At 4:00 p.m., the analgesic has not had time to enter the client’s system, so it is too soon to perform the dressing change. If the client received the analgesic at 4:00 PM, it is not at the highest or best concentration at 7:00 p.m. to facilitate a dressing change with minimal discomfort. 18. C. For an unresponsive client, the nurse should administer naloxone (Narcan) 0.4 mg (diluted in 10 mL) over a 2-minute time period to reverse the action of the opioid analgesic. The order may need to be altered or changed, but calling for a medication order change is not the first action that the nurse should take in an unresponsive client. Nurses do not change orders in terms of dosage or frequency; the care provider changes the order. A sedated client will not be able to complete a cognitive assessment, and this action would waste time that should be spent on reversing the effects of hydromorphone. 19. B. The client’s desires about analgesia are the most important consideration in this scenario. He should be consulted initially about his family’s request. This open-ended type of question acknowledges the family, while keeping the client as the major decision maker. Although the physician might have an opinion about the family’s request, pain is subjective, and the client’s desires about analgesia are the most important consideration. Telling the family that the father’s pain control is more important than their concerns is a demeaning response, although technically true; it is dismissive of the family and is nontherapeutic. Giving the family control of pain relief for their father is inappropriate in this situation; the subjective nature of pain places decisions about the use of analgesia with the client who is experiencing the pain. The family and the client may need to make adjustments, but reducing pain relief for the client is not an advisable way to accomplish this goal. 20. C. The RN from the neurology unit will have the skills and experience needed to assess the neurologic and orthopedic status of this client, as well as the client’s pain status. The travel RN may have the expertise to care for the client, but will not be familiar with hospital policies or equipment. The LPN/LVN does not have the education or scope of practice to be assigned the care of this complex client, although the RN may delegate some aspects of the client’s care to the LPN/LVN. The case manager’s expertise involves coordinating discharge for the client rather than caring for the client during the acute hospitalization. 21. C. The RN team leader should assess this client’s level of pain and the need for a change in the plan of care. The LPN/LVN will assist with management of the client’s pain, but assessment should be done by the RN. The RN nurse manager has the education and scope of practice to assess the client’s pain, but providing direct client care is not the designated role for this nurse. The RN from the emergency department will not be familiar with assessments and interventions for postoperative back pain. 22. C. LPN/LVN education and scope of practice include working within practice parameters to administer pain medication and to perform dressing changes. Assessment and education are not within the LPN/LVN scope of practice. 23. D. Distraction techniques such as conversation, music, and television may be implemented by unlicensed nursing staff members. Application of a TENS unit, education about nonpharmacologic pain interventions, and community resource referrals require specialized nursing education and scope of practice and should be performed by licensed nursing staff. 24. C. Because acute pain is a biological warning signal, the nurse should assess the client with pancreatitis for complications such as bleeding or perforation that may be causing the client’s increasing pain. The clients with back pain, lung cancer pain, and rheumatoid arthritis have chronic pain; they should be assessed and treated as rapidly as possible, but the client with acute pain takes priority. 25. C. Current national guidelines from regulatory agencies and nursing organizations indicate that placebos should never be used for clients who are experiencing pain. Asking the client a closed-ended question about his or her pain, attempting to instruct a confused client, and asking the client with chronic pain to specify its location all indicate a need for further education in assessment and management of pain, but would not be as great a concern as the possible use of placebos. 26. D.To prevent drug errors, it is recommended that two RNs program the dosing parameters into the PCA delivery device to prevent drug errors. A pharmacy technician or CNA would not be authorized or credentialed to perform this task. 27. C. Changing dressings or performing other procedures may produce pain for the client. Imagery can be used to calm and distract the client from pain. Animal-assisted therapy would be difficult because the nurse will be performing a dressing change, and the animal could get in the way, contaminate the wound, or cause the client to move around too much. Hydrotherapy may be contraindicated for this client. Acupuncture is not something that the nurse can easily offer during a dressing change. 28. C. Imagery is often used for reducing pain, nausea and vomiting, and anxiety. The remaining CAM therapies are not typically used for pain control. Herbs are typically used as a means to promote health, prevent disease, or cure a variety of ailments. Homeopathic medicine uses small doses of specially prepared plant extracts and minerals to promote healing. Tai chi integrates body movements, mind concentration, muscle relaxation, and breathing to achieve a desired outcome. 29. B, D,E Distraction stimulates efferent nerve fibers and reduces the client’s perception of painful experiences. Music therapy provides a distraction and can reduce the client’s pain perception; efferent nerve fibers are stimulated. Premedication before painful treatments is a good method of controlling pain during treatment. Involving the client in an uncomfortable dressing change would tend to increase the client’s perception of pain; it is a better tactic to distract the client. Although epidural analgesia is effective, it is a method of providing pain relief that requires an epidural catheter to be in place; the use of such an invasive procedure would not be indicated for pain relief during a dressing change. Use of a TENS unit is effective in controlling certain types of pain, such as incisional pain; its use during a dressing change would not be feasible Pain management - Pottery and Perry Test Bank Course: Fundamentals of Nursing (NRS 130 ) Potter & Perry: Fundamentals of Nursing, 7th EditionTest BankChapter 43: Pain Management MULTIPLE CHOICE 1. Which one of the following nursing interventions for a client in pain is based on the gate-control theory? 1. Giving the client a back massage 2. Changing the client’s position in bed 3. Giving the client a pain medication 4. Limiting the number of visitors ANS: 1The gate-control theory suggests that cutaneous stimulation activates larger, faster-transmitting A-beta sensory nerve fibers. This decreases pain transmission through small-diameter A-delta and C fibers. A back massage is a nursing intervention based on the gate-control theory. Changing the client’s position in bed is not a form of cutaneous stimulation used to relieve pain. Giving the client a pain medication is a pharmacological approach to relieving pain. Limiting the number of visitors may provide a quiet environment conducive to relaxation, but it is not based on the gate-control theory.DIF: A REF: 1053-1054 OBJ: ComprehensionTOP: Nursing Process: AssessmentMSC: NCLEX® test plan designation: Pharmacological Therapies/Pharmacological Pain Management; Physiological Integrity/Basic Care and Comfort 2. A priority nursing intervention when caring for a client who is receiving an epidural infusion for pain relief is to: 1. Use aseptic technique 2. Label the port as an epidural catheter 3. Monitor vital signs every 15 minutes 4. Avoid supplemental doses of sedatives ANS: 3When clients are receiving epidural analgesia, monitoring occurs as often as every 15 minutes, including assessment of respiratory rate, respiratory effort, and skin color. Complications of epidural opioid use include nausea and vomiting, urinary retention, constipation, respiratory depression, and pruritus. A common complication of epidural anesthesia is hypotension. Assessing vital signs is the priority nursing intervention. Because of the catheter location, strict surgical asepsis is needed to prevent a serious and potentially fatal infection. To reduce the risk for accidental epidural injection of drugs intended for IV use, the catheter should be clearly labeled “epidural catheter.” Supplemental doses of opioids or sedative/hypnotics are avoided because of possible additive central nervous system adverse effect. 3. The nurse should describe pain that is causing the client a “burning sensation in the epigastric region” as: 1. Referred 2. Radiating 3. Deep or visceral 4. Superficial or cutaneous ANS: 3Deep or visceral pain is diffuse and may radiate in several directions. Visceral pain may be described as a burning sensation. Referred pain is felt in a part of the body separate from the source of pain, such as with a myocardial infarction, in which pain may be referred to the jaw, left arm, and left shoulder. Radiating pain feels as though it travels down or along a body part, such as low back pain that is accompanied by pain radiating down the leg from sciatic nerve irritation. Superficial or cutaneous pain is of short duration and is localized as in a small cut. ames: Nursing Care of Children: Principles and Practice, 3rd Edition Test Bank Chapter 15: Pain Management for Children ● MULTIPLE CHOICE 1. The nurse is aware when assessing a child for pain that: a. neonates do not feel pain. b. pain is an individualized experience. c. children do not remember pain. d. a child must cry to express pain. ANS: B Feedback A This is a myth. Neonates do express a total-body response to pain with a cry that is intense, high pitched, and harsh sounding. B The manner and intensity of how a child expresses pain is dependent on the individual childs experiences. C This is a myth. Children of all ages have been reported to have sleeping and eating disruptions after painful experiences. D Not all children will cry to express pain. DIF: Cognitive Level: Comprehension REF: Text Reference: pg 396 OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 2. When pain is assessed in an infant, it would be inappropriate to assess for which of the following? a. Facial expressions of pain b. Localization of pain c. Crying d. Thrashing of extremities ANS: B Feedback A Frowning, grimacing, and facial flinching in an infant may indicate pain. B Infants cannot localize pain to any great extent. C Infants often exhibit high-pitched, tense, harsh crying to express pain. D Infants may exhibit thrashing extremities in response to a painful stimulus. DIF: Cognitive Level: Comprehension REF: Text Reference: pg 399 OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 3. The nurse is aware that physiologic changes associated with pain in the neonate include which of the following? a. Increased blood pressure and decreased arterial saturation b. Decreased blood pressure and increased arterial saturation c. Increased urine output and increased heart rate d. Decreased urine output and increased blood pressure ANS: A Feedback A Increased blood pressure and heart rate and decreased arterial saturation are physiologic responses to pain in the neonate. B An increase in blood pressure and a decrease in arterial saturation are documented when the neonate is feeling pain. C Although an increase in heart rate is associated with pain, urine output changes have not been associated with pain. D An increase in blood pressure occurs with pain, but urine output changes have not been associated with pain. DIF: Cognitive Level: Comprehension REF: Text Reference: pg 399 OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 4. Which of the following is a myth that may interfere with the treatment of pain in infants and children? a. Infants may have sleep difficulties after a painful event. b. Children and infants are more susceptible to respiratory depression from narcotics. c. Pain in children is multidimensional and subjective. d. A childs cognitive level does not influence the pain experience. ANS: B Feedback A It is true that infants may have sleep difficulties after a painful event. This is not a myth. B No data are available to support the belief that infants and children are at higher risk of respiratory depression when given narcotic analgesics. This is a myth. C This is a true statement, not a myth. D The childs cognitive level, along with emotional factors and past experiences, does influence the perception of pain in children. This is not a myth. DIF: Cognitive Level: Comprehension REF: Text Reference: pg 398 OBJ: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 5. The nurse caring for the child in pain knows that distraction: a. can give total pain relief to the child. b. is effective when the child is in severe pain. c. is the best method for pain relief. d. must be developmentally appropriate to refocus attention. ANS: D Feedback A Distraction can help control pain but is rarely able to provide total pain relief. B Children in severe pain are not distractible. C Children may use distraction to help control pain, but it is not the best method for pain relief. D Distraction can be very effective in helping to control pain, but it must be appropriate to the childs developmental level. DIF: Cognitive Level: Comprehension REF: Text Reference: pg 406 OBJ: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 6. Which of the following medications is the most effective choice for treating pain associated with inflammation? a. Opioids b. Acetaminophen c. Ibuprofen d. Midazolam ANS: C Feedback A Opioids are the preferred drugs for the management of acute, severe pain, including postoperative pain, posttraumatic pain, pain from vaso-occlusive crisis, and chronic cancer pain. B Acetaminophen lacks the anti-inflammatory effects of nonsteroidal antiinflammatory drugs (NSAIDs) and provides only minimal anti-inflammatory relief. C Ibuprofen is a type of NSAID, which is used primarily for pain associated with inflammation. D Midazolam (Versed) is a short-acting drug used for conscious sedation, preoperative sedation, and as an induction agent for general anesthesia. DIF: Cognitive Level: Comprehension REF: Text Reference: pg 409 OBJ: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 7. When using the Poker Chip Tool, it is important for the nurse to know which of the following? a. Any number of chips can be used. b. Only a specified number of chips can be used. c. The assessment tool is used with adolescents. d. The assessment tool is most effectively used with 2-year-old children. ANS: B Feedback A Pain tools are valid only if used as directed. The Poker Chip Tool uses four chips. B In the Poker Chip Tool, four chips are used to represent a hurt. One chip represents a little hurt, and four chips represent the most hurt the child could have. C Adolescents are able to think abstractly. They can describe, quantify, and identify intensity and feelings about pain. This scale is recommended for children ages 4 to 12. D Self-report tools are effective in children older than 3 years of age, not 2 years of age. DIF: Cognitive Level: Knowledge REF: Text Reference: pgs 402-403 OBJ: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 8. An appropriate tool to assess pain in a 3-year-old child would be which of the following? a. The Visual Analogue Scale (VAS) b. The Adolescent and Pediatric Pain Tool c. The Oucher Tool d. The Poker Chip Tool ANS: C Feedback A The VAS is indicated for use with older school-age children and adolescents. It can be used with younger school-age children, although less-abstract tools are more appropriate. B The Adolescent and Pediatric Pain Tool is indicated for use with children 8 to 17 years of age. C The Oucher Tool can be used to assess pain for children 3 to 12 years of age. D The Poker Chip Tool can be used to assess pain in children 4 to 12 years of age. DIF: Cognitive Level: Knowledge REF: Text Reference: pg 403 OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 9. In which of the following developmental stages is the child first able to localize pain and describe both the amount and the intensity of the pain felt? a. Toddler stage b. Preschool stage c. School-age stage d. Adolescent stage ANS: B Feedback A The toddler expresses pain by guarding or touching the painful area, verbalizes words that indicate discomfort, such as ouch and hurt, and demonstrates generalized restlessness when feeling pain. B The preschool stage is the period when the child is first able to describe the location and intensity of pain, stating for example, ear hurts bad, when feeling pain. C The preschool stage is the period when the child is first able to describe the location and intensity of pain. The school-age child describes both the location of the pain and its intensity. D The preschool stage is the period when the child is first able to describe the location and intensity of pain. The adolescent also describes location and intensity of pain. DIF: Cognitive Level: Knowledge REF: Text Reference: pg 399 OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 10. Which of the following statement indicates a nurses lack of understanding about the use of patient-controlled analgesia (PCA) therapy? a. Children as young as 3 years old can effectively and successfully use a PCA pump. b. Two registered nurses (RNs) are required to double check the dosage and programmed administration of opioids. c. The child should be carefully monitored for signs and symptoms of overmedication with opioids. d. Naloxone (Narcan) should be readily available. ANS: A Feedback A Children as young as 5 years old have effectively used PCA therapy. Further data are needed to evaluate the use of PCA therapy in children younger than 5 years of age. B Two RNs are needed to check the amount of opioid being administered. Once the opioid infusion is hung and programmed, a second RN must double check the process. C Children receiving PCA therapy should be monitored closely to ensure effective pain control and for signs or symptoms of overmedication. Initially, vital signs should be monitored every 15 to 30 minutes and then every 2 to 4 hours. Respiratory rate should be assessed every hour. D Narcan should be readily available to reverse opioid overmedication exhibited by respiratory distress. DIF: Cognitive Level: Knowledge REF: Text Reference: pg 407 OBJ: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 11. Which of the following assessments indicates to a nurse that a 2-year-old child is in need of pain medication? a. The child is lying rigidly in bed and not moving. b. The childs current vital signs are consistent with vital signs over the past 4 hours. c. The child is quieted when held and cuddled. d. The child has just returned from the recovery room and is crying. ANS: A Feedback A Behaviors such as crying, distressed facial expressions, certain motor responses such as lying rigidly in bed and not moving, and interrupted sleep patterns are indicative of pain in children. B Current vital signs that are consistent with earlier vital signs do not suggest that the child is feeling pain. C Response to comforting behaviors does not suggest the child is feeling pain. D Crying in a child who is returning from the recovery room may not be indicative of pain. The child may just be fearful or having anxiety because of the strange surroundings and having just completed surgery. DIF: Cognitive Level: Application REF: Text Reference: pg 399 OBJ: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 12. When assessing pain in any child, the nurse should consider which of the following? a. Any pain assessment tool can be used to assess pain in children. b. Children as young as 1 year old use words to express pain. c. The childs behavioral, physiologic, and verbal responses are valuable when assessing pain. d. Pain assessment tools are minimally effective for communicating about pain. ANS: C Feedback A The childs age is important in determining the appropriate pain assessment tool to use. B Developmentally appropriate assessment tools need to be used to effectively identify and determine the level of pain felt by a child. Toddlers may use words such as ouch or hurt to identify pain, but infants and young children may not have the language or cognitive abilities to express pain. C Childrens behavioral, physiologic, and verbal responses are indicative when assessing pain. The use of pain measurement tools greatly assists in communicating about pain. D Pain assessment tools when used appropriately are successful and efficient in identifying and quantifying pain with children. Behavioral and physiologic signs and symptoms in combination with pain assessment tools a