Deck 30: Pain Assessment and Management

Question 1

The nurse is caring for James,a 19-year-old college student,in the emergency department.He has a medical diagnosis of a sprained ankle.What type of pain is James most likely experiencing?

A)Mild pain
B)Referred pain
C)Somatic pain
D)Visceral pain

Answer 1

Somatic pain

Question 2

The health care team agrees that Marie's injury has resulted in changes to her central nervous system (CNS)causing an abnormal interpretation of normal stimuli and the chronic pain that she now feels.What kind of nervous system plasticity does this explanation describe?

A)Gate control theory
B)Central sensitization
C)Perception
D)Peripheral sensitization

Answer 2

Central sensitization

Question 3

The nurse is caring for Mrs.Henri,who has been placed on a Patient Controlled Analgesic (PCA)pump to control pain following an appendectomy.What are the advantages for Mrs.Henri of this type of pain control?

A)The nurse is able to spend more time with her patients.
B)It is cost effective because it requires less actual medication.
C)The patient is less likely to receive an overdose of the opioid.
D)The client can manage when the next dose of analgesia is given.

Answer 3

The client can manage when the next dose of analgesia is given.

Question 4

Marie,a 25-year-old nurse,injured her back at work a year ago.She is now feeling angry,frustrated,and depressed because of persistent back pain.What type of pain is Marie experiencing?

A)Acute pain
B)Chronic pain
C)Visceral pain
D)Nociceptive pain

Question 5

Mrs.Cheema has just returned to the surgical unit following a bowel resection.While repositioning her,the nurse notices her grimacing.She states she is having pain.What type of pain is Mrs.Cheema most likely experiencing?

A)Acute Pain
B)Chronic Pain
C)Neuropathic pain
D)Phantom pain

Question 6

Which of the following pain syndromes is characterized by widespread musculoskeletal pain and fatigue?

A)Fibromyalgia
B)Trigeminal neuralgia
C)Post-herpetic neuralgia
D)Phantom pain

Question 7

While the nurse is checking the orders for analgesia,which of the following nursing interventions is most appropriate in response to Simon's perception of pain?

A)Have his mother hold him to provide comfort
B)Have another nurse provide reassurance for him
C)Teach him about the meaning of his pain
D)Tell him "When you cry,it makes it hurt worse."

Question 8

The nurse is providing discharge instructions to Mr.Charles,who was started on a fentanyl citrate skin patch.Which of the following measures can be used to decrease the risk of constipation?

A)Take an antihistamine three times per day
B)Drink six to eight glasses of water per day
C)Assess respiratory rate before taking medication
D)Assess dietary intake before taking medication

Question 9

Mrs.Franco has brought her 13-month-old daughter Ella into the emergency room with nausea and vomiting.Ella is crying.Which of the following behavioural pain assessment scales would be appropriate for the nurse to use to determine the intensity of Ella's pain?

A)Behavioural Pain Scale (BPS)
B)Faces Pain Scale
C)Visual Analog Scale
D)Face,Legs,Activity,Cry,Consolability (FLACC)

Question 10

Mrs.Beamish describes her pain at an 8 out of 10,with 0 being no pain.She receives a dose of morphine sulphate subcutaneously (SC).After 30 minutes,which of the following evaluative data is the most accurate indicator that Mrs.Beamish's pain has decreased?

A)She is sleeping soundly.
B)She states that it doesn't hurt if she doesn't move.
C)Her nonverbal responses are decreased.
D)She rates her pain as 4 on a scale where 0 is no pain.

Question 11

It has been determined that Simon has gastroenteritis and the appropriate health care provider orders Tylenol for him for abdominal pain.What is the best indicator that the Tylenol is effective for Simon's pain?

A)It is verified on the numeric rating scale.
B)Simon is no longer crying.
C)Simon is sleeping in a fetal position.
D)Simon is playing happily in the crib.

Question 12

Sally,18 years old,fractured her tibia and fibula in a ski accident.She has just returned to her room following an open reduction of her tibia and fibula.During the next 24 to 48 hours,what is the most effective timing for the nurse to administer Sally's prn analgesic?

A)When Sally requests it
B)On a regular schedule
C)When Sally exhibits signs of pain
D)Four hours after surgery

Question 13

Which of the following cutaneous stimulation techniques will provide Mr.Murray,who suffers from chronic back pain,with pain relief by closing the pain gate?

A)Distraction
B)Relaxation exercises
C)Massage
D)Psychoeducation

Question 14

Which of the four processes involved in nociception uses mediators such as serotonin or histamine to create an action potential from noxious stimuli?

A)Transduction
B)Transmission
C)Modulation
D)Perception

Question 15

The nurse is caring for Mr.Aaron,a 34-year-old who has an epidural catheter with fentanyl and bupificaine for pain relief following a thoracotomy.The nurse observes that his respiratory rate is eight breaths a minute and shallow.What should the nurse's priority action be?

A)Administer naloxone hydrochloride (Narcan)and monitor vital signs
B)Call the emergency response team and prepare to intubate
C)Decrease fentanyl dose and check vital signs again in 30 minutes
D)Stop epidural fentanyl and notify physician

Question 16

Mr.Williams has been diagnosed with inoperable bowel cancer.Over the past month the nurse has observed his dose of morphine slowly increase as his pain has increased.Which of the following best describes the effect of his response to the opioid analgesic?

A)Equianalgesia
B)Addiction
C)Physical dependence
D)Drug tolerance

Question 17

Mr.Johnson,a regular client in the emergency room,reports that he has severe abdominal pain.Which of the following is an important consideration as the nurse completes her pain assessment?

A)The amount of tissue damage is directly related to the amount of pain a client feels.
B)Regular administration of analgesia for pain will lead to addiction.
C)Physiological or behavioural signs accompany pain and can be used to verify its existence.
D)Physiological and behavioural adaptation can occur with severe pain.

Question 18

Simon is a 4-year-old brought to the clinic by his mother,Mrs.Meyers.She states that he has been vomiting all day.He is curled up in his mother's arms,and is moaning and crying.What is the best way of finding out where his pain is located?

A)Ask Simon to tell you where the pain is
B)Ask Simon to point to where the pain is
C)Observe Simon's nonverbal behaviour
D)Ask Simon's mother where the pain is

Question 19

Mr.Alexander is a nurse working on a surgical floor.He is working with a student nurse who is learning about medication administration.What would his response be when the student asks him what the normal duration of action is for an oral opiate analgesic?

A)2 hours
B)4 hours
C)6 hours
D)8 hours

Question 20

Mr.Neilson had an epidural catheter placed for pain management following a pneumonectomy.He has a combination of fentanyl and bupivacaine infusing continuously.When his pain is assessed he describes it as 2/10,with 0 being no pain.What considerations would the nurse make when assisting Mr.Neilson up to the chair?

A)Mr.Neilson should remain on bed rest with an epidural catheter
B)Disconnect tubing from epidural pump and cover with sterile cap
C)Move slowly to the sitting position
D)Provide for pre-emptive opioid before assisting him to the chair

Question 21

Mrs.Fynn,78 years old,comes into the clinic with complaints of increasing pain in both her knees.The nurse is conducting a thorough assessment using the PQRSTU pneumonic.What information would the nurse gather under "understanding"?

A)Location
B)Nausea and vomiting
C)Leisure activities
D)Pain-free intervals

Question 22

Mrs.Hanson is going home on continuous subcutaneous infusion (CSCI)for pain management after an esophagectomy for cancer.What statement by Mrs.Hanson would indicate that she has understood the instructions regarding the pain pump provided by the nurse?

A)The use of this device will decrease my side effects from the analgesics.
B)I need to plug the unit in at least 6 hours per day.
C)I will call the nurse to change the medication.
D)I will rotate the site between my thigh and abdomen every 3-7 days.

Question 23

In which mechanism involving the experience of pain are endogenous opioids bound to opiate receptor sites?

A)Transduction
B)Transmission
C)Modulation
D)Perception

Question 24

Mrs.June has been on the same dose of morphine for two weeks to control pain from terminal ovarian cancer.Which of the following subjective signs indicate that Mrs.June's morphine dosage may need to be adjusted?

A)She states that she has pain when she moves.
B)She states that she feels lightheaded.
C)She is moaning loudly when repositioned.
D)She states that she feels nauseated.

Question 25

Daniel,17,has just returned to his room following knee surgery.Which of the following objective assessment data does the nurse obtain prior to administering an opioid analgesic to Daniel?

A)Pain level as stated by client
B)Feelings of nausea
C)Respiratory rate
D)Pedal pulses

Question 26

Which of the following statements by nurses demonstrate an accurate understanding of pain?

A)Patients in pain are likely to become addicted,so waiting as long as possible before requesting prn narcotics is advisable.
B)A woman in early labour with mild contractions,who is restless,crying out,and complaining,cannot be having that much pain from her contractions.
C)Pain in a 70-year-old man who is not experiencing any physiological or behavioural signs is not severe.
D)All clients should be assessed carefully for pain; even minor surgical clients can experience intense post-operative pain.

Question 27

Mr.Percy has terminal prostate cancer.He is currently being cared for in the hospice unit.What is the benefit of prescribing a full agonist opioid such as Fentanyl to manage Mr.Percy's pain?

A)No ceiling dose
B)Decreased incidence of drug tolerance
C)Decreased incidence of drug dependence
D)Maximal ceiling dose

Question 28

Mrs.Allyson has just sustained a soft tissue injury from an automobile accident.She has a past history of a gastrointestinal bleed.Which of the following would be contraindicated for pain management?

A)Cox-2 inhibitors
B)Tylenol
C)Transcutaneous Electrical Nerve Stimulation (TENS)
D)Proton-pump inhibitor