Deck 15: Pain Management

Question 1

A patient who is obviously in pain refuses the morphine that has been ordered for pain control because of a fear of addiction.The nurse explains that the percentage of patients taking prescribed pain protocols who become addicted is estimated at:

A) Less than 1%
B) 10% to 25%
C) 30% to 50%
D) 80% to 90%

Answer 1

Less than 1%

Question 2

The nurse attempts to evaluate the presence of pain in a patient who is cognitively impaired by assessing for:

A) Amount of time spent sleeping during the day
B) Consistent stoic facial expression
C) Increased social interaction
D) Increasing confusion

Answer 2

Increasing confusion

Question 3

A patient who had a myocardial infarction 2 days earlier has been eating well,is ambulating with assistance,and is receiving antibiotics and morphine by intravenous (IV)drip.The patient complains of constipation this morning.The nurse assesses the probable cause of the constipation as:

A) Inadequate fluid intake
B) Lack of exercise
C) Administration of antibiotics
D) Administration of an analgesic medication

Answer 3

Administration of an analgesic medication

Question 4

The nurse is alert for sympathetic responses to pain such as:

A) Increased blood pressure, increased pulse, and increased respiratory rate
B) Decreased blood pressure, decreased pulse, and increased respiratory rate
C) Increased blood pressure, decreased pulse, and increased respiratory rate
D) Decreased blood pressure, decreased pulse, and decreased respiratory rate

Question 5

The patient still complains of pain after the administration of the ordered analgesic.The nurse changes the nursing care plan because the:

A) Patient's pain threshold has risen.
B) Patient's pain threshold has lowered.
C) Patient has become addicted.
D) Patient is seeking attention.

Question 6

The patient with an extensive abdominal operation is assessed by the nurse as having predictable pain.Analgesics for this patient will be most effective when administered:

A) As needed (PRN)
B) Once a day
C) Twice a day
D) Around the clock

Question 7

To perform a nursing assessment correctly,the nurse must remember that pain perception involves several central nervous system (CNS)processes such as:

A) Afferent pathways carry messages to the spinal cord.
B) Efferent pathways stimulate the spinal cord to recognize the location of pain.
C) Nociceptors in the brain stimulate the spinal cord.
D) Pain receptors in muscle, skin, and subcutaneous tissue stimulate efferent pathways.

Question 8

The nurse explains to a patient who is to undergo a hip replacement that his postoperative pain will be greatly reduced by:

A) Femoral nerve blocks
B) Extremely deep general anesthesia
C) Practicing leg lifting exercises before surgery
D) Placing an analgesic patch directly over the incision

Question 9

The nurse using the gate-control methods of pain relief would help the patient control pain by:

A) Assisting the patient to ambulate.
B) Giving a massage.
C) Providing an ice cold beverage.
D) Instructing the patient in stretching exercises.

Question 10

A prescription for morphine sulfate (0.5 gr IM PRN)was ordered for pain for an 80-year-old patient with emphysema who weighs 100 pounds.The most appropriate action for the licensed practical/vocational nurse (LPN/LVN)is to:

A) Transcribe the order and wait to see if the patient needs it.
B) Transcribe the order for an oral dose instead of IM dose.
C) Call the physician and clarify the order.
D) Tell the RN about the order.

Question 11

In performing a pain assessment,the LPN/LVN would follow which steps?

A) Assess vital signs, status of pain, and aggravating factors.
B) Assess location, quality, and intensity on an identified scale.
C) Assess the intensity on an identified scale and record findings.
D) Assess vital signs and location, and report to the RN.

Question 12

The nurse applying heat to an injured hip of a patient is careful not to leave the heat on longer than:

A) 15 minutes
B) 20 minutes
C) 30 minutes
D) 1 hour

Question 13

The nurse administers nalbuphine (Nubain),an opioid agonist-antagonist to a 78-year-old patient.The family is worried about the patient and thinks that this drug is too strong and will cause harm.The nurse assures the family that this drug:

A) Does not accumulate in the body.
B) Blocks the side effects observed in opioid agonists.
C) Does not affect the CNS.
D) Can only be given orally.

Question 14

The physician has ordered both heat and cold treatments for the older adult patient with a leg injury.The nursing care plan reflects secondary diagnoses of peripheral vascular disease (PVD),diabetes,and an allergy to latex.Which of the ordered treatments would the nurse prefer to administer and why?

A) The nurse will use cold treatment because patients with diabetes and a latex allergy cannot tolerate heat.
B) The nurse will use cold treatment for this patient with a fracture because cold will help set the cast.
C) The nurse will use heat treatment because cold is contraindicated for patients with PVD.
D) The nurse will use heat treatment because heat will increase circulation and increase the threat of infection in the injured part.

Question 15

Two patients are hospitalized with the same diagnosis,but one is 23 years old,with acute recent pain from an injury,and the other is 64 years old,with pain of long-standing duration of several years.The difference in anticipated assessment is which of the following?

A) Acute pain for young patients is more intense at the same level, but these patients experience few changes in vital signs.
B) Young patients with acute pain exhibit fewer changes in vital signs but still report true levels of pain at levels 8 to 10.
C) Older adult patients with chronic pain exhibit increased changes in vital signs and report levels of pain lower than reality.
D) Older adult patients with chronic pain usually report lower levels of pain much less severe than they really are.

Question 16

The nurse notices that the patient seems calm and peaceful despite an assessment that the patient's injuries might be causing severe pain.The patient tells the nurse that using yoga,meditation,and __________________ lessens the perceptions of pain to tolerable levels.

A) Indulging in a favorite food
B) Music by a favorite artist
C) Reading exciting science fiction
D) Self-administration of drugs

Question 17

The sensation of pain has been defined by the International Association for the Study of Pain as:

A) Unpleasant sensory and emotional experience
B) Whatever the person experiencing it says it is
C) Psychogenic response to tissue injury
D) Physical and psychogenic response to the need for drugs

Question 18

The nurse is teaching a patient how to use a transcutaneous electrical nerve stimulation (TENS)unit and how it works.Appropriate information for this patient would be:

A) "The stimulation of the skin seeks to localize the acute pain and will last for several minutes after the unit is applied."
B) "This unit stimulates both the skin and the underlying tissues to decrease the intensity of the pain."
C) "The mechanism for use of this unit is well known and can be read."
D) "During those days when using the TENS unit, no analgesic can be given."

Question 19

Every time the right arm is raised,the patient reports to the nurse that pain is triggered in the right shoulder.The nurse charts this description as an example of a(n):

A) Referred pain
B) Aggravating factor
C) Alleviating factor
D) Past experience with the pain

Question 20

A patient admitted with the diagnosis of possible myocardial infarction complains of pain and tingling in his left arm and says,"How in the world could I be having a heart attack when it's just my arm that is giving me trouble?" The nurse explains that the patient is experiencing:

A) Referred pain
B) Psychogenic pain
C) Neuromuscular pain
D) Muscle spasms of shoulder

Question 21

The nurse explains the standards for pain management published by The Joint Commission ( TJC ).The nurse will: (Select all that apply.)

A) Perform organized pain assessment.
B) Record results of analgesia.
C) Give adequate discharge instruction about pain relief.
D) Recognize the right of a patient to manage pain.
E) Teach patients about pain control methods.
F) None of above

Question 22

____________________ and ____________________ are natural opioid-like substances that block pain perception.

Question 23

When the patient with sciatica seats himself in a chair,he gasps and complains of a burning and shooting pain in his hip.The nurse assesses that this is _______________ pain.

A) Referred
B) Neuropathic
C) Visceral
D) Acute

Question 24

The nurse is administering morphine IM,ordered for a patient reporting severe pain.To evaluate the patient's response to this drug,the nurse will assess primarily for:

A) Cardiac rhythms for tachycardia
B) Respiratory rate for tachypnea
C) Increased bowel sounds in the gastrointestinal (GI) system.
D) Sedative effects in the neurologic system.

Question 25

The nurse is notified when the patient,newly admitted with liver and gallbladder disease,complains of pain in the right middle back and asks for some pain medication.As the basis for the assessment,the nurse uses knowledge of pain to determine that the patient:

A) Is just complaining to see whether the staff will give out pain medications.
B) Has referred pain sensations. The nurse should follow orders for administering pain medication.
C) Has an injury on the back from an unknown cause that needs immediate assessment.
D) Is a chronic complainer with anxieties about his condition.

Question 26

The nurse explains that afferent pathways are activated by pain receptors called ____________________.

Question 27

The nurse instructs a patient who has had a rhizotomy for leg pain that:

A) Relief may not be permanent.
B) The leg will tingle and burn occasionally.
C) The foot may discolor and twitch at times.
D) Snug shoes should be worn at all times.
E) Caution should be taken to prevent injury to the leg.

Question 28

The nurse explains to a patient that the gate-control theory of pain claims that pain is perceived as a stimulation of receptors in the:

A) Large arteries
B) Vena cava
C) Large nerve fibers
D) Small nerve fibers

Question 29

The nurse has assessed that prolonged and unrelieved pain will:

A) Release endorphins
B) Lower the pain threshold
C) Stimulate gate control
D) Lower the blood pressure