Deck 10: Pain

Question 1

A patient is receiving morphine sulfate intravenously (IV) for right flank pain associated with a kidney stone in the right ureter. The patient also complains of right inner thigh pain and asks the nurse whether something is wrong with the right leg. In responding to the question, the nurse understands that the patient

A) is experiencing referred pain from the kidney stone.
B) has neuropathic pain from nerve damage caused by inflammation.
C) has acute pain that may be progressing into chronic pain.
D) is experiencing pain perception that has been affected by the morphine received earlier.

Answer 1

is experiencing referred pain from the kidney stone.

Question 2

To obtain the most complete assessment data about a patient's chronic pain pattern, the nurse asks the patient

A) "Can you describe where your pain is the worst?"
B) "What is the intensity of your pain on a scale of 0 to 10?"
C) "Would you describe your pain as aching, throbbing, or sharp?"
D) "Can you describe your daily activities in relation to your pain?"

Answer 2

"Can you describe your daily activities in relation to your pain?"

Question 3

A patient receiving prn intermittent IV administration of opiates following gastric surgery watches a favorite television program every morning. The patient does not request pain medication during this time and when questioned denies the need for medication. The nurse's evaluation of this situation is that

A) lying quietly in bed is the best method of controlling the patient's incisional pain.
B) encouraging the patient to watch other television programs will decrease the pain.
C) the distraction of the television enables the patient to decrease the perception of pain.
D) the patient's dose of opiates needs to be decreased because her pain is well controlled.

Answer 3

the distraction of the television enables the patient to decrease the perception of pain.

Question 4

The hospice RN obtains the following information about a 72-year-old terminally ill patient with cancer of the colon. The patient takes oxycodone (OxyContin) 100 mg twice daily for level 6 abdomen pain on a 10-point scale. The pain has made it difficult to continue with favorite activities such as playing cards with friends twice a week. The patient's children are supportive of the patient's wish to stop chemotherapy but express sadness that the patient does not have long to live. Based on this information, which nursing diagnosis has priority in planning the patient's care?

A) Impaired social interaction related to disabling pain
B) Anxiety related to poor patient coping skills
C) Disabled family coping related to patient-family conflict
D) Risk for aspiration related to opioid use

Question 5

A patient with chronic cancer pain experiences breakthrough pain (level 9 of 10) and anxiety while receiving sustained-release morphine sulfate (MS Contin) 160 mg every 12 hours. All these medications are ordered for the patient. Which one will be most appropriate for the nurse to administer first?

A) Ibuprofen (Motrin) 400-800 mg orally
B) Immediate-release morphine 30 mg orally
C) Amitriptyline (Elavil) 10 mg orally.
D) Lorazepam (Ativan) 1 mg orally

Question 6

A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. The nurse's reply will be based on the information that these strategies

A) impact the
B) prevent transmission of nociceptive stimuli to the cortex.
C) increase the modulating effect of the efferent pathways.
D) slow the release of transmitter chemicals in the dorsal horn.

Question 7

A postoperative patient who has undergone extensive bowel surgery moves as little as possible and does not use the incentive spirometer unless specifically reminded. The patient rates the pain severity as an 8 on a 10-point scale but tells the nurse, "I can tough it out." In encouraging the patient to use pain medication, the best explanation by the nurse is that

A) very few patients become addicted to opioids when using them for acute pain control.
B) there is little need to worry about side effects because these problems decrease over time.
C) there are many pain medications and if one drug is ineffective, other drugs may be tried.
D) unrelieved pain can be harmful due to the effect on respiratory function and activity level.

Question 8

A patient with a history of chronic cancer pain is admitted to the hospital. When reviewing the patient's home medications, which of these will be of most concern to the admitting nurse?

A) Oxycodone (OxyContin) 80 mg twice daily
B) Ibuprofen (Advil) 800 mg three times daily
C) Amitriptyline (Elavil) 50 mg at bedtime
D) Meperidine (Demerol) 25 mg every 4 hours

Question 9

A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (of a 0-10 scale) and requests "something for pain that will work quickly." The best way for the nurse to document this information is as

A) breakthrough pain.
B) neuropathic pain.
C) somatic pain.
D) referred pain.

Question 10

All the following medications are included in the admission orders for an 86-year-old patient with moderate degenerative arthritis in both hips. Which medication will the nurse use as an initial therapy?

A) Aspirin (Bayer) 650 mg orally
B) Oxycodone (Roxicodone) 5 mg orally
C) Acetaminophen (Tylenol) 650 mg orally
D) Naproxen (Aleve) 200 mg orally

Question 11

The health care provider tells a patient to use ibuprofen (Motrin, Advil) to relieve pain after treating a laceration on the patient's forearm from a dog bite. The patient asks the nurse how ibuprofen will control the pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing the

A) production of pain-sensitizing chemicals.
B) spinal cord transmission of pain impulses.
C) sensitivity of the brain to painful stimuli.
D) modulating effect of descending nerves.

Question 12

The nurse is evaluating the effectiveness of imipramine (Tofranil), a tricyclic antidepressant, for a patient who is receiving the medication to help relieve chronic cancer pain. Which information is the best indicator that the imipramine is effective?

A) The patient states, "I feel much less depressed since I've been taking the imipramine."
B) The patient sleeps 8 hours every night.
C) The patient says that the pain is manageable and that he or she can accomplish desired activities.
D) The patient has no symptoms of anxiety.

Question 13

A patient with extensive second-degree burns on the legs and trunk is using patient-controlled analgesia (PCA) with IV morphine to be delivered at 1 mg every 10 minutes to control the pain. Several times during the night, the patient awakens in severe pain, and it takes more than an hour to regain pain relief. The most appropriate action by the nurse is to

A) request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
B) consult with the patient's health care provider about adding a continuous morphine infusion to the PCA regimen at night.
C) teach the patient to push the button every 10 minutes for an hour before going to sleep even if the pain is minimal.
D) administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.

Question 14

A home health patient has a prescription for pentazocine (Talwin,) a mixed opioid agonist-antagonist. When teaching the patient and family about adverse effects, the nurse will plan to focus on how to monitor for

A) agitation.
B) respiratory depression.
C) hypotension.
D) physical dependence.

Question 15

When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication?

A) The patient complains of a "pounding" headache.
B) The patient becomes restless and agitated.
C) The patient has not voided for over 10 hours.
D) The patient has cramping abdominal pain.

Question 16

A patient being treated for chronic musculoskeletal pain tells the nurse, "I feel depressed because I can't even go out and play a round of golf." The patient describes the pain as "aching" and says it is usually at a level 7 of a scale of 1 to10. Based on these assessment data, which patient goal is most appropriate? After treatment, the patient will

A) state that pain is at a level 2 of 10.
B) be able to play 1 to 2 rounds of golf.
C) exhibit fewer signs of depression.
D) say that the aching has decreased.

Question 17

Morphine 10 mg IV every 4 to 6 hours prn is ordered for a patient with a pancreatic tumor who has a distant history of opioid abuse. After 3 days of receiving the morphine every 6 hours, the patient tells the nurse that the medication is needed more frequently to control the pain. The best initial action by the nurse is to

A) administer the morphine every 4 hours as needed.
B) consult with the doctor about initiating an appropriate weaning protocol for the morphine.
C) remind the patient that the previous substance abuse increases the risk for addiction.
D) use alternative therapies such as heat or cold.

Question 18

A hospice patient is in continuous pain, and the health care provider has left orders to administer morphine at a rate that controls the pain. When the nurse visits the patient, the patient is awake but moaning with severe pain and asks for an increase in the morphine dosage. The respiratory rate is 10 breaths per minute. The most appropriate action by the nurse is to

A) titrate the morphine dose upward until the patient states there is adequate pain relief.
B) administer a nonopioid analgesic, such as ibuprofen, to improve patient pain control.
C) tell the patient that additional morphine can be administered when the respirations are 12.
D) inform the patient that increasing the morphine will cause the respiratory drive to fail.

Question 19

A 45-year-old patient has breast cancer that has spread to the liver and spine. The patient has been taking oxycodone (OxyContin) and amitriptyline (Elavil) for pain control at home but now has constant severe pain and is hospitalized for pain control and development of a pain-management program. When doing the initial assessment, which question will be most appropriate to ask first?

A) How would you describe your pain?
B) How much medication do you take for the pain?
C) How long have you had this pain?
D) How many times a day do you medicate for pain?

Question 20

A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic pain complains of nausea and abdominal fullness. The most appropriate initial action by the nurse is to

A) consult with the health care provider about using a different opioid.
B) administer the ordered metoclopramide (Reglan) 10 mg IV.
C) tell the patient that the nausea will subside in about a week.
D) order the patient a clear liquid diet until the nausea decreases.

Question 21

The health care provider plans to titrate a patient-controlled opioid infusion (PCA) to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time? (Select all that apply.)

A) Monitoring for therapeutic and adverse effects of opioid administration
B) Teaching about the need to decrease opioid doses by the second postoperative day
C) Assessing for signs that the patient is becoming addicted to the opioid
D) Educating the patient about how analgesics improve postoperative activity level
E) Emphasizing that the risk of opioid side effects increases over time
Correct