Deck 13: Pain Management

Question 1

The nurse teaches the patient in ambulatory care to apply ice packs to an injured knee.What instructions should the nurse include in patient teaching?

A) Leave the ice on for no more than 5 minutes.
B) Remove the ice pack when the ice melts completely.
C) A cold pack has the potential to cause tissue damage.
D) Apply ice for an hour and then apply a heating pad.

Answer 1

A cold pack has the potential to cause tissue damage.

Question 2

The nurse cares for several postoperative patients using patient-controlled analgesia (PCA)pain management with a combination of an opioid and a local anesthetic agent on the first postoperative day.Which patient should the nurse assess first?

A) A patient after a bowel resection for recurrent colon cancer
B) A patient after an internal fixation of an ankle fracture
C) A first-time hospitalized patient after amputation of a leg
D) A patient with emphysema who had a lung tumor resection

Answer 2

A first-time hospitalized patient after amputation of a leg

Question 3

A patient is receiving care for a soft tissue sports injury.Which explanation by the nurse explains part of the treatment using the acronym PRICE?

A) "I'll be alternating ice and heat to the injured area."
B) "You'll be exercising with ice packs for a while."
C) "Rest is indicated before and after cold treatments."
D) "The cold therapy decreases venous congestion."

Answer 3

"The cold therapy decreases venous congestion."

Question 4

The patient has metastatic bone pain from cancer with nausea and vomiting after receiving periodic opioid analgesia intravenously.Which can the nurse implement to manage the patient's pain effectively without nausea and vomiting?

A) Dispense the opioid 30 minutes after providing food.
B) Combine the opioid with an antiemetic or antihistamine.
C) Collaborate with the healthcare provider for around-the-clock analgesia.
D) Replace the analgesic with a nonsteroidal anti-inflammatory agent.

Question 5

The nurse plans care for four patients receiving heat therapy.Which patient admission diagnosis presents the highest risk of injury to an extremity?

A) Osteoarthritis
B) Nephrolithiasis
C) Chronic bronchitis
D) Peripheral neuropathy

Question 6

The patient has hypotension,receives as much opioid analgesia as the prescription allows,and continues to have difficulty sleeping at night because of pain.Which should the nurse implement to relieve pain and improve sleep?

A) Encourage controlled breathing.
B) Provide a glass of wine at bedtime.
C) Give a sedative 1 hour before sleep.
D) Increase fluids and reposition the patient.

Question 7

The nurse wants to use massage to promote relaxation.In which patient diagnosis would massage be potentially contraindicated?

A) Spinal cord injury
B) Hypertension
C) Acute asthma
D) Crohn's disease

Question 8

The nurse receives the patient in the postanesthesia recovery unit and assesses the epidural analgesic infusion.Which is the nurse's priority?

A) The filter needle is attached to the catheter tubing.
B) The distal end of the tubing is attached to the catheter.
C) The infusion contains an opioid and a local anesthetic.
D) The pump settings match the provider prescription.

Question 9

The school nurse provides first aid to the 10-year-old student with a new uncomplicated arm fracture.The nurse wants to provide nonpharmacological pain relief and minimize regional edema.Which first-aid treatment does the nurse provide for the patient?

A) A cold compress
B) A covered ice bag
C) An aquathermia pad
D) A moist heat compress

Question 10

The patient complains of a slight burning-like pain and numbness on the skin under a cold compress.Which action should the nurse take immediately?

A) Reassure the patient that some numbness is expected.
B) Assess the entire patient before continuing the treatment.
C) Remove the compress and assess the affected area.
D) Provide a warm blanket for the patient's treatment.

Question 11

The nurse decides that collaboration with the healthcare provider is needed to review and possibly adjust the dose of analgesic for an 87-year-old patient.What is the rationale for this request?

A) Older adults have higher risks of injury with intramuscular (IM) injections.
B) Analgesics aren't necessary for older adults because of decreased pain sensation.
C) Impaired cognition impairs reporting of pain by older patients.
D) Liver and kidney metabolism is usually slower in older adults.

Question 12

The patient awakens at 3:00 AM requesting pain medication,but the nurse does not administer additional pain medication.What justifies the nurse's decision to withhold the medication?

A) The patient had a reaction to aspirin 5 years ago.
B) The nurse wants to help the patient avoid drug addiction.
C) The patient is asleep when the nurse returns with analgesia.
D) The patient wants pain medication every 3 3/4 hours exactly.

Question 13

The patient receives opioid analgesia with naproxen (Naprosyn)after a total abdominal hysterectomy.Which patient datum is the nurse's priority?

A) The patient has not had a bowel movement since surgery.
B) The patient declines a massage after analgesic administration.
C) Respiratory rate drops from 22 to 16 breaths/min.
D) The patient receives famotidine (Pepcid) for esophageal reflux.

Question 14

The patient who receives patient-controlled analgesia (PCA)with an opioid analgesic reports that the pain level is 9 on a scale of 0 to 10.Which does the nurse implement to increase patient pain control?

A) Elevates the head of the bed (HOB) to 30 degrees
B) Increases the interval between demand doses
C) Increases the demand and the basal doses
D) Checks patient manipulation of the PCA button

Question 15

The patient who receives morphine sulfate intravenously by patient-controlled analgesia (PCA)tells the nurse that the pain level is 8 on a scale of 0 to 10.Which is the best intervention for the nurse?

A) Check the volume of morphine in the PCA syringe.
B) Check the frequency of patient-controlled dosing.
C) Collaborate with the provider to increase basal rate.
D) Instruct the family to activate the patient-controlled dose.

Question 16

The nurse prepares an oral opioid analgesic for the patient who has dementia and pain.After checking the patient's medication administration record (MAR)for the last administration time and the patient's response to pain medication,the nurse chooses the correct analgesic and compares the patient's picture and wristband to the medical record.Which is the most important intervention for the nurse to implement before administering pain medication to the patient?

A) Fill the pitcher with water.
B) Record the administration time.
C) Check the medication dose.
D) Help the patient to sit upright.

Question 17

The nurse massages the patient to promote relaxation.Which is a suitable intervention for the nurse to implement during the massage?

A) Use the friction technique over the spine.
B) Assess for pain, anxiety, and discomfort.
C) Instruct the patient to sit upright and forward.
D) Knead the patient's scalp with warm lotion.

Question 18

The nurse assesses the patient who is 2 days postoperative to determine the need for continuing patient-controlled analgesia (PCA).Which information should the nurse use to decide that the patient is ready for oral administration of analgesia?

A) Patient is hypoventilating.
B) Pain level ranges from 2 to 4.
C) Sedation level is consistent.
D) BP is 168/96, HR 110, RR 26.

Question 19

The nursing assistive personnel (NAP)reports that the patient is dizzy during a warm sitz bath.Which action should the nurse take before moving the patient?

A) Check the patient's pulse rate.
B) Dry off the patient completely.
C) Ask the patient if he or she is able to ambulate.
D) State that dizziness is common.

Question 20

The nurse teaches the patient progressive self-relaxation techniques.Which should the nurse implement first?

A) Direct the patient to envision sailing on a sailboat.
B) Instruct the patient to increase respiratory rate and depth.
C) Establish the patient's ability to participate and cooperate.
D) Darken the patient's room significantly and close the door.

Question 21

MATCHING
The nurse prepares to administer pain medication to a patient. Place the following nursing interventions in order, beginning with the initial action of the nurse to administer pain medication safely.

2. Step 2

A)Compare routes on an equianalgesic chart.
B)Determine the patient response to analgesia.
C)Ask the patient to rate the pain a scale of 1 to 10.
D)Check the last analgesia administration time.

Question 22

The nurse prepares to administer patient-controlled analgesia (PCA) to a patient. Rank the nursing interventions in sequential order.

8. Step 4

A) Allow the patient to depress the PCA system button before infusion begins.
B) Prime the tubing with medication from the drug reservoir.
C) Instruct the patient that lockout time prevents overdose.
D) Insert the PCA tubing into the injection port nearest the patient.

Question 23

The nurse assesses a patient who has an epidural catheter for patient-controlled analgesia (PCA)on the second postoperative day.Which patient data does the nurse group together to establish the nurse's priority? (Select all that belong to the group.)

A) Temperature 38.1° C (100.6° F)
B) Patient ready for oral analgesia
C) Low tension on epidural catheter
D) Respiratory rate 14, sedation level 1
E) Epidural drainage looks like medication
F) Hemoglobin 15 mg/dL, leukocytes 14,500

Question 24

The nurse admits a patient with left hand and wrist cellulitis.Which action does the nurse take when applying dry heat to the area using an aquathermia pad?

A) Keeps the fluid chamber in the device empty
B) Covers the pad with a towel or pillowcase
C) Positions the patient directly on the pad
D) Sets the aquathermia temperature at 36.6° C (98° F)

Question 25

The nurse prepares to administer patient-controlled analgesia (PCA) to a patient. Rank the nursing interventions in sequential order.

5. Step 1

A) Allow the patient to depress the PCA system button before infusion begins.
B) Prime the tubing with medication from the drug reservoir.
C) Instruct the patient that lockout time prevents overdose.
D) Insert the PCA tubing into the injection port nearest the patient.

Question 26

The patient received treatment for a sprained ankle and is receiving home care instructions regarding cold therapy.Which instructions should the nurse include?

A) Place the gel pack on the ankle for 30 minutes every 4 hours for the first 48 hours after the injury.
B) Wrap the ankle with a lightweight cloth before applying the ice bag to it.
C) Wrap the elastic bandage firmly before applying the ice to the ankle.
D) Immerse the foot in a pan of ice water every 4 hours for as long as the patient can wiggle his toes.

Question 27

In the postanesthesia care unit the nurse applies an ice bag to the patient's leg at the surgical site.Which therapeutic effect does the nurse expect from this treatment?

A) Decreased pain and diaphoresis
B) Decreased bleeding and vasoconstriction
C) Vasodilation and decreased blood flow
D) Increased oxygenation and increased inflammation

Question 28

The nurse caring for a female patient 1 day after a thoracotomy assesses that the patient is in pain,but the patient states that she has no pain.Which does the nurse use to confirm the patient's pain?(Select all that apply.)

A) Facial grimacing during linen changes
B) Eats a full liquid diet without assistance
C) Uses the incentive spirometer every hour
D) Patient's culture forbids complaints of pain
E) Has received nothing for pain since surgery
F) Heart rate 110, blood pressure 169/90

Question 29

The nurse prepares to administer patient-controlled analgesia (PCA) to a patient. Rank the nursing interventions in sequential order.

6. Step 2

A) Allow the patient to depress the PCA system button before infusion begins.
B) Prime the tubing with medication from the drug reservoir.
C) Instruct the patient that lockout time prevents overdose.
D) Insert the PCA tubing into the injection port nearest the patient.

Question 30

MATCHING
The nurse prepares to administer pain medication to a patient. Place the following nursing interventions in order, beginning with the initial action of the nurse to administer pain medication safely.

4. Step 4

A)Compare routes on an equianalgesic chart.
B)Determine the patient response to analgesia.
C)Ask the patient to rate the pain a scale of 1 to 10.
D)Check the last analgesia administration time.

Question 31

MATCHING
The nurse prepares to administer pain medication to a patient. Place the following nursing interventions in order, beginning with the initial action of the nurse to administer pain medication safely.

1. Step 1

A)Compare routes on an equianalgesic chart.
B)Determine the patient response to analgesia.
C)Ask the patient to rate the pain a scale of 1 to 10.
D)Check the last analgesia administration time.

Question 32

The nurse prepares to administer patient-controlled analgesia (PCA) to a patient. Rank the nursing interventions in sequential order.

7. Step 3

A) Allow the patient to depress the PCA system button before infusion begins.
B) Prime the tubing with medication from the drug reservoir.
C) Instruct the patient that lockout time prevents overdose.
D) Insert the PCA tubing into the injection port nearest the patient.

Question 33

MATCHING
The nurse prepares to administer pain medication to a patient. Place the following nursing interventions in order, beginning with the initial action of the nurse to administer pain medication safely.

3. Step 3

A)Compare routes on an equianalgesic chart.
B)Determine the patient response to analgesia.
C)Ask the patient to rate the pain a scale of 1 to 10.
D)Check the last analgesia administration time.

Question 34

The nurse assesses the patient and realizes that patient pain is interfering with postoperative therapies.Which does the nurse determine before using medication and relaxation techniques simultaneously to reduce patient pain? (Select all that apply.)

A) The patient has used guided imagery in the past successfully.
B) Nonpharmacological relaxation methods appeal to the patient.
C) The patient moves in the bed and disrupts the nurse incessantly.
D) The provider plans to discharge the patient to home in 2 days.
E) The patient understands written information on relaxation techniques.
F) The patient cannot receive additional analgesia for unresolved pain.

Question 35

The nurse prepares patient-controlled analgesia (PCA)for a postoperative patient in the postanesthesia recovery unit (PACU).To rule out contraindications to therapy,which should the nurse assess before the patient receives PCA?(Select all that apply.)

A) Consider patient cognitive level.
B) Evaluate patient communication.
C) Confirm two separate intravenous (IV) infusions.
D) Determine patient physical ability.
E) Assess for history of constipation.
F) Verify patient medication allergies.