Deck 19: Pain Management, Rest, and Restorative Sleep

Question 1

When considering how a patient is likely to respond to a nonpharmaceutical treatment for pain, a nurse understands that according to gate control theory,

A) The hypothalamus can open and close the gate in relation to stress and anxiety.
B) Stimulation of the narrow nerve fibers closes the gate, reducing pain.
C) Endorphins help to close the gate, reducing pain.
D) One should not immediately rub an injured body part because that can increase pain.

Answer 1

Endorphins help to close the gate, reducing pain.

Question 2

A patient complains that regardless of the methods of alternative pain control that have been used, her pain remains a 7 on a scale of 10. The nurse suggests that her pain may be ____ pain.

A) Radiating
B) Intractable
C) Referred
D) Chronic

Answer 2

Intractable

Question 3

A 52-year-old Chinese American patient is admitted to hospice care because of terminal cancer. The nurse understands that this patient may hold that pain

A) Is better expressed by moaning than by complaining in words.
B) Should be verbalized instead of communicated by grimacing.
C) Does not need to be endured, so pain medication should be asked for when needed.
D) Should be suffered in silence, without verbal complaints or other expressions of discomfort.

Answer 3

Should be suffered in silence, without verbal complaints or other expressions of discomfort.

Question 4

A patient has a sore, injured hip. If rising out of a chair causes the patient's back and upper leg to hurt as well, then a nurse would document the pain as

A) Referred pain.
B) Radiating pain.
C) Acute pain.
D) Intractable pain.

Question 5

At a health fair, a nurse explains to a participant, who is complaining of nagging pain, that it is important to report the pain to the primary care physician rather than ignoring it because

A) The physician may have to order a potent analgesic.
B) Being stoic is not a trait that many nurses and physicians respect.
C) Pain will interfere with the gate, according to gate control theory.
D) Pain could be an indication that tissue damage has occurred.

Question 6

A patient who is suffering from terminal cancer asks a nurse how massage decreases his pain. The nurse explains that in theory,

A) Massage blocks endorphins that, when released, inhibit pain receptors.
B) Massage stimulates the release of endorphins, which are thought to block the transmission of pain.
C) Massage assists endorphins in opening the gate and attaching to opiate receptors.
D) Massage stimulates opiate or pain receptors to release endorphins, and thereby essentially changes how the brain identifies pain.

Question 7

A nurse could appropriately respond to a patient's complaint that he awakens frequently during the night by saying:

A) "Perhaps you should try going to bed earlier."
B) "You could try watching TV. That helps me fall asleep."
C) "Drinking alcohol can cause you to wake up during the night."
D) "Exercising at night before you go to bed can enhance sleep."

Question 8

A patient tells her nurse that she has had chronic pain for approximately 2 years and that her primary care physician is talking about ordering her a transcutaneous electrical nerve stimulator (TENS) unit. When asked how a TENS unit helps pain, the nurse explains that it

A) Relieves pain by stimulating and opening the gate.
B) Delivers electrical stimulation, which, in turn, stimulates the broad nerve fibers.
C) Uses electrical shock waves to numb pain.
D) Comforts by tricking the brain's impulse delivery.

Question 9

A nurse explains to a patient with chronic pain that exercise may relieve some pain. The nurse goes on to explain that based on the gate control theory, exercise

A) Stimulates the narrow nerve fibers to shut the gate.
B) Stimulates the narrow nerve fibers to open the gate.
C) Stimulates the broad nerve fibers to shut the gate.
D) Stimulates the broad nerve fibers to open the gate.

Question 10

A critically ill patient may have difficulty in getting the restorative sleep necessary for healing. A nurse will

A) Dim the lights and close the door.
B) Encourage the patient to get some exercise.
C) Refrain from waking the patient for nursing care.
D) Silence alarms on equipment to enhance rest.

Question 11

An elderly patient with a compression fracture of the spine says, "I've had plenty of pain in my lifetime, but never anything like this. I feel like I'm being stabbed." A nurse could correctly respond:

A) "The type of pain you're feeling is radiating pain. Because the pain originates in a nerve, it spreads to other areas of the body."
B) "The type of pain you're feeling is neuropathic pain. Instead of pain in the surrounding tissue that the nerve is relaying to the brain, it is pain caused by pressure on the nerve itself."
C) "The type of pain you're feeling is deep somatic pain. This is often caused by fractures and is more intense than other kinds of pain."
D) "Your pain must feel more intense than pain you've felt previously because your pain 'gate' is open. It's possible that massage or a distraction like reading will help the pain."

Question 12

A patient complains of pain at 9 on a scale of 10 and requests pain medication. Understanding that it is important to quickly treat severe pain, a nurse will expect to administer

A) An NSAID.
B) A nonopiate analgesic.
C) An opiate/opioid analgesic.
D) An adjuvant analgesic.

Question 13

A patient who had an amputation just below the knee several days ago expresses confusion about why a foot that has been amputated is still causing intense pain. A nurse explains that the type of pain experienced by the patient is

A) Cutaneous pain.
B) Deep somatic pain.
C) Neuropathic pain.
D) Soft-tissue pain.

Question 14

A patient who was admitted with severe back pain is watching TV and smiling. The patient received pain medication 4 hours ago and rates his pain at an 8. Knowing that the patient's pain medication may be given every 4 to 6 hours, the nurse will

A) Administer the pain medication now.
B) Tell the patient that if diversion does not work, then the nurse will administer pain medication in 2 hours.
C) Explain the gate control theory and suggest a massage.
D) Call the physician and request an order for a transcutaneous electrical nerve stimulator (TENS) unit.

Question 15

A patient asks the nurse, "Why has my primary care physician ordered an antidepressant for me? I'm not depressed. I'm just in pain." The nurse could appropriately explain:

A) "It was ordered because it is known to potentiate the pain medication that you are taking."
B) "Anyone who is suffering from pain will eventually begin to suffer from depression, so your physician wants to prevent that."
C) "Everyone experiences depression at one time or another."
D) "I guess your primary care physician must have misunderstood you. I'll talk to the physician later."

Question 16

As a result of major surgery, a patient feels deep pain. The nurse correctly documents this pain as

A) Cutaneous pain.
B) Neuropathic pain.
C) Deep somatic pain.
D) Visceral pain.

Question 17

A nurse would recognize that further instruction was needed if a nursing student expressed the assumption that a patient

A) Cannot be in pain if she is sleeping.
B) Is the pain expert.
C) May be able to get more rest with pain medication.
D) May experience sleeplessness because of the hospital environment.

Question 18

When teaching a patient about restorative rest, the nurse explains that

A) The sleep cycle is enhanced by medications for sleep.
B) The sleep cycle should be approximately 80% rapid eye movement (REM).
C) Non-rapid eye movement (NREM) sleep is the most restful cycle.
D) REM sleep consists of four stages.

Question 19

Culture plays a strong role in determining whether a patient will be willing to communicate if he or she is in pain or how severe the pain may be. Therefore, a nurse understands that extra time may need to be taken to determine the pain level of

A) An older South African woman
B) A young Irishman
C) A young Saudi woman
D) An older Latina woman

Question 20

A mother, concerned that her toddler is not getting enough rest, asks a nurse what the average amount of sleep is for a 4-year-old. The nurse replies:

A) "A 4-year-old should sleep 16 hours a day, including naps."
B) "A 4-year-old should sleep no more than 10 hours a day."
C) "A 4-year-old should sleep an average of 13 to 14 hours a day."
D) "A 4-year-old should sleep approximately 12 hours a day."

Question 21

When assessing a patient's pain, a nurse will note all of the following except

A) The exact location of the pain.
B) What causes the pain to become better or worse.
C) The patient's desires for pain relief.
D) The nurse's opinion of whether the patient is over-reporting or underreporting the severity of the pain.

Question 22

During a routine physical, a 34-year-old patient who works two jobs and has a young child mentions that she gets about 5 hours of sleep most nights. A nurse could appropriately follow up by saying:

A) "That's very understandable, given everything that you need to do each day. I hope you are able to catch up on your sleep on your days off."
B) "Five hours of sleep is not quite enough, since most adults need at least 6 hours of sleep a night. Can you arrange your schedule so you can go to bed an hour earlier or get up an hour later?"
C) "That is concerning because not getting enough sleep increases your risk for accidents and can make it harder to make good decisions and maintain emotional stability. Can we talk about how you could get more sleep to ensure the safety of yourself and your child?"
D) "Most adults need about 8 hours of sleep a night. You should speak to your doctor about getting a prescription for a medication that will help you sleep."
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 23

A 3-year-old who has suffered a bee sting on the foot is screaming and cannot be consoled. The patient's response indicates that

A) The child lacks previous remembered experience with pain and is frightened.
B) The bee sting is extremely painful.
C) There may be something wrong in addition to the bee sting, because bee stings do not usually hurt this much.
D) The child has suffered bee stings or similar injuries before and is expressing the remembered pain, as well as responding to current discomfort.

Question 24

Providing therapeutic nursing care to a patient with chronic pain encompasses which of the following?

A) Weaning the patient off pain medications
B) Suggesting a variety of alternative therapies
C) Accepting the patient as an expert
D) Not medicating the patient with narcotics
E) Verbalizing acknowledgment of the patient's pain

Question 25

A nurse has determined that a patient's pain is acute and plans to administer pain medication. Which of the following are signs and symptoms of acute pain on which the nurse may have based her decision?

A) Dilated pupils
B) Constricted pupils
C) Syncope
D) Increased heart rate
E) Reduced attention span