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I. Interpretation, Completion, and Comparison
MULTIPLE CHOICE
Read each question carefully. Circle your answer.
1. Although the criterion is arbitrary, acute pain can be classified as chronic when it has persisted for:
a. 1 to 2 months.
c. 3 to 5 months.
b. 3 months.
d. longer than 6 months.
2. Acute pain may be described as having the following characteristic.
a. It does not usually respond well to treatment.
c. It serves no useful purpose.
b. It is associated with a specific injury.
d. It responds well to placebos.
3. A physiologic response not usually associated with acute pain is:
a. decreased cardiac output.
c. increased metabolic rate.
b. altered insulin response.
d. decreased production of cortisol.
4. Chronic pain may be described as:
a. attributable to a specific cause.
b. prolonged in duration.
d. separate from any central or peripheral
pathology.
c. rapidly occurring and subsiding with
treatment.
5. An example of chronic benign pain is:
a. a migraine headache.
b. an exacerbation of rheumatoid arthritis.
c. low back pain.
d. sickle cell crisis.
6. A chemical substance thought to inhibit the transmission of pain is:
a. acetylcholine.
b. bradykinin.
c. enkephalin.
d. histamine.
7. All of the following statements about endorphins are true except:
a. Their release inhibits the transmission of
painful impulses.
b. They represent the same mechanism of pain
relief as nonnarcotic analgesics.
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c. They are endogenous neurotransmitters
structurally similar to opioids.
d. They are found in heavy concentrations in the
central nervous system.
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Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
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8. The nurse assessing for pain should:
a. believe a patient when he or she states that
pain is present.
b. doubt that pain exists when no physical
origin can be identified.
c. realize that patients frequently imagine and
state that they have pain without actually
feeling painful sensations.
d. do all of the above.
9. When a nurse asks a patient to describe the quality of his or her pain, the nurse expects the patient to use
a descriptive term such as:
a. burning.
b. chronic.
c. intermittent.
d. severe.
10. A physiologic indicator of acute pain is:
a. diaphoresis.
b. bradycardia.
c. hypotension.
d. lowered respiratory rate.
11. A nursing measure to manage anxiety during the anticipation of pain should include:
a. focusing the patient’s attention on another
problem.
c. using an anxiety-reducing technique, such as
desensitization.
b. teaching about the nature of the impending
pain and associated relief measures.
d. any or all of the above.
12. A nursing plan of care for pain management should include:
a. altering factors that influence the pain
sensation.
b. determining responses to the patient’s
behavior toward pain.
c. selecting goals for nursing intervention.
d. all of the above.
13. Pain in the elderly requires careful assessment, because older people:
a. are expected to experience chronic pain.
c. experience reduced sensory perception.
b. have a decreased pain threshold.
d. have increased sensory perception.
14. Administration of analgesics to the elderly requires careful patient assessment, because older people:
a. metabolize drugs more rapidly.
c. are more sensitive to drugs.
b. have increased hepatic, renal, and
gastrointestinal function.
d. have lower ratios of body fat and muscle
mass.
15. The most serious side effect of opioid analgesic agents is:
a. renal toxicity.
b. respiratory depression.
c. seizures.
d. hypotension.
16. A preventive approach to pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs) means that the
medication is given:
a. before the pain becomes severe.
b. before the pain is experienced.
c. when pain is at its peak.
d. when the level of pain tolerance has been
exceeded.
17. The nurse’s major area of assessment for a patient receiving patient-controlled analgesia (PCA) is assessment of which system?
a. Cardiovascular
b. Integumentary
c. Neurologic
d. Respiratory
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Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
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18. The advantage of using intraspinal infusion to deliver analgesics is:
a. reduced side effects of systemic analgesia.
b. reduced effects on pulse, respirations, and
blood pressure.
c. reduced need for frequent injections.
d. all of the above.
19. This single-dose, extended-release drug is used for epidural administration for patients undergoing major
surgical procedures:
a. codeine.
c. Dilaudid.
b. Demerol.
d. Depodur.
20. The most worrisome adverse effect of epidural opioids is:
a. asystole.
b. hypertension.
c. bradypnea.
d. tachycardia.
21. Cutaneous stimulation is helpful in reducing painful sensations, because it:
a. provides distraction from the pain source and
decreases awareness.
c. stimulates large-diameter nerve fibers and
reduces the intensity of pain.
b. releases endorphins.
d. accomplishes all of the above.
SHORT ANSWER
Read each statement carefully. Write your response in the space provided.
1. Pain can be defined according to its: ________________, ___________________, and __________________.
2. The three basic categories of pain are: _______________, _______________, and _______________.
3. Pain can be categorized by its etiology. List four of eight pain syndromes: _____________,
________________, _________________, and _____________________.
4. One pathophysiologic response to chronic pain is: _____________________________________________.
5. List five algogenic substances that are released into the tissues and affect the sensitivity of nociceptors:
_______________, _______________, _______________, _______________, and _______________.
6. List seven factors that directly influence an individual’s response to pain: __________________,
___________________, _____________________, ______________________, ______________________,
___________________, and __________________________.
7. A person’s reported intensity of pain is determined by an individual’s ________________ (the smallest
stimulus where pain is felt) and _______________ (the maximum amount of pain a person can tolerate).
8. Identify seven factors that a nurse needs to consider for complete pain assessment:
_____________________, ___________________, ________________________, ________________________,
__________________________, _____________________, and _____________________________.
9. List eight common physiologic responses to pain: _______________, _______________, _______________,
_______________, _______________, _______________, _______________, and _______________.
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Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
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10. The only currently approved COX-2 inhibitor is: ____________________.
11. Define the term balanced analgesia.
________________________________________________________________________________________________________.
12. After administration of an epidural opioid, the nurse needs to assess for _________________, which may
occur up to ___________ hours but usually peaks between _________________ hours.
13. Define the term placebo effect.
_________________________________________________________________________________________________________
14. List four of eight nonpharmacologic interventions for pain management: ___________________,
____________________, __________________, and ___________________________.
MATCHING
Match the term listed in column II with its definition listed in column I.
Column I
Column II
1. ______ Pain receptors sensitive to noxious stimuli.
a. Fentanyl
2. ______ Nonsteroidal agents that decrease inflammation.
b. Endorphins
c. Placebo
3. ______ The only commercially available transdermal opioid medication.
4. ______ Significantly increases a person’s response to pain.
5. ______ Chemicals known to inhibit the transmission or perception of pain.
d. Waning
e. TENS
7. ______ An inactive substance given in place of pain medication.
f. Nociceptors
g. Histamine
h. Anxiety
8. ______ Medication administered directly into the subarachnoid space and
cerebrospinal fluid.
i. Epidural
j. NSAIDS
6. ______ This substance, released in response to painful stimuli, causes vasodilation.
9. ______ Transcutaneous stimulation of nonpain receptors in the same area of an injury.
10. ______ Term used to describe a pain’s rhythm.
II. Critical Thinking Questions and Exercises
DISCUSSION AND ANALYSIS
Discuss the following topics with your classmates.
1. Explain the seven rights that patients have according to the Pain Care Bill of Rights, officially enacted by
the state of California.
2. Distinguish among acute, chronic (persistent, nonmalignant), and cancer-related pain and cite an example
of each.
3. Describe the transmission and awareness of pain (nociception system) by explaining the role of the central
nervous system and the ascending and descending sensory pathways.
4. Describe the classic Gate Control Theory of pain as described by Melzack and Well in 1965.
5. Recognizing the value of your own culture, discuss feelings of pain with your classmates who might
represent different cultures.
6. Using role-playing with a classmate, describe the sequence of nursing activities for assessing pain
management for pharmacologic and nonpharmacologic interventions.
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Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
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7. Discuss pain management strategies for those at the end of their life.
8. Compare and contrast the precautions and contraindications for the following opioids: morphine,
codeine, Oxycodone, Demerol, Darvon, and Vicodin.
9. Describe nursing responsibilities for management of patient-controlled analgesia (PCA).
10. Explain how the technique of distraction works to relieve acute and chronic pain.
CLINICAL SITUATIONS
Read the following case study. Circle the correct answer.
CASE STUDY: Pain Experience
Courtney is a young, healthy adult who slipped off the stairs going down to the basement and struck her
forehead on the cement flooring. Courtney did not lose consciousness but did sustain a mild concussion and a
hematoma that was 5 cm in width and protruded outward about 6 cm. She experienced immediate acute pain
at the site of injury plus a pounding headache.
1. An immediate assessment of the localized pain, based on the patient’s description, is that it should be:
a. brief in duration.
c. persistent after healing has occurred.
b. mild in intensity.
d. recurrent for 3 to 4 months.
2. During the assessment process, the nurse attempts to determine Courtney’s physiologic and behavioral
responses to her pain experience. The nurse is aware that a patient can be in pain yet appear to be “pain
free.” A behavioral response indicative of acute pain is:
a. an expressionless face.
b. clear verbalization of details.
c. muscle tension.
d. physical inactivity.
3. The nurse uses distraction to help Courtney cope with her pain experience. A suggested activity is:
a. promoting relaxation.
b. playing music or using a videotape.
c. using cutaneous stimulation.
d. any or all of the above.
4. After treatment, Courtney is discharged to home while still in pain. The nurse should:
a. clarify that Courtney knows what type of pain
signals a problem.
b. remind Courtney that acute pain may persist
for several days.
c. review methods of pain management.
d. do all of the above.
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.