PAIN MANAGEMENT
1. A nurse instructor is teaching a class of student nurses about the nature of pain. Which
statements accurately describe this phenomenon? Select all that apply.
a) Pain is whatever the physician treating the pain says it is.
b) Pain exists whenever the person experiencing it says it exists.
c) Pain is an emotional and sensory reaction to tissue damage.
d) Pain is a simple, universal, and easy-to-describe phenomenon.
e) Pain that occurs without a known cause is psychological in nature.
f) Pain is classified by duration, location, source, transmission, and etiology.
b, c, f
The classic definition of pain that is probably of greatest benefit to nurses and their patients:
"Pain is whatever the experiencing person says it is, existing whenever he (or she) says it does."
The International Association for the Study of Pain (IASP) further defines pain as an unpleasant
sensory and emotional experience associated with actual or potential tissue damage (IASP,
1994). Pain is an elusive and complex phenomenon, and despite its universality, its exact nature
remains a mystery. Pain is present whenever a person says it is, even when no specific cause of
the pain can be found. Pain may be classified according to its duration, its location or source, its
mode of transmission, or its etiology.
2. One of the most common distinctions of pain is whether it is acute or chronic. Which
examples describe chronic pain? Select all that apply.
a) A patient is receiving chemotherapy for bladder cancer.
b) An adolescent is admitted to the hospital for an appendectomy.
c) A patient is experiencing a ruptured aneurysm.
d) A patient who has fibromyalgia requests pain medication.
e) A patient has back pain related to an accident that occurred last year.
f) A patient is experiencing pain from second-degree burns.
a, d, e
Chronic pain is pain that may be limited, intermittent, or persistent but that lasts beyond the
normal healing period. Examples are cancer pain, fibromyalgia pain, and back pain. Acute pain
is generally rapid in onset and varies in intensity from mild to severe, as occurs with an
emergency appendectomy, a ruptured aneurysm, and pain from burns.
3. A patient complains of abdominal pain that is difficult to localize. The nurse documents
this as which type of pain?
a) Cutaneous
b) Visceral
c) Superficial
d) Somatic
b) Visceral
The patient's pain would be categorized as visceral pain, which is poorly localized and can
originate in body organs in the abdomen. Cutaneous pain (superficial pain) usually involves the
skin or subcutaneous tissue. A paper cut that produces sharp pain with a burning sensation is an
example of cutaneous pain. Deep somatic pain is diffuse or scattered and originates in tendons,
ligaments, bones, blood vessels, and nerves. Strong pressure on a bone or damage to tissue that
occurs with a sprain causes deep somatic pain.
4. A female patient who is having a myocardial infarction complains of pain that is situated
in her jaw. The nurse documents this as what type of pain?
a) Transient pain
b) Superficial pain
c) Phantom pain
d) Referred pain
d) Referred pain
Referred pain is perceived in an area distant from its point of origin, whereas transient pain is
brief and passes quickly. Superficial pain originates in the skin or subcutaneous tissue. Phantom
pain may occur in a person who has had a body part amputated, either surgically or
traumatically.
5. The three types of responses to pain are physiologic, behavioral, and affective. Which are
examples of behavioral responses to pain? Select all that apply.
a) A patient cradles a wrist that was injured in a car accident.
b) A child is moaning and crying due to a stomachache.
c) A patient's pulse is increased following a myocardial infarction.
d) A patient in pain strikes out at a nurse who attempts to bathe him.
e) A patient who has chronic cancer pain is depressed and withdrawn.
f) A child pulls away from a nurse trying to give him an injection.
a, b, f
Protecting or guarding a painful area, moaning and crying, and moving away from painful
stimuli are behavioral responses. Examples of a physiologic or involuntary response would be
increased blood pressure or dilation of the pupils. Affective responses, such as anger,
withdrawal, and depression, are psychological in nature.
6. An elderly patient is confined to bedrest following cervical spine surgery to treat nerve
pinching. The nurse is vigilant about turning the patient and assessing the patient
regularly to prevent the formation of pressure ulcers. What type of agent is the stimulus
for pressure ulcers?
a) Mechanical
b) Thermal
c) Chemical
d) Electrical a) Mechanical
Receptors in the skin and superficial organs may be stimulated by mechanical, thermal,
chemical, and electrical agents. Friction from bed linens causing pressure sores and pressure
from a cast are mechanical stimulants. Sunburn is a thermal stimulant. An acid burn is the result
of a chemical stimulant. The jolt from a lightening bolt is an electrical stimulant.
7. A nurse uses a whirlpool to relax a patient following intense physical therapy to restore
movement in her legs. What is a potent pain-blocking neuromodulator, released through
relaxation techniques?
a) Prostaglandins
b) Substance P
c) Endorphins
d) Serotonin
c) Endorphins
Endorphins are produced at neural synapses at various points along the CNS pathway. They are
powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It
is thought that endorphins are released through pain relief measures, such as relaxation
techniques. Prostaglandins, substance P, and serotonin (a hormone that can act to stimulate
smooth muscles, inhibit gastric secretion, and produce vasoconstriction) are neurotransmitters or
substances that either excite or inhibit target nerve cells.
8. A patient is postoperative following an emergency cesarean section birth. The patient
asks the nurse about the use of pain medications following surgery. What would be a
correct response by the nurse?
a) "It's not a good idea to ask for pain medication regularly as it can be addictive."
b) "It is better to wait until the pain gets unbearable before asking for pain medication."
c) "It's natural to have to put up with pain after surgery and it will lessen in intensity in a few
days."
d) "Your doctor has ordered pain medications for you, which you should not be afraid to request
any time you have pain."
d) "Your doctor has ordered pain medications for you, which you should not be afraid to request any time you have pain."
Many pain medications are ordered on a PRN (as needed) basis. Therefore, nurses must be
diligent to assess patients for pain and administer medications as needed. A patient should not be
afraid to request these medications and should not wait until the pain is unbearable. Few people
become addicted to the medications if used for a short period of time. Pain following surgery can
be controlled and should not be considered a natural part of the experience that will lessen in
time.
9. Applying the gate control theory of pain, what would be an effective nursing intervention
for a patient with lower back pain?
a) Encouraging regular use of analgesics
b) Applying a moist heating pad to the area at prescribed intervals
c) Reviewing the pain experience with the patient
d) Ambulating the patient after administering medication b) Applying a moist heating pad to
the area at prescribed intervals
Nursing measures such as applying warmth to the lower back stimulate the large nerve fibers to
close the gate and block the pain. The other choices do not involve attempts to stimulate large
nerve fibers that interfere with pain transmission as explained by the gate control theory.
10. The nurse is assessing the pain of a neonate who is admitted to the NICU with a heart
defect. Which pain assessment scale would be the best tool to use with this patient?
a) CRIES scale
b) COMFORT scale
c) FLACC scale
d) FACES scale
a) CRIES scale
The CRIES Pain Scale is a tool intended for use with neonates and infants from 0 to 6 months.
The COMFORT Scale, used to assess pain and distress in critically ill pediatric patients, relies on
six behavioral and two physiologic factors that determine the level of analgesia needed to
adequately relieve pain in these children. The FLACC scale (F—Faces, L—Legs, A—Activity,
C—Cry, C—Consolability) was designed for infants and children from age 2 months to 7 years
who are unable to validate the presence or severity of pain. The FACES scale is used for children
who can compare their pain to the faces depicted on the scale.
Mr. Wright is recovering from abdominal surgery. When the nurse assists him to walk, she
observes that he grimaces, moves stiffly, and becomes pale. She is aware that he has consistently
refused his pain medication. What would be a priority nursing diagnosis for this patient?
a) Acute Pain related to fear of taking prescribed postoperative medications
b) Impaired Physical Mobility related to surgical procedure
c) Anxiety related to outcome of surgery
d) Risk for Infection related to surgical incision
a) Acute Pain related to fear of taking
prescribed postoperative medications
Mr. Wright's immediate problem is his pain that is unrelieved because he refuses to take his pain
medication for an unknown reason. The other nursing diagnoses are plausible, but not a priority
in this situation.
When developing the plan of care for a patient with chronic pain, the nurse plans interventions
based on the knowledge that chronic pain is most effectively relieved when analgesics are
administered in what matter?
a) On a PRN (as needed) basis
b) Conservatively
c) Around the clock (ATC)
d) Intramuscularly
c) Around the clock (ATC)
The PRN protocol is totally inadequate for patients experiencing chronic pain. ATC doses of
analgesics are more effective, whereas conservative pain management for whatever reason may
also prove ineffective. Intramuscular administration is not practical on a long-range basis for a
patient with chronic pain.
When assessing pain in a child, the nurse needs to be aware of what considerations?
a) Immature neurologic development results in reduced sensation of pain.
b) Inadequate or inconsistent relief of pain is widespread.
c) Reliable assessment tools are currently unavailable.
d) Narcotic analgesic use should be avoided. b) Inadequate or inconsistent relief of pain is
widespread.
Health care personnel are only now becoming aware of pain relief as a priority for children in
pain. The evidence supports the fact that children do indeed feel pain and reliable assessment
tools are available specifically for use with children. Opioid analgesics may be safely used with
children as long as they are carefully monitored.
A pregnant woman is receiving an epidural analgesic prior to delivery. The nurse provides
vigilant monitoring of this patient to prevent the occurrence of:
a) Pruritus
b) Urinary retention
c) Vomiting
d) Respiratory depression
d) Respiratory depression
Too much of an opioid drug given by way of an epidural catheter or a displaced catheter may
result in the occurrence of respiratory depression. Pruritus, urinary retention, and vomiting may
occur but are not life threatening.
When assessing a patient receiving a continuous opioid infusion, the nurse immediately notifies
the physician when the patient has:
a) A respiratory rate of 10/min with normal depth
b) A sedation level of 4
c) Mild confusion
d) Reported constipation
b) A sedation level of 4
Sedation level is more indicative of respiratory depression because a drop in level usually
precedes it. A sedation level of 4 calls for immediate action because the patient has minimal or
no response to stimuli. A respiratory level of 10 with normal depth of breathing is usually not a
cause for alarm. Mild confusion may be evident with the initial dose and then disappear;
additional observation is necessary. Constipation should be reported to the physician, but is not
the priority in this situation.
The nurse is preparing to administer an NSAID to a client for pain relief. The nurse notices that
the client is diagnosed with a bleeding disorder. What should the nurse do?
a) Administer the medication.
b) Ask the client if they want the medication.
c) Administer the medication with food.
d) Contact the physician.
d) Contact the physician.
The nurse should contact the physician regarding the diagnosis of a bleeding disorder and the
order for the NSAID. NSAIDs are contraindicated in clients with bleeding disorders, as the
action of the NSAID can interfere with the client's platelet function.
Three days after surgery, a patient continues to have moderate to severe incisional pain. Based
on the gate control theory, what action should the nurse take?
a) Decrease external stimuli in the room during painful episodes.
b) Advise the patient to try to sleep following administration of pain medication.
c) Reposition the patient and gently massage the patient's back.
d) Administer pain medications in smaller doses but more frequently.
c) Reposition the
patient and gently massage the patient's back.
The nurse would reposition the client and gently massage the client's back using the gate control
theory of pain. The gate control theory provides the most practical model regarding the concept
of pain. It describes the transmission of painful stimuli and recognizes a relation between pain
and emotions. Nursing measures, such as massage or a warm compress to a painful lower back
area, stimulate large nerve fibers to close the gate, thus blocking pain impulses from that area.
Which of the following is the priority assessment for a nurse caring for a client with a Patient
Controlled Analgesia (PCA) pump?
a) Cardiovascular
b) Respiratory
c) Peripheral Vascular
d) Nueromuscular
b) Respiratory
A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a
burning sensation in the amputated arm. What kind of pain is the client experiencing?
a) Visceral pain
b) Chronic pain
c) Cutaneous pain
d) Neuropathic pain d) Neuropathic pain
After the nurse has instructed a client with low-back pain about the use of a transcutaneous
electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the
client has a need for further instruction when the client states what?
a) "I may need fewer pain medications with the TENS unit in place."
b) "Wearing the TENS unit should not interfere with my daily activities."
c) "One advantage of the TENS unit is it increases blood flow."
d) "I could use the TENS unit if I feel pain somewhere else on my body." d) "I could use the
TENS unit if I feel pain somewhere else on my body."
The client needs further instruction when she says she can use the TENS unit on other areas of
the body. Such a statement would indicate that the client does not understand that the unit should
be used as prescribed by the physician in the location defined by the physician.
After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off
during conversations. What number on the sedation scale would the nurse document for this
client?
a) 2
b) 1
c) 3
d) 4
c) 3
The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as
follows:
1 = awake and alert; no action necessary
2 = occasionally drowsy but easy to arouse; requires no action
3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose
4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of
naloxone.
The nurse recognizes which of the following statements is true of chronic pain?
a) It can be easily described by the client.
b) It disappears with treatment.
c) It may cause depression in clients.
d) It is always present and intense. c) It may cause depression in clients.
Which guideline regarding pain should be included in the nurse's education plan for a group of
parents with infants and toddlers?
a) Toddlers often try to be brave and not cry.
b) Toddlers are often reluctant to express pain.
c) Infants cannot express pain until 8 months of age.
d) Pain can be a source of fear and threat to the toddler's security. d) Pain can be a source of
fear and threat to the toddler's security.
A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA)
system. Which statement is true of this medication delivery system?
a) Thorough client education is necessary to prevent overdoses.
b) The dose that is delivered when the client activates the machine is preset.
c) An antidote is automatically delivered if the client exceeds the recommended dose.
d) Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression.
b) The dose that is delivered when the client activates the machine is preset.
A nurse is caring for a client who complains of an aching pain in the abdomen. The nurse also
noted that the client is guarding the area. What kind of pain is the client experiencing?
a) Visceral pain
b) Somatic pain
c) Cutaneous pain
d) Neuropathic pain a) Visceral pain
How should the nurse position the head of the bed for a client receiving epidural opioids?
a) Elevated 30 degrees
b) Reverse trendelenberg
c) Flat
d) Trendelenberg
a) Elevated 30 degrees
A nurse is performing pain assessments on clients in a physician's office. Which clients would
the nurse document as having acute pain? Select all that apply.
a) A client who has diabetic neuropathy
b) A client who fell and broke an ankle
c) a client who is having a myocardial infarction
d) A client who presents with the signs and symptoms of appendicitis
e) A client who has bladder cancer
f) A client who has rheumatoid arthritis
b, c, d
The nurse caring for a client receiving opioid therapy notes that the client's respirations are 7.
What is the first action by the nurse?
a) Physically stimulate client.
b) Take the client's blood pressure.
c) Begin cardiac compressions.
d) Administer Narcan.
a) Physically stimulate client.
The first action by the nurse is to physically stimulate the client by shaking the client or using a
loud sound, followed by reminders every few minutes to breathe deeply. If this is ineffective,
Narcan can be used to reverse the respiratory depressant effect of the opioid.
A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the
nurse's best intervention in this situation?
a) Medicate the boy with analgesics to reduce the anxiety of experiencing pain.
b) Ask the boy to draw a cartoon about the color or shape of his pain.
c) Ignore the boy's pain if he is not complaining about it.
d) Distract the boy so he does not notice his pain. b) Ask the boy to draw a cartoon about the
color or shape of his pain.
A client states that he is pain and requests the ordered pain medication. When entering the
client's room, the client is laughing with visitors and does not appear to be in pain. What is the
appropriate action by the nurse?
a) Reassess the client's pain in 30 minutes.
b) Contact the client's physician.
c) Hold the pain medication.
d) Administer the pain medication. d) Administer the pain medication.
A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the
pain scale. What opioid neuromodulator does the nurse know is released with skin stimulation
and is more than likely responsible for this increased level of comfort?
a) Melatonin
b) Dopamine
c) Endorphins
d) Serotonin c) Endorphins
Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking
chemicals, which have prolonged analgesic effects and produce euphoria. It is thought that
certain measures, such as skin stimulation and relaxation techniques, release endorphins.
A nurse administers pain medication to clients on a med-surg ward. The client that would benefit
from a p.r.n. drug regimen as an effective method of pain control would be the client:
a) experiencing chronic pain.
b) in the postoperative stage with occasional pain.
c) experiencing acute pain.
d) in the early postoperative period. b) in the postoperative stage with occasional pain.
A p.r.n. (as needed) medication would be most appropriate for a client in the postoperative stage
with occasional pain. A client in the early postoperative period would benefit from the dosage of
pain medication with around the clock dosing. A client experiencing chronic pain would benefit
from the dosage of pain medication with around the clock dosing. A client experiencing acute
pain would benefit from the dosage of pain medication with around the clock dosing.
A postoperative client who has been receiving morphine for pain management is exhibiting a
depressed respiratory rate and is not responsive to stimuli. Which drug has the potential to
reverse the respiratory-depressant effect of an opioid?
a) Naloxone
b) Epinephrine
c) Diphenhydramine
d) Atropine a) Naloxone
While assessing an infant, the nurse notes that the infant displays an occasional grimace and is
withdrawn; legs are kicking, body is arched, and the infant is moaning during sleep. When
awakened, the infant is inconsolable. What scale should the nurse use while assessing pain in this
infant?
a) BRADEN SCALE
b) APGAR SCORE
c) FACES SCALE
d) FLACC SCALE d) FLACC SCALE
A client has required frequent scheduled and breakthrough doses of opioid analgesics in the 6
days since admission to the hospital. The client's medication regimen may necessitate which
intervention?
a) Supplementary oxygen and chest physiotherapy
b) Calorie restriction and dietary supplements
c) Frequent turns and application of skin emollients
d) Stool softeners and increased fluid intake d) Stool softeners and increased fluid intake
The most common side effect of opioid use is constipation. Consequently, stool softeners and
increased fluid intake may be indicated. Opioids may cause respiratory depression, but this fact
in and of itself does not create a need for oxygen supplementation or chest physiotherapy. The
use of opioids does not create a need for calorie restriction, supplements, frequent turns, or the
use of skin emollients.
The nurse preparing to admit a client receiving epidural opioids should make sure that which of
the following medications is readily available on the unit?
a) Lasix
b) Narcan
c) Digoxin
d) Lopressor b) Narcan
A client asks the nurse which vitamins should be taken daily for feelings of fatigue, anxiety, and
depression 1 week before menses. Which of the following is the correct response by the nurse?
a) Vitamin D
b) Vitamin A
c) Vitamin C
d) Vitamin B6
d) Vitamin B6
A client comes to the emergency department complaining of a shooting pain in his chest. When
assessing the client's pain, which behavioral response would the nurse expect to find?
a) Decreased heart rate
b) High blood pressure
c) Guarding of the chest area
d) Increased respiratory rate c) Guarding of the chest area
Which of the following means of pain control is based on the gate control theory?
a) Distraction
b) Hypnosis
c) Biofeedback
d) Acupuncture
d) Acupuncture
Acupuncture is a means of pain control that is based on the gate control theory. Biofeedback,
distraction, and hypnosis are alternative and complementary therapies that are
nonpharmacological means of pain control. They are not based on the gate control theory.
The nurse is teaching a novice nurse about the therapeutic effects of laughter. Which example
correctly identifies one of these effects?
a) It activates the immune system.
b) It causes shallow breathing.
c) It increases the level of epinephrine.
d) It decreases heart rate.
a) It activates the immune system.
A client is experiencing acute pain following the amputation of a limb. What nursing
interventions would be most appropriate when treating this client?
a) Increase and decrease the serum level of the analgesic as needed.
b) Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical
regimen.
c) Treat the pain only as it occurs to prevent drug addiction.
d) Do not provide analgesia if there is any doubt about the likelihood of pain occurring. b)
Encourage the use of nonpharmacologic complementary therapies as adjuncts to the medical
regimen.
The client would benefit from the use of nonpharmacologic complementary therapies as adjuncts
to the medical regimen. The phantom pain is real pain and should be treated as such. The nurse
would not increase and decrease the serum level of the analgesic as needed. The nurse would not
doubt the client's report of pain and would not withhold analgesia if she doubted the likelihood
of the pain occurring.
A nurse consults with a nurse practitioner trained to perform acupressure to teach the method to a
client being discharged. What process is involved in this pain relief measure?
a) Biofeedback mechanism
b) Transcutaneous electrical nerve stimulation
c) Cutaneous stimulation
d) Client-controlled analgesia
c) Cutaneous stimulation
Cutaneous stimulation techniques include acupressure, massage, application of heat and cold,
and transcutaneous electrical nerve stimulation (TENS).
The nurse is providing education to a client about the role of endogenous opioids in the
transmission of pain. Which information about the release of endogenous opioids is most
accurate?
a) They block glutamate receptors and peptides.
b) They occupy cell receptors for neurotransmitters.
c) They react with acetylcholine and serotonin.
d) They bind to opioid receptor sites throughout the CNS. d) They bind to opioid receptor sites
throughout the CNS.
Which medication would the nurse most likely see on the medication administration record
(MAR) of a client with diabetic neuropathy?
a) Lorazepam
b) Hydromorphone
c) Morphine
d) Gabapentin d) Gabapentin
Gabapentin is used to treat nerve pain.
Which clients would be the best candidate to receive epidural analgesia for pain management?
a) a client who is experiencing chest pains
b) a child undergoing hip surgery
c) a cliient with a strained back
d) a client with an inoperable brain tumor b) a child undergoing hip surgery
Epidural analgesia is being used more commonly to provide pain relief during the immediate
postoperative phase and for chronic pain situations. Epidural pain management is also being used
in children with terminal cancer and children undergoing hip, spinal, or lower extremity surgery.
When performing an assessment on a client with chronic pain, the nurse notes that the client
frequently shifts conversational topics. The nurse determines that this may be an indicator for
which of the following?
a) Boredom
b) Depression
c) Moodiness
d) Anxiety d) Anxiety
Clients in pain may experience anxiety, and the anxiety may also increase the perception of pain.
Signs of anxiety include decreased attention span or ability to follow directions, asking frequent
questions, shifting topics of conversation, and avoidance of discussion of feelings.
A postoperative client has not voided for 8 hours (since surgery). He is restless and reports
abdominal pain. How and what would the nurse assess before administering pain medications?
a) Check database for last bowel movement.
b) Palpate abdomen for distended bladder.
c) Percuss abdomen for sounds of tympany.
d) Auscultate abdomen for bowel sounds. b) Palpate abdomen for distended bladder.
Nurses can provide interventions to alter or relieve pain. A client who has not voided for 8 hours
after surgery, is restless, and is having abdominal pain probably has pain from a distended
bladder and needs to be catheterized.
Based on your knowledge of pain and the body's response, when assessing a client in pain, you
would anticipate the
a) Pulse rate is decreased
b) Blood pressure is normal
c) Respirations are shallow
d) Pupils are dilated d) Pupils are dilated
Acute pain stimulates the sympathetic nervous system and produces the following objective
symptoms: increased blood pressure, increased pulse, increased respiratory rate, dilated pupils,
and diaphoresis.
Endogenous opioids such as endorphins:
a) release neurotensin.
b) excite neural pathways.
c) contribute to analgesia.
d) cause muscle spasms.
c) contribute to analgesia.
The opioid receptors, important for the inhibition of pain perception, are sites where endogenous
opioids and exogenous opioids bind. Three groups of endogenous opioids relieve pain:
enkephalins, endorphins, and dynorphins.
A middle-age client tells the nurse that her neck pain reduced considerably after she underwent a
treatment in which thin needles were inserted into her skin. What kind of pain relief treatment
did the client undergo?
a) Transcutaneous electrical nerve stimulation
b) Biofeedback
c) Rhizotomy
d) Acupuncture
d) Acupuncture
Which circumstance may preclude the use of cutaneous stimulation to relieve a client's pain?
a) The client has difficulty localizing his pain.
b) The client has a history of heart disease.
c) The client is receiving both scheduled and breakthrough analgesia.
d) The client's pain is chronic rather than acute.
a) The client has difficulty localizing his
pain.
The nurse is preparing to initiate PCA therapy for a client with sleep apnea. What is the correct
action by the nurse?
a) Increase the lock out time.
b) Contact the physician.
c) Initiate the therapy.
d) Decrease the loading dose.
b) Contact the physician.
The nurse should contact the physician, as PCA therapy for pain management is contraindicated
for clients with sleep apnea. This is due to the fact that oversedation in clients with sleep apnea
poses a significant health risk. PCA therapy is also contraindicated in confused clients, infants
and very young children, cognitively impaired clients, and clients with asthma.
A client with chronic pain reports to you, the charge nurse, that the nurse have not been
responding to requests for pain medication. What is your initial action?
A) Check the MARs and nurses' notes for the past several days.
B) Ask the nurse educator to give an in-service about pain management.
C) Perform a complete pain assessment and history on the client.
D) Have a conference with the nurses responsible for the care of this client D) Have a conference
with the nurses responsible for the care of this client
As charge nurse, you must assess for the performance and attitude of the staff in relation to this
client. After gathering data from the nurses, additional information from the records and the
client can be obtained as necessary. The educator may be of assistance if knowledge deficit or
need for performance improvement is the problem.
Family members are encouraging your client to "tough it out" rather than run the risk of
becoming addicted to narcotics. The client is stoically abiding by the family's wishes. Priority
nursing interventions for this client should target which dimension of pain?
A) Sensory
B) Affective
C) Sociocultural
D) Behavioral
E) Cognitive C) Sociocultural
The family is part of the sociocultural dimension of pain. They are influencing the client and
should be included in the teaching sessions about the appropriate use of narcotics and about the
adverse effects of pain on the healing process. The other dimensions should be included to help
the client/family understand overall treatment plan and pain mechanism
A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that
is not responding to NSAIDs. You anticipate that the physician will order which adjuvant
medication for this type of pain?
A) Amitriptyline (Elavil)
B) Corticosteroids
C) Methylphenidate (Ritalin)
D) Lorazepam (Ativan)
A) Amitriptyline (Elavil)
Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are
for pain associated with inflammation. Methylphenidate is given to counteract sedation if the
client is on opioids. Lorazepam is an anxiolytic.
Which client is most likely to receive opioids for extended periods of time?
A) A client with fibromyalgia
B) A client with phantom limb pain
C) A client with progressive pancreatic cancer
D) A client with trigeminal neuralgia C) A client with progressive pancreatic cancer
Cancer pain generally worsens with disease progression and the use of opioids is more generous.
Fibromyalgia is more likely to be treated with non-opioid and adjuvant medications. Trigeminal
neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom
limb pain usually subsides after ambulation begins.
As the charge nurse, you are reviewing the charts of clients who were assigned to a newly
graduated RN. The RN has correctly charted dose and time of medication, but there is no
documentation regarding non-pharmaceutical measures. What action should you take first?
A) Make a note in the nurse's file and continue to observe clinical performance
B) Refer the new nurse to the in-service education department.
C) Quiz the nurse about knowledge of pain management
D) Give praise for the correct dose and time and discuss the deficits in charting.
for the correct dose and time and discuss the deficits in charting.
In caring for a young child with pain, which assessment tool is the most useful?
A) Simple description pain intensity scale
B) 0-10 numeric pain scale
C) Faces pain-rating scale
D) McGill-Melzack pain questionnaire
D) Give praise
C) Faces pain-rating scale
The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is appropriate for
young children who may have difficulty describing pain or understanding the correlation of pain
to numerical or verbal descriptors. The other tools require abstract reasoning abilities to make
analogies and use of advanced vocabulary.
Place the examples of drugs in the order of usage according to the World Health Organization
(WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b.
NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine
A) B, A, C
B) C, A, B
C) B, C, A
D) A, B, C
C) B, C, A
Step 1 includes non-opioids and adjuvant drugs. Step 2 includes opioids for mild pain plus Step 1
drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain (replacing Step 2
opioids) and continuing Step 1 drugs and adjuvant drugs as needed.
Which client is at greater risk for respiratory depression while receiving opioids for analgesia?
A) An elderly chronic pain client with a hip fracture
B) A client with a heroin addiction and back pain
C) A young female client with advanced multiple myeloma
D) A child with an arm fracture and cystic fibrosis D) A child with an arm fracture and cystic
fibrosis
at greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary
disease. The child has two of the three risk factors.
In providing care to a client with chronic pain, which of the following characteristics or client
responses should the nurse expect?
a) Heart rate, blood pressure, and pulse rate may be normal while the client is experiencing pain.
b) Opioid-based analgesics may have little if any effect on reducing the quality of chronic pain.
c) The client may have adapted so successfully to the presence of chronic pain that measures for
relief are unnecessary.
d) The actual intensity of chronic pain is difficult to assess because the client may complain
constantly
a) Heart rate, blood pressure, and pulse rate may be normal while the client is
experiencing pain.
Adaptation to the presence of chronic pain is physiologic. Thus, the usual alterations in
physiologic parameters when acute pain is present do not accompany chronic pain.
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 (0 to 10 scale) and requests "something for pain that will
work quickly." The nurse will document this as
a) somatic pain.
b) referred pain.
c) breakthrough pain.
d) neuropathic pain. c) breakthrough pain.
Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is
termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the
central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle,
skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.
A postoperative client that recently returned from surgery has a morphine PCA pump. The basal
rate is ordered to be 1 mg/hour and the patient can have a 1-mg bolus every 15 minutes. When
the nurse assesses the client, the nurse finds the client stuporous, hard to arouse, with a
respiratory rate of 6 breaths/minute. After successfully treating the client, which action by the
nurse takes priority? The nurse should
a- request the physician order different basal and bolus rates.
b- question the client about how he/she has been using the button on the pump.
c- check the IV pump to ensure the basal rate is set correctly.
d- Ask the physician to discontinue the PCA pump and revert to prn opioids for pain.
check the IV pump to ensure the basal rate is set correctly.
c-
The patient exhibited manifestations of opioid toxicity. The ordered dose was well within a safe
range for a postoperative client. On a PCA pump, the demand feature has a lock-out device
limiting the amount of opioid the client can administer. This could have been set incorrectly,
allowing the client to overdose him/herself; however, a sleepy postoperative client often cannot
use the demand feature without reminders. This leaves the basal rate as the most likely source of
error and the nurse should check to see that it was set correctly. Giving prn pain medications
often results in undertreatment of pain and should not be used on a postoperative client. If the
pump was set incorrectly, there is no need to adjust the rates. Questioning the client and reeducating him/her if needed are always appropriate, but it is not the priority since the pump most
likely was set incorrectly.
Which physiologic or behavioral manifestation is more commonly associated with acute pain
rather than chronic pain?
a- Reduced tendency to touch or move the affected area
b- Psychosocial withdrawal
c- Inability to concentrate
d-Dry skin and moist oral mucous membranes
c- Inability to concentrate
The characteristic most common to chronic pain is psychosocial withdrawal. Dry skin and moist
mucous membranes indicate an absence of or physiologic adaptation to the stress response
associated with chronic pain. Clients experiencing either acute or chronic pain tend to protect the
painful area. The inability to concentrate is associated much more with acute pain before any
physiologic or behavioral adaptation has occurred.
The nurse instructs the client taking ibuprofen that the drug is effective for pain relief because it
acts to
a- slow painful stimuli through type A-delta pain fibers.
b- reduce inflammation and block prostaglandins.
c- interrupt the transmission of pain impulses.
d- interfere with the relay of pain information through the dorsal horn.
inflammation and block prostaglandins.
b- reduce
The site of action of nonsteroidal anti-inflammatory drugs (NSAIDs) is primarily the periphery
at the receptor site, where NSAIDs serve an anti-inflammatory function and prevent the
production of prostaglandins.