Chapter 10: Pain
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1.
When doing a pain assessment for a client who has been admitted with metastatic breast
cancer, which question asked by the nurse will give the most information about the client’s
pain?
a. “How long have you had this pain?”
b. “How would you describe your pain?”
c. “How much medication do you take for the pain?”
d. “How many times a day do you medicate for pain?”
2.
A client who uses a fentanyl patch for chronic cancer pain complains to the nurse of the
rapid onset of pain at a level 9 (0–10 scale) and requests “something for pain that will work
quickly.” Which of the following types of pain is the most appropriate for the nurse to
document for this client? a. Somatic pain
b. Referred pain
c. Neuropathic pain
d. Breakthrough pain
3.
A postoperative client asks the nurse how the prescribed ibuprofen will control the incisional
pain. The nurse will teach the client that ibuprofen interferes with the pain process by
decreasing which of the following physiological responses? a. Modulating effect of
descending nerves
b. Sensitivity of the brain to painful stimuli
c. Production of pain-sensitizing chemicals
d. Spinal cord transmission of pain impulses
4.
The nurse is caring for a client who is taking an opioid for postoperative pain. Which of the
following interventions should the nurse include in the clients plan of care to manage
possible adverse effects of opioids?
a. Ensure the medication is given PRN only.
b. Administer the prescribed stool softener OD.
c. Ensure the administration route maximizes drug concentration at the site of the adverse
effect.
d. Request a prescription for a different classification of medication.
5.
A client 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. Which of the
following reasons provide the basis for the nurse’s response in relation to the effectiveness
of these strategies?
a. Impact the cognitive and affective components of pain.
b. Increase the modulating effect of the efferent pathways.
c. Prevent transmission of nociceptive stimuli to the cortex.
d. Slow the release of transmitter chemicals in the dorsal horn.
6.
A client who is receiving sustained-release morphine sulphate every 12 hours for chronic
pain experiences level 9 (0–10 scale) breakthrough pain and anxiety. Which of these
prescribed medications should the nurse anticipate administering? a. Lorazepam 1 mg orally
b. Amitriptyline 10 mg orally
c. Ibuprofen 400–800 mg orally
d. Immediate-release morphine 30 mg orally
7.
The nurse is caring for a client with chronic back pain who has arrived at the pain clinic for
a follow-up appointment. In order to evaluate whether the pain management is effective,
which of the following questions is most appropriate for the nurse to ask? a. “Can you
describe the quality of your pain?”
b. “Has there been a change in the pain location?”
c. “How would you rate your pain on a 0–10 scale?”
d. “Does the pain keep you from doing things you enjoy?”
8.
A client with second-degree burns has been receiving morphine through patient-controlled
analgesia (PCA) for a week. The client wakes up frequently during the night complaining of
pain. Which of the following actions should the nurse implement?
a. Administer a dose of morphine every 1–2 hours from the PCA machine while the client
is sleeping.
b. Consult with the health care provider about using a different treatment protocol to
control the client’s pain.
c. Request that the health care provider order a bolus dose of morphine to be given when
the client awakens with pain.
d. Teach the client to push the button every 10 minutes for an hour before going to sleep,
even if the pain is minimal.
9.
The nurse is caring for a client who is receiving epidural morphine. Which of the following
information obtained by the nurse indicates that the client may be experiencing an adverse
effect of the medication?
a. The client has cramping abdominal pain.
b. The client becomes restless and agitated.
c. The client has not voided for over 10 hours.
d. The client complains of a “pounding” headache.
10. The nurse visits a hospice client and assesses a respiratory rate of 8 breaths/minute and the
client states “I am having severe pain.” Which of the following interventions should the
nurse implement at this time?
a. Inform the client that increasing the morphine will cause the respiratory drive to fail.
b. Administer a nonopioid analgesic, such as a nonsteroidal anti-inflammatory drug
(NSAID), to improve client pain control.
c. Tell the client that additional morphine can be administered when the respirations are
12.
d. Titrate the prescribed morphine dose upward until the client indicates adequate pain
relief.
11. The nurse is admitting a client to hospital with a history of chronic cancer pain. When
reviewing the client’s home medications, which of the following medications should be of
most concern?
a. Amitriptyline 50 mg at bedtime
b. Oxycodone 80 mg twice daily
c. Ibuprofen 800 mg three times daily
d. Meperidine 25 mg every 4 hours
12. The nurse is caring when caring for a client with cancer pain that the client describes as at
“level 8 (0–10 scale), deep, and aching.” Which of the following prescribed medications
should the nurse administer first? a. Fentanyl patch
b. Ketorolac tablets PO
c. Hydromorphone IV
d. Acetaminophen suppository
13. The nurse is caring for a client with diabetes who has chronic burning leg pain even when
taking oxycodone twice daily. Which of the following prescribed medications is the most
appropriate choice for the nurse to administer as an adjuvant to decrease the client’s pain? a.
Acetylsalicylic acid
b. Dextroamphetamine
c. Amitriptyline
d. Acetaminophen
14. The nurse is preparing a client for discharge who has been receiving morphine 10 mg IV for
pain and will continue to take morphine PO at home. Which of the following dosages is an
equianalgesic oral dose for this client? a. 10 mg
b. 20 mg
c. 30 mg
d. 40 mg
15. These medications are prescribed by the health care provider for a client who uses long-
acting morphine for chronic back pain, but still has ongoing pain. Which of the following
medications should the nurse question? a. Morphine
b. Pentazocine
c. Celecoxib
d. Dexamethasone
16. The nurse assesses a postoperative client who is receiving morphine through patient-
controlled analgesia (PCA). Which information is most important to report to the health care
provider?
a. The client complains of nausea after eating.
b. The client’s respiratory rate is 10 breaths/minute.
c. The client has not had a bowel movement for 3 days.
d. The client has a distended bladder and has not voided.
17. The nurse is caring for a client who has chronic musculo-skeletal pain and states “I feel
depressed because I ache too much to play golf.” The client says the pain is usually at a level
7 (0–10 scale). Which of the following client goals has the highest priority when the nurse is
developing the treatment plan?
a. The client will exhibit fewer signs of depression.
b. The client will say that the aching has decreased.
c. The client will state that pain is at a level 2 of 10.
d. The client will be able to play 1–2 rounds of golf.
18. The nurse is caring for a client who has just started taking sustained-release morphine
sulphate for chronic pain and is nausea with abdominal fullness. Which of the following
interventions is the most appropriate for the nurse to implement? a. Administer the ordered
antiemetic medication.
b. Tell the client that the nausea will subside in about a week.
c. Order the client a clear liquid diet until the nausea decreases.
d. Consult with the health care provider about using a different opioid.
19. A client with cancer-related pain and a history of opioid abuse complains of breakthrough
pain 2 hours before the next dose of morphine sulphate extended-release is due. Which of
the following actions is priority for the nurse to implement?
a. Administer the prescribed PRN immediate-release morphine.
b. Suggest the use of alternative therapies such as heat or cold.
c. Utilize distraction by talking about things the client enjoys.
d. Consult with the doctor about increasing the morphine sulphate extended-release
dose.
20. The nurse is caring for a client diagnosed with tendinitis in the outpatient clinic and advises
that the client use a topical ointment to assist with pain relief. The client informs the nurse
that they have never used a topical ointment for pain relief before so the nurse provides
education related to the correct use of the ointment. Which of the following information
should the nurse include in the teaching plan?
a. Apply the ointment after a 20-minute massage of the area.
b. Use moist heat for 10 minutes to the area prior to applying the ointment.
c. Test the ointment on a small area of the skin for adverse effects.
d. Use EMLA to the area prior to applying the ointment.
21. The nurse is caring for a client who is using fentanyl patch and immediate-release morphine
for chronic cancer pain who develops new-onset confusion, dizziness, and a decrease in
respiratory rate. Which of the following actions is the priority for the nurse to implement?
a. Remove the fentanyl patch.
b. Notify the health care provider.
c. Continue to monitor the client’s status.
d. Give the prescribed PRN naloxone.
22. These medications are ordered for an older-adult client with arthritis in both hips who is
complaining of level 3 (0–10 scale) hip pain while ambulating. Which medication should the
nurse use as initial therapy?
a. Acetylsalicylic acid 650 mg orally
b. Naproxen 200 mg orally
c. Oxycodone 5 mg orally
d. Acetaminophen 650 mg orally
MULTIPLE RESPONSE
1. The health care provider plans to titrate a patient-controlled analgesia (PCA) machine to
provide pain relief for a client 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. Assessing for signs that the client is becoming addicted to the opioid
b. Monitoring for therapeutic and adverse effects of opioid administration
c. Emphasizing that the risk of some opioid adverse effects increases over time
d. Educating the client about how analgesics improve postoperative activity level
e. Teaching about the need to decrease opioid doses by the second postoperative day