Nursing Assessment and Pain Review 59 Questions with Verified Answers
1. Which of the following examples are steps of nursing assessment? (Select all
... [Show More] that apply.)
1. Collection of information from patient's family members
2. Recognition that further observations are needed to clarify information
3. Comparison of data with another source to determine data accuracy
4. Complete documentation of observational information
5. Determining which medications to administer based on a patient's assessment data - CORRECT ANSWER 1, 2,3 Assessment includes collection of data from secondary sources such as the patient's family. Recognizing that more observation is needed is an example of validation of data. Comparing data to determine accuracy is a feature of interpretation. Although complete documentation is an important step in communicating assessment data, it is not an assessment step.
2. A nurse assesses a patient who comes to the pulmonary clinic. "I see that it's been over 6 months since you've been here, but your appointment was for every 2 months. Tell me about that. Also I see from your last visit that the doctor recommended routine exercise. Can you tell me how successful you've been in following his plan?" The nurse's assessment covers which of Gordon's functional health patterns?
1. Value-belief pattern
2. Cognitive-perceptual pattern
3. Coping-stress-tolerance pattern
4. Health perception-health management pattern - CORRECT ANSWER 4 The nurse's assessment covers health perception and health management pattern, which is a patient's self report of how he or she manages their health and their knowledge of preventive health practices. The coping stress tolerance pattern would include questions focused on how the patient manages stress and sources of support. An assessment covering the value belief pattern leads a patient to describe patterns of values, beliefs and life goals. An assessment of the cognitive-perceptual pattern includes questions that focus on the patient's language adequacy, memory and decision making ability.
3. When a nurse conducts an assessment, data about a patient often comes from which of the following sources? (Select all that apply.)
1. An observation of how a patient turns and moves in bed
2. The unit policy and procedure manual
3. The care recommendations of a physical therapist
4. The results of a diagnostic x-ray film
5. Your experiences in caring for other patients with similar problems - CORRECT ANSWER 1, 3, 4 There are many sources of data for an assessment, including the patient through interview, observations, and physical exam; family members or significant others, health care team members like a physical therapist, the medical record which includes x ray results and the scientific and medical literature.
4. The nurse observes a patient walking down the hall with a shuffling gait. When the patient returns to bed, the nurse checks the strength in both of the patient's legs. The nurse applies the information gained to suspect that the patient has a mobility problem. This conclusion is an example of:
1. Cue.
2. Reflection.
3. Clinical inference.
4. Probing. - CORRECT ANSWER 3 An inference is your judgment or interpretation of cues, such as the shuffling gait and reduced leg strength. Any information gathered through your senses is a cue. Probing is a technique used in interviewing. Reflection is an internal though process of thinking back about a situation.
5. A 72-year-old male patient comes to the health clinic for an annual follow-up. The nurse enters the patient's room and notices him to be diaphoretic, holding his chest and breathing with difficulty. The nurse immediately checks the patient's heart rate and blood pressure and asks him, "Tell me where your pain is." Which of the following assessment approaches does this scenario describe?
1. Review of systems approach
2. Use of a structured database format
3. Back channeling
4. A problem-oriented approach - CORRECT ANSWER 4 This is an example of a problem focused approach. The nurse focuses on assessing one body system (cardiovascular) to determine nature of the patient's pain and other presenting symptoms.
6. The nurse asks a patient, "Describe for me a typical night's sleep. What do you do to fall asleep? Do you have difficulty falling or staying asleep? This series of questions would likely occur during which phase of a patient-centered interview?
1. Orientation
2. Working phase
3. Data validation
4. Termination - CORRECT ANSWER The gathering of information is the working phase of a patient-centered interview.
7. A nurse is assigned to a 42-year-old mother of 4 who weighs 136.2 kg (300 lbs), has diabetes, and works part time in the kitchen of a restaurant. The patient is facing surgery for gallbladder disease. Which of the following approaches demonstrates the nurse's cultural competence in assessing the patient's health care problems?
1. "I can tell that your eating habits have led to your diabetes. Is that right?"
2. "It's been difficult for people to find jobs. Is that why you work part time?"
3. "You have four children; do you have any concerns about going home and caring for them?"
4. "I wish patients understood how overeating affects their health." - CORRECT ANSWER 3 The gathering of information is the working phase of a patient-centered interview.
8. Which type of interview question does the nurse first use when assessing the reason for a patient seeking health care?
1. Probing
2. Open-ended
3. Problem-oriented
4. Confirmation - CORRECT ANSWER 2.The best interview question for determining initially the reason a patient is seeking healthcare is by asking an open ended question that allows the patient to tell their story. This is also a more patient-centered approach. Probing questions are done after data are gathered to seek more in depth information. Problem oriented and confirmation are not types of interview question.
9. A nurse gathers the following assessment data. Which of the following cues together form(s) a pattern suggesting a problem? (Select all that apply.)
1. The skin around the wound is tender to touch.
2. Fluid intake for 8 hours is 800 mL.
3. Patient has a heart rate of 78 beats/min and regular.
4. Patient has drainage from surgical wound.
5. Body temperature is 38.3° C (101° F).
6. Patient states, "I'm worried that I won't be able to return to work when I planned." - CORRECT ANSWER 1,4,5 Tender skin around the wound, drainage from the surgical wound, and a temperature of 101° indicate a wound infection. Fluid intake of 800 mL over 8 hours and a heart rate of 78 and regular are normal assessment findings. A patient's expressed concern about returning to work is a patient's subjective response about a separate issue and insufficient to form a pattern.
10. A nurse is checking a patient's intravenous line and, while doing so, notices how the patient bathes himself and then sits on the side of the bed independently to put on a new gown. This observation is an example of assessing:
1. Patient's level of function.
2. Patient's willingness to perform self-care.
3. Patient's level of consciousness.
4. Patient's health management values. - CORRECT ANSWER 1 Observing a patient perform activities physical, socially, psychologically and developmentally assesses their level of function. In the case of this question the nurse assesses physical functional level. Observation does not measure willingness to perform self care but the ability to do so. Observing physical performance of self-hygiene is not a measure of level of consciousness nor does it reveal a patient's values.
11. A nurse makes the following statement during a change-of-shift report to another nurse. "I assessed Mr. Diaz, my 61-year-old patient from Chile. He fell at home and hurt his back 3 days ago. He has some difficulty turning in bed, and he says that he has pain that radiates down his leg. He rates his pain at a 6, and he moves slowly as he transfers to a chair." What can the nurse who is beginning a shift do to validate the previous nurse's assessment findings when she conducts rounds on the patient? (Select all that apply.)
1. The nurse asks the patient to rate his pain on a scale of 0 to 10.
2. The nurse asks the patient what caused his fall.
3. The nurse asks the patient if he has had pain in his back in the past.
4. The nurse assesses the patient's lower-limb strength.
5. The nurse asks the patient what pain medication is most effective in managing his pain. - CORRECT ANSWER 1, 4
12. A patient who visits the surgery clinic 4 weeks after a traumatic amputation of his right leg tells the nurse practitioner that he is worried about his ability to continue to support his family. He tells the nurse he feels that he has let his family down after having an auto accident that led to the loss of his left leg. The nurse listens and then asks the patient, "How do you see yourself now?" On the basis of Gordon's functional health patterns, which pattern does the nurse assess?
1. Health perception-health management pattern
2. Value-belief pattern
3. Cognitive-perceptual pattern
4. Self-perception-self-concept pattern - CORRECT ANSWER 4 This is an example of assessment of a patient's feelings about his worth and body image which is the self-perception and self-concept health pattern.
13. A nurse is conducting a patient-centered interview. Place the statements from the interview in the correct order, beginning with the first statement a nurse would ask.
1. "You say you've lost weight. Tell me how much weight you've lost in the last month."
2. "My name is Todd. I'll be the nurse taking care of you today. I'm going to ask you a series of questions to gather your health history."
3. "I have no further questions. Thank you for your patience."
4. "Tell me what brought you to the hospital."
5. "So, to summarize, you've lost about 6 lbs in the last month, and your appetite has been poor—correct?" - CORRECT ANSWER 2,4,1,5,3
14. During a visit to the clinic, a patient tells the nurse that he has been having headaches on and off for a week. The headaches sometimes make him feel nauseated. Which of the following responses by the nurse is an example of probing?
1. So you've had headaches periodically in the last week and sometimes they cause you to feel nauseated—correct?
2. Have you taken anything for your headaches?
3. Tell me what makes your headaches begin.
4. Uh huh, tell me more. - CORRECT ANSWER 3, A probing question such as "Tell me what makes your headaches begin" encourages a more full description of a situation by asking an open ended question. The statement "So you've had headaches periodically in the last week and sometimes they cause you to feel nauseated—correct?" is a summarative statement. Asking whether the patient has taken anything for the headaches is a close ended question. Saying "Uh huh, tell me more" is an example of back channeling.
15. The nurse enters the room of an 82-year-old patient for whom she has not cared previously. The nurse notices that the patient wears a hearing aid. The patient looks up as the nurse approaches the bedside. Which of the following approaches are likely to be effective with an older adult? (Select all that apply.)
1. Listen attentively to the patient's story.
2. Use gestures that reinforce your questions or comments.
3. Stand back away from the bedside.
4. Maintain direct eye contact.
5. Ask questions quickly to reduce the patient's fatigue.
Answers: - CORRECT ANSWER 1,2,4 Approaches for collecting an older adult assessment include listening patiently, using nonverbal communication when a patient has a hearing deficit, and maintaining patient-directed eye gaze. Leaning forward, not backward shows interest in what the patient has to say.
1. The patient health history and physical examination provide the nurse with information to primarily
a. diagnose a medical problem.
b. investigate a patient's signs and symptoms.
c. classify subjective and objective patient data.
d. identify nursing diagnoses and collaborative problems. - CORRECT ANSWER d,During the patient history interview and physical examination, the nurse collects the necessary data to support the identification of nursing diagnoses and collaborative problems.
2. The nurse would place information about the patient's concern that his illness is threatening his job security in which functional health pattern?
a. Role-relationship
b. Cognitive-perceptual
c. Coping-stress tolerance
d. Health perception-health management - CORRECT ANSWER a,Role-relationship pattern describes the roles and relationships of the patient, including major responsibilities. This concept also accounts for the patient's self-evaluation of his or her performance of the expected behaviors related to these roles.
3. The nurse is preparing to examine a patient's abdomen. Identify the proper order of the steps in the assessment of the abdomen, using the numbers 1-4, with 1 = the first technique and 4 = the last technique:
___ Inspection
___ Palpation
___ Percussion
___ Auscultation - CORRECT ANSWER 1, 4,3,2
4. Which situation would require the nurse to obtain a focused assessment (select all that apply)?
a. A patient denies a current health problem.
b. A patient reports a new symptom during rounds.
c. A previously identified problem needs reassessment.
d. A baseline health maintenance examination is required.
e. An emergency problem is identified during physical examination. - CORRECT ANSWER b,c, A focused assessment is an abbreviated assessment used to evaluate the status of previously identified problems and to monitor for signs of new problems. It can be performed when a specific problem is identified or a new symptom is reported.
1. Which of the following signs or symptoms in a patient who is opioid-naïve is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid?
1. Oxygen saturation of 95%
2. Difficulty arousing the patient
3. Respiratory rate of 10 breaths/min
4. Pain intensity rating of 5 on a scale of 0 to 10 - CORRECT ANSWER 2,edation is a concern because it may indicate that the patient is experiencing opioid-related side effects. Advancing sedation may indicate that the patient may progress to respiratory depression.
2. A health care provider writes the following order for a patient who is opioid-naïve who returned from the operating room following a total hip replacement: "Fentanyl patch 100 mcg, change every 3 days." On the basis of this order, the nurse takes the following action:
1. Calls the health care provider and questions the order
2. Applies the patch the third postoperative day
3. Applies the patch as soon as the patient reports pain
4. Places the patch as close to the hip dressing as possible - CORRECT ANSWER 1,The nurse needs to call the health care provider about the order because Fentanyl patches are not indicated for acute pain. They are indicated for patients with chronic pain who are opioid tolerant.
3. A patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication?
1. Opioid antagonists
2. Antiemetics
3. Stool softeners
4. Muscle relaxants - CORRECT ANSWER 3 Constipation is a common opioid-related side effect, and patients do not become tolerant to it.
4. A new medical resident writes an order for oxycodone CR (Oxy Contin) 10 mg PO q2h prn. Which part of the order does the nurse question?
1. The drug
2. The time interval
3. The dose
4. The route - CORRECT ANSWER 2Long-acting or sustained-release opioids are dosed on a scheduled basis, not prn, to provide a base of continuous opioid analgesia.
5. The nurse reviews a patient's medical administration record (MAR) and finds that the patient has received oxycodone/acetaminophen (Percocet) (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most?
1. The patient's level of pain
2. The potential for addiction
3. The amount of daily acetaminophen
4. The risk for gastrointestinal bleeding - CORRECT ANSWER 3 The Food and Drug Administration (FDA) recommends a maximum daily dose of 4 g of acetaminophen, and many authorities believe that the maximum daily dose should be lower (3000 to 3200 mg/day) in the outpatient setting to reduce the risk of hepatotoxicity.
6. A patient with chronic low back pain who took an opioid around-the-clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking chills, abdominal cramps, and joint pain. The nurse recognizes that this patient is experiencing symptoms of:
1. Opioid toxicity.
2. Opioid tolerance.
3. Opioid addiction.
4. Opioid withdrawal. - CORRECT ANSWER 4 The common symptoms of opioid withdrawal that are associated with physical dependence may develop when an opioid is withdrawn rapidly. Symptoms include shaking chills, abdominal cramps, and joint pain.
7. A patient has returned from the operating room, recovering from repair of a fractured elbow, and states that her pain level is 6 on a 0-to-10 pain scale. She received a dose of hydromorphone just 15 minutes ago. Which interventions may be beneficial for this patient at this time? (Select all that apply.)
1. Transcutaneous electrical nerve stimulation (TENS)
2. Administer naloxone (Narcan) 2 mg intravenously
3. Provide back massage
4. Reposition the patient
5. Withhold any pain medication and tell the patient that she is at risk for addiction - CORRECT ANSWER 4,3,1
8. Which of the following instructions is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine? (Select all that apply.)
1. Only the patient should push the button.
2. Do not use the PCA until the pain is severe.
3. The PCA system can set limits to prevent overdoses from occurring.
4. Notify the nurse when the button is pushed.
5. Do not push the button to go to sleep. - CORRECT ANSWER 1,3,5
9. A patient with a 3-day history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The patient has been taking hydrocodone/APAP 5/325 up to four tablets/day before her stroke for arthritic pain. The health care provider's order reads as follows: "Hydrocodone/APAP 5/325 1 tab, per gastrostomy tube, q4h, prn." Which action by the nurse is most appropriate?
1. No action is required by the nurse because the order is appropriate.
2. Request to have the order changed to around the clock (ATC) for the first 48 hours.
3. Ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3 hours, prn.
4. Begin the hydrocodone/APAP when the patient shows nonverbal symptoms of pain. - CORRECT ANSWER 2,The patient can be expected to have acute pain related to the G-tube insertion; in addition, she has a history of chronic pain. Her pain should be treated with ATC medication to match the timing of her pain.
10. A patient is prescribed morphine patient-controlled analgesia (PCA). Arrange the following steps for administering PCA in the correct order.
1. Program computerized PCA pump to deliver prescribed medication dose and lockout interval.
2. Check label of medication 3 times: when removed from storage, when brought to bedside, when preparing for assembly.
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3. Administer loading dose of analgesia as prescribed.
4. Attach drug reservoir to infusion device, prime tubing, and attach needleless adapter to end of tubing.
5. Identify patient using two identifiers.
6. Insert and secure needleless adapter into injection port nearest patient. - CORRECT ANSWER 2,5,1,4,6,3
11. A patient rates his pain as a 6 on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. The patient's wife says that he can't be in that much pain since he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain?
1. Patient's self-report
2. Behaviors
3. Surrogate (wife) report
4. Vital sign changes - CORRECT ANSWER 1Patient's self-report of pain. Sleep is not an indicator of pain intensity. Unless a patient is stimulated, it is difficult to distinguish sleep from sedation, which may occur as a side effect of the opioid. Patients in pain sometimes sleep from exhaustion.
12. When using ice massage for pain relief, which of the following is correct? (Select all that apply.)
1. Apply ice using firm pressure over skin.
2. Apply ice for 5 minutes or until numbness occurs.
3. Apply ice no more than 3 times a day.
4. Limit application of ice to no longer than 10 minutes.
5. Use a slow, circular steady massage. - CORRECT ANSWER 1,2,5Apply the ice with firm pressure over the skin; then use a slow, steady circular massage. Apply ice for 5 minutes or until the patient feels numbness. It is acceptable to apply ice 2 to 5 times a day.
13. When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information do you include?
1. TENS works by causing distraction.
2. TENS therapy does not require a health care provider's order.
3. TENS requires an electrical source for use.
4. TENS electrodes are applied near or directly on the site of pain. - CORRECT ANSWER 4,TENS units act on both the central and peripheral nervous systems. The peripheral effect occurs through activation of the neuroreceptors at or near the source of pain; therefore the electrodes should be placed near the site.
14. While caring for a patient with cancer pain, the nurse knows that a multimodal analgesia plan includes: (Select all that apply.)
1. Using analgesics such as nonsteroidal antiinflammatory drugs (NSAIDs) along with opioids.
2. Stopping acetaminophen when the pain becomes very severe.
3. Avoiding polypharmacy by limiting the use of medication to one agent at a time.
4. Avoiding total sedation, regardless of the severity of the pain.
5. The use of adjuvants (co-analgesics) such as gabapentin (Neurontin) to manage neuropathic type pain. - CORRECT ANSWER 1, 5,Multimodal analgesia involves the use of a combination of drugs with at least two different mechanisms of action so pain control can be optimized. The use of acetaminophen, NSAIDs, gabapentin, and opioids represents a multimodal analgesic plan because each agent relies on a different mechanism of action to reduce pain, with the benefit of reducing the amount of opioid that is needed to control pain. This differs from polypharmacy because the combination of drugs is intentional and based on understanding of the action of each product on the pain pathway.
15. A postoperative patient currently is asleep. Therefore the nurse knows that:
1. The sedative administered may have helped him sleep, but it is still necessary to assess pain.
2. The intravenous (IV) pain medication given in recovery is relieving his pain effectively.
3. Pain assessment is not necessary.
4. The patient can be switched to the same amount of medication by the oral route. - CORRECT ANSWER 1A pain assessment is still needed because sleep in a postoperative patient cannot be used as an assessment of a patient's pain level. Sleep may result from sedating effects of medication, but analgesia may not be present. It is important to wake and assess the patient to ensure that the pain is controlled and the patient is not overly sedated from the medication (a sign of impending respiratory depression).
1. Pain is best described as
a. a creation of a person's imagination.
b. an unpleasant, subjective experience.
c. a maladaptive response to a stimulus.
d. a neurologic event resulting from activation of nociceptors. - CORRECT ANSWER b
Rationale: The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage."
2. A patient is receiving a PCA infusion after surgery to repair a hip fracture. She is sleeping soundly but awakens when the nurse speaks to her in a normal tone of voice. Her respirations are 8 breaths/minute. The most appropriate nursing action in this situation is to
a. stop the PCA infusion.
b. obtain an oxygen saturation level.
c. continue to closely monitor the patient.
d. administer naloxone and contact the physician. - CORRECT ANSWER c
Rationale: Close monitoring is indicated for this patient with a respiratory rate of 8 breaths/minute. If the respiration rate falls below 8 breaths/minute, the nurse should vigorously stimulate the patient and try to keep the patient awake.
3. Which words are most likely to be used to describe neuropathic pain (select all that apply)?
a. Dull
b. Mild
c. Burning
d. Shooting
e. Shock-like - CORRECT ANSWER c, d, e
Rationale: Neuropathic pain is caused by damage to peripheral nerves or structures in the central nervous system (CNS). Typically described as numbing, hot or burning, shooting, stabbing, sharp, or electric shock-like in nature, neuropathic pain can be sudden, intense, short-lived, or lingering.
4. Unrelieved pain is
a. expected after major surgery.
b. expected in a person with cancer.
c. dangerous and can lead to many physical and psychologic complications.
d. an annoying sensation, but it is not as important as other physical care needs. - CORRECT ANSWER c
Rationale: Consequences of untreated pain include unnecessary suffering, physical and psychosocial dysfunction, impaired recovery from acute illness and surgery, immunosuppression, and sleep disturbances. In the acutely ill patient, unrelieved pain can result in increased morbidity as a result of respiratory dysfunction, increased heart rate and cardiac workload, increased muscular contraction and spasm, decreased gastrointestinal motility and transit, and increased breakdown of body energy stores (i.e., catabolism).
5. A cancer patient who reports ongoing, constant moderate pain with short periods of severe pain during dressing changes is
a. probably exaggerating his pain.
b. best treated by referral for surgical treatment of his pain.
c. best treated by receiving a long-acting and a short-acting opioid.
d. best treated by regularly scheduled short-acting opioids plus acetaminophen. - CORRECT ANSWER c
Rationale: Moderate to severe pain usually necessitates an opioid analgesic. Constant, moderate pain is treated with a long-acting opioid; procedural severe pain is treated with a short-acting opioid.
6. An example of distraction to provide pain relief is
a. TENS.
b. music.
c. exercise.
d. biofeedback. - CORRECT ANSWER b
Rationale: Distraction involves redirection of attention away from the pain and to something else. Distraction can be achieved by engaging the patient in any activity that can hold his or her attention (e.g., watching TV or a movie, conversing, using a laptop, listening to music, playing a game).
7. Appropriate nonopioid analgesics for mild pain include (select all that apply)
a. oxycodone.
b. ibuprofen (Advil).
c. lorazepam (Ativan).
d. acetaminophen (Tylenol).
e. codeine with acetaminophen (Tylenol #3). - CORRECT ANSWER b, d
Rationale: Nonopioid analgesics include acetaminophen, aspirin and other salicylates, and nonsteroidal antiinflammatory drugs (NSAIDs).
8. An important nursing responsibility related to pain is to
a. leave the patient alone to rest.
b. help the patient appear to not be in pain.
c. believe what the patient says about the pain.
d. assume responsibility for eliminating the patient's pain. - CORRECT ANSWER c
Rationale: Pain is a subjective experience, and patients need to feel confident that the nurse will believe their reports of pain.
10. A nurse believes that patients with the same type of tissue injury should have the same amount of pain. This statement reflects
a. a belief that will contribute to appropriate pain management.
b. an accurate statement about pain mechanisms and an expected goal of pain therapy.
c. a belief that will have no effect on the type of care provided to people in pain.
d. a lack of knowledge about pain mechanisms, which is likely to contribute to poor pain management. - CORRECT ANSWER d
Rationale: Genetic makeup and variability among individuals affects the plasticity of the central nervous system; this phenomenon helps explain individual differences in responses to pain. Poor knowledge of pain mechanisms often leads to poor pain management.
9. Providing opioids to a dying patient who is experiencing moderate to severe pain
a. may cause addiction.
b. will probably be ineffective.
c. is an appropriate nursing action.
d. will likely hasten the person's death. - CORRECT ANSWER c
Rationale: Opioid therapy is an appropriate intervention for moderate to severe pain experienced by a dying patient, and the drugs may be titrated upward many times over the course of therapy to maintain adequate pain control.
An adolescent with cancer, in hospice care, has had a transdermal fentanyl (Duragesic) patch that has provided pain relief for several hours but now complains of severe pain. What is the most appropriate nursing action?
Try a non-pharmacologic approach to comfort care.
Administer a low dose of meperidine (Demerol) IM.
Place a new Duragesic patch on the adolescent
Administer the ordered rapid-release opioid IV - CORRECT ANSWER Administer the ordered rapid-release opioid IV
The nurse should administer the rapid-release IV opioid for the breakthrough pain. Non-pharmacologic strategies will not be effective for alleviating severe pain. Intramuscular injections should be avoided in cancer patients. A Duragesic patch will take up to 24 hours to reach peak effect.
The nurse is reviewing the list of medications that his patients are receiving. Which medications are members of the group considered opioid medications?
Codeine
Fentanyl
Morphine
ibuprofen
methadon - CORRECT ANSWER Codeine, Fentanyl, Morphine, and Methadone are opioids. Ibuprofen is a nonsteroidal anti-inflammatory drug.
The parents of a child who just had experienced severe trauma ask how their child's pain will be managed. Which response by the nurse is most accurate?
We will give pain medications early to keep her comfortable."
"We withhold medication until it is absolutely needed."
"We will give medication to minimize the pain experienced."
"Giving the maximum dosage initially should alleviate her pain." - CORRECT ANSWER "We will give medication to minimize the pain experienced."
Preventing pain from becoming severe is the best approach, because once the pain becomes severe, controlling it becomes more difficult. Administering the minimum, not the maximum, dosage should be done initially based on the assessment of the pain level and the child's response to pain medication. Prevention of pain is the best approach, not giving medication early. Withholding medication is not only unethical but it is also not the best approach to pain management.
What should the nurse include in the teaching plan when discussing pain management with a child and his or her parents?
The possibility of addiction to pain medication
Assurance that the child will be kept pain-free
Telling the parents that pain medication and management is to control pain but has limitations
Telling the parents that they will need to talk with the physician if the pain medication is not effective - CORRECT ANSWER Telling the parents that pain medication and management is to control pain but has limitations
Children and parents need to understand the limitations of pain medications and management. Telling the parents that they will need to talk with the physician if the pain medication is not effective is not appropriate. If pain medication management is not working, the nurse needs to know first. Discussing addiction to pain medication is not an ideal starting point in the teaching plan. Keeping the child free of pain is inaccurate and misleading, not realistic.
A child has been given too much opioid pain medications and now requires a reversal agent. Which medication should the nurse expect to administer?
Naproxen
Naloxone
NeurontinNortriptyline - CORRECT ANSWER Naloxone
Naloxone (Narcan) will reverse opioid-related analgesia and respiratory depression. Neurontin is an anticonvulsant. Nortriptyline is a tricyclic antidepressant. Naproxen sodium is a nonsteroidal anti-inflammatory drug.
The nurse is starting an IV on a school-age child with cancer. The child says, "I have had a million IVs. They hurt." The nurse's response should be based on what information about children and pain?Children tolerate pain better than adults.
Children often lie about experiencing pain.
Children become accustomed to painful procedures and often demonstrate no increase in behavioral signs of discomfort.
Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures. - CORRECT ANSWER Children often demonstrate increased behavioral signs of discomfort with repeated painful procedures.
Children with chronic illnesses are more likely to identify invasive procedures as being stressful compared with children who have acute illnesses. There are no data to support the assertion that children tolerate pain better than adults. Pain is whatever the experiencing person says it is. The child experiences increasing difficulty rather than learns to tolerate a painful procedure.
A nurse is caring postoperatively for an 8-year-old child in severe pain with multiple fractures and other trauma caused by a motor vehicle injury. Which is the most important consideration in managing the child's pain?
Give only an opioid analgesic at this time.
Plan a preventive schedule of pain medication around the clock.
Increase the dosage of analgesic until the child is adequately sedated.
Give the child a clock and explain when he or she can have pain medications. - CORRECT ANSWER Plan a preventive schedule of pain medication around the clock.
An around-the-clock administration strategy should be used for a child recovering from trauma and surgery. This schedule will help prevent low plasma levels of the drug that could lead to breakthrough pain. The dose is increased until pain is controlled, not necessarily until sedation. Pain medication dosages are ordered by the physician. The nurse communicates the effectiveness of the medications to the physician so that dosages may be modified appropriately. Explaining the medication schedule is not appropriate; the child should be frequently assessed for pain, and medication doses should be adjusted accordingly. An opioid analgesic is appropriate for the immediate concern of the child's pain but will not facilitate a management plan.
The nurse is caring for children after a variety of surgeries. What should the nurse consider when using the FACES Pain Rating Scale with children?
This scale is not appropriate for use with adolescents.
This scale can be used with most children as young as 3 years old.
Children color the face with the color they choose to best describe their pain.
The FACES scale uses a scale to document physiologic responses. - CORRECT ANSWER This scale can be used with most children as young as 3 years old.
The FACES scale has been validated for children as young as 3 years of age. The child points at the face that best describes the pain being felt. The FACES scale does not have a scale for physiologic data. The scale is useful for all ages above 3 years, including adults.
The nurse educator is explaining how to assess pain in infants to a group of new nurses. Which behaviors should be explained as the most consistent indicators of pain in infants?
Increased heart rate
Squirming and jerking
Increased respirations
Facial expression and withdrawing - CORRECT ANSWER Facial expression and withdrawing
Facial expression and withdrawing are the most consistent behavioral manifestations of pain in infants. Increased heart rate, squirming and jerking, and increased respirations depends on the specific infant and on the characteristics of the pain.
A child is receiving morphine sulfate intravenously (IV) and has a new order to start receiving morphine sulfate orally. Based on the nurse's knowledge of morphine sulfate's actions and therapeutic effects, what is the relationship of the oral dose to the intravenous dose?
The oral dose will be the same as the IV dose.
The oral dose will be half of the IV dose
The oral dose will be greater than the IV dose.
The oral dose will be one-fourth of the IV dose. - CORRECT ANSWER The oral dose will be greater than the IV dose.
When the route of morphine administration is changed from intravenous to oral, it is essential that the dose be increased to achieve an equal effect. Oral morphine is not as effective at the same dose as IV morphine. Oral morphine is not as effective at the same dose as IV morphine. Oral morphine is not as effective at the same dose as IV morphine.
Which of the following is a priority for a nurse to include in a teaching plan for a patient who desires self-management and alternative strategies?
Body alignment and superficial heat and cooling
Patient-controlled analgesia (PCA) pump
Neurostimulation
Peripheral nerve blocks - CORRECT ANSWER Body alignment and superficial heat and cooling
Body alignment and thermal management are examples of nonpharmacological measures to manage pain. They can be used individually or in combination with other nondrug therapies. Proper body alignment achieved through proper positioning can help prevent or relieve pain. Thermal measures such as the application of localized, superficial heat and cooling may relieve pain and provide comfort. PCA, neurostimulation, and peripheral nerve blocks are not totally self-managed or alternative therapies, because they are used under the direction of medical professionals.
Stephanie is a 70-year-old retired schoolteacher who is interested in nondrug, mind-body therapies, self-management, and alternative strategies to deal with joint discomfort from rheumatoid arthritis. Which of the following options should you suggest for her plan of care, considering her expressed wishes?
Using a stationary exercise bicycle and free weights and attending a spinning class
Using mind-body therapies such as music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy
Drinking chamomile tea and applying icy/hot gel
Receiving acupuncture and attending church services - CORRECT ANSWER Using mind-body therapies such as music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy
Mind-body therapies are designed to enhance the mind's capacity to affect bodily functions and symptoms and include music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy, among many others. Although getting exercise, drinking chamomile tea and applying gels, and receiving acupuncture and attending church services may be beneficial, they are not classified as mind-body therapies in combination as specified in these answer choices.
A 65-year-old woman has fallen while sweeping her driveway, sustaining a tissue injury. She describes her condition as an aching, throbbing back. Which type of pain are these complaints most indicative of?
Neuropathic pain
Nociceptive pain
Chronic pain
Mixed pain syndrome - CORRECT ANSWER Nociceptive pain
Nociceptive pain refers to the normal functioning of physiological systems that leads to the perception of noxious stimuli (tissue injury) as being painful. Patients describe this type of pain as dull or aching, and it is poorly localized. Neuropathic pain is described as shooting, tingling, burning, or numbness that is constant in the extremities, as in diabetic neuropathy. Chronic pain lasts longer than 30 days and is characterized by a disease affecting brain structure and function, such as chronic headaches or open wounds. Mixed pain syndromes are caused by different pathophysiological mechanisms such as a combination of neuropathic and nociceptive pain; this occurs in syndromes such as sciatica, spinal cord injuries, and cervical or lumbar spinal stenosis.
Postoperative surgical patients should be given alternating doses of acetaminophen and which medication throughout the postoperative course, unless contraindicated?
Antihistamine
Local anesthetic
Opioids
Nonsteroidal anti-inflammatory drug (NSAID) - CORRECT ANSWER Nonsteroidal anti-inflammatory drug (NSAID)
Unless contraindicated, all surgical patients should routinely be given acetaminophen and an NSAID in scheduled doses throughout the postoperative course. Opioid analgesics are added to the treatment plan to manage moderate-to-severe postoperative pain. A local anesthetic is sometimes administered epidurally or by continuous peripheral nerve block.
Following the initiation of a pain management plan, pain should be reassessed and documented on a regular basis as a way to evaluate the effectiveness of treatments. Pain should be reassessed at which minimum interval?
Select all that apply.
With each new report of pain
Before and after administration of narcotic analgesics
Every 10 minutes
Every shift - CORRECT ANSWER With each new report of pain
Before and after administration of narcotic analgesics
Following the initiation of a pain management plan, pain should be reassessed and documented on a regular basis as a way to evaluate the effectiveness of treatments. At a minimum, pain should be reassessed with each new report of pain and before and after administration of analgesics. [Show Less]