Nursing Pain Management Exam 62 Questions with Verified Answers
A nurse is caring for an older adult client who has a cognitive impairment and is
... [Show More] postoperative. Which of the following actions should the nurse take? - CORRECT ANSWER Evaluate the client for pain by observing their behavior.
A nurse is reviewing information for several clients on the unit. The nurse should recognize that which of the following clients is at greatest risk for respiratory depression? - CORRECT ANSWER A client who had surgery 3 hr ago and is receiving IV hydromorphone PRN
A nurse is caring for a client who has kidney stones. Which of the following manifestations is an objective indicator of pain? - CORRECT ANSWER The client is diaphoretic.
A nurse is providing end-of-life care for a client who is unresponsive and near death. The client's family asks the nurse about managing the client's pain. Which of the following statements should the nurse make to the client's family? - CORRECT ANSWER "Your family member has the right to receive effective pain management."
A nurse is assisting with a staff in-service regarding pain control. Which of the following statements by a staff member indicates an understanding of the information? (Select all that apply.) - CORRECT ANSWER "A client's religious beliefs might affect the way they respond to pain."
"The client's past pain experiences are not related to their current pain and pain management."
"Pain control might be harder to achieve if the nurse and client speak different primary languages."
A nurse is caring for a client who reports muscle pain to the lower back that has persisted for over a year after a motor-vehicle crash. In which way should the nurse categorize this client's pain? - CORRECT ANSWER Chronic pain
A nurse is caring for a group of clients on the pediatric unit. For which of the following clients should the nurse use the FLACC Pain Scale to determine their pain level? (Select all that apply.) - CORRECT ANSWER A 3-year-old toddler who has a fractured femur
A 14-year-old client who has severe cognitive and developmental delays
A 5-year-old preschooler who is experiencing pain during a sickle cell crisis
A nurse is assessing a client who is nonverbal for the presence of pain. Which of the following findings indicate an increased level of discomfort? (Select all that apply.) - CORRECT ANSWER Grimacing
Restlessness
Increased diaphoresis
A nurse is discussing transcutaneous electrical nerve stimulation (TENS) treatment with a client who has chronic lower back pain. Which of the following statements should the nurse include? (Select all that apply.) - CORRECT ANSWER "You can be taught how to use TENS therapy at home."
"The TENS therapy delivers low-voltage electrical impulses to the skin over the painful areas."
"We will adjust the intensity, pulse rate, and duration of the electrical pulses during your therapy."
A nurse is discussing cutaneous stimulation with a client who has back pain. Which of the following methods should the nurse include? (Select all that apply.) - CORRECT ANSWER Transcutaneous electronic stimulating unit (TENS unit)
Massage
Acupuncture
Cold therapy
A nurse is caring for a client who has a prescription for oxycodone 5 to 10 mg PO every 4 to 6 hr as needed for pain rating 7 to 10 on a 0 to 10 scale. Fifteen minutes after receiving the dose, the client reports to the nurse their pain is still a 7 and has not changed. Which of the following actions should the nurse take? - CORRECT ANSWER Offer to assist the client with nonpharmacological relief strategies.
A nurse is monitoring a client who is 2 hr postoperative and is receiving morphine via PCA pump. Which of the following findings should the nurse plan to monitor to detect opioid-induced ventilatory impairment (OIVI)? (Select all that apply.) - CORRECT ANSWER Respiratory rate
Capnography
Oxygen saturation
A nurse is evaluating a client's pain level using the PQRST mnemonic. Which of the following questions should the nurse ask to evaluate the letter "R"? - CORRECT ANSWER "Can you point to where you are having your pain?"
A nurse is reviewing a new prescription with a client who reports difficulty managing their chronic pain. Which of the following statements should the nurse include? - CORRECT ANSWER "You should write down the pain interventions you use and your pain rating before and after."
A nurse is discussing the use of heat therapy with a newly licensed nurse. The nurse should include that heat therapy is effective for which of the following conditions? (Select all that apply.) - CORRECT ANSWER Muscular pain
Backache
Menstrual discomfort
A nurse is teaching staff about the ethical principle of justice and how it relates to pain management for clients. Which of the following statements should the nurse make? - CORRECT ANSWER "Justice allows the client the opportunity to be treated fairly."
A nurse is caring for a client who is postoperative following abdominal surgery and has a morphine PCA pump. Which of the following medications should the nurse ensure is available in case the client develops respiratory depression? - CORRECT ANSWER Naloxone
A nurse is caring for a client who has a prescription for hydromorphone 1 to 2 mg IM every 4 hr as needed for a pain rating of 4 to 6 on a 0 to 10 scale. The client has never taken hydromorphone before. Which of the following actions should the nurse plan to take? - CORRECT ANSWER Administer 1 mg IM.
A nurse is caring for a client who has a prescription for heat therapy for knee pain. The nurse should apply heat therapy to the client's knee for how long? - CORRECT ANSWER 20 min
A charge nurse is reviewing factors that can affect a client's perception of pain with a newly licensed nurse. Which of the following should the charge nurse include? (Select all that apply.) - CORRECT ANSWER Stress
Culture
Social support
Disease severity
A nurse is planning to teach coworkers about the legal and ethical principles used with pain management. Which of the following examples should the nurse include as an example of autonomy? - CORRECT ANSWER A nurse provides a client with the opportunity to take an intramuscular injection or oral medication for pain relief.
A nurse is evaluating a group of clients who are experiencing pain. Which of the following clients should the nurse identify as experiencing neuropathic pain? - CORRECT ANSWER A client who has diabetes mellitus and reports bilateral burning foot pain without signs of injury
A nurse is discussing end-of-life pain management with a group of coworkers. Which of the following should the nurse include as barriers to end-of life pain management? (Select all that apply.) - CORRECT ANSWER Fear of addiction
Belief that pain is an expected part of their illness
Inadequate pain assessment
A nurse is caring for a client who has severe pain and repeatedly asks for pain medication. The nurse is busy and forgets to assess the client's pain and administer prescribed pain medication. Which of the following can the nurse be charged with? - CORRECT ANSWER Negligence
A nurse is reviewing the plan of care for several clients who are receiving treatment for pain. Which of the following actions should the nurse plan to take to evaluate the clients' pain control? (Select all that apply.) - CORRECT ANSWER Consider each client's cultural preferences.
Determine the effectiveness of nonpharmacological strategies.
Use a pain scale specific to each client's cognitive abilities.
A nurse is reviewing discharge instructions for a client who has a prescription for morphine oral solution 10 to 20 mg every 4 hr PRN. Which of the following statements by the client indicates an understanding of the instructions? - CORRECT ANSWER "I will keep the morphine bottle in a locked cabinet in my kitchen."
A nurse is discussing the FLACC scale with a newly licensed nurse. Which of the following categories should the nurse include? (Select all that apply.) - CORRECT ANSWER Face
Legs
Consolability
A nurse is caring for two clients who are 2 hr postoperative following the same procedure. Which of the following factors should the nurse expect to be similar for both clients? - CORRECT ANSWER Prescriptions containing guidelines for pain medication administration
A nurse is preparing to assess the pain level of a 4-year-old child. Which of the following pain assessment tools should the nurse use? - CORRECT ANSWER FACES
A nurse is speaking with a client who reports experiencing frequent, severe migraines and asks, "Can you tell me about biofeedback?" Which of the following responses should the nurse make? - CORRECT ANSWER "Biofeedback measures skin tension and uses learned techniques to relieve pain."
A nurse is planning to administer a dose of morphine sulfate IV for a client who is postoperative. Which of the following pain management protocols should the nurse use when caring for this client? - CORRECT ANSWER Have an opioid antagonist available during the administration.
A nurse is caring for a client prescribed IV morphine via PCA with a demand of 1 mg every 15 min and a 4 mg/hr lockout. The client reports unbearable pain after attempting six demand doses within the last hour. After assessing the client's pain, which of the following actions should the nurse take? - CORRECT ANSWER Check the IV site and PCA pump for proper functioning.
During a pain assessment, a nurse asks questions about the quality of an adult client's pain. Which of the following statements by the client refers to pain quality? - CORRECT ANSWER My pain feels like I'm being stabbed by a knife."
A nurse is caring for a client who was admitted to the emergency department for severe pain following a fall from a ladder. The client reports taking an opioid prescription for chronic pain. Which of the following provider prescriptions for initial pain relief should the nurse question? - CORRECT ANSWER Naloxone
A patient is admitted to the hospital for multiple injuries and is put on an intravenous analgesia. After a couple of hours, the patient is still in severe pain. The nurse finds that the skin around the intravenous catheter is red and swollen. The nurse finds no other changes in the patient's condition. What should be the immediate response of the nurse? - CORRECT ANSWER Change the intravenous access line.
The nurse should continuously monitor the intravenous access line to check the patency of the IV line. Pain medication or analgesics are effective only if the intravenous (IV) access is patent. The swelling around the intravenous catheter indicates that the IV line is blocked. Therefore, the nurse should first change the intravenous access line. If there is no improvement in the patient's condition after changing the IV line then the nurse should notify the primary health care provider. The primary health care provider would change the analgesic or increase the dose of the analgesic drug if necessary.
Which nursing action is most appropriate while providing transcutaneous electrical nerve stimulation (TENS) to a patient for pain relief? - CORRECT ANSWER Removing any hair at the site before attaching the electrodes
The nurse should remove any hair or skin preparations at the site before attaching the electrodes to provide maximum effectiveness. The intensity and quality of skin stimulation is adjusted by the primary health care provider until the pain subsides. While providing cold therapy, the nurse has to apply firm pressure and provide slow, steady, and circular massage to the patient in pain. A tingling sensation is common, which is harmless, while providing TENS.
While treating a patient, the primary health care provider encourages the patient to watch funny videos. This is an example of which pain management technique? - CORRECT ANSWER Distraction
Patients who are bored or in isolation may think more frequently about their pain, thus perceiving it more acutely. Watching videos may direct the patient's attention to something other than pain, reducing awareness of it. This is an example of using distraction to manage pain. Relaxation techniques include meditation, yoga, guided imagery, and progressive relaxation exercises. Acupressure is applying pressure to specific points on the body in order to influence nerve pathways to decrease pain perception. Like distraction, music therapy works by taking the patient's attention away from the pain, but this is done with music, not videos.
A physician put a postoperative patient on a patient-controlled opioid analgesic pump to be used around the clock for a week. Which assessment should the nurse make at regular intervals? - CORRECT ANSWER Respiratory rate
While there is little risk for overdose with patient-controlled analgesic pumps, respiratory depression is a side effect associated with opioids, so while the patient is on opioid pain management, the nurse should regularly check respiratory rate. A nurse may check liver enzymes in a patient who is taking acetaminophen, not opioids, because acetaminophen can adversely affect the liver. Whereas blood pressure and body temperature may be checked regularly, it is unlikely that the nurse is doing this to monitor for side effects of opioid pain management.
Which statement is true regarding nonpharmacological pain interventions? - CORRECT ANSWER Nonpharmacological interventions are useful for patients who cannot tolerate pain medications.
Nonpharmacological pain relief can be useful for patients who cannot tolerate pain medications. The remaining statements, however, are false. Nonpharmacological interventions may be used alone, but they can also be used in combination with pharmacological therapies. Depending on the nonpharmacological therapy, research is still in progress to determine clear guidelines for intensity and duration. For acute pain, nonpharmacological therapy should never replace pharmacological therapy.
Which pain management drug is considered the best tolerated and safest analgesic? - CORRECT ANSWER Acetaminophen
Acetaminophen is considered the best tolerated and safest analgesic used in pain management. Fentanyl and tramadol are opioids, which have the potential for significant side effects and often result in patients building a tolerance to them. Acetylcysteine is not an analgesic; rather, it is used to treat acetaminophen overdose.
The nurse has to administer opioids to a female patient after a surgical procedure. Which conditions may require special consideration before administration of opioids? Select all that apply. - CORRECT ANSWER Breastfeeding
Dialysis
Respiratory disease
Special considerations such as a breastfeeding mother, a patient on dialysis, and any respiratory conditions should be assessed carefully before administering opioids. Opioids may pass into the breast milk. It is excreted through the kidneys, and a patient on dialysis may require adjustment of the dose. Opioids tend to depress the respiratory system. Therefore, a preexisting respiratory disease may become aggravated. A history of orthopedic surgery and chronic headaches do not affect opioid administration.
The nurse is initiating patient-controlled analgesia (PCA) per the health care provider's prescription to the patient who has myalgia. The nurse inserts the needleless adaptor at the Y-site of the intravenous tubing. What is the purpose of this nursing action? - CORRECT ANSWER The route for medication administration into IV line is established.
Inserting the needleless adapter at the Y-site of the peripheral IV site establishes medication entry into the main IV line. Wiping the needle with alcohol or antiseptic solution provides aseptic environment by reducing the chances of infection. Positioning the patient in a comfortable position while providing PCA ensures unimpeded flow of infusion. Inserting a medication cartridge into the infusion device and prime tubing prevents entry of air from infusion to the IV line.
A patient with cancer is administered 60 mg oral morphine per day for chronic pain. The response to this dose is decreasing after repeated administration. The patient now needs to increase the dose of the morphine to achieve adequate pain control. What is this phenomenon called? - CORRECT ANSWER Tolerance
In patients with chronic pain, if the dose of the drug for pain relief needs to be increased over time to achieve the same effect, the condition is called tolerance. There is no craving for the drug in tolerance. In cases of addiction, the patient craves the drug and uses the drug compulsively despite knowing that it is harmful. In pseudoaddiction, the patient seeks many primary health care providers for pain medications to get adequate pain relief. Physical dependence is a state in which the patient develops withdrawal symptoms upon stopping the drug abruptly.
Which analgesic drug depresses the central nervous system? - CORRECT ANSWER Fentanyl
Opioid analgesics like fentanyl work by depressing the central nervous system. Aspirin, naproxen, and ibuprofen are nonsteroidal antiinflammatory drugs (NSAIDs), which do not work by depressing the central nervous system but rather by inhibiting prostaglandin synthesis.
A patient has had arthritic pain for 8 years and has surgery to remove a buildup of septic fluid. Postoperative, the patient received morphine through a patient-controlled analgesia (PCA) device for the management of pain. What is the advantage of PCA that the nurse should teach the patient? - CORRECT ANSWER PCA allows self-administration of analgesics.
PCA allows the patient to self-administer analgesic medication whenever needed. There is no risk of overdosage due to the programming. Opioids can be safely administered using PCA. It allows intravenous or subcutaneous administration of medications.
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. What does the nurse recognize as these symptoms? - CORRECT ANSWER Physical dependence
Physical dependence is a state of adaptation that is manifested by a drug-class specific withdrawal syndrome produced by abrupt cessation of the drug, rapid dose reduction, decreasing blood levels of the drug, and/or the administration of an antagonist.
The patient who has chronic back pain and is on analgesic treatment reports, "The medication isn't helping my back pain. I am not getting any relief." Which immediate nursing action would be beneficial? - CORRECT ANSWER Seeking the primary health care provider's help to obtain an alternative treatment
If a patient has no relief from pain and experiences discomfort, the nurse should inform the health care provider regarding the patient's condition. An alternative treatment should be given to the patient to provide comfort. Any discomfort experienced by the patient should be considered as a priority issue and must be resolved immediately. The maximum effective treatment is provided by time and patience. Therefore, the nurse has to explain to the patient about what is expected before initiation of the treatment. Reassuring the patient about frequent checkups and assessment for changes in pain level is not an immediate nursing action in this situation.
A group of nursing students is learning about nociceptive and neuropathic pain. What are examples of neuropathic pain? Select all that apply. - CORRECT ANSWER Diabetic neuropathy
Trigeminal neuralgia
Nerve root compression
Neuropathic pain arises when there is abnormal processing of sensory input by the peripheral or central nervous system. Pain felt along the distribution of many peripheral nerves as in diabetic neuropathy is a neuropathic pain. Pain felt partly along the distribution of a damaged nerve such as in nerve root compression is also an example of neuropathic pain. Pain associated with trigeminal neuralgia is also a neuropathic pain. Aching muscles and a throbbing pain at the knee joint are examples of nociceptive pain.
The nurse is initiating patient-controlled analgesia (PCA) for the postoperative patient. The nurse inserts the drug cartridge into the infusion pump and primes the PCA tubing. What is the rationale behind this action? - CORRECT ANSWER To establish flow and prevent air from infusing
While administering PCA, the drug cartridge is inserted into the infusion device and prime tubing to establish flow and prevent air from infusing. The infuser and patient-controlled modules are checked for accurate labeling to avoid medication error. Needleless systems are used to prevent needlestick injuries. The patient is positioned comfortably and venipuncture or central line site is checked for accessibility to ensure unimpeded flow of infusion.
When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information should the nurse include? - CORRECT ANSWER TENS electrodes are applied near or directly on the site of pain.
TENS involves stimulation of the skin with a mild electrical current passed through external electrodes. The therapy requires a health care provider order. The TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. Place the electrodes directly over or near the site of pain.
Which nursing action facilitates visual inspection of the intravenous site? - CORRECT ANSWER Using a transparent dressing to secure the catheter
Using a transparent dressing to secure the catheter aids in inspection of the intravenous site and helps maintain the catheter's function. Changing the dressing frequently may increase the risk of infection. Securing the catheter to outside of the skin prevents catheter displacement. Using strict aseptic techniques when caring for catheters prevents infection.
A postoperative patient is currently asleep. Which statement is correct? - CORRECT ANSWER The sedative administered may have helped him sleep, but assessment of pain is still needed.
Sedatives, antianxiety agents, and muscle relaxants have no analgesic effect; however, they can cause drowsiness impaired coordination, judgment, and mental alertness and contribute to respiratory depression. It is important to avoid attributing these adverse effects solely to the opioid. You need to conduct a thorough reassessment.
The nurse is teaching a patient with acute pain about transcutaneous electrical nerve stimulation (TENS). Which statement made by the patient indicates a need for further teaching? - CORRECT ANSWER "TENS can be applied at a frequency of my choice."
TENS can be applied at a frequency of between 10 and 50 Hz. The frequency is prescribed by the primary health care provider, not according to the patient's choice. The patient may adjust the intensity or quality of the stimulation, but not the frequency. The TENS electrodes are applied near the site of pain. It works effectively to relieve postsurgical pain and requires a health care provider's order.
The nursing student is massaging the patient who has peripheral vascular disease to provide relaxation by reducing pain. Which action if performed by the nursing student indicates a need for correction? - CORRECT ANSWER Massaging the patient's legs and calf muscles
The nurse should not massage the leg and calf regions in a patient who has peripheral vascular disease, because it may lead dislodge a clot. The nurse should massage the wrist and forearm using gliding strokes to provide a stretch to the muscles and help the patient to relax. The nurse should use a warm body lotion, such as a lubricant that helps maintain skin integrity. The nurse should massage each finger with a corkscrew-like motion from the base of the finger to the fingertip, which makes the muscle soften and relax.
While assessing a patient who is taking morphine, the nurse notices that the patient is developing signs of respiratory depression. Which drug should be immediately administered to this patient? - CORRECT ANSWER Naloxone
Respiratory depression is a complication of opioid overdose. Naloxone is an opioid antagonist administered to patients who experience opioid overdose. Fentanyl is an opioid drug by itself and, therefore, should not be administered to the patient. Naproxen is a nonsteroidal antiinflammatory drug, which will not improve the patient's respiratory status. Acetylcysteine is a drug of used to reverse an acetaminophen overdose.
Which instructions are crucial for the nurse to give to both family members and the patient who is about to be started on patient-controlled analgesia (PCA) of morphine? - CORRECT ANSWER Only the patient should push the button.
Patient preparation and teaching are critical to the safe and effective use of PCA devices. Patients need to understand PCA and be physically able to locate and press the button to deliver the dose. Be sure to instruct family members not to push the button for the patient.
The registered nurse instructed the nursing student to wipe the injection port vigorously with alcohol for 15 seconds, while caring for a patient receiving intravenous pain medication. What is the rationale behind the nursing action? - CORRECT ANSWER To reduce the risk of a blood-stream infection
The registered nurse instructed the nursing student to wipe the injection port vigorously with alcohol for 15 seconds to reduce the risk of blood-stream injection. The nurse should recheck before leaving the patient to ensure patency of the IV line. When the nurse labels patient-controlled analgesia tubing, he or she prevents medication incompatibility. When the nurse inserts the drug cartridge into the infusion device, it prevents air from infusing into the IV tubing.
A nurse at a clinic is collecting data about pain from a client who reports severe abdominal pain. the nurse asks the client whether he has nausea and has been vomiting. which of the following pain characteristics is the nurse attempting to determine? - CORRECT ANSWER A. presence of associated manifestations
A nurse is collecting data from a client who is reporting pain despite taking analgesia. which of the following actions should the nurse take to determine the intensity of the client's pain? - CORRECT ANSWER C. offer the client a pain scale to measure his pain
A nurse is discussing the care of a group of clients with a newly licensed nurse. which of the following clients should the newly licensed nurse identify has experiencing chronic pain? - CORRECT ANSWER D. a client who has episodic back pain following a fall 2 years ago
A nurse is monitoring a client who is receiving opioid analgesia for adverse effects of the medication. which of the following effects should the nurse anticipate? select all that apply - CORRECT ANSWER C. bradypnea
D. orthostatic hypotension
E. nausea
A nurse is caring for a client who is receiving morphine via a Patient controlled analgesia infusion device after abdominal surgery. which of the following statements indicates that the client knows how to use the device? - CORRECT ANSWER C. i should tell the nurse if the pain does't stop while i am using the device [Show Less]