Pain Management NCLEX Practice Quiz 57 Questions with Verified Answers
A client with chronic pain reports to you, the charge nurse, that the nurse have
... [Show More] 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. - CORRECT ANSWER have a conference with the nurses responsible for the care of this client
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 - CORRECT ANSWER sociocultural
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) - CORRECT ANSWER amitriptyline (Elavil)
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 - CORRECT ANSWER A client with progressive pancreatic cancer
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. - CORRECT ANSWER Give praise 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 - CORRECT ANSWER C. Faces pain-rating scale
In applying the principles of pain treatment, what is the first consideration?
A. Treatment is based on client goals.
B. A multidisciplinary approach is needed.
C. The client must be believed about perceptions of own pain.
D. Drug side effects must be prevented and managed. - CORRECT ANSWER C. The client must be believed about perceptions of own pain.
Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
A. Intraspinal
B. Patient-controlled analgesia (PCA)
C. Intravenous (IV)
D. Sublingual - CORRECT ANSWER C. Intravenous (IV)
When titrating an analgesic to manage pain, what is the priority goal?
A. Administer smallest dose that provides relief with the fewest side effects.
B. Titrate upward until the client is pain free.
C. Titrate downwards to prevent toxicity.
D. Ensure that the drug is adequate to meet the client's subjective needs. - CORRECT ANSWER A. Administer smallest dose that provides relief with the fewest side effects.
In educating clients about non-pharmaceutical alternatives, which topic could you delegate to an experienced LPN/LVN, who will function under your continued support and supervision?
A. Therapeutic touch
B. Use of heat and cold applications
C. Meditation
D. Transcutaneous electrical nerve stimulation (TENS) - CORRECT ANSWER B. Use of heat and cold applications
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
_____, _____, _____ - CORRECT ANSWER bca
NSAIDS & corticosteroids; Codeine, oxycodone and diphenhydramine; morphine, hydromorphone, acetaminophen, and lorazepam
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 - CORRECT ANSWER D. A child with an arm fracture and cystic fibrosis
A client appears upset and tearful, but denies pain and refuses pain medication, because "my sibling is a drug addict and has ruined out lives." What is the priority intervention for this client?
A. Encourage expression of fears on past experiences.
B. Provide accurate information about use of pain medication.
C. Explain that addiction is unlikely among acute care clients.
D. Seek family assistance in resolving this problem. - CORRECT ANSWER A. Encourage expression of fears on past experiences.
A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?
A. Fever
B. Nausea
C. Diaphoresis
D. Abdominal cramps - CORRECT ANSWER C. Diaphoresis
In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant?
A. Assist the client with preparation of a sitz bath.
B. Monitor the client for signs of discomfort while ambulating
C. Coach the client to deep breathe during painful procedures
D. Evaluate relief after applying a cold application. - CORRECT ANSWER A. Assist the client with preparation of a sitz bath.
The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take?
A. Prepare the medication and hand it to the physician
B. Check the hospital policy regarding use of the placebo.
C. Follow a personal code of ethics and refuse to give it.
D. Contact the charge nurse for advice. - CORRECT ANSWER D. Contact the charge nurse for advice.
For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?
A. Closely assess for nonverbal signs such as grimacing or rocking.
B. Obtain baseline behavioral indicators from family members.
C. Look at the MAR and chart, to note the time of the last dose and response.
D. Give the maximum PRS dose within the minimum time frame for relief. - CORRECT ANSWER B. Obtain baseline behavioral indicators from family members.
Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)?
A. IV
B. IM or subcutaneous
C. Oral
D. Transdermal
E. PCA - CORRECT ANSWER C. Oral
A first day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
A. Deliver the bolus dose per standing order.
B. Contact the physician to increase the dose.
C. Try non-pharmacological comfort measures.
D. Assess the pain for location, quality, and intensity. - CORRECT ANSWER D. Assess the pain for location, quality, and intensity.
Which non-pharmacological measure is particularly useful for a client with acute pancreatitis?
A. Diversional therapy, such as playing cards or board games
B. Massage of back and neck with warmed lotion
C. Side-lying position with knees to chest and pillow against abdomen
D. Transcutaneous electrical nerve stimulation (TENS) - CORRECT ANSWER C. Side-lying position with knees to chest and pillow against abdomen
What is the best way to schedule medication for a client with constant pain?
A. PRN at the client's request
B. Prior to painful procedures
C. IV bolus after pain assessment
D. Around-the-clock - CORRECT ANSWER D. Around-the-clock
Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.)
A. A client who needs pre-op teaching for use of a PCA pump
B. A client with a leg cast who needs neurologic checks and PRN hydrocodone
C. A client post-op toe amputation with diabetic neuropathic pain
D. A client with terminal cancer and severe pain who is refusing medication - CORRECT ANSWER B. A client with a leg cast who needs neurologic checks and PRN hydrocodone
C. A client post-op toe amputation with diabetic neuropathic pain
For a client who is taking aspirin, which laboratory value should be reported to the physician?
A. Potassium 3.6 mEq/L
B. Hematocrit 41%
C. PT 14 seconds
D. BUN 20 mg/dL - CORRECT ANSWER C. PT 14 seconds
Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? (Choose all that apply.)
A. An anxious, chronic pain client who frequently uses the call button
B. A client second day post-op who needs pain medication prior to dressing changes
C. A client with HIV who reports headache and abdominal and pleuritic chest pain
D. A client who is being discharged with a surgically implanted catheter - CORRECT ANSWER B. A client second day post-op who needs pain medication prior to dressing changes
A family member asks you, "Why can't you give more medicine? He is still having a lot of pain." What is your best response?
A. "The doctor ordered the medicine to be given every 4 hours."
B. "If the medication is given too frequently he could suffer ill effects."
C. "Please tell him that I will be right there to check of him."
D. "Let's wait about 30-40 minutes. If there is no relief I'll call the doctor." - CORRECT ANSWER C. "Please tell him that I will be right there to check of him."
____ 1. A patient suddenly develops right lower-quadrant pain, nausea, vomiting, and rebound tenderness. How should the nurse classify this patients pain?
1)
Acute
2)
Chronic
3)
Intractable
4)
Neuropathic - CORRECT ANSWER 1
____ 2. How should the nurse classify pain that a patient with lung cancer is experiencing?
1)
Radiating
2)
Deep somatic
3)
Visceral
4)
Referred - CORRECT ANSWER 3
____ 3. A patient who underwent a left above-the-knee amputation complains of pain in his left foot. The nurse should document this finding as what type of pain?
1)
Psychogenic
2)
Phantom
3)
Referred
4)
Radiating - CORRECT ANSWER 2
____ 4. A patient who sustained a leg laceration in an industrial accident is brought to the emergency department. The area around the laceration is red, swollen, and tender. Which substance is responsible for causing this response?
1)
Histamine
2)
Prostaglandin
3)
Bradykinin
4)
Serotonin - CORRECT ANSWER 3
____ 5. In which process do peripheral nerves carry the pain message to the dorsal horn of the spinal cord?
1)
Transduction
2)
Transmission
3)
Perception
4)
Modulation - CORRECT ANSWER 2
____ 6. A patient reports that he uses music therapy to help control his chronic pain. Music therapy works by prompting the release of endogenous opioids during which stage of the pain process?
1)
Perception
2)
Transduction
3)
Transmission
4)
Modulation - CORRECT ANSWER 4
____ 7. The nurse is assessing an intubated patient who returned from coronary artery bypass surgery 3 hours ago. Which assessment finding might indicate that this patient is experiencing pain?
1)
Blood pressure 160/82 mm Hg
2)
Temperature 100.6F
3)
Heart rate 80 beats/min
4)
Oxygen saturation 95% - CORRECT ANSWER 1
____ 8. A patient who sustained rib fractures in a motor vehicle accident is complaining that his pain medication is ineffective. Inadequate pain control places this patient at risk for which complication?
1)
Metabolic alkalosis
2)
Pneumothorax
3)
Pneumonia
4)
Hemothorax - CORRECT ANSWER 3
____ 9. When should the nurse assess pain?
1)
Whenever a full set of vital signs is taken
2)
During the admission interview
3)
Every 4 hours for the first 2 days after surgery
4)
Only when the patient complains of pain - CORRECT ANSWER 1
____ 10. Which nursing diagnosis is most appropriate for the patient who returns from the postanesthesia care unit after undergoing right hemicolectomy surgery for colon cancer?
1)
Acute pain secondary to surgery
2)
Acute pain (abdominal) secondary to surgery for colon cancer
3)
Chronic pain secondary to cancer diagnosis
4)
Chronic pain (abdominal) secondary to abdominal surgery - CORRECT ANSWER 2
____ 11. Which drug might the primary care provider prescribe to help facilitate pain management in a client with chronic pain?
1)
Selective serotonin reuptake inhibitor
2)
Selective norepinephrine reuptake inhibitor
3)
Narcotic analgesic
4)
Anti-emetic - CORRECT ANSWER 1
____ 12. The nurse administers acetaminophen 325 mg and codeine 30 mg orally to a patient complaining of a severe headache. When should the nurse reassess the patients pain?
1)
15 minutes after administration
2)
60 minutes after administration
3)
90 minutes after administration
4)
Immediately before the next dose is due - CORRECT ANSWER 2
____ 13. After receiving ibuprofen (Motrin) 800 mg orally for right hip pain, the patient states that his pain is 8 out of 10 on the numerical pain scale. Which action should the nurse take?
1)
Use nonpharmacological therapy while waiting 3 more hours before the next dose.
2)
Administer an additional 800 mg oral dose of ibuprofen right away.
3)
Do nothing because the patients facial expression indicates he is comfortable.
4)
Notify the prescriber that the current pain management plan is ineffective. - CORRECT ANSWER 4
____ 14. The nurse is teaching a client who sustained an ankle injury about cold application. Which instruction should the nurse include in the teaching plan?
1)
Place the cold pack directly on the skin over the ankle.
2)
Apply the cold pack to the ankle for 30 minutes at a time.
3)
Check the skin frequently for extreme redness.
4)
Keep the cold pack in place for at least 24 hours. - CORRECT ANSWER 3
____ 15. The nurse plays music for a child with leukemia who is experiencing pain. Which pain management technique is this nurse using?
1)
Distraction
2)
Guided imagery
3)
Sequential muscle relaxation
4)
Hypnosis - CORRECT ANSWER 1
____ 16. The nurse uses his hands to direct energy fields surrounding the patients body. After this intervention, the patient states that his pain has lessened. How should the nurse document the intervention?
1)
Tactile distraction was performed and appeared effective in reducing pain.
2)
Guided imagery was effective to relax the patient and reduce the pain.
3)
Therapeutic touch was performed; patient verbalized lessening of pain after treatment.
4)
Sequential muscle relaxation was performed; patient states pain is less. - CORRECT ANSWER 3
____ 17. A patient prescribed a nonsteroidal anti-inflammatory drug (NSAID), naproxen (Aleve, Naprosyn), for treatment of arthritis complains of stomach upset. What should the nurse instruct the patient to do?
1)
Notify the prescriber immediately.
2)
Take the medication with food.
3)
Take the medication with 8 ounces of water.
4)
Take the medication before bedtime. - CORRECT ANSWER 2
____ 18. A patient is prescribed morphine sulfate 4 mg intravenously for postoperative pain. Which action should the nurse take before administering the medication?
1)
Monitor the patients respiratory status.
2)
Auscultate the patients heart sounds.
3)
Check blood pressure in supine and sitting positions.
4)
Monitor the patient for psychological drug dependence. - CORRECT ANSWER 1
____ 19. A client reports taking acetaminophen (Tylenol) to control osteoarthritis. Which instruction should the nurse give the patient requiring long-term acetaminophen use?
1)
Caution the patient against combining acetaminophen with alcohol.
2)
Explain that acetaminophen increases the risk for bleeding.
3)
Advise taking acetaminophen with meals to prevent gastric irritation.
4)
Explain that physical dependence may occur with long-term oral use. - CORRECT ANSWER 1
____ 20. Which side effects associated with opioid use may improve after taking a few doses of the drug?
1)
Constipation
2)
Drowsiness
3)
Dry mouth
4)
Difficulty with urination - CORRECT ANSWER 2
____ 21. A patient develops a respiratory rate 6 breaths/minute after receiving IV hydromorphone (Dilaudid) 2 mg. Which medication should the nurse anticipate administering to this patient after notifying the prescriber of this side effect?
1)
Physostigmine (Antilirium)
2)
Flumazenil (Romazicon)
3)
Naloxone (Narcan)
4)
Protamine sulfate - CORRECT ANSWER 3
____ 22. Which pain management task can be safely delegated to nursing assistive personnel?
1)
Assessing the quality and intensity of the patients pain
2)
Evaluating the effectiveness of pain medication
3)
Providing a therapeutic back massage
4)
Administering oral dose of acetaminophen - CORRECT ANSWER 3
____ 23. Which expected outcome is best for the patient with a nursing diagnosis of Acute Pain related to movement and secondary to surgical resection of a ruptured spleen and possible inadequate analgesia?
1)
The patient will verbalize a reduction in pain after receiving pain medication and repositioning.
2)
The patient will rest quietly when undisturbed.
3)
On a scale of 0 to 10, the patient will rate pain as a 3 while in bed or as a 4 during ambulation.
4)
The patient will receive pain medication every 2 hours as prescribed. - CORRECT ANSWER 3
____ 24. A patient had a bowel resection 5 days ago. Which request by the patient might alert the nurse that the patient has a history of substance abuse?
1)
Oral pain medication once every 6 to 8 hours
2)
Patient-controlled analgesic
3)
Oral pain medications instead of the IM form
4)
Only nonpharmacological pain measures - CORRECT ANSWER 2
____ 25. A patient with Raynauds disease receives no symptomatic relief with diltiazem (Cardizem). Which surgical intervention might be a treatment option for this patient to help provide symptomatic relief?
1)
Cordotomy
2)
Rhizotomy
3)
Neurectomy
4)
Sympathectomy - CORRECT ANSWER 4
____ 26. Which action should the nurse take first when the patient has a score of 4 on the sedation rating scale?
1)
Stimulate the patient.
2)
Prepare to administer naloxone (Narcan).
3)
Administer a dose of pain medication.
4)
Notify the physician immediately. - CORRECT ANSWER 1
____ 27. A patient with a history of mitral valve replacement, hypertension, and type 2 diabetes mellitus undergoes emergency surgery to remove an embolus in her right leg. Which factor contraindicates the use of epidural analgesia in this patient?
1)
Anticoagulant therapy
2)
Diabetes mellitus
3)
Hypertension
4)
Embolectomy - CORRECT ANSWER 1
____ 28. After undergoing dural puncture while receiving epidural pain medication, a patient complains of a headache. Which action can help alleviate the patients pain?
1)
Encourage the client to ambulate to promote flow of spinal fluid.
2)
Offer caffeinated beverages to constrict blood vessels in his head.
3)
Encourage coughing and deep breathing to increase CSF pressure.
4)
Restrict oral fluid intake to prevent excess spinal pressure. - CORRECT ANSWER 2
____ 29. An older adult receiving hospice care has dementia as a result of metastasis to the brain. His bone cancer has progressed to an advanced stage. Why might the client fail to request pain medication as needed? The client:
1)
Experiences less pain than in earlier stages of cancer.
2)
Cannot communicate the character of his pain effectively.
3)
Recalls pain at a later time than when it occurs.
4)
Relies on caregiver to provide pain relief without asking. - CORRECT ANSWER 2
____ 30. What is typically the most reliable indicator of pain?
1)
Patients self-report
2)
Past medical history
3)
Description by caregiver(s)
4)
Behavioral cues - CORRECT ANSWER 1
____ 1. A 73-year-old patient admitted after a stroke has expressive aphasia. Which pain intensity scale(s) would be appropriate to use with this patient? Choose all that apply.
1)
Visual analog
2)
Numerical rating
3)
Wong-Baker face rating
4)
Simple descriptor - CORRECT ANSWER 1, 3
____ 2. A patient diagnosed with lung cancer who is receiving morphine (MS Contin) complains of constipation. Which instruction(s) by the nurse might help relieve the patients constipation? Choose all that apply.
1)
Be sure the amount of fruit, vegetables, and fiber in your diet is adequate.
2)
Drink at least eight 8-ounce glasses of water each day.
3)
Avoid using stool softeners because they may become habit forming.
4)
Increase your exercise routine to include 1 hour of exercise a day. - CORRECT ANSWER 1,2 [Show Less]