Pain Management Practice 62 Questions with Verified Answers
B
Sedation is a concern because it may indicate that the patient is experiencing
... [Show More] opioid-related side effects. Advancing sedation may indicate that the patient may progress to respiratory depression. - CORRECT ANSWER Which of the following signs or symptoms in an opioid-naive patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid?
A. Oxygen saturation of 95%
B. Difficulty arousing the patient
C. Respiratory rate of 10 breaths/min
D. Pain intensity rating of 5 on a scale of 0 to 10
C
Constipation is a common opioid-related side effect, and patients do not become tolerant to it. - CORRECT ANSWER 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?
A. Opioid antagonists
B. Antiemetics
C. Stool softeners
D. Muscle relaxants
B
Long-acting or sustained-release opioids are dosed on a scheduled basis, not prn, to provide a base of continuous opioid analgesia. - CORRECT ANSWER 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?
A. The drug
B. The time interval
C. The dose
D. The route
C
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. - CORRECT ANSWER The nurse reviews a patient's medical administration record (MAR) and finds that the patient has received acetaminophen 2Gs, two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most?
A. The patient's level of pain
B. The potential for addiction
C. The amount of daily acetaminophen
D. The risk for gastrointestinal bleeding
D
The common symptoms of opioid withdrawal that are associated with physical dependence may develop when an opioid is withdrawn rapidly.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. - CORRECT ANSWER 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:
A. Opioid toxicity.
B. Opioid tolerance.
C. Opioid addiction.
D. Opioid withdrawal.
A
Patient'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. - CORRECT ANSWER 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?
A. Patient's self-report
B. Behaviors
C. Surrogate (wife) report
D. Vital sign changes
A
A 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). - CORRECT ANSWER A postoperative patient currently is asleep. Therefore the nurse knows that:
A. The sedative administered may have helped him sleep, but it is still necessary to assess pain.
B. The intravenous (IV) pain medication given in recovery is relieving his pain effectively.
C. Pain assessment is not necessary.
D. The patient can be switched to the same amount of medication by the oral route.
A, C, E
The safety of PCA is based on the fact that it requires an awake patient to activate the button. The safety is compromised when someone else pushes the button for the patient. A limit on the number of doses per hour or 4-hour intervals may be set. Opioids (morphine PCA) are intended to provide analgesia; drowsiness is an undesirable potential side effect of opioids, and the PCA should only be used for analgesia. - CORRECT ANSWER 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.)
A. Only the patient should push the button.
B. Do not use the PCA until the pain is severe.
C. The PCA system can set limits to prevent overdoses from occurring.
D. Notify the nurse when the button is pushed.
E. Do not push the button to go to sleep.
2, 5
Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, act by inhibiting prostaglandin synthesis, thereby inhibiting cellular response to inflammation and thus reducing pain. Gastrointestinal bleeding is a major adverse effect of NSAIDs. The remaining statements are incorrect. Opiates, not NSAIDs, depress the central nervous system to relieve pain. Because of the risk for gastrointestinal bleeding, ibuprofen and other NSAIDs are not frequently the first choice for treating pain in older adults. Ibuprofen is not a prescription drug; it is widely available over the counter. - CORRECT ANSWER A primary health care provider recommends ibuprofen to a patient in pain. Which statements about this medication are correct? Select all that apply.
1 It depresses the central nervous system in order to relieve pain.
2 It acts by inhibiting the synthesis of prostaglandins.
3 It is highly recommended for older adults experiencing pain.
4 It is the most effective prescription drug available for pain relief.
5 One of its serious side effects is gastrointestinal bleeding
1
Opioids, not nonsteroidal antiinflammatory drugs (NSAIDs), depress the central nervous system. The other statements indicate effective teaching: NSAIDs inhibit prostaglandin synthesis, which inhibits cellular responses to inflammation; this helps relieve pain. An allergy to aspirin may be indicative of an allergy to other NSAIDs, and NSAIDs may put older adults at an increased risk for gastrointestinal bleeding. - CORRECT ANSWER A registered nurse is teaching a nursing student about using nonsteroidal antiinflammatory drugs (NSAIDs) for pain management. Which of the nursing student's statements indicates a need for further teaching?
1 "NSAIDs work by depressing the central nervous system."
2 "NSAIDs act by inhibiting the synthesis of prostaglandins."
3 "Patients allergic to aspirin are more likely to be allergic to other NSAIDs."
4 "Use of NSAIDS in older adults may result in increased risk of adverse events."
4
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. - CORRECT ANSWER Which pain management drug is considered the best tolerated and safest analgesic?
1 Fentanyl
2 Tramadol
3 Acetylcysteine
4 Acetaminophen
3
Prostaglandins are generated from the breakdown of phospholipids of the cell membrane and are known to increase pain sensitivity. NSAIDs act by decreasing the levels of such compounds in the blood. Renin is involved in balancing water and electrolytes in the body. Neurotransmitters such as serotonin inhibit the transmission of pain. Diclofenac sodium is a painkiller that reduces pain sensitivity. - CORRECT ANSWER A student nurse is reading about the mode of action of nonsteroidal anti-inflammatory drugs (NSAIDS). The NSAID drug decreases the level of a chemical that is known to increase pain sensitivity. With which chemical does the NSAID react?
1 Renin
2 Serotonin
3 Prostaglandin
4 Diclofenac sodium
3
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. - CORRECT ANSWER 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?
1 Liver enzymes
2 Blood pressure
3 Respiratory rate
4 Body temperature
4
A physician may first recommend acetaminophen to this patient because the pain is mild, and acetaminophen is relatively safe and widely available over the counter for musculoskeletal pain. The physician may prescribe aspirin, naproxen, or ibuprofen, but these may be second-choice drugs because they are nonsteroidal antiinflammatory drugs which carry a risk for bleeding, especially in older adults, and may not be necessary if the pain is mild. - CORRECT ANSWER A 65-year-old patient is experiencing mild musculoskeletal pain. Which drug is the primary health care provider most likely to prescribe?
1 Aspirin
2 Naproxen
3 Ibuprofen
4 Acetaminophen
1
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. - CORRECT ANSWER 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?
1 PCA allows self-administration of analgesics.
2 PCA is associated with a risk of overdose.
3PCA does not allow administration of opioids.
4 PCA allows intramuscular administration of medications.
2
Opioid analgesics are effective when used for pain management, but a common side effect is disruption of bowel or bladder function. Anticonvulsants are more commonly associated with side effects like dizziness, fatigue, and confusion than with disrupted bowel and bladder function. Nonopioid analgesics and nonsteroidal antiinflammatory drugs more commonly result in gastric bleeding, hypertension, and nausea than in disruption of bowel and bladder function. - CORRECT ANSWER Which class of pain management drugs may interfere with bowel or bladder function?
1 Anticonvulsants
2 Opioid analgesics
3 Nonopioid analgesics
4 Nonsteroidal antiinflammatory drugs
1
The nurse asks questions such as, "Can you tell me what your discomfort feels like?" to assess the quality of pain. To identify the severity of pain, the nurse can ask, "On a scale of 0 to 10, how bad is your pain now?" To identify the onset and duration of pain the nurse can ask, "When did your pain start?" To identify the intensity of pain the nurse can ask, "How much pain do you have now?" - CORRECT ANSWER During the subjective data collection for pain assessment, the nurse asks the patient, "Can you tell me what your discomfort feels like?" What is the reason for this question?
1 The nurse wants the patient to identify the quality of pain.
2 The nurse wants the patient to identify the severity of pain.
3 The nurse wants the patient to identify the duration of pain.
4 The nurse wants the patient to identify the intensity of pain.
1, 2, 3
The nurse should teach the patient about PCA and evaluate the patient's understanding by asking the patient to repeat what the nurse has taught. The patient should control the administration of the medication based on the pain. The device is programmed to prevent overdose. The family members should not operate the PCA device for the patient because the dose depends on the patient's perception of pain. The patient should be taught the use of the device before the procedures in order to be ready to administer the analgesia after awakening from sedation. - CORRECT ANSWER The nurse is teaching a patient the use of patient-controlled analgesia (PCA). Which interventions should the nurse perform? Select all that apply.
1 Ask the patient to describe the purpose of the PCA device.
2 Emphasize that the patient controls medication delivery.
3 Explain that the pump prevents the risk of overdose.
4 Tell family members to operate the PCA device for the patient.
5 Teach the use of PCA after the patient awakens from sedation
2
The duration of action or half-life of naloxone is less than that of methadone. Therefore, recurrence of respiratory depression by the relatively long action of methadone can be prevented by reassessing the patient every 15 minutes for 2 hours after naloxone administration. Methadone has a greater half-life than naloxone. Therefore, the effect of methadone is more prolonged than that of naloxone. Naloxone is an opioid-antagonist drug. Naloxone does not act as an agonist to morphine after 2 hours. Opioid-naïve patients are patients who have not taken opioid medications for at least a week. Naloxone causes morphine withdrawal symptoms only in patients who are physically dependent on morphine, not the patients who are opioid naïve. - CORRECT ANSWER An opioid-naïve patient is on naloxone for respiratory depression caused by methadone overdose. The nurse is instructed to reassess the patient every 15 minutes for 2 hours following drug administration. What is the reason behind the schedule of reassessment of the patient?
1 The half-life of naloxone is greater than that of methadone.
2 Duration of the action of naloxone is less than that of methadone.
3 Naloxone acts as an agonist to methadone after 2 hours of administration.
4 Naloxone can cause methadone withdrawal symptoms in an opioid-naïve patient.
2
Pain extending from the initial site of injury to another body part is radiating pain. Therefore, because the patient has pain in the back accompanied by pain in the leg, it indicates radiating pain. Pain resulting from stimulation of the skin is cutaneous pain. A patient with pain from a small cut or laceration has cutaneous pain. If the patient has pain at one site but injury at a different site, it indicates referred pain. A patient experiencing a crushing sensation with pain in chest and a burning sensation with severe stomach pain indicates referred pain. - CORRECT ANSWER The nurse concludes that a patient has radiating pain. Which assessment findings support the nurse's conclusion?
1 The patient has pain from a small cut or laceration.
2 The patient has pain in the back accompanied by pain in the leg.
3 The patient has a crushing sensation with pain in the chest.
4 The patient has a burning sensation with severe stomach pain
1
Opioids can cause nausea and vomiting because of the action on the brainstem centers. This side effect decreases with repeated use, but until then, treatment for nausea should be instituted. Decreasing the dose may be ineffective for pain relief. Asking the patient to wait for pain relief is unethical. Withholding the dose may increase the pain. - CORRECT ANSWER A patient complains of nausea after receiving the first dose of morphine for pain. What should the nurse do?
1 Treat nausea with an anti-nausea medication and continue to use morphine
2 Request an order for a nonsteroidal anti-inflammatory drug (NSAID) instead of morphine.
3 Encourage the patient to wait as long as possible for the next dose.
4 Withhold the next dose of morphine until reevaluated by the health care provider.
3
Fentanyl is an opioid analgesic and is available for intravenous or transdermal administration. It is 100 times more potent than morphine. However, transdermal patches are not effective in patients weighing less than 100 pounds, because these patients have very little subcutaneous tissue for absorption. Therefore, the nurse should discuss a more appropriate analgesic drug with the primary health care provider. The dose and the number of patches for the therapeutic action are predetermined. The duration of drug action is about 48 to 72 hours. - CORRECT ANSWER A patient who is in the terminal stages of liver cancer reports continuous vomiting after taking oral opioid analgesics. The patient's weight is 85 pounds. The nurse applies a transdermal fentanyl patch to the patient. The next day, the patient informs the nurse that the pain is not alleviated. What could be the possible reason for this?
1 The dose of pain medication is not enough.
2 The number of patches used is not enough.
3 The route of administration of the analgesic is not correct.
4 The patient needs to wait longer for the medication to act.
2, 3, 4
A patient in acute pain may not be able to concentrate on anything. The patient may have a reduced attention span and may focus only on pain relief. The nurse may observe the patient clenching teeth or biting his or her lips to tolerate or suppress the pain. These patients are usually physically restless due to pain and they do not interact or talk incessantly. - CORRECT ANSWER The nurse is attending to a postsurgical patient who underwent a nephrectomy. What observations would tell the nurse the patient is in severe pain? Select all that apply.
1 The patient is motionless.
2 The patient has a reduced attention span.
3 The patient is constantly asking for pain relief medication.
4 The patient has clenched teeth and is biting his or her lips.
5 The patient is talking incessantly for a long time.
2
Patients usually become tolerant to the side effects of opioids, with the exception of constipation. Routinely administering stimulant laxatives, not simple stool softeners, will prevent and treat constipation in these patients. - CORRECT ANSWER 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 Stool softener
2 Stimulant laxative
3 H2 receptor blocker
4 Proton pump inhibitor
2
Inadequate pain management for postsurgical clients can affect quality of life, function, recovery, and postsurgical complication; thus, all the manifestations are examples of negative results. However, venous thromboembolism can lead to pulmonary embolism, and this is an immediate life-threatening concern. The nurse also needs to implement interventions to resolve unsatisfied needs, fear of pain, and hopelessness related to pain and function.
Test Taking Tip: Use Maslow's hierarchy to identify priorities in caring for clients. Physiologic needs are the first concern. In this case, venous thromboembolism is the most serious physiologic outcome secondary to inadequate pain management - CORRECT ANSWER Which postoperative client is manifesting the most serious negative effect of inadequate pain management?
1. Demonstrates continuous use of call bell related to unsatisfied needs and discomfort
2. Develops venous thromboembolism related to immobility caused by pain and discomfort
3. Refuses to participate in physical therapy because of fear of pain caused by exercises
4. Feels depressed about loss of function and hopeless about getting relief from pain
4
The charge nurse must assess the performance and attitude of the staff in relation to this client. After data are gathered from the nurses, additional information can be obtained from the records and the client as necessary. The educator may be of assistance if a knowledge deficit or need for performance improvement is the problem.
Test Taking Tip: The first step of nursing process is assessment. In this case, the charge nurse applies nursing process to assess the nursing staff's performance and attitudes. - CORRECT ANSWER A client with chronic pain reports to the charge nurse that the other nurses have not been responding to requests for pain medication. What is the charge nurse's initial action?
1. Check the medication administration records for the past several days.
2. Ask the nurse educator to provide in-service training about pain management.
3. Perform a complete pain assessment on the client and take a pain history.
4. Have a conference with the staff nurses to assess their care of this client.
4
One of the common features of rheumatoid arthritis is joint pain and stiffness when first rising. This usually resolves over the course of the day. A nonpharmaceutical measure is to take a warm shower (or apply warm packs to joints if pain is limited to one or two joints). If pain worsens, then the nurse may elect to contact other members of the health care team for additional interventions - CORRECT ANSWER The home health nurse is interviewing an older client with a history of mild heart failure and rheumatoid arthritis. The client reports "feeling pretty good,except for the pain and stiffness in my joints when I first get out of bed." Which member of the health care team would be the most appropriate to aid in the client's report of pain?
1. Health care provider to review the dosage and frequency of pain medication
2. Physical therapist for evaluation of function and possible exercise therapy
3. Social worker to locate community resources for complementary therapy
4. Unlicensed assistive personnel to help client with a warm shower in the morning
3
Beliefs, attitudes, and familial influence are part of the sociocultural dimension of pain. Location and radiation of pain address the sensory dimension. Describing pain and its effects addresses the affective dimension.
Activity level and function address the behavioral dimension. Asking about knowledge addresses the cognitive dimension. - CORRECT ANSWER Family members are encouraging the client to "tough out the pain" rather than risk drug addiction to opioids. The client is stoically abiding. The nurse recognizes that the sociocultural dimension of pain is the current priority for the client. Which question will the nurse ask?
1. "Where is the pain located, and does it radiate to other parts of your body?"
2. "How would you describe the pain, and how is it affecting you?"
3. "What do you believe about pain medication and drug addiction?"
4. "How is the pain affecting your activity level and your ability to function?"
3
Cancer pain generally worsens with disease progression, and the use of opioids is more generous. Fibromyalgia is more likely to be treated with nonopioid and adjuvant medications. Trigeminal neuralgia is treated with antiseizure medications such as carbamazepine. Phantom limb pain usually subsides after ambulation begins - CORRECT ANSWER Which client is most likely to receive opioids for extended periods of time?
1. A client with fibromyalgia
2. A client with phantom limb pain in the leg
3. A client with progressive pancreatic cancer
4. A client with trigeminal neuralgia
1
Multimodal therapies for postoperative clients include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies. This approach is thought to be the most important strategy for pain management for most postoperative clients. Standing orders are less optimal because there is no consideration of individual needs or characteristics. PCA is one important element, but not all clients can manage PCA devices. Assessment tools are an important part of overall management, but basing opioid dose on a numerical scale does not consider individual client circumstances - CORRECT ANSWER The nurse is caring for a postoperative client who reports pain. Based on recent evidence-based guidelines, which approach would be best?
1. Multimodal strategies
2. Standing orders by protocol
3. Intravenous patient-controlled analgesia (PCA)
4. Opioid dosage based on valid numerical scale
4
In supervision of the new RN, good performance should be reinforced first and then areas of improvement can be addressed. Asking the nurse about knowledge of pain management is also an option; however, it would be a more indirect and time-consuming approach. Making a note and watching do not help the nurse to correct the immediate problem. In-service training might be considered if the problem persists - CORRECT ANSWER The charge nurse is reviewing the records of clients who were assigned to a newly graduated RN. The RN has correctly documented dose and time of medication, but there is no documentation regarding nonpharmaceutical measures. What action should the charge nurse take first?
1. Make a note in the nurse's file and continue to observe clinical performance.
2. Refer the new nurse to the in-service education department.
3. Quiz the nurse about knowledge of pain management and pharmacology.
4. Give praise for documenting dose and time and discuss documentation deficits
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