Pain Management Quiz 53 Questions with Verified Answers
A post operative client who has been receiving morphine for pain management is exhibiting a
... [Show More] depressed respiratory rate and is not responsive to stimuli. which drug has the potential to reverse the respiratory the respiratory depressant effect of an opioid?
A.Naloxone
B.Epinephrine
C.Diphenhydramine
D.Atropine - CORRECT ANSWER A
A male college student age 20 years has been experienced increasingly sharp pain in the right lower quadrant of his abdomen over the last 12 hours.. A visit to the emergency department it apartment and subsequent diagnostic is agnostic testing have resulted in a diagnose of appendicitis what category of pain is the client most likely experiencing?
A.Referred pain
B.Visceral pain
C.Cutaneous pain
D.Somatic pain - CORRECT ANSWER B
Which principle should the nurse integrate into the pain assessment in pain management of pediatric client?
A. Pharmacologic pain relief should be used only as an intervention of last resort
B. The developing neurologic system of children transmit less pain than in older clients
C. Pain assessment may require multiple methods in order to ensure accurate pain data
D. A numeric scale should be used to assess pain if the child is older than 5 years of age - CORRECT ANSWER C
A client has been admitted to a post surgical unit with a patient controlled analgesia(PCA) system which statement is true of this medication delivery system?
A. Use of opiate analgesic in APC a is contraindications due to the risk of respiratory depression
B. The dose that is delivered when the client activates the machine is present
C. An antidote is automatically delivered if the client exceeds the recommended dose
D. Thorough client education is necessary to prevent overdose - CORRECT ANSWER B
A client has required frequent scheduled and breakthrough doses of opioid analgesics in the last 6 days since submission to the hospital. the client's medication regiment may necessitate which intervention?
A. Frequent turns and application of skin emollients
B. Supplementary oxygen and chest physiotherapy
C. Calorie restriction in dietary supplements
D. Stool softeners and increase fluid intake - CORRECT ANSWER D
A nurse assesses a client who is being given an opiate analgesic and finds the client unresponsive to shaking and other stimuli which drug might be ordered to reverse the state?
A. Cortisone
B. aspirin
C. penicillin
D. Naloxone - CORRECT ANSWER D
A physician orders a placebo for a client what is a placebo?
A. Is an inactive substance given in place of a drug
B. Is a smaller than usual dose of an analgesic
C. an analgesic with no known side effects
D. Is an intravenous form of a potential analgesic - CORRECT ANSWER A
A client with an amputated arm tells ignorance that sometimes he experiences throbbing pain Or a burning sensation in the amputated arm what kind of pain is this plant experiencing?
A. chronic pain
B. cutaneous pain
C. visceral pain
D. Neuropathic pain - CORRECT ANSWER D
A nurse is caring for a client who was administered opioid narcotics. The client reports constipation what is another potential side effect of opioid narcotics?
A. sedition
B. Diarrhea
C. Anxiety
D. Insomnia - CORRECT ANSWER A
A nurse is caring for a client with acute back pain when should the nurse assess the client's pain?
A. Whenever the vital signs are measured and documented
B. Once per day when the pain is potential problem
C. After the client is discharged from the healthcare facility
D. 6 hours after administering a prescribed analgesic - CORRECT ANSWER A
A middle aged client tells the nurse that the client's neck pain reduced considerably after the client underwent a treatment in which the needles were inserted into the skin what kind of pain relief treatment did the client undergo
A. biofeedback
B. transcutaneous electrical nerve stimulation
C. acupuncture
D. rhizotomy - CORRECT ANSWER C
A nurse observes that a client who underwent knee surgery 2 weeks ago needs progressively larger doses of analgesics to get relief from pain. the nurse interprets this as:
A. sedation
B. dependence
C. addiction
D. Tolerance - CORRECT ANSWER D
A client describes pain in the lower leg a d has been diagnosed with a herniated lumbar disk. the pain in the leg is what type of pain?
A. limited pain
B. chronic pain
C. referred pain
D. acute pain - CORRECT ANSWER C
which guideline regarding pain should be included in the nurse's education plan for a group of parents with infants and toddlers?
A. pain can be a source of fear and threat to the toddlers security
B. infant's cannot express pain until 8 months of age
C. toddlers often try to be brave and not cry
D. toddlers are often reluctant to express pain - CORRECT ANSWER A
a nurse is assessing a client's pain. the nurse notes which database finding that is Indicative of acute pain?
A. decrease pulse
B. increased blood pressure
C. pupil constriction
D. decrease respiratory rate - CORRECT ANSWER B
after the nurse has instructed a client with low-back pain about the use of a transcutaneous electrical nerve stimulation (TENS) unit for pain management, the nurse determines that the client has a need for further instruction when the client states what?
A. I could use the TENS unit if I feel pain somewhere else on my body
B. wearing the TENS unit should not interfere with my daily activities
C. I may need fewer pain medications with the TENS unit in place
D. one advantage of the TENS unit is it increases blood flow - CORRECT ANSWER A
The nurse has completed a preoperative education session with a client who will receive morphine via a patient controlled analgesia pump (pca) after surgery. which statement by the client indicates the need for further education?
A. I will remind my family member to push the pca pump button for me if I doze off during the day
B. I can push the button whenever I feel pain
C. I will let my nurse know if the pain medication is not effective enough to help me move after surgery
D. I will use the pca pump until oral pain medication controls my pain - CORRECT ANSWER A
what is the most reliable method for assessing pain?
A. observing the client
B. asking the primary care provider
C. asking the significant other
D. asking the client - CORRECT ANSWER D
A nurse attempts to arouse a postoperative client and finds him frequently drowsy and drifting off during conversation; however, he can be aroused. what would be the sedation score for this client?
A. 4
B. 3
C. 1
D. 2 - CORRECT ANSWER B
which statement accurately describes a consideration when using a patient controlled analgesia (pca) pump to relieve clients pain?
A. this approach can only be used with oral analgesics
B. a pca pump must be used and monitored in a health-care facility
C. the pca pump is not effective for chronic pain
D. the pump mechanism can be programmed to deliver a specific amount of analgesic within a given time interval. - CORRECT ANSWER D
A client reports after a back massage that his lower back pain has decreased from an 8 to a 3. what opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort?
A. dopamine
B. melatonin
C. serotonin
D. endorphins - CORRECT ANSWER D
While assessing an infant the nurse notes that the infant displays an occasional grimace and is withdrawn; legs are kicking body is arched and the infant is moaning during sleep. when awake the infant is inconsolable. what scale should the nurse use while assessing pain in this Infant?
A. FLACC SCALE
B. APGAR SCORE
C. FACES SCALE
D. BRADEN SCALE - CORRECT ANSWER A
the nurse is caring for a client utilizing a pca pump that is programmed to allow a bolus dose every 10 minutes. the client is sleeping with a visitor at bedside. which of the following instructions should the nurse give the client's visitor?
A. remind the client to push the button more often than every 10 minutes
B. push the button on the pump every 10 mi minutes
C. only the client should push the pump button
D. push the pump button when you think the client is in pain - CORRECT ANSWER C
The nurse is administering oxycodone to a client. To which category of analgesics does this belong?
A. cyclooxygenase 2 inhibitor
B. nonsteroidal anti inflammatory
C. antibiotic
D. opioid - CORRECT ANSWER D
The nurse is caring for a client who has a long history of using opioid medication.. When the client reports back pain of 10 on a 1 to 10 scale what is the appropriate nursing action?
A. Recognize that clients who take opioids have less pain than clients who don't.
B. Reassure the client that the pain is not excruciating since they take opioid
C. document that the pain is 5 on 1-10 scale
D. acknowledge the pain as the client reports it - CORRECT ANSWER D
The nurse witnesses a caregiver interacting with a client with chronic pain. when helping the client get dressed the caregiver appears hurried and frustrated and speaks to the client angrily. what is the appropriate nursing response?
A. You are clearly angry and should not be here
B. Stop talking to your loved one like that
C. Let me help you dress the client while we talk about home health resources that can assist when the client goes home
D. Use therapeutic silence and let the caregiver and client continue interacting - CORRECT ANSWER C
A fellow staff nurse working with a client who has 2 broken femur States to another nurse "my older adult client is so easy to care for because he says he doesn't have a bit of pain" what is the appropriate response from the other nurse to whom the statement was made?
A. I'm glad you performed a thorough assessment
B. I frequently find that my older adult clients do not have pain too
C. That has to make care very easy just document that he has no pain
D. Older adults may not report pain so they won't be thought of as a bother - CORRECT ANSWER D
Which client is at a greater risk for fluid volume deficit related to the loss of total body fluid and extracellular fluid?
A. a man age 50
B. an adolescent age 17
C. an infant age 4 month
D. a woman age 45 - CORRECT ANSWER C
A client with chronic pain reports to you, the charge nurse, that the nurse have not been responding to requests for pain medication. What is your initial action?
Check the MARs and nurses' notes for the past several days.
Ask the nurse educator to give an in-service about pain management.
Perform a complete pain assessment and history on the client.
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
As charge nurse, you must assess for the performance and attitude of the staff in relation to this client. After gathering data from the nurses, additional information from the records and the client can be obtained as necessary. The educator may be of assistance if knowledge deficit or need for performance improvement is the problem.
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?
Sensory
Affective
Sociocultural
Behavioral
Cognitive - CORRECT ANSWER Sociocultural
The family is part of the sociocultural dimension of pain. They are influencing the client and should be included in the teaching sessions about the appropriate use of narcotics and about the adverse effects of pain on the healing process. The other dimensions should be included to help the client/family understand overall treatment plan and pain mechanism
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?
Amitriptyline (Elavil)
Corticosteroids
Methylphenidate (Ritalin)
Lorazepam (Ativan) - CORRECT ANSWER Amitriptyline (Elavil)
Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract sedation if the client is on opioids. Lorazepam is an anxiolytic.
Which client is most likely to receive opioids for extended periods of time?
A client with fibromyalgia
A client with phantom limb pain
A client with progressive pancreatic cancer
A client with trigeminal neuralgia - CORRECT ANSWER A client with progressive pancreatic cancer
Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioid and adjuvant medications. Trigeminal neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.
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?
Make a note in the nurse's file and continue to observe clinical performance
Refer the new nurse to the in-service education department.
Quiz the nurse about knowledge of pain management
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 supervising 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 might be considered if the problem persists.
In caring for a young child with pain, which assessment tool is the most useful?
Simple description pain intensity scale
0-10 numeric pain scale
Faces pain-rating scale
McGill-Melzack pain questionnaire - CORRECT ANSWER Faces pain-rating scale
The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is appropriate for young children who may have difficulty describing pain or understanding the correlation of pain to numerical or verbal descriptors. The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary.
In applying the principles of pain treatment, what is the first consideration?
Treatment is based on client goals.
A multidisciplinary approach is needed.
The client must be believed about perceptions of own pain.
Drug side effects must be prevented and managed - CORRECT ANSWER The client must be believed about perceptions of own pain.
The client must be believed and his or her experience of pain must be acknowledged as valid. The data gathered via client reports can then be applied to other options in developing the treatment plan.
Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
Intraspinal
Patient-controlled analgesia (PCA)
Intravenous (IV)
Sublingual - CORRECT ANSWER Intravenous (IV)
the IV route is preferred as the fastest and most amenable to titration. A PCA bolus can be delivered; however, the pump will limit the dosage that can be delivered unless the parameters are changed. Intraspinal administration requires special catheter placement and there are more potential complications with this route. Sublingual is reasonably fast, but not a good route for titration, medication variety in this form is limited.
When titrating an analgesic to manage pain, what is the priority goal?
Administer smallest dose that provides relief with the fewest side effects.
Titrate upward until the client is pain free.
Titrate downwards to prevent toxicity.
Ensure that the drug is adequate to meet the client's subjective needs. - CORRECT ANSWER Administer smallest dose that provides relief with the fewest side effects.
the goal is to control pain while minimizing side effects. For severe pain, the medication can be titrated upward until pain is controlled. Downward titration occurs when the pain begins to subside. Adequate dosing is important; however, the concept of controlled dosing applies more to potent vasoactive drugs.
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?
Therapeutic touch
Use of heat and cold applications
Meditation
Transcutaneous electrical nerve stimulation (TENS) - CORRECT ANSWER Use of heat and cold applications
Use of heat and cold applications is a standard therapy with guidelines for safe use and predictable outcomes, and an LPN/LVN will be implementing this therapy in the hospital, under the supervision of an RN. Therapeutic touch requires additional training and practice. Meditation is not acceptable to all clients and an assessment of spiritual beliefs should be conducted. Transcutaneous electrical stimulation is usually applied by a physical therapist.
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
B, A, C
C, A, B
B, C, A
A, B, C - CORRECT ANSWER B, C, A
Step 1 includes non-opioids and adjuvant drugs. Step 2 includes opioids for mild pain plus Step 1 drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain (replacing Step 2 opioids) and continuing Step 1 drugs and adjuvant drugs as needed.
Which client is at greater risk for respiratory depression while receiving opioids for analgesia?
An elderly chronic pain client with a hip fracture
A client with a heroin addiction and back pain
A young female client with advanced multiple myeloma
A child with an arm fracture and cystic fibrosis - CORRECT ANSWER A child with an arm fracture and cystic fibrosis
at greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors.
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?
Encourage expression of fears on past experiences
Provide accurate information about use of pain medication
Explain that addiction is unlikely among acute care clients
Seek family assistance in resolving this problem - CORRECT ANSWER Encourage expression of fears on past experiences
This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.
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?
Fever
Nausea
Diaphoresis
Abdominal cramps - CORRECT ANSWER Diaphoresis
Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.
In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant?
Assist the client with preparation of a sitz bath.
Monitor the client for signs of discomfort while ambulating
Coach the client to deep breathe during painful procedures
Evaluate relief after applying a cold application - CORRECT ANSWER Assist the client with preparation of a sitz bath.
The nursing assistant is able to assist the client with hygiene issues and knows the principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and evaluating outcomes are nursing responsibilities.
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?
Prepare the medication and hand it to the physician
Check the hospital policy regarding use of the placebo.
Follow a personal code of ethics and refuse to give it.
Contact the charge nurse for advice - CORRECT ANSWER Contact the charge nurse for advice
the charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following one's own ethical code is correct, you must ensure that the client is not abandoned and that care continues
For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?
Closely assess for nonverbal signs such as grimacing or rocking.
Obtain baseline behavioral indicators from family members.
Look at the MAR and chart, to note the time of the last dose and response.
Give the maximum PRS dose within the minimum time frame for relief. - CORRECT ANSWER Obtain baseline behavioral indicators from family members.
Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.
Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)?
IV
IM or subcutaneous
Oral
Transdermal
PCA - CORRECT ANSWER Oral
If the gastrointestinal system is function, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms.
A first day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
Deliver the bolus dose per standing order.
Contact the physician to increase the dose.
Try non-pharmacological comfort measures.
Assess the pain for location, quality, and intensity - CORRECT ANSWER Assess the pain for location, quality, and intensity
Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps.
Which non-pharmacological measure is particularly useful for a client with acute pancreatitis
Diversional therapy, such as playing cards or board games
Massage of back and neck with warmed lotion
Side-lying position with knees to chest and pillow against abdomen
Transcutaneous electrical nerve stimulation (TENS) - CORRECT ANSWER Side-lying position with knees to chest and pillow against abdomen
The side-lying, knee-chest position opens retroperitoneal space and provides relief. The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain, especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain. The additional stimulation of massage may be distressing to the client.
What is the best way to schedule medication for a client with constant pain?
PRN at the client's request
Prior to painful procedures
IV bolus after pain assessment
Around-the-clock - CORRECT ANSWER Around-the-clock
IF the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control
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 client who needs pre-op teaching for use of a PCA pump
A client with a leg cast who needs neurologic checks and PRN hydrocodone
A client post-op toe amputation with diabetic neuropathic pain
A client with terminal cancer and severe pain who is refusing medication - CORRECT ANSWER A client with a leg cast who needs neurologic checks and PRN hydrocodone
A client post-op toe amputation with diabetic neuropathic pain
The clients with the cast and the toe amputation are stable clients and need ongoing assessment and pain management that are within the scope of practice for an LPN/LVN under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and the terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication.
For a client who is taking aspirin, which laboratory value should be reported to the physician?
Potassium 3.6 mEq/L
Hematocrit 41%
PT 14 seconds
BUN 20 mg/dL - CORRECT ANSWER PT 14 seconds
When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%, female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).
Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? Choose all that apply.
An anxious, chronic pain client who frequently uses the call button
A client second day post-op who needs pain medication prior to dressing changes
A client with HIV who reports headache and abdominal and pleuritic chest pain
A client who is being discharged with a surgically implanted catheter - CORRECT ANSWER A client second day post-op who needs pain medication prior to dressing changes
A second day postoperative client who needs medication prior to dressing changes has predictable and routine care that a new nurse can manage. Although clients with chronic pain can be relatively stable, the interaction with this client will be time consuming and may cause the new nurse to fall behind. The client with HIV has complex complaints that require expert assessment skills. The client pending discharge will need special and detailed instructions.
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?
"The doctor ordered the medicine to be given every 4 hours."
"If the medication is given too frequently he could suffer ill effects."
"Please tell him that I will be right there to check of him."
"Let's wait about 30-40 minutes. If there is no relief I'll call the doctor." - CORRECT ANSWER "Please tell him that I will be right there to check of him."
directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next. [Show Less]