Chapter 16Pain Management My Nursing Test Banks

Chapter 16Pain Management

MULTIPLE CHOICE

1.A client tells the nurse that she rarely experiences pain, but when she does, she seeks medical attention. The nurse realizes this client understands that pain is important because it:

1.

is a protective system.

2.

includes the automatic withdrawal reflex.

3.

creates sensitivity to pain.

4.

helps with healing.

ANS: 1

Pain is a protective system that includes protection from unsafe behaviors by use of reflexes, memory, and avoidance. Even though the automatic withdrawal reflex is a part of the pain response, it does not explain why pain is important. Pain does not create sensitivity to pain. Pain does not help with healing.

PTS: 1 DIF: Analyze REF: Definitions and Implications of Pain

2.A client complains that the bed sheets touching his skin are extremely painful. The nurse realizes this client is experiencing:

1.

allodynia.

2.

modulation.

3.

kinesthesia.

4.

proprioception.

ANS: 1

Allodynia or hyperalgesia is a state where a slight or nonpainful stimulus is interpreted as very painful. Kinesthesia is the awareness of movement. Proprioception is the awareness of body position. Modulation is an influencing factor in the perception of pain.

PTS: 1 DIF: Analyze REF: Peripheral Nervous System

3.A client is complaining of severe abdomen pain. The nurse realizes this client is experiencing which type of pain?

1.

Neuralgia

2.

Pathological

3.

Somatic

4.

Visceral

ANS: 4

Visceral pain is pain arising from the body organs or gastrointestinal tract. Somatic pain is pain that originates from the bone, joints, muscles, skin, or connective pain. Neuralgia and pathological pain are both types of pain that result from injury to a nerve or malfunction of the neuronal transmission process or due to impaired regulation.

PTS:1DIF:AnalyzeREF:Types of Pain

4.A client, diagnosed with acute appendicitis, is experiencing abdominal pain. The best way for the nurse to describe this clients pain would be:

1.

chronic.

2.

neuropathic.

3.

referred.

4.

acute.

ANS: 4

Acute pain onset is sudden and of short duration. Chronic pain is a sudden or slow onset of mild to severe pain that lasts longer than 6 months. Referred pain is the result of the transfer of visceral pain sensations to a body surface at a distance from the actual origin. Neuropathic pain is paroxysmal pain that occurs along the branches of a nerve.

PTS:1DIF:ApplyREF:Types of Pain

5.A client is observed holding a pillow over the abdominal region with both knees flexed in a side-lying position. Vital signs assessment reveals an elevated blood pressure and heart rate. Which of the following should the nurse say to this client?

1.

Can I get you anything?

2.

Would you like something for pain?

3.

You look comfortable.

4.

Your blood pressure is up.

ANS: 2

Sympathetic responses to pain include elevated blood pressure and heart rate. And since the client is hugging a pillow over the abdominal region with both knees flexed in a side-lying position, the best thing for the nurse to say to this client is Would you like something for pain? The other responses are incorrect because they do not acknowledge that the client is experiencing pain.

PTS: 1 DIF: Apply REF: Assessing the Clinical Manifestations of Pain

6.A client experiencing chronic pain asks the nurse why she is not prescribed Demerol like she received when she had a total knee replacement. Which of the following should the nurse respond to this client?

1.

You dont need something that strong.

2.

That medication does not exist anymore.

3.

That medication does not last very long.

4.

It can cause you have high blood pressure.

ANS: 3

Meperidine is no longer a major drug for acute or chronic pain due to its short analgesic duration of 2 to 3 hours and the potential for accumulative toxic effects of its metabolite, normeperidine. The best response for the nurse to make to the client would be that medication does not last very long. The other responses are inaccurate.

PTS:1DIF:ApplyREF:Opioid Analgesics

7.A client is informed that a tricyclic antidepressant medication is going to help control his chronic pain. The nurse would expect the physician to prescribe:

1.

Amitriptyline.

2.

Baclofen.

3.

Gabapentin.

4.

Diazepam.

ANS: 1

Amitriptyline is an antidepressant. Gabapentin is an anticonvulsant. Baclofen is a muscle relaxant. Diazepam is a benzodiazepine.

PTS: 1 DIF: Analyze REF: Adjuvant Medications

8.A client receiving around-the-clock medication for terminal cancer experiences additional pain when performing activities of daily living. The nurse realizes this client is experiencing:

1.

breakthrough pain.

2.

intractable pain.

3.

psychosomatic pain.

4.

acute pain.

ANS: 1

Breakthrough pain is commonly seen in the advanced stages of cancer. It is spontaneous, unpredictable, and can be initiated by certain activities such as during activities of daily living. Intractable pain is resistant to some or all forms of therapy. Psychosomatic pain is that which has a psychological origin. The client is diagnosed with terminal cancer. Acute pain has a sudden onset and resolves within 6 months.

PTS:1DIF:AnalyzeREF:Breakthrough Pain

9.A client recovering from surgery tells the nurse that she is nauseated and is experiencing an increase in pain. Which of the following does this clients symptoms suggest to the nurse?

1.

The client is becoming dependent upon the pain medication.

2.

The clients pain threshold is lower when experiencing nausea.

3.

The client is experiencing withdrawal symptoms from pain medication.

4.

The client is experiencing referred pain.

ANS: 2

Pain threshold is influenced by nausea, fatigue, and lack of sleep. The client experiencing an increase in pain during nausea is demonstrating an alteration in the pain threshold. The client is not becoming dependent upon the pain medication. The client is not experiencing withdrawal symptoms. The client is also not experiencing referred pain.

PTS: 1 DIF: Analyze REF: Pain Threshold and Pain Tolerance

10.A client with a history of malingering pain tells the nurse that he needs a prescription for pain medication. Which of the following should the nurse do first to assist this client?

1.

Ask the physician for a pain medication prescription for the client.

2.

Remind the client that he does not have pain but just wants the medication.

3.

Thoroughly assess the client for pain.

4.

Suggest the client seek counseling for his pain medication-seeking behavior.

ANS: 3

Pain of a psychological origin is when an individual seeks treatment for pain when no actual pain exists. This is also referred to as malingering or pretending pain. The nurse should not assume that the pain does not exist but rather should conduct a thorough pain assessment to rule out an actual physiological problem. The nurse should not immediately ask the physician for pain medication. The nurse should not remind the client that he does not have pain but just wants the medication. The nurse should also not suggest the client seek counseling for pain medication-seeking behavior.

PTS: 1 DIF: Apply REF: Box 16-1 Pain Descriptions

11.The nurse is implementing the five Cs of pain management for a client. Which of the following is included in this intervention?

1.

Caring for the client in a holistic manner

2.

Creating a calm environment

3.

Comparing the degree of pain reported with previous episodes

4.

Continuously assessing the clients pain

ANS: 4

The five Cs of pain management include comprehensive assessment, consistent use of assessment tools, continuous reassessment, customize the plan of care, and collaborate with other health care providers to plan pain management. The other choices are not included in the five Cs of pain management.

PTS: 1 DIF: Apply REF: Planning and Implementation

12.A client, diagnosed with arthritis, should be instructed to avoid the use of NSAIDs because of which of the following prescribed medications?

1.

Penicillin

2.

Coumadin

3.

Digoxin

4.

Diazide

ANS: 2

Persons at greatest risk for adverse reactions to NSAIDs include those who are prescribed warfarin (Coumadin) since the NSAID can increase the effects of the Coumadin and promote bleeding.

PTS: 1 DIF: Apply REF: Box 16-2 Groups of NSAID Drugs

MULTIPLE RESPONSE

1.Prior to hospitalization, a client had been ingesting high doses of oxycodone. The nurse suspects the client is experiencing symptoms of withdrawal when which of the following are assessed? (Select all that apply.)

1.

Muscle twitching and spasms

2.

Restlessness

3.

Increased heart rate

4.

Drop in blood pressure

5.

Increase in blood pressure

6.

Irritability

ANS: 1, 2, 3, 5, 6

Withdrawal symptoms include myoclonus or muscle twitching and spasms, restlessness, irritability, increased heart rate, and increased blood pressure. A decrease in blood pressure is not a symptom of narcotic medication withdrawal.

PTS:1DIF:Analyze

REF: Potential and Actual Side Effects of Opioid Analgesics

2.The nurse would be concerned that a client is at risk for developing chronic pain when which of the following health problems are diagnosed? (Select all that apply.)

1.

Osteoarthritis

2.

Osteoporosis

3.

Heart disease

4.

Diabetes mellitus

5.

Chronic pulmonary disease

6.

Anemia

ANS: 1, 2, 5

Common health problems associated with chronic pain include osteoarthritis, osteoporosis, and chronic pulmonary disease. Heart disease, diabetes mellitus, and anemia are not associated with chronic pain.

PTS:1DIF:AnalyzeREF:Chronic Pain

3.An 84-year-old client is experiencing severe arthritis pain. The nurse realizes that which of the following pain management approaches would be the most beneficial for this client? (Select all that apply.)

1.

Avoid NSAIDs.

2.

Utilize morphine or morphine-like medication.

3.

Provide medication through the oral route.

4.

Utilize diazepam.

5.

Suggest Darvocet.

6.

Provide medication through the intramuscular route.

ANS: 1, 2, 3

When providing pain medication to a geriatric client, pain management approaches include the utilization of morphine or morphine-like medication to control pain and provide medication using the oral route. NSAIDs should also be avoided because of the risk of gastrointestinal bleeding. Diazepam should be avoided because of a long half-life. Darvocet should be avoided because of toxic effects with renal insufficiency. Medication should not be provided using the intramuscular route because of muscle wasting and loss of fatty tissue in the elderly client.

PTS: 1 DIF: Apply REF: Geriatric Considerations

4.A client with severe pain from spinal stenosis is prescribed Methadone. The nurse realizes that the advantages of this medication are what? (Select all that apply.)

1.

Decrease in the need for antidepressant adjuvant medication

2.

Less frequent dosing schedule

3.

Long half-life

4.

Inexpensive

5.

Can be used for intermittent pain

6.

Does not cause respiratory depression

ANS: 1, 2, 4

The advantages of methadone include that it decreases the need for antidepressant adjuvant medication because it increases the release of serotonin and norepinephrine, dosing is every 12 hours, and it is inexpensive. Disadvantages of this medication include: it has a long half-life; it cannot be used for intermittent pain management; and it does cause respiratory depression.

PTS:1DIF:AnalyzeREF:Intractable Pain

5.The nurse is using the PAINAID Scale to assess a clients level of pain. Which of the following are assessed with this pain scale? (Select all that apply.)

1.

Breathing rate

2.

Assign a number to the degree of pain

3.

Negative vocalizations

4.

Assign a facial expression to the degree of pain

5.

Facial expression

6.

Body language

ANS: 1, 3, 5, 6

The PAINAID scale assesses breathing, negative vocalizations, facial expression, body language, and comfort. The Numerical Rating Scale assigns a number to the degree of pain. The Wong-Baker FACES Scale assigns a facial expression to the degree of pain.

PTS: 1 DIF: Apply REF: Skills 360: Pain Assessment Tools

6.A client diagnosed with severe arthritis tells the nurse that she always has some degree of pain. Which of the following could explain this clients poor pain management? (Select all that apply.)

1.

Client does not appear to be in pain.

2.

Client does not report pain.

3.

Client cannot afford pain medication.

4.

Client is fearful of becoming addicted to pain medication.

5.

Client believes pain medication means the condition is worse.

6.

Client has a high pain tolerance.

ANS: 1, 2, 4, 5

Barriers to pain assessment and management include that the client is not demonstrating overt signs of pain, and therefore she does not need pain medication; the client does not report pain, so therefore she does not need pain medication; the client is fearful of becoming addicted to pain medication; and the client believes pain medication means the condition is worse. The fact that the client is unable to afford pain medication and is having a high pain tolerance are not identified barriers to pain assessment and management.

PTS: 1 DIF: Analyze REF: Barrier to Pain Assessment and Pain Management

7.The nurse determines that a client is experiencing chronic pain when which of the following is assessed? (Select all that apply.)

1.

Suffering

2.

Fatigue

3.

Sleeplessness

4.

Apathy

5.

Sadness

6.

Anger

ANS: 1, 3, 5

The descriptor triad for chronic pain is suffering, sleeplessness, and sadness. Fatigue, apathy, and anger do not describe chronic pain.

PTS: 1 DIF: Analyze REF: Interventions for the Management of Chronic Pain

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