Chapter 18: Pain Management, Comfort, Rest, and Sleep My Nursing Test Banks

Chapter 18: Pain Management, Comfort, Rest, and Sleep

Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition

MULTIPLE CHOICE

1.A patient reports to the nurse that he is experiencing a moderate amount of back pain rated 6 out of 10 on the pain scale. What should the nurse recognize about this assessment?

a. Pain is objective for the nurse.
b. Pain is easy to recognize.
c. Pain is subjective for the patient.
d. Pain is easily relieved if found early.

ANS: C

Pain is subjective. Pain is exactly what the patient says it is.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 464

OBJ: 3 | 5 TOP: Pain KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

2.A patient has pain in the left arm secondary to coronary insufficiency. This is an example of what type of pain?

a. Acute pain
b. Chronic pain
c. Referred pain
d. Subacute pain

ANS: C

An example of referred pain is coronary insufficiency manifested by pain in the left arm, which is a distant location from the real source of discomfort.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 465

OBJ: 1 | 2 TOP: Pain KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

3.The nurse reassures a patient that most acute pain is intense and of short duration. How long does can acute pain usually last?

a. 1 week
b. Less than 6 months
c. At least 9 months
d. More than 1 year

ANS: B

Acute pain lasts less than 6 months.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 465

OBJ: 1 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

4.What is the defining term for continuous or intermittent pain that does not serve as a warning of tissue damage?

a. Acute
b. Unrelieved
c. Chronic
d. Subacute

ANS: C

Chronic pain can be continuous or intermittent and may not be indicative of tissue damage.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 465

OBJ: 1 | 2 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

5.The nurse is planning interventions for a patient experiencing pain. For what type of synergistic relationship should the nurse assess?

a. Inflammatory process
b. Circulatory disorder
c. Food allergy
d. Fatigue

ANS: D

Fatigue, sleep disturbance, and depression act in a synergistic relationship.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 465

OBJ: 2 | 7 TOP: Pain KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

6.The nurse is giving a backrub to a patient to relieve pain. What pain theory is the nurse  using?

a. Synergism
b. Gate control
c. Distraction
d. Guided imagery

ANS: B

The pressure of a backrub will close the gate, according to the gate control theory of pain.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 465

OBJ: 4 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

7.A young athlete asks the nurse why he felt little pain when he broke his leg during a game. What does the nurse describe as having an effect on this patients perception of pain?

a. Hormones
b. Enzymes
c. Adrenaline
d. Endorphins

ANS: D

Endorphins found in the pituitary gland and other areas of the central nervous system create the same effect as morphine, producing an analgesic effect.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 465

OBJ: 1 | 2 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

8.Where does the nurse recognize that many institutions are now including pain assessment in implementing patient care?

a. The initial assessment
b. Discharge planning
c. Assessing vital signs
d. Care planning

ANS: C

Making pain a vital sign would ensure that pain is monitored on a regular basis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 466

OBJ: 6 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9.Why should a nurse promptly administer a prescribed analgesic after a pain assessment?

a. The physician has ordered it
b. It is an efficient use of time
c. Unrelieved pain can cause setbacks
d. It meets the goals of the nursing care plan

ANS: C

Appropriate pain management can bring about quicker recoveries, shorter hospital stays, fewer readmissions, and can improve the quality of life.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 467

OBJ: 10 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10.The nurse obtains information from a patient about the site, severity, and duration of the pain. What type of data is this considered?

a. Patient data
b. Objective data
c. Focused data
d. Subjective data

ANS: D

Information from the patient concerning site, severity, and duration of the pain is subjective data that only the patient knows.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 473

OBJ: 5 TOP: Pain KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

11.The nurse is assessing pain reported by a Latino male patient. What is important for the nurse take into  consideration when observing objective data?

a. Latino men are suspicious of female caregivers.
b. Latino men have a cultural bias against use of narcotics.
c. Latino men believe pain is necessary for cure.
d. Latino men feel it is unmanly to admit to pain.

ANS: D

Many Latino men feel that to admit to being in pain is unmanly.

PTS:1DIF:Cognitive Level: Application

REF: Page 476, Cultural Considerations OBJ: 10 TOP: Latino culture

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

12.To share assessment findings and pain relief interventions, which documentation sample is the most helpful?

a. 1600: Patient reports chest pain. Medicated with morphine sulfate.
b. 1600: Patient reports sharp chest pain. Morphine sulfate given IM.
c. 1600: Patient reports sharp pain in left chest radiating to neck. Morphine sulfate 5 mg administered IM in right deltoid.
d. 1600: Patient requested medication for pain in left chest. Morphine sulfate 10 mg PO given.

ANS: C

The nurse should record subjective information relative to the pain, as well as the intervention and administration route.

PTS: 1 DIF: Cognitive Level: Application REF: Page 473

OBJ:10TOPain medication documentation

KEY:Nursing Process Step: Implementation

MSC:NCLEX: Safe, Effective Care Environment

13.The nurse teaches noninvasive pain relief techniques, such as guided imagery, biofeedback, and relaxation. What is the primary advantage of these techniques?

a. Can be done any time
b. Does not require a nurse
c. Gives the patient some control
d. Is most effective

ANS: C

The greatest advantage of noninvasive pain relief techniques is that they give the patient some control.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 467, 476

OBJ:11TOP:Noninvasive pain control

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

14.The nurse explains that transcutaneous electrical nerve stimulation (TENS) provides a continuous mild electrical current to the skin. How does the TENS unit act to reduce pain?

a. Distracts the patient
b. Blocks endorphin production
c. Warms the skin
d. Blocks pain impulses

ANS: D

TENS works by blocking pain impulses.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Pages 468, Table 18-1

OBJ: 11 TOP: TENS KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

15.An American Indian patient requests that an egg yolk be placed in a saucer and put under his bed to absorb the pain. What should the nurse do?

a. Explain that medication will relieve the pain better
b. Place the egg in a saucer under the bed
c. Ask the physician for permission
d. Warn that housekeeping staff will remove the egg

ANS: B

The nurse should use methods of pain control that the patient believes will work.

PTS: 1 DIF: Cognitive Level: Application REF: Pages 466-467, 482

OBJ:10TOP:Cultural considerations

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

16.The home health nurse is caring for a patient with an implanted pacemaker. What type of pain management would be contraindicated?

a. Peripheral analgesics
b. A TENS unit
c. Opioid analgesics
d. Adjuvant analgesics

ANS: B

A TENS unit may interfere with the function of the pacemaker.

PTS: 1 DIF: Cognitive Level: Application REF: Page 468

OBJ: 10 TOP: Pain control KEY: Nursing Process Step: Analysis

MSC: NCLEX: Physiological Integrity

17.The nurse is trying to reassure a patient who is concerned about receiving addictive drugs. What percentage of patients become addicted to analgesics?

a. Less than 0.1%
b. Less than 1%
c. Less than 5%
d. Less than 6%

ANS: B

Research findings suggest that less than 1% of patients receiving analgesics become addicted.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 469

OBJ: 10 TOP: Addiction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

18.The nurse is caring for a patient using patient-controlled analgesia (PCA). What is a major advantage to this method?

a. Less expensive
b. More effective
c. Less addictive
d. Quicker

ANS: D

The use of the PCA gives quicker relief as there is no delay in waiting for the nurse to respond to the request for analgesia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Pages 471-472

OBJ:10TOPatient-controlled analgesia (PCA)

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

19.A patient tearfully declares the use of relaxation techniques does not work for her. What is the best action for the nurse to implement?

a. Give up on the idea
b. Encourage the patient to try again
c. Assure the patient that not everyone is successful
d. Give the patient a sedative

ANS: B

Some alternative approaches to pain control require practice. Encouragement to try again is appropriate.

PTS: 1 DIF: Cognitive Level: Application REF: Pages 473, 482

OBJ:11TOP:Alternate methods of pain control

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

20.A patient is receiving an opioid narcotic. What common side effect should the nurse be aware of when assessing this patient?

a. Addiction
b. Vomiting
c. Constipation
d. Diarrhea

ANS: C

Constipation is the most common opioid narcotic side effect for which patients do not develop a tolerance.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 469

OBJ: 10 TOP: Constipation KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

21.A male patient reports to the home health nurse that he does not feel rested although he has slept 8 hours. For what should the nurse assess?

a. Having vivid dreams
b. Eating a heavy meal before going to bed
c. Consuming an excessive amount of alcohol
d. Taking an anxiolytic medication

ANS: D

Anxiolytic (antianxiety) medications interfere with REM sleep, which is when people achieve full rest.

PTS: 1 DIF: Cognitive Level: Application REF: Page 479, Box 18-4

OBJ: 14 | 15 TOP: Sleep KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

22.Although denying pain, a patient is irritable, responds slowly, and exhibits periods of tachycardia. What should the nurse assess for in this patient?

a. Electrolyte imbalance
b. Allergic response
c. Sleep deprivation
d. Constipation

ANS: C

With sleep deprivation, patients may experience a variety of physiologic and psychological symptoms.

PTS: 1 DIF: Cognitive Level: Application REF: Pages 480-481

OBJ:16TOP:Sleep deprivation

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

23.When preparing a patient for sleep, diming the lights and decreasing the noise levels are examples of nursing interventions. What are these interventions designed to do?

a. Mimic usual sleep patterns
b. Decrease environmental stimuli
c. Prepare the patient for sleep
d. Provide for more rest

ANS: B

Environmental stimuli should be decreased when preparing the patient for sleep.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 481

OBJ: 13 TOP: Sleep KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

24.What is the best approach for a nurse to use when planning pain relief measures?

a. Use a variety of pain relief methods
b. Use only nonopioid analgesics
c. Use at least three alternating methods
d. Use only one method at a time

ANS: A

A variety of methods applied simultaneously have an additive effect on pain control.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 477

OBJ: 10 TOP: Pain control KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

25.The nurse is trying to establish an effective relationship with a patient in pain. What is the best statement for the nurse to make when beginning the assessment?

a. Ill check to see if you can have anything.
b. Let me give you a backrub and see if it helps.
c. I believe you are in pain.
d. When was your last medication for pain?

ANS: C

A nursing intervention to establish an effective relationship is to believe the patient. Al-though the other options are not wrong, they do not help establish an effective relationship.

PTS: 1 DIF: Cognitive Level: Application REF: Pages 473, 482

OBJ: 10 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

26.What action should the nurse take when evaluating the effectiveness of new or revised therapies for pain relief?

a. Observe the patient performing activities of daily living
b. Observe the patients facial expressions
c. Frequently assess subjective data
d. Perform evaluation of outcome goals

ANS: D

Continuous evaluation allows the nurse to determine if new or revised therapies are required.

PTS: 1 DIF: Cognitive Level: Application REF: Pages 482-483

OBJ: 10 TOP: Pain KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity

27.The home health nurse is instructing the family of an older adult patient with arthritis about sleep promotion. What intervention can best promote sleep for the older adult patient?

a. Giving nonsteroidal anti-inflammatory drugs (NSAIDs) in the mornings
b. Administering diuretics in the mornings
c. Encouraging daytime sleeping
d. Avoiding the stimulation of backrubs or warm drinks before bedtime

ANS: B

Older adults sleep lightly. Give NSAIDs before bedtime for comfort. Diuretics should be given in the mornings to reduce having to wake up to go to the bathroom during the night. Daytime sleeping may negatively affect nighttime sleep. Nonpharmacologic interventions are helpful to induce sleep.

PTS:1DIF:Cognitive Level: Comprehension

REF: Page 478, Life Span Considerations OBJ: 13

TOP: Sleep promotion KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

28.The nurse is using a pain scale of 0 to 10 to assess pain in a postoperative patient. What is considered the maximum pain level at which a patient can usually function effectively?

a. 2
b. 3
c. 4
d. 5

ANS: C

Most patients do not function effectively if the pain level exceeds 4 on a scale of 10.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 474, 476

OBJ: 8 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

29.A patient is receiving epidural analgesics. What should the nurse monitor closely in this patient?

a. Temperature elevation to 99.2 F from 98 F
b. Increase in pulse rate from 88 to 99
c. Decrease in respirations from 16 to 14
d. Decrease in blood pressure from 120/80 to 110/68

ANS: C

Administering epidural analgesics requires close monitoring for respiratory depression. None of the other options is indicative of opiate toxicity.

PTS: 1 DIF: Cognitive Level: Application REF: Page 468

OBJ:10TOP:Opiate toxicity

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

30.When should a nurse administer prescribed analgesic medication when treating a postoperative patient?

a. Before activity
b. Only when requested by the physician
c. Only when requested by the family
d. Only when requested by the patient

ANS: A

To control pain early, an analgesic should be given 30 to 40 minutes before a patient must walk or perform an activity. PRN medications should be given around the clock to effectively control moderately severe to severe pain. Waiting for the patient or family to request analgesics results in delays in administration and inadequate pain control.

PTS: 1 DIF: Cognitive Level: Application REF: Page 477

OBJ: 10 TOP: Pain control KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

31.What action should the nurse implement when assisting a postoperative patient with pain control and comfort?

a. Pull the patient up in bed
b. Lift the patient up in bed
c. Tighten constricting bandages
d. Restrict fluid and dietary intake

ANS: B

Pain control and comfort measures include loosening constricting bandages, lifting, not pulling the patient up in bed, and preventing constipation by encouraging appropriate fluid and dietary intake.

PTS: 1 DIF: Cognitive Level: Application REF: Page 477

OBJ: 10 TOP: Pain control KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

32.A nurse is caring for a patient who requires long-term management for severe pain. What should be the drug of choice for this patient?

a. Aspirin
b. Morphine
c. Oxycodone
d. Acetaminophen

ANS: B

Morphine and hydromorphone are the opioids of choice for long-term management of severe pain.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 473, Box 18-2

OBJ: 9 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

33.The nurse should administer an analgesic to an unconscious patient after observing which signs? (Select all that apply.)

a. Increased heart rate from 82 to 94
b. Decreased systolic blood pressure
c. Increased muscle tension
d. Perspiration on upper lip
e. Facial grimacing

ANS: A, C, D, E

Pain indicators in the unconscious patient might include increased heart rate, blood pressure, and muscle tension; diaphoresis; and grimacing.

PTS: 1 DIF: Cognitive Level: Application REF: Pages 476-477

OBJ:10TOP:Assessing pain in the unconscious patient

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

34.A patient tells the nurse he is reluctant to report his pain because he does not want to be a bother. What problems is the nurse aware that unrelieved pain can cause? (Select all that apply.)

a. Decreased oxygen demand
b. Depression
c. Respiratory dysfunction
d. Decreased GI motility
e. Irritability

ANS: B, C, D, E

Pain, which is unrelieved, can cause many physical and psychological symptoms including depression, respiratory dysfunction, decreased GI motility, and irritability. Pain causes increased oxygen demand.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 467

OBJ:10TOP:Unrelieved pain

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

COMPLETION

35.The pain relief intervention that stimulates large cutaneous nerve fibers to close the gate is the _________ unit.

ANS:

TENS: transcutaneous electrical nerve stimulator

TENS stimulates cutaneous nerve fibers with electrical impulses, which follow the same spinal pathway as do pain impulses. The cutaneous nerves close the gate to the pain impulses.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 467

OBJ: 4 | 11 TOP: TENS KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

36.The nurse clarifies that the term peripheral analgesics describes the group of drugs also referred to as ___________.

ANS:

NSAIDs

Peripheral analgesics are also the group of drugs referred to as NSAIDs.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 468-469

OBJ: 10 TOP: Nonsteroidal anti-inflammatory drugs (NSAIDs)

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

37.The nurse is aware that the state at which a person is mentally relaxed, free from worry, and is physically calm is __________.

ANS:

rest

When a person is mentally relaxed, free from worry and is physically calm, he or she is at rest.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 478

OBJ: 12 TOP: Rest KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

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