Chapter 20: Drugs Used for Pain Management My Nursing Test Banks

Chapter 20: Drugs Used for Pain Management

Test Bank

MULTIPLE CHOICE

1. The nurse is completing an assessment on a nonverbal adult patient. Which type of pain scale assessment tool is the most accurate to use?

a.

TPPPS

b.

FLACC

c.

POCIS

d.

MOPS

ANS: B

The Face, Legs, Activity, Cry, Consolability (FLACC) scale would be used to assess pain in the nonverbal patient. The Toddler Preschooler Postoperative Pain Scale (TPPPS), Pain Observation Scale for Young Children (POCIS), and Modified Objective Pain Scale (MOPS) would not be appropriate for this patient.

DIF: Cognitive Level: Application REF: p. 314 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

2. Which action will the nurse take when a patient receiving morphine sulfate via percutaneous coronary angioplasty (PCA) has a shallow, irregular respiratory rate of 6 breaths/min?

a.

Elevate the patients head of bed to facilitate lung expansion.

b.

Increase the patients primary intravenous (IV) flow rate.

c.

Complete the FLACC scale.

d.

Notify the health care provider and prepare to administer naloxone (Narcan).

ANS: D

The patient is exhibiting signs of respiratory depression. Administration of the antidote naloxone would be the most appropriate nursing intervention. Lung expansion or increasing the primary IV infusion rate would not relieve respiratory depression. Assessing the patients pain at this point is a lesser priority than treating the respiratory depression.

DIF: Cognitive Level: Application REF: p. 326 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

3. Which patient assessment would indicate to the nurse that salicylate toxicity is occurring?

a.

Gastrointestinal (GI) bleeding

b.

Increased bleeding times

c.

Tinnitus

d.

Occasional nausea

ANS: C

Symptoms of salicylism include ringing in the ears (tinnitus), impaired hearing, dimming of vision, sweating, fever, lethargy, dizziness, mental confusion, nausea, and vomiting. Although salicylates may cause GI bleeding over time, it is not a symptom associated with toxicity. Increased bleeding time is an effect associated with the treatment of clots. Occasional nausea is a common adverse effect of treatment with salicylates; it is not a sign of toxicity.

DIF: Cognitive Level: Comprehension REF: p. 330 OBJ: 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

4. What is the advantage of taking a nonsteroidal anti inflammatory drug (NSAID) that is a COX 2 inhibitor?

a.

The medication is cheaper than aspirin.

b.

There are fewer GI adverse effects.

c.

They are more effective than COX 1 inhibitors.

d.

They have no known adverse effects.

ANS: B

COX 2 inhibitor NSAIDs have fewer GI adverse effects than salicylates or COX 1 inhibitors. Aspirin is one of the least expensive analgesics available. The anti inflammatory actions of NSAIDs are caused by COX 2 inhibition; the unwanted adverse effects are caused by inhibition of COX 1. All these medications have adverse effects.

DIF: Cognitive Level: Knowledge REF: p. 335 OBJ: 9

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

5. An 86 year old patient who was admitted with GI bleeding as a result of salicylate therapy is being discharged. As the nurse reviews the discharge medication list, the patient states that she doesnt understand why Tylenol doesnt work as well as the aspirin she had been taking. What would be the nurses best response?

a.

Tylenol and aspirin are chemically the same drug.

b.

Tylenol is appropriate for only minor pain.

c.

Tylenol does not help with inflammatory discomfort.

d.

A therapeutic blood level must be established with Tylenol.

ANS: C

Acetaminophen (Tylenol) is effective as an analgesic or antipyretic. Tylenol does not possess any anti inflammatory activity and is therefore ineffective in relieving symptoms related to inflammation. Tylenol and aspirin are distinctly different drugs. Tylenol can be useful in the relief of moderate pain. Tylenol can be effective in a single dose, without needing treatment over a period of time.

DIF: Cognitive Level: Application REF: p. 329 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

6. What term is used to define an awareness of pain?

a.

Tolerance

b.

Threshold

c.

Perception

d.

Sensation

ANS: C

Pain perception, also known as nociception, is an individuals awareness of the feeling of pain. Pain tolerance is an individuals ability to endure pain. Pain threshold is the point at which an individual first acknowledges or interprets a sensation as being painful. Pain is a sensation characterized by a group of unpleasant perceptual and emotional experiences that trigger autonomic, psychological, and somatomotor responses.

DIF: Cognitive Level: Knowledge REF: p. 310 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

7. Which statement is true about neuropathic pain?

a.

This pain is the result of a stimulus to pain receptors.

b.

Patients describe it as dull and aching.

c.

It commonly originates in the abdominal region.

d.

The pain is a result of nerve injury.

ANS: D

Neuropathic pain results from injury to the peripheral or central nervous system, such as trigeminal neuralgia. Nociceptive pain is the result of a stimulus to pain receptors. Nociceptive pain is usually described as dull and aching. Visceral pain originates from the abdominal and thoracic regions.

DIF: Cognitive Level: Comprehension REF: p. 311 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

8. How long after the administration of a parenteral pain medication will the nurse complete the next pain assessment to evaluate the effectiveness of the medication?

a.

10 minutes

b.

30 minutes

c.

1 hour

d.

2 hours

ANS: B

Evaluation of pain effectiveness of parenteral pain medications needs to occur within 15 to 30 minutes of administration. Ten minutes, 1 hour, and 2 hours are not accurate time frames to evaluate the effectiveness of parenteral medications.

DIF: Cognitive Level: Application REF: p. 314 OBJ: 2

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

9. Which sign or symptom displayed by a patient would be indicative of opiate withdrawal?

a.

Bradycardia

b.

Diarrhea

c.

Lethargy

d.

Hypothermia

ANS: B

Symptoms of opiate withdrawal include muscular spasms; severe aches in the back, abdomen, and legs; abdominal and muscle cramps; hot and cold flashes; insomnia; nausea, vomiting, and diarrhea; severe sneezing; and increases in body temperature, blood pressure, and respiratory and heart rates. Bradycardia is not a sign of opiate withdrawal; increased heart rate is a sign of opiate withdrawal. Lethargy is not a sign of opiate withdrawal; restlessness is a sign of opiate withdrawal. Hypothermia is not a sign of opiate withdrawal; fever is a sign of opiate withdrawal.

DIF: Cognitive Level: Application REF: p. 323 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

10. Which medication is contraindicated when a patient is taking warfarin (Coumadin)?

a.

Aspirin

b.

Acetaminophen (Tylenol)

c.

Propoxyphene (Darvon)

d.

Morphine (Roxanol)

ANS: A

Salicylates enhance the anticoagulant effect of warfarin. Acetaminophen, propoxyphene, and morphine are not contraindicated with warfarin use.

DIF: Cognitive Level: Comprehension REF: p. 333 OBJ: 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

11. What is the best way for the nurse to evaluate the effectiveness of the patients opiate agonist?

a.

Ability of the patient to tolerate more activity

b.

Increased sleep time throughout the night

c.

Reduction of respiratory rate from 24 to 18 breaths/min

d.

Verbal report of 2 on a 1 to 10 scale

ANS: D

A verbal report is the best indicator because pain is individually perceived and using a pain rating scale is a consistent manner of assessment. Toleration of activity and an increased sleep pattern are not the most accurate methods of pain evaluation. Reduction of respiratory rate is not an appropriate measurement of pain control.

DIF: Cognitive Level: Application REF: p. 314 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

12. Which medication would the nurse administer to a patient who is rating the pain at 8 on a 0 to 10 scale?

a.

Acetaminophen (Tylenol)

b.

Morphine (Roxanol)

c.

Oxycodone (OxyContin)

d.

Oxycodone and aspirin (Percodan)

ANS: B

Severe pain is treated with an opiate agonist (i.e., morphine). Severe pain is not treated with acetaminophen, oxycodone, or Percodan.

DIF: Cognitive Level: Application REF: p. 323 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. In which case would the nurse be correct in withholding an opiate agonist?

a.

Evidence of postural hypotension

b.

Presence of constipation

c.

Pain rating of 7 on a 0 to 10 scale

d.

Respiratory rate of 10 breaths/min

ANS: D

The nurse would withhold the medication if respirations are less than 12 breaths/min. Postural hypotension is a common adverse effect that most frequently occurs when therapy is initiated. Providing for patient safety is important, but it does not warrant withholding the medication. Constipation is an expected adverse effect and does not warrant withholding an opiate agonist. A pain rating of 7 would not warrant holding an opiate agonist.

DIF: Cognitive Level: Application REF: pp. 323-324 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

14. What information is most accurate regarding the nurses understanding of pain management?

a.

Older patients have difficulty describing their pain level.

b.

Encourage patients to report pain before the pain becomes too severe.

c.

Use the smallest dose of medication possible to control pain.

d.

Pain medication administration ordered PRN will maintain a constant blood level.

ANS: B

Even though pain medicine administration may be scheduled, encourage the patient to request pain medication before the pain escalates and becomes severe. Although the smallest dose possible to control the pain is the goal of therapy, it is also important that the dose be sufficient to provide adequate relief. Older patients are able to describe pain; a variety of tools are available for a variety of patient populations. Analgesics given on a scheduled basis every 3 to 4 hours will maintain a more constant plasma level.

DIF: Cognitive Level: Application REF: p. 318 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

15. The nurse is assessing a patients pain. When the patient describes his pain as cramping and burning, which component of the pain history is being addressed?

a.

Depth

b.

Location

c.

Quality

d.

Severity

ANS: C

The actual sensation of the pain is often described as stabbing, dull, cramping, sore, burning, or a combination of these. Depth of pain, location of pain, and severity of pain are not described as cramping and burning.

DIF: Cognitive Level: Application REF: p. 317 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

16. A patient experiencing chronic pain as a result of metastatic cancer has a new order for fentanyl (Duragesic) transdermal patch. The initial patch is applied at 8 AM on Monday. At 8 PM on Monday, the patient reports a pain level of 8. The nurses best response is to:

a.

immediately contact the physician.

b.

reassess pain level in 30 to 45 minutes.

c.

remove current patch and reapply a new patch.

d.

provide a PRN analgesic medication as ordered.

ANS: D

The fentanyl (Duragesic) patch takes approximately 12 to 24 hours for the initial patch of medication to reach a steady blood level, so other analgesics must be used during this time. Therefore, it is not necessary to immediately contact the physician. The patient is reporting severe pain and requires immediate intervention to help relieve this discomfort.

DIF: Cognitive Level: Analysis REF: p. 319 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

17. A patient is taking meperidine (Demerol) as needed for moderate to severe pain following an open appendectomy. The nurse assesses the following: current pain level 2, temperature 99 F, BP 130/76, respirations 10, lung sounds clear, abdomen soft and tender, bowel sounds present. Based on this assessment information, the priority nursing diagnosis is:

a.

altered breathing pattern.

b.

risk for altered body temperature.

c.

risk for constipation.

d.

pain.

ANS: A

Meperidine (Demerol) is an opiate agonist and can cause respiratory depression. Respirations less than 12/min indicates altered breathing pattern and requires immediate intervention. Temperature of 99 F is not the priority concern. The abdomen is soft, so there is no indication of constipation. Pain level of 2 is considered mild; therefore, this is not the top priority.

DIF: Cognitive Level: Analysis REF: p. 324 OBJ: 3

TOP: Nursing Process Step: Diagnosis

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

18. Which additional nursing intervention(s) would be effective with pain management in the pediatric population? (Select all that apply.)

a.

Provide diversional activities such as coloring, puzzles, and games.

b.

Allow uninterrupted sleep and rest.

c.

Perform hygiene measures.

d.

Encourage parental participation with caregiving to diminish the childs anxiety.

e.

With the health care providers approval, encourage the child to drink eight to ten 8 ounce glasses of fluid daily.

ANS: A, B, C, D

Diversional activities, adequate sleep, comfort measures (such as hygiene), and parental participation with care are alternative nursing interventions that may be used in pain management. Forcing fluids is not likely to assist with pain management in the child.

DIF: Cognitive Level: Application REF: p. 317 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

19. Which common adverse effect(s) is/are associated with opiate agonists? (Select all that apply.)

a.

Dizziness

b.

Orthostatic hypotension

c.

Respiratory depression

d.

Confusion

e.

Diarrhea

f.

Urinary urgency

ANS: A, B, C, D

Dizziness, orthostatic hypotension, respiratory depression, and confusion are adverse effects associated with opiate agonists. Constipation, not diarrhea, is an adverse effect associated with opiate agonists. Urinary retention, not urgency, is an adverse effect associated with opiate agonists.

DIF: Cognitive Level: Comprehension REF: p. 323 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

20. Which condition(s) may be managed by salicylates? (Select all that apply.)

a.

Migraine headache

b.

Swollen joints

c.

Fever

d.

Muscle aches

e.

Myocardial infarction

ANS: B, C, D, E

Salicylates inhibit prostaglandins that produce the signs and symptoms of inflammation, inhibit the synthesis and release of prostaglandins in the brain that cause the elevation of body temperature, inhibit the formation of prostaglandins that sensitize pain receptors (providing analgesia), and inhibit platelet aggregation and decrease the risk of clot development. Salicylates are not typically used for migraine headache.

DIF: Cognitive Level: Application REF: pp. 329-330 OBJ: 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

21. When teaching a patient who is starting therapy with NSAIDs, the nurse must be sure to mention drug interactions with which drug(s)? (Select all that apply.)

a.

Warfarin (Coumadin)

b.

Lithium (Eskalith)

c.

Hydroxyzine (Vistaril)

d.

Insulin

e.

Diuretics

f.

Digitalis (Digoxin)

ANS: A, B, E

NSAIDs may enhance the effects of warfarin, lithium, and diuretics. NSAIDs are not known to interact with hydroxyzine, insulin, or digitalis.

DIF: Cognitive Level: Knowledge REF: pp. 330-331 OBJ: 9

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

22. When performing a baseline neurologic assessment prior to the administration of an NSAID medication, the nurse will assess which patient characteristic(s)? (Select all that apply.)

a.

Vital signs

b.

Orientation to date, time, and place

c.

Mental alertness

d.

Bowel sounds

e.

Concurrent use of anticoagulant agents

ANS: B, C

Orientation to date, time, and place as well as assessment of mental alertness are components of a baseline neurologic assessment to be completed prior to medicating with an NSAID. Vital signs, bowel sounds, and assessment of concurrent use of anticoagulant drugs are not considered components of a neurologic assessment.

DIF: Cognitive Level: Application REF: p. 335 OBJ: 9

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

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