Chapter 5- Relieving Pain and Providing Comfort(FREE) My Nursing Test Banks

 

1.

A patient is in the ICU after suffering multiple trauma from a car wreck that occurred 24 hours ago. The patient feels pain from many sources, including lacerations on the arm, a fractured femur, a tension headache from the stress of the accident, lower back pain from a sports injury 30 years ago, nasal irritation from an endotracheal tube, and joint aches from ongoing arthritis. The nurse recognizes which of the following as the most likely instances of chronic pain? Select all that apply.

A)

Lacerations on arm

B)

Fractured femur

C)

Tension headache

D)

Lower back pain from old sports injury

E)

Irritation in throat from endotracheal tube

F)

Arthritis in joints

2.

A Nepali man is in the ICU recovering from spinal surgery to remove a malignant tumor. He does not speak English, and struggles to communicate with the nurse by using hand motions. His family is constantly at his bedside, speaking with him in Nepalese. Frequently, he puts on headphones and listens to music on his MP3 player. His wife occasionally massages his feet. Which of the following factors is most likely exacerbating this patients pain?

A)

Inability to communicate with the nurse

B)

Constant presence of his family

C)

Listening to music

D)

His wife massaging his feet

3.

A nurse is caring for a patient in the ICU who is recovering from coronary artery bypass graft surgery. Over the course of the next few days, the nurse will be responsible for changing a dressing over the surgical incision site, having the patient change positions in bed, assisting with tracheal suctioning, and assisting with drain removal. The nurse should anticipate that the patient will most likely perceive pain resulting from these procedures in which order, from least painful to most?

A)

Changing the dressing, position change in bed, tracheal suctioning, drain removal

B)

Position change in bed, changing the dressing, drain removal, tracheal suctioning

C)

Drain removal, tracheal suctioning, position change in bed, changing the dressing

D)

Tracheal suctioning, position change in bed, changing the dressing, drain removal

4.

A patient in the ICU is receiving intravenous opioid analgesia following myocardial infarction. Despite receiving continuous infusion of the opioid, the patient is grimacing and asks for an increase in the medication level. Consulting the medical chart, the nurse recognizes that this patient has a history of opioid addiction. What would be the most appropriate intervention?

A)

Immediately take the patient off of the opioid and give him Tylenol.

B)

Leave the patient on the opioid at the current dose level.

C)

Increase the dose of opioid to provide more effective pain relief.

D)

Reduce the dose of opioid and offer to turn on the television as a distraction from the pain.

5.

A patient with no history of opioid abuse is receiving opioid analgesia intravenously in the ICU for severe pain from extensive third-degree burns. The patient and his family are concerned about the likelihood of developing an addiction to the medication. What would be the best response on the part of the nurse?

A)

Stop the opioid infusion immediately and use only nonpharmacological means of analgesia.

B)

Begin tapering off the medication gradually.

C)

Explain that the risk for addiction is low and that opioids are necessary for the patients level of pain.

D)

Explain that addiction is likely but cannot be avoided and suggest a rehabilitation program following discharge.

6.

A nurse is working with an elderly patient with Alzheimers disease and congestive heart failure in the ICU. Which of the following methods of pain assessment would be essential to include in this situation, according to the American Geriatric Society?

A)

No assessment is appropriate; the patient should be started on a standardized protocol for analgesia for Alzheimers patients

B)

The verbal zero to ten scale

C)

The word descriptor scale

D)

Assessment of behavior and family observations

7.

A patient in the ICU with renal dysfunction is to begin receiving intravenous opioids and a nonsteroidal anti-inflammatory drug (NSAID) for severe pain. The medication is expected to be administered for at least seven days. Which NSAID would be most appropriate for this patient? Select all that apply.

A)

Ketorolac (Toradol)

B)

Indomethacin (Indocin)

C)

Celecoxib (Celebrex)

D)

Rofecoxib (Vioxx)

8.

A nurse is working with a cancer patient who has chronic pain related to her illness. The nurse must administer fentanyl to the patient in the form of a transdermal patch. Which of the following should the nurse do in administering this medication?

A)

Use lotion to prepare the skin where the patch will be applied.

B)

Wear gloves when handling the patch.

C)

Apply the patch over a wound or abrasion, if possible, to maximize absorption.

D)

Leave old patches on the patients bedside table for the doctor to examine later.

9.

A patient in the ICU is receiving an intravenous opioid infusion for pain, but is experiencing anxiety due to being on mechanical ventilation. The physician has decided to prescribe a sedative for the patient. The patients health history indicates an allergy to soy products. Which sedative should be avoided in this situation?

A)

Propofol

B)

Midazolom

C)

Diazepam

D)

Lorazepam

10.

An elderly patient in the ICU is receiving intravenous opioid analgesia for pain. The nurse observes that the patients respiratory rate has decreased to 8 breaths per minute. Which nursing intervention would be most appropriate?

A)

Administer naloxone intravenously very slowly.

B)

Administer diazepam immediately.

C)

Increase the dose of opioid.

D)

Massage the patients feet to stimulate her breathing.

11.

The nurse is caring for an otherwise healthy victim of a motor vehicle crash who is experiencing considerable pain. What factor indicates that the patient may be experiencing acute pain?

A)

It is associated with an acute and severe injury.

B)

It is expected to resolve as the injury heals.

C)

It requires treatment with intravenous opioids.

D)

No chronic illnesses have been diagnosed.

12.

The nurse is caring for a critically ill patient who has experienced multiple trauma. The patient has high levels of pain from the injury and is receiving an intravenous opioid as treatment. In managing the patients pain, what nursing action best demonstrates understanding of other factors that exacerbate pain in the critically ill patient?

A)

Provide supportive care without discussing it with the patient.

B)

Limit visits to immediate family for a few minutes at a time.

C)

Minimize care tasks during normal hours of sleep.

D)

Give higher doses of intravenous opioid as needed.

13.

Before turning and repositioning a critically ill patient, the nurse ensures that a pain medication is administered. This action demonstrates the nurses understanding of what phenomenon?

A)

Research has shown that critically ill patients perceive turning as a painful procedure.

B)

The patient is ordered to receive pain medication every 4 to 6 hours.

C)

This patient becomes very stiff when turned and the medication will be relaxing.

D)

The nurse is not concerned that this patient will become addicted to the medication.

14.

The patient is scheduled for a painful procedure. In addition to premedicating the patient with an opioid drug, what other nursing action is most likely to alleviate the pain?

A)

Give intravenous midazolam (Versed).

B)

Monitor vital signs during the procedure.

C)

Give explanations before and during the procedure.

D)

Ask the family to wait outside during the procedure.

15.

The nurse is caring for a patient who has required increasing doses of opioids to control pain and expresses a concern that the patient is becoming addicted to the opioid. What patient behavior would best support the nurses concern about addiction?

A)

He needs more medication to control pain.

B)

He has withdrawal symptoms when the medication is stopped.

C)

He states that he dislikes the opioid as it makes him feel drugged.

D)

He asks for another dose of the opioid to relieve anxiety and get a buzz.

16.

The nurse is caring for a critically ill patient who has developed tolerance to an opioid medication used for pain control. As the dose of the opioid is increased, the nurse observes the patient closely for respiratory depression. If the patient has developed tolerance to the opioid, what effect on the respiratory system does the nurse expect?

A)

None

B)

Depression

C)

Stimulation

D)

Exacerbation

17.

The nurse is caring for a critically ill patient with serious pain and wishes to consult national guidelines. What is the most comprehensive source for pain management guidelines?

A)

Web-based National Guideline Clearinghouse

B)

American Association of Critical-Care Nurses

C)

Society of Critical Care Medicine

D)

Agency for Healthcare Research and Quality

18.

The nurse is developing a policy and procedure for pain management in a critical care unit. Based on national standards, what should the nurse include?

A)

Pain assessment in critical care must depend on vital sign monitoring as patients are not verbal.

B)

Continuous intravenous opioids are preferred over as-needed dosing.

C)

Intravenous sedation of agitated patients takes priority over pain control.

D)

Pain control is an independent nursing function and responsibility.

19.

According to national standards, pain in critically ill patients should be assessed at regular intervals using a variety of methods. What statement about pain assessment is true?

A)

Absence of physical signs or behaviors is equivalent to absence of pain.

B)

Many of the factors in critical care combine to invalidate patient self-report of pain.

C)

Behavioral observation and physiological parameters should be considered along with the patients report.

D)

The family has a more accurate assessment of pain than the patient.

20.

The nurse is administering an intravenous opioid to manage a patients pain. What criteria can the nurse use to determine the adequacy of therapy?

A)

Minute ventilation is somewhat compromised.

B)

Patient rates pain below 5 on scale of 1 to 10.

C)

Minute ventilation is minimally compromised.

D)

Patient rates pain below own predetermined goal.

21.

A severely ill critical care patient is receiving intravenous opioids for pain management. The physician adds a nonsteroidal anti-inflammatory drug (NSAID) to the patients plan of care. The nurse understands that the most significant advantage of adding this drug is what?

A)

NSAIDs are cheaper than opioids while providing the same pain relief.

B)

Inhibition of prostaglandin and histamine at the site of injury will relieve pain without sedation.

C)

NSAIDs are available without prescription.

D)

Addiction and physical dependence are less of a problem with NSAIDs.

22.

A critically ill patient is receiving acetaminophen (Tylenol) in combination with opioids for pain management. Under what circumstances would the nurse question the use of acetaminophen?

A)

Normal liver function tests

B)

Low platelet levels

C)

Relative hypothermia

D)

Reduced pain levels

23.

The nurse is caring for a critically ill patient with high levels of pain. To potentiate pharmacological pain relief, the nurse uses several nonpharmacological interventions. What nursing strategies will be helpful in this situation? Select all that apply.

A)

Frequent turning and repositioning

B)

Earphones with music of the patients choice

C)

Limiting visits to twice a day

D)

Using guided imagery and distraction

E)

Teaching the quieting reflex

F)

Using therapeutic touch

Answer Key

1.

D, F

2.

A

3.

A

4.

C

5.

C

6.

D

7.

C, D

8.

B

9.

A

10.

A

11.

B

12.

C

13.

A

14.

C

15.

D

16.

A

17.

A

18.

B

19.

C

20.

D

21.

B

22.

C

23.

B, D, E, F

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