Pain Management in Acute and Chronic Conditions, Exams of Nursing

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1. Which route of administration of medication is preferred in the most acute care situations?
   • Intravenous
2. A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect? - Addiction
3. A client who fell at home is hospitalized for a hip fracture. The client is in Buck's traction, anticipating surgery, and reports pain as "2" on a pain intensity scale of 0 to 10. The client also exhibits moderate anxiety and moves restlessly in the bed. The best nursing intervention to address the client's anxiety is to: - Assess the reason for the client's anxiety.
4. A client is being taught to self-administer a narcotic analgesic by means of an intravenous pump system. Which of the following would help prevent accidental overdosage? - Programming the dosage and time interval into the device
5. Which type of pain arises from an internal organ, such as the kidneys?
   • Visceral
6. The nurse asks the client about a reddened area on the left arm. The client states that he was bitten by an insect, and it burned briefly. What type of pain does the nurse document this as? - Superficial somatic pain
7. Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission? - A child quickly removing a hand when touching a hot object
8. The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain? - Diaphoresi
9. The nurse assessed a patient's pain subsequent to a broken ankle. The nurse documented that the patient's pain was categorized as: - Acute
10. When drafting a nursing care plan for a patient in pain, it is important for the nurse to determine if the pain is acute or chronic. Choose an example of chronic pain.
    • Intervertebral disk herniation
11. The client is taking continuous-release oxycodone (Oxycontin) for chronic pain and now reports constipation. The first question the nurse asks is:
    • "When was your last bowel movement?"
12. The nurse is to administer meperidine (Demerol) 75 mg intramuscularly to a client. The medication is supplied in an ampule of 50 mg/mL. How many milliliters should the nurse administer to the client? Enter the correct number ONLY.
13. An older adult is being treated with opioids for pain relief. Which of the following should the nurse strongly recommend to this client?
    • Follow a bowel regimen.

14. A client is recovering from abdominal surgery and sleeping. The client had received an opioid

medication 3 hours ago. The client's son requests pain medication for the client, stating "I do not want her to wake up in pain." The first nursing action is:

• Instruct the son about lack of client consent.

MedSurg - Chapter 12 Pain Management

15. The nurse is administering a narcotic analgesic for the control of a newly postoperative client’s pain. What medication will the nurse administer to this client?
    • Fentanyl (Duragesic)
16. A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client:
    • That medication will be prescribed for pain relief
17. The client is postoperative for a right total-knee arthroplasty, and medications include lidocaine 5% (Lidoderm). Past history includes a left mastectomy and herpes zoster following treatment with chemotherapy. The best nursing action is to:
    • Remove the patch after 12 hours.
18. A new surgical patient has been prescribed an opioid analgesic intravenously for pain control. The nurse should be aware of which most serious adverse effect of this medication?
    • Respiratory depression
19. A patient is complaining of a headache during epidural administration of an anesthetic agent. Which of the following nursing interventions should be completed?
    • Keep the head of the bed flat.
20. Which of the following is a disadvantage of using the transdermal route of opioid administration?
    • A delay in effect until the dermal layer is saturated
21. A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing?
    • visceral
22. Which of the following nursing interventions contributes to achieving a client’s pain relief?
    • Collaborate with the client about his or her goal for a level of pain relief.
23. How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?
    • Administering the analgesics on a regular basis
24. The nurse is assisting the anesthesiologist with the insertion of an epidural catheter and the administration of an epidural opioid for pain control. What adverse effect of epidural opioids should the nurse monitor for?
    • Bradypnea
25. Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain?
    • Do not administer if respirations are <12 breaths per minute.
26. An older adult has been medicated with an oral opioid for postoperative pain. To make the pain medication more effective, the nurse first:
    • Provides the client with a fresh gown and changes the bed linens
27. A client receives hydromorphone 2 mg intravenously for report of postoperative pain. Fifteen minutes later, the nurse notes respirations are 6 breaths/minute and the client is nonresponsive. The nurse administers prescribed naloxone. The next time the client reports pain, the best nursing action is:
    • Consult with the healthcare provider to reduce the dose.

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28. Opioid analgesics are effective pain management tools for many clients. A significant portion of a nurse's practice is older adults who suffer from chronic pain. What impact does a client's age have on initial dosing?
    • Older clients should receive a reduced dose.
29. A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be:
    • Prolonged in duration.
30. Which phase of pain transmission occurs when the brain experiences pain at a conscious level?
    • Perception
31. The nurse is caring for a client with kidney stones who is complaining of severe pain. What type of pain does the nurse understand this client is experiencing?
    • Visceral Pain
32. A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing?
    • Neuropathic pain
33. About which issue should the nurse inform clients who use pain medications on a regular basis?
    • Inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesics consistently without consulting a physician.
34. Nociception includes four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission?
    • A child quickly removing a hand when touching a hot object
35. Regarding tolerance and addiction, the nurse understands that:
    • although clients may need increasing levels of opioids, they are not addicted.
36. When using transdermal Fentanyl, the nurse and patient should be aware of which sign or symptom of Fentanyl overdose?
    • Confusion
37. The client reports chest pain. The nurse uses which of the following questions to assess the pain further. Select all answers that apply.
    • "How long have you experienced this pain?"
    • "Please point to where you are experiencing pain."
    • "Rate the pain on a scale of 0 to 10, with 10 being the worst possible pain."
    • "What aggravates your chest pain?"
38. According to The Joint Commission’s pain assessment and management standards, which of the following are essential components of a comprehensive pain assessment?
    • location, onset, alleviating factors, and aggravating factors
39. The nurse is administering a narcotic analgesic for the control of a newly postoperative client’s pain. What medication will the nurse administer to this client?
    • Fentanyl (Duragesic)
40. The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient?
    • Older people experience reduced sensory perception.

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41. The nurse observes the anesthesiologist administer a single-dose, extended release drug in an epidural catheter for a patient undergoing a major surgical procedure. What drug does she understand is being administered?
    • Depodur
42. A client is admitted with generalized abdominal pain, nausea, vomiting, and hypotension. The client has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect the client to be experiencing?
    • visceral
43. A client being treated for rheumatoid arthritis has been prescribed a glucocorticosteroid. How should the nurse best ensure this client's safety during treatment?
    • Ensure the client knows to taper down the dose if it is discontinued by the care provider.
44. The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain?
    • Diaphoresis
45. The nurse applies a transdermal patch of fentanyl for a client with pain due to cancer of the pancreas. The client puts the call light on 1 hour later and tells the nurse that it has not helped. What is the best response by the nurse?
    • “It will take approximately 12 to 18 hours for the medication to begin to work, so I will give you something else now to relieve the pain.”
46. A nurse documents the presence of chronic pain on an electronic health record. Choose a description that could be used. The pain can be:
    • Prolonged in duration.
47. Which of the following is a physiologic response to pain?
    • Pallor
48. A client is receiving morphine through a patient–controlled analgesia (PCA) system following surgery. The nurse states to the client:
    • "Only you are to push the button for medication."
49. A client is prescribed morphine for a possible ankle fracture. When the nurse brings in a second dose of the medication, the client states, "This medicine made me sick." The nurse replies:
    • "What do you mean by the word sick?"
50. Which of the following is the appropriate intervention to avoid physical dependence on drugs in a client?
    • Discontinue drugs gradually.
51. Acute pain can be distinguished from chronic pain by assessing which characteristic?
    • Acute pain is specific and localized.
52. Which medication should be readily available for patients receiving epidural opioids who are experiencing respiratory depression?
    • Naloxone
53. A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing?
    • Neuropathic pain
54. The nurse is obtaining data regarding the medication that the client is taking on a regular basis. The client states he is taking duloxetine, an antidepressant for the treatment of neuropathic pain. What type of therapy does the nurse understand the client is receiving?

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• Adjuvant drug therapy

55. When a nurse asks a patient to describe the quality of the pain, what type of descriptive term does the nurse expect the patient to use?

• Burning

56. The nurse is assessing an older adult patient just admitted to the hospital. Why is it important that the nurse carefully assess pain in the older adult patient?

• Older people experience reduced sensory perception.

57. A client is recovering from abdominal surgery and sleeping. The client had received an opioid medication 3 hours ago. The client's son requests pain medication for the client, stating "I do not want her to wake up in pain." The first nursing action is

• Instruct the son about lack of client consent.

58. When caring for a patient who is deaf, which of the following should be used to elicit information regarding the patient’s level of pain?

• An outside interpreter should be used.

59. A client who has undergone extensive fracture repair continues to request opioid pain medication with increasing frequency. The initial surgeries occurred more than 2 months ago, and the nurse is concerned about the repeated requests. What does the nurse suspect to be the cause of the client's frequent appeals for pain medication?

• tolerance

60. A preschool-age child is admitted for complaints of abdominal pain and vomiting. What is the best method for the nurse to collect data about the pain level of the child?

• The Wong-Baker FACES scale

61. The nurse is administering an analgesic to an older adult patient. Why is it important for the nurse to assess the patient carefully?

• Older people are more sensitive to drugs.

62. Regarding tolerance and addiction, the nurse understands that

• although clients may need increasing levels of opioids, they are not addicted.

63. Which substance reduces the transmission of pain?

• Endorphins

64. A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect?

• Addiction

65. The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to

• Educate the client that this goal may not be achievable.

66. The client is taking oxycodone (Oxycontin) for chronic back pain and reports decreased pain relief when he began taking a herb to improve his physical stamina. The nurse asks if the herb is

• ginseng

67. The client experienced abdominal surgery the previous day and has just received an opioid medication for report of pain. The client is sitting in a chair next to the bed. An additional activity that the nurse uses to relieve pain is

• encourage the client to watch television

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68. The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe?
    • Gabapentin, which is a first-line analgesic agent for neuropathic pain.
69. Which is a gastrointestinal route for administration of analgesics?
    • Rectal
70. A client has been prescribed a fentanyl patch for pain control. The nurse understands that this patch should be replaced every
    • 48 – 72 hours.
71. A teenage client is undergoing a dressing change to burns on the thigh. The client refuses pain medication and states, "I do not hurt, and I don't need it." He is withdrawn, grimaces, and turns away during the dressing change. He was last medicated 8 hours ago. What is the best statement by the nurse?
    • "I saw you grimacing during the dressing change. Please explain the reason you refused the pain medication."
72. How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?
    • Administering the analgesics every three hours
73. Which of the following is a true statement with regards to the preventative approach to the use of analgesics?
    • Smaller doses of medication are needed.
74. The nurse is visiting a client at home with intractable cancer pain. The client has a transdermal fentanyl patch on her right chest area. It is most important for the nurse to:
    • Remove the heating pad present on the chest area.
75. A home health nurse is visiting a client who has been taking the same dose of acetaminophen/hydrocodone for 2 months. To monitor for the presence of expected side effects of this medication, what should the nurse include in the assessment of the client?
    • Ask about the client’s bowel pattern.