Chapter 36: Pain Management Yoost & Crawford: Fundamentals of Nursing: Active Learning for Collaborative Practice, 2nd Edition

1. The nurse is caring for a patient recovering from knee replacement surgery. The patient complains of severe pain in the knee after receiving hydrocodone with acetaminophen (Vicodin) 2 hours previously. What is the nurse's best action?

a. Administer another dose of the medication.

b. Apply ice packs to the knee.

c. Apply heat packs to the knee.

d. Perform gentle range of motion.

B

1. The nurse is checking on the patient after administering pain medication 30 minutes previously. Which assessment finding best indicates to the nurse that the pain medication was effective?

a. The patient is sleeping quietly.

b. The patient states a reduction of the pain.

c. The patient's respirations are slow and regular.

d. The patient's blood pressure has returned to baseline.

B

1. The nurse is caring for a patient who has severe abdominal pain caused by acute cholecystitis. The nurse recognizes which type of pain is this patient experiencing?

a. Visceral pain

b. Somatic pain

c. Radiating pain

d. Referred pain

A

1. The nurse knows which is the best pain medication option for a patient to manage severe long-term cancer pain at home?

a. Fentanyl (Duragesic) 50 mcg transdermal patch q 72 hours

b. Meperidine (Demerol) 50 mg IM q 6 hours

c. Hydromorphone (Dilaudid) 0.2 mg q 10 minutes IV via PCA pump

d. Hydromorphone (Dilaudid) 0.08 mg/hour infusion through epidural catheter

A

1. The nurse is caring for a patient with severe chronic pain and applied the first 50 mcg transdermal fetanyl (Duragesic) patch 2 hours ago. The patient states that the pain is presently rated at 9 on a 1 to 10 scale. What is the nurse's best action?

a. Instruct the patient that the fentanyl patch will start to work soon.

b. Check the provider's orders for a short-acting narcotic medication to administer for breakthrough pain.

c. Give the patient a gentle back rub and encourage guided imagery.

d. Apply a second 25-mcg transdermal fentanyl patch now.

B

1. The nurse is caring for a patient who has been taking ibuprofen (Motrin) 800 mg TID for the last several months to relieve knee pain from arthritis. Which assessment finding must be reported by the nurse to the provider promptly?

a. The patient has abdominal pain and pale skin.

b. The patient has constipation and takes stool softeners daily.

c. The patient enjoys a glass of wine every Friday and Saturday evening.

d. The patient has gained 15 lb in the last 3 months.

A

1. The nurse is caring for a patient who just underwent laparoscopic appendectomy. The patient complains of severe postoperative pain between the shoulder blades. Which term best describes the pain that this patient is having?

a. Referred pain

b. Phantom pain

c. Neuropathic pain

d. Psychogenic pain

A

1. The nurse administered 100 mcg sublingual fentanyl spray (Subsys) at 10:00 a.m. to a patient experiencing severe breakthrough pain. At what time will the nurse ask the patient if pain relief was obtained?

a. 10:30 a.m.

b. 11:00 a.m.

c. 11:30 a.m.

d. 12:00 noon

A

1. The nurse is caring for a patient who will be using a hydromorphone (Dilaudid) PCA analgesia pump following surgery. Which intervention is the highest priority for the nurse to include in the patient's care plan related to this pump?

a. Assess the patient's respiratory status frequently after PCA pump started.

b. Review patient's medication profile to check for interactions with hydromorphone.

c. Teach the patient how to use PCA pump when the pain level is still tolerable.

Keep naloxone (Narcan) available at the bedside in case of respiratory depression

C

1. The nurse is caring for a 6-month-old infant who has just undergone surgery. The infant's facial muscles are tight with a furrowed brow and the infant's respirations are shallow and irregular. The infant is mildly fussy and softly crying without muscular rigidity in the arms and legs. What score will the nurse give to the infant on the Neonatal Infant Pain Scale?

a. 2

b. 3

c. 4

d. 5

C

1. The nurse is caring for a patient with rheumatoid arthritis who is in constant severe pain. Which nursing diagnosis is the highest priority for this patient?

a. Impaired mobility r/t patient's need to use a cane or walker with ambulation

b. Impaired health maintenance r/t sedentary lifestyle and poor physical condition

c. Anxiety r/t mistrust of health care personnel

d. Chronic pain r/t ongoing inflammatory tissue damage and joint destruction

D

1. The nurse is caring for a patient with rheumatoid arthritis who is in constant severe pain. Which nursing diagnosis is the highest priority for this patient?

a. Impaired mobility r/t patient's need to use a cane or walker with ambulation

b. Impaired health maintenance r/t sedentary lifestyle and poor physical condition

c. Anxiety r/t mistrust of health care personnel

d. Chronic pain r/t ongoing inflammatory tissue damage and joint destruction

D

1. The nurse is caring for a cancer patient with ongoing pain from widespread metastasis to the bones. The nurse notes that the patient's morphine dosage had to be increased to sufficiently manage the discomfort. What is the nurse's interpretation of this assessment finding?

a. The patient became tolerant to the previous morphine dosage.

b. The patient is becoming addicted to the pain medication.

c. The patient has been abusing the prescribed pain medications.

d. The patient may be seeking to end life with an overdose of morphine.

A

1. The nurse identifies which patient to be best suited for PCA analgesia?

a. A patient who is confused after a head injury

b. A patient recovering from total hysterectomy surgery

c. A patient who has severe psychogenic pain

d. A patient with arthritis who is unable to push the nurse call button

B

1. What is the priority nursing assessment for a patient who is receiving postoperative epidural analgesia with hydromorphone (Dilaudid)?

a. Respiratory rate, depth, and pattern

b. Skin underneath the epidural dressing

c. Bladder scanning to check for urinary retention

d. Itching on the trunk and/or extremities

A

1. The nurse is caring for a diabetic patient who has painful foot neuropathy. The patient asks why the nurse is administering gabapentin (Neurontin) when there is no history of seizure disorder. What is the nurse's best response?

a. "Gabapentin will help you sleep at night so you can deal with the pain more effectively."

b. "Long-term diabetes can put patients at risk for certain type of seizures."

c. "This medication can help relieve your anxiety from being admitted to the hospital."

d. "Gabapentin works on the nervous system to help relieve the burning pain in your feet."

D

1. The nurse is caring for a patient who has a PCA pump following total hysterectomy surgery. The nurse sees the visitor push the PCA button while the patient is sleeping quietly. What is the best response of the nurse?

a. "Thank you for pushing the button for her to help keep her comfortable after surgery."

b. "Please do not push the button for the patient—she could receive more medication than she needs."

c. "You can push the button for her now, but please have her do it herself when she awakens."

d. "PCA pumps are great because she doesn't have to wait for me to administer her pain medication."

B

1. Which assessment question helps the nurse determine the character of the patient's pain?

a. "What does the pain feel like?"

b. "When did the pain first start?"

c. "What interventions make the pain better?"

d. "Is there any pattern to when the pain occurs?"

A

1. The nurse is caring for a patient who only speaks a foreign language. What is the best method for the nurse to assess the patient's pain level?

a. Perform a pain assessment using a translator.

b. Check the patient's vital signs and pulse oximetry.

c. Check the patient's respiratory rate, depth, and rhythm.

d. Look to see if the patient appears to be resting comfortably.

A

1. The nurse is caring for a trauma patient with the Nursing diagnosis of acute pain r/t fracture and muscle spasms. Which is an appropriate goal for this Nursing diagnosis?

a. The patient will experience less pain when participating in physical therapy.

b. The patient will describe meditation techniques that can be used to cope with pain.

c. Nursing staff will explain the ordered pain management approach to the patient.

d. The patient will feel less pain each day when range-of-motion therapy is performed.

B

1. The nurse is caring for a patient who has pain following abdominal surgery. Which actions are independent nursing interventions that can be used to make the patient more comfortable? (Select all that apply.)

a. Encourage the patient to relax and imagine resting on a tropical beach.

b. Provide headphones so that the patient can listen to favorite music.

c. Increase pain medication dosage if prescribed regimen is ineffective to manage pain.

d. Teach the patient to take pain medication before discomfort becomes severe.

e. Switch the patient from IV to oral pain medication when bowel sounds return.

f. Demonstrate the use of relaxation breathing before painful procedures.

A,B,D,F

1. The nurse is caring for a patient who has severe burning pain in the right arm caused by a compressed nerve in the neck. Which medications can be used along with a narcotic pain reliever to relieve the patient’s pain until surgery can be performed to release the nerve? (Select all that apply.)

a. Diphenhydramine (Benadryl) 50 mg PO daily

b. Amitriptyline (Elavil) 50 mg PO BID

c. Ondansetron (Zofran) 8 mg PO q 4 hours PRN

d. Gabapentin (Neurontin) 400 mg PO BID

e. Senna (Senokot) 8.6 mg PO daily

f. Naloxone (Narcan) 0.4 mg IV now, may repeat in 1 hour PRN

B,D

1. The nurse is caring for a patient who just had knee replacement surgery. Which factors will affect how the patient experiences pain after this surgery? (Select all that apply.)

a. The patient has had rheumatoid arthritis for the last 16 years.

b. The patient is allergic to aspirin and strawberries.

c. The patient owns a business and is self-insured.

d. The patient has been a vegetarian for the last 8 years.

e. The patient had the other knee replaced 2 years ago.

f. The patient was a marathon runner in high school and college.

A,E,F