Chapter 15: Pain Management
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. The length of time that a nurse should leave heat to an injured hip of a patient is no longer
than:
a.
15 minutes.
b.
20 minutes.
c.
30 minutes.
d.
1 hour.
2. A patient with an extensive abdominal surgical procedure is assessed by the nurse as having
predictable pain. How often should the nurse administer analgesics to this patient to be most
effective?
a.
As needed (PRN)
b.
Once a day
c.
Twice a day
d.
Around the clock
3. What sympathetic responses to pain might be assessed by the nurse?
a.
Increased blood pressure, increased pulse, and increased respiratory rate
b.
Decreased blood pressure, decreased pulse, and increased respiratory rate
c.
Increased blood pressure, decreased pulse, and increased respiratory rate
d.
Decreased blood pressure, decreased pulse, and decreased respiratory rate
4. A health care provider has prescribed both heat and cold treatments for an older adult patient
with a leg injury. The nursing care plan reflects secondary diagnoses of peripheral vascular
disease (PVD), diabetes, and an allergy to latex. Which of the prescribed treatments should
the nurse administer and why?
a.
The nurse will use cold treatment because patients with diabetes and a latex allergy
cannot tolerate heat.
b.
The nurse will use cold treatment for this patient with a fracture because cold will
help set the cast.
c.
The nurse will use heat treatment because cold is contraindicated for patients with
PVD.
d.
The nurse will use heat treatment because heat will increase circulation and
increase the threat of infection in the injured part.
5. A nurse notices that a patient seems calm and peaceful despite an assessment that the patient’s
injuries might be causing severe pain. The patient tells the nurse that using yoga and
meditation lessens the perceptions of pain to tolerable levels. Which other alternative
intervention should the nurse suggest to help relax this patient for pain relief?
a.
Indulging in a favorite food
b.
Music by a favorite artist
c.
Reading exciting science fiction
d.
Self-administration of drugs
6. What intervention of pain control exemplifies the gate control methods of pain relief?
a.
Assisting the patient to ambulate
b.
Giving a massage
c.
Providing an ice cold beverage
d.
Instructing the patient in stretching exercises
7. To perform a nursing assessment correctly, a nurse must remember that pain perception
involves several central nervous system (CNS) processes. Which are examples of CNS
processes?
a.
Afferent pathways carry messages to the spinal cord.
b.
Efferent pathways stimulate the spinal cord to recognize the location of pain.
c.
Nociceptors in the brain stimulate the spinal cord.
d.
Pain receptors in muscle, skin, and subcutaneous tissue stimulate efferent
pathways.
8. A nurse is teaching a patient how to use a transcutaneous electrical nerve stimulation (TENS)
unit and how it works. What is the most appropriate information for the nurse to relay?
a.
“The stimulation of the skin seeks to localize the acute pain and will last for
several minutes after the unit is applied.”
b.
“This unit stimulates both the skin and the underlying tissues to decrease the
intensity of the pain.”
c.
“The mechanism for use of this unit is well known and can be read.”
d.
“During those days when using the TENS unit, no analgesic can be given.”
9. What should greatly reduce postoperative pain for a patient about to undergo a hip
replacement?
a.
Femoral nerve blocks
b.
Extremely deep general anesthesia
c.
Practicing leg lifting exercises before surgery
d.
Placing an analgesic patch directly over the incision
10. A patient continues to report pain after the administration of the prescribed analgesic. Why
should the nurse change the nursing care plan?
a.
Patient’s pain threshold has risen.
b.
Patient’s pain threshold has lowered.
c.
Patient has become addicted.
d.
Patient is seeking attention.
11. A nurse administers nalbuphine (Nubain), an opioid agonist–antagonist, to a 78-year-old
patient. The family is worried about the patient and thinks that this drug is too strong and will
cause harm. What should the nurse assure the family regarding this drug?
a.
Does not accumulate in the body
b.
Blocks the side effects observed in opioid agonists
c.
Does not affect the CNS
d.
Can only be given orally
12. A patient admitted with the diagnosis of possible myocardial infarction complains of pain and
tingling in the left arm and says, “How in the world could I be having a heart attack when it’s
just my arm that is giving me trouble?” What type of pain should the nurse explain that the
patient is experiencing?
a.
Referred pain
b.
Psychogenic pain
c.
Neuromuscular pain
d.
Muscle spasms of shoulder
13. Every time the right arm is raised, a patient reports to the nurse that pain is triggered in the
right shoulder. How should the nurse document this description?
a.
Referred pain
b.
Aggravating factor
c.
Alleviating factor
d.
Past experience with the pain
14. A patient who had a myocardial infarction 2 days earlier has been eating well, is ambulating
with assistance, and is receiving antibiotics and morphine by intravenous (IV) drip. The
patient complains of constipation this morning. What should the nurse assess as the probable
cause of the constipation?
a.
Inadequate fluid intake
b.
Lack of exercise
c.
Administration of antibiotics
d.
Administration of an analgesic medication
15. A patient who is obviously in pain refuses the morphine that has been prescribed for pain
control because of a fear of addiction. What should the nurse explain is the estimated
percentage of patients taking prescribed pain protocols who become addicted?
a.
Less than 1%
b.
10% to 25%
c.
30% to 50%
d.
80% to 90%
16. Morphine sulfate (30 mg) IM PRN was prescribed for pain for an 80-year-old patient with
emphysema who weighs 100 lb. What is the most appropriate action for the licensed
practical/vocational nurse (LPN/LVN)?
a.
Transcribe the order and wait to see if the patient needs it.
b.
Transcribe the order for an oral dose instead of IM dose.
c.
Call the physician and clarify the order.
d.
Tell the RN about the order.
17. What assessment should a nurse make to evaluate the presence of pain in a patient who is
cognitively impaired?
a.
Amount of time spent sleeping during the day
b.
Consistent stoic facial expression
c.
Increased social interaction
d.
Increasing confusion
18. Which steps should the LPN/LVN follow when performing a pain assessment?
a.
Assess vital signs, status of pain, and aggravating factors.
b.
Assess location, quality, and intensity on an identified scale.
c.
Assess the intensity on an identified scale and record findings.
d.
Assess vital signs and location, and report to the RN.
19. Two patients are hospitalized with the same diagnosis, but one is 23 years old, with acute
recent pain from an injury, and the other is 64 years old, with pain of long-standing duration
of several years. What is the difference in the anticipated assessments?
a.
Acute pain for young patients is more intense at the same level, but these patients
experience few changes in vital signs.
b.
Young patients with acute pain exhibit fewer changes in vital signs but still report
true levels of pain at levels 8 to 10.
c.
Older adult patients with chronic pain exhibit increased changes in vital signs and
report levels of pain lower than reality.
d.
Older adult patients with chronic pain usually report lower levels of pain much less
severe than they really are.
20. How does the International Association for the Study of Pain define the sensation of pain?
a.
Unpleasant sensory and emotional experience
b.
Whatever the person experiencing it says it is
c.
Psychogenic response to tissue injury
d.
Physical and psychogenic response to the need for drugs
21. A nurse is notified when a patient, newly admitted with liver and gallbladder disease,
complains of pain in the right middle back and asks for some pain medication. What is the
best interpretation of this reported assessment by the nurse?
a.
The patient is just complaining to see whether the staff will give out pain
medications.
b.
The patient has referred pain sensations. The nurse should follow orders for
administering pain medication.
c.
The patient has an injury on the back from an unknown cause that needs
immediate assessment.
d.
The patient is a chronic complainer with anxieties about his condition.
22. What is the most common result of prolonged and unrelieved pain?
a.
Release of endorphins
b.
Lowered pain threshold
c.
Stimulated gate control
d.
Lowered blood pressure
23. A nurse is administering morphine IM, which was prescribed for a patient reporting severe
pain. What should be the nurse’s primary assessment focus on to evaluate the patient’s
response to this drug?
a.
Cardiac rhythms for tachycardia
b.
Respiratory rate for tachypnea
c.
Increased bowel sounds in the gastrointestinal system
d.
Sedative effects in the neurologic system
24. A nurse explains to a patient the gate control theory of pain. Where does the perception of
pain originate in the gate control theory?
a.
Large arteries
b.
Vena cava
c.
Large nerve fibers
d.
Small nerve fibers
25. When a patient with sciatica seats himself in a chair, he gasps and complains of a burning and
shooting pain in his hip. What type of pain does this represent?
a.
Referred
b.
Neuropathic
c.
Visceral
d.
Acute
MULTIPLE RESPONSE
26. What are the standards for pain management published by The Joint Commission (TJC)?
(Select all that apply.)
a.
Perform organized pain assessment.
b.
Record results of analgesia.
c.
Give adequate discharge instruction about pain relief.
d.
Recognize the right of a nurse to manage pain.
e.
Teach patients about pain control methods.
27. What instruction should the nurse provide to a patient who has had a rhizotomy for leg pain?
(Select all that apply.)
a.
Relief may not be permanent.
b.
The leg will tingle and burn occasionally.
c.
The foot may discolor and twitch at times.
d.
Snug shoes should be worn at all times.
e.
Caution should be taken to prevent injury to the leg.
COMPLETION
28. A nurse explains that afferent pathways are activated by pain receptors called _____.
29. _____ and _____ are natural opioid-like substances that block pain perception.