Deck 20: Clients with Pain

Question 1

A client is in the hospital with an exacerbation of a chronic pain condition. Orders are for prn morphine IV push. When the primary nurse left for the weekend, the client's pain was under control. When the nurse returns to work, the client is reporting wild swings in pain control, being oversedated at some times and having extreme pain at other times. Which action by the primary nurse would best get this client's pain under control?

A) Ask the physician to order the pain medication on a round-the-clock schedule.
B) Observe the client for behaviors that might indicate possible addiction.
C) Plan to administer the maximum amount of pain medication the next time it is due.
D) Question the client about the pain to determine if he/she is exaggerating.

Answer 1

Ask the physician to order the pain medication on a round-the-clock schedule.

Question 2

A client is receiving an opioid analgesic through an epidural catheter. The nurse places the highest priority on

A) assessing for respiratory depression.
B) assisting the client with frequent position changes.
C) establishing a baseline laboratory profile.
D) performing hourly inspection of the catheter insertion site.

Answer 2

assessing for respiratory depression.

Question 3

The client with neuropathic pain develops allodynia, which

A) can be relieved by daily doses of opioids.
B) is a vague pain that is difficult for the client to describe.
C) is pain due to a stimulus that does not normally cause pain.
D) responds to NSAIDs taken several times a day.

Answer 3

is pain due to a stimulus that does not normally cause pain.

Question 4

A client with metastatic cancer is being dismissed to home health care. The client's orders include both a long-acting opioid analgesic and a short-acting analgesic for breakthrough pain. In addition, the client will be taking an NSAID every 8 hours. The client's spouse is very upset with these directions and voices concern to the nurse that the client "will become an addict." Which information will best help the spouse and client maintain the medication schedule? The nurse should

A) call the physician and ask him/her to come speak to the family.
B) help them understand the need for such strong medications.
C) inform them that in time, the medications can be decreased.
D) initiate a referral to a pain specialist.

Question 5

An elderly client has mild dementia and the nurse feels the client may be in pain. The best way for the nurse to assess this client for pain is by

A) asking direct questions about pain.
B) changing the way the nurse phrases the questions.
C) having the client rate pain with a 1-10 scale.
D) using the FACES pain scale.

Question 6

A client is receiving intravenous morphine every hour for severe pain. The nurse assesses the client and notes a blood pressure of (90/70) mm Hg, pulse rate of 90 beats/min, and respirations of 6 breaths/min. Which action by the nurse takes priority? The nurse should

A) administer the next dose of morphine when it is due.
B) notify the physician about the patient's hypotension.
C) prepare to administer naloxone (Narcan).
D) return in 1 hour so the client can get some uninterrupted sleep.

Question 7

The nurse instructs the client taking ibuprofen that the drug is effective for pain relief because it acts to

A) interfere with the relay of pain information through the dorsal horn.
B) interrupt the transmission of pain impulses.
C) reduce inflammation and block prostaglandins.
D) slow painful stimuli through type A-delta pain fibers.

Question 8

The nurse caring for a client with suspected appendicitis knows that the pain associated with appendicitis is

A) cutaneous pain.
B) somatic pain.
C) superficial pain.
D) visceral pain.

Question 9

A client is having a small wart removed from his index finger. The nurse assisting with this procedure would question the use of

A) lidocaine.
B) Novocain with epinephrine.
C) procaine.
D) Xylocaine.

Question 10

A client who has been dealing with chronic pain for the past 2 years would like to try biofeedback as a method of pain relief. The statement that indicates that the client understands this method of treatment is

A) "I want to give my attention to something other than my pain."
B) "I work really well with groups. I think that support will be just what I need."
C) "I'm willing to try to control how blood flows to different parts of my body."
D) "It will be nice to try something that won't cost me anything."

Question 11

The nurse reminds a group of student nurses that the most significant problem associated with the use of "demand" or nurse-administered analgesia is

A) determination of the difference between pain control and addiction.
B) inability of heavily assigned nurses to respond in a timely manner.
C) pain medications being administered too close to one another.
D) the nurse's underestimation of the need for medication.

Question 12

A client who has been in chronic pain after an automobile accident successfully reduces his pain through a combination of biofeedback and meditation. The conclusion the nurse may draw from his success is that the

A) pain was acute in nature.
B) pain was psychological in nature.
C) placebo effect occurred.
D) therapy caused physiologic changes.

Question 13

A client with end-stage cancer is on a continuous IV of morphine to control intractable pain. The family is concerned that the client has a decreasing level of consciousness and has shallow respirations. Which action by the nurse is most appropriate?

A) Call the physician and report the family's concerns.
B) Prepare to administer naloxone (Narcan).
C) Review the goals of end-of-life care with the family.
D) Slow the rate of the IV infusion.

Question 14

The most effective way for the nurse to administer pain medication to a client who is experiencing severe pain related to metastatic liver cancer is to

A) administer medication only when other methods of pain relief are ineffective.
B) dispense pain medications on a regular basis.
C) give only intravenous pain medications.
D) respond promptly to as-needed (prn) pain requests.

Question 15

A client has chronic back pain from an injury several years ago. The client is in the doctor's office, complaining of insomnia with fatigue and dissatisfaction with the previous physician who "did nothing to help the pain." The client has a blunt affect and relates no longer being able to do many things that once were enjoyable. The nurse working with an interdisciplinary team to manage this client's pain understands the client

A) has adapted a sick role out of frustration with the situation and health care.
B) is probably malingering to get workers' compensation.
C) might be addicted to drugs and should have a urine drug screen.
D) would not be so irritable after getting some sleep.

Question 16

A client's leg was pinned under a piece of heavy equipment in the workplace for several hours, during which he was in severe pain. The physiologic response that the occupational health nurse could have assessed in this situation is

A) a wide pulse pressure.
B) constricted pupils.
C) dry, cold skin.
D) tachycardia.

Question 17

The client who had a right below-the-knee amputation 2 days ago is requesting pain medication for pain in his right foot. The nurse should

A) administer the prescribed analgesic.
B) elevate the stump on pillows and apply ice.
C) offer an alternative therapy such as a massage.
D) tell the client that he cannot be medicated for pain in the absent foot.

Question 18

The nurse practitioner (NP) infiltrates with lidocaine the area around a lesion to be incised. For optimal anesthesia, the NP should anticipate a waiting period of

A) 5 to 10 minutes.
B)(1/4) to (1/2) hour.
C) no significant time.
D) optimally, 1 hour.

Question 19

To provide the best care to a client having pain, the nurse must assess which information in addition to using a pain measuring scale?

A) A record of any healing taking place in damaged tissue
B) Objective measurements of the tissue damage
C) The client's perception of the pain
D) The type of pain fibers conducting the pain

Question 20

The teaching plan for an individual receiving transcutaneous electrical nerve stimulation (TENS) should include the information that

A) one electrode only is used over the painful site.
B) the client can adjust both voltage and pulsation.
C) the electrode wires should be visible to detect early problems.
D) this therapy is useful for very few clients.

Question 21

A postoperative client has liberal orders for pain medication and the nurse is delivering them on a strict schedule. The client denies pain when assessed but appears worried, is fidgeting in bed, cries occasionally, and uses the call light frequently for "minor" requests. When analyzing this situation, which component of the pain medication plan might the nurse discover needs revision?

A) The doses of medications are too low.
B) The interval between doses is too long.
C) The nurse needs a better therapeutic relationship with the client.
D) The route of administration should be changed to a faster acting route.

Question 22

Two days after a cholecystectomy the client is kept comfortable with oral NSAIDs. The client's spouse asks the nurse why the client is not receiving something stronger, saying, "I know the procedure causes a lot of pain because I also had my gallbladder removed." The nurse's answer is based on the fact that

A) oral medications are always the preferred route for pain medication.
B) strong analgesics interfere with client assessment.
C) the client should be switched to mild pain medication as quickly as possible.
D) the client's perception of the relief of pain is the best standard of pain relief.

Question 23

A client who had surgery refuses pain medication. The nurse assessing this client would first ask questions regarding the client's (select all that apply)

A) beliefs about the benefits of placebos.
B) cultural expectations regarding pain behaviors and pain treatment.
C) interpretation or meaning the client gives to the pain.
D) prior experiences with pain and pain relief.
E) understanding how different pain medications work.

Question 24

When the client complains of nausea after receiving his first dose of morphine for pain, the nurse should

A) encourage the client to wait as long as possible for the next dose.
B) give only half of the prescribed dose of morphine the next time.
C) instruct the client that with continued use the nausea will lessen.
D) withhold the next dose of morphine until re-evaluation by the physician.

Question 25

A nurse is describing a client to a nursing student as "watching the clock" for the next dose of pain medication, "liking pain medication too much," and being overly dramatic when expressing pain. This nurse described the client as addicted. The nursing instructor conferences with the student later, describing the client's behavior as

A) addicted, because the instructor agrees with the staff nurse's opinion.
B) consistent with increasing tolerance to the ordered pain medication.
C) displaying behaviors consistent with pseudoaddiction.
D) requiring the assistance of a psychiatric social worker.

Question 26

A postoperative client that recently returned from surgery has a morphine PCA pump. The basal rate is ordered to be 1 mg/hour and the patient can have a 1-mg bolus every 15 minutes. When the nurse assesses the client, the nurse finds the client stuporous, hard to arouse, with a respiratory rate of 6 breaths/minute. After successfully treating the client, which action by the nurse takes priority? The nurse should

A) ask the physician to discontinue the PCA pump and revert to prn opioids for pain.
B) check the IV pump to ensure the basal rate is set correctly.
C) question the client about how he/she has been using the button on the pump.
D) request the physician order different basal and bolus rates.

Question 27

A client is being discharged with scheduled doses of morphine every 8 hours. The goals for discharge teaching have been met when the client says "I will

A) eat high fiber foods and drink lots of fluids to avoid constipation."
B) monitor my blood pressure carefully, and report any elevations over (140/90)."
C) take the morphine with food to avoid GI upset and possible stomach ulceration."
D) notice a decrease in pain in about a week."

Question 28

The nurse is caring for a client from the Mexican culture who is moaning and groaning in response to pain. The nurse plans care understanding that this response is viewed in the client's culture as

A) a means to eliminate the pain.
B) a method of expressing unmet needs.
C) a woman-like and weak response to pain.
D) an expression of acceptance of pain.

Question 29

A client with a known opioid addiction is scheduled for surgery tomorrow. The nurse can best meet this client's needs for pain control by incorporating which interventions into the plan of care? (Select all that apply.)

A) Be prepared to use higher than normal doses of pain medications.
B) Involve the client and significant others in planning pain management techniques.
C) Offer a referral to an addictions' specialist.
D) Plan to taper opioids slowly to avoid withdrawal symptoms.
E) Request a patient-controlled analgesia (PCA) pump for the immediate postoperative phase.