Question 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?

Accepted Answer

Tight muscles and furrowed brow = 1 point. Softly crying = 1 point. Shallow, irregular respirations = 1 point. Relaxed arms and legs = 0 points. Mild fussiness = 1 point. Total = 4 points.

Question 2

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?

Accepted Answer

Anticonvulsant medication like gabapentin and tricyclic antidepressants are often used to relieve neuropathic pain as they work directly on the nervous system. The other statements do not correctly indicate why the patient is receiving this medication.

Question 3

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?

Accepted Answer

Application of cold decreases swelling and pain, produces local analgesia, and slows nerve conduction, which improves functioning. Examples of cold therapy are ice bags and cold compresses. The nurse should not administer another dose of medication without an order from the provider. Heat will increase blood flow to the area rather than reduce swelling. Gentle ROM will increase pain if done at this time.

Question 4

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?

Accepted Answer

Independent nursing interventions may be carried out without an order from the provider. Changing medication orders must be done by the provider; increasing pain medication dosage and switching the patient to PO pain medications are not independent nursing interventions.

Question 5

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?

Accepted Answer

Transdermal administration of medication does not become effective for 12 to 16 hours after application. Short-acting narcotic medication should be given in the meantime to make the patient comfortable.

Question 6

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?

Accepted Answer

Referred pain is pain that occurs when discomfort is felt in a different area than the source of the pain. Phantom pain occurs in amputees when pain is felt in the missing limb. Neuropathic pain occurs in the nervous system and often feels like burning or tingling. Psychogenic pain is discomfort felt by the patient that has no physical cause.

Question 7

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?

Accepted Answer

Chronic pain is the highest priority diagnosis for this patient because it is severe. The other diagnoses may be addressed once the patient's pain is controlled.

Question 8

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?

Accepted Answer

Visceral pain arises from the organs of the body and occurs when inflammation and tissue damage occur, such as with cholecystitis. Somatic pain occurs when there is tissue damage to skin, muscle, joints, and bones. Referred pain occurs when the discomfort is felt at a location other than the origin of the pain. Radiating pain extends to another area of the body.

Question 9

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?

Accepted Answer

The best method to determine pain in a patient who speaks only a foreign language is to use an interpreter. The Universal Pain Assessment Tool is available with foreign-language phrases that may also be used. Measuring vital signs and seeing if the patient is resting comfortably are not accurate pain assessment techniques.

Question 10

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

Accepted Answer

The respiratory system is the priority nursing assessment for patients receiving narcotic pain medication via any route. This is because narcotics can cause respiratory suppression. The other assessments are a lower priority and may be done after a respiratory assessment is completed.

Question 11

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?

Accepted Answer

The best way for the nurse to determine that the pain medication was effective is for the patient to state a reduction of the pain. The other assessment findings cannot definitively determine whether the patient is still in pain.

Question 12

The nurse is caring for a patient who is recovering from thoracotomy surgery and notes that the patient's pain is rated 9/10 and is unable to focus on anything. Which intervention by the nurse is the highest priority?

Accepted Answer

The highest priority intervention for a patient in acute pain is to provide pain relief. The other interventions do not address acute pain relief.

Question 13

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?

Accepted Answer

A side effect of ibuprofen and other NSAIDs is the risk of gastrointestinal bleeding, especially with long-term use. Abdominal pain with pale skin in this patient may be indicative of a bleeding ulcer and should be reported to the provider promptly.

Question 14

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?

Accepted Answer

Drug tolerance is an adaptation to the medication, which eventually leads to less effective pain relief. The patient is requiring higher doses of narcotic pain medication because of this tolerance. This is common when patients require long-term pain medication. Since the patient is taking morphine to control ongoing pain, the patient is not addicted to it. Need for increased morphine dosage is not indicative of drug abuse or a wish to die.

Question 15

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?

Accepted Answer

Only the patient should operate the PCA and push the administration button. Family members and visitors should never activate the PCA pump for the patient because too much medication could be delivered, resulting in overdose and respiratory suppression.

Question 16

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

Accepted Answer

Pain character should be assessed using questions to learn more about what the pain feels like. Examples like stabbing, aching, burning may be used so that patients can understand what the nurse is requesting. Onset is determined by asking when the pain started. Exacerbating/relieving factors are determined by asking which interventions make the pain better. Time course is determined by asking if there is a pattern to when the pain occurs.

Question 17

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?

Accepted Answer

For patient safety, the nurse would check the patient's respirations frequently after the pump has been initiated due to possible respiratory depression. Reviewing the medication profile would occur prior to initiating the pump. Teaching the patient how to use the pump is important, but not the priority. Naloxone should be close by to treat respiratory depression but monitoring the respirations frequently would hopefully prevent depression.

Question 18

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

Accepted Answer

An opioid transdermal patch is the best pain management option for home use with patients who have long-term, severe cancer pain as no injections are required and the opioid is slowly released over 72 hours. Epidurals and PCA pumps are intended for hospital use. Frequent IM injections require nursing administration, are not comfortable for the patient and are not optimal for chronic long-term pain.

Question 19

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

Accepted Answer

Patients recuperating from surgery are often good candidates for PCA analgesia. Confusion, inability to push the PCA button, and psychogenic pain are all contraindications for PCA analgesia.

Question 20

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?

Accepted Answer

Goals must be measurable and objective so that nursing staff can determine when each of the goals has been met. Having the patient describe meditation techniques is measurable because the nursing staff can determine whether he can actually describe them. Goals are achieved by the patient, not nursing staff. The nursing staff cannot accurately measure whether the patient is experiencing or feeling less pain. The goal statements "The patient will report less pain … or state that he has less pain …" are not measurable and appropriate.

Quiz 36: Pain Management