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.

Accepted Answer

Intermittent dosing, such as seen with prn orders, causes wild swings in the blood levels of the pain medication, leaving the client overly sedated or undertreated. Nurses are typically uncomfortable with clients who demonstrate pain behavior or who request pain medication and often give the smallest doses possible while waiting the longest amount of time between doses that is possible. The client would respond best to scheduled pain medication given around the clock without having to ask for it and wait for the nurse to prepare and administer it. Another option would be a PCA pump.

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.

Accepted Answer

Possible side effects of epidural opioids are pruritus, urinary retention, and delayed respiratory depression, occurring 4 to 12 hours after a dose.

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.

Accepted Answer

Allodynia is pain that is evoked by stimuli that do not normally cause pain. Neuropathic pain responds poorly to typical pain medications and is treated with gabapentin and antidepressants. It is usually described as numbness, burning, stabbing, "needles," and electric shock

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.

Accepted Answer

Clients with painful conditions, including metastatic cancers, are often treated at home and are responsible for self-care measures, including pain control. Many people worry about the possibility of addiction and as a result do not ask for or take adequate pain medications. Helping the client's spouse understand the rationale behind using such powerful medications may help the spouse overcome irrational fears and may promote self-care in the client. If the spouse is judgmental and the client wants to please him or her, the client may not take enough pain medication. Having the physician or pain specialist speak to the family is not incorrect, but it avoids the nurses' primary responsibility to the client and family. With metastatic cancer, the need for pain medications will likely increase, not decrease, as the disease progresses.

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.

Accepted Answer

Assessing older clients, especially those with dementia, requires special considerations. A client with dementia may not be able to answer questions about pain even if phrased in different ways. Typical assessment tools are hard to use in this population, but the FACES scale can be used even in older adults with some dementia.

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.

Accepted Answer

This client has respiratory depression, which is a known side effect of narcotic administration. Treatment of respiratory depression includes arousing the client, establishing a patent airway, administering an opiate antagonist such as naloxone, and providing artificial ventilation as necessary.

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.

Accepted Answer

The site of action of nonsteroidal anti-inflammatory drugs (NSAIDs) is primarily the periphery at the receptor site, where NSAIDs serve an anti-inflammatory function and prevent the production of prostaglandins.

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.

Accepted Answer

Visceral pain originates from body organs, or viscera, and often includes pain caused by acute appendicitis, cholecystitis, inflammation of the biliary and hepatic tract, gastroduodenal disease, cardiovascular disease, pleurisy, and renal and ureteral colic. Somatic pain is from ligaments, tendons, bones, blood vessels, and nerves. It is often poorly localized, may produce nausea, and may be associated with sweating and blood pressure changes. Cutaneous pain would arise from the skin structures. "Superficial" pain is not a defining designation.

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.

Accepted Answer

Epinephrine-containing solutions are not used for nerve blocks of the penis, fingers, or toes, where vasoconstriction could cause inadequate blood flow and necrosis of the distal extremity. Lidocaine, procaine, and Xylocaine are all acceptable local anesthetics.

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."

Accepted Answer

The purpose of biofeedback in pain management is to teach the client self-control over physiologic variables that relate to the pain, such as muscle contraction and blood flow. Biofeedback takes a great deal of concentration. The equipment is very expensive. It is not used in a support group setting.

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.

Accepted Answer

The traditional method of treating pain is by nurse-administered pain medication. It is unfortunate that with this system pain is often significantly undertreated because nurses underestimate the client's need for pain 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.

Accepted Answer

Many nonpharmaceutical interventions have been used clinically with positive results. The therapies are thought to cause 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.

Accepted Answer

Respiratory depression is a side effect of opioid medications and is treated with naloxone. However, in a case where the client is receiving end-of-life care, the goals are a peaceful and pain-free death. All terminally ill clients experience some degree of altered mentation and respiratory changes. The nurse should review this information with the family and not plan on slowing the IV rate or giving naloxone. The nurse can call the physician to relay the family's concerns, but the primary nursing action would be to discuss the situation with the family.

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.

Accepted Answer

Patients experiencing pain caused by widespread cancer require routine pain-relieving medication in order to function, often at higher doses.

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.

Accepted Answer

Clients with chronic pain are challenging. They may present with symptoms of depression, insomnia, and limited functioning, and may voice frustration with the health care system as they search for the specific cause of their pain and one definitive treatment. They may adapt what are known as "pain behaviors" and the sick role in order to gain more compassion, thus treatment, from health care providers.

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.

Accepted Answer

The physiologic response to acute pain is caused by stimulation of the sympathetic nervous system. The client will probably exhibit the manifestations of (a) increased or decreased blood pressure, (b) tachycardia, (c) diaphoresis, (d) tachypnea, (e) focusing on the pain, and (f) guarding the painful part.

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.

Accepted Answer

Phantom pain occurs with amputation of a body part. The person may continue to experience sensations in the missing part as if it were still there. When phantom pain does occur, throbbing, burning, stabbing, boring, or vise-like sensations are experienced in the amputated area. Pain medication for this complaint is appropriate.

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.

Accepted Answer

Lidocaine produces its effect in 5 to 10 minutes and usually lasts about 2 hours.

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

Accepted Answer

Because clinical pain is subjective and no objective measures of it exist, the only persons who can accurately define their own pain are those experiencing 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.

Accepted Answer

Voltage and pulsation are controlled by the person wearing the device. Positive and negative poles (electrodes) are placed within several inches of each other. TENS has been shown to relieve pain effectively in many people.

Quiz 20: Clients with Pain

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

The client with neuropathic pain develops allodynia, which

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 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

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

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

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

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

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 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 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?

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 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

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

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

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

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