Understanding Medical Surgical Nursing 5th Edition by Linda S. Williams , Paula D. Hopper Test Bank

Understanding Medical Surgical Nursing 5th Edition by Linda S. Williams , Paula D. Hopper Test Bank

Chapter 10. Nursing Care of Patients in Pain

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is preparing to assess a patient’s pain level. Which definition of pain should the nurse use to guide practice?
a. Pain is whatever the experiencing person says it is.
b. Pain is an unpleasant sensation caused by physical injury.
c. Pain is a sensation that causes the patient to avoid its source.
d. Pain is discomfort manifested by elevated vital signs and grimacing.

____ 2. The nurse answers a patient’s call for pain medication, only to find the patient laughing and joking with visitors. Which response by the nurse is appropriate?
a. “You don’t need this pain medication after all, do you?”
b. “I’ll bring your medication back later after your visitors are gone.”
c. “I can see your pain is better. Call again when you need your medication.”
d. “Would you like your visitors to step out while I give you your pain medication?”

____ 3. A nursing assistant, observing the licensed practical nurse (LPN) prepare medication for a patient asks why so much morphine is being provided since patients have quit breathing after receiving such a high dose. The patient has been receiving the same dose of medication for several days without respiratory compromise. Which response by the LPN is best?
a. “I am a licensed professional and am able to decide what a safe dose is for my patient.”
b. “You are correct; several days of this high a dose could be cumulative and cause problems.”
c. “As long as I monitor the patient closely after giving the dose, breathing will not be affected.”
d. “As long as the dose is increased gradually, patients develop tolerance to the side effects of morphine.”

____ 4. A patient has been on opioids for 3 months to control pain caused by injuries from a motor vehicle crash. The patient asks about the risk of withdrawal symptoms when the drugs are no longer needed. How should the nurse respond to the patient?
a. “Ask your doctor for a sedative to get you through the worst of the withdrawal symptoms.”
b. “As long as you taper the drug dose down slowly, you should not experience withdrawal symptoms.”
c. “You would have to be on these drugs much longer than 3 months to have problems with withdrawal.”
d. “You were using the drugs for legitimate pain, so you will not have to go through withdrawal when you stop them.”

____ 5. A patient has abdominal pain after gallbladder surgery. For which type of pain should the nurse provide care?
a. Chronic
b. Nociceptive
c. Neuropathic
d. Non-physiological

____ 6. A patient with terminal cancer describes a pain rating of 7 on a 0-to-10 scale. The nurse notes that the patient’s vital signs are unchanged and recalls that vital signs may be elevated with pain. What is the best explanation for this?
a. The patient is not really in pain.
b. The patient has adapted to chronic pain.
c. Acute pain is not associated with elevated vital signs.
d. The patient’s vital signs are not responding because of the cancer.

____ 7. A patient with chronic pain is on a sustained-release opioid that is ordered every 12 hours. After 6 hours, the patient complains of increasing pain. Which intervention by the nurse is appropriate?
a. Obtain an order for an immediate-release opioid for breakthrough pain.
b. Teach the patient a relaxation technique to use until the next dose is due.
c. Assess the patient’s vital signs, and administer the next dose of opioid early.
d. Explain to the patient that the medication being administered lasts for 12 hours.

____ 8. A 91-year-old nursing home resident has been receiving meperidine (Demerol) injections for right shoulder pain. During the morning assessment, the nurse finds the resident irritable and jumpy. Which nursing actions and rationales is appropriate?
a. Administer a dose of Demerol because the patient is exhibiting signs of withdrawal.
b. Administer a dose of Demerol because these are symptoms of pain in an older adult patient.
c. Notify the registered nurse (RN) or physician that the resident may be experiencing toxic effects of Demerol.
d. Assess the patient’s pain level before determining the appropriate dose of Demerol to administer.

____ 9. The nurse is preparing to provide an opioid medication for a patient’s postoperative pain. Which action should the nurse take first?
a. Determine the respiratory rate.
b. Observe the patient’s skin color.
c. Take the patient’s oral temperature.
d. Ask the patient when he last ate something.

____ 10. A patient with peripheral neuropathy states, “I don’t know why the doctor put me on an antidepressant. I am not depressed!” Which response by the nurse is best?
a. “Depression is often a factor in pain. Treating the depression helps treat the pain.”
b. “Maybe you are more depressed than you realize. Would you like to talk about it?”
c. “Antidepressants are sometimes used to treat nerve pain such as you are experiencing.”
d. “Why don’t you try it for a while, and if you don’t feel better, you can ask your doctor if you can stop it?”

____ 11. A patient receiving large doses of opioids is lethargic and difficult to arouse, with a respiratory rate of 6 per minute and constricted pupils. Which medication should the nurse anticipate being prescribed?
a. Naloxone (Narcan)
b. Furosemide (Lasix)
c. Diazepam (Valium)
d. Flumazenil (Romazicon)

____ 12. A nurse provides an opioid antidote to a patient experiencing opioid toxicity. Which outcome should the nurse expect after providing this medication?
a. Pain
b. Sedation
c. Confusion
d. Tachypnea

____ 13. A physician writes an order to give a saline injection to a patient who has been requesting frequent meperidine (Demerol) shots. Which initial response by the LPN is best?
a. Tell the patient that the physician has ordered a placebo.
b. Administer the saline and carefully document the patient’s response.
c. Tell the patient that a pain shot is being administered, without revealing exactly what it is.
d. Tell the physician of feeling uncomfortable administering saline if the patient thinks it is Demerol.

____ 14. A patient with chronic back pain has a new order for a fentanyl (Duragesic) patch. As the nurse applies the patch, the patient states, “I’m really glad to get that patch on. I am really hurting bad.” Which response by the nurse is correct?
a. “You should feel some relief of your pain within about half an hour.”
b. “The patch may take a while to work. Would you like a pain shot in the meantime?”
c. “Other analgesics can’t be given while the patch is on, so try to bear it until it takes effect.”
d. “Because it is absorbed right through the skin, you will feel relief within minutes after I apply this patch.”

____ 15. The nurse enters a room just as a patient’s daughter pushes the button of his intravenous (IV) patient-controlled analgesia (PCA) pump. Which response by the nurse is appropriate?
a. “Thanks for helping out your dad. Is he too weak to push the button?”
b. “If you need to push the button for your dad, first be sure his respiratory rate is higher than 10.”
c. “It is dangerous for anyone but your dad to push the button. Remind him to push it himself if he needs it.”
d. “It is against hospital policy for anyone but the patient to push the button. If I see you pushing it again, I will have to call the supervisor.”

____ 16. The nurse is determining the effective of pain medication provided to a patient. What is the best way for the nurse to measure effectiveness of pain medication?
a. The patient goes to sleep.
b. The patient stops groaning.
c. The patient states the pain is relieved.
d. The patient’s vital signs return to normal.

____ 17. The nurse enters the room of a patient who is moaning loudly and thrashing around in bed. What action should the nurse take first?
a. Ask the patient to quiet down.
b. Ask the patient what is wrong.
c. Go and get a dose of the patient’s prn pain medication.
d. Administer a sedative, and then assess the patient’s pain after it has taken effect.

____ 18. A patient who has just returned from abdominal surgery states, “I learned relaxation exercises, so I won’t need any drugs.” Which statement about relaxation therapy should the nurse use to guide care for this patient?
a. Relaxation therapy works much the same as a placebo.
b. Relaxation therapy is not useful for postoperative patients or for severe pain.
c. Relaxation therapy is an excellent adjunct treatment for pain when used with analgesics.
d. Effective use of relaxation therapy can eliminate the need for analgesics postoperatively.

____ 19. A patient describes abdominal pain as “my belly feels as if a watermelon is stuck in it.” What is the best way for the nurse to document this information?
a. Patient feels bloated.
b. Patient’s abdomen is distended.
c. Patient has acute pain related to distended abdomen.
d. Patient states his “belly feels as if a watermelon is stuck in it.”

____ 20. The nurse is having difficulty assessing the pain of a mentally impaired patient who has an approximate functional level of a 4-year-old child. Which method should the nurse use to determine the patient’s pain level?
a. Use the Faces scale.
b. Ask “are you hurting?”
c. Observe the patient’s facial expression.
d. Explain to the patient how to use a 0-to-10 pain scale, with 0 being no pain, and 10 being the worst possible pain.

____ 21. A large family of a patient with terminal cancer pain is constantly calling to report that the patient is in pain or needs to be moved or needs a drink. The nurse is having difficulty caring for other patients because this family is so demanding. What is the best way to deal with this situation?
a. Ask the family to leave.
b. Teach the family how to help provide for the patient’s basic needs.
c. Show the family the hospital policy stating that only two visitors are allowed in the room at a time.
d. Negotiate with the family that if they avoid using the call light, the nurse will check on the patient every 30 minutes.

____ 22. The nurse is determining a pain management plan for a patient with chronic pain. What should the nurse identify as the best analgesic schedule for this patient?
a. Prn
b. Qid
c. Around the clock
d. Only when pain is severe, to prevent tolerance

____ 23. A patient has been requesting hydrocodone/acetaminophen (Vicodin) for pain every 4 hours for several days. Now the patient calls the nurse after only 3 hours and says, “I need more Vicodin. The pain is worse.” On which initial assumption should the nurse base a decision about what to do next?
a. The patient is in pain.
b. The patient is becoming addicted to Vicodin.
c. The patient is exhibiting drug-seeking behavior.
d. The patient is physically dependent on Vicodin.

____ 24. A patient is given a prescription for oxycodone/acetaminophen (Vicodin), two tablets to be taken every 4 to 6 hours as needed for pain. What should the nurse include when teaching about this medication?
a. “You shouldn’t take this more than every 4 hours, because oxycodone will cause respiratory depression.”
b. “Be careful not to take this more than every 4 hours, because Vicodin always relieves pain for at least 4 hours.”
c. “Oxycodone and acetaminophen interact to form a dangerous metabolite if they are taken less than 4 hours apart.”
d. “It is important to not to take this more often than prescribed, because acetaminophen can cause dangerous side effects if taken more frequently.”

____ 25. A patient comes into the emergency department after vomiting blood. The nurse should be most concerned if the patient reports taking which medication?
a. Aspirin
b. Codeine
c. Meperidine (Demerol)
d. Acetaminophen (Tylenol)

____ 26. A patient admitted with liver disease complains of pain in his right shoulder. What should the nurse use as explanation for this patient’s site of pain?
a. The patient hurt his shoulder.
b. The patient is experiencing referred pain.
c. The patient is tense because of concern about the possible diagnosis.
d. The patient is pretending to have more pain to obtain more analgesics.

____ 27. A nursing home resident complains of joint pain. Which medication should the nurse choose first to relieve the patient’s pain?
a. Ibuprofen (Motrin)
b. Acetaminophen (Tylenol)
c. Acetaminophen/oxycodone (Vicodin)
d. Acetaminophen/codeine (Tylenol no. 3)

____ 28. A patient is experiencing neuropathic pain. What class of medications should the nurse expect to be prescribed for this patient?
a. Opioids
b. Beta blockers
c. Tricyclic antidepressants
d. NSAIDs

____ 29. A patient is determined to be physically dependent on prescribed pain medication. How should the nurse interpret this patient’s dependency?
a. The patient is addicted to pain medication.
b. Stopping the drug causes symptoms of withdrawal.
c. The patient requests pain medication more often than it is ordered.
d. It takes more medication than previously to relieve the patient’s pain.

____ 30. The nurse is questioning if a patient is experiencing pain. Which myth should the nurse recall when determining this patient’s pain level?
a. A patient can sleep and still experience severe pain.
b. A patient who is laughing and talking is not in pain.
c. Respiratory depression can occur in patients receiving opioids.
d. Oral pain medication can be as effective as injected medication.

____ 31. The nurse notes that a patient experiencing a pain level of 9 on a scale from 0 to 10 has a change in vital signs. What type of pain should the nurse realize this patient is experiencing?
a. Cancer pain
b. Neuropathic pain
c. Acute pain from trauma
d. Chronic nonmalignant pain

____ 32. A patient recovering from surgery for a ruptured appendix yesterday has an order for morphine 4 mg q 6 hours prn. Every 5 hours and 55 minutes, the patient puts on the call light and asks for the morphine. A staff member comments that the patient is drug-seeking. Which action by the nurse is most appropriate first?
a. Administer the morphine every 4 hours instead of every 6 hours.
b. Explain to the staff member that labeling the patient as drug seeking is inappropriate.
c. Consult with the RN or physician about ordering a higher or more frequent dose of morphine.
d. Explain to the patient that weaning off the morphine as soon as possible is essential to reduce the risk of addiction.

____ 33. A patient is experiencing phantom limb pain. For which type of pain should the nurse plan care for this patient?
a. Acute pain
b. Cancer pain
c. Intermittent pain
d. Chronic nonmalignant pain

____ 34. A patient receiving morphine sulfate 5 mg IV every 4 hours around the clock and acetaminophen PO every 4 hours reports intense itching. Assuming all are ordered, which prn medication should the nurse administer?
a. Ibuprofen (Motrin)
b. Fentanyl (Duragesic)
c. Nalbuphine (Nubain)
d. Methadone (Dolophine)

____ 35. A patient taking hydromorphone for cancer pain is experiencing constipation. What should the nurse teach to help this patient?
a. Take a mild laxative.
b. How to self-administer a Fleet enema.
c. Slowly decrease the dose of hydromorphone.
d. Eat a high-fiber diet and increase fluid intake.

____ 36. A patient of Asian American descent recovering from abdominal surgery refuses all pain medication. What can the nurse do to ensure for this patient’s comfort?
a. Provide a cup of tea.
b. Offer to pray with the patient.
c. Offer pain medication to promote healing.
d. Document that pain medication is refused.

____ 37. A patient requesting pain medication asks that the medication be provided in the form of an injection because it works better. The patient is prescribed oral pain medication. What should the nurse respond to this patient?
a. “Injected medications last longer than oral medications.”
b. “Injected medications work better than oral medications.”
c. “Injected medications are painful and don’t absorb consistently from the muscle.”
d. “I’ll contact your physician to get an order for the medication to be given as an injection.”

____ 38. The mother of an adolescent recovering from surgery for a fractured leg asks if all pain medication can be non-narcotic, because she does not want her child to become addicted. What should the nurse respond to the mother?
a. “All pain medication is addicting.”
b. “Addiction to opioids is uncommon when taken for pain.”
c. “I will give the medication that you request to your child.”
d. “Teenagers are more likely to become addicted to pain medication than other patients.”

____ 39. A patient with a gastrostomy tube is prescribed a sustained-released opioid medication. What should the nurse do when preparing to provide this medication to the patient?
a. Provide the medication orally for the patient to swallow
b. Crush the medication and administer it through the tube
c. Dissolve the medication in water and administer it through the tube
d. Ask the physician to prescribe the medication as an elixir for tube administration

____ 40. A patient receiving opioid medication for cancer pain is experiencing increasing pain when being repositioned and changing bed linen. What should the nurse consider is occurring with this patient?
a. Tolerance
b. Addiction
c. Hyperalgesia
d. Breakthrough pain

____ 41. A patient is prescribed acetaminophen to help with pain control. How many grams of acetaminophen can the nurse safely administer to the patient each day?
a. 4 grams
b. 5 grams
c. 6 grams
d. 7 grams

Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 42. A patient is prescribed a nonopioid medication for pain. Which characteristics of nonopioid drugs should the nurse keep in mind when caring for this patient? (Select all that apply.)
a. They work peripherally.
b. They produce tolerance.
c. They have a ceiling effect.
d. They are used for acute and chronic pain.
e. They work in the central nervous system.
f. They can be safely increased to treat increasing pain.

____ 43. The nurse is reviewing medications prescribed for a patient experiencing pain. Which medications should the nurse realize are being used as adjuvant agents for this patient’s pain? (Select all that apply.)
a. Steroids
b. Antibiotics
c. Cox 2 inhibitors
d. Anticonvulsants
e. Benzodiazepines
f. Tricyclic antidepressants

____ 44. The nurse is determining equivalent doses of pain medication for a patient. Which dose is equivalent to a 10-mg dose of subcutaneous morphine? (Select all that apply.)
a. 5 mg IV morphine
b. 10 mg IV morphine
c. 25 mg IM morphine
d. 15 mg IM morphine
e. 30 mg oral morphine
f. 10 mg oral morphine

____ 45. The nurse is admitting a patient with pancreatitis. What should the nurse include in the patient’s pain history? (Select all that apply.)
a. How much alcohol does the patient drink each day?
b. Is the patient having difficulty sleeping, eating, or working?
c. How does the patient describe the pain in his or her own words?
d. Are there any aggravating or alleviating factors that alter the pain?
e. How has the pain affected the patient’s ability to perform activities of daily living?
f. Is the patient experiencing any nausea, vomiting, or anorexia associated with the pain?

____ 46. The nurse is providing care for a patient being discharged on opioid therapy. What should the nurse include when teaching the patient about this medication? (Select all that apply.)
a. “You may feel sleepy when you take this medication.”
b. “If you experience nausea, stop taking the medication.”
c. “Avoid driving or operating machinery for a few days.”
d. “It is important to drink 8 to 10 glasses of fluid each day.”
e. “Fiber or bulk laxatives may be needed to prevent constipation.”
f. “You should wait as long as possible to take your pain medication to prevent addiction.”

Completion
Complete each statement.

47. A nurse is preparing an order for grain of morphine IM. It is supplied as 10 mg per mL. How many mL should the nurse administer? Round to the nearest 10th mL. ____________________ mL