Preview Extract
Chapter 15
1. While caring for a nonverbal patient, which of the following ensures appropriate and
timely pain management?
1. Medicate the patient based on the pathologic condition, nonverbal cues, and pain
procedures.
2. Have the family medicate the patient, based on their knowledge of the patient’s response to
pain.
3. Administer non-narcotic analgesics around the clock, adding narcotic analgesia when
necessary.
4. Use the McGill pain questionnaire to determine the optimal pain management plan.
Answer: Medicate the patient based on the pathologic condition, nonverbal cues, and pain
procedures.
Rationale:
Use of a behavioral pain assessment in addition to administering analgesics based on what
would be considered a painful condition or procedure to others is the standard of practice.
The family members most likely do not have knowledge of pharmacology and physiologic
parameters to make pain management decisions, and in fact, out of concern, may “over-read”
the presence of pain. The appropriate analgesic should be used for the situation; a nonnarcotic analgesic may be all that is needed. The McGill questionnaire requires the client’s
input regarding pain and impact on ADLs and therefore is not an appropriate screening tool.
2. The nurse in the emergency department is caring for a patient with a fractured tibia and
fibula who admits to regular heroin use. Which of the following should be used to determine
the presence of pain and need for pain medication?
1. The patient reports pain in the leg of an intensity of 10 out of 10 on the numeric rating
scale.
2. The shift report indicates the patient has been sleeping on and off.
3. The patient is angry he is in the hospital.
4. The patient has taken an opiate already today.
Answer: The patient reports pain in the leg of an intensity of 10 out of 10 on the numeric
rating scale.
Rationale:
The nurse should accept all patient pain reports as valid, but negotiate treatment goals early in
care. The client’s report of pain is the best means of assessing pain intensity. A client in pain
may appear asleep or have closed eyes, but the quality of sleep may be poor. Anger at the
nursing staff does not reflect the presence or absence of pain. A chronic opiate user/abuser
will experience withdrawal symptoms if the usual or base dose of opiate is not given and then
additional medication added for pain.
3. The nurse assessing a patient with chronic pain learns the patient is not able to sleep
throughout the night. The nurse realizes this patient is demonstrating:
1. Sleep deprivation because of poor pain control.
2. A side effect of chronic pain medication use.
3. The inability to cope with pain.
4. A way to be prescribed more pain medication without an identified need.
Answer: Sleep deprivation because of poor pain control.
Rationale:
Pain has been associated with agitation, decreased mobility, and sleep deprivation. There is
no evidence to suggest that this patient is experiencing a side effect of pain medication use or
does not have the ability to copy with pain. The nurse should be nonjudgmental and not
assume the patient is attempting to obtain more pain medication without an identified need.
4. The nurse is administering analgesic medication to a group of clients. Which of the
following is most correct regarding the ethical issues in pain management?
1. Pain should be managed to improve the patient’s quality of life.
2. Opiates are not recommended for patients with addiction issues.
3. Patients with psychiatric diseases should avoid opiates for malignant pain.
4. The nurse should be certain pain is present prior to administering opiates.
Answer: Pain should be managed to improve the patient’s quality of life.
Rationale:
The purpose of effective pain management is to relieve/reduce pain to improve the quality of
life. Opiates may be needed in clients with addiction issues if severe pain is present; the
dosage is adjusted to include the daily intake, plus additional medicine to control pain.
Patients with psychiatric disorders will still experience pain and are entitled to equivalent
pain relief of those without psychiatric disorders. If the nurse follows the definition of pain as
what the client describes, then the nurse’s role is to respond to the clients’ report of pain.
5. Which of the following represents an ethical/legal issue in pain management that requires
further assessment and investigation?
1. Withholding information from the supervisor that a narcotic was taken for personal use by
a staff member
2. Administering a higher-than-usual dose of an opiate analgesic to a patient with malignant
pain
3. Managing pain in a client with a history of narcotic addiction
4. Utilizing sedation with analgesia during the management of pain
Answer: 1. Withholding information from the supervisor that a narcotic was taken for
personal use
Rationale:
Diverting narcotics or controlled substances for personal use is illegal and unethical.
Impaired nurses should be reported to the supervisor so appropriate treatment may be given.
Clients with malignant pain may develop tolerance to opiates over time and require more
analgesic than the opiate-“naïve” client. Clients with narcotic addiction and abuse will still
require analgesic medication if pain is present, following the stepladder approach outlined by
the World Health Organization. Using sedation with analgesic medications is considered and
adjunct in pain management and is acceptable practice.
6. A patient says that she has pain every day but never asks her health care provider for
medication because she doesn’t want to “become addicted.” Whish of the following is the
nurse’s best response to this patient?
1. “There are many medications your doctor can prescribe that are not addicting.”
2. “I wouldn’t want to become addicted either.”
3. “It’s better to experience the pain than to cover it up.”
4. “Pain isn’t always a bad thing to experience.”
Answer: “There are many medications your doctor can prescribe that are not addicting.”
Rationale:
This patient’s fear of becoming addicted to pain medication is evidence of inaccurate
consumer education and consumer fears. The nurse should suggest that the patient talk with
her health care provider regarding pain medication alternatives. The nurse should not support
the patient’s fears regarding addiction. The nurse should not minimize the impact of the
patient’s pain on her ability to function or experience the pain.
7. When performing a complete pain assessment, which of the following data indicate
assessment of pain in the affective domain?
1. “This pain is punishment for my misdeeds.”
2. “The pain is a 9 on a scale of 1 to 10.”
3. “The pain comes in waves in my abdomen.”
4. “The patient is pale and moaning.”
Answer: “This pain is punishment for my misdeeds.”
Rationale:
The affective domain is the emotions or feeling associated with the pain. Pain scales are tools
to determine the severity of the pain. The quality of pain coming in waves is a subjective
report of the sensory component of pain. The patient appearing pale and moaning is an
objective finding.
8. When assessing the sensory component of pain, __________ is a description indicative of
neuropathic pain.
1. Burning and shooting
2. Heavy and squeezing
3. Colicky coming in waves
4. Sore and tender
Answer: Burning and shooting
Rationale:
Neuropathic pain is described as tingling, burning, shooting, electric, or shock-like. Heavy,
squeezing, colicky, and sore and tender are nociceptive types of pain.
9. A patient is seen resting quietly; however, when the nurse enters the room, the patient
begins to grimace and asks for more pain medication. Which of the following should the
nurse do?
1. Assess the level of pain and provide the requested pain medication.
2. Confront the patient and ask about the sudden demonstration of pain.
3. Tell the patient that medication cannot be provided at this time and leave the room.
4. Refuse the medication and document that the patient appears to be faking the need for pain
medication.
Answer: Assess the level of pain and provide the requested pain medication.
Rationale:
The behavioral dimension of pain states that responses to pain can be situational,
developmental, or learned. Failure to respond to a patient’s complaint of pain may lead to
learned pain behaviors. The patient may have learned that unless she has an open
demonstration of pain, the complaint of pain might be ignored. The nurse should assess the
level of pain and provide the medication. The nurse should not confront the patient, deny the
medication, or document the patient faking the need for medication.
10. The nurse is performing a multidimensional pain assessment. Which of the following
should be included in this type of assessment?
Select all that apply.
1. “How are you managing your daily activities?”
2. “Can you point to the area of pain?”
3. “How does the pain make you feel?”
4. “Can you rate the pain’s severity?”
5. “Is there a history of similar pain in your family?”
Answer: 1. “How are you managing your daily activities?”
2. “Can you point to the area of pain?”
3. “How does the pain make you feel?”
4. “Can you rate the pain’s severity?”
Rationale:
“How are you managing your daily activities?” A multidimensional pain assessment tool
assesses more than one dimension of pain, including the client’s ability to participate in ADLs
and quality of life. “Can you point to the area of pain?” A multidimensional pain assessment
tool assesses more than one dimension of pain, including the area of pain. “How does the
pain make you feel?” A multidimensional pain assessment tool assesses more than one
dimension of pain, including the quality and characteristics of pain. “Can you rate the pain’s
severity?” A multidimensional pain assessment tool assesses more than one dimension of
pain, including pain intensity. “Is there a history of similar pain in your family?” The client is
the focus of the pain assessment, not the family.
11. The nurse is assessing a patient who is unable to supply a self-report of pain. Which of the
following should the nurse do to further assess the client’s pain?
1. Use a proxy pain rating from the family or caregiver.
2. Document the client’s pain using a numeric rating scale.
3. Document that the client cannot scale his pain.
4. Use the McGill pain questionnaire to assess the pain.
Answer: Use a proxy pain rating from the family or caregiver.
Rationale:
Using a proxy pain rating from caregivers and family is an acceptable assessment strategy for
at-risk patients. The client who cannot report his pain will be unable to use the numeric rating
scale. Documenting that the client cannot scale his pain is not an assessment tool. The client
must be aware and able to answer questions regarding pain and quality of life to use the
McGill pain questionnaire.
12. The nurse is reviewing a patient’s completed pain assessment questionnaire that provides
information about the impact of pain on the ability to function. The pain assessment tool the
patient completed was most likely the:
1. Brief Pain Inventory.
2. Simple Verbal Descriptive Scale.
3. Visual Analog Scale.
4. Numeric Rating Scale.
Answer: Brief Pain Inventory.
Rationale:
The Brief Pain Inventory asks multiple questions regarding pain and its impact on patient
function and addresses the multidimensionality of the pain experience. The Simple Verbal
Descriptive Scale asks the patient to rate the pain from “no pain” to “excruciating.” The
Visual Analog Scale uses “No Pain” and “Pain as Bad as It Can Possibly Be” as descriptors at
either end of a horizontal line measuring 10 centimeters in length. Each centimeter on the
scale corresponds to a number from 0 to 10. The Numeric Rating Scale uses a horizontal line
and the patient is asked to rate pain on a scale from 0 to 10.
13. When conducting a class on pain for a group of nursing students, the nurse teaches that
which of the following is typical of chronic pain?
1. The pain rating may be inconsistent with underlying pathology.
2. There is usually a clear physiologic cause.
3. Pain typically lasts 6 months or less.
4. The pain reported is usually less severe than acute pain.
Answer: The pain rating may be inconsistent with underlying pathology.
Rationale:
Chronic pain is typically of 3 to 6 months in duration and may not have an identified
physiologic cause. The client might not exhibit signs of pain such as elevations in vital signs,
grimacing, writhing, or moaning as adaptation to the pain occurring. There is no indication
that chronic pain is less severe than acute pain, although in some instances it may be more
diffuse.
14. The nurse is managing care for a group of clients with pain. Which of the following is an
example of a process that may cause acute pain?
1. Cholecystectomy
2. Phantom limb pain
3. Complex regional pain syndrome
4. Degenerative joint disease
Answer: Cholecystectomy
Rationale:
Surgical pain, such as after gallbladder removal, is considered acute pain because it should
have a duration of less than 6 months. The neuropathic pain associated with amputation,
phantom limb pain, may not begin immediately and may become a chronic problem lasting
more than 6 months. Complex regional pain syndrome is a chronic exaggerated response to a
painful stimulus. Degenerative joint disease is chronic and though it may not progress, it does
not usually improve.
15. The nurse is planning care for a patient with chronic pain. Which of the following would
be the most appropriate pain control goal for this patient?
1. Reduce the focus on pain.
2. Reduce the sympathetic stress response.
3. Be completely pain free.
4. Improve patient outcomes.
Answer: Reduce the focus on pain.
Rationale:
Pain management goals for the patient with chronic pain include reducing the focus on pain;
optimizing comfort through the use of analgesics and alternative pain control strategies;
increasing participation in activities of daily living, work, and relationships; and restoring a
sense of joy and purpose despite the presence of pain. Reducing the sympathetic pain
response and improving patient outcomes would be appropriate acute pain management
goals. Being completely pain free might be an unattainable goal for a patient with chronic
pain.
16. The nurse is caring for a client with prostate cancer with metastasis to S-1 and the
adjacent nerve root. The client complains of unrelenting pain. When collaborating with the
provider, which of the following examples of balanced analgesia would the nurse advocate
for?
1. Use of an opioid for background pain and gabapentin (Neurontin) for the neuropathic pain.
2. Use of an opioid around the clock rather than on an as-needed (PRN ) basis.
3. Use of escalating doses of a narcotic analgesic per the third step of the World Health
Organization (WHO) analgesic ladder.
4. Begin with the first step of the analgesic ladder as described by the World Health
Organization (WHO), and then evaluate the client’s response.
Answer: Use of an opioid for background pain and gabapentin (Neurontin) for the
neuropathic pain.
Rationale:
Balanced analgesia or multimodal analgesia allows improved analgesia that is not possible
with a single medication; various medications and adjunctive therapies are used to target
specific types of pain and provide optimal relief in a safe manner. The use of around-theclock medication over PRN is appropriate; however, it does not address balanced analgesia.
The step approach according to the WHO that permits the provider to begin at the lowest step
and move through each step to reach the top is not necessary, nor does it address balanced
analgesia.
17. The nurse is evaluating the client receiving hydromorphone (Dilaudid) for side effects of
the medication. Which of the following reflect side effects of this medication?
Select all that apply.
1. Respiratory rate less than 12
2. Pruritis
3. Nausea
4. Tachypnea
5. Polyuria
Answer: 1. Respiratory rate less than 12
2. Pruritis
3. Nausea
Rationale:
Respiratory rate less than 12. Side effects of narcotic or opioid analgesics include respiratory
depression. Pruritis. Side effects of narcotic or opioid analgesics include itching (pruritis).
Nausea. Side effects of narcotic or opioid analgesics include nausea and vomiting.
Tachypnea. Tachypnea refers to rapid breathing, which is not consistent with a side effect of
respiratory depression. Polyuria. Polyuria, excessive urine output, does not occur with
opiates.
18. A patient is prescribed ibuprofen for back pain. The nurse realizes this analgesic:
1. Is the first step in the World Health Organization’s three-step approach to pain
management.
2. Should be used with caution in patients who consume more than three alcoholic beverages
per day.
3. Can be taken safely up to the day of a surgical procedure.
4. Needs to be taken at a higher dose if administered with an opioid.
Answer: Is the first step in the World Health Organization’s three-step approach to pain
management.
Rationale:
Acetaminophen and nonsteroidal anti-inflammatory drugs such as ibuprofen are considered
the first step in the World Health Organization’s three-step approach to pain management.
Acetaminophen should be used with caution in patients who consume more than three
alcoholic beverages per day. Nonsteroidal anti-inflammatory drugs should be discontinued 1
to 2 weeks prior to a surgical procedure to reduce the risk of bleeding. If a nonsteroidal antiinflammatory drug is administered with an opioid, the opioid dose can be reduced.
19. The nurse plans to include nonpharmacologic pain management strategies when caring
for patients experiencing pain. Which of the following rationales best explains why massage
is helpful for pain relief?
1. Skin stimulation inhibits transmission of impulses from the spinal cord to the brain.
2. Vasoconstriction due to heat application prevents prostaglandin release.
3. Friction from massage causes heat in the area, which distracts the patient from the pain.
4. Massage will mask the symptoms of pain during the massage and for several hours after.
Answer: Skin stimulation inhibits transmission of impulses from the spinal cord to the brain.
Rationale:
According to the gate control theory of pain, stimulation of nerves that do not transmit pain
signals can interfere with signals from pain fibers, thereby inhibiting pain. Massage
stimulates the nonpain fibers and “closes the gate” to perception of painful sensations. Heat
application is not discussed in this scenario. Masking the symptoms of pain is vague and not
specific to the scientific rationale of the gate control theory of pain.
20. A client experiencing chronic back pain asks how a TENS unit works. Which of the
following should the nurse teach the patient?
1. The TENS unit produces a tingling or vibrating sensation, which stimulates nonpain
receptors.
2. The TENS unit alternates heat and cold to decrease inflammation and promote
vasodilation.
3. The TENS unit provides for a slow release of non-narcotic analgesic that is absorbed
through the skin.
4. The TENS unit promotes muscle relaxation through a biofeedback mechanism.
Answer: The TENS unit produces a tingling or vibrating sensation that stimulates nonpain
receptors.
Rationale:
The TENS unit is applied to the site of pain and emits a low-level electrical stimulation that
produces a tingling or vibrating sensation; this stimulates nonpain receptors and interferes
with pain perception. The TENS unit does not provide heat/cold, release medications, or
work through biofeedback.
21. A patient tells the nurse that putting a small pillow under her knee and rubbing the thigh
helps reduce the hip pain. The nurse realizes this patient is describing:
1. A nonmedication intervention to reduce the hip pain.
2. A way to deny the presence of the hip pain.
3. A fear of taking pain medication.
4. A previous pain medication addiction.
Answer: A nonmedication intervention to reduce the hip pain.
Rationale:
Even though there is a lack of scientific evidence, complementary therapies are often used in
conjunction with medications, or alone, to control chronic pain. The patient is not denying the
presence of pain if a pillow is used along with tactile treatment. The nurse should not assume
that the patient is fearful of taking pain medication or has a history of pain medication
addiction.
22. When carrying out the order morphine 2 mg IV every 3 hours PRN, the nurse recognizes
that which of the following interventions is most appropriate?
1. The nurse should assess pain every hour and routinely offer the drug.
2. For best results, the patient should receive the morphine every 3 hours.
3. The nurse should wait until the patient requests the morphine to administer the drug.
4. The nurse should wait until the previous dose of morphine has worn off before
administering more.
Answer: The nurse should assess pain every hour and routinely offer the drug.
Rationale:
While around-the-clock dosing has been proven more effective than the as-needed (PRN)
dosing, the nurse should educate the client about the medication, assess pain frequently, and
offer the drug hourly. Administering the medication every 3 hours around the clock
circumvents the nurse’s responsibility to assess the pain and administer medication when the
client needs it. Waiting for the client to request the drug may allow too much time to elapse,
resulting severe pain that will require more than the ordered amount to relieve the pain.
Waiting for a previous dose of medication to wear off will cause a reduced blood level of
analgesic; the client may need more than the ordered amount to regain control over pain.
23. A narcotic substance abuser complains of severe incisional pain 1 hour after receiving 4
mg of intravenous morphine. When collaborating with the provider, which statement by the
nurse indicates correct knowledge of pain management in opiate-tolerant patients?
1. “I think the patient has a tolerance to opiates and needs a higher dose than ordered.”
2. “The patient continually complains of pain to get more narcotics.”
3. “Perhaps administering a saline flush as a placebo will help the pain.”
4. “The patient should be getting ketorolac (Toradol) for pain, not morphine.”
Answer: “I think the patient has a tolerance to opiates and needs a higher dose than ordered.”
Rationale:
An opiate abuser will be tolerant to the effects of narcotics; it will take more medication to
gain the same level of relief than it would for a nontolerant client. If the nurse accepts the
patient’s definition of pain as the standard, the nurse would not judge the patient as a “drug
seeker” and infer the patient is not in pain. Placebos are considered unethical and should not
be used. Administering a non-narcotic pain reliever such as ketoralac, an NSAID, will
precipitate withdrawal symptoms, causing the patient further discomfort.
24. The nurse asks a patient who refuses to take pain medication for chronic back pain to
explain his reasons for avoiding medication. This nurse is attempting to:
1. Identify a barrier to the patient’s pain control treatment plan.
2. Determine if the patient should remain in the hospital.
3. Decide if the patient is being argumentative.
4. Figure out if the patient should leave the hospital against medical advice.
Answer: Identify a barrier to the patient’s pain control treatment plan.
Rationale:
Identifying barriers to the pain control treatment plan can help with the development of
assessment tools and educational materials to help with compliance on pain control. The
nurse is not attempting to question the patient’s admission or stay in the hospital, to decide if
the patient is being argumentative, or if the patient should leave the hospital against medical
advice.
25. The nurse is receiving a report on a client described as a “clock watcher” who requests
pain medication every 2 hours when it is due. Which of the following statements made to the
client indicates understanding of effective pain management?
1. “You ask for this medication every 2 hours, when due. It seems as if your pain is not well
treated.”
2. “You will develop addiction if you take too much of this medication.”
3. “The doctor is not likely to continue giving you narcotics when you go home.”
4. “It does not seem like you are in pain. I saw you were visiting with your family and
napping.”
Answer: “You ask for this medication every 2 hours, when due. It seems as if your pain is not
well treated.”
Rationale:
“Clock watching” is a symptom of pseudo-addiction or inadequate pain relief. Addiction is a
physiologic and psychologic process that develops in less than 3% of individuals taking
opiates. It is too soon to determine the type of pain management that will be required upon
discharge. Pain is what the client says it is; it is possible to participate in ADLs and still be in
pain.
26. A client who has undergone abdominal surgery is refusing hyromorphone (Dilaudid)
because she has heard that people may become addicted. She is crying and rates her pain as
10 of 10. Which of the following statements should the nurse include as part of the patient’s
education?
Select all that apply.
1. Narcotics result in addiction in less than 1% to 3% of patients.
2. Untreated pain can result in poor wound healing.
3. Patients with uncontrolled pain have increased risk of blood clots.
4. Dehydration can result from poorly managed pain.
5. Family members will not want to visit patients with visible signs of pain.
Answer: 1. Narcotics result in addiction in less than 1% to 3% of patients.
2. Untreated pain can result in poor wound healing.
3. Patients with uncontrolled pain have increased risk of blood clots.
Rationale:
Narcotics result in addiction in less than 1% to 3% of patients. Narcotic addiction occurs in
only 1% to 3% of the population. Untreated pain can result in poor wound healing. Pain
causes physiological consequences, including poor wound healing. Patients with uncontrolled
pain have increased risk of blood clots. Pain causes physiological consequences, including
coagulation leading to DVT or PE. Dehydration can result from poorly managed pain. There
is no evidence that poor pain relief will cause dehydration. Family members will not want to
visit patients with visible signs of pain. There is no evidence that poor pain relief will cause
family members to refuse to visit.
27. A patient tells the nurse that he won’t fill the pain medication prescription when he goes
home. Which of the following should the nurse do to help this patient?
1. Ask the patient if there is a reason why he won’t fill the prescription.
2. Tell the health care provider to not write a prescription for the pain medication.
3. Suggest that the patient purchase and use over-the-counter pain medication instead.
4. Stop providing the patient with pain medication while he is still hospitalized.
Answer: Ask the patient if there is a reason why he won’t fill the prescription.
Rationale:
The nurse needs to assess the patient’s affective, cognitive, and behavioral dimensions of pain
and should ask the patient to explain why the prescription will not be filled. The nurse should
not suggest that the health care provider stop writing out the prescription, nor should the
nurse suggest the patient take over-the-counter pain medication. The nurse should not stop
providing pain medication to the hospitalized patient.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
