Chapter 36 Pain Management

Chapter 36  Pain Management

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The nurse is caring for a patient who is 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?
a.
Administer another dose of Vicodin.
b.
Apply ice packs to the knee.
c.
Apply heat packs to the knee.
d.
Perform gentle range of motion.

ANS: B
Application of ice packs will help reduce swelling and pain that was not relieved with the patient’s pain medication. The nurse should not administer another dose of Vicodin without an order from the physician. Heat will increase blood flow to the area rather than reduce swelling. Gentle ROM will increase pain if done at this time.

DIF: Applying REF: p. 886 | p. 900 TOP: Implementation
MSC: NCLEX Client Needs Category: Basic Care and Comfort: Non-Pharmacological Comfort Interventions NOT: Concepts: Pain

2. 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?
a.
The patient is sleeping quietly.
b.
The patient states that she has no pain.
c.
The patient’s respirations are slow and regular.
d.
The patient’s blood pressure has returned to baseline.

ANS: B
The best way for the nurse to determine that the pain medication was effective is for the patient to state that she has no pain. The other assessment findings cannot definitively determine whether or not the patient is still in pain.

DIF: Remembering REF: p. 894 | p. 903
TOP: Evaluation
MSC: NCLEX Client Needs Category: Pharmacological and Parenteral Therapies: Expected Outcomes NOT: Concepts: Pain

3. The nurse is caring for a patient who has severe abdominal pain caused by acute cholecystitis. What type of pain is this patient experiencing?
a.
Visceral pain
b.
Somatic pain
c.
Radiating pain
d.
Referred pain

ANS: A
Visceral pain arises from the organs of the body and occurs when inflammation and tissue damage occurs, 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.

DIF: Remembering REF: p. 890 TOP: Assessment
MSC: NCLEX Client Needs Category: Physiological Adaptation: Pathophysiology
NOT: Concepts: Pain

4. Which is the best pain medication option for a patient to manage severe long-term cancer pain at home?
a.
Duragesic 50 mcg transdermal patch q 72 hours
b.
Meperidine (Demerol) 50 mg IM q 6 hours
c.
Hydromorphone (Dilaudid) 0.2 mg q 10 minutes IV via PCA pump
d.
Hydromorphone (Dilaudid) 0.08 mg/hour infusion through epidural catheter

ANS: A
Duragesic 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 fentanyl is slowly released over 72 hours. Epidurals and PCA pumps are intended for hospital use. Frequent IM injections require nursing administration and are not optimal for chronic long-term pain.

DIF: Applying REF: p. 900 TOP: Implementation
MSC: NCLEX Client Needs Category: Pharmacological and Parenteral Therapies: Pharmacological Pain Management NOT: Concepts: Pain

5. The nurse is caring for a patient with severe chronic pain. The nurse applied the first 50 mcg transdermal fentanyl (Duragesic) patch 2 hours ago. The patient states that the pain is presently rated at 9 on a 1-10 scale. What is the nurse’s best action?
a.
Instruct the patient that the Duragesic patch will start to work soon.
b.
Administer a short-acting narcotic medication like morphine liquid (Roxanol).
c.
Give the patient a gentle back rub and encourage guided imagery.
d.
Apply a second 25-mcg transdermal fentanyl (Duragesic) patch now.

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

DIF: Remembering REF: pp. 901-902 | pp. 904-905
TOP: Implementation
MSC: NCLEX Client Needs Category: Pharmacological and Parenteral Therapies: Pharmacological Pain Management NOT: Concepts: Pain