Pain Nursing Quiz 10 Basic Principles

Pain nursing quiz for your nursing review. Pain is a physically uncomfortable sensation brought on by illness or damage.

Pain Nursing Quiz and Answer Key

Pain has been defined as “whatever the person experiencing the pain says it is, existing whenever
the patient says it does.” This definition is problematic for the nurse when caring for which type
of patient?

a. A patient placed on a ventilator

b. A patient with a history of opioid addiction

c. A patient with decreased cognitive function

d. A patient with pain resulting from severe trauma

Answer Key:
c. Because the patient's self-report is the most valid means of pain assessment, patients who have decreased cognitive function, such as those who are comatose, have dementia, are mentally disabled or have expressive aphasia, may not be able to report pain. In these cases, nonverbal information and behaviors are necessary considerations in pain assessment.

On the first postoperative day following a bowel resection, the patient complains of abdominal and incisional pain rated 9 on a scale of 0 to 10. Postoperative orders include morphine (4 mg IV q4hr) for pain and may repeat morphine (4 mg IV) for breakthrough pain. The nurse determines
that it has been only 1¾ hours since the last dose of morphine and wants to wait a little longer. What effect does the nurse’s action have on the patient?

a. Protects the patient from addiction and toxic effects of the drug

b. Prevents hastening or causing a patient’s death from respiratory dysfunction

c. Contributes to unnecessary suffering and physical and psychosocial dysfunction

d. This indicates that the nurse understands the adage of “start low and go slow” in administering
analgesics

Answer Key:
c. Unnecessary suffering, impaired recovery from acute illness, increased morbidity as a result of respiratory dysfunction, increased heart rate, cardiac workload, and other physical dysfunction can occur. Administering the smallest prescribed analgesic dose when given a choice is not consistent with current pain management guidelines and leads to undertreatment of pain and inadequate pain control. Without reassessing the pain within 30 minutes of the IV analgesic, the nurse is unsure how well the previous dose of medication worked for the patient to determine the current dose needed. Respiratory and sedation effects of the analgesic must be assessed before fearing overdosage. “Start low and go slow” applies to pain therapy in older adults, but age is not a factor for this patient.

List and briefly describe the five dimensions of pain.
a. _______________________________________
b. _______________________________________
c. _______________________________________
d. _______________________________________
e. _______________________________________

Answer Key
a. Physiologic: the genetic, anatomic, and physical determinants of pain
b. Affective: the emotional response to pain
c. Cognitive: the beliefs, attitudes, memories, and meaning attributed to pain
d. Behavioral: observable actions that express or control pain, or changed behavior
e. Sociocultural: age and gender influences, family and caregiver influence, and culture that influences the pain experience

Once generated, what may block the transmission of an action potential along a peripheral nerve
fiber to the dorsal root of the spinal cord?

a. Nothing can stop the action potential along an intact nerve until it reaches the spinal cord.

b. The action potential must cross several synapses, points at which the impulse may be blocked by drugs.

c. The transmission may be interrupted by drugs (e.g., local anesthetics) that act on peripheral sodium channels.

d. The nerve fiber produces neurotransmitters that may activate nearby nerve fibers to transmit pain impulses.

Answer Key:
c. Although a peripheral nerve is one cell that carries an impulse directly from the periphery to the dorsal horn of the spinal cord with no synapses, transmission of the impulse can be interrupted by drugs known as membrane stabilizers or sodium-channel inhibitors, such as local anesthetics and some antiseizure drugs. The nerve fiber produces neurotransmitters at the dorsal root of the spinal cord, not during the transmission of the action potential.

A patient comes to the clinic with a complaint of dull pain in the anterior and posterior neck. On examination, the nurse notes that the patient has the full range of motion (ROM) of the neck and no throat redness or enlarged head or neck lymph nodes. What will be the nurse’s next appropriate assessment indicated by these findings?

a. Palpation of the liver

b. Auscultation of bowel sounds

c. Inspection of the patient’s ears

d. Palpation for the presence of hip pain

Answer Key:
a. The anterior and posterior right neck, shoulder, and posterior flank are common areas of referred pain from liver damage. Examination of the liver should be considered when pain occurs without other findings in these areas. Other common referred areas are mid-scapular and left arm for cardiac pain, inner legs for bladder pain, shoulders for gallbladder pain, and hip for gynecologic or back pain.

While caring for an unconscious patient, the nurse discovers a stage 2
pressure ulcer on the patient’s heel. During the care of the ulcer, what is the nurse’s understanding of the patient’s perception of pain?

a. The patient will have a behavioral response if the pain is perceived.

b. The area should be treated as a painful lesion, using gentle cleansing and dressing.

c. The area can be thoroughly scrubbed because the patient is not able to perceive pain.

d. All nociceptive stimuli that are transmitted to the brain result in the perception of pain.

Answer Key:
b. It is known that the brain is necessary for pain perception but because it is not clearly understood where in the brain pain is perceived, pain may be perceived even in a comatose patient who may not respond behaviorally to noxious stimuli. Any noxious stimulus should be treated as potentially painful.

Number in order of the nociceptive processes that occur to communicate tissue damage to the central nervous system (CNS). Number 1 is the first process and number 4 is the last process.

a. Perception

b. Modulation

c. Transmission

d. Transduction

Answer Key:
a. 3; b. 4; c. 2; d. 1

Match the following types of pain in the left column with a category of pain from the upper right column and an example of the source of the pain from the lower right column.

Types of Pain

a. Pain from loss of afferent input
b. Pain persisting from sympathetic nervous system (SNS) activity
c. Pain caused by dysfunction in the CNS
d. Pain arising from the skin and subcutaneous tissue; well-localized
e. Pain arising from muscles and bones; localized or diffuse and radiating f. Pain felt along with the distribution of peripheral nerve(s) from nerve damage g. Pain arising from visceral organs; well or poorly localized; referred to cutaneously

Categories of Pain

  1. Nociceptive pain
  2. Neuropathic pain

Sources of Pain

  1. Sunburn
  2. Pancreatitis
  3. Osteoarthritis
  4. Poststroke pain
  5. Phantom limb pain
  6. Trigeminal neuralgia
  7. Postmastectomy pain
Answer Key
a. 2, 7, 9; b. 2, 7; c. 2, 6; d. 1, 3; e. 1, 5; f. 2, 8; g. 1, 4

Patient-Centered Care: Amitriptyline is prescribed for a patient with chronic pain from fibromyalgia. When the nurse explains that this drug is an antidepressant, the patient states that she is in pain, not depressed. What is the nurse’s best response to the patient?

a. Antidepressants will improve the patient’s attitude and prevent a negative emotional response to the pain.

b. Chronic pain almost always leads to depression, and the use of this drug will prevent depression from occurring.

c. Some antidepressant drugs relieve pain by releasing neurotransmitters that prevent pain impulses from reaching the brain.

d. Certain antidepressant drugs are metabolized in the liver to substances that numb the ends of nerve fibers, preventing the onset of pain.

Answer Key:
c. Several antidepressants affect the modulatory systems by inhibiting the reuptake of serotonin and norepinephrine in descending modulatory fibers, thereby increasing their availability to inhibit transmission of pain impulses. Although chronic pain is often accompanied by anxiety and depression, the antidepressants that affect the physiologic process of pain modulation are used for pain control whether depression is present or not.

A patient with trigeminal neuralgia has moderate to severe burning and shooting pain. In helping the patient to manage the pain, the nurse recognizes what about this type of pain?

a. Includes treatment with adjuvant analgesics

b. Will be chronic and require long-term treatment

c. Responds to small to moderate around-the-clock doses of oral opioids

d. Can be well controlled with salicylates or nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer Key:
a. Trigeminal neuralgia is neuropathic pain from damage to peripheral or cranial nerves that is not well controlled by opioid analgesics alone and often includes the adjuvant use of tricyclic antidepressants, antiseizure drugs, or GABA receptor agonists to help inhibit pain transmission. Salicylates and nonsteroidal anti-inflammatory drugs (NSAIDs) are not effective for the intensity of neuropathic pain.

In the following scenario, identify the assessment finding that corresponds to the elements of a pain assessment.

A 62-yr-old male patient is admitted to the medical unit from the emergency department. On arrival, he is trembling and nearly doubled over with severe, cramping abdominal pain. He indicates that he has severe right upper quadrant pain that radiates to his back and he is more comfortable walking bent forward than lying in bed. He notes that he has had several similar bouts of abdominal pain in the last month but “not as bad as this. This is the worst pain I can imagine.” The other episodes lasted only about 2 hours. Today he experienced an acute onset of pain and nausea after eating fish and chips at a fast-food restaurant about 4 hours ago.

Element of Pain AssessmentAssessment Finding
Onset
Duration and pattern of pain
Location
Intensity
Quality
Associated symptoms
Management strategies
Answer Key:
Element of Pain AssessmentAssessment Finding
OnsetAbout 4 hours ago
Duration and pattern of painContinuously for about 4 hours. Similar episodes in the past month but lasted only 2 hours
LocationRight upper quadrant
IntensitySevere, 10 on a scale of 0 to 10, “This is the worst pain I can imagine.”
QualitySevere cramping radiates to the back
Associated symptomsNausea
Management strategiesPain better walking bent forward, more intense lying in bed

List the 10 basic principles that should guide the treatment of all pain.

a. b. c. d. e. f. g. h. i. j.

Answer Key:
a. Follow the principles of pain assessment.
b. Use a holistic approach to pain management.
c. Every patient deserves adequate pain management.
d. Base the treatment plan on the patient's goals.
e. Use both drug and non-drug therapies.
f. When appropriate, use a multimodal approach to analgesic therapy.
g. Address pain using an interprofessional approach.
h. Evaluate the effectiveness of all therapies to ensure that they are meeting the patient's goals.
i. Prevent or manage medication side effects.
j. Incorporate patient and caregiver teaching throughout assessment and treatment.

A patient with advanced colorectal cancer has continuous, poorly localized abdominal pain at an intensity of 5 on a scale of 0 to 10. How does the nurse teach the patient to use pain medications?

a. On an around-the-clock schedule

b. As often as necessary to keep the pain controlled

c. By alternating two different types of drugs to prevent tolerance

d. When the pain cannot be controlled with distraction or relaxation

Answer Key:
a. Analgesics should be scheduled around the clock for patients with constant pain to prevent pain from escalating and becoming difficult to relieve. If pain control is not adequate, the analgesic dose may be increased or an adjunctive drug may be added to the treatment plan.

A patient who has been taking ibuprofen and imipramine (Tofranil) for control of cancer pain is having increased pain. What would the nurse recommend to the HCP as an appropriate change in the medication plan?

a. Add PO oxycodone to the other medications.

b. Substitute PO ketorolac, an NSAID, for imipramine.

c. Add transdermal fentanyl (Duragesic) to the use of the other medications.

d. Substitute PO hydrocodone with acetaminophen for the other medications.

Answer Key:
a. As cancer pain increases, stronger drugs are added to the regimen. This patient is using an NSAID and an antidepressant. A stronger preparation would be an opioid, but because an NSAID is already being used, a combination NSAID/opioid is not indicated. An appropriate stronger drug would be an oral opioid, in this case, oral oxycodone, and this still leaves stronger drugs for expected increasing pain.

A patient with chronic cancer-related pain has started using MS Contin for pain control and has developed common side effects of the drug. The nurse reassures the patient that tolerance will develop to most of these side effects but that continued treatment will most likely be required for what?

a. Pruritus

b. Dizziness

c. Constipation

d. Nausea and vomiting

Answer Key:
c. Although tolerance to many of the side effects of opioids (pruritus, dizziness, nausea, sedation, respiratory depression) develops within days, tolerance to opioid-induced constipation does not occur. A bowel regimen that includes a gentle-stimulant laxative and a stool softener should be started at the beginning of opioid therapy and continued for as long as the drug is taken.

A postoperative 68-yr-old opioid-naive patient is receiving morphine by patient-controlled analgesia (PCA) for postoperative pain. What is the rationale for not initiating the PCA analgesia with a basal dose of analgesic as well?

a. Opioid overdose

b. Nausea and itching

c. Lack of pain control

d. Adverse respiratory outcomes

Answer Key:
d. Use of a basal dose may increase the risk of serious respiratory events in opioid-naive patients and those at risk for respiratory difficulties (older age, existing pulmonary disease, etc.). Overdose is not expected, as the dosages are calculated and the PCA pump is programmed to prevent this. Nausea and itching are common side effects but not related to a basal dose of analgesic. A lack of pain control would not be expected with or without a basal dose. The nurse should be assessing the patient and notify the HCP if a lack of pain control occurs but, again, this is not related to receiving a basal dose of analgesic via PCA pump.

Which measures or drugs may be effective in controlling pain in the physiologic pain process stage of transduction (select all that apply)?

a. Distraction

b. Corticosteroids

c. Epidural opioids

d. Local anesthetics

e. Antiseizure medications

f. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer Key:
b, d, e, f. Corticosteroids, local anesthetics, antiseizure medications, and NSAIDs are effective in the transduction stage of pain. Distraction is effective in the perception stage. Epidural opioids are effective in the transmission stage.

A patient is receiving a continuous infusion of morphine via an epidural catheter following major abdominal surgery. Which actions should the nurse include in the plan of care (select all that apply)?

a. Label the catheter as epidural access.

b. Assess the patient’s pain relief frequently.

c. Use sterile technique when caring for the catheter.

d. Monitor the patient’s level of consciousness (LOC).

e. Monitor patient vital signs (blood pressure, heart rate, respiration).

f. Assess the motor and sensory function of the patient’s lower extremities.

Answer Key:
a, b, c, d, e, f. The major complications of epidural analgesia are catheter displacement and migration, accidental infusions of neurotoxic agents, and infection. These actions will help to reduce those risks.

A patient with multiple injuries resulting from an automobile accident tells the nurse that he has “bad” pain but that he can “tough it out” and does not require pain medication. To gain the patient’s participation in pain management, what is most important for the nurse to explain to the patient?

a. Patients have a responsibility to keep the nurse informed about their pain.

b. Unrelieved pain has many harmful effects on the body that can impair recovery.

c. Using pain medications rarely leads to addiction when they are used for actual pain.

d. Nonpharmacologic therapies can be used to relieve his pain if he is afraid to use pain medications.

Answer Key:
b. When a patient wants to be stoic about pain, it is important that he or she understand that pain itself can have harmful physiologic effects and that failure to report pain and participate in its control can result in severe unrelieved pain. No evidence that indicates fear of taking the medication is present in this situation.

The patient has chronic pain that is no longer relieved with oral morphine. Which medication would the nurse expect to be ordered to provide better pain relief for this patient?

a. Fentanyl

b. Hydrocodone

c. Intranasal butorphanol

d. Morphine sustained-release

Answer Key:
a. Fentanyl is frequently used for chronic pain in patients who are not opiate-naive. Hydrocodone is used for acute and short-term pain, not chronic pain. Intranasal butorphanol is used for acute headaches and recurrent, not chronic, pain. Sustained-release morphine given buccally will have the same absorption as morphine, so it would not be expected to be more effective than oral morphine. The route used will depend on the swallowing ability of the patient.

After the family members of a postoperative patient leave, the patient tells the nurse that his family gave him a headache by fussing over him so much. What is an appropriate intervention by the nurse?

a. Administer the PRN analgesic prescribed for his postoperative pain.

b. Ask the patient’s permission to use acupressure to ease his headache.

c. Reassure the patient that his headache will subside now that his family has gone.

d. Teach the patient biofeedback methods to relieve his headaches by controlling cerebral blood flow.

Answer Key:
b. If the nurse knows enough about acupressure to suggest its use, it is appropriate to use with the patient's permission; otherwise massage, heat or cold, distraction, or meditation may help. The PRN analgesic prescribed for postoperative pain is not usually appropriate for a headache, nor would biofeedback training be appropriate for this situation. Simply reassuring the patient that the headache will go away is not helpful. The HCP could be called for an analgesic for his headache.

Copyright © by Elsevier, Inc. All rights reserved.

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