Chapter 16 - Pain Management, Comfort, Rest And Sleep

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Pain is determined by tissue damage alone
- True
- False

About This Quiz

From Foundations of Nursing (6th edition) by Christensen and Kockrow, pages 394-415. For any question, email arnoldjr2@gmail. Com

Quiz Preview

2.

Suggests that pain impulses are regulated and blocked by mechanisms located along the CNS. The proposed location of this theory is in the dorsal horn of the spinal cord. Pain and other sensations of the skin and muscles travel the same pathways through the large nerves in the spinal cord.
- Gate theory
- Open impulse theory
- Window Theory
- Shutter theory
Correct Answer

A. Gate theory

Explanation

p. 396

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3.

Definition of pain according to the American Pain society:
- An unpleasant tactile and sentimental experience associated with the entrance of pathogens that causes a disrupted homeostasis
- An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
- An unpleasant epidermal experience characterized by blisters and purulence which disrupts the balance of electrolytes.
- A chaotic humoral experience that creates physiological disturbances and disorders
Correct Answer

A. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

Explanation

p. 395

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4.

"Chronic pain related to joint and muscle inflammation manifested by complaints of discomfort, anorexia, loss of focus and social withdrawal". What part of the nursing care plan is this statement?
- Nursing Intervention
- Nursing Diagnosis
- Patient Goals and Expected Outcome
- Evaluation
Correct Answer

A. Nursing Diagnosis

Explanation

p. 406

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5.

People with less pain than others from a similar injury have a:
- Higher level of endorphins
- Lower level of endorphins
Correct Answer

A. Higher level of endorphins

Explanation

People with a higher level of endorphins experience less pain than others with a similar injury. Endorphins are natural painkillers produced by the body, and they help to reduce pain sensations. Therefore, individuals with higher levels of endorphins have a greater ability to manage pain and experience less discomfort from injuries.

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6.

What route is most appropriate for treating rapidly escalating severe pain?
- Oral
- IM
- IV
- SubQ
Correct Answer

A. IV

Explanation

p. 415, number 16

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7.

Pain impulses are regulated or even blocked by mechanisms located along the CNS.
- Patient controlled Analgesia
- Gate Control theory
- Circadian event
- Radiating pain
Correct Answer

A. Gate Control theory

Explanation

p. 415, number 3

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8.

No longer used because of toxic complications such as seizures
- Codeine
- Advil
- Meperidine (Demerol)
- Morphine
Correct Answer

A. Meperidine (Demerol)

Explanation

p. 415, number 17

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9.

A cutaneous stimulation management device
- PCA
- TENS
- SVJ
- ONES
Correct Answer

A. TENS

Explanation

p. 415, number 11

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10.

An opioid antagonist that blocks or reverses all the actions of an opioid
- Santyl
- Mucomyst
- Naloxone (Narcan)
- Aspirin
Correct Answer

A. Naloxone (Narcan)

Explanation

p. 401

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11.

Difference between a PCA and a PRN medication
- PCA and PRN are administered according to specific times as prescribed
- PCA is administered by the patient which eliminates wait time for a nurse who usually administers a PRN
- PCA is more effective than a PRN medication
- PRN medication can also be administered by a patient without any supervision
Correct Answer

A. PCA is administered by the patient which eliminates wait time for a nurse who usually administers a PRN

Explanation

p. 402

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12.

__________________ is the most common opioid side effect and the only one for which the individual does not develop tolerance
- Diaphoresis
- Constipation
- Urticaria
- Hyponatremia
Correct Answer

A. Constipation

Explanation

p. 414

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13.

Drug delivery system to control pain via a portable computerized pump with a chamber for a syringe
- Placebo
- Morphine
- PCA
- STD
Correct Answer

A. PCA

Explanation

p. 415, number 4

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14.

Risks of clinically significant opioid induced respiratory depression
- 5%
- Less than 1%
- 20%
- 10%
Correct Answer

A. Less than 1%

Explanation

p.16, number 15

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15.

__________ indicates when the pain started. _____________ is how long the pain lasts.
- Inflammation, Infection
- Onset, Duration
- Beginning, Length
- Duration, Onset
Correct Answer

A. Onset, Duration

Explanation

p. 413

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16.

Morphine-like substances composed of amino acids found in the pituitary gland and other areas of the CNS.
- Adrenaline
- Endorphins
- Epinephrine
- Corticosteroid
Correct Answer

A. Endorphins

Explanation

p. 396

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17.

Formerly called narcotics, they decrease the perception of pain by binding to pain receptor sites in the CNS. They are considered the cornerstone or gold standards for managing moderate to severe acute pain.
- Proton Pump Inhibitors
- Nonsteroidal anti-inflammatory drugs
- Opioid analgesics
- Monoamine oxidase inhibitors
Correct Answer

A. Opioid analgesics

Explanation

p. 400

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18.

How does the "gate theory" explain the prevention or elimination of pain?
- The stimuli for pain is shut off when chemical elements stimulate the gates that trigger pain receptors
- When gates are closed, pain impulses are blocked. Sensory impulses such as back rub, heat of a warm compress, cold ice applications, will close the gates to painful stimuli because they are distracting the brain from interpreting a painful stimuli
- The gate theory explains that pain is reduced because the compensatory mechanisms of the CNS emulates analgesia
- The "gate theory" proposes that for every painful sensation, there is a defense mechanism the shuts off further transmission of pain
Correct Answer

A. When gates are closed, pain impulses are blocked. Sensory impulses such as back rub, heat of a warm compress, cold ice applications, will close the gates to painful stimuli because they are distracting the brain from interpreting a painful stimuli

Explanation

p. 396

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19.

It blocks the pain impulses in the CNS and reduces inflammation
- Penicillin
- Aspirin
- Bengay
- Salonpas
Correct Answer

A. Aspirin

Explanation

p. 399

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20.

A group of analgesics that can pose the risk of gastrointestinal (GI) bleeding
- Mono-Amine Oxidase Inhibitors
- NSAIDs
- ACE Inhibitors
- Beta Blockers
Correct Answer

A. NSAIDs

Explanation

p. 399

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21.

The standard agent for opioid therapy, although it could compromise renal function
- Morphine
- Benzodiazepine
- Sedatives
- Benadryl
Correct Answer

A. Morphine

Explanation

p. 400

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22.

Nurses treating pain have a tendency to
- Over treat
- Under treat
Correct Answer

A. Under treat

Explanation

p. 415, number 10

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23.

The following are Joint Commission Standards about pain. Select all that are true:
- Patients have the right to an appropriate assessment.
- Patients will be treated for pain or referred for treatment
- Patients do not need to be involved in making care decisions
- Discharge planning and teaching will include continuing care based on the patient's needs at the time of discharge, including the need for pain management
- Patients will be taught that pain management is part of treatment
Correct Answer(s)

A. Patients have the right to an appropriate assessment.
A. Patients will be treated for pain or referred for treatment
A. Discharge planning and teaching will include continuing care based on the patient's needs at the time of discharge, including the need for pain management
A. Patients will be taught that pain management is part of treatment

Explanation

p. 397 - Patients will be involved in making care decisions

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24.

Because of its potential for producing seizures, it is no longer the drug of choice for pain management
- Antitussive (Cordex)
- Acetaminophen (Tylenol)
- Meperidine (Demerol)
- Antiemetic (Vomitus)
Correct Answer

A. Meperidine (Demerol)

Explanation

p. 400

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1
25.

After a total knee replacement, a patient was given an epidural catheter for fentanyl epidural analgesia. What should the nurse do next?
- Provide PRN oral pain medications
- Change the dressing every shift
- Assess respiratory rate
- Perform a range of motion exercise
Correct Answer

A. Assess respiratory rate

Explanation

p. 414, number 1

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2
26.

A pocket sized, battery-operated device that provides a continuous, mild electric current to the skin via electrodes that re attached to a stimulator by flexible wires. Typically used for patients suffering post-operative or chronic pain.
- PCA
- WMA
- TENS
- SKG
Correct Answer

A. TENS

Explanation

p. 399

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27.

Maximum recommended dosage of acetaminophen
- 4000 mg (4 g) in 24 hours
- 2000 mg (2 g) in 24 hours
- 3000 mg (3 g) in 12 hours
- 1000 mg (1 g) in 1 hours
Correct Answer

A. 4000 mg (4 g) in 24 hours

Explanation

p. 399

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28.

An inflammatory mediator released when cells are damaged that sensitizes nerves that carry information about pain. By inhibiting the release of this mediator, the drugs diminish trans mission of pain stimuli
- Leukocytes
- Prostaglandin
- Fibrin
- Platelets
Correct Answer

A. Prostaglandin

Explanation

p. 401

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29.

Singultus
- Dyspnea
- Hiccups
- Flatus
- Thirst
Correct Answer

A. Hiccups

Explanation

p. 394

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2
30.

When choosing the right route, which of these are appropriate statements regarding pain medication
- IV and oral routes are preferred; IM and SubQ are best avoided
- IV and oral routes are best avoided; IM and SubQ are preferred
- IV, oral, IM and SubQ are equally preferred
- Oral, IM and SubQ should all be avoided
Correct Answer

A. IV and oral routes are preferred; IM and SubQ are best avoided

Explanation

p. 404

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31.

A patient describes her angina pectoris pain as radiating down her left inner arm to the little finger and upward. What do you call this pain?
- Localized
- Referred
- Intermittent
- Chronic
Correct Answer

A. Referred

Explanation

p. 415, number 7

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32.

How do endorphins work to eliminate pain?
- Endorphins are chemical substances directly responsible for shutting down the gates that simulate pain
- Endorphins block sensory sites for pain
- Endorphins are elements that take away sensation, therefore they take away pain
- Stress and pain activate endorphins. Analgesia results when certain endorphins attach to opioid receptor sites in the brain and prevent the release of neurotransmitters, thereby inhibiting the transmission of pain impulses
Correct Answer

A. Stress and pain activate endorphins. Analgesia results when certain endorphins attach to opioid receptor sites in the brain and prevent the release of neurotransmitters, thereby inhibiting the transmission of pain impulses

Explanation

p. 396

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33.

Examples of over the counter NSAID's. Select all that apply
- Aspirin
- Ibuprofen ( Advil, Motrin, Nuprin)
- Bacitricin
- Naproxen sodium (Aleve)
Correct Answer(s)

A. Aspirin
A. Ibuprofen ( Advil, Motrin, Nuprin)
A. Naproxen sodium (Aleve)

Explanation

p. 399

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34.

Based on the idea that only the patient can feel the pain and only the patient knows how much analgesic will relieve it.
- MAOI
- NSAID
- PCA
- BSP
Correct Answer

A. PCA

Explanation

p. 402

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35.

Examples of Opioid. Select all that apply
- Hydromorphone (Dilaudid)
- Meperidine (Demerol)
- Morphine
- Viagra
- Fentanyl (Actiq, Duragesic)
Correct Answer(s)

A. Hydromorphone (Dilaudid)
A. Meperidine (Demerol)
A. Morphine
A. Fentanyl (Actiq, Duragesic)

Explanation

p. 400

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1
36.

The following are certain considerations needed when providing pain medication to an older adult. Select all that apply:
- Changes n peripheral vascular function and skin as well as decreased transmission of pain impulses place the older adult at risk for being unable to sense pain
- The effects of aging on the pain process re sometimes compounded in an older adult who has a chronic illness that affects the nervous system
- The risk for gastric and renal toxicity from NSAIDs is increased in older adults
- Meperidine is an ideal choice for pain control in the older adult
Correct Answer(s)

A. Changes n peripheral vascular function and skin as well as decreased transmission of pain impulses place the older adult at risk for being unable to sense pain
A. The effects of aging on the pain process re sometimes compounded in an older adult who has a chronic illness that affects the nervous system
A. The risk for gastric and renal toxicity from NSAIDs is increased in older adults

Explanation

p. 400 Meperidine is a particularly poor choice for pain control in the older adult because of diminished renal function

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37.

Behavioral characteristics of Patients in Pain. Select all that apply:
- Self protective and has a narrow focus; withdraws from social contacts and impairs thought processes
- Demonstrates distraction behavior: moaning, rocking, crying, pacing, restlessness or seeking out other people
- Presents facial mask of pain; eyes that are dull, teeth clenched
- Alterations in muscle tone, diaphoresis, changes in blood pressure and pulse
- Displays perky, manic obsessive mood swings
Correct Answer(s)

A. Self protective and has a narrow focus; withdraws from social contacts and impairs thought processes
A. Demonstrates distraction behavior: moaning, rocking, crying, pacing, restlessness or seeking out other people
A. Presents facial mask of pain; eyes that are dull, teeth clenched
A. Alterations in muscle tone, diaphoresis, changes in blood pressure and pulse

Explanation

p. 395

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1
38.

Sleep and Rest. Select all that is applicable and true:
- Bed rest does not necessarily mean a patient is resting. Emotional or metabolic stressors naturally cause the patient to be restless
- Sleep is a state of rest that occurs for a sustained period
- The theory that sleep is associated with healing suggests that achieving optimum sleep quality is important for patient's recovery
- The sleep of an older adult is less deep which increases the risk of early awakening and complaints of sleep disturbance.
- Hospitals and other health care facilities are the best places for a person to sleep
Correct Answer(s)

A. Bed rest does not necessarily mean a patient is resting. Emotional or metabolic stressors naturally cause the patient to be restless
A. Sleep is a state of rest that occurs for a sustained period
A. The theory that sleep is associated with healing suggests that achieving optimum sleep quality is important for patient's recovery
A. The sleep of an older adult is less deep which increases the risk of early awakening and complaints of sleep disturbance.

Explanation

p. 409 - Hospitals or other health care facilities are quick to disrupt a patient's sleep habits and patterns

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39.

Side effects of Opioid therapy. Select all that apply
- Delays gastric emptying, slows bowel motility and decreases peristalsis
- Reduces secretions from colonic mucosa
- Gastrointestinal dysfunction can result in ileus, fecal impaction, and obstruction
- Loose bowel movement is the most common side effect of opioids and the only one for which individuals develop tolerance
Correct Answer(s)

A. Delays gastric emptying, slows bowel motility and decreases peristalsis
A. Reduces secretions from colonic mucosa
A. Gastrointestinal dysfunction can result in ileus, fecal impaction, and obstruction

Explanation

p. 401 - Constipation is the most common side effect of opioids and the only one for which individuals do not develop tolerance

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40.

What does it mean to give comfort to a patient? Select all that apply:
- Give strength and hope
- To cheer
- To ease the grief, pain or trouble of another
- To provide all pain medication as the patient requests
Correct Answer(s)

A. Give strength and hope
A. To cheer
A. To ease the grief, pain or trouble of another

Explanation

p. 394

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0
41.

Necessary for body tissue restoration and healthy cardiac functions. A person's biologic function slows down during this phase
- REM
- NREM
- ROM
- PROM
Correct Answer

A. NREM

Explanation

p. 411

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1
42.

The danger of morphine and other opioid analgesics is their potential to cause ______________ of vital nervous system functions. Most significantly, opiates cause ____________ depression by depressing the __________ center of the brain stem.
- Depression, respiratory, respiratory
- Inflammation, gastric, temporal
- Atrophy, pulmonary, respiratory
- Malfunction, respiratory, parasympathetic
Correct Answer

A. Depression, respiratory, respiratory

Explanation

p. 400

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1
43.

Behavioral signs of pain. Select all that apply
- Frowning, grimacing
- Clenched teeth and clenched fist
- Crying and Moaning
- Muscular spasms
- Rigid body position and restlessness
Correct Answer(s)

A. Frowning, grimacing
A. Clenched teeth and clenched fist
A. Crying and Moaning
A. Rigid body position and restlessness

Explanation

p. 408

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44.

Physical illness that can disrupt normal conditions for sleep. Select all that apply:
- COPD, hypertension
- Arthritis, nocturia
- Restless leg syndrome
- Presbyopia
Correct Answer(s)

A. COPD, hypertension
A. Arthritis, nocturia
A. Restless leg syndrome

Explanation

p. 410

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45.

The Nature of Pain. Select all that apply:
- It is a complex, abstract, personal subjective experience
- An unpleasant sensation caused by noxious stimulation of the sensory nerve endings
- A cardinal symptom of inflammation
- Pain is whatever the person says it is, existing whatever he says it does
- Both the person in pain and the health care professional are experts about the pain
Correct Answer(s)

A. It is a complex, abstract, personal subjective experience
A. An unpleasant sensation caused by noxious stimulation of the sensory nerve endings
A. A cardinal symptom of inflammation
A. Pain is whatever the person says it is, existing whatever he says it does

Explanation

p. 395 - Only the person with pain, AND NOT THE HEALTH CARE PROFESSIONAL, is the expert about the pain: its onset, duration, location, intensity, quality, and pattern as well as the degree of pain relief obtained from therapy

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46.

Based on studies of IV and epidural administration routes for opioid, what is the likelihood of a clinically significant opioid-induced respiratory depression?
- Less than 1%
- Less than 5% but more than 1%
- More than 5% but less than 10%
- Between 1% and 2%
Correct Answer

A. Less than 1%

Explanation

page 400

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47.

What is the principle of effective pain management?
- Failure to treat pain is patient abandonment. Every patient has the right to cure his pain
- Failure to treat pain is inhumane and constitutes professional negligence. Every patient has the right to be free of pain.
- Failure to treat pain is a violation against the patient's bill of rights. The patient has the right for a proper litigation
- Failure to treat pain is against agency policy. The nurse may be terminated from employment for not doing so
Correct Answer

A. Failure to treat pain is inhumane and constitutes professional negligence. Every patient has the right to be free of pain.

Explanation

p. 404

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48.

"Patient indicates improved pain relief within 1 hour of implementation of pain management techniques." Which part of the nursing process and/or care plan is this statement?
- Patient Goals
- Evaluation
- Expected Outcomes
- Nursing Interventions
Correct Answer

A. Evaluation

Explanation

p. 406

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49.

A protein found in foods such as milk, cheese, and meats, that frequently helps induce sleep
- Gluten
- L-tryptophan
- Amino Acids
- Lactose
Correct Answer

A. L-tryptophan

Explanation

p. 410

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Quiz Edited by
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Quiz Created by
Arnoldjr2

Chapter 16 - Pain Management, Comfort, Rest And Sleep

Pain is determined by tissue damage alone

Quiz Preview

Suggests that pain impulses are regulated and blocked by mechanisms located along the CNS. The proposed location of this theory is in the dorsal horn of the spinal cord. Pain and other sensations of the skin and muscles travel the same pathways through the large nerves in the spinal cord.

Definition of pain according to the American Pain society:

"Chronic pain related to joint and muscle inflammation manifested by complaints of discomfort, anorexia, loss of focus and social withdrawal". What part of the nursing care plan is this statement?

People with less pain than others from a similar injury have a:

What route is most appropriate for treating rapidly escalating severe pain?

Pain impulses are regulated or even blocked by mechanisms located along the CNS.

No longer used because of toxic complications such as seizures

A cutaneous stimulation management device

An opioid antagonist that blocks or reverses all the actions of an opioid

Difference between a PCA and a PRN medication

__________________ is the most common opioid side effect and the only one for which the individual does not develop tolerance

Drug delivery system to control pain via a portable computerized pump with a chamber for a syringe

Risks of clinically significant opioid induced respiratory depression

__________ indicates when the pain started. _____________ is how long the pain lasts.

Morphine-like substances composed of amino acids found in the pituitary gland and other areas of the CNS.

Formerly called narcotics, they decrease the perception of pain by binding to pain receptor sites in the CNS. They are considered the cornerstone or gold standards for managing moderate to severe acute pain.

How does the "gate theory" explain the prevention or elimination of pain?

It blocks the pain impulses in the CNS and reduces inflammation

A group of analgesics that can pose the risk of gastrointestinal (GI) bleeding

The standard agent for opioid therapy, although it could compromise renal function

Nurses treating pain have a tendency to

The following are Joint Commission Standards about pain. Select all that are true:

Because of its potential for producing seizures, it is no longer the drug of choice for pain management

After a total knee replacement, a patient was given an epidural catheter for fentanyl epidural analgesia. What should the nurse do next?

A pocket sized, battery-operated device that provides a continuous, mild electric current to the skin via electrodes that re attached to a stimulator by flexible wires. Typically used for patients suffering post-operative or chronic pain.

Maximum recommended dosage of acetaminophen

An inflammatory mediator released when cells are damaged that sensitizes nerves that carry information about pain. By inhibiting the release of this mediator, the drugs diminish trans mission of pain stimuli

Singultus

When choosing the right route, which of these are appropriate statements regarding pain medication

A patient describes her angina pectoris pain as radiating down her left inner arm to the little finger and upward. What do you call this pain?

How do endorphins work to eliminate pain?

Examples of over the counter NSAID's. Select all that apply

Based on the idea that only the patient can feel the pain and only the patient knows how much analgesic will relieve it.

Examples of Opioid. Select all that apply

The following are certain considerations needed when providing pain medication to an older adult. Select all that apply:

Behavioral characteristics of Patients in Pain. Select all that apply:

Sleep and Rest. Select all that is applicable and true:

Side effects of Opioid therapy. Select all that apply

What does it mean to give comfort to a patient? Select all that apply:

Necessary for body tissue restoration and healthy cardiac functions. A person's biologic function slows down during this phase

The danger of morphine and other opioid analgesics is their potential to cause ______________ of vital nervous system functions. Most significantly, opiates cause ____________ depression by depressing the __________ center of the brain stem.

Behavioral signs of pain. Select all that apply

Physical illness that can disrupt normal conditions for sleep. Select all that apply:

The Nature of Pain. Select all that apply:

Based on studies of IV and epidural administration routes for opioid, what is the likelihood of a clinically significant opioid-induced respiratory depression?

What is the principle of effective pain management?

"Patient indicates improved pain relief within 1 hour of implementation of pain management techniques." Which part of the nursing process and/or care plan is this statement?

A protein found in foods such as milk, cheese, and meats, that frequently helps induce sleep

indicates when the pain started. ___ is how long the pain lasts.

The danger of morphine and other opioid analgesics is their potential to cause ____ of vital nervous system functions. Most significantly, opiates cause depression by depressing the center of the brain stem.