1.
1. A chronic pain client reports to you, the charge nurse, that the
nurse have not been responding to requests for pain medication. What is
your initial action?
Correct Answer
D. Have a conference with the nurses responsible for the care of this client
Explanation
As charge nurse, you must assess for the performance and attitude of the staff in relation to this client. After gathering data from the nurses, additional information from the records and the client can be obtained as necessary. The educator may be of assistance if knowledge deficit or need for performance improvement is the problem.
2.
Family members are encouraging your client to “tough it out” rather than run the risk of becoming addicted to narcotics. The client is stoically abiding by the family’s wishes. Priority nursing interventions for this client should target which dimension of pain?
Correct Answer
C. Sociocultural
Explanation
The family is part of the sociocultural dimension of pain. They are influencing the client should be included in the teaching sessions about the appropriate use of narcotics and about the adverse effects of pain on the healing process. The other dimensions should be included to help the client/family understand overall treatment plan and pain mechanism
3.
A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain?
Correct Answer
A. Amitriptyline (Elavil)
Explanation
Antidepressants such as amitriptyline can be given for diabetic neuropathy. Corticosteroids are for pain associated with inflammation. Methylphenidate is given to counteract sedation if the client is on opioids. Lorazepam is an anxiolytic.
4.
Which client is most likely to receive opioids for extended periods of time?
Correct Answer
C. A client with progressive pancreatic cancer
Explanation
Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opiod and adjuvant medicatios. Trigeminal neuralgia is treated with anti-seizure medications such as carbamezapine (Tegretol). Phantom limb pain usually subsides after ambulation begins.
5.
As the charge nurse, you are reviewing the charts of clients who were assigned to a newly graduated RN. The RN has correctly charted dose and time of medication, but there is no documentation regarding non-pharmaceutical measures. What action should you take first?
Correct Answer
D. Give praise for the correct dose and time and discuss the deficits in charting.
Explanation
In supervising the new RN, good performance should be reinforced first and then areas of improvement can be addressed. Asking the nurse about knowledge of pain management is also an option; however, it would be a more indirect and time-consuming approach. Making an ote and watching do not help the nurse to correct the immediate problem. In-service might be considered if the problem persists.
6.
In caring for a young child with pain, which assessment tool is the most useful?
Correct Answer
C. Faces pain-rating scale
Explanation
The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is appropriate for young children who may have difficulty describing pain or understanding the correlation of pain to numerical or verbal descriptors. The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary.
7.
In applying the principles of pain treatment, what is the first consideration?
Correct Answer
C. The client must be believed about perceptions of own pain.
Explanation
The client must be believed and his or her experience of pain must be acknowledged as valid. The data gathered via client reports can then be applied to other options in developing the treatment plan.
8.
Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
Correct Answer
C. Intravenous (IV)
Explanation
the IV route is preferred as the fastest and most amenable to titration. A PCA bolus can be delivered; however, the pump will limit the dosage that can be delivered unless the parameters are changed. Intraspinal administration requires special catheter placement and there are more potential complications with this route. Sublingual is reasonably fast, but not a good route for titration, medication variety in this form is limited.
9.
When titrating an analgesic to manage pain, what is the priority goal?
Correct Answer
A. Administer smallest dose that provides relief with the fewest side effects.
Explanation
the goal is to control pain while minimizing side effects. For severe pain, the medication can be titrated upward until pain is controlled. Downward titration occurs when the pain begins to subside. Adequate dosing is important; however, the concept of controlled dosing applies more to potent vasoactive drugs.
10.
In educating clients about non-pharmaceutical alternatives, which topic could you delegate to an experienced LPN/LVN, who will function under your continued support and supervision?
Correct Answer
B. Use of heat and cold applications
Explanation
Use of heat and cold applications is a standard therapy with guidelines for safe use and predictable outcomes, and an LPN/LVN will be implementing this therapy in the hospital, under the supervision of an RN. Therapeutic touch requires additional training and practice. Meditation is not acceptable to all clients and an assessment of spiritual beliefs should be conducted. Transcutaneous electrical stimulation is usually applied by a physical
11.
Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b. NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine _____, _____, _____ (Type the letters with space without comma)
12.
Which client is at greater risk for respiratory depression while receiving opioids for analgesia?
Correct Answer
D. A child with an arm fracture and cystic fibrosis
Explanation
at greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors.
13.
A client appears upset and tearful, but denies pain and refuses pain medication, because “my sibling is a drug addict and has ruined out lives.” What is the priority intervention for this client?
Correct Answer
A. Encourage expression of fears on past experiences
Explanation
This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.
14.
A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?
Correct Answer
C. DiapHoresis
Explanation
Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.
15.
In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant?
Correct Answer
A. Assist the client with preparation of a sitz bath.
Explanation
The nursing assistant is able to assist the client with hygiene issues and knows the principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and evaluating outcomes are nursing responsibilities.
16.
The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take?
Correct Answer
D. Contact the charge nurse for advice.
Explanation
the charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following one’s own ethical code is correct, you must ensure that the client is not abandoned and that care continues.
17.
For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?
Correct Answer
B. Obtain baseline behavioral indicators from family members.
Explanation
Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.
18.
Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)?
Correct Answer
C. Oral
Explanation
If the gastrointestinal system is function, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms.
19.
A first day post-operative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
Correct Answer
D. Assess the pain for location, quality, and intensity.
Explanation
Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps.
20.
Which non-pharmacological measure is particularly useful for a client with acute pancreatitis?
Correct Answer
C. Side-lying position with knees to chest and pillow against abdomen
Explanation
The side-lying, knee-chest position opens retroperitoneal space and provides relief. The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain, especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain. The additional stimulation of massage may be distressing to the client.
21.
What is the best way to schedule medication for a client with constant pain?
Correct Answer
D. Around-the-clock
Explanation
IF the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control
22.
For a client who is taking aspirin, which laboratory value should be reported to the physician?
Correct Answer
C. PT 14 seconds
Explanation
When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%, female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).
23.
Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? (Choose all that apply.)
Correct Answer
B. A client second day post-op who needs pain medication prior to dressing changes
Explanation
A second day post-operative client who needs medication prior to dressing changes has predictable and routine care that a new nurse can manage. Although chronic pain clients can be relatively stable, the interaction with this client will be time consuming and may cause the new nurse to fall behind. The HIV client has complex complaints that require expert assessment skills. The client pending discharge will need special and detailed instructions.
24.
A family member asks you, “Why can’t you give more medicine? He is still having a lot of pain.” What is your best response?
Correct Answer
C. “Please tell him that I will be right there to check of him.”
Explanation
directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next.
25.
Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.)
Correct Answer(s)
B. A client with a leg cast who needs neurologic checks and PRN hydrocodone
C. A client post-op toe amputation with diabetic neuropathic pain
Explanation
The clients with the cast and the toe amputation are stable clients and need ongoing assessment and pain management that are within the scope of practice for an LPN/LVN under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and the terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication.