Chapter 16 - Pain Management, Comfort, Rest And Sleep

1. Pain is determined by tissue damage alone

True

False

p. 395 - Pain is not determined by tissue damage alone. No predictable relationship exists between identifiable tissue injury and the sensation of pain.

Explanation

p. 395 - Pain is not determined by tissue damage alone. No predictable relationship exists between identifiable tissue injury and the sensation of pain.

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

p. 396

Explanation

p. 396

3. Match the type of pain on the left with its definition/description on the right

Referred pain

Acute pain

Chronic pain

Intractable

p. 396

Explanation

p. 396

Submit

4. 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

p. 395

Explanation

p. 395

5. "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

p. 406

Explanation

p. 406

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

Higher level of endorphins

Lower level of endorphins

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.

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.

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

Oral

IM

IV

SubQ

p. 415, number 16

Explanation

p. 415, number 16

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

Patient controlled Analgesia

Gate Control theory

Circadian event

Radiating pain

p. 415, number 3

Explanation

p. 415, number 3

9. No longer used because of toxic complications such as seizures

Codeine

Advil

Meperidine (Demerol)

Morphine

p. 415, number 17

Explanation

p. 415, number 17

10. A cutaneous stimulation management device

PCA

TENS

SVJ

ONES

p. 415, number 11

Explanation

p. 415, number 11

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

Santyl

Mucomyst

Naloxone (Narcan)

Aspirin

p. 401

Explanation

p. 401

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

Placebo

Morphine

PCA

STD

p. 415, number 4

Explanation

p. 415, number 4

13. Risks of clinically significant opioid induced respiratory depression

5%

Less than 1%

20%

10%

p.16, number 15

Explanation

p.16, number 15

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

Inflammation, Infection

Onset, Duration

Beginning, Length

Duration, Onset

p. 413

Explanation

p. 413

15. 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

p. 402

Explanation

p. 402

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

Diaphoresis

Constipation

Urticaria

Hyponatremia

p. 414

Explanation

p. 414

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

p. 400

Explanation

p. 400

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

Adrenaline

Endorphins

Epinephrine

Corticosteroid

p. 396

Explanation

p. 396

19. It blocks the pain impulses in the CNS and reduces inflammation

Penicillin

Aspirin

Bengay

Salonpas

p. 399

Explanation

p. 399

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

Mono-Amine Oxidase Inhibitors

NSAIDs

ACE Inhibitors

Beta Blockers

p. 399

Explanation

p. 399

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

Morphine

Benzodiazepine

Sedatives

Benadryl

p. 400

Explanation

p. 400

22. Nurses treating pain have a tendency to

Over treat

Under treat

p. 415, number 10

Explanation

p. 415, number 10

23. 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

p. 396

Explanation

p. 396

24. 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

p. 414, number 1

Explanation

p. 414, number 1

25. 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

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

Explanation

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

Submit

26. 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)

p. 400

Explanation

p. 400

27. The left column enumerates key words for a pain assessment guide. Match the key words on the left with its specific concepts on the right.

H - how does you pain feel

I - intensity

L - location

D - duration

A - aggravating and alleviating

Submit

28. 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

p. 399

Explanation

p. 399

29. 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

p. 399

Explanation

p. 399

30. 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

p. 401

Explanation

p. 401

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

p. 415, number 7

Explanation

p. 415, number 7

32. Singultus

Dyspnea

Hiccups

Flatus

Thirst

p. 394

Explanation

p. 394

33. 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

p. 404

Explanation

p. 404

34. 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

p. 396

Explanation

p. 396

35. 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

p. 402

Explanation

p. 402

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

Aspirin

Ibuprofen ( Advil, Motrin, Nuprin)

Bacitricin

Naproxen sodium (Aleve)

p. 399

Explanation

p. 399

Submit

37. Examples of Opioid. Select all that apply

Hydromorphone (Dilaudid)

Meperidine (Demerol)

Morphine

Viagra

Fentanyl (Actiq, Duragesic)

p. 400

Explanation

p. 400

Submit

38. 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

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

Explanation

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

Submit

39. 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

p. 395

Explanation

p. 395

Submit

40. 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

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

Explanation

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

Submit

41. 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

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

Explanation

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

Submit

42. 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

p. 394

Explanation

p. 394

Submit

43. Match the physical nonpharmacological intervention on the left with a description on the right

Progressive muscle relaxation

Massage

Transcutaneous electric nerve stimulation (TENS)

Heat or cold application

p. 399

Explanation

p. 399

Submit

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

REM

NREM

ROM

PROM

p. 411

Explanation

p. 411

45. 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

p. 400

Explanation

p. 400

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

COPD, hypertension

Arthritis, nocturia

Restless leg syndrome

Presbyopia

p. 410

Explanation

p. 410

Submit

47. 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

p. 408

Explanation

p. 408

Submit

48. 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%

page 400

Explanation

page 400

49. 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

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

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

Submit

50. 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

p. 404

Explanation

p. 404

51. A common CNS analgesic often prescribed for pain control

Aspirin

Acetaminophen (Tylenol)

Morphine

Ibuprofen (Motrin)

p. 414, number 3

Explanation

p. 414, number 3

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

Gluten

L-tryptophan

Amino Acids

Lactose

p. 410

Explanation

p. 410

53. "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

p. 406

Explanation

p. 406

54. People experience cyclic rhythms as part of their everyday life. What do you call the 24-hour day and night cycle?

Nocturnal or vigilance

Diurnal or circadian

Sleep-wake cycle

Work-rest cycle

p. 409

Explanation

p. 409

55. Responsible for mental restoration

NREM - Stage 3

NREM - Stage 2

REM sleep

NREM - Stage 4

p. 411

Explanation

p. 411

56. The following are psychological and cognitive interventions for pain. Which one of them is not?

TENS

Music

Biofeedback

Imagery

Education

p. 399

Explanation

p. 399

57. Match the following routes of opioid administration on the left with a brief description of their benefits/disadvantage on the right.

IV route

IM administration

Oral route

topical route

p. 402

Explanation

p. 402

Submit

58. Which of the following are objective signs of pain? Select all that apply

Increased pulse rate, increased depth and frequency of respiration

Diaphoresis and Pallor, Nausea and vomiting (with severe pain)

Increased Blood Pressure

Dilated pupils, Muscle tension

Urticaria and Pruritus

p. 408

Explanation

p. 408

Submit

59. Which of the following is not a guideline for individualizing pain therapy

Use different types of pain relief measures

Provide pain relief measures before pain becomes severe

Adapt the best practices on pain healing from different cultures across the board

Use measures the patient believes are effective

Consider the patient's ability or willingness to participate in pain relief measures

p. 408

Explanation

p. 408

60. Match the following stages of sleep on the left with what happens during that stage of sleep on the right colum

NREM - Stage 1

NREM - Stage 2

NREM - Stage 3

NREM - Stage 4

REM - Rapid Eye Movement

p. 411

Explanation

p. 411

Submit

61. Restores and Rests the body

REM

NREM - Stage 2

NREM - Stage 3

NREM - Stage 4

p. 411

Explanation

p. 411

62. From what time to what time does everyone have an increased sleep tendency?

From 11 pm to 3 am

From 2 am to 7 am

From 7 am to 11 am

From 2 pm to 5 pm

p. 410

Explanation

p. 410

63. What is the right time and interval for the administration of pain medication?

Only before a required wound dressing change or before physical therapy

Only as needed on a PRN basis according to the MAR

Do not give analgesics only on "as needed" schedule. An around the clock administration schedule is best

An hour before or after meal time

p. 404

Explanation

p. 404

64. Reasons why pain is oftentimes pharmacologically undertreated . Select all that apply:

Misunderstanding or insufficient knowledge of pharmacologic principles

The after taste is unbearable

Anxiety over administering too large a dose of an opioid analgesic

The cost is not affordable

Concerns about addiction

p. 399

Explanation

p. 399

Submit

65. The following are physical nonpharmacological interventions for pain. Select all that apply:

Progressive muscle relaxation

Biofeedback

Transcutaneous electric nerve stimulation

Heat or cold application

Massage

p. 399, Biofeedback is a psychological and cognitive intervention

Explanation

p. 399, Biofeedback is a psychological and cognitive intervention

Submit

66. Which of the following does NOT form part of the essential message about pain assessment

Ask patients about their pain, then respect and accept what they say.

Intervene to relieve their pain and ask them again about their pain.

Pain assessment is a linear task of assessment, intervention, and reassessment

Without assessment of the patient's pain, none of the pain relief measurement will be useful

p. 398 - Pain assessment is a circular task of assessment, intervention, and reassessment

Explanation

p. 398 - Pain assessment is a circular task of assessment, intervention, and reassessment

67. Physical effects of unrelieved pain. Select all that apply:

Increased oxygen demand

Respiratory dysfunction,

Decreased GI motility, Anxiety, Depression, Irritability

Confusion, depressed immune response

Irrational exuberance

p. 398

Explanation

p. 398

Submit

68. A nurse's __________ and ___________ of pain potentially results in ineffective control of patient's pain

Bias, misconception

Ignorance, interpretation

Perception, judgment

Sense, feeling

p. 414

Explanation

p. 414

69. Most widely available and frequently used non-opioid analgesic group for mild to moderate pain

Acetaminophen (Tylenol)

Anesthetics

Anticonvulsives

Nonsteroidal anti-inflammatory drugs

p. 399

Explanation

p. 399

Submit

70. Which of the following are guidelines for individualizing pain therapy? Select all that apply:

Choose pain relief measures appropriate to the severity of the pain as reflected by the patient's behavior

If therapy is ineffective at first, encourage the patient to try again before finally giving it up.

Keep a scientific mind about what has potential to relieve pain only in so far as patient compliance exists.

Keep trying

Protect the patient

p. 409 - Keep an open mind about has potential to relieve paint

Explanation

p. 409 - Keep an open mind about has potential to relieve paint

Submit

71. Which of the following statements regarding the use of patient controlled analgesia is not true, inappropriate or not applicable. Select all that apply

Any patient has the right to use a PCA if so preferred

Patients with respiratory problems and renal or hepatic complications are ideal candidates for PCA

PCA should be used by an alert oriented patient and should receive instructions before surgery

PCA is for patient use only delivered either through bolus dose or continuous infusion

Instruct patient on the purpose of PCA, operating instructions, lockout intervals, expected pain relief, precautions and potential side effects.

pages 402-403 - Only an alert and oriented patient can use a PCA. He/she also needs to be able to follow instructions.
Patients with respirator complications are at high risk of taking IV Opioids of any type. Patients with renal or hepatic dysfunctions are not suitable for a PCA

Explanation

pages 402-403 - Only an alert and oriented patient can use a PCA. He/she also needs to be able to follow instructions.
Patients with respirator complications are at high risk of taking IV Opioids of any type. Patients with renal or hepatic dysfunctions are not suitable for a PCA

Submit

72. Which of the following are pain rating scales? Select all that apply

Visual analog

Numerical

FACES

Braden Scale

Verbal Descriptive

p. 407

Explanation

p. 407

Submit

73. Meperidine administration is contraindicated against what? Select all that apply:

Monoamine oxidase inhibitors

Untreated hypothyroidism

Addison's disease

BPH, urethral structure

COPD

p. 400

Explanation

p. 400

Submit

74. Match the pain mechanism affected on the right column to each analgesic group on the left

Nonopioid: acetaminophen (Tylenol)

Nonopioid: acetasalicylic acid (Aspirin)

Nonopioid: NSAID - tramadol (Ultram), ibuprofen (Motrin), naproxen (Naprosyn), celecoxib (Celebrex)

Opioid

Adjuvant analgesics

p. 401

Explanation

p. 401

Submit

75. Epidural Analgesia. Select all that apply:

Epidural medication diffuses slowly from the epidural space across the dura and arachnoid matters membranes into the CSF

Drugs used for epidural analgesia are morphine, fentanyl, and hydromorphone

It is an appropriate first-line route for moderate to severe acute pain expected to last for at least 24 hours.

Epidural analgesia is beneficial for controlling acute pain during labor and for relieving chronic pain, such as that seen in patients with advanced cancer

p. 404

Explanation

p. 404

Submit

76. Among older adults, which medication are often taken that takes away sleep? Select all that apply:

Diuretics

Antihistamine

Antitussive

Theophylline

p. 409

Explanation

p. 409

Submit

77. Physiologic signs and symptoms that may arise from sleep deprivation. Select all that apply:

Hand tremors and decreased reflexes

Slowed response time, decrease in word memory

Decreased reasoning and judgment

Cardiac dysrhythmias

Mood swings, disorientation and hyperexcitability

p. 412

Explanation

p. 412

Submit

78. Factors affecting sleep. Select all that apply

Sleeping 1 hour later results in falling asleep1 hour later the next day

Stress causes release of corticosteroids and adrenalin, which leads to catabolism and sleeplessness

Exercise 2 hours before bedtime allows the body to cool down and promote relaxation

Weight gain causes longer sleep periods with fewer interruptions and later awakening

As anxiety and depression increase, so does the lack of sleep; as sleep decreases, anxiety and depression also decrease

p. 410 - As anxiety and depression increase, so does the lack of sleep; as sleep decreases, anxiety and depression increase

Explanation

p. 410 - As anxiety and depression increase, so does the lack of sleep; as sleep decreases, anxiety and depression increase

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79. Selecting the Proper medication when more than one is ordered. Mark the statements that are true:

Use NSAIDs or milder opioids for mild to moderate pain

Use of NSAIDs can help reduce opioid side effects

Morphine and Hydromorphone are the opioids of choice for long term management of severe pain

Injectable medications act more quickly often relieving severe acute pain within an hour. Oral medications take as long as two hours

p. 404 - Older adults should avoid combination of opioids

Explanation

p. 404 - Older adults should avoid combination of opioids

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