Fundamentals Of Nursing NCLEX Quiz 43

1. In caring for a young child with pain. which assessment tool is the most useful?

Simple description pain intensity scale

0-10 numeric pain scale

Faces pain-rating scale

McGill-Melzack pain questionnaire

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.

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.

2. Which route of administration is preferred if immediate analgesia and rapid titration are necessary?

Intraspinal

Patient-controlled analgesia (PCA)

Intravenous (IV)

Sublingual

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.

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.

3. 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?

Make a note in the nurse’s file and continue to observe clinical performance

Refer the new nurse to the in-service education department.

Quiz the nurse about knowledge of pain management

Give praise for the correct dose and time and discuss the deficits in charting.

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 a note and watching do not help the nurse to correct the immediate problem. In-service might be considered if the problem persists.

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 a note and watching do not help the nurse to correct the immediate problem. In-service might be considered if the problem persists.

4. Which client is most likely to receive opioids for extended periods of time?

A client with fibromyalgia

A client with phantom limb pain

A client with progressive pancreatic cancer

A client with trigeminal neuralgia

Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opioid and adjuvant medications. Trigeminal neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.

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-opioid and adjuvant medications. Trigeminal neuralgia is treated with anti-seizure medications such as carbamazepine (Tegretol). Phantom limb pain usually subsides after ambulation begins.

5. 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?

Sensory

Affective

Sociocultural

Behavioral

Cognitive

The family is part of the sociocultural dimension of pain. They are influencing the client and 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

Explanation

The family is part of the sociocultural dimension of pain. They are influencing the client and 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

6. In applying the principles of pain treatment. what is the first consideration?

Treatment is based on client goals.

A multidisciplinary approach is needed.

The client must be believed about perceptions of own pain.

Drug side effects must be prevented and managed.

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.

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.

7. When titrating an analgesic to manage pain. what is the priority goal?

Administer smallest dose that provides relief with the fewest side effects.

Titrate upward until the client is pain free.

Titrate downwards to prevent toxicity.

Ensure that the drug is adequate to meet the client’s subjective needs.

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.

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.

8. 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?

Therapeutic touch

Use of heat and cold applications

Meditation

Transcutaneous electrical nerve stimulation (TENS)

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 therapist.

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 therapist.

9. 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?

Amitriptyline (Elavil)

Corticosteroids

Methylphenidate (Ritalin)

Lorazepam (Ativan)

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.

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.

10. A client with chronic pain reports to you. the charge nurse. that the nurse have not been responding to requests for pain medication. What is your initial action?

Check the MARs and nurses’ notes for the past several days.

Ask the nurse educator to give an in-service about pain management.

Perform a complete pain assessment and history on the client.

Have a conference with the nurses responsible for the care of this client.

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.

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.