Question 1

A patient with terminal cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin)is due.Which action should the nurse take first?

Accepted Answer

A)   Use distraction by talking about things the patient enjoys.
B)   Administer the prescribed PRN immediate-acting morphine.
C)   Suggest the use of alternative therapies such as heat or cold.
D)   Consult with the doctor about increasing the MS Contin dose. B

Question 2

A nurse assesses a patient with chronic cancer pain who is receiving imipramine (Tofranil)in addition to long-acting morphine.Which statement,if made by the patient,indicates to the nurse that the patient is receiving adequate pain control?

Accepted Answer

A)   "I'm not anxious at all."
B)   "I sleep 8 hours every night."
C)   "I feel much less depressed since I've been taking the Tofranil."
D)   "The pain is manageable and I can accomplish my desired activities. D

Question 3

The nurse assesses that a patient receiving epidural morphine has not voided for over 10 hours.What action should the nurse take initially?

Accepted Answer

A)   Monitor for withdrawal symptoms.
B)   Place an indwelling urinary catheter.
C)   Ask if the patient feels the need to void.
D)   Document this allergic reaction in the patient's chart. C

Question 4

A patient who uses a fentanyl (Duragesic)patch for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone (Vicodin)tablets,but the patient is asleep when the nurse returns with the medication.Which action is best for the nurse to take?

Accepted Answer

A)   Wake the patient and administer the hydrocodone.
B)   Wait until the patient wakes up and reassess the pain.
C)   Suggest the use of nondrug therapies for pain relief instead of additional opioids.
D)   Consult with the health care provider about changing the fentanyl (Duragesic)  dose.

Question 5

The health care provider orders a patient-controlled analgesia (PCA)machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past.Which nursing actions regarding opioid administration are appropriate at this time (select all that apply)?

Accepted Answer

A)   Assess for signs that the patient is becoming addicted to the opioid.
B)   Monitor for therapeutic and adverse effects of opioid administration.
C)   Emphasize that the risk of some opioid side effects increases over time.
D)   Teach the patient about how analgesics improve postoperative activity levels.
E)   Provide instructions on decreasing opioid doses by the second postoperative day.

Question 6

Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP)when caring for a patient who is using a fentanyl (Duragesic)patch and a heating pad for treatment of chronic back pain?

Accepted Answer

A)   Check the skin under the heating pad.
B)   Take the respiratory rate every 2 hours.
C)   Monitor sedation using the sedation assessment scale.
D)   Ask the patient about whether pain control is effective.

Question 7

The nurse teaches a student nurse about the action of ibuprofen.Which statement,if made by the student,indicates that teaching was effective?

Accepted Answer

A)   "The drug decreases pain impulses in the spinal cord."
B)   "The drug decreases sensitivity of the brain to painful stimuli."
C)   "The drug decreases production of pain-sensitizing chemicals."
D)   "The drug decreases the modulating effect of descending nerves."

Question 8

A patient with chronic back pain has learned to control the pain with the use of imagery and hypnosis.The patient's spouse asks the nurse how these techniques work.Which response by the nurse is best?

Accepted Answer

A)   "The strategies work by affecting the perception of pain."
B)   "These techniques block the pain pathways of the nerves."
C)   "Both strategies prevent transmission of painful stimuli to the brain."
D)   "The therapies slow the release of chemicals in the spinal cord that cause pain."

Question 9

The nurse is caring for a 1-day postoperative patient who is receiving morphine through patient-controlled analgesia (PCA).What action by the nurse is a priority?

Accepted Answer

A)   Check the respiratory rate.
B)   Assess for nausea after eating.
C)   Inspect the abdomen and auscultate bowel sounds.
D)   Evaluate the sacral and heel areas for signs of redness.

Question 10

A patient who is receiving sustained-release morphine sulfate (MS Contin)every 12 hours for chronic pain experiences level 9 (0 to 10 scale)breakthrough pain and anxiety.Which action by the nurse is best?

Accepted Answer

A)   Provide amitriptyline (Elavil)  10 mg orally.
B)   Administer lorazepam (Ativan)  1 mg orally.
C)   Offer ibuprofen (Motrin)  400 to 800 mg orally.
D)   Give immediate-release morphine 30 mg orally.

Question 11

A nurse assesses a postoperative patient 2 days after chest surgery.What findings indicate that the patient requires better pain management (select all that apply)?

Accepted Answer

A)   Confusion
B)   Hypoglycemia
C)   Poor cough effort
D)   Shallow breathing
E)   Elevated temperature

Question 12

The nurse reviews the medication orders for an older patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale)hip pain while ambulating.Which medication should the nurse use as initial therapy?

Accepted Answer

A)   Naproxen (Aleve)  200 mg orally
B)   Oxycodone (Roxicodone)  5 mg orally
C)   Acetaminophen (Tylenol)  650 mg orally
D)   Aspirin (acetylsalicylic acid, AS
A)   650 mg orally

Question 13

A patient who is using a fentanyl (Duragesic)patch and immediate-release morphine for chronic cancer pain develops new-onset confusion,dizziness,and a decrease in respiratory rate.Which action should the nurse take first?

Accepted Answer

A)   Obtain vital signs.
B)   Remove the fentanyl patch.
C)   Notify the health care provider.
D)   Administer the prescribed PRN naloxone (Narcan) .

Question 14

A patient who uses a fentanyl (Duragesic)patch for chronic cancer pain suddenly complains of rapid onset pain at a level 9 (0 to 10 scale)and requests "something for pain that will work now." How will the nurse document the type of pain reported by this patient?

Accepted Answer

A)   Somatic pain
B)   Referred pain
C)   Neuropathic pain
D)   Breakthrough pain

Question 15

A patient who has just started taking sustained-release morphine sulfate (MS Contin)for chronic arthritic joint pain following a traumatic injury complains of nausea and abdominal fullness.Which action should the nurse take initially?

Accepted Answer

A)   Administer the ordered antiemetic medication.
B)   Tell the patient that the nausea will subside in about a week.
C)   Order the patient a clear liquid diet until the nausea decreases.
D)   Consult with the health care provider about using a different opioid.

Question 16

Which question asked by the nurse will give the most information about the patient's metastatic bone cancer pain?

Accepted Answer

A)   "How long have you had this pain?"
B)   "How would you describe your pain?"
C)   "How much medication do you take for the pain?"
D)   "How many times a day do you take medication for the pain?"

Question 17

The following medications are prescribed by the health care provider for a middle-aged patient who uses long-acting morphine (MS Contin)for chronic back pain,but still has ongoing pain.Which medication should the nurse question?

Accepted Answer

A)   Morphine (Roxanol) 
B)   Pentazocine (Talwin) 
C)   Celecoxib (Celebrex) 
D)   Dexamethasone (Decadron)

Question 18

A patient who has fibromyalgia tells the nurse,"I feel depressed because I ache too much to play golf." The patient says the pain is usually at a level 7 (0 to 10 scale).Which patient goal has the highest priority when the nurse is developing the treatment plan?

Accepted Answer

A)   The patient will exhibit fewer signs of depression.
B)   The patient will say that the aching has decreased.
C)   The patient will state that pain is at a level 2 of 10.
D)   The patient will be able to play 1 to 2 rounds of golf.

Question 19

When visiting a hospice patient,the nurse assesses that the patient has a respiratory rate of 11 breaths/minute and complains of severe pain.Which action is best for the nurse to take?

Accepted Answer

A)   Inform the patient that increasing the morphine will cause the respiratory drive to fail.
B)   Tell the patient that additional morphine can be administered when the respirations are 12.
C)   Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.
D)   Administer a nonopioid analgesic, such as a nonsteroidal antiinflammatory drug (NSAI
D)  , to improve patient pain control.

Question 20

A patient with second-degree burns has been receiving hydromorphone through patient-controlled analgesia (PCA)for a week.The patient wakes up frequently during the night complaining of pain.What action by the nurse is most appropriate?

Accepted Answer

A)   Administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.
B)   Consult with the health care provider about using a different treatment protocol to control the patient's pain.
C)   Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
D)   Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.

Exam 4: Pain Management

A patient with terminal cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due.Which action should the nurse take first?

A nurse assesses a patient with chronic cancer pain who is receiving imipramine (Tofranil) in addition to long-acting morphine.Which statement,if made by the patient,indicates to the nurse that the patient is receiving adequate pain control?

The nurse assesses that a patient receiving epidural morphine has not voided for over 10 hours.What action should the nurse take initially?

A patient who uses a fentanyl (Duragesic) patch for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone (Vicodin) tablets,but the patient is asleep when the nurse returns with the medication.Which action is best for the nurse to take?

The health care provider orders a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past.Which nursing actions regarding opioid administration are appropriate at this time (select all that apply) ?

Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain?

The nurse teaches a student nurse about the action of ibuprofen.Which statement,if made by the student,indicates that teaching was effective?

A patient with chronic back pain has learned to control the pain with the use of imagery and hypnosis.The patient's spouse asks the nurse how these techniques work.Which response by the nurse is best?

The nurse is caring for a 1-day postoperative patient who is receiving morphine through patient-controlled analgesia (PCA) .What action by the nurse is a priority?

A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety.Which action by the nurse is best?

A nurse assesses a postoperative patient 2 days after chest surgery.What findings indicate that the patient requires better pain management (select all that apply) ?

The nurse reviews the medication orders for an older patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale) hip pain while ambulating.Which medication should the nurse use as initial therapy?

A patient who is using a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion,dizziness,and a decrease in respiratory rate.Which action should the nurse take first?

A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain suddenly complains of rapid onset pain at a level 9 (0 to 10 scale) and requests "something for pain that will work now." How will the nurse document the type of pain reported by this patient?

A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic arthritic joint pain following a traumatic injury complains of nausea and abdominal fullness.Which action should the nurse take initially?

Which question asked by the nurse will give the most information about the patient's metastatic bone cancer pain?

The following medications are prescribed by the health care provider for a middle-aged patient who uses long-acting morphine (MS Contin) for chronic back pain,but still has ongoing pain.Which medication should the nurse question?

A patient who has fibromyalgia tells the nurse,"I feel depressed because I ache too much to play golf." The patient says the pain is usually at a level 7 (0 to 10 scale) .Which patient goal has the highest priority when the nurse is developing the treatment plan?

When visiting a hospice patient,the nurse assesses that the patient has a respiratory rate of 11 breaths/minute and complains of severe pain.Which action is best for the nurse to take?

A patient with second-degree burns has been receiving hydromorphone through patient-controlled analgesia (PCA) for a week.The patient wakes up frequently during the night complaining of pain.What action by the nurse is most appropriate?