Question 1

The patient had knee replacement surgery and has a local infusion pump to provide a local anesthetic to the surgical site.The patient puts on the call light and complains that pain at the site is more intense than it has ever been and is getting worse.The nurse checks the site and finds that the dressing is damp but intact.The infusion pump is pumping, and there is medication in the bag.The most probable cause of the problem might be the:

Accepted Answer

A)  catheter may be clogged.
B)  pump may be releasing too much drug into the site.
C)  catheter may be displaced.
D)  patient may be exaggerating the pain. C

Question 2

When evaluating the effects of PCA, the nurse notes that the patient is sedated and is difficult to arouse.What step should the nurse take next?

Accepted Answer

A)  Insert an airway.
B)  Turn patient to the side.
C)  Stop the PCA.
D)  Expect this as a patient outcome of the therapy. C

Question 3

The patient has morphine sulfate ordered for pain every 4 hours "prn." The patient complains of severe pain and usually requests more morphine an hour before it is due.The nurse should: (Select all that apply.)

Accepted Answer

A)  Request a "placebo order" from the physician.
B)  Offer the patient medication "around the clock" instead of "prn".
C)  Offer the patient massage between medication doses.
D)  Offer the patient a nonopioid medication between morphine doses if ordered. B, C, D

Question 4

Pain is experienced differently by different people, because pain perception is based on which of the following? (Select all that apply.)

Accepted Answer

A)  Past pain experiences
B)  Personal values
C)  Cultural expectations
D)  Emotions
E)  None of above

Question 5

Drugs administered in the epidural space spread by: (Select all that apply.)

Accepted Answer

A)  diffusion through the dura mater.
B)  transport through blood vessels.
C)  absorption by fat.
D)  absorption through muscle.

Question 6

The application of touch and movement to muscles, tendons, and ligaments without manipulation of the joints is called _________________.

Accepted Answer

The answer of The application of touch and movement to...

Question 7

The patient's family is concerned that the patient may get too much pain medication after surgery and become addicted to the medication if he is placed on a PCA pump.They also voice concern about the effectiveness of the PCA.The nurse should instruct the family and the patient that:

Accepted Answer

A)  pain relief with the PCA pump is not as good as when the nurse provides it, but it does save on nursing time.
B)  pain relief is good when the medication peaks, but less so when the levels drop, and that is when the patient will know that he needs more.
C)  because the device provides medication as soon as the patient needs it, he will probably use less of the medication.
D)  the patient will be kept in bed for several days after surgery to make sure it is safe to ambulate.

Question 8

The patient states that the PCA is not controlling his pain.The nurse checks the infusion setup and IV site and then evaluates the patient's ability to use the system.All looks in order.The nurse should notify the physician to: (Select all that apply.)

Accepted Answer

A)  report suspected drug-seeking behavior.
B)  possibly change the drug being used.
C)  adjust the dosage of the drug being used.
D)  request placebo medication to evaluate true pain.

Question 9

The nurse knows that an advantage of intraspinal analgesia is the:

Accepted Answer

A)  smaller doses of epidural than intrathecal medication.
B)  lack of significant patient complications.
C)  systemic distribution of morphine faster than fentanyl.
D)  ability to achieve appropriate analgesia with smaller dosages.

Question 10

________________ is a method of preventing pain while reducing overall opioid use.

Accepted Answer

The answer of ________________ is a method of preventing pain...

Question 11

When assessing a local infusion pump site, the nurse notes that which of the following requires an intervention?

Accepted Answer

A)  The device is labeled, indicating that an anesthetic is being used.
B)  The catheter connections are loose.
C)  Surgical dressings are dry and intact.
D)  No blood backup is present in the tubing.

Question 12

___________ has an identifiable cause and rapid onset and generally disappears with healing.

Accepted Answer

The answer of ___________ has an identifiable cause and rapid...

Question 13

The patient is admitted for chronic pain.He states that morphine sulfate (Morphine) has been used to relieve his pain, but recently he has been needing to use more of the medication to relieve pain.This patient's plan of care will have to incorporate interventions to deal with which of the following?

Accepted Answer

A)  Addiction
B)  Pseudoaddiction
C)  Drug tolerance
D)  Physical dependence

Question 14

While reviewing a patient's medication history, the nurse determines that intraspinal analgesia is contraindicated as a result of:

Accepted Answer

A)  previous spinal anesthesia.
B)  recent administration of anticoagulants.
C)  a history of cardiac problems.
D)  a diagnosis of advanced cancer.

Question 15

A nonpharmacological approach that the nurse may implement for patients who are experiencing pain that focuses on diverting the patient's attention away from the pain sensation by promoting pleasurable and meaningful stimuli is:

Accepted Answer

A)  massage.
B)  heat/cold.
C)  guided imagery.
D)  distraction.

Question 16

The nurse is preparing to administer a bolus of epidural medication.The nurse must remember to:

Accepted Answer

A)  clean the injection cap of the epidural catheter with an anti-infective according to agency policy.
B)  clean the injection cap of the epidural catheter with alcohol.
C)  inject opioids quickly and smoothly.
D)  flush with saline after the injection.

Question 17

The patient is unable to rest even after pain medication has been administered.The nurse decides to give the patient a backrub.Which of the following strokes should the nurse use when finishing the backrub?

Accepted Answer

A)  Long firm stroking movements down the back
B)  Light strokes while moving up the back in a circular motion
C)  Kneading movements toward the sacrum
D)  Circular motion upward from buttocks to shoulders

Question 18

The _______________ is a potential space between the vertebral bones and the dura mater, the outermost meninges covering the brain and spinal cord.

Accepted Answer

The answer of The _______________ is a potential space between...

Question 19

A nurse is evaluating the epidural catheter insertion site and suspects that the intraspinal catheter has punctured the dura when _____ noted.

Accepted Answer

A)  clear drainage is
B)  bloody drainage is
C)  purulent drainage is
D)  redness, warmth, and swelling are

Question 20

The nurse frequently must assess a patient who is experiencing pain.When assessing the intensity of the pain, the nurse should:

Accepted Answer

A)  ask whether there are any precipitating factors.
B)  question the patient about the location of the pain.
C)  offer the patient a pain scale to objectify the information.
D)  use open-ended questions to find out about the sensation.

Exam 15: Pain Assessment and Basic Comfort Measures