Question 1

The nurse is talking to the spouse of a client who is not requiring pain medication a few hours after surgery. The spouse states that she is amazed that her husband is able to endure such pain without medication. Which response by the nurse is the most appropriate in this situation?

Accepted Answer

A)  "Some people just don't need any analgesics." 
B)  "Have you seen any nonverbal cues that might indicate your husband is experiencing pain?" 
C)  "We will need to contact the healthcare provider to report your husband is refusing analgesics." 
D)  "Have you noticed your husband's monitor alarming?"

Question 2

The nurse is caring for two clients involved in a motor vehicle accident. Both clients required explorative abdominal surgery. Neither has received any pain medication in six hours and both have asked. However, one client is in greater distress than the other. Which pain theory is useful in explaining this phenomenon?

Accepted Answer

A)  Pattern. 
B)  Specificity. 
C)  Stress. 
D)  Gate control.

Question 3

The nurse is assessing a postoperative client who reports a pain level of 10 on a 0 to 10 scale. The client is grimacing and appears anxious. Which is the priority action by the nurse?

Accepted Answer

A)  Administer pain medication if it has been longer than the ordered interval. 
B)  Offer to call the pastoral service to provide spiritual counseling. 
C)  Obtain an order for an anti-anxiety medication. 
D)  Call the family to come in and stay with the client.

Question 4

The nurse conducts a pain assessment on a client who has terminal breast cancer with extensive metastasis. The client tells the nurse, "Nothing helps the pain." Which documentation regarding this client's pain is the most appropriate?

Accepted Answer

A)  The client is experiencing referred pain. 
B)  The client is experiencing intractable pain. 
C)  The client is experiencing retractable pain. 
D)  The client is experiencing radiating pain.

Question 5

A nurse working in a healthcare provider's office is interviewing a client who reports experiencing daily migraines. The nurse decides to further assess the impact of the client's pain. Which assessment tool is most appropriate to use for this client?

Accepted Answer

A)  Psychologic well-being inventory. 
B)  Body Diagram tool. 
C)  Intensity rating scale. 
D)  Brief Pain Inventory.

Question 6

The nurse is assessing a client who presents to the emergency department after recently being discharged from the hospital after a right above-the-knee amputation. The client tells the nurse that her right foot hurts. Which type of pain does the nurse suspect that this client is experiencing?

Accepted Answer

A)  Phantom pain. 
B)  Radiating pain. 
C)  Intractable pain. 
D)  Cutaneous pain.

Question 7

The parents of a young toddler who requires a venipuncture for laboratory studies ask the nurse what they can do to help with pain during the procedure. Which response by the nurse is the most appropriate?

Accepted Answer

A)  Have the parents leave the area during the procedure. 
B)  Tell the parents to touch and reassure the toddler during the procedure. 
C)  Wait until the toddler is asleep to do the procedure. 
D)  Administer an analgesic 30 minutes before the procedure.

Question 8

The nurse is assessing pain level with vital signs for an adolescent client. The client is reporting pain but when the nurse asks for a description of the pain the client says, "It just hurts. Why can't I have something?" Which action by the nurse is the most appropriate?

Accepted Answer

A)  Leave the room and come back later. 
B)  Provide questions that require yes or no answers related to pain. 
C)  Ask the client what they would like to have for pain. 
D)  Continue with the vital signs assessment.

Question 9

A school-age client is brought to the emergency department after an arm injury during a football game. When the nurse tells the client that pain medication will be administered through the intravenous line the client begins to scream and wave the unaffected arm. The client's parents ask the nurse why their child is behaving this way. Which response by the nurse is the most appropriate?

Accepted Answer

A)  "Your child is just immature." 
B)  "Your child is just scared." 
C)  "It looks like your child may have experienced a head injury as well." 
D)  "Your child may be remembering a painful injection experience."

Exam 11: Pain Assessment