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Ignatavicius: Medical-Surgical Nursing, 6th Edition

Chapter 5: Pain: The Fi th !ital Sign Test "an# M$%TIP%E C&'ICE 1. The nurse is caring for a client who was medicated for pain 1 hour ago. The client is stating that the medication is not working and she still has pain. What is the first action that the nurse will take? a Assess the client to determine her pain score. . b Believe the clients report of pain. . c Wait until it is time for the next pain medication dose. . d Teach the client how to use guided imager . . A!"# B $ealth care providers often do not believe the clients report of pain. The nurses primar role in pain management is to advocate for the client b believing reports of pain. %t is important to remember that self&reporting is alwa s the most reliable indication of pain. After believing that the client is in pain' the client can be assessed to determine her pain score and also be taught nonpharmacologic methods to relieve pain. The nurse needs to take action to alleviate the pain and not wait until the next medication dosage is due. (%)# /B0# T/1# *are4 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome 1 *lient !eeds *ategor # "afe and -ffective *are -nvironment 23anagement of %ntegrated 1rocess# !ursing 1rocess 2Anal sis4

5. When is the nurse correct in decreasing the dose of pain medication in a client with end& stage cancer? a The spouse is worried that the client ma become addicted. . b The client wants to remain alert during the visit of a long time friend. . c The client has lost considerable weight and does not want to eat. . d The client is becoming combative at night. . A!"# B
-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank The client has the right to choose whether or not to take the pain medication. The analgesic regimen should not interfere with the clients sleep' rest' appetite' level of ph sical mobilit ' or driving abilit . *lose relationships are important factors in providing ongoing support for effective pain management intervention. (%)# /B0# T/1# *are4 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome 5 *lient !eeds *ategor # "afe and -ffective *are -nvironment 23anagement of %ntegrated 1rocess# !ursing 1rocess 2%mplementation4

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9. A client with chronic pain is being discharged from the hospital. When planning the clients pain relief regimen for home' it is most important for the nurse to communicate with which member of the health care team? a Advanced practice nurse specialist . b $ome health care nurse . c 1rimar ph sician . d 1s chologist . A!"# B All members of the listed health care team are important. $owever the home health care nurse will provide the immediate home supervision and assistance to the client and famil . The home health care nurse can then refer to other health care team members as necessar . %n order for the home health care nurse to carr out the role' it is essential that the acute care nurse communicate the clients ph sical condition' support network' and an issues with pain management. (%)# /B0# T/1# *are4 3"*# *ognitive +evel# *omprehension ,-)# p. :; +earning /utcome 5 *lient !eeds *ategor # "afe and -ffective *are -nvironment 23anagement of %ntegrated 1rocess# *ommunication and (ocumentation

<. A client with arthritic pain is considering taking an herbal supplement to relieve arthritic pain. What teaching is most important for the nurse to carr out with this client? a %nform an health care providers about the use of this supplement. . b 1ractice imager along with the herbal supplement. . c Take onl herbal supplements that are prescribed. .

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank d Take herbal supplement at the onset of pain. . A!"# A Alwa s ask the client about the use of herbal supplements' because some can cause serious interactions with other pharmacologic agents. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 9 T/1# *lient !eeds *ategor # $ealth 1romotion and 3aintenance 21rinciples of Teaching.+earning4 3"*# %ntegrated 1rocess# Teaching.+earning

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:. What instruction should the nurse include in the discharge teaching plan of a client who has had a transcutaneous electrical nerve stimulation 2T-!"4 unit implanted? a =1ain relief is sustained when stimulation is stopped.> . b =The current is ad?usted b the ph sician.> . c =The electrodes are placed awa from the painful site.> . d =@ou can perceive a pins and needles sensation.> . A!"# ( The T-!" unit works through electrodes that are placed near the painful area site. The electrodes are connected to a small box that contains the current needed for pain relief. The current can be ad?usted b an health care provider. Ad?ustment of this current can cause a pins and needles sensation. 1ain relief with cutaneous therap is generall sustained onl as long as the stimulation continues. (%)# *ognitive +evel# *omprehension ,-)# p. :: /B0# +earning /utcome 9 T/1# *lient !eeds *ategor # $ealth 1romotion and 3aintenance 21rinciples of Teaching.+earning4 3"*# %ntegrated 1rocess# Teaching.+earning 8. Wh does the nurse alwa s ask the client his or her pain level after taking routine vital signs? a To determine if the pain is influencing the blood pressure and heart rate . b To determine the need for more freAuent vital sign measurement . c To ensure that pain assessment occurs on a regular basis . d To follow 3c*affer s guidelines on pain management

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank .

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A!"# * 3aking pain the fifth vital sign allows more freAuent and accurate assessment' which can contribute to better pain management. (%)# /B0# T/1# 3"*# *ognitive +evel# *omprehension ,-)# p. <1 +earning /utcome < *lient !eeds *ategor # $ealth 1romotion and 3aintenance 2$ealth "creening4 %ntegrated 1rocess# !ursing 1rocess 2Assessment4

B. A client with cholec stitis has pain in the right shoulder area and asks' =What is happening to me? What did % do to m shoulder?> What is the nurses best response? a =@ou are weak from sta ing in bed.> . b =(oes our other arm hurt too?> . c ="ometimes pain from a certain organ is referred elsewhere in the bod .> . d =% am going to hold our medication until we can determine what is happening.> . A!"# * 3an t pes of visceral pain can be felt in bod areas other than the originating site. This is known as referred pain. 1ain originating in the gallbladder can be referred to the right posterior shoulder. The client should be reassured that this is normal and medicated appropriatel . (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome < T/1# *lient !eeds *ategor # $ealth 1romotion and 3aintenance 21rinciples of Teaching.+earning4 3"*# %ntegrated 1rocess# !ursing 1rocess 2%mplementation4 ;. A nurse is assigned to care for the following four clients who have the potential for having pain. Which client is most likel not to be treated adeAuatel for this problem? a 3iddle&aged woman with a fractured arm . b *lient with expressive aphasia . c /lder adult client with arthritis . d *lient who has undergone an appendectom .

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank

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A!"# * 1ain is not adeAuatel treated in all areas of health care. 1opulations at the highest risk are older adults' minorities' and those with histor of substance abuse. /lder adults in nursing homes are especiall at risk. (%)# /B0# T/1# 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome : *lient !eeds *ategor # 1s chosocial %ntegrit 2"upport " stems4 %ntegrated 1rocess# !ursing 1rocess 2Assessment4

C. The ph sician orders a dose of medication that does not resolve the clients chronic pain. When the nurse Auestions the order' the ph sician explains that he fears that the client will develop an addiction with higher drug dosages. What is the nurses best response? a Administer the medication as ordered. . b Assist the client to use guided imager . . c *onsult with the pain control specialist. . d -xplain to the client that lower doses are better. . A!"# * There are man reasons wh a health care provider ma underprescribe medications for clients in pain' such as regulator scrutin and cultural and societal attitudes. Dndertreatment of pain is a serious problem in the Dnited "tates' as well as the rest of the world. The nurse can act as an advocate for the client in pain b consulting with a pain care specialist. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome : T/1# *lient !eeds *ategor # 1s chosocial %ntegrit 2*hemical and /ther (ependencies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2%mplementation4 17. A client' who has been taking ox codone 2/x *ontin4 for an extended period of time comes to the clinic complaining that the drug is no longer relieving his pain. Which categor would be given to the clients complaint? a Addiction . b 1h sical dependence . c 1seudoaddiction .

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank d Tolerance .

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A!"# ( Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a decrease in one or more of the drugs effects over time. )or example' clients who have been taking an opioid for an extended period report less pain relief the longer the are on the medication. (%)# *ognitive +evel# *omprehension ,-)# p. 9C /B0# +earning /utcome 8 T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2Assessment4 11. A home care client who is taking morphine for pain management abruptl stops taking his medication. Which s mptom would indicate ph sical dependence? a Abdominal cramping . b *raving for morphine . c (ecreased heart rate . d -levated temperature . A!"# A 1h siologic dependence on opioids such as morphine allows tissues to adapt to their presence. When opioids are suddenl removed' the dependent tissues stimulate an autonomic nervous s stem response that includes nausea and vomiting' abdominal cramping' muscle twitching' profuse perspiration' delirium' and convulsions. (%)# /B0# T/1# 3"*# *ognitive +evel# *omprehension ,-)# p. <7 +earning /utcome 8 *lient !eeds *ategor # 1h siological %ntegrit 21h siological Adaptation4 %ntegrated 1rocess# !ursing 1rocess 2Assessment4

15. A home care client who is currentl on h dromorphone 2(ilaudid4 for pain management presents to the hospital complaining of abdominal cramping' nausea' and sweating. When taking the clients histor ' the nurse should ask which Auestion first? a =Are ou in pain?> . b =(id ou take more (ilaudid than prescribed?> . c =When did ou take our last dose of (ilaudid?>

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank . d =When was our last bowel movement?> .

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A!"# * 1h sical dependence occurs in ever one who takes opioids over a period of time. Withdrawal s ndrome occurs when the client abruptl stops taking the medication. The s mptoms include abdominal cramping' nausea' sweating' delirium' and convulsions. Although the other distractors ma be asked as part of the admission assessment' the are not of priorit . (%)# /B0# T/1# 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome 8 *lient !eeds *ategor # 1h siological %ntegrit 21h siological Adaptation4 %ntegrated 1rocess# !ursing 1rocess 2Assessment4

19. The nurse is assessing a client with a histor of arthritic pain. Assessment findings reveal a heart rate of 157 beats.min' blood pressure 1B7.;7 mm $g. What intervention will the nurse carr out first? a Administers blood pressure medication . b Administers anti&arthritis drug . c Assesses if the client has developed another t pe of pain . d *ontinue to assessE these are common findings with chronic pain. . A!"# * Arthritis is categoriFed as chronic pain. With chronic pain' the bod adapts b blocking the s mpathetic nervous s stem' which causes tach cardia and increased blood pressure. Therefore' this clients high blood pressure and heart rate are not caused b his chronic pain and ma be a result of a more acute t pe of pain. Therefore' the best intervention is for the nurse to establish whether the client is having pain other than arthritic and then to decide which intervention to carr out. (%)# /B0# T/1# 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome B *lient !eeds *ategor # 1h siological %ntegrit 21h siological Adaptation4 %ntegrated 1rocess# !ursing 1rocess 2%mplementation4

1<. The nurse is caring for four clients who are complaining of pain. Based on the following assessments and histories' which clients pain is most likel chronic in nature? a )ole catheter inserted 97 minutes ago with a heart rate of 177.min

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank . b $istor of heart disease with a heart rate of 157.min . c $istor of rheumatoid arthritis with a blood pressure of 117.B7 mm $g . d $ip replacement surger with a blood pressure of 1B7.C7 mm $g .

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A!"# * The definition of chronic pain involves the length of time the pain is experienced and.or the progressive nature of the problem causing the pain. $eart disease and rheumatoid arthritis both could fit into this categor . $owever' pain of a chronic nature does not call the s mpathetic nervous s stem into pla . Therefore' the rise in heart rate and blood pressure is not seen in a client having chronic pain. The client with arthritis who is having pain is not experiencing the increased blood pressure that would be seen with acute pain. (%)# /B0# T/1# 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome B *lient !eeds *ategor # 1h siological %ntegrit 2,eduction of ,isk 1otential4 %ntegrated 1rocess# !ursing 1rocess 2Anal sis4

1:. When assessing a client' which behavior most indicates that he or she is experiencing changes associated with acute pain? a Anger and hostilit . b (esperation . c %nabilit to concentrate . d 1s chosocial withdrawal . A!"# * The characteristics most common to chronic pain are ps chosocial withdrawal' anger and hostilit ' and desperation. The inabilit to concentrate is associated much more with acute pain' before an ph siologic or behavioral adaptation has occurred. (%)# /B0# T/1# 3"*# *ognitive +evel# *omprehension ,-)# p. 9B +earning /utcome B *lient !eeds *ategor # 1h siological %ntegrit 21h siological Adaptation4 %ntegrated 1rocess# !ursing 1rocess 2Assessment4

18. The nurse anticipates that the client who rates his pain level as a 17 on a scale of 1 to 17 has undergone which of the following surgical procedures?

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank a . b . c . d . *ranial surger +eg surger !eck surger Dpper abdominal surger

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A!"# ( %n general' intrathoracic and upper intra&abdominal surgical approaches are associated with more severe pain. 3uscle&splitting procedures are generall far more painful than muscle&stretching procedures. (%)# /B0# T/1# 3"*# *ognitive +evel# *omprehension ,-)# p. 9B +earning /utcome B *lient !eeds *ategor # 1h siological %ntegrit 21h siological Adaptation4 %ntegrated 1rocess# !ursing 1rocess 2Assessment4

1B. Which assessment finding is cause for concern in a client who has taken < g of acetaminophen 2T lenol4 to relieve his back pain? a (ifficult with urination . b (ecreased respirator rate . c Gastrointestinal bleeding . d %ncreased liver function tests . A!"# ( T lenol has few anti&inflammator properties. Therefore' it will not cause bleeding. Dnlike nerve blocks and opioid drugs' it does not affect the respirator rate or cause difficult with urination. %t can cause liver toxicit ' especiall in higher doses and taken more freAuentl than ever < hours for long&term use. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome ; T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2Anal sis4 1;. (uring the preoperative assessment' the client tells the nurse that he has been taking nonsteroidal anti&inflammator drugs 2!"A%(s4 for ears. What Auestion is most important for the nurse to ask?

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank a . b . c . d . =(id ou ever have a problem with bleeding?> =(o ou bruise easil ?> =$ow man tablets do ou take ever da ?> =When was the last time ou took our !"A%(?

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A!"# ( !"A%(s can prevent platelet aggregation' which results in a tendenc toward bleeding. 1rior to notif ing the surgeon' the nurse should find out the last time the client took the medication and check the chart to see if there is a note that clarifies the surgeons awareness of the clients use of this medication. (%)# /B0# T/1# 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome ; *lient !eeds *ategor # 1h siological %ntegrit 2,eduction of ,isk 1otential4 %ntegrated 1rocess# !ursing 1rocess 2Assessment4

1C. The client has been receiving 17 mg of morphine parenterall ever < hours for acute pain. $is discharge medications include an oral combination opioid and !"A%( preparation' ox codone. What dosage would be considered eAuianalgesic to the morphine dose? a 17 mg . b 97 mg . c 87 mg . d 157 mg . A!"# B The pain relief provided b 17 mg of %3 or subcutaneous morphine is eAuivalent to that provided b 97 mg of ox codone. (%)# *ognitive +evel# *omprehension ,-)# p. <B' Table :&B /B0# +earning /utcome C T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2%mplementation4 57. The client is taking an ox codone&acetaminophen combination 2T lox4 at home dail for chronic pain management. What instruction will the nurse give this client?

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank a . b . c . d . =Avoid taking aspirin while ou are on this medication.> =(rink plent of water and eat foods high in fiber.> ="top this medication after 9 da s.> =Weigh ourself dail to determine if ou are retaining sodium or water.>

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A!"# B /pioid agonists' like ox codone' act on s stemic as well as neural opioid receptors and decrease gastrointestinal motilit . *onstipation is common and can be an aggravating problem. )luids and food high in fiber can prevent constipation. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 17 T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# Teaching.+earning 51. The client was given 1: mg of morphine %3 for postsurger pain. When the nurse checks the client for pain relief 1 hour later' the client is sleeping and has a respirator rate of ; breaths.min. What is the nurses first action? a Administers naloxone 2!arcan4 . b Administers ox gen b mask . c Arouses the client b calling his or her name and lightl shaking the clientHs arm . d *ontinues to monitor the respirator rate and document the findings . A!"# * 3an clients experience some degree of respirator depression with opioid analgesics. %f the client can be aroused with minimall intrusive techniAues and increases the rate of respiration spontaneousl ' no further intervention is reAuired. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 17 T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2%mplementation4 55. The nurse accidentall administers 1: mg of morphine 2(uramorph4 %3 to a client who had been given another dose of morphine' 1: mg %3' about 97 minutes earlier. What initial action should the nurse be prepared to take?

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank a . b . c . d . Administers !aloxone 2!arcan4 Administers ox gen Assists with intubation 3onitors pain level

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A!"# A A combined dose of 97 mg of morphine ma cause severe respirator depression in some clients. !aloxone is an opioid antagonist and can be used 2intravenousl 4 as an antidote to a morphine overdose. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 17 T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 21lanning4 59. A client is admitted to the hospital with a histor of ox codone 21ercodan4 abuse. )or which clinical manifestation would the nurse observe the client? a Anorexia and weight loss . b (ecreased heart rate and respirations . c 3uscle twitching and profuse perspiration . d "edation . A!"# * 1h siologic dependence on opioids allows tissues to adapt to their presence. When opioids are suddenl removed' the dependent tissues stimulate an autonomic nervous s stem response that includes nausea and vomiting' abdominal cramping' muscle twitching' profuse perspiration' delirium' and convulsions. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 17 T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2Assessment4 5<. Which client would the nurse suggest tr subcutaneous opioid analgesia for pain management? a *lient who has had a surgical procedure

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank . b *lient with back pain who likes to walk . c *lient with cancer who is nauseous . d *lient experiencing acute chest pain .

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A!"# * "ubcutaneous opioid analgesia is recommended for cancer clients who cannot take an thing b mouth. %t is not recommended for acute pain' such as pain from a surgical procedure' because subcutaneous boluses have slower onset and a lower peak effect than %I boluses. %t also reAuires the use of an ambulator infusion pump' which ma not alwa s be acceptable to someone who is ph sicall active. (%)# /B0# T/1# 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome 11 *lient !eeds *ategor # 1h siological %ntegrit 21h siological Adaptation4 %ntegrated 1rocess# !ursing 1rocess 2Anal sis4

5:. A client with colon cancer is discharged to home with morphine for pain management. $e is having episodes of nausea and vomiting. Which route of morphine administration would be most advantageous to use? a /ral . b ,ectal . c %ntravenous . d %ntramuscular . A!"# B ,ectal administration of opioids is recommended for clients who are !1/' nauseated' or at home. /ral agents are the preferred route of analgesia in man cases. $owever' because of his nausea and vomiting' this client does not have the functional gastrointestinal 2G%4 s stem needed for good absorption of oral agents. %ntramuscular agents are not recommended for cancer pain. %ntravenous agents are recommended when oral or rectal routes fail to provide pain control. (%)# *ognitive +evel# *omprehension ,-)# p. :7' Table :&17 /B0# +earning /utcome 11 T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2Assessment4

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank

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58. The nurse is caring for four clients. Which client assessment would be the most indicative of having pain? a Blood pressure 1:7.B7 mm $g and sleeping . b *lient stating that =he is anxious.> . c $eart rate of 177 beats.min and restless . d 1ostoperative client with an abdominal incision . A!"# * 3c*affer s definition of pain is =whatever the experiencing person sa s it is and exists whenever he or she sa s it does.> $owever' at times clients are unable to verbaliFe that the are in pain. The American Geriatrics "ociet 1anel has found six common indicators of pain that ou can observe. /ne is restlessness. All the other distractors could be clients who have the potential for being in pain' but * is the most indicative. (%)# /B0# T/1# 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome 15 *lient !eeds *ategor # 1h siological %ntegrit 21h siological Adaptation4 %ntegrated 1rocess# !ursing 1rocess 2Anal sis4

5B. The client has a histor of alcohol abuse. Which pain relief regimen should the nurse anticipate if morphine 23" *ontin4 is given for pain? a A higher dose of opioids will be needed to provide effective pain relief. . b A lower dose of opioids will be needed to provide effective pain relief. . c The appropriate drug selection is an opioid agonist&antagonist combination. . d The client will receive no pain relief from the morphine. . A!"# A 1eople who drink significant amounts of alcohol dail have elevated liver enF me activit that degrades morphine and morphine agonists. As a result' these clients freAuentl have tolerance for opioid analgesics and reAuire higher doses of agonists to achieve an acceptable level of pain relief during acute pain episodes. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 15 T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2Anal sis4

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5;. The client describes his pain as being a 9 on a scale of 1 to 17. What is the most appropriate pain medication to give? a Acetaminophen 2T lenol4 . b )entan l 2(uragesic patch4 . c $ dromorphone 2(ilaudid4 . d Dltram 2Tramadol4 . A!"# A The World $ealth /rganiFation has suggested guidelines to help prescribers select the most appropriate medications based on the clients level of pain. )or level 1 pain 21 to 9 rating4' nonopioids such as acetaminophen or !"A%(s are recommended. (%)# *ognitive +evel# *omprehension ,-)# p. <: /B0# +earning /utcome 15 T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2Anal sis4 5C. Which instruction is the most accurate for the nurse to give a client who has a client& controlled analgesia device 21*A4 after abdominal surger ? a =%nstruct our famil or visitors to press the button for ou when ou are . sleeping.> b =1ush the button ever 1: minutes whether ou feel pain at that time or not.> . c =1ush the button when ou feel the pain beginning rather than waiting until the . pain is at its worst.> d =Tr to go as long as ou possibl can before ou press the button.> . A!"# * *lients should be instructed to push the button to release medication when the pain begins rather than waiting until the pain becomes so great that the dose given b the pump cannot control the pain. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 19 T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# Teaching.+earning

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank 97. The nurse assesses several postoperative clients receiving patient&controlled epidural analgesia 2 1*-A4. Which client will the nurse prioritiFe to assess first? a *lient receiving bupivacaine 23arcaine4 complaining of =inabilit to move legs> . b *lient receiving fentan l complaining of =itch arms> . c *lient receiving h dromorphone 2(ilaudid4' complaining of =full feeling> . d *lient receiving morphine complaining of =difficult sta ing awake> .

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A!"# A -pidural analgesia can cause sensor and motor deficits. The inabilit to move the legs could mean that the client is receiving too high a dose of the drug or damage has been done to the spinal cord. This reAuires immediate intervention. %tch arms' full feeling' and difficult sta ing awake could be side effects of the medications' but the are not of priorit . (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 1< T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 21lanning4 91. Because the client has epidural analgesia with bupivacaine 23arcaine4 for pain relief' which condition should the nurse anticipate as a potential problem? a -xtremit itching . b %nabilit to raise legs off the bed . c !ausea and vomiting . d ,espirator rate of ; breaths.min . A!"# B +ower motor weakness is more common when an epidural local anesthetic 2such as bupivacaine4 is used. The other three problems are seen more when opioids are used. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 1< T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 21lanning4

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank

:&1B

95. When assessing a client who is taking long&term ibuprofen 23otrin4 for pain' the nurse finds numerous areas of bruising. What is the nurses first action? a Assesses for gastric discomfort . b Assesses for the presence of pain . c *ontinues to monitor the bruising . d 1laces client on falls precaution . A!"# A !"A%(s can cause gastrointestinal disturbances and can prevent platelet aggregation' which results in G% bleeding. Therefore' clients should be observed for gastric discomfort or vomiting and bleeding. (%)# *ognitive +evel# Application ,-)# !.A for Application and above /B0# +earning /utcome 1: T/1# *lient !eeds *ategor # 1h siological %ntegrit 21harmacological and 1arenteral Therapies4 3"*# %ntegrated 1rocess# !ursing 1rocess 2-valuation4 99. Which statement made b a nurse represents the need for further education regarding pain management in older adult clients? a =/lder adults are at greatest risk for undertreated pain.> . b =/lder adults tend to report pain less often than ounger adults.> . c =/lder clients usuall have had more experience with pain than ounger clients.> . d =/lder clients have a different pain mechanism and do not feel it as much.> . A!"# ( There is no evidence to support the idea that older adult clients perceive pain an differentl than ounger clients. (%)# /B0# T/1# 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome 1: *lient !eeds *ategor # 1h siological %ntegrit 21h siological Adaptation4 %ntegrated 1rocess# Teaching.+earning

9<. 1rior to surger ' the nurse observes the client listening to music on the radio. Based on this observation' the nurse ma tr which nonpharmacologic intervention for pain relief in the postoperative setting?

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank a . b . c . d . *utaneous skin stimulation $ pnosis %mager ,adiofreAuenc ablation

:&1;

A!"# * %mager is a form of distraction in which the client is encouraged to visualiFe about some pleasant or desirable feeling' sensation' or event. Behaviors that are helpful in assessing a clients capacit for imager include being able to listen to music or other auditor stimuli. (%)# /B0# T/1# 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome 18 *lient !eeds *ategor # 1h siological %ntegrit 2Basic *are and *omfort4 %ntegrated 1rocess# !ursing 1rocess 2Assessment4

9:. A client who is at the end of life is being given morphine for pain management. The famil expresses concern that the morphine ma cause the client to stop breathing and die. What is the nurses best response? a =$e needs the morphine to prevent pain.> . b =$is respirations are not affected b this morphine dosing.> . c =We will decrease the drug dose if his breathing slows.> . d =We will place ox gen on him to help with his breathing.> . A!"# B Because clients become tolerant to the respirator effects of an opioid' it does not hasten death unless the dose was not properl and graduall titrated. (ecreasing the drug would cause pain to occur' and ox gen will not help with his rate of respirations. (%)# /B0# T/1# *are4 3"*# *ognitive +evel# Application ,-)# !.A for Application and above +earning /utcome 5 *lient !eeds *ategor # "afe and -ffective *are -nvironment 23anagement of %ntegrated 1rocess# Teaching.+earning

M$%TIP%E (ESP'NSE

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.

Test Bank

:&1C

1. Which is most indicative of pain in a client who is confused? (Select all that apply.) a (ecreased blood pressure . b "creaming . c )acial grimace . d ,estlessness . A!"# B' *' ( !o one scale has been found to be the best tool to use in pain assessment for adults with cognitive impairments. )acial expression' motor behavior' mood' socialiFation' and vocaliFation are common indicators of pain with cognitivel impaired adults. (%)# /B0# T/1# 3"*# *ognitive +evel# *omprehension ,-)# p. << +earning /utcome : *lient !eeds *ategor # 1s chosocial %ntegrit 2Therapeutic *ommunications4 %ntegrated 1rocess# !ursing 1rocess 2Assessment4

-lsevier items and derived items 6 5717' 5778' 5775 b "aunders' an imprint of -lsevier %nc.