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MSN Exam for Pain (PM)
Choose the letter of the correct answer. Good luck!
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Congratulations - you have completed MSN Exam for Pain (PM).
You scored %%SCORE%% out of %%TOTAL%%.
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Question 1
In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant?
A
Monitor the client for signs of discomfort while ambulating
B
Coach the client to deep breathe during painful procedures
C
Evaluate relief after applying a cold application.
D
Assist the client with preparation of a sitz bath.
Question 1 Explanation:
The nursing assistant is able to assist the client with hygiene issues and knows the principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and evaluating outcomes are nursing responsibilities.
Question 2
Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
A
Patient-controlled analgesia (PCA)
B
Sublingual
C
Intravenous (IV)
D
Intraspinal
Question 2 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.
Question 3
What is the best way to schedule medication for a client with constant pain?
A
IV bolus after pain assessment
B
PRN at the client’s request
C
Prior to painful procedures
D
Around-the-clock
Question 3 Explanation:
IF the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control
Question 4
Which client is at greater risk for respiratory depression while receiving opioids for analgesia?
A
A young female client with advanced multiple myeloma
B
A client with a heroin addiction and back pain
C
A child with an arm fracture and cystic fibrosis
D
An elderly chronic pain client with a hip fracture
Question 4 Explanation:
at greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors.
Question 5
Which non-pharmacological measure is particularly useful for a client with acute pancreatitis?
Diversional therapy, such as playing cards or board games
C
Side-lying position with knees to chest and pillow against abdomen
D
Massage of back and neck with warmed lotion
Question 5 Explanation:
The side-lying, knee-chest position opens retroperitoneal space and provides relief. The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain, especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain. The additional stimulation of massage may be distressing to the client.
Question 6
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?
A
Methylphenidate (Ritalin)
B
Amitriptyline (Elavil)
C
Lorazepam (Ativan)
D
Corticosteroids
Question 6 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.
Question 7
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?
A
Make a note in the nurse’s file and continue to observe clinical performance
B
Give praise for the correct dose and time and discuss the deficits in charting.
C
Quiz the nurse about knowledge of pain management
D
Refer the new nurse to the in-service education department.
Question 7 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 an ote and watching do not help the nurse to correct the immediate problem. In-service might be considered if the problem persists.
Question 8
A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?
A
Nausea
B
Abdominal cramps
C
Fever
D
Diaphoresis
Question 8 Explanation:
Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.
Question 9
In applying the principles of pain treatment, what is the first consideration?
A
A multidisciplinary approach is needed.
B
Drug side effects must be prevented and managed.
C
Treatment is based on client goals.
D
The client must be believed about perceptions of own pain.
Question 9 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.
Question 10
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?
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
Question 11
Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? (Choose all that apply.)
A
A client who is being discharged with a surgically implanted catheter
B
A client second day post-op who needs pain medication prior to dressing changes
C
An anxious, chronic pain client who frequently uses the call button
D
A client with HIV who reports headache and abdominal and pleuritic chest pain
Question 11 Explanation:
A second day post-operative client who needs medication prior to dressing changes has predictable and routine care that a new nurse can manage. Although chronic pain clients can be relatively stable, the interaction with this client will be time consuming and may cause the new nurse to fall behind. The HIV client has complex complaints that require expert assessment skills. The client pending discharge will need special and detailed instructions.
Question 12
A chronic pain client reports to you, the charge nurse, that the nurse have not been responding to requests for pain medication. What is your initial action?
A
Perform a complete pain assessment and history on the client.
B
Have a conference with the nurses responsible for the care of this client
C
Check the MARs and nurses’ notes for the past several days.
D
Ask the nurse educator to give an in-service about pain management.
Question 12 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.
Question 13
Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder.
Morphine, hydromorphone, acetaminophen and lorazepam
NSAIDs and corticosteroids
Codeine, oxycodone and diphenhydramine
A
1,2,3
B
2,3,1
C
2,1,3
D
3,1,2
Question 14
A client appears upset and tearful, but denies pain and refuses pain medication, because “my sibling is a drug addict and has ruined out lives.” What is the priority intervention for this client?
A
Explain that addiction is unlikely among acute care clients.
B
Seek family assistance in resolving this problem.
C
Provide accurate information about use of pain medication
D
Encourage expression of fears on past experiences
Question 14 Explanation:
This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.
Question 15
Which client is most likely to receive opioids for extended periods of time?
A
A client with trigeminal neuralgia
B
A client with progressive pancreatic cancer
C
A client with fibrolyalgia
D
A client with phantom limb pain
Question 15 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-opiod and adjuvant medicatios. Trigeminal neuralgia is treated with anti-seizure medications such as carbamezapine (Tegretol). Phantom limb pain usually subsides after ambulation begins.
Question 16
In caring for a young child with pain, which assessment tool is the most useful?
A
Faces pain-rating scale
B
McGill-Melzack pain questionnaire
C
Simple description pain intensity scale
D
0-10 numeric pain scale
Question 16 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.
Question 17
A first day post-operative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
A
Deliver the bolus dose per standing order.
B
Assess the pain for location, quality, and intensity.
C
Try non-pharmacological comfort measures.
D
Contact the physician to increase the dose.
Question 17 Explanation:
Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps.
Question 18
For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?
A
Look at the MAR and chart, to note the time of the last dose and response.
B
Closely assess for nonverbal signs such as grimacing or rocking.
C
Give the maximum PRS dose within the minimum time frame for relief.
D
Obtain baseline behavioral indicators from family members.
Question 18 Explanation:
Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.
Question 19
Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)?
A
IM or subcutaneous
B
IV
C
Oral
D
Transdermal
Question 19 Explanation:
If the gastrointestinal system is function, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms.
Question 20
For a client who is taking aspirin, which laboratory value should be reported to the physician?
A
Potassium 3.6 mEq/L
B
Hematocrit 41%
C
PT 14 seconds
D
BUN 20 mg/dL
Question 20 Explanation:
When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%, female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).
Question 21
Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.)
A
A client post-op toe amputation with diabetic neuropathic pain
B
A client with a leg cast who needs neurologic checks and PRN hydrocodone
C
A client who needs pre-op teaching for use of a PCA pump
D
A client with terminal cancer and severe pain who is refusing medication
Question 21 Explanation:
The clients with the cast and the toe amputation are stable clients and need ongoing assessment and pain management that are within the scope of practice for an LPN/LVN under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and the terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication.
Question 22
When titrating an analgesic to manage pain, what is the priority goal?
A
Titrate upward until the client is pain free.
B
Titrate downwards to prevent toxicity.
C
Ensure that the drug is adequate to meet the client’s subjective needs.
D
Administer smallest dose that provides relief with the fewest side effects.
Question 22 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.
Question 23
The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take?
A
Check the hospital policy regarding use of the placebo.
B
Contact the charge nurse for advice.
C
Prepare the medication and hand it to the physician
D
Follow a personal code of ethics and refuse to give it.
Question 23 Explanation:
the charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following one’s own ethical code is correct, you must ensure that the client is not abandoned and that care continues.
Question 24
A family member asks you, “Why can’t you give more medicine? He is still having a lot of pain.” What is your best response?
A
“The doctor ordered the medicine to be given every 4 hours.”
B
“Please tell him that I will be right there to check of him.”
C
“Let’s wait about 30-40 minutes. If there is no relief I’ll call the doctor.”
D
“If the medication is given too frequently he could suffer ill effects.”
Question 24 Explanation:
directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next.
Question 25
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?
A
Affective
B
Sociocultural
C
Behavioral
D
Sensory
Question 25 Explanation:
The family is part of the sociocultural dimension of pain. They are influencing the client 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
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Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.
MSN Exam for Pain (EM)
Choose the letter of the correct answer. You got 25 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed MSN Exam for Pain (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder.
Morphine, hydromorphone, acetaminophen and lorazepam
NSAIDs and corticosteroids
Codeine, oxycodone and diphenhydramine
A
3,1,2
B
2,3,1
C
1,2,3
D
2,1,3
Question 2
A family member asks you, “Why can’t you give more medicine? He is still having a lot of pain.” What is your best response?
A
“Please tell him that I will be right there to check of him.”
B
“The doctor ordered the medicine to be given every 4 hours.”
C
“Let’s wait about 30-40 minutes. If there is no relief I’ll call the doctor.”
D
“If the medication is given too frequently he could suffer ill effects.”
Question 2 Explanation:
directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next.
Question 3
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?
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
Question 4
Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)?
A
Transdermal
B
Oral
C
IM or subcutaneous
D
IV
Question 4 Explanation:
If the gastrointestinal system is function, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms.
Question 5
A chronic pain client reports to you, the charge nurse, that the nurse have not been responding to requests for pain medication. What is your initial action?
A
Check the MARs and nurses’ notes for the past several days.
B
Have a conference with the nurses responsible for the care of this client
C
Ask the nurse educator to give an in-service about pain management.
D
Perform a complete pain assessment and history on the client.
Question 5 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.
Question 6
In applying the principles of pain treatment, what is the first consideration?
A
A multidisciplinary approach is needed.
B
Treatment is based on client goals.
C
Drug side effects must be prevented and managed.
D
The client must be believed about perceptions of own pain.
Question 6 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.
Question 7
Which client is most likely to receive opioids for extended periods of time?
A
A client with phantom limb pain
B
A client with trigeminal neuralgia
C
A client with fibrolyalgia
D
A client with progressive pancreatic cancer
Question 7 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-opiod and adjuvant medicatios. Trigeminal neuralgia is treated with anti-seizure medications such as carbamezapine (Tegretol). Phantom limb pain usually subsides after ambulation begins.
Question 8
Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
A
Patient-controlled analgesia (PCA)
B
Intraspinal
C
Intravenous (IV)
D
Sublingual
Question 8 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.
Question 9
For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?
A
Obtain baseline behavioral indicators from family members.
B
Give the maximum PRS dose within the minimum time frame for relief.
C
Look at the MAR and chart, to note the time of the last dose and response.
D
Closely assess for nonverbal signs such as grimacing or rocking.
Question 9 Explanation:
Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.
Question 10
A first day post-operative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
A
Try non-pharmacological comfort measures.
B
Contact the physician to increase the dose.
C
Deliver the bolus dose per standing order.
D
Assess the pain for location, quality, and intensity.
Question 10 Explanation:
Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps.
Question 11
A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?
A
Nausea
B
Diaphoresis
C
Fever
D
Abdominal cramps
Question 11 Explanation:
Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.
Question 12
In caring for a young child with pain, which assessment tool is the most useful?
A
0-10 numeric pain scale
B
McGill-Melzack pain questionnaire
C
Faces pain-rating scale
D
Simple description pain intensity scale
Question 12 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.
Question 13
A client appears upset and tearful, but denies pain and refuses pain medication, because “my sibling is a drug addict and has ruined out lives.” What is the priority intervention for this client?
A
Explain that addiction is unlikely among acute care clients.
B
Seek family assistance in resolving this problem.
C
Provide accurate information about use of pain medication
D
Encourage expression of fears on past experiences
Question 13 Explanation:
This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.
Question 14
For a client who is taking aspirin, which laboratory value should be reported to the physician?
A
BUN 20 mg/dL
B
Hematocrit 41%
C
PT 14 seconds
D
Potassium 3.6 mEq/L
Question 14 Explanation:
When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%, female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).
Question 15
What is the best way to schedule medication for a client with constant pain?
A
IV bolus after pain assessment
B
PRN at the client’s request
C
Prior to painful procedures
D
Around-the-clock
Question 15 Explanation:
IF the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control
Question 16
In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant?
A
Evaluate relief after applying a cold application.
B
Assist the client with preparation of a sitz bath.
C
Coach the client to deep breathe during painful procedures
D
Monitor the client for signs of discomfort while ambulating
Question 16 Explanation:
The nursing assistant is able to assist the client with hygiene issues and knows the principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and evaluating outcomes are nursing responsibilities.
Question 17
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?
A
Methylphenidate (Ritalin)
B
Lorazepam (Ativan)
C
Corticosteroids
D
Amitriptyline (Elavil)
Question 17 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.
Question 18
Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.)
A
A client post-op toe amputation with diabetic neuropathic pain
B
A client with terminal cancer and severe pain who is refusing medication
C
A client with a leg cast who needs neurologic checks and PRN hydrocodone
D
A client who needs pre-op teaching for use of a PCA pump
Question 18 Explanation:
The clients with the cast and the toe amputation are stable clients and need ongoing assessment and pain management that are within the scope of practice for an LPN/LVN under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and the terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication.
Question 19
The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take?
A
Check the hospital policy regarding use of the placebo.
B
Prepare the medication and hand it to the physician
C
Contact the charge nurse for advice.
D
Follow a personal code of ethics and refuse to give it.
Question 19 Explanation:
the charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following one’s own ethical code is correct, you must ensure that the client is not abandoned and that care continues.
Question 20
When titrating an analgesic to manage pain, what is the priority goal?
A
Titrate upward until the client is pain free.
B
Ensure that the drug is adequate to meet the client’s subjective needs.
C
Titrate downwards to prevent toxicity.
D
Administer smallest dose that provides relief with the fewest side effects.
Question 20 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.
Question 21
Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? (Choose all that apply.)
A
A client second day post-op who needs pain medication prior to dressing changes
B
A client who is being discharged with a surgically implanted catheter
C
An anxious, chronic pain client who frequently uses the call button
D
A client with HIV who reports headache and abdominal and pleuritic chest pain
Question 21 Explanation:
A second day post-operative client who needs medication prior to dressing changes has predictable and routine care that a new nurse can manage. Although chronic pain clients can be relatively stable, the interaction with this client will be time consuming and may cause the new nurse to fall behind. The HIV client has complex complaints that require expert assessment skills. The client pending discharge will need special and detailed instructions.
Question 22
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?
A
Give praise for the correct dose and time and discuss the deficits in charting.
B
Make a note in the nurse’s file and continue to observe clinical performance
C
Quiz the nurse about knowledge of pain management
D
Refer the new nurse to the in-service education department.
Question 22 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 an ote and watching do not help the nurse to correct the immediate problem. In-service might be considered if the problem persists.
Question 23
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?
A
Affective
B
Sociocultural
C
Sensory
D
Behavioral
Question 23 Explanation:
The family is part of the sociocultural dimension of pain. They are influencing the client 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
Question 24
Which non-pharmacological measure is particularly useful for a client with acute pancreatitis?
Diversional therapy, such as playing cards or board games
D
Side-lying position with knees to chest and pillow against abdomen
Question 24 Explanation:
The side-lying, knee-chest position opens retroperitoneal space and provides relief. The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain, especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain. The additional stimulation of massage may be distressing to the client.
Question 25
Which client is at greater risk for respiratory depression while receiving opioids for analgesia?
A
An elderly chronic pain client with a hip fracture
B
A young female client with advanced multiple myeloma
C
A child with an arm fracture and cystic fibrosis
D
A client with a heroin addiction and back pain
Question 25 Explanation:
at greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors.
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1. A chronic pain client 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
2. 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
3. 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)
4. Which client is most likely to receive opioids for extended periods of time?
A client with fibrolyalgia
A client with phantom limb pain
A client with progressive pancreatic cancer
A client with trigeminal neuralgia
5. 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.
6. 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
7. 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.
8. Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
Intraspinal
Patient-controlled analgesia (PCA)
Intravenous (IV)
Sublingual
9. 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.
10.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?
11.Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder.
Morphine, hydromorphone, acetaminophen and lorazepam
NSAIDs and corticosteroids
Codeine, oxycodone and diphenhydramine
2,3,1
2,1,3
1,2,3
3,1,2
12.Which client is at greater risk for respiratory depression while receiving opioids for analgesia?
An elderly chronic pain client with a hip fracture
A client with a heroin addiction and back pain
A young female client with advanced multiple myeloma
A child with an arm fracture and cystic fibrosis
13.A client appears upset and tearful, but denies pain and refuses pain medication, because “my sibling is a drug addict and has ruined out lives.” What is the priority intervention for this client?
Encourage expression of fears on past experiences
Provide accurate information about use of pain medication
Explain that addiction is unlikely among acute care clients.
Seek family assistance in resolving this problem.
14.A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal?
Fever
Nausea
Diaphoresis
Abdominal cramps
15.In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant?
Assist the client with preparation of a sitz bath.
Monitor the client for signs of discomfort while ambulating
Coach the client to deep breathe during painful procedures
Evaluate relief after applying a cold application.
16.The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take?
Prepare the medication and hand it to the physician
Check the hospital policy regarding use of the placebo.
Follow a personal code of ethics and refuse to give it.
Contact the charge nurse for advice.
17.For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?
Closely assess for nonverbal signs such as grimacing or rocking.
Obtain baseline behavioral indicators from family members.
Look at the MAR and chart, to note the time of the last dose and response.
Give the maximum PRS dose within the minimum time frame for relief.
18.Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)?
IV
IM or subcutaneous
Oral
Transdermal
PCA
19.A first day post-operative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
Deliver the bolus dose per standing order.
Contact the physician to increase the dose.
Try non-pharmacological comfort measures.
Assess the pain for location, quality, and intensity.
20.Which non-pharmacological measure is particularly useful for a client with acute pancreatitis?
Diversional therapy, such as playing cards or board games
Massage of back and neck with warmed lotion
Side-lying position with knees to chest and pillow against abdomen
21.What is the best way to schedule medication for a client with constant pain?
PRN at the client’s request
Prior to painful procedures
IV bolus after pain assessment
Around-the-clock
22.Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.)
A client who needs pre-op teaching for use of a PCA pump
A client with a leg cast who needs neurologic checks and PRN hydrocodone
A client post-op toe amputation with diabetic neuropathic pain
A client with terminal cancer and severe pain who is refusing medication
23.For a client who is taking aspirin, which laboratory value should be reported to the physician?
Potassium 3.6 mEq/L
Hematocrit 41%
PT 14 seconds
BUN 20 mg/dL
24.Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? (Choose all that apply.)
An anxious, chronic pain client who frequently uses the call button
A client second day post-op who needs pain medication prior to dressing changes
A client with HIV who reports headache and abdominal and pleuritic chest pain
A client who is being discharged with a surgically implanted catheter
25.A family member asks you, “Why can’t you give more medicine? He is still having a lot of pain.” What is your best response?
“The doctor ordered the medicine to be given every 4 hours.”
“If the medication is given too frequently he could suffer ill effects.”
“Please tell him that I will be right there to check of him.”
“Let’s wait about 30-40 minutes. If there is no relief I’ll call the doctor.”
Answers and Rationales
ANSWER D– 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.
ANSWER C – The family is part of the sociocultural dimension of pain. They are influencing the client 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
ANSWER A – 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.
ANSWER C – Cancer pain generally worsens with disease progression and the use of opioids is more generous. Fibromyalgia is more likely to be treated with non-opiod and adjuvant medicatios. Trigeminal neuralgia is treated with anti-seizure medications such as carbamezapine (Tegretol). Phantom limb pain usually subsides after ambulation begins.
ANSWER D – 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 an ote and watching do not help the nurse to correct the immediate problem. In-service might be considered if the problem persists.
ANSWER C – 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.
ANSWER C – 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.
ANSWER C – 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.
ANSWER A – 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.
ANSWER B – 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.
ANSWER A – Step 1 includes non-opioids and adjuvant drugs. Step 2 includes opioids for mild pain plus Step 1 drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain (replacing Step 2 opioids) and continuing Step 1 drugs and adjuvant drugs as needed.
ANSWER D – at greatest risk are elderly clients, opiate naïve clients, and those with underlying pulmonary disease. The child has two of the three risk factors.
ANSWER A – This client has strong beliefs and emotions related to the issue of sibling addiction. First, encourage expression. This indicated to the client that the feelings are real and valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is appropriate at the right time. Family involvement is important, bearing in mind that their beliefs about drug addiction may be similar to those of the client.
ANSWER C – Diaphoresis is one of the early signs that occur between 6 and 12 hours. Fever, nausea, and abdominal cramps are late signs that occur between 48 and 72 hours.
ANSWER A – The nursing assistant is able to assist the client with hygiene issues and knows the principles of safety and comfort for this procedure. Monitoring the client, teaching techniques, and evaluating outcomes are nursing responsibilities.
ANSWER D – the charge nurse is a resource person who can help locate and review the policy. If the physician is insistent, he or she could give the placebo personally, but delaying the administration does not endanger the health or safety of the client. While following one’s own ethical code is correct, you must ensure that the client is not abandoned and that care continues.
ANSWER B – Complete information from the family should be obtained during the initial comprehensive history and assessment. If this information is not obtained, the nursing staff will have to rely on observation of nonverbal behavior and careful documentation to determine pain and relief patterns.
ANSWER C – If the gastrointestinal system is function, the oral route is preferred for routine analgesics because of lower cost and ease of administration. Oral route is also less painful and less invasive than the IV, IM, subcutaneous, or PCA routes. Transdermal route is slower and medication availability is limited compared to oral forms.
ANSWER D – Assess the pain for changes in location, quality, and intensity, as well as changes in response to medication. This assessment will guide the next steps.
ANSWER C – The side-lying, knee-chest position opens retroperitoneal space and provides relief. The pillow provides a splinting action. Diversional therapy is not the best choice for acute pain, especially if the activity requires concentration. TENS is more appropriate for chronic muscular pain. The additional stimulation of massage may be distressing to the client.
ANSWER D – IF the pain is constant, the best schedule is around-the-clock, to provide steady analgesia and pain control. The other options may actually require higher doses to achieve control
ANSWER B, C – The clients with the cast and the toe amputation are stable clients and need ongoing assessment and pain management that are within the scope of practice for an LPN/LVN under the supervision of an RN. The RN should take responsibility for pre-operative teaching, and the terminal cancer needs a comprehensive assessment to determine the reason for refusal of medication.
ANSWER C – When a client takes aspirin, monitor for increases in PT (normal range 11.0-12.5 seconds in 85%-100%). Also monitor for possible decreases in potassium (normal range 3.5-5.0 mEq/L). If bleeding signs are noted, hematocrit should be monitored (normal range male 42%-52%, female 37%-47%). An elevated BUN could be seen if the client is having chronic gastrointestinal bleeding (normal range 10-20 mg/dL).
ANSWER B – A second day post-operative client who needs medication prior to dressing changes has predictable and routine care that a new nurse can manage. Although chronic pain clients can be relatively stable, the interaction with this client will be time consuming and may cause the new nurse to fall behind. The HIV client has complex complaints that require expert assessment skills. The client pending discharge will need special and detailed instructions.
ANSWER C – directly ask the client about the pain and do a complete pain assessment. This information will determine which action to take next.