chapter 46 posttest

8/3/2019 Chapter 46 Posttest

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1. A client who is experiencing acute pain from a severely sprained lower back is requesting painmedication 2 hours before it is due per physician order. What intervention does the nurserecommended for this client that demonstrates the gate control theory?a. Ask the doctor for higher medication doses.b. Use a heating pad before attempting to get out of bed.c. Exercise to stimulate endorphins.d. Keep the environment warm.

Grade: 1User Responses: b.Use a heating pad before attempting to get out of bed.Feedback: a.Rationale: Applying heat to the painful area can calm the substantia

gelatinosa and close the gate, thereby reducing pain perception.

Cognitive Level: ApplyingNursing Process: ImplementationClient Need: Physiological Integrity

2. The nurse, working in a long-term care facility, is caring for an older adult client who is diagnosed witharthritis. The client has been sitting alone in the hallway and reports pain. What action initiated by thenurse indicates an awareness of the gate control theory?a. Tell the client to gently exercise the involved area.b. Administer an analgesic with anti-inflammatory properties.c. Encourage the client to attend a bingo game that is about to start.d. Tell the client that the doctor will be notified.

Grade: 1User Responses: c.Encourage the client to attend a bingo game that is about to start.Feedback: a.Rationale: Encouraging the client to participate in the bingo game will

help the client to socialize and have some fun, which can help block orclose the gates and reduce pain perception.


3. The nurse is caring for a client who experiences chronic pain. While conducting an assessment, thenurse notes that the clients pulse is elevated. Using the gate control theory, what nursing interventionwould the nurse initiate for this client to stimulate the large-diameter fibers in the dorsal horn?

a. Ambulate the client.b. Provide a back massage.c. Offer the client a snack.d. Turn on the TV.

Grade: 1User Responses: b.Provide a back massage.Feedback: a.Rationale: Using the gate control theory, the nurse would consider back

massage to stimulate the large-diameter fibers in the dorsal horn to close

the gate and reduce pain perception.

Cognitive Level: UnderstandingNursing Process: ImplementationClient Need: Physiological Integrity


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4. The nurse delegates the clients back massage to the unlicensed assistive personnel (UAP) andevaluates the massage was properly performed when observing the UAP:a. Using the fingertips to make circular strokes over the clients sacral area.b. Moving quickly from one area of the clients back to another.c. Massaging in a circular motion over the clients scapulae.d. Moving the hands lightly up the sides of the clients trunk from the hips to the axilla.

Grade: 1User Responses: c.Massaging in a circular motion over the clients scapulae.Feedback: a.Rationale: Massaging in a circular motion over the clients scapulae is

appropriate technique and indicates the UAP is skilled in performing aback massage.Cognitive Level: UnderstandingNursing Process: PlanningClient Need: Psychosocial Integrity

5. A client experiencing physiologic pain tells the nurse that he is afraid the pain might last forever, as itdid with a family member. The best response by the nurse is:a. Physiologic pain involves permanent damage to the peripheral nerves.

b. With care and proper treatment, this pain should subside in time.c. Physiologic pain is difficult to treat.d. You are correct, this pain is likely to be chronic.

Grade: 1User Responses: b.With care and proper treatment, this pain should subside in time.Feedback: a.Rationale: Physiologic pain is usually transient with prompt and proper

treatment. The pain subsides when tissues have healed.

Cognitive Level: UnderstandingNursing Process: ImplementationClient Need: Physiological Integrity

6. The nurse is evaluating the pain level of a client with somatic pain. The nurse plans to conduct athorough examination of:a. Liver tenderness.b. The renal system.c. Respirations.d. The skeletal system.

Grade: 1User Responses: d.The skeletal system.Feedback: a.Rationale: Somatic pain is a subcategory of physiologic pain that

includes the skin and musculoskeletal systems.

Cognitive Level: ApplyingNursing Process: Assessment

Client Need: Physiological Integrity7. The nurse is caring for a client with neuropathic pain from peripheral neuropathy associated withdiabetes. The nurse determines that the client understood teaching when the client states:

a. The pain is a result of a broken leg I had as a child.b. This type of pain is caused by damage to my muscles.c. This type of pain is due to my diabetes.d. I should be prepared to experience nausea with this pain.


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Grade: 1User Responses: c.This type of pain is due to my diabetes.Feedback: a.Rationale: Neuropathic pain is often manifested as peripheral neuropathy

in clients with diabetes.

Cognitive Level: AnalyzingNursing Process: EvaluationClient Need: Physiological Integrity

8. The nurse is caring for a client who has been experiencing pain in the left knee for 8 months from abone injury. The nurse selects which nursing diagnosis for this client?a. Chronic Pain related to injury of the left kneeb. Chronic Pain related to nerve damagec. Acute Paind. Risk for Injury

Grade: 1User Responses: a.Chronic Pain related to injury of the left kneeFeedback: a.Rationale: Pain lasting more than 6 months is considered chronic pain.

The nurse would also specify in the diagnosis related factors so that thediagnosis is specific.Cognitive Level: UnderstandingNursing Process: ImplementationClient Need: Physiological Integrity

9. Click the thumbnail below to see a larger view of the image.

Using the table shown, which nursing diagnosis would the nurse select for the client who takes painmedication for acute pain when the client can no longer tolerate the pain?a. Deficient Knowledge related to understanding the treatment regimenb. Defensive Copingc. Ineffective Copingd. Chronic Pain

Grade: 1User Responses: a.Deficient Knowledge related to understanding the treatment regimen


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Feedback: a.Rationale: Click the thumbnail below to see a larger view of the image.

Relieving pain before it escalates to become severe is an intervention foracute pain. The nurse plans to address the problem by addressing thecliens knowledge deficit.Cognitive Level: UnderstandingNursing Process: DiagnosisClient Need: Physiological Integrity

10. The nurse determines the administration of a back massage is useful to help manage clients painlevel. When documenting the massage, the nurse should also include information related to:a. Normal assessment findings.b. Pain intensity before and after the massage.c. Cause of clients pain.

d. Steps followed when performing the massage.

Grade: 1User Responses: b.Pain intensity before and after the massage.Feedback: a.Rationale: When using a massage as a nonpharmacologic pain

management strategy, it is important to document information related tothe type, location, and intensity of pain before and after the massage.Cognitive Level: ApplyingNursing Process: ImplementationClient Need: Safe, Effective Care Environment

11. When a client has moderate pain, the nurse appropriately uses the nonpharmacologic intervention of:a. Distraction.b. Nerve block.c. Medication administration.d. Acupuncture.

Grade: 1User Responses: a.Distraction.Feedback: a.Rationale: Distraction draws the person's attention away from the pain

and lessens the perception of pain. In some instances, distraction canmake a client completely unaware of pain.Cognitive Level: UnderstandingNursing Process: ImplementationClient Need: Physiological Integrity

12. The nurse, working on an oncology unit, determines the type of analgesic needed by the client basedon:a. The narrow therapeutic index.b. Pharmaceutical company recommendations.c. Providers orders.d. The 1-10 pain scale.


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Grade: 1User Responses: d.The 1-10 pain scale.Feedback: a.Rationale: The World Health Organization three-step approach is based

on the pain scale of 1-10, with 1 being the least amount of pain.

Cognitive Level: UnderstandingNursing Process: PlanningClient Need: Physiological Integrity

13. While waiting to perform x-rays on an injured right hand, according to nonpharmacologic painmanagement practice, pain can be modulated or reduced if the nurse:a. Performs frequent pain assessments.b. Applies ice to the right elbow.c. Administers a placebo.d. Applies a topical anesthetic to minimize pain sensation.

Grade: 1User Responses: b.Applies ice to the right elbow.Feedback: a.Rationale: Applying ice to the right elbow can help reduce pain.


14. When planning care for the client experiencing pain, the nurse includes in the plan of care theunderstanding that descending fibers of the spinal cord contribute to pain relief by:a. Only transmitting certain stimuli.b. Transmitting epinephrine to the spinal cord.c. Releasing endogenous opioids and serotonin.d. Blocking the recognition of painful stimuli.

Grade: 1User Responses: c.Releasing endogenous opioids and serotonin.Feedback: a.Rationale: During modulation, descending nerve fibers release opioids,

norepinephrine, and serotonin.

Cognitive Level: UnderstandingNursing Process: PlanningClient Need: Physiological Integrity

15. A client from China, who is 1 day postsurgery, has not requested pain medication for 8 hours anddenies pain. The nurse assesses this client because knowledge of the clients culture leads the nurseto suspect that the client:a. Does not perceive pain correctly.b. Has faulty pain transmission.c. Is not experiencing pain.

d. Does not wish to bring dishonor on her family.

Grade: 1User Responses: d.Does not wish to bring dishonor on her family.


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Feedback: a.Rationale: Many clients of Chinese heritage view silence in the presenceof pain as a positive value that demonstrates bravery and strength. Toverbalize pain is to bring dishonor on oneself and ones family.Cognitive Level: ApplyingNursing Process: AssessmentClient Need: Physiological Integrity

16. The African American client arrives on the unit from the surgical recovery room. When planning carefor the relief of pain for this client, the nurse includes:

a. Telling the client to be quieter when expressing pain.b. Assessing the clients spiritual needs.c. Asking the client to provide a true account of pain level.d. Asking the family to assess the clients pain level.

Grade: 1User Responses: b.Assessing the clients spiritual needs.Feedback: a.Rationale: African Americans often hold close ties to their church

community and may be comforted by involvement of this community.

Cognitive Level: ApplyingNursing Process: PlanningClient Need: Physiological Integrity

17. The nurse correctly describes nonopioids by explaining:a. A nonopioid is used to treat only pain that the client rates as a 3 or less on the pain scale.b. Side effects from long-term use of NSAIDs are considerably less severe and life threatening than

those from daily doses of opioids.c. Nonopioids alone are often sufficient to relieve severe pain.d. Giving a dose of nonopioid at the same time as a dose of opioid poses no more danger than

giving the doses at different times.

Grade: 1User Responses: d.Giving a dose of nonopioid at the same time as a dose of opioid poses n

more danger than giving the doses at different times.Feedback: a.Rationale: Giving a dose of a nonopioid at the same time as a dose ofopioid poses no more danger than giving the doses at different times. Infact, many opioids are compounded with a nonopioid (e.g., Percocet [oxycodone and acetaminophen]).Cognitive Level: UnderstandingNursing Process: AssessmentClient Need: Physiological Integrity

18. The nurse is conducting a teaching session for older adults who will be having surgery. Whendiscussing opioid medication for relief of operative pain, the nurse includes which of the following abouopioids and the older adult?a. Older clients get the same level of relief from similar dosages as younger clients.b. Older clients do not feel pain the same as younger clients.c. Older clients develop dependence on opioids faster.d. Older clients may require less medication.


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Grade: 1User Responses: d.Older clients may require less medication.Feedback: a.Rationale: Older clients are particularly sensitive to the analgesic

properties of opioids and may require less medication.


19. This "Ranking" question type is not supported in printed tests

20. The nurse overhears a coworker talking and determines that the coworker has a misconception aboutpain when the coworker states:a. Regular administration of analgesics leads to addiction.b. The client is the authority on pain.c. People can adapt to severe pain.d. Minor injuries can cause intense pain.

Grade: 1User Responses: a.Regular administration of analgesics leads to addiction.Feedback: a.Rationale: The common misconception that regular use of narcotic

analgesics lead to addiction often prevents clients from receiving the bestpossible pain control.Cognitive Level: UnderstandingNursing Process: AssessmentClient Need: Physiological Integrity

21. The nurse is assessing a clients level of pain. The client had minor surgery this morning anddescribes the pain level at 4 on a scale of 1 to 10, and denies the need for analgesia. The nursedetermines that this client has:a. A high pain tolerance level.b. Low pain tolerance.c. A low pain threshold.d. Hyperalgesia.

Grade: 1User Responses: a.A high pain tolerance level.Feedback: a.Rationale: The client with a high pain tolerance is willing to experience

greater amounts of pain without requiring pain relief.Cognitive Level: AnalyzingNursing Process: AssessmentClient Need: Physiological Integrity

22. The nurse is teaching a client about effects of taking narcotic analgesics for pain. The nurse concludesthat the client understood teaching when the client states:a. I should only take the drug for 2 days to prevent dependence.b. I will experience withdrawal if I become dependent on the drug.c. I am addicted to the drug if I stop taking the drug and experience withdrawal.d. I am experiencing addiction if the drugs effects decrease.


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Grade: 1User Responses: b.I will experience withdrawal if I become dependent on the drug.Feedback: a.Rationale: Dependence on a drug is physical and will result in physical

symptoms of withdrawal if dependence occurs.

Cognitive Level: ApplyingNursing Process: EvaluationClient Need: Physiological Integrity

23. The nurse is planning care for the 70-year-old client who is returning to the unit after abdominal surgerThe physician has ordered fentanyl for pain control. The nurses priorities of care related to fentanyladministration for this client include:(Select all that apply.)Note: Credit will be given only if all correct choices and no incorrect choices are selected.a. Monitoring respiratory status.b. Providing skin care.c. Monitoring urinary output.d. Providing for the clients safety.

e. Providing bulk in the diet.

Grade: 1User Responses: a.Monitoring respiratory status.,d.Providing for the clients safety.Feedback: a.Rationale: Cognitive Level: Applying

Nursing Process: PlanningClient Need: Physiological Integrity

Due to depression of the respiratory center of the brain as a resultof anesthesia and narcotic pain medications, monitoringrespiratory status is the priority of care.

Fentanyl impacts the central nervous system perception of pain,which can place the client at risk for injury. Older adults mayexperience confusion in response to narcotic analgesics, which

increases risk for injury; therefore, the nurse should provide for theclients safety. The client is likely NPO immediately after surgery. Skin care is important, but respiratory maintenance and safety are

the two top priorities. These priorities are not directly related to thefentanyl administration.

Urine output is not affected by fentanyl administration, althoughthe nurse assesses for potential urinary retention.


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24. Click the thumbnail below to see a larger view of the image.

The 22-year-old client with several PRN orders for the postoperative control of pain reports pain of 5 ona 0 to 10 scale. Using the box shown, the nurse plans to administer a:a. Strong opioid.b. Mixed or weak opioid.c. Coanalgesic.d. Nonopioid.

Grade: 1User Responses: b.Mixed or weak opioid.Feedback: a.Rationale: Click the thumbnail below to see a larger view of the image.

The World Health Organization suggests that mixed or weak opioids beused for mild to moderate pain.

Cognitive Level: ApplyingNursing Process: PlanningClient Need: Physiological Integrity

25. A postoperative 17-year-old client identifies experienced pain as a 6 on a scale of 1 to 10. What is thenurses priority intervention?a. Distract the client.b. Discuss the pain with the client.c. Administer an analgesic.

d. Document the clients pain rating.

Grade: 1User Responses: c.Administer an analgesic.Feedback: a.Rationale: The adolescent may be slow to admit to pain. If the client

identifies pain at a level of 6, the nurse would medicate.

Cognitive Level: ApplyingNursing Process: AssessmentClient Need: Physiological Integrity


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26. When assessing the client for pain, the nurses best strategy is to:a. Listen and believe the client.b. Minimize the clients statement as exaggeration.c. Validate the clients statement by taking vital signs.d. Anticipate specific results from the client.

Grade: 1User Responses: a.Listen and believe the client.Feedback: a.Rationale: Listening and believing is critical to establishing a trusting

relationship with the client. Pain is a subjective finding and the nurse mustaccept the clients perception.

Cognitive Level: ApplyingNursing Process: AssessmentClient Need: Physiological Integrity

27. The nurse describes the inability of some clients to bear even the slightest pain as:a. Hyperalgesia.b. Pain tolerance.

c. Pain threshold.d. Pain reaction.

Grade: 1User Responses: a.Hyperalgesia.Feedback: a.Rationale: Hyperalgesia is extreme sensitivity to pain.

Cognitive Level: UnderstandingNursing Process: AssessmentClient Need: Physiological Integrity

28. The nurse is conducting a preoperative assessment of a 53-year-old client. The nurse determines thatpain control after surgery may need special attention when the client states:a. My sister will be staying with me after surgery.b. I have a high pain tolerance.c. I know that the pain from surgery will not last long.d. My neighbor had a terrible time with pain after having this surgery.

Grade: 1User Responses: d.My neighbor had a terrible time with pain after having this surgery.

Feedback: a.Rationale: The client is fearful of the pain of surgery based oninformation the client received from a neighbor. The nurse should addressthis fear because anticipation of severe pain can impact pain controlpostoperatively.

Cognitive Level: AnalyzingNursing Process: AssessmentClient Need: Physiological Integrity

29. The nurse explains that a common barrier to effective pain management includes:a. Pain is often accepted as an unavoidable effect of illness and is underreported.b. Nurses and other health care providers believe pain has objective signs.c. The clients inability to understand pain rating scales.d. Acute pain often is not capable of being controlled and may need to be tolerated.


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Grade: 1User Responses: a.Pain is often accepted as an unavoidable effect of illness and is

underreported.Feedback: a.Rationale: For many people, pain is expected and believed to be anatural aspect of illness, so there is underreporting. Nurses overcome thisbarrier by providing client teaching related to pain control.Cognitive Level: UnderstandingNursing Process: ImplementationClient Need: Health Promotion and Maintenance

30. A client experiencing chronic pain from rheumatoid arthritis is in the rheumatologists office for routinepain control assessment. The client tells the nurse that the primary care physician has started a dose oaspirin daily. The nurse notes that the client is currently taking ibuprofen for pain and is concernedabout the combination of medications because:(Select all that apply.)Note: Credit will be given only if all correct choices and no incorrect choices are selected.a. Nonopioids should not be taken with other medications.

b. Aspirin may potentiate ibuprofen, which can cause bleeding.c. Taking antacids can decrease gastric distress of NSAIDs.d. Polypharmacy is not needed for pain relief from rheumatoid arthritis.e. Aspirin and ibuprofen both cause gastric distress.

Grade: 1User Responses: b.Aspirin may potentiate ibuprofen, which can cause bleeding.,e.Aspirin

and ibuprofen both cause gastric distress.Feedback: a.Rationale: Cognitive Level: ApplyingNursing Process: AssessmentClient Need: Physiological Integrity

The nurse is concerned about the combination of ibuprofen andaspirin because ibuprofen can affect platelet function and causebleeding. Adding aspirin, which can also cause bleeding, puts the

client at increased risk of bleeding. The nurse is concerned about the combination of ibuprofen and

aspirin because both aspirin and ibuprofen can cause gastricdistress and should not be taken together over a long period oftime.

It is safe for nonopioids to be taken with some medications, but notaspirin and ibuprofen.

While antacids do block the absorption of nonopioids, that is not aconcern in this situation with the described combination ofmedications.

Polypharmacy may be necessary for some clients, but the risksrelated to these two medications indicates a different combinationof medications if needed.


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31. The nurse is teaching the client about the concept of rational polypharmacy and includes which of thefollowing information?a. Have a family member administer all pain medication because the client may be too incoherent to

take the proper dosage.b. A combination of analgesics reduces the need for high doses and maximizes pain control with

minimal side effects or toxicity.c. Determine the amount of medication needed as the amount that produces the fewest adverse

effects.d. Use as much of the prescribed medication as necessary in order to obtain the desired level of pa

relief.

Grade: 1User Responses: b.A combination of analgesics reduces the need for high doses and

maximizes pain control with minimal side effects or toxicity.Feedback: a.Rationale: Using a combination of analgesics is an approach that hasevolved into what is currently termed "rational polypharmacy," whichdemands that health professionals be aware of all ingredients ofmedications that alleviate pain and use combinations to reduce the need fohigh doses of any one medication and to maximize pain control withminimal side effects or toxicity.Cognitive Level: ApplyingNursing Process: ImplementationClient Need: Physiological Integrity

chapter 46 posttest

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