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Chapter 36 Pain Management
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- Oxford College Of Emory University
Chapter 36 Pain Management
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DAWITChapter 36: Pain Management
Yoost & Crawford: Fundamentals of Nursing: Active Learning for Collaborative
Practice, 3RD Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient recovering from knee replacement surgery. The patient
complains of severe pain in the knee after receiving hydrocodone with acetaminophen
(Vicodin) 2 hours previously. What is the nurse‘s best action?
a. Administer another dose of the medication.
b. Apply ice packs to the knee.
c. Apply heat packs to the knee.
d. Perform gentle range of motion.
ANS: B
Application of cold decreases swelling and pain, produces local analgesia, and slows nerve
conduction, which improves functioning. Examples of cold therapy are ice bags and cold
compresses. The nurse should not administer another dose of medication without an order
from the provider. Heat will increase blood flow to the area rather than reduce swelling.
Gentle ROM will increase pain if done at this time.
DIF: Applying OBJ: 36.8 TOP: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Basic Care and Comfort
NOT: Concepts: Pain
2. The nurse is checking on the patient after administering pain medication 30 minutes
previously. Which assessmenN finR
tU inI
dS beGsT
gN t iB
nd.icaO
tes to the nurse that the pain medication was
effective?
a. The patient is sleeping quietly.
b. The patient states a reduction of the pain.
c. The patient‘s respirations are slow and regular.
d. The patient‘s blood pressure has returned to baseline.
ANS: B
The best way for the nurse to determine that the pain medication was effective is for the
patient to state a reduction of the pain. The other assessment findings cannot definitively
determine whether the patient is still in pain.
DIF: Remembering OBJ: 35.5 TOP: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies NOT: Concepts: Pain
3. The nurse is caring for a patient who has severe abdominal pain caused by acute cholecystitis.
The nurse recognizes which type of pain is this patient experiencing?
a. Visceral pain
b. Somatic pain
c. Radiating pain
d. Referred pain
ANS: A
, DAWIT
Visceral pain arises from the organs of the body and occurs when inflammation and tissue
damage occur, such as with cholecystitis. Somatic pain occurs when there is tissue damage to
skin, muscle, joints, and bones. Referred pain occurs when the discomfort is felt at a location
other than the origin of the pain. Radiating pain extends to another area of the body.
DIF: Remembering OBJ: 36.1 TOP: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation
NOT: Concepts: Pain
4. The nurse knows which is the best pain medication option for a patient to manage severe
long-term cancer pain at home?
a. Fentanyl (Duragesic) 50 mcg transdermal patch q 72 hours
b. Meperidine (Demerol) 50 mg IM q 6 hours
c. Hydromorphone (Dilaudid) 0.2 mg q 10 minutes IV via PCA pump
d. Hydromorphone (Dilaudid) 0.08 mg/hour infusion through epidural catheter
ANS: A
An opioid transdermal patch is the best pain management option for home use with patients
who have long-term, severe cancer pain as no injections are required and the opioid is slowly
released over 72 hours. Epidurals and PCA pumps are intended for hospital use. Frequent IM
injections require nursing administration, are not comfortable for the patient and are not
optimal for chronic long-term pain.
DIF: Applying OBJ: 36.8 TOP: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies NOT: Concepts: Pain
5. The nurse is caring for a patiN Rith
entUw SIsev
NGereTBc.
hrC
onicMpain and applied the first 50 mcg
transdermal fetanyl (Duragesic) patch 2 hours ago. The patient states that the pain is presently
rated at 9 on a 1 to 10 scale. What is the nurse‘s best action?
a. Instruct the patient that the fentanyl patch will start to work soon.
b. Check the provider‘s orders for a short-acting narcotic medication to administer for
breakthrough pain.
c. Give the patient a gentle back rub and encourage guided imagery.
d. Apply a second 25-mcg transdermal fentanyl patch now.
ANS: B
Transdermal administration of medication does not become effective for 12 to 16 hours after
application. Short-acting narcotic medication should be given in the meantime to make the
patient comfortable.
DIF: Remembering OBJ: 36.8 TOP: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies NOT: Concepts: Pain
6. The nurse is caring for a patient who has been taking ibuprofen (Motrin) 800 mg TID for the
last several months to relieve knee pain from arthritis. Which assessment finding must be
reported by the nurse to the provider promptly?
a. The patient has abdominal pain and pale skin.
b. The patient has constipation and takes stool softeners daily.
c. The patient enjoys a glass of wine every Friday and Saturday evening.
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