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Chapter 10. Pain
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Exam of 9 pages for the course medical surgical nursing at medical surgical nursing (Chapter 10. Pain)
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Chapter 10: PainLewis: Medical-Surgical Nursing in Canada
MULTIPLE CHOICE
1. When doing a pain assessment for a client who has been admitted with metastatic breast
cancer, which question asked by the nurse will give the most information about the client’s
pain?
a. “How long have you had this pain?”
b. “How would you describe your pain?”
c. “How much medication do you take for the pain?”
d. “How many times a day do you medicate for pain?”
ANS: B
Because pain is a multidimensional experience, asking a question that addresses the client’s
experience with the pain is likely to elicit more information than the more specific
information asked in the other three responses. All of these questions are appropriate, but the
response beginning “How would you describe your pain?” is the best initial question.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2. A client who uses a fentanyl patch for chronic cancer pain complains to the nurse of the rapid
onset of pain at a level 9 (0–10 scale) and requests “something for pain that will work
quickly.” Which of the following types of pain is the most appropriate for the nurse to
document for this client?
a. Somatic pain
b. Referred pain
c. Neuropathic pain
d. Breakthrough pain
ANS: D
Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is
termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the
central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle,
skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
3. A postoperative client asks the nurse how the prescribed ibuprofen will control the incisional
pain. The nurse will teach the client that ibuprofen interferes with the pain process by
decreasing which of the following physiological responses?
a. Modulating effect of descending nerves
b. Sensitivity of the brain to painful stimuli
c. Production of pain-sensitizing chemicals
d. Spinal cord transmission of pain impulses
ANS: C
, Nonsteroidal anti-inflammatory drugs (NSAIDs) provide analgesic effects by decreasing the
production of pain-sensitizing chemicals such as prostaglandins at the site of injury.
Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending
nerve pathways are not affected by the NSAIDs.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
4. The nurse is caring for a client who is taking an opioid for postoperative pain. Which of the
following interventions should the nurse include in the clients plan of care to manage possible
adverse effects of opioids?
a. Ensure the medication is given PRN only.
b. Administer the prescribed stool softener OD.
c. Ensure the administration route maximizes drug concentration at the site of the
adverse effect.
d. Request a prescription for a different classification of medication.
ANS: B
Examples of ways to manage anticipated adverse effects of opioids are to administer stool
softeners to prevent constipation and an antiemetic to prevent nausea. The medication should
have a scheduling dosage regimen to maintain blood levels rather than only PRN. Changing to
a different medication in the same classification may be appropriate rather than changing the
drug classification. Another way to manage an adverse effect is to use an administration route
that minimizes rather than maximizes drug concentrations at the site of the adverse effect.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
NURSINGTB.COM
5. A client with chronic abdominal pain has learned to control the pain with the use of imagery
and hypnosis. A family member asks the nurse how these techniques work. Which of the
following reasons provide the basis for the nurse’s response in relation to the effectiveness of
these strategies?
a. Impact the cognitive and affective components of pain.
b. Increase the modulating effect of the efferent pathways.
c. Prevent transmission of nociceptive stimuli to the cortex.
d. Slow the release of transmitter chemicals in the dorsal horn.
ANS: A
Cognitive therapies impact on the perception of pain by the brain rather than affecting efferent
or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. A client who is receiving sustained-release morphine sulphate every 12 hours for chronic pain
experiences level 9 (0–10 scale) breakthrough pain and anxiety. Which of these prescribed
medications should the nurse anticipate administering?
a. Lorazepam 1 mg orally
b. Amitriptyline 10 mg orally
c. Ibuprofen 400–800 mg orally
d. Immediate-release morphine 30 mg orally
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