Pain test

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition Chapter 7: Pain

1. Which approach, definition, or theory of pain allows the greatest degree of individualization with the pain experience?
A. Specificity theory
B. Goldscheider’s theory
C. McCaffery’s definition
D. Sternbach’s definition

2. Why is emotion able to modify the client’s response to or perception of pain?
A. The substantia gelatinosa, which can enhance pain transmission by “opening the gate,” increases in size when emotions are expressed.
B. The gating mechanism is proposed to exist between the thalamus and the cerebral cortex as well as between the periphery and the brain cells.
C. Clients who have had much experience with pain learn to “close the gate” at the level of the spinal cord.
D. Emotions can stimulate pain impulse transmission to the trigger cells (T-cells).

3. What is the effect on pain when endogenous endorphins are released?
A. Released endorphins in the brain bind to neuromodulating receptor sites and reduce the person’s perception of pain.
B. Released endorphins prevent peripheral neural pain transmission along sensory nerves before entering the spinal cord.
C. A greater the amount of endorphins released creates a greater perception of pain intensity at the conscious level.
D. Endorphins degrade morphine and other morphine agonists in the brain, requiring greater amounts of drugs to relieve pain.

4. Which situation(s) or factor(s) represents a modifiable variable that influences the client’s perception of pain?
A. Age and gender
B. Anxiety and fear
C. An introverted personality
D. Previous pain experience

5. After surgery, the client tells you that she would rather not take the prescribed opioid analgesic because she is afraid she might become addicted to the drug. What is your best response?
A. “Opioid-based drugs are not addictive.”
B. “Have you or anyone in your family ever been addicted to drugs?”
C. “When opioid drugs are taken for acute pain symptoms, they are not addictive.”
D. “If you take the medication no more frequently than every four hours, it is not possible for you to become addicted.”

6. Which characteristic is more common among clients experiencing chronic pain rather than acute pain?
A. Pain serves as a protective or warning mechanism.
B. The client’s stress response is stimulated for “fight or flight.”
C. Pain limits the client’s ability to participate in his or her care.
D. The client has a difficult time describing the exact nature of the pain.

7. The client comes to the emergency department stating that she has had a severe headache for the past six hours. What would be an appropriate next question to ask when performing a pain assessment with this client?
A. “When was your last check-up?”
B. “Has any member of your family ever had a brain tumor?”
C. “Are you allergic to any prescribed or over-the-counter medications?”
D. “Has the presence of the headache interfered with your usual activities?”

8. The postoperative client rates the pain intensity of the surgical incision area as a “3” on the Numeric Pain Distress Scale. In addition, he is sweating heavily, grimacing, and splinting the area of the incision. Which nursing diagnosis would you give the highest priority at this time?
A. Acute pain related to surgical procedure
B. Anxiety/fear related to potential for addiction
C. Risk for deficient fluid volume related to excessive diaphoresis
D. Risk for impaired skin integrity related to pain and damp bedding

9. According to the Acute Pain Management Guideline Panel, how should you schedule analgesics to a client during the first 24 hours after surgery when the prescription reads: “Morphine 12 mg q 4-6 hours prn for pain”?
A. Every four hours around the clock.
B. Every six hours around the clock.
C. Whenever the client asks for it.
D. At least once each eight-hour shift.

10. For which type of pain is nortriptyline (Pamelor) most effective?
A. Acute pain in a client after coronary artery bypass graft surgery
B. Procedural pain during a bone marrow aspiration or biopsy
C. Metastatic bone pain in a client with advanced prostate cancer
D. Chronic neuropathic pain in a client with spinal stenosis

11. Which precaution should you include when teaching a client about proper use of NSAIDs in treatment of chronic pain?
A. “Be sure to drink at least three liters of fluids each day.”
B. “Take this drug one hour before or two hours after eating.”
C. “Stop taking the drug one week before dental work or surgery.”
D. “Avoid driving or operating dangerous equipment while taking this drug.”

12. The 85-year-old client is receiving meperidine 100 mg IM for postoperative pain. This client would be at increased risk for which specific complication of meperidine therapy?
A. Dehydration
B. Hypertension
C. Respiratory depression
D. Central nervous system irritability and seizures

13. For which client should you avoid the use of guided imagery as a distraction technique for pain?
A. A client with chronic pain
B. A confused client
C. An illiterate client
D. A client who has never used a computer

14. The family of a client just started on a fentanyl transdermal patch for analgesic administration calls to report that 12 hours later the client is still in severe pain. What is your best response?
A. “Remove the patch and administer the oral pain medications as previously prescribed.”
B. “Apply a second patch on the opposite side as the first one and reevaluate the pain in four hours.”
C. “Remove the first patch, which obviously is either not working or not in the correct location, and apply a new one to a different site.”
D. “Continue to give the oral medication the first day as the patch may take up to 36 hours before enough medication is absorbed to relieve the pain.”