N2 Pain and Cancer Practice Test

This is one of the practice tests from docushare.

Pain Management and Cancer Practice Questions

1. The physician tells a patient to use ibuprofen (Motrin, Advil) to relieve the pain after treating a laceration on the patient’s forearm from a dog bite. The patient tells the nurse that he doesn’t think ibuprofen will control his pain. The nurse’s response to the patient is based on the knowledge that ibuprofen interferes with the pain process by decreasing
a.
perception.
b.
modulation.
c.
transduction.
d.
transmission.

2. A postoperative patient who has undergone extensive bowel surgery moves as little as possible and does not use his incentive spirometer unless specifically reminded. He rates his pain severity as an 8 on a 10-point scale but tells the nurse that he can “tough it out.” In encouraging the patient to use pain medication, the nurse explains that
a.
very few patients become addicted to opioids when using them for pain control.
b.
he should not worry about side effects because these problems usually decrease over time.
c.
there are multiple options of medications and if one drug does not relieve his pain, other drugs may be tried.
d.
unrelieved pain can be harmful because it impairs respiratory and GI function and can impair his recovery from surgery.

3. A patient with a kidney stone in her right ureter has pain in her right flank area and also complains of pain in her right inner thigh. She asks the nurse whether something is wrong with her leg. In responding to her question, the nurse understands that
a.
referred pain results when dorsal horn neurons receive input from both C fibers and A-delta fibers.
b.
stimulation of the cerebral cortex by small C fibers causes muscle spasm, leading to pain perception in large muscle groups.
c.
radiating type of pain results from activation of normally inactive receptors by repetitive nociceptive signals to the dorsal horn.
d.
poor localization of pain occurs when primary afferent nociceptors release neurotransmitters that inhibit nerve cells in the dorsal column.

4. Following an auto accident, a patient is brought to the emergency department with multiple fractures and lacerations. The patient is dazed, but oriented, and denies severe pain. The patient’s decreased pain perception is most likely related to
a.
the inability of the brain to recognize nociceptive input as pain as a result of head trauma.
b.
the release of endogenous opioids in response to the physical and emotional stress of the accident.
c.
the presence of spinal cord trauma, which prevents the transmission of pain impulses to higher nervous centers.
d.
damage of A-delta and C fibers at the injury sites, which results in a lack of stimulus for the physiologic pain process.


5. A 45-year-old woman has breast cancer that has spread to her liver and spine. She has been taking oxycodone (Percodan) and amitriptyline (Elavil) for pain control at home but now has constant severe pain and is hospitalized for pain control and development of a pain-management program. During assessment of the patient, the information related to her pain that is most important for the nurse to obtain initially is
a.
the pattern, area, intensity, and nature of her pain.
b.
identification of trigger points of pain by palpation and manual pressure of painful areas.
c.
the schedule and total dosages of the drugs she is currently taking and when breakthrough pain occurs.
d.
the presence of a sympathetic response, such as tachycardia, diaphoresis, and rise in blood pressure, caused by acute pain
.
End-of-Life

6. Imipramine (Tofranil), a tricyclic antidepressant, is being administered to a patient with chronic cancer pain. The nurse recognizes that the expected outcome of administration of this drug is
a.
increased pain threshold by stimulating the release of endogenous enkephalins.
b.
decreased perception of pain by blocking opiate receptors in the brain and descending inhibitory nerves.
c.
decreased transmission of pain impulses by altering serotonin and norepinephrine activity at nerve synapses.
d.
increased pain tolerance through relief of depression by increasing the amounts of norepinephrine in the brain.

7. A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. The nurse recognizes that these cognitive strategies
a.
reduce the sensory and affective components of pain.
b.
prevent transmission of nocieceptive stimuli to the cortex.
c.
decrease the intensity of the pain that the patient is willing to tolerate.
d.
decrease sensitization by increasing the production of glutamate in the spinal cord.

8. A patient in a hospice program has increasing amounts of pain. The nurse caring for the patient plans the scheduling of pain medications to provide
a.
prn doses of medication when the pain is severe.
b.
around-the-clock routine administration of analgesics.
c.
enough pain medication to keep the patient sedated and unaware of stimuli.
d.
a medication-free period so that the patient can carry out necessary daily activities.

9. Nursing care of the patient in a hospice program emphasizes
a.
use of technology to promote physiologic functioning until the patient is ready to die.
b.
providing bedside care to give relief to family members responsible for the care of the patient.
c.
helping to prevent grief in family members and significant others regarding the death of the patient.
d.
support and symptom management, including pain control, for patients and families during the last phases of incurable diseases.

10. A hospice nurse who has become very close to a terminally ill patient and her family is present in the home when the patient dies. The family members are crying softly, and the nurse also feels like crying. The nurse recognizes that
a.
it is acceptable and healthy to cry with the family during this phase of the grief process.
b.
personal expression of sorrow and loss should be shared with a support group, not the family.
c.
it would be unprofessional to cry at this time when the family’s feelings need to be addressed.
d.
the family should be allowed to be alone together at this time and the nurse should leave as soon as possible.

Cancer

11. The nurse closely monitors the laboratory results of a patient receiving chemotherapy, knowing that the drug regimen may need to be discontinued or modified if the results include
a.
RBC count of 3.2 × 106/µL.
b.
WBC count of 1700/µl (1.7 × 109/L).
c.
platelets of less than 100,000/µl (100 × 103/µl).
d.
creatine level of 1.2 mg/dl (110 µmol/L).


12. A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. The patient has many questions and concerns regarding the procedure. In discussing the treatment with the patient, the nurse explains that
a.
protective isolation will be used for several weeks after the procedure to help prevent infection.
b.
the bone marrow cells are transplanted into the patient’s bone marrow under general anesthesia.
c.
the most common complication of the procedure is attack of the patient’s tissues by donated T lymphocytes.
d.
tissue-matching requirements are not as strict for bone marrow transplants as for transplantation of other organs.

13. The nurse provides a high-protein diet to a patient with cancer of the liver to promote protein for immune function. The nurse recognizes that immune activity related to recognition and destruction of tumor cells
a.
is promoted by antigenic modulation of malignant cells.
b.
involves all immune cell types, functions, and chemical mediators.
c.
is increased by immunologic enhancement activities of tumor cells.
d.
is the selective role of T cells in the cell-mediated immune response.

14. A patient with cancer of the lung has lost 10% of his body weight. The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. An appropriate nursing intervention that addresses the etiology of this problem is to
a.
add strained baby meats to soups and casseroles.
b.
provide foods that are highly spiced to stimulate the taste buds.
c.
avoid presenting foods for which the patient has a strong dislike.
d.
teach the patient to eat whatever is nutritious since he cannot taste the food.

15. After 3 weeks of radiation therapy, a patient has lost 10 pounds and does not eat well because nothing tastes good. An appropriate nursing diagnosis for the patient is
a.
risk for infection related to poor nutrition.
b.
ineffective therapeutic regimen management related to refusal to eat.
c.
imbalanced nutrition: less than body requirements related to anorexia.
d.
ineffective health maintenance related to lack of knowledge of nutritional requirements during radiation therapy.


1c, 2d, 3a, 4b, 5, 6c, 7a, 8b, 9d, 10a, 11b, 12a, 13b, 14c, 15b