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.”

Care Plan Help

You all should check out http://allnurses.com/ You can find humor pages and all kinds of resources ( there are some funny clinical comics for us beginners there), for nurses as well as nursing students (we need a laugh). There is a help forum for students to post questions regarding problems they are haveing, or to ask for help or advice from nurses or fellow students . I was reading from the various posts that came in response to a student asking for help with care plan writing and found a neat mnemonic to remember. (I added the 's after the M). S 'n' M's Excites Frank. It stands for, Safety, Nutrition, Maslow's, Mobility, Elimination, Fluids. Made up by a psych nurse. The explanations that follow this mnemonic is very good advice for careplan writing. If you want to see it, go here...
Http://allnurses.com/forums/showthread.php?t=89691
If you want to be directed to the student nurse part of this website, try this... Http://allnurses.com/Student_Nursing/

N2 test Cancer Development

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition Chapter 24: Altered Cell Growth and Cancer Development

1. Why are cancer causes so difficult to establish?
A. Malignant cells all have the same appearance.
B. Not all cancers divide more rapidly than do normal cells.
C. The pattern and location of metastases are very similar for many different types of cancer.
D. The time between initiation and the development of a recognizable cancer can be many years.

2. Which characteristic separates malignant tumors from benign tumors?
A. Benign tumors are composed of normal cells.
B. Only malignant cells are killed with chemotherapy.
C. Malignant cells have a small nuclear-to-cytoplasmic ratio.
D. Benign tumors grow more slowly than do malignant tumors.

3. What is the most common known risk factor for lung cancer development?
A. Cigarette smoking
B. Pre-existing emphysema
C. Excessive chest X-rays
D. Genetic deficiency of mucus-secreting glands

4. For which cancer type is primary prevention possible and feasible?
A. Prostate cancer
B. Breast cancer
C. Skin cancer
D. Liver cancer

5. By which process does “promotion” assist in cancer development?
A. Stimulating or enhancing cell division of cells damaged by a carcinogen
B. Inflicting mutations at specific sites on the exposed cell’s DNA
C. Increasing the transformed cell’s capacity for error-free DNA repair
D. Making cancer cells appear more normal in order to escape immunosurveillance

6. The staging of the client’s cancer by the TNM classification is T2, N1, M0. What is your interpretation of this classification? The client has:
A. two tumors that are nonresponsive to treatment.
B. leukemia confined to the bone marrow.
C. a 2 cm tumor with one regional lymph node involved and no distant metastasis.
D. one primary tumor, one secondary tumor, lymph node extension at the primary, and no metastasis of the secondary tumor.

7. Which pathologic description of a tumor would you interpret as a “less malignant” or “low grade” cancer?
A. Poorly differentiated; mitotic index = 20%
B. Moderately differentiated; mitotic index = 50%
C. Undifferentiated; mitotic index = 50%
D. Highly differentiated; mitotic index = 10%

8. Which statement best describes the role of oncogenes in cancer development?
A. The presence of oncogenes increases the risk for gene damage by carcinogens.
B. Activation of oncogenes changes the activity and function of a cell, making it malignant.
C. Oncogenes reduce immune function, increasing the risk for cancer development and immune deficiency.
D. Oncogenes control the expression of suppressor genes, reducing the risk for cancer development.

9. What is/are the most common site(s) of metastasis?
A. Lung, bone, and liver
B. Kidney and thymus gland
C. Stomach and bladder
D. Prostate gland

10. Which statement accurately reflects the role of the immune system in cancer development?
A. Malignant transformation cannot occur in lymphocytes.
B. Malignancies are more common among people who are immunosuppressed.
C. The high white blood cell count found in people with leukemia protects them from infection.
D. The development of autoantibodies predisposes the individual to cancer development.

11. Which cancer arises from connective tissue?
A. Adenocarcinoma
B. Neuroblastoma
C. Condrosarcoma
D. Meningioblastoma

12. Which statement regarding genetic predisposition for cancer is true?
A. Men can only inherit a genetic predisposition for cancer from their fathers.
B. The cancer type with the most clear genetic link for predisposition is lung cancer.
C. Cancers with a genetic predisposition generally develop at an earlier age than do sporadic cancers.
D. A person who has a genetic predisposition to develop a specific type of cancer can do nothing to reduce his or her risk.

13. Which health behavior or activity can reduce the risk for cancer development?
A. Jogging three miles per day.
B. Having a mammogram yearly after age 50.
C. Eliminating all dairy products from the diet.
D. Surgically removing a mole from the shoulder.

N4 Pain test

http://www.nursingceu.com/courses/91/index_nceu.html
1.
Pain is considered one of the most important:
a. Protective mechanisms.
b. Regenerative processes.
c. Emotional coordinators.
d. Chemical synthesizers.

2.
The objective measurement of pain:
a. Lets nurses know who is malingering.
b. Provides both quantitative and qualitative data.
c. Is more accurate with infants than adults.
d. Is not possible at the present time.

3.
All but one of the following is true about acute pain. Select the untrue characteristic.
a. Onset may be sudden or slow.
b. It serves no purpose and is nonprotective.
c. Intensity may vary from mild to severe.
d. It subsides as healing takes place.

4.
Pain that results when tissue damage produces stimuli sent as electric impulses by way of nerve fibers to the central nervous system is called:
a. Psychogenic.
b. Neuropathic.
c. Nociceptor.
d. Non-nociceptor.

5.
Typically, when tissue is damaged it releases:
a. Substantia gelatinosa.
b. Electric impulses.
c. Neuromodulators.
d. Excitatory neurotransmitters.

6.
The experience of pain involves a sequence of five biochemical and electrical processes. The one in which the person becomes aware of pain is:
a. Transduction.
b. Perception.
c. Transmission.
d. Modulation.

7.
The significance of the gate-control theory is that it helps explain how:
a. Thoughts and emotions may modify the perception of pain.
b. Spinal cord injury affects pain.
c. Neurotransmitters influence pain perception.
d. Neuromodulators influence pain.

8.
When caring for people in pain, nurses should consider all but one of the following factors. Select the least important factor.
a. Cultural differences
b. Physiologic issues
c. Socioeconomic status
d. Psychological factors

9.
The Joint Commission on Accreditation of Healthcare Organizations:
a. Requires pain management policies of all government agencies.
b. Excludes psychiatric facilities from pain management requirements.
c. Encourages but does not mandate pain policies of accredited facilities.
d. Mandates pain management policies in all of its accredited facilities.

10.
The American Academy of Pediatrics policy statement regarding pain management makes all but one of the following recommendations. Select the one not recommended.
a. Restrict involvement of families in the child’s treatment.
b. Advocate for the effective use of pain medications.
c. Advocate for child-specific research in pain management.
d. Provide a calm environment for procedures designed to reduce distress.

11.
The primary source of information about pain is the:
a. Parent or guardian.
b. Nurse or caregiver.
c. Attending physician.
d. Person in pain.

12.
A pain history interview includes questions about all of the following issues except one. Select the issue that is not included in a pain history.
a. What triggers the pain or makes it worse
b. The intensity of the pain
c. Names of persons who have tried to help
d. The location of the pain

13.
The two primary diagnoses for pain identified by the North American Nursing Diagnosis Association (NANDA) are:
a. Adult and pediatric.
b. Acute and chronic.
c. Short-term and long-term.
d. Physical and psychological.

14.
Adjuvants are drugs that address:
a. Symptoms that accompany pain.
b. Central nervous system pain.
c. Pain caused by tissue damage.
d. Derivatives of opium.

15.
Most nonopioid drugs are potent:
a. Anti-emetics.
b. Antibiotics.
c. Anti-inflammatory agents.
d. Sedatives.

16.
In general, nonsteroidal anti-inflammatory drugs (NSAIDs):
a. Include such drugs as Tylenol.
b. Act on mu and kappa receptors in the brain.
c. Are classified as co-analgesics.
d. Affect peripheral nerve endings at the injury site.

17.
Opioid analgesics that bind to mu receptor sites and block pain impulses are:
a. Antagonists.
b. Full agonists.
c. Partial agonists.
d. Mixed agonist-antagonists.

18.
Many adverse symptoms of opioids are due to their effect on:
a. Body systems other than the CNS.
b. Prostaglandin production capabilities.
c. Glucose metabolism and its byproducts.
d. The complex mind-body interaction.

19.
A need to increase opioid dosages for reasons other than the physical adaptation of continuous use is called:
a. Pseudotolerance.
b. Drug tolerance.
c. Psychological dependency.
d. Addiction.

20.
A placebo violates the ethical principles of honesty because it:
a. Strips individuals of the right to make decisions about themselves.
b. Has been used by hucksters throughout history.
c. Seeks to deceive the person who takes the placebo.
d. Is may be used in research to study the effects of drugs.

21.
Cognitive-behavioral interventions are used for all of the following reasons except one. Select the incorrect reason.
a. Anxiety and fear reduction
b. Greater sense of control
c. Greater insight to psychic conflicts
d. Alter perception of pain

22.
Rhizotomy and cordotomy are:
a. Considered low-risk pain-relieving measures.
b. Indicated for specific types of pain.
c. Both performed in conjunction with a laminectomy.
d. Surgical procedures that involve nerve destruction.

23.
Evaluation is a critical phase of nursing care because it tells us:
a. We need to document more thoroughly.
b. The importance of ethical principles to the practice of nursing.
c. The dangers inherent in opioid dependency.
d. The degree to which an intervention achieved an expected outcome.

24.
The ethical perspective that considers the end result of an act, such as relieving pain regardless of risk, is called:
a. Teleological.
b. Deontological.
c. Analytical.
d. Descriptive.

25.
When the nurse accepts a client’s decision to refuse a pain-relieving intervention, the nurse is honoring the ethical principle of:
a. Beneficence.
b. Honesty.
c. Autonomy.
d. Justice.

26.
An ethical dilemma requires a choice between:
a. Belief systems and religious doctrines.
b. Ethical principles and theories proposed by philosophers.
c. Ethical behaviors and illegal behaviors.
d. Two or more ethical principles and actions they support.

27.
The American Nurses Association Code of Ethics states that the nurse’s primary commitment is to the:
a. Profession of nursing.
b. Client.
c. Healthcare environment.
d. Employer.

28.
The International Council of Nurses Code of Ethics says nurses have four fundamental responsibilities. Select the responsibility not included in their list:
a. Promote health
b. control overpopulation
c. Prevent illness
d. Restore health
e. Alleviate suffering

29.
The critical issue affecting schedule C-I to C-V drugs is their:
a. Pain-relieving capacity.
b. Interaction with other drugs.
c. Potential for abuse.
d. Ease of administration.

30.
Drugs for which there is no approved medical use are classified as schedule:

a. C-I.
b. C-II.
c. C-III.
d. C-IV.
e. C-V.

31.
States have a constitutionally derived right to create laws concerning the manufacture and distribution of drugs because of the:
a. Controlled Substance Act of 1971.
b. Pure Food and Drug Act of 1906.
c. Kefauver-Harris Amendment.
d. Tenth Amendment to the U.S. Constitution.

32.
The generic name for tetrahydrocannabinol (THC) is:
a. Chloral hydrate.
b. Cannabis sativa.
c. Dronabinol.
d. Cannabinol.

33.
Oregon’s medical marijuana laws:
a. Permit unrestricted cultivation of marijuana.
b. Have become increasingly restrictive.
c. Require an honest effort by police to keep confiscated plants alive.
d. Exempt physicians from responsibility for marijuana use by their patients.

34.
The age group of children in whom imagination merges with the real world is:
a. Infants.
b. Toddlers.
c. Preschoolers.
d. Adolescents.

35.
Vital signs are not reliable indicators of pain in children because:
a. Children are growing and developing.
b. Their bodies adapt to pain.
c. Children tend to exaggerate pain.
d. Hyperglycemia may mask signs of pain.

36.
The most commonly measured variable of pain is:
a. Precipitating factors.
b. Location.
c. Quality.
d. Intensity.

37.
Continuous infusion analgesia:
a. Eliminates the highs and lows of pain control.
b. Is not recommended for children.
c. Requires greater levels of medication to control pain.
d. Is directly related to risk of future addiction.

38.
Failure to thrive may result in infants who lack sufficient:
a. Nutrition.
b. Pain control.
c. Touching.
d. Space to move about.

39.
Barriers to effective pain management in older adults include all but one of the following. Select the one that is not a barrier.
a. Financial constraints
b. Inappropriate or incorrect route analgesics
c. Fear of addiction
d. Uncaring healthcare professionals

40.
A nonverbal behavior that indicates pain in an older adult is:
a. Squirming.
b. Clenched fists.
c. Placid facial expression.
d. Stern, frightened look.

41.
Old-old adults are described as:
a. 65 to 74 years of age.
b. 75 to 84 years of age.
c. 85 years of age and older.
d. Any age, if an adult is frail.

42.
The adverse effects of analgesics are of specific concern in older adults because of:
a. Cultural biases that influence adverse effects.
b. Age-related changes in body anatomy and physiology.
c. Effects of alcohol on analgesic drug potency.
d. The exaggerated reports of pain by elders.

43.
JCAHO recommends all but one of the following actions healthcare providers should take when they care for seniors. Select the inappropriate action.
a. Assume cognitive impairment in older adults.
b. Assess all older adults for chronic pain.
c. Seek information about impaired older adults from caregivers.
d. Instruct older adults to create a “pain diary.”

44.
Addiction is characterized by all but one of the following behaviors. Select the one noncharacteristic behavior of drug dependency.
a. Craving for drug(s) of choice
b. Behaving in a morally depraved manner
c. Continuing to use despite the harm it brings
d. Compulsive use of drug(s) of choice

45.
Migraine headaches are believed to occur because of:
a. A shift in male-female hormones.
b. Stimulation of the limbic system.
c. Activation of the trigeminal-vascular system.
d. Interaction of the hypothalamus and adrenal gland.

46.
Brain tumors in adults cause headaches because they:
a. Increase psychological tension.
b. Stimulate peripheral nerves.
c. Increase intracranial pressure.
d. Initiate neuromodulator production.

47.
Cancer pain:
a. Comes from cancer itself and its treatment.
b. Follows a predictable pattern.
c. Is primarily neuropathic.
d. Derives from psychogenic sources.

48.
The percent of pain experienced by cancer clients due to treatment is:
a. 10% to 15%.
b. 20% to 25%.
c. 30% to 35%.
d. 40% to 45%.

49.
Treatment modalities for cancer include all but one of the following. Select the nontherapeutic intervention for cancer.
a. Surgical removal of tumor
b. Radiation
c. Selective 5-HT antagonist
d. Cell-destroying chemicals

50.
The American Pain Society recommends the use of placebos to treat pain:
a. On a regular basis.
b. For individuals who abuse drugs.
c. For infants and children.
d. Under no circumstances.

51.
The goal of palliative care is to:
a. Enhance the quality of life of dying clients.
b. Prolong life under any circumstances.
c. Comfort, cure, and prolong the life of sufferers.
d. Help people face the realities of death.

52.
Partnership for Care recommends the following healthcare directive(s):
a. Living will only.
b. Healthcare proxy and living will.
c. Living trust only.
d. Healthcare proxy and living trust.

Interesting New Drug of Note

You can find out about this drug and a few others that are new, at the evolve textbook pharmacology website. Once in the pharm site, click on course material, then Lehne's Pharmacology for nursing care updates, then Vol. 5.1 February 2005. This drug and others are part of the drug families in which we are being tested on, Monday.
Daptomycin [Cubicin], the first cyclic lipopeptide. It is the first representative of a new class of antibiotics, the cyclic lipopeptides. The drug has a unique mechanism of action and can rapidly kill virtually all clinically relevant gram-positive bacteria, including methicillin-resistant staphylococcus aureus. It is devoid of significant drug interactions, and the only side effect of note is possible muscle injury. The drug is given once a day by IV infusion, and there is no need to monitor it's plasma level.

Angiogenisis

If you have started or completed the reading in Med Surg Nursing you have read about tumor angiogenisis. It is fascinating and there is a lot more to it than it talks about in our book. There is a really interesting book out about it, Dr Folkman's War: Angiogenesis and the Struggle to Defeat Cancer. Look it up if you get a chance. It will really increase you knowledge of cancer and of the politics of medicine too.

Congratulations to All!

Hey, we made it through the first class, it's been intense, but fun! I counted 77 out of our original 80, that's really good.
Make use the ATI site and practice the tests, we all paid for it and it gives us practice for our upcoming test. Once you have made your initial choice you can go ahead and look at the rationale for all of the choices, and it will not affect your score.

Fluid and Electrolyte Quizzes!

Hey everyone, if you want to practice your knowledge in a fun way, go to ask.com, aka, "Ask Jeeves" and type in "fluid and electrolyte quiz". You will hit a jackpot of practice tests that will really help for Thurs. There is on site, that plays like, Who wants to be a Millionaire using F& E Questions. If you miss a question the game ends. It will ask you if you want to play again and the questions will be different each time. The link is too long for me to post, butI will come back and edit in any info to point you in the right direction.

Acid Base Website

I wanted to share a website I found on acid-base balance. It includes multiple choice self-tests that are similar to what we did in class.

http://www.nursingceu.com/NCEU/courses/acidbase2/

Cultural Diversity

This is probably going to be too late to help most, but this is a really good site to find information about the cultural practices of our diverse minority groups within the US. Even if it is too late for our presentations, it is never too late for us to learn how we can better meet the unique needs every individual that we might have the opportunity to help. Does this sound soap boxy enough to you? It must be getting late.
www.minoritynurse.com Check out the featured articles.
www.sunyit.edu/library/html/culturedmed

Study Group this Sunday

If you are interested in getting together and studying for the Pharm. test this Mon. night, there will be a study group meeting at my house (North Stockton), this Sunday (Mar. 6). For info, call 329-1369 or 474-6339.

SJDeltaRNstudents12/06

Hi....I thought I would find out how everyone felt about exam 3 today (Thursday) and find out if anyone is as frustrated as I am. After these past weeks of not getting exam and quiz scores back in a timely manner, being told we would get scores back at a certain time and then not having it happen, and just all around frustration w/ the way lecture goes, i.e. somewhat unorganized and not providing information we need, and lastly, lack of attention to the fact that there have been questions on exams that 92% miss, but they are still kept in, is making me really nervous about the next two weeks. I am at a loss of what to do. My clinical instructor has been telling us to document any problems and let her know, but we have yet to see any results from that. Anybody have any ideas on what to do?
I figured after watching 50% or more fail our exam today someone would be upset also.