MEDICAL SURGICAL NURSING LEWIS CHAPTER 8 - PAIN
UPDATED ACTUAL QUESTIONS AND CORRECT
ANSWERS
Question:
1. Pain has been defined as "whatever the person experiencing the pain says it is, existing whenever the
patient says it does." This definition is problematic for the nurse when caring for which type of patient?
a. A patient placed on a ventilator
b. A patient with a history of opioid addiction
c. A patient with decreased cognitive function
d. A patient with pain resulting from severe trauma
Answer:
c. Because the patient's self-report is the most valid means of pain assessment, patients who have
decreased cognitive function, such as those who are comatose, have dementia, or are mentally disabled,
might not be able to report pain. In these cases, nonverbal information and behaviors are necessary
considerations in pain assessment.
Question:
2. On the first postoperative day following a bowel resection, the patient complains of abdominal and
incisionalpain rated 9 on a scale of 0 to 10. Postoperative orders include morphine, 4 mg IV q2 hr, for pain
and may repeat morphine, 4 mg IV, for breakthrough pain. The nurse determines that it has been only 2
hours since the last dose of morphine and wants to wait a little longer. What effect does the nurse's action
have on the patient?
a. Protects the patient from addiction and toxic effects of the drug
b. Prevents hastening or causing a patient's death from respiratory dysfunction
c. Contributes to unnecessary suffering and physical and psychosocial dysfunction
d. Indicates that the nurse understands the adage of "start low and go slow" in administering analgesics
Answer:
c. Administering the smallest prescribed analgesic dose when given a choice is not consistent with current
pain management guidelines and leads to undertreatment of pain and inadequate pain control. Without
reassessing the pain within 30 minutes of the IV analgesic the nurse is unsure how well the previous dose
of medication worked for the patient to determine the current dose needed. Unnecessary suffering,
impaired recovery from acute illness, increased morbidity as a result of respiratory dysfunction, increased
heart rate and cardiac workload, and other physical dysfunction can occur.
Question:
3. List and briefly describe the five dimensions of pain.
Answer:
a. Physiologic—the anatomic and physical determinants of pain
b. Affective—the emotional response to pain
c. Cognitive—the beliefs, attitudes, and meanings attributed to pain
d. Behavioral—observable actions that express or control pain
e. Sociocultural—age and gender, family and caregiver influence, and culture that influences the pain
experience
, Question:
4. Once generated, what may block the transmission of an action potential along a peripheral nerve fiber to
the dorsal root of the spinal cord?
a. The transmission may be interrupted by drugs such as local anesthetics.
b. Nothing can stop the action potential along an intact nerve until it reaches the spinal cord.
c. The action potential must cross several synapses, points at which the impulse may be blocked by drugs.
d. The nerve fiber produces neurotransmitters that may activate nearby nerve fibers to transmit pain
impulses.
Answer:
a. Although a peripheral nerve is one cell that carries an impulse directly from the periphery to the dorsal
horn of the spinal cord with no synapses, transmission of the impulse can be interrupted by drugs known as
membrane stabilizers or sodium-channel inhibitors, such as local anesthetics and some antiseizure drugs.
The nerve fiber produces neurotransmitters only at synapses, not during transmission of the action
potential.
Question:
5. A patient comes to the clinic with a complaint of a dull pain in the anterior and posterior neck. On
examination, the nurse notes that the patient has full range of motion (ROM) of the neck and no throat
redness or enlarged head or neck lymph nodes. What will be the nurse's next appropriate assessment
indicated by these findings?
a. Palpation of the liver
b. Auscultation of bowel sounds
c. Inspection of the patient's ears
d. Palpation for the presence of left flank pain
Answer:
a. The right neck and flank are common areas of referred pain from liver damage and examination of the
liver should be considered when pain occurs without other findings in these areas. Other common referred
areas are midscapular and left arm for cardiac pain, inner legs for bladder pain, and shoulders for
gallbladder pain.
Question:
6. While caring for an unconscious patient, the nurse discovers a stage 2 pressure ulcer on the patient's
heel. During care of the ulcer, what is the nurse's understanding of the patient's perception of pain?
a. The patient will have a behavioral response if pain is perceived.
b. The area should be treated as a painful lesion, using gentle cleansing and dressing.
c. The area can be thoroughly scrubbed because the patient is not able to perceive pain.
d. All nociceptive stimuli that are transmitted to the brain result in the perception of pain
Answer:
b. It is known that the brain is necessary for pain perception but because it is not clearly understood where
in the brain pain is perceived, pain may be perceived even in a comatose patient who may not respond
behaviorally to noxious stimuli. Any noxious stimulus should be treated as potentially painful.
UPDATED ACTUAL QUESTIONS AND CORRECT
ANSWERS
Question:
1. Pain has been defined as "whatever the person experiencing the pain says it is, existing whenever the
patient says it does." This definition is problematic for the nurse when caring for which type of patient?
a. A patient placed on a ventilator
b. A patient with a history of opioid addiction
c. A patient with decreased cognitive function
d. A patient with pain resulting from severe trauma
Answer:
c. Because the patient's self-report is the most valid means of pain assessment, patients who have
decreased cognitive function, such as those who are comatose, have dementia, or are mentally disabled,
might not be able to report pain. In these cases, nonverbal information and behaviors are necessary
considerations in pain assessment.
Question:
2. On the first postoperative day following a bowel resection, the patient complains of abdominal and
incisionalpain rated 9 on a scale of 0 to 10. Postoperative orders include morphine, 4 mg IV q2 hr, for pain
and may repeat morphine, 4 mg IV, for breakthrough pain. The nurse determines that it has been only 2
hours since the last dose of morphine and wants to wait a little longer. What effect does the nurse's action
have on the patient?
a. Protects the patient from addiction and toxic effects of the drug
b. Prevents hastening or causing a patient's death from respiratory dysfunction
c. Contributes to unnecessary suffering and physical and psychosocial dysfunction
d. Indicates that the nurse understands the adage of "start low and go slow" in administering analgesics
Answer:
c. Administering the smallest prescribed analgesic dose when given a choice is not consistent with current
pain management guidelines and leads to undertreatment of pain and inadequate pain control. Without
reassessing the pain within 30 minutes of the IV analgesic the nurse is unsure how well the previous dose
of medication worked for the patient to determine the current dose needed. Unnecessary suffering,
impaired recovery from acute illness, increased morbidity as a result of respiratory dysfunction, increased
heart rate and cardiac workload, and other physical dysfunction can occur.
Question:
3. List and briefly describe the five dimensions of pain.
Answer:
a. Physiologic—the anatomic and physical determinants of pain
b. Affective—the emotional response to pain
c. Cognitive—the beliefs, attitudes, and meanings attributed to pain
d. Behavioral—observable actions that express or control pain
e. Sociocultural—age and gender, family and caregiver influence, and culture that influences the pain
experience
, Question:
4. Once generated, what may block the transmission of an action potential along a peripheral nerve fiber to
the dorsal root of the spinal cord?
a. The transmission may be interrupted by drugs such as local anesthetics.
b. Nothing can stop the action potential along an intact nerve until it reaches the spinal cord.
c. The action potential must cross several synapses, points at which the impulse may be blocked by drugs.
d. The nerve fiber produces neurotransmitters that may activate nearby nerve fibers to transmit pain
impulses.
Answer:
a. Although a peripheral nerve is one cell that carries an impulse directly from the periphery to the dorsal
horn of the spinal cord with no synapses, transmission of the impulse can be interrupted by drugs known as
membrane stabilizers or sodium-channel inhibitors, such as local anesthetics and some antiseizure drugs.
The nerve fiber produces neurotransmitters only at synapses, not during transmission of the action
potential.
Question:
5. A patient comes to the clinic with a complaint of a dull pain in the anterior and posterior neck. On
examination, the nurse notes that the patient has full range of motion (ROM) of the neck and no throat
redness or enlarged head or neck lymph nodes. What will be the nurse's next appropriate assessment
indicated by these findings?
a. Palpation of the liver
b. Auscultation of bowel sounds
c. Inspection of the patient's ears
d. Palpation for the presence of left flank pain
Answer:
a. The right neck and flank are common areas of referred pain from liver damage and examination of the
liver should be considered when pain occurs without other findings in these areas. Other common referred
areas are midscapular and left arm for cardiac pain, inner legs for bladder pain, and shoulders for
gallbladder pain.
Question:
6. While caring for an unconscious patient, the nurse discovers a stage 2 pressure ulcer on the patient's
heel. During care of the ulcer, what is the nurse's understanding of the patient's perception of pain?
a. The patient will have a behavioral response if pain is perceived.
b. The area should be treated as a painful lesion, using gentle cleansing and dressing.
c. The area can be thoroughly scrubbed because the patient is not able to perceive pain.
d. All nociceptive stimuli that are transmitted to the brain result in the perception of pain
Answer:
b. It is known that the brain is necessary for pain perception but because it is not clearly understood where
in the brain pain is perceived, pain may be perceived even in a comatose patient who may not respond
behaviorally to noxious stimuli. Any noxious stimulus should be treated as potentially painful.
