1.
A 4-year-old boy is brought to the emergency department by his mother. She
says he points to his stomach and says, "It hurts so bad." Which pain
assessment tool would be the best choice when assessing this child's pain?
A) The Descriptor Scale
B) A numeric rating scale
C) The Brief Pain Inventory
D) The Faces Pain Scale—Revised (FPS-R) - -Feedback:
Rating scales can be introduced at the age of 4 or 5 years. The Faces Pain
Scale—Revised (FPS-R) is designed for use by children and asks the child to
choose a face that shows "how much hurt (or pain) you have now." Young
children should not be asked to rate pain by using numbers.
Points Earned: 2.0/2.0
Correct Answer(s): D
-2.
A patient has had arthritic pain in her hips for several years since a hip
fracture. She is able to move around in her room and has not offered any
complaints so far this morning. However, when asked, she states that her
pain is "bad this morning" and rates it at an 8 on a 1 to 10 scale. What does
the nurse suspect?
A) She is addicted to her pain medications and cannot obtain pain relief.
B) She does not want to trouble the nursing staff with her complaints.
C) She is not in pain but rates it high to receive pain medication.
D) She has experienced chronic pain for years and has adapted to it. - -
Feedback:
Persons with chronic pain typically try to give little indication that they are in
pain and, over time, adapt to the pain. As a result, they are at risk for
underdetection.
Points Earned: 2.0/2.0
Correct Answer(s): D
-3.
The nurse is assessing a patient's pain. The nurse knows that the most
reliable indicator of pain would be the:
A) patient's vital signs.
B) physical examination.
C) results of a computerized axial tomography scan.
D) subjective report. - -Feedback:
The subjective report is the most reliable indicator of pain. Physical
examination findings can lend support, but the clinician cannot base the
diagnosis of pain exclusively on physical assessment findings.
Points Earned: 0.0/2.0
Correct Answer(s): D
, -The nurse is reviewing principles of pain. Which type of pain is due to an
abnormal processing of the pain impulse through the peripheral or central
nervous system?
A) Visceral
B) Referred
C) Cutaneous
D) Neuropathic - -Feedback:
Neuropathic pain implies an abnormal processing of the pain message. The
other types of pain are named according to their sources.
Points Earned: 2.0/2.0
Correct Answer(s): D
-When assessing a patient's pain, the nurse knows that an example of
visceral pain would be:
A) hip fracture.
B) cholecystitis.
C) second-degree burns.
D) pain after a leg amputation. - -Feedback:
Visceral pain originates from the larger interior organs, such as the
gallbladder, liver, or kidneys.
Points Earned: 2.0/2.0
Correct Answer(s): B
-When assessing the intensity of a patient's pain, which question by the
nurse is appropriate?
A) "What makes your pain better or worse?"
B) "How much pain do you have now?"
C) "How does pain limit your activities?"
D) "What does your pain feel like?" - -Feedback:
Asking the patient "how much pain do you have?" is an assessment of the
intensity of a patient's pain; various intensity scales can be used. Asking
what makes one's pain better or worse assesses alleviating or aggravating
factors. Asking if pain limits one's activities assesses the degree of
impairment and quality of life. Asking "what does your pain feel like"
assesses the quality of pain.
Points Earned: 0.0/2.0
Correct Answer(s): B
-During assessment of a patient's pain, the nurse keeps in mind that certain
nonverbal behaviors are associated with chronic pain. Which of these
behaviors are associated with chronic pain? Select all that apply.
A) Sleeping
B) Moaning
C) Diaphoresis
D) Bracing
E) Restlessness
, F) Rubbing - -Feedback:
Behaviors that have been associated with chronic pain include bracing,
rubbing, diminished activity, sighing, and change in appetite. In addition,
those with chronic pain may sleep in an attempt at distraction. The other
behaviors are associated with acute pain.
Points Earned: 0.7/2.0
Correct Answer(s): A, D, F
-The nurse is seeing for the first time a patient who has no history of
nutrition-related problems. The initial nutritional screening should include
which activity?
A) Calorie count of nutrients
B) Anthropometric measures
C) Complete physical examination
D) Measurement of weight and weight history - -Feedback:
Parameters used for nutrition screening typically include weight and weight
history, conditions associated with increased nutritional risk, diet
information, and routine laboratory data. The other responses reflect a more
in-depth assessment rather than a screening.
Points Earned: 0.0/2.0
Correct Answer(s): D
-During a nutritional assessment, why is it important for the nurse to ask a
patient what medications he or she is taking?
A) Certain drugs can affect the metabolism of nutrients.
B) The nurse needs to assess the patient for allergic reactions.
C) Medications need to be documented on the record for the physician's
review.
D) Medications can affect one's memory and ability to identify food eaten in
the last 24 hours. - -Feedback:
Analgesics, antacids, anticonvulsants, antibiotics, diuretics, laxatives,
antineoplastic drugs, steroids, and oral contraceptives are drugs that can
interact with nutrients, impairing their digestion, absorption, metabolism, or
use. The other responses are not correct.
Points Earned: 2.0/2.0
Correct Answer(s): A
-A 50-year-old woman with elevated total cholesterol and triglyceride levels
is visiting the clinic today to find out about her laboratory results. What
would be important for the nurse to include in patient teaching in relation to
these tests?
A) The risks of undernutrition
B) Methods to reduce stress in her life
C) Information regarding a diet low in saturated fat
D) The fact that this condition is hereditary and there is nothing she can do
to change the levels - -Feedback:
A 4-year-old boy is brought to the emergency department by his mother. She
says he points to his stomach and says, "It hurts so bad." Which pain
assessment tool would be the best choice when assessing this child's pain?
A) The Descriptor Scale
B) A numeric rating scale
C) The Brief Pain Inventory
D) The Faces Pain Scale—Revised (FPS-R) - -Feedback:
Rating scales can be introduced at the age of 4 or 5 years. The Faces Pain
Scale—Revised (FPS-R) is designed for use by children and asks the child to
choose a face that shows "how much hurt (or pain) you have now." Young
children should not be asked to rate pain by using numbers.
Points Earned: 2.0/2.0
Correct Answer(s): D
-2.
A patient has had arthritic pain in her hips for several years since a hip
fracture. She is able to move around in her room and has not offered any
complaints so far this morning. However, when asked, she states that her
pain is "bad this morning" and rates it at an 8 on a 1 to 10 scale. What does
the nurse suspect?
A) She is addicted to her pain medications and cannot obtain pain relief.
B) She does not want to trouble the nursing staff with her complaints.
C) She is not in pain but rates it high to receive pain medication.
D) She has experienced chronic pain for years and has adapted to it. - -
Feedback:
Persons with chronic pain typically try to give little indication that they are in
pain and, over time, adapt to the pain. As a result, they are at risk for
underdetection.
Points Earned: 2.0/2.0
Correct Answer(s): D
-3.
The nurse is assessing a patient's pain. The nurse knows that the most
reliable indicator of pain would be the:
A) patient's vital signs.
B) physical examination.
C) results of a computerized axial tomography scan.
D) subjective report. - -Feedback:
The subjective report is the most reliable indicator of pain. Physical
examination findings can lend support, but the clinician cannot base the
diagnosis of pain exclusively on physical assessment findings.
Points Earned: 0.0/2.0
Correct Answer(s): D
, -The nurse is reviewing principles of pain. Which type of pain is due to an
abnormal processing of the pain impulse through the peripheral or central
nervous system?
A) Visceral
B) Referred
C) Cutaneous
D) Neuropathic - -Feedback:
Neuropathic pain implies an abnormal processing of the pain message. The
other types of pain are named according to their sources.
Points Earned: 2.0/2.0
Correct Answer(s): D
-When assessing a patient's pain, the nurse knows that an example of
visceral pain would be:
A) hip fracture.
B) cholecystitis.
C) second-degree burns.
D) pain after a leg amputation. - -Feedback:
Visceral pain originates from the larger interior organs, such as the
gallbladder, liver, or kidneys.
Points Earned: 2.0/2.0
Correct Answer(s): B
-When assessing the intensity of a patient's pain, which question by the
nurse is appropriate?
A) "What makes your pain better or worse?"
B) "How much pain do you have now?"
C) "How does pain limit your activities?"
D) "What does your pain feel like?" - -Feedback:
Asking the patient "how much pain do you have?" is an assessment of the
intensity of a patient's pain; various intensity scales can be used. Asking
what makes one's pain better or worse assesses alleviating or aggravating
factors. Asking if pain limits one's activities assesses the degree of
impairment and quality of life. Asking "what does your pain feel like"
assesses the quality of pain.
Points Earned: 0.0/2.0
Correct Answer(s): B
-During assessment of a patient's pain, the nurse keeps in mind that certain
nonverbal behaviors are associated with chronic pain. Which of these
behaviors are associated with chronic pain? Select all that apply.
A) Sleeping
B) Moaning
C) Diaphoresis
D) Bracing
E) Restlessness
, F) Rubbing - -Feedback:
Behaviors that have been associated with chronic pain include bracing,
rubbing, diminished activity, sighing, and change in appetite. In addition,
those with chronic pain may sleep in an attempt at distraction. The other
behaviors are associated with acute pain.
Points Earned: 0.7/2.0
Correct Answer(s): A, D, F
-The nurse is seeing for the first time a patient who has no history of
nutrition-related problems. The initial nutritional screening should include
which activity?
A) Calorie count of nutrients
B) Anthropometric measures
C) Complete physical examination
D) Measurement of weight and weight history - -Feedback:
Parameters used for nutrition screening typically include weight and weight
history, conditions associated with increased nutritional risk, diet
information, and routine laboratory data. The other responses reflect a more
in-depth assessment rather than a screening.
Points Earned: 0.0/2.0
Correct Answer(s): D
-During a nutritional assessment, why is it important for the nurse to ask a
patient what medications he or she is taking?
A) Certain drugs can affect the metabolism of nutrients.
B) The nurse needs to assess the patient for allergic reactions.
C) Medications need to be documented on the record for the physician's
review.
D) Medications can affect one's memory and ability to identify food eaten in
the last 24 hours. - -Feedback:
Analgesics, antacids, anticonvulsants, antibiotics, diuretics, laxatives,
antineoplastic drugs, steroids, and oral contraceptives are drugs that can
interact with nutrients, impairing their digestion, absorption, metabolism, or
use. The other responses are not correct.
Points Earned: 2.0/2.0
Correct Answer(s): A
-A 50-year-old woman with elevated total cholesterol and triglyceride levels
is visiting the clinic today to find out about her laboratory results. What
would be important for the nurse to include in patient teaching in relation to
these tests?
A) The risks of undernutrition
B) Methods to reduce stress in her life
C) Information regarding a diet low in saturated fat
D) The fact that this condition is hereditary and there is nothing she can do
to change the levels - -Feedback:
