prioritization delegation and assignment 4th edition lacharity nursing test bank

, Prioritization Delegation and Assignment 4th Edition LaCharity Test Bank e e e e e e e e




Chapter 1. Pain MULT e e e


IPLE CHOICE e


1.A client tells the nurse that she rarely experiences pain, but when she does, she seeks medical attent
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ion. The nurse realizes this client understands that pain is important because it:
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1. is a protective system.
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2. includes the automatic withdrawal reflex.
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3. creates sensitivity to pain. e e e




4. helps with healing. e e



ANS: 1 e


Pain is a protective system that includes protection from unsafe behaviors by use of reflexes, memor
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y, and avoidance. Even though the automatic withdrawal reflex is a part of the pain response, it does
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not explain why pain is important. Pain does not create sensitivity to pain. Pain does not help with he
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aling.
PTS: 1 DIF: Analyze REF: Definitions and Implications of Pain
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2.A client complains that the bed sheets touching his skin are extremely painful. The nurse realizes t
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his client is experiencing:
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1. allodynia.
2. modulation.
3. kinesthesia.
4. proprioception.
ANS: 1 e


Allodynia or hyperalgesia is a state where a slight or nonpainful stimulus is interpreted as very painf
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ul. Kinesthesia is the awareness of movement. Proprioception is the awareness of body position. M
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odulation is an influencing factor in the perception of pain.
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PTS: 1 DIF: Analyze REF: Peripheral Nervous System
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3.A client is complaining of severe abdomen pain. The nurse realizes this client is experiencing whic
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h type of pain?
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1. Neuralgia
2. Pathological
3. Somatic
4. Visceral
ANS: 4 e


Visceral pain is pain arising from the body organs or gastrointestinal tract. Somatic pain is pain that
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originates from the bone, joints, muscles, skin, or connective pain. Neuralgia and
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,pathological pain are both types of pain that result from injury to a nerve or malfunction of the neuro
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nal transmission process or due to impaired regulation.
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PTS:1DIF:AnalyzeREF:Types of Pain e e


4.A client, diagnosed with acute appendicitis, is experiencing abdominal pain. The best way for the
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nurse to describe this clients pain would be:
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1. chronic.
2. neuropathic.
3. referred.
4. acute.
ANS: 4 e


Acute pain onset is sudden and of short duration. Chronic pain is a sudden or slow onset of mild to se
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vere pain that lasts longer than 6 months. Referred pain is the result of the transfer of visceral pain se
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nsations to a body surface at a distance from the actual origin. Neuropathic pain is paroxysmal pain t
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hat occurs along the branches of a nerve.
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PTS:1DIF:ApplyREF:Types of Pain e e


5.A client is observed holding a pillow over the abdominal region with both knees flexed in a sid
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e-
lying position. Vital signs assessment reveals an elevated blood pressure and heart rate. Which o
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f the following should the nurse say to this client?
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1. Can I get you anything? e e e e




2. Would you like something for pain? e e e e e




3. You look comfortable. e e




4. Your blood pressure is up. e e e e



ANS: 2 e


Sympathetic responses to pain include elevated blood pressure and heart rate. And since the client is
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hugging a pillow over the abdominal region with both knees flexed in a side-
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lying position, the best thing for the nurse to say to this client is Would you like something for pain?
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The other responses are incorrect because they do not acknowledge that the client is experiencing pai
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n.
PTS: 1 DIF: Apply REF: Assessing the Clinical Manifestations of Pain
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6.A client experiencing chronic pain asks the nurse why she is not prescribed Demerol like she recei
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ved when she had a total knee replacement. Which of the following should the nurse respond to this
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client?


1. You dont need something that strong.
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2. That medication does not exist anymore.
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3. That medication does not last very long.
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4. It can cause you have high blood pressure.
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, ANS: 3 e


Meperidine is no longer a major drug for acute or chronic pain due to its short analgesic duration of 2
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to 3 hours and the potential for accumulative toxic effects of its metabolite, normeperidine. The best
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eresponse for the nurse to make to the client would be that medication does not last very long. The ot
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her responses are inaccurate.
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PTS:1DIF:ApplyREF:Opioid Analgesics e


7.A client is informed that a tricyclic antidepressant medication is going to help control his chronic p
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ain. The nurse would expect the physician to prescribe:
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1. Amitriptyline.
2. Baclofen.
3. Gabapentin.
4. Diazepam.
ANS: 1 e


Amitriptyline is an antidepressant. Gabapentin is an anticonvulsant. Baclofen is a muscle relaxant.
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Diazepam is a benzodiazepine. e e e


PTS: 1 DIF: Analyze REF: Adjuvant Medications
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8.A client receiving around-the-
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clock medication for terminal cancer experiences additional pain when performing activities of dail
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y living. The nurse realizes this client is experiencing:
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1. breakthrough pain. e




2. intractable pain. e




3. psychosomatic pain. e




4. acute pain. e



ANS: 1 e


Breakthrough pain is commonly seen in the advanced stages of cancer. It is spontaneous, unpredicta
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ble, and can be initiated by certain activities such as during activities of daily living. Intractable pain
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is resistant to some or all forms of therapy. Psychosomatic pain is that which has a psychological orig
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in. The client is diagnosed with terminal cancer. Acute pain has a sudden onset and resolves within 6
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months.
PTS:1DIF:AnalyzeREF:Breakthrough Pain e


9.A client recovering from surgery tells the nurse that she is nauseated and is experiencing an increas
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e in pain. Which of the following does this clients symptoms suggest to the nurse?
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1 The client is becoming dependent upon the pain medication.
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.
2 The clients pain threshold is lower when experiencing nausea.
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3 The client is experiencing withdrawal symptoms from pain medication.
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