Chapter 9 Pain Management
1. The nurse who is a member of the palliative care team is assessing a patient. The patient
indicates that he has been saving his PRN analgesics until the pain is intense because his pain
control has been inadequate. What teaching should the nurse do with this patient?
A) Medication should be taken when pain levels are low so the pain is easier to reduce.
B) Pain medication can be increased when the pain becomes intense.
C) It is difficult to control chronic pain, so this is an inevitable part of the disease
process.
D) The patient will likely benefit more from distraction than pharmacologic
interventions. Ans: A
Feedback:
Better pain control can be achieved with a preventive approach, reducing the amount of
time patients are in pain. Low levels of pain are easier to reduce or control than intense levels
of pain. Pain medication is used to prevent pain so pain medication is not increased when pain
becomes intense. Chronic pain is treatable. Giving the patient alternative methods to control
pain is good, but it will not work if the patient is in so much pain that he cannot institute
reliable alternative methods.
2. Two patients on your unit have recently returned to the postsurgical unit after knee
arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other
patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most
plausible rationale for understanding the patients' different perceptions of pain?
A) Endorphin levels may vary between patients, affecting the perception of pain. B) One
of the patients is exaggerating his or her sense of pain.
C) The patients are likely experiencing a variance in vasoconstriction. D) One of the
patients may be experiencing opioid tolerance.
Ans: A
, Feedback:
Different people feel different degrees of pain from similar stimuli. Opioid tolerance is
associated with chronic pain treatment and would not likely apply to these patients. The nurse
should not assume the patient is exaggerating the pain because the patient is the best
authority of his or her existence of pain, and definitions for pain state that pain is ìwhatever
the person says it is, existing whenever the experiencing person says it does.î
3. You are frequently assessing an 84-year-old woman's pain after she suffered a humeral
fracture in a fall. When applying the nursing process in pain management for a patient of this
age, what principle should you best apply?
A) Monitor for signs of drug toxicity due to a decrease in metabolism.
B) Monitor for an increase in absorption of the drug due to age-related changes. C)
Monitor for a paradoxical increase in pain with opioid administration.
D) Administer analgesics every 4 to 6 hours as ordered to control pain. Ans: A
Feedback:
Older people may respond differently to pain than younger people. Because elderly
people have a slower metabolism and a greater ratio of body fat to muscle mass compared
with younger people, small doses of analgesic agents may be sufficient to relieve pain, and
these doses may be effective longer. This fact also corresponds to an increased risk of adverse
effects. Paradoxical effects are not a common phenomenon. Frequency of administration will
vary widely according to numerous variables.
4. The nurse is assessing a patient's pain while the patient awaits a cholecystectomy. The patient
is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at
this time using a 0-to-10 pain scale. How should the nurse best respond to this assessment
finding?
A) Remind the patient that he is indeed experiencing pain.
B) Reinforce teaching about the pain scale number system. C) Reassess the patient's
pain in 30 minutes.
D) Administer an analgesic and then reassess. Ans: B
Feedback:
, The patient is physically exhibiting signs and symptoms of pain. Further teaching may need to
be done so the patient can correctly rate the pain. The nurse may also verify that the same
scale is being used by the patient and caregiver to promote continuity. Although all answers
are correct, the most accurate conclusion would be to reinforce teaching about the pain scale.
5. You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis
and a secondary diagnosis of chronic pain. What common trait of patients who live with
chronic pain should inform your care planning?
A) They are typically more comfortable with underlying pain than patients without
chronic pain.
B) They often have a lower pain threshold than patients without chronic pain.
C) They often have an increased tolerance of pain.
D) They can experience acute pain in addition to chronic pain.
Ans: D
Feedback:
It is tempting to expect that people who have had multiple or prolonged experiences with
pain will be less anxious and more tolerant of pain than those who have had little experience
with pain. However, this is not true for many people. The more experience a person has had
with pain, the more frightened he or she may be about subsequent painful events. Chronic
pain and acute pain are not mutually exclusive.
6. The nurse is caring for a 51-year-old female patient whose medical history includes chronic
fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the
possibility of what consequent health problem?
A) Anxiety
B) Skin breakdown
C) Depression
D) Hallucinations
, Ans: C
Feedback:
Depression is associated with chronic pain and can be exacerbated by the effects of chronic
fatigue. Anxiety is also plausible, but depression is a paramount risk. Skin breakdown and
hallucinations are much less likely.
7. Your patient has just returned from the postanesthetic care unit (PACU) following left tibia
open reduction internal fixation (ORIF). The patient is complaining of pain, and you are
preparing to administer the patient's first scheduled dose of hydromorphone (Dilaudid). Prior
to administering the drug, you would prioritize which of the following assessments?
A) The patient's electrolyte levels
B) The patient's blood pressure
C) The patient's allergy status
D) The patient's hydration status
Ans: C
Feedback:
Before administering medications such as narcotics for the first time, the nurse should assess
for any previous allergic reactions. Electrolyte values, blood pressure, and hydration status are
not what you need to assess prior to giving a first dose of narcotics.
8. Your patient is receiving postoperative morphine through a patient-controlled analgesic
(PCA) pump and the patient's orders specify an initial bolus dose. What is your priority
assessment?
A) Assessment for decreased level of consciousness (LOC) B) Assessment for respiratory
depression
C) Assessment for fluid overload
D) Assessment for paradoxical increase in pain
Ans: B
Feedback:
1. The nurse who is a member of the palliative care team is assessing a patient. The patient
indicates that he has been saving his PRN analgesics until the pain is intense because his pain
control has been inadequate. What teaching should the nurse do with this patient?
A) Medication should be taken when pain levels are low so the pain is easier to reduce.
B) Pain medication can be increased when the pain becomes intense.
C) It is difficult to control chronic pain, so this is an inevitable part of the disease
process.
D) The patient will likely benefit more from distraction than pharmacologic
interventions. Ans: A
Feedback:
Better pain control can be achieved with a preventive approach, reducing the amount of
time patients are in pain. Low levels of pain are easier to reduce or control than intense levels
of pain. Pain medication is used to prevent pain so pain medication is not increased when pain
becomes intense. Chronic pain is treatable. Giving the patient alternative methods to control
pain is good, but it will not work if the patient is in so much pain that he cannot institute
reliable alternative methods.
2. Two patients on your unit have recently returned to the postsurgical unit after knee
arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other
patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most
plausible rationale for understanding the patients' different perceptions of pain?
A) Endorphin levels may vary between patients, affecting the perception of pain. B) One
of the patients is exaggerating his or her sense of pain.
C) The patients are likely experiencing a variance in vasoconstriction. D) One of the
patients may be experiencing opioid tolerance.
Ans: A
, Feedback:
Different people feel different degrees of pain from similar stimuli. Opioid tolerance is
associated with chronic pain treatment and would not likely apply to these patients. The nurse
should not assume the patient is exaggerating the pain because the patient is the best
authority of his or her existence of pain, and definitions for pain state that pain is ìwhatever
the person says it is, existing whenever the experiencing person says it does.î
3. You are frequently assessing an 84-year-old woman's pain after she suffered a humeral
fracture in a fall. When applying the nursing process in pain management for a patient of this
age, what principle should you best apply?
A) Monitor for signs of drug toxicity due to a decrease in metabolism.
B) Monitor for an increase in absorption of the drug due to age-related changes. C)
Monitor for a paradoxical increase in pain with opioid administration.
D) Administer analgesics every 4 to 6 hours as ordered to control pain. Ans: A
Feedback:
Older people may respond differently to pain than younger people. Because elderly
people have a slower metabolism and a greater ratio of body fat to muscle mass compared
with younger people, small doses of analgesic agents may be sufficient to relieve pain, and
these doses may be effective longer. This fact also corresponds to an increased risk of adverse
effects. Paradoxical effects are not a common phenomenon. Frequency of administration will
vary widely according to numerous variables.
4. The nurse is assessing a patient's pain while the patient awaits a cholecystectomy. The patient
is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at
this time using a 0-to-10 pain scale. How should the nurse best respond to this assessment
finding?
A) Remind the patient that he is indeed experiencing pain.
B) Reinforce teaching about the pain scale number system. C) Reassess the patient's
pain in 30 minutes.
D) Administer an analgesic and then reassess. Ans: B
Feedback:
, The patient is physically exhibiting signs and symptoms of pain. Further teaching may need to
be done so the patient can correctly rate the pain. The nurse may also verify that the same
scale is being used by the patient and caregiver to promote continuity. Although all answers
are correct, the most accurate conclusion would be to reinforce teaching about the pain scale.
5. You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis
and a secondary diagnosis of chronic pain. What common trait of patients who live with
chronic pain should inform your care planning?
A) They are typically more comfortable with underlying pain than patients without
chronic pain.
B) They often have a lower pain threshold than patients without chronic pain.
C) They often have an increased tolerance of pain.
D) They can experience acute pain in addition to chronic pain.
Ans: D
Feedback:
It is tempting to expect that people who have had multiple or prolonged experiences with
pain will be less anxious and more tolerant of pain than those who have had little experience
with pain. However, this is not true for many people. The more experience a person has had
with pain, the more frightened he or she may be about subsequent painful events. Chronic
pain and acute pain are not mutually exclusive.
6. The nurse is caring for a 51-year-old female patient whose medical history includes chronic
fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the
possibility of what consequent health problem?
A) Anxiety
B) Skin breakdown
C) Depression
D) Hallucinations
, Ans: C
Feedback:
Depression is associated with chronic pain and can be exacerbated by the effects of chronic
fatigue. Anxiety is also plausible, but depression is a paramount risk. Skin breakdown and
hallucinations are much less likely.
7. Your patient has just returned from the postanesthetic care unit (PACU) following left tibia
open reduction internal fixation (ORIF). The patient is complaining of pain, and you are
preparing to administer the patient's first scheduled dose of hydromorphone (Dilaudid). Prior
to administering the drug, you would prioritize which of the following assessments?
A) The patient's electrolyte levels
B) The patient's blood pressure
C) The patient's allergy status
D) The patient's hydration status
Ans: C
Feedback:
Before administering medications such as narcotics for the first time, the nurse should assess
for any previous allergic reactions. Electrolyte values, blood pressure, and hydration status are
not what you need to assess prior to giving a first dose of narcotics.
8. Your patient is receiving postoperative morphine through a patient-controlled analgesic
(PCA) pump and the patient's orders specify an initial bolus dose. What is your priority
assessment?
A) Assessment for decreased level of consciousness (LOC) B) Assessment for respiratory
depression
C) Assessment for fluid overload
D) Assessment for paradoxical increase in pain
Ans: B
Feedback:
