Which statement best describes the concept of pain?
a.
Pain is an uncomfortable experience present only in the patient with an intact nervous sys-
tem.
b.
Pain is an unpleasant experience accompanied by crying and tachycardia.
c.
Pain is activation of the sympathetic nervous system from an injury.
d.
Pain is whatever the patient experiencing it says it is, occurring when that patient says it
does. - ANSWER ANS: D
Pain is described as an unpleasant sensory and emotional experience associated with actual
or potential tissue damage or described in terms of such damage. This definition emphasizes
the subjective and multidimensional nature of pain. More specifically, the subjective charac-
teristic implies that pain is whatever the person experiencing it says it is and that it exists
whenever he or she says it does.
What are the neural processes of encoding and processing noxious stimuli associated with
pain called?
a.
Perception
b.
Nociception
c.
Transduction
d.
1
,Transmission - ANSWER ANS: B
Nociception represents the neural processes of encoding and processing noxious stimuli
necessary, but not sufficient, for pain. Transduction refers to mechanical (eg, surgical inci-
sion), thermal (eg, burn), or chemical (eg, toxic substance) stimuli that damage tissues. As a
result of transduction, an action potential is produced and is transmitted by nociceptive
nerve fibers in the spinal cord that reach higher centers of the brain. This is called transmis-
sion, and it represents the second process of nociception. Pain sensation transmitted by the
nervous system (NS) pathway reaches the thalamus, and the pain sensation transmitted by
the parasympathetic nervous system (PS) pathway reaches brainstem, hypothalamus, and
thalamus. These parts of the central nervous system (CNS) contribute to the initial percep-
tion of pain.
C fibers are small-diameter, unmyelinated fibers that transmit what type of pain?
a.
Aching
b.
Sharp
c.
Prickling
d.
Concentrated - ANSWER ANS: A
C fibers are implicated in the transmission of pain described as dull, diffuse, prolonged, and
delayed. Alpha fibers conduct the rapid acute pain sensation described as prickling, sharp,
and fast. These fibers are activated by mechanical and thermal stimuli and are carried by the
neospinothalamic tract.
Which assessment findings might indicate respiratory depression after opioid administra-
tion?
a.
Flushed, diaphoretic skin
b.
Shallow respirations with a rate of 24 breaths/min
2
,c.
Tense, rigid posture
d.
Snoring - ANSWER Answer: D. Snoring is a warning sign. It can be a sign of respiratory
depression associated with airway obstruction by the tongue, leading to hypoxemia and pos-
sibly to cardiorespiratory arrest. A patient snoring after the administration of an opioid re-
quires the critical care nurse to observe closely.
The patient is admitted to the critical care unit with hemodynamic instability and an allergy
to morphine. The nurse anticipates that the practitioner will order which medication for se-
vere pain?
a.
Hydromorphone
b.
Codeine
c.
Fentanyl
d.
Methadone - ANSWER Answer: C. Fentanyl is a synthetic opioid preferred for critically ill
patients with hemodynamic instability or morphine allergy. Hydromorphone is a semisyn-
thetic opioid that has an onset of action and a duration similar to those of morphine. It is
more potent than morphine. Hydromorphone produces an inactive metabolite (ie, hydro-
morphone-3-glucuronide), making it the opioid of choice for use in patients with end-stage
renal disease. Codeine has limited use in the management of severe pain. It is rarely used in
critical care units. It provides analgesia for mild to moderate pain. It is usually compounded
with a nonopioid. Methadone is a synthetic opioid with morphine-like properties but less se-
dation. It is longer acting than morphine and has a long half-life. This makes it difficult to ti-
trate in the critical care patient
Which combinations of drugs has been found to be effective in managing the pain associ-
ated with musculoskeletal and soft tissue inflammation?
a.
3
, Nonsteroidal antiinflammatory drugs (NSAIDs) and opioids
b.
NSAIDs and antidepressants
c.
Opioid agonists and opioid antagonists
d.
Adjuvants and partial agonists - ANSWER ANS: A
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with opioids is in-
dicated in patients with acute musculoskeletal and soft tissue inflammation.
A patient underwent a thoracotomy 12 hours ago and has continuous epidural analgesia
with morphine. In addition to respiratory depression, the patient should be monitored for
which complications?
a.
Urinary retention, undue somnolence, itching, nausea, and vomiting
b.
Urinary incontinence, photophobia, headache, and skin rash
c.
Apprehension, anxiety, restlessness, sadness, anger, and myoclonus
d.
Gastric bleeding, nasal discharge, cerebrospinal fluid leak, and calf pain - ANSWER ANS:
A
Epidural analgesia is commonly used in critical care units after major abdominal surgery, ne-
phrectomy, thoracotomy, and major orthopedic procedures. Monitor for adverse reactions,
including respiratory depression, urinary retention, undue somnolence, itching, seizures,
nausea, and vomiting.
A patient underwent a thoracotomy 12 hours ago and has continuous epidural analgesia
with morphine. In addition to closely monitoring the patient for side effects and complica-
tions, which intervention might enhance the patient's pain control?
4
a.
Pain is an uncomfortable experience present only in the patient with an intact nervous sys-
tem.
b.
Pain is an unpleasant experience accompanied by crying and tachycardia.
c.
Pain is activation of the sympathetic nervous system from an injury.
d.
Pain is whatever the patient experiencing it says it is, occurring when that patient says it
does. - ANSWER ANS: D
Pain is described as an unpleasant sensory and emotional experience associated with actual
or potential tissue damage or described in terms of such damage. This definition emphasizes
the subjective and multidimensional nature of pain. More specifically, the subjective charac-
teristic implies that pain is whatever the person experiencing it says it is and that it exists
whenever he or she says it does.
What are the neural processes of encoding and processing noxious stimuli associated with
pain called?
a.
Perception
b.
Nociception
c.
Transduction
d.
1
,Transmission - ANSWER ANS: B
Nociception represents the neural processes of encoding and processing noxious stimuli
necessary, but not sufficient, for pain. Transduction refers to mechanical (eg, surgical inci-
sion), thermal (eg, burn), or chemical (eg, toxic substance) stimuli that damage tissues. As a
result of transduction, an action potential is produced and is transmitted by nociceptive
nerve fibers in the spinal cord that reach higher centers of the brain. This is called transmis-
sion, and it represents the second process of nociception. Pain sensation transmitted by the
nervous system (NS) pathway reaches the thalamus, and the pain sensation transmitted by
the parasympathetic nervous system (PS) pathway reaches brainstem, hypothalamus, and
thalamus. These parts of the central nervous system (CNS) contribute to the initial percep-
tion of pain.
C fibers are small-diameter, unmyelinated fibers that transmit what type of pain?
a.
Aching
b.
Sharp
c.
Prickling
d.
Concentrated - ANSWER ANS: A
C fibers are implicated in the transmission of pain described as dull, diffuse, prolonged, and
delayed. Alpha fibers conduct the rapid acute pain sensation described as prickling, sharp,
and fast. These fibers are activated by mechanical and thermal stimuli and are carried by the
neospinothalamic tract.
Which assessment findings might indicate respiratory depression after opioid administra-
tion?
a.
Flushed, diaphoretic skin
b.
Shallow respirations with a rate of 24 breaths/min
2
,c.
Tense, rigid posture
d.
Snoring - ANSWER Answer: D. Snoring is a warning sign. It can be a sign of respiratory
depression associated with airway obstruction by the tongue, leading to hypoxemia and pos-
sibly to cardiorespiratory arrest. A patient snoring after the administration of an opioid re-
quires the critical care nurse to observe closely.
The patient is admitted to the critical care unit with hemodynamic instability and an allergy
to morphine. The nurse anticipates that the practitioner will order which medication for se-
vere pain?
a.
Hydromorphone
b.
Codeine
c.
Fentanyl
d.
Methadone - ANSWER Answer: C. Fentanyl is a synthetic opioid preferred for critically ill
patients with hemodynamic instability or morphine allergy. Hydromorphone is a semisyn-
thetic opioid that has an onset of action and a duration similar to those of morphine. It is
more potent than morphine. Hydromorphone produces an inactive metabolite (ie, hydro-
morphone-3-glucuronide), making it the opioid of choice for use in patients with end-stage
renal disease. Codeine has limited use in the management of severe pain. It is rarely used in
critical care units. It provides analgesia for mild to moderate pain. It is usually compounded
with a nonopioid. Methadone is a synthetic opioid with morphine-like properties but less se-
dation. It is longer acting than morphine and has a long half-life. This makes it difficult to ti-
trate in the critical care patient
Which combinations of drugs has been found to be effective in managing the pain associ-
ated with musculoskeletal and soft tissue inflammation?
a.
3
, Nonsteroidal antiinflammatory drugs (NSAIDs) and opioids
b.
NSAIDs and antidepressants
c.
Opioid agonists and opioid antagonists
d.
Adjuvants and partial agonists - ANSWER ANS: A
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with opioids is in-
dicated in patients with acute musculoskeletal and soft tissue inflammation.
A patient underwent a thoracotomy 12 hours ago and has continuous epidural analgesia
with morphine. In addition to respiratory depression, the patient should be monitored for
which complications?
a.
Urinary retention, undue somnolence, itching, nausea, and vomiting
b.
Urinary incontinence, photophobia, headache, and skin rash
c.
Apprehension, anxiety, restlessness, sadness, anger, and myoclonus
d.
Gastric bleeding, nasal discharge, cerebrospinal fluid leak, and calf pain - ANSWER ANS:
A
Epidural analgesia is commonly used in critical care units after major abdominal surgery, ne-
phrectomy, thoracotomy, and major orthopedic procedures. Monitor for adverse reactions,
including respiratory depression, urinary retention, undue somnolence, itching, seizures,
nausea, and vomiting.
A patient underwent a thoracotomy 12 hours ago and has continuous epidural analgesia
with morphine. In addition to closely monitoring the patient for side effects and complica-
tions, which intervention might enhance the patient's pain control?
4
