N322 EXAM 2 Review Questions With Complete Solutions
5-1. A client taking newly prescribed gabapentin for persistent
neuropathic pain reports dizziness. What is the best nursing
response?
A. "This is common side effect of gabapentin and will decrease
with use."
B. "Stop taking the medication and contact the healthcare
provider."
C. "The dizziness is caused by the neuropathic pain, not the
medication."
D. "The dizziness is likely from another medication, not the
gabapentin." Correct Answers Answer: A
Rationale: Gabapentin is commonly used for neuropathic pain.
The most common side effect is dizziness which will generally
decrease with use. It is not appropriate to tell the client to stop
taking the medication and it is unlikely that the neuropathic pain
or another medication is causing the dizziness.
5-2. A client has been receiving the same dose of an intravenous
opioid for two days to manage post-surgical pain. The client
reports that the drug is no longer controlling the pain. What does
the nurse suspect?
A. There is likely a history of addiction.
B. Tolerance to the opioid is developing.
C. Physical dependence is developing.
D. The client is opioid-naïve. Correct Answers Answer: B.
Rationale: A client who has been receiving the same dose of an
opioid for several days and now reports that the drug is not
,controlling the pain is likely developing tolerance. This is not
the same thing as addiction or physical dependence. Physical
dependence is manifested when a drug is stopped and the client
shows withdrawal symptoms. Tolerance means the body has
adapted to the drug and the client may require an increased dose
or switching to a different drug for pain control. An opioid-naïve
person has not recently taken enough opioid on a regular basis to
become tolerant to the effects of an opioid. Tolerance does not
indicate addiction or a history of addiction.
5. A 44-year-old client with osteoarthritis pain tells the nurse, "I
take two extra-strength acetaminophen (500 mg) every 8 hours."
How does the nurse respond?
-"More acetaminophen is needed to provide effective pain relief
for you."
-"You will need to have routine blood draws to monitor clotting
time."
-"That is the appropriate dose of acetaminophen for your pain."
-"Aspirin would be a better, more effective choice for your pain
relief." Correct Answers "That is the appropriate dose of
acetaminophen for your pain."
In the healthy adult, a maximum daily dose below 4000 mg is
rarely associated with liver toxicity. Many experts recommend
reducing the daily dose (e.g., 2500 to 3000 mg daily) when used
for long-term treatment in older adults. Acetaminophen does not
increase bleeding time and has a low incidence of GI adverse
effects, making it the analgesic of choice for many people in
pain, especially older adults. The dose is appropriate; more is
not indicated or advised. Acetaminophen is a better choice for
,pain relief than aspirin because it has fewer side effects on the
gastrointestinal system, such as bleeding.
5. A client being discharged after hip replacement says, "I am
going to use hypnosis instead of medication to manage my pain.
I believe in mind over body." Which nursing response is
appropriate?
-"I will discuss cancelling your medication order with your
health care provider."
-"That sounds like a wonderful idea; and I think it will definitely
work!"
-"That sounds like a great plan; can you tell me more about it?"
-"Your plan will not work; people with your type of pain need
opioids." Correct Answers "That sounds like a great plan; can
you tell me more about it?"
Complementary and integrative therapies are most often used to
supplement, not replace, medication management. The nurse
needs to obtain more data, and will ask for more information
about the client's plan. Contacting the health care provider to
cancel the medication order is not appropriate. Telling the client
that his idea is wonderful and will definitely work is not
appropriate, as alternative strategies alone, may not work to
relieve the client's pain. Telling the client that his or her plan
will not work is dismissive of the client. In addition, the client
may not need to be prescribed opioids for the pain.
5. A client reports increasing pain during dressing changes to the
nurse. Which interventions are recommended for the client?
(Select all that apply.)
Select all that apply.
, -Music therapy
-Assistance by the client with the dressing change
-Epidural analgesic
-Transcutaneous electrical nerve stimulation (TENS)
-Distraction
-Premedication Correct Answers -Music therapy
-Distraction
-Premedication
Interventions recommended for the client include distraction,
music therapy, and premedication. Distraction stimulates
efferent nerve fibers and reduces the client's perception of
painful experiences. Music therapy provides a distraction and
can reduce the client's pain perception; efferent nerve fibers are
stimulated. Premedication before painful treatments is a good
method of controlling pain during treatment. Involving the client
in an uncomfortable dressing change would tend to increase the
client's perception of pain; it is a better tactic to distract the
client. Although epidural analgesia is effective, it is a method of
providing pain relief that requires an epidural catheter to be in
place; the use of such an invasive procedure would not be
indicated for pain relief during a dressing change. Use of a
TENS unit is effective in controlling certain types of pain, such
as incisional pain, but its use during a dressing change would not
be feasible.
5. A client who had a hip replacement 2 days ago, reports having
pain rated as a 7 on a pain scale of 0-10. What nursing
intervention is the highest priority?
-Teaching key points of the relaxation response
-Incorporating activities of daily living as soon as possible
5-1. A client taking newly prescribed gabapentin for persistent
neuropathic pain reports dizziness. What is the best nursing
response?
A. "This is common side effect of gabapentin and will decrease
with use."
B. "Stop taking the medication and contact the healthcare
provider."
C. "The dizziness is caused by the neuropathic pain, not the
medication."
D. "The dizziness is likely from another medication, not the
gabapentin." Correct Answers Answer: A
Rationale: Gabapentin is commonly used for neuropathic pain.
The most common side effect is dizziness which will generally
decrease with use. It is not appropriate to tell the client to stop
taking the medication and it is unlikely that the neuropathic pain
or another medication is causing the dizziness.
5-2. A client has been receiving the same dose of an intravenous
opioid for two days to manage post-surgical pain. The client
reports that the drug is no longer controlling the pain. What does
the nurse suspect?
A. There is likely a history of addiction.
B. Tolerance to the opioid is developing.
C. Physical dependence is developing.
D. The client is opioid-naïve. Correct Answers Answer: B.
Rationale: A client who has been receiving the same dose of an
opioid for several days and now reports that the drug is not
,controlling the pain is likely developing tolerance. This is not
the same thing as addiction or physical dependence. Physical
dependence is manifested when a drug is stopped and the client
shows withdrawal symptoms. Tolerance means the body has
adapted to the drug and the client may require an increased dose
or switching to a different drug for pain control. An opioid-naïve
person has not recently taken enough opioid on a regular basis to
become tolerant to the effects of an opioid. Tolerance does not
indicate addiction or a history of addiction.
5. A 44-year-old client with osteoarthritis pain tells the nurse, "I
take two extra-strength acetaminophen (500 mg) every 8 hours."
How does the nurse respond?
-"More acetaminophen is needed to provide effective pain relief
for you."
-"You will need to have routine blood draws to monitor clotting
time."
-"That is the appropriate dose of acetaminophen for your pain."
-"Aspirin would be a better, more effective choice for your pain
relief." Correct Answers "That is the appropriate dose of
acetaminophen for your pain."
In the healthy adult, a maximum daily dose below 4000 mg is
rarely associated with liver toxicity. Many experts recommend
reducing the daily dose (e.g., 2500 to 3000 mg daily) when used
for long-term treatment in older adults. Acetaminophen does not
increase bleeding time and has a low incidence of GI adverse
effects, making it the analgesic of choice for many people in
pain, especially older adults. The dose is appropriate; more is
not indicated or advised. Acetaminophen is a better choice for
,pain relief than aspirin because it has fewer side effects on the
gastrointestinal system, such as bleeding.
5. A client being discharged after hip replacement says, "I am
going to use hypnosis instead of medication to manage my pain.
I believe in mind over body." Which nursing response is
appropriate?
-"I will discuss cancelling your medication order with your
health care provider."
-"That sounds like a wonderful idea; and I think it will definitely
work!"
-"That sounds like a great plan; can you tell me more about it?"
-"Your plan will not work; people with your type of pain need
opioids." Correct Answers "That sounds like a great plan; can
you tell me more about it?"
Complementary and integrative therapies are most often used to
supplement, not replace, medication management. The nurse
needs to obtain more data, and will ask for more information
about the client's plan. Contacting the health care provider to
cancel the medication order is not appropriate. Telling the client
that his idea is wonderful and will definitely work is not
appropriate, as alternative strategies alone, may not work to
relieve the client's pain. Telling the client that his or her plan
will not work is dismissive of the client. In addition, the client
may not need to be prescribed opioids for the pain.
5. A client reports increasing pain during dressing changes to the
nurse. Which interventions are recommended for the client?
(Select all that apply.)
Select all that apply.
, -Music therapy
-Assistance by the client with the dressing change
-Epidural analgesic
-Transcutaneous electrical nerve stimulation (TENS)
-Distraction
-Premedication Correct Answers -Music therapy
-Distraction
-Premedication
Interventions recommended for the client include distraction,
music therapy, and premedication. Distraction stimulates
efferent nerve fibers and reduces the client's perception of
painful experiences. Music therapy provides a distraction and
can reduce the client's pain perception; efferent nerve fibers are
stimulated. Premedication before painful treatments is a good
method of controlling pain during treatment. Involving the client
in an uncomfortable dressing change would tend to increase the
client's perception of pain; it is a better tactic to distract the
client. Although epidural analgesia is effective, it is a method of
providing pain relief that requires an epidural catheter to be in
place; the use of such an invasive procedure would not be
indicated for pain relief during a dressing change. Use of a
TENS unit is effective in controlling certain types of pain, such
as incisional pain, but its use during a dressing change would not
be feasible.
5. A client who had a hip replacement 2 days ago, reports having
pain rated as a 7 on a pain scale of 0-10. What nursing
intervention is the highest priority?
-Teaching key points of the relaxation response
-Incorporating activities of daily living as soon as possible
