Chapter 05: Assessment and Care of Patients
with Pain
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client who had surgery has extreme postoperative pain that is worsened when trying
to participate in physical therapy. Which intervention for pain management does the
nurse include in the client’s care plan?
a. As-needed pain medication after therapy
b. Pain medications prior to therapy only
c. Patient-controlled analgesia with a basal rate
d. Round-the-clock analgesia with PRN analgesics
ANS: D
Severe pain related to surgery or tissue trauma is best managed with round-the-clock
dosing. Breakthrough pain associated with specific procedures is managed with
additional medication. An as-needed regimen will not control postoperative pain. A
patient-controlled analgesia pump might be a good idea but needs bolus (intermittent)
settings to accomplish adequate pain control, with or without a basal rate. Pain control
needs to be continuous, not just administered prior to therapy.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Pain, Pharmacologic pain management
MSC: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
,2. A nurse on the postoperative inpatient unit receives hand-off report on four clients
using patient-controlled analgesia (PCA) pumps. Which client would the nurse see
first?
a. Client who appears to be sleeping soundly.
b. Client with no bolus request in 6 hours.
c. Client who is pressing the button every 10 minutes.
d. Client with a respiratory rate of 8 breaths/min.
ANS: D
Continuous delivery of opioid analgesia can lead to respiratory depression and
extreme sedation. A respiratory rate of 8 breaths/min is below normal, so the nurse
would first check this client. The client “sleeping soundly” could be comfortable (no
indicators of respiratory distress) and would be checked next. Pressing the button
every 10 minutes indicates that the client has a high level of pain, but the device has a
lockout determining how often a bolus can be delivered. Therefore, the client cannot
overdose. The nurse would next assess that client’s pain. The client who has not
needed a bolus of pain medicine in several hours has well-controlled pain.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Pain, Pharmacologic pain management MSC: Client
Needs Category: Safe and Effective Care Environment: Management
of Care
3. A registered nurse is caring for a client who is receiving pain medication via patient-
controlled analgesia (PCA). Which action by the nurse indicates the need for further
education on pain control with PCA?
a. Assesses the client’s pain level per agency policy.
b. Monitors the client’s respiratory rate and sedation.
c. Presses the button when the client cannot reach it.
d. Reinforces client teaching about using the PCA pump.
ANS: C
, The client is the only person who should press the PCA button. If the client cannot
reach it, the nurse would either reposition the client or the button, and would not press
the button for the client. Pressing the button for the client (“PCA by proxy”) indicates
the need to review the information about this treatment modality. The other actions
are appropriate.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Pain, Pharmacologic pain management MSC: Client
Needs Category: Safe and Effective Care Environment: Safety and Infection
Control
4. A client is put on twice-daily acetaminophen for osteoarthritis. Which finding in the
client’s health history would lead the nurse to consult with the primary health care
provider over the choice of medication?
a. 25–pack-year smoking history
b. Drinking 3 to 5 beers a day
c. Previous peptic ulcer
d. Taking warfarin
ANS: B
The major serious side effect of acetaminophen is hepatotoxicity and liver damage.
Drinking 3 to 5 beers each day may indicate underlying liver disease, which would be
investigated prior to prescribing chronic acetaminophen. The nurse would relay this
information to the primary health care provider. Smoking is not related to
acetaminophen side effects. Acetaminophen does not cause bleeding, so a previous
peptic ulcer or taking warfarin would not be a problem.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Pharmacologic pain management, Adverse drug reactions
MSC: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
with Pain
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client who had surgery has extreme postoperative pain that is worsened when trying
to participate in physical therapy. Which intervention for pain management does the
nurse include in the client’s care plan?
a. As-needed pain medication after therapy
b. Pain medications prior to therapy only
c. Patient-controlled analgesia with a basal rate
d. Round-the-clock analgesia with PRN analgesics
ANS: D
Severe pain related to surgery or tissue trauma is best managed with round-the-clock
dosing. Breakthrough pain associated with specific procedures is managed with
additional medication. An as-needed regimen will not control postoperative pain. A
patient-controlled analgesia pump might be a good idea but needs bolus (intermittent)
settings to accomplish adequate pain control, with or without a basal rate. Pain control
needs to be continuous, not just administered prior to therapy.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Pain, Pharmacologic pain management
MSC: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
,2. A nurse on the postoperative inpatient unit receives hand-off report on four clients
using patient-controlled analgesia (PCA) pumps. Which client would the nurse see
first?
a. Client who appears to be sleeping soundly.
b. Client with no bolus request in 6 hours.
c. Client who is pressing the button every 10 minutes.
d. Client with a respiratory rate of 8 breaths/min.
ANS: D
Continuous delivery of opioid analgesia can lead to respiratory depression and
extreme sedation. A respiratory rate of 8 breaths/min is below normal, so the nurse
would first check this client. The client “sleeping soundly” could be comfortable (no
indicators of respiratory distress) and would be checked next. Pressing the button
every 10 minutes indicates that the client has a high level of pain, but the device has a
lockout determining how often a bolus can be delivered. Therefore, the client cannot
overdose. The nurse would next assess that client’s pain. The client who has not
needed a bolus of pain medicine in several hours has well-controlled pain.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Pain, Pharmacologic pain management MSC: Client
Needs Category: Safe and Effective Care Environment: Management
of Care
3. A registered nurse is caring for a client who is receiving pain medication via patient-
controlled analgesia (PCA). Which action by the nurse indicates the need for further
education on pain control with PCA?
a. Assesses the client’s pain level per agency policy.
b. Monitors the client’s respiratory rate and sedation.
c. Presses the button when the client cannot reach it.
d. Reinforces client teaching about using the PCA pump.
ANS: C
, The client is the only person who should press the PCA button. If the client cannot
reach it, the nurse would either reposition the client or the button, and would not press
the button for the client. Pressing the button for the client (“PCA by proxy”) indicates
the need to review the information about this treatment modality. The other actions
are appropriate.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Pain, Pharmacologic pain management MSC: Client
Needs Category: Safe and Effective Care Environment: Safety and Infection
Control
4. A client is put on twice-daily acetaminophen for osteoarthritis. Which finding in the
client’s health history would lead the nurse to consult with the primary health care
provider over the choice of medication?
a. 25–pack-year smoking history
b. Drinking 3 to 5 beers a day
c. Previous peptic ulcer
d. Taking warfarin
ANS: B
The major serious side effect of acetaminophen is hepatotoxicity and liver damage.
Drinking 3 to 5 beers each day may indicate underlying liver disease, which would be
investigated prior to prescribing chronic acetaminophen. The nurse would relay this
information to the primary health care provider. Smoking is not related to
acetaminophen side effects. Acetaminophen does not cause bleeding, so a previous
peptic ulcer or taking warfarin would not be a problem.
DIF: Applying TOP: Integrated Process: Communication and Documentation
KEY: Pharmacologic pain management, Adverse drug reactions
MSC: Client Needs Category: Physiological Integrity:
Pharmacological and Parenteral Therapies
