TEST BANK FOR
PRIORITIZATION,DELEGATION,AND ASSIGNMENT 6TH
EDITION
BY LINDA|CANDICE|SHIRLEY(CHAPTERS 1-22)LATEST
VERSION
,TABLE OF CONTENTS
CHAPTER 1. PAIN ........................................................................................................................................... 3
CHAPTER 2. CANCER.................................................................................................................................... 12
CHAPTER 3. IMMUNOLOGIC PROBLEMS ..................................................................................................... 21
CHAPTER 4. FLUID, ELECTROLYTE, AND ACID-BASE BALANCE PROBLEMS .................................................. 30
CHAPTER 5. SAFETY AND INFECTION CONTROL .......................................................................................... 39
CHAPTER 6. RESPIRATORY PROBLEMS ........................................................................................................ 47
CHAPTER 7. CARDIOVASCULAR PROBLEMS................................................................................................. 57
CHAPTER 8. HEMATOLOGIC PROBLEMS...................................................................................................... 64
CHAPTER 9. NEUROLOGIC PROBLEMS......................................................................................................... 70
CHAPTER 10. VISUAL AND AUDITORY PROBLEMS....................................................................................... 78
CHAPTER 11. MUSCULOSKELETAL PROBLEMS ............................................................................................ 87
CHAPTER 12. GASTROINTESTINAL AND NUTRITIONAL PROBLEMS ............................................................. 95
CHAPTER 13. DIABETES MELLITUS............................................................................................................. 104
CHAPTER 14. OTHER ENDOCRINE PROBLEMS ........................................................................................... 113
CHAPTER 15. INTEGUMENTARY PROBLEMS.............................................................................................. 119
CHAPTER 16. RENAL AND URINARY PROBLEMS ........................................................................................ 124
CHAPTER 17. REPRODUCTIVE PROBLEMS ................................................................................................. 133
CHAPTER 18. PROBLEMS IN PREGNANCY AND CHILDBEARING ................................................................ 142
CHAPTER 19. PEDIATRIC PROBLEMS ......................................................................................................... 150
CHAPTER 20. PHARMACOLOGY ................................................................................................................. 160
CHAPTER 21. EMERGENCIES AND DISASTERS............................................................................................ 168
CHAPTER 22. PSYCHIATRIC–MENTAL HEALTH PROBLEMS ........................................................................ 176
,CHAPTER 1. PAIN
MULTIPLE CHOICE
1.A PATRON TELLS THE NURSE THAT SHE RARELY EXPERIENCES PAIN, BUT WHEN SHE DOES, SHE SEEKS
MEDICAL ATTENTION. THE NURSE REALIZES THIS PATRON UNDERSTANDS THAT PAIN IS IMPORTANT
BECAUSE IT:
1. IS A PROTECTIVE SYSTEM.
2. INCLUDES THE AUTOMATIC WITHDRAWAL REFLEX.
3. CREATES SENSITIVITY TO PAIN.
4. HELPS WITH HEALING.
ANSWER: 1
PAIN IS A PROTECTIVE SYSTEM THAT INCLUDES PROTECTION FROM UNSAFE BEHAVIORS BY USE OF
REFLEXES, MEMORY, AND AVOIDANCE. EVEN THOUGH THE AUTOMATIC WITHDRAWAL REFLEX IS A
PART OF THE PAIN RESPONSE, IT DOES NOT EXPLAIN WHY PAIN IS IMPORTANT. PAIN DOES NOT
CREATE SENSITIVITY TO PAIN. PAIN DOES NOT HELP WITH HEALING.
PTS: 1 DIF: ANALYZE REF: DEFINITIONS AND IMPLICATIONS OF PAIN
2.A PATRONCOMPLAINS THAT THE BED SHEETS TOUCHING HIS SKIN ARE EXTREMELY PAINFUL. THE
NURSE REALIZES THISPATRONIS EXPERIENCING:
1. ALLODYNIA.
2. MODULATION.
3. KINESTHESIA.
4. PROPRIOCEPTION.
ANSWER: 1
ALLODYNIA OR HYPERALGESIA IS A STATE WHERE A SLIGHT OR NONPAINFUL STIMULUS IS
INTERPRETED AS VERY PAINFUL. KINESTHESIA IS THE AWARENESS OF MOVEMENT. PROPRIOCEPTION
IS THE AWARENESS OF BODY POSITION. MODULATION IS AN INFLUENCING FACTOR IN THE
PERCEPTION OF PAIN.
PTS: 1 DIF: ANALYZE REF: PERIPHERAL NERVOUS SYSTEM
,3.APATRONIS COMPLAINING OF SEVERE ABDOMEN PAIN. THE NURSE REALIZES THISPATRONIS
EXPERIENCING WHICH TYPE OF PAIN?
1. NEURALGIA
2. PATHOLOGICAL
3. SOMATIC
4. VISCERAL
ANSWER: 4
VISCERAL PAIN IS PAIN ARISING FROM THE BODY ORGANS OR GASTROINTESTINAL TRACT. SOMATIC PAIN
IS PAIN THAT ORIGINATES FROM THE BONE, JOINTS, MUSCLES, SKIN, OR CONNECTIVE PAIN. NEURALGIA
AND
PATHOLOGICAL PAIN ARE BOTH TYPES OF PAIN THAT RESULT FROM INJURY TO A NERVE OR
MALFUNCTION OF THE NEURONAL TRANSMISSION PROCESS OR DUE TO IMPAIRED REGULATION.
PTS:1DIF:ANALYZEREF:TYPES OF PAIN
4.A CLIENT, DIAGNOSED WITH ACUTE APPENDICITIS, IS EXPERIENCING ABDOMINAL PAIN. THE BEST WAY
FOR THE NURSE TO DESCRIBE THIS CLIENTS PAIN WOULD BE:
1. CHRONIC.
2. NEUROPATHIC.
3. REFERRED.
4. ACUTE.
ANSWER: 4
ACUTE PAIN ONSET IS SUDDEN AND OF SHORT DURATION. CHRONIC PAIN IS A SUDDEN OR SLOW
ONSET OF MILD TO SEVERE PAIN THAT LASTS LONGER THAN 6 MONTHS. REFERRED PAIN IS THE
RESULT OF THE TRANSFER OF VISCERAL PAIN SENSATIONS TO A BODY SURFACE AT A DISTANCE FROM
THE ACTUAL ORIGIN. NEUROPATHIC PAIN IS PAROXYSMAL PAIN THAT OCCURS ALONG THE
BRANCHES OF A NERVE.
PTS:1DIF:APPLYREF:TYPES OF PAIN
5. APATRONIS OBSERVED HOLDING A PILLOW OVER THE ABDOMINAL REGION WITH BOTH KNEES
FLEXED IN A SIDE- LYING POSITION. VITAL SIGNS ASSESSMENT REVEALS AN ELEVATED BLOOD PRESSURE
AND HEART RATE. WHICH OF THE FOLLOWING SHOULD THE NURSE SAY TO THIS CLIENT?
,1. CAN I GET YOU ANYTHING?
2. WOULD YOU LIKE SOMETHING FOR PAIN?
3. YOU LOOK COMFORTABLE.
4. YOUR BLOOD PRESSURE IS UP.
ANSWER: 2
SYMPATHETIC RESPONSES TO PAIN INCLUDE ELEVATED BLOOD PRESSURE AND HEART RATE. AND
SINCE THEPATRONIS HUGGING A PILLOW OVER THE ABDOMINAL REGION WITH BOTH KNEES FLEXED
IN A SIDE-LYING POSITION, THE BEST THING FOR THE NURSE TO SAY TO THISPATRONIS WOULD YOU
LIKE SOMETHING FOR PAIN? THE OTHER RESPONSES ARE INCORRECT BECAUSE THEY DO NOT
ACKNOWLEDGE THAT THEPATRONIS EXPERIENCING PAIN.
PTS: 1 DIF: APPLY REF: ASSESSING THE CLINICAL MANIFESTATIONS OF PAIN
6. APATRONEXPERIENCING CHRONIC PAIN ASKS THE NURSE WHY SHE IS NOT PRESCRIBED DEMEROL
LIKE SHE RECEIVED WHEN SHE HAD A TOTAL KNEE REPLACEMENT. WHICH OF THE FOLLOWING SHOULD
THE NURSE RESPOND TO THIS CLIENT?
1. YOU DONT NEED SOMETHING THAT STRONG.
2. THAT MEDICATION DOES NOT EXIST ANYMORE.
3. THAT MEDICATION DOES NOT LAST VERY LONG.
4. IT CAN CAUSE YOU HAVE HIGH BLOOD PRESSURE.
ANSWER: 3
MEPERIDINE IS NO LONGER A MAJOR DRUG FOR ACUTE OR CHRONIC PAIN DUE TO ITS SHORT
ANALGESIC DURATION OF 2 TO 3 HOURS AND THE POTENTIAL FOR ACCUMULATIVE TOXIC EFFECTS OF
ITS METABOLITE, NORMEPERIDINE. THE BEST RESPONSE FOR THE NURSE TO MAKE TO
THEPATRONWOULD BE THAT MEDICATION DOES NOT LAST VERY LONG. THE OTHER RESPONSES ARE
INACCURATE.
PTS:1DIF:APPLYREF:OPIOID ANALGESICS
7. APATRONIS INFORMED THAT A TRICYCLIC ANTIDEPRESSANT MEDICATION IS GOING TO HELP
CONTROL HIS CHRONIC PAIN. THE NURSE WOULD EXPECT THE PHYSICIAN TO PRESCRIBE:
1. AMITRIPTYLINE.
,2. BACLOFEN.
3. GABAPENTIN.
4. DIAZEPAM.
ANSWER: 1
AMITRIPTYLINE IS AN ANTIDEPRESSANT. GABAPENTIN IS AN ANTICONVULSANT. BACLOFEN IS A MUSCLE
RELAXANT. DIAZEPAM IS A BENZODIAZEPINE.
PTS: 1 DIF: ANALYZE REF: ADJUVANT MEDICATIONS
8. APATRONRECEIVING AROUND-THE-CLOCK MEDICATION FOR TERMINAL CANCER EXPERIENCES
ADDITIONAL PAIN WHEN PERFORMING ACTIVITIES OF DAILY LIVING. THE NURSE REALIZES
THISPATRONIS EXPERIENCING:
1. BREAKTHROUGH PAIN.
2. INTRACTABLE PAIN.
3. PSYCHOSOMATIC PAIN.
4. ACUTE PAIN.
ANSWER: 1
BREAKTHROUGH PAIN IS COMMONLY SEEN IN THE ADVANCED STAGES OF CANCER. IT IS
SPONTANEOUS, UNPREDICTABLE, AND CAN BE INITIATED BY CERTAIN ACTIVITIES SUCH AS DURING
ACTIVITIES OF DAILY LIVING. INTRACTABLE PAIN IS RESISTANT TO SOME OR ALL FORMS OF THERAPY.
PSYCHOSOMATIC PAIN IS THAT WHICH HAS A PSYCHOLOGICAL ORIGIN. THEPATRONIS DIAGNOSED
WITH TERMINAL CANCER. ACUTE PAIN HAS A SUDDEN ONSET AND RESOLVES WITHIN 6 MONTHS.
PTS:1DIF:ANALYZEREF:BREAKTHROUGH PAIN
9. APATRONRECOVERING FROM SURGERY TELLS THE NURSE THAT SHE IS NAUSEATED AND IS
EXPERIENCING AN INCREASE IN PAIN. WHICH OF THE FOLLOWING DOES THIS CLIENTS
SYMPTOMS SUGGEST TO THE NURSE?
1. THEPATRONIS BECOMING DEPENDENT UPON THE PAIN MEDICATION.
2. THE CLIENTS PAIN THRESHOLD IS LOWER WHEN EXPERIENCING NAUSEA.
3. THEPATRONIS EXPERIENCING WITHDRAWAL SYMPTOMS FROM PAIN MEDICATION.
4. THEPATRONIS EXPERIENCING REFERRED PAIN.
,.
ANSWER: 2
PAIN THRESHOLD IS INFLUENCED BY NAUSEA, FATIGUE, AND LACK OF SLEEP.
THEPATRONEXPERIENCING AN INCREASE IN PAIN DURING NAUSEA IS DEMONSTRATING AN
ALTERATION IN THE PAIN THRESHOLD. THEPATRONIS NOT BECOMING DEPENDENT UPON THE PAIN
MEDICATION. THEPATRONIS NOT EXPERIENCING WITHDRAWAL SYMPTOMS. THEPATRONIS ALSO NOT
EXPERIENCING REFERRED PAIN.
PTS: 1 DIF: ANALYZE REF: PAIN THRESHOLD AND PAIN TOLERANCE
10. APATRONWITH A HISTORY OF MALINGERING PAIN TELLS THE NURSE THAT HE NEEDS A
PRESCRIPTION FOR PAIN MEDICATION. WHICH OF THE FOLLOWING SHOULD THE NURSE DO FIRST
TO ASSIST THIS CLIENT?
1. ASK THE PHYSICIAN FOR A PAIN MEDICATION PRESCRIPTION FOR THE CLIENT.
2. REMIND THEPATRONTHAT HE DOES NOT HAVE PAIN BUT JUST WANTS THE MEDICATION.
3. THOROUGHLY ASSESS THEPATRONFOR PAIN.
4. SUGGEST THEPATRONSEEK COUNSELING FOR HIS PAIN MEDICATION-SEEKING BEHAVIOR.
ANSWER: 3
PAIN OF A PSYCHOLOGICAL ORIGIN IS WHEN AN INDIVIDUAL SEEKS TREATMENT FOR PAIN WHEN NO
ACTUAL PAIN EXISTS. THIS IS ALSO REFERRED TO AS MALINGERING OR PRETENDING PAIN. THE NURSE
SHOULD NOT ASSUME THAT THE PAIN DOES NOT EXIST BUT RATHER SHOULD CONDUCT A
THOROUGH PAIN ASSESSMENT TO RULE OUT AN ACTUAL PHYSIOLOGICAL PROBLEM. THE NURSE
SHOULD NOT IMMEDIATELY ASK THE PHYSICIAN FOR PAIN MEDICATION. THE NURSE SHOULD NOT
REMIND THEPATRONTHAT HE DOES NOT HAVE PAIN BUT JUST WANTS THE MEDICATION. THE NURSE
SHOULD ALSO NOT SUGGEST THEPATRONSEEK COUNSELING FOR PAIN MEDICATION- SEEKING
BEHAVIOR.
PTS: 1 DIF: APPLY REF: BOX 16-1 PAIN DESCRIPTIONS
11. THE NURSE IS IMPLEMENTING THE FIVE CS OF PAIN MANAGEMENT FOR A CLIENT. WHICH OF THE
FOLLOWING IS INCLUDED IN THIS INTERVENTION?
1. CARING FOR THEPATRONIN A HOLISTIC MANNER
2. CREATING A CALM ENVIRONMENT
3. COMPARING THE DEGREE OF PAIN REPORTED WITH PREVIOUS EPISODES
4. CONTINUOUSLY ASSESSING THE CLIENTS PAIN
,ANSWER: 4
THE FIVE CS OF PAIN MANAGEMENT INCLUDE COMPREHENSIVE ASSESSMENT, CONSISTENT USE OF
ASSESSMENT TOOLS, CONTINUOUS REASSESSMENT, CUSTOMIZE THE PLAN OF CARE, AND
COLLABORATE WITH OTHER HEALTH CARE PROVIDERS TO PLAN PAIN MANAGEMENT. THE OTHER
CHOICES ARE NOT INCLUDED IN THE FIVE CS OF PAIN MANAGEMENT.
PTS: 1 DIF: APPLY REF: PLANNING AND IMPLEMENTATION
12. A CLIENT, DIAGNOSED WITH ARTHRITIS, SHOULD BE INSTRUCTED TO AVOID THE USE OF
NSAIDS BECAUSE OF WHICH OF THE FOLLOWING PRESCRIBED MEDICATIONS?
1. PENICILLIN
2. COUMADIN
3. DIGOXIN
4. DIAZIDE
ANSWER: 2
PERSONS AT GREATEST RISK FOR ADVERSE REACTIONS TO NSAIDS INCLUDE THOSE WHO ARE PRESCRIBED
WARFARIN (COUMADIN) SINCE THE NSAID CAN INCREASE THE EFFECTS OF THE COUMADIN AND PROMOTE
BLEEDING.
PTS: 1 DIF: APPLY REF: BOX 16-2 GROUPS OF NSAID DRUGS MULTIPLE RESPONSE
1. PRIOR TO HOSPITALIZATION, APATRONHAD BEEN INGESTING HIGH DOSES OF
OXYCODONE. THE NURSE SUSPECTS THEPATRONIS EXPERIENCING SYMPTOMS OF WITHDRAWAL
WHEN WHICH OF THE FOLLOWING ARE ASSESSED? (SELECT ALL THAT APPLY.)
1. MUSCLE TWITCHING AND SPASMS
2. RESTLESSNESS
3. INCREASED HEART RATE
4. DROP IN BLOOD PRESSURE
5. INCREASE IN BLOOD PRESSURE
6. IRRITABILITY
ANSWER: 1, 2, 3, 5, 6
,WITHDRAWAL SYMPTOMS INCLUDE MYOCLONUS OR MUSCLE TWITCHING AND SPASMS, RESTLESSNESS,
IRRITABILITY, INCREASED HEART RATE, AND INCREASED BLOOD PRESSURE. A DECREASE IN BLOOD PRESSURE
IS NOT A SYMPTOM OF NARCOTIC MEDICATION WITHDRAWAL.
PTS:1DIF:ANALYZE
REF: POTENTIAL AND ACTUAL SIDE EFFECTS OF OPIOID ANALGESICS
2. THE NURSE WOULD BE CONCERNED THAT APATRONIS AT RISK FOR DEVELOPING CHRONIC
PAIN WHEN WHICH OF THE FOLLOWING HEALTH PROBLEMS ARE DIAGNOSED? (SELECT ALL THAT
APPLY.)
1. OSTEOARTHRITIS
2. OSTEOPOROSIS
3. HEART DISEASE
4. DIABETES MELLITUS
5. CHRONIC PULMONARY DISEASE
6. ANEMIA
ANSWER: 1, 2, 5
COMMON HEALTH PROBLEMS ASSOCIATED WITH CHRONIC PAIN INCLUDE OSTEOARTHRITIS,
OSTEOPOROSIS, AND CHRONIC PULMONARY DISEASE. HEART DISEASE, DIABETES MELLITUS, AND
ANEMIA ARE NOT ASSOCIATED WITH CHRONIC PAIN.
PTS:1DIF:ANALYZEREF:CHRONIC PAIN
3. AN 84-YEAR-OLDPATRONIS EXPERIENCING SEVERE ARTHRITIS PAIN. THE NURSE REALIZES
THAT WHICH OF THE FOLLOWING PAIN MANAGEMENT APPROACHES WOULD BE THE MOST
BENEFICIAL FOR THIS CLIENT? (SELECT ALL THAT APPLY.)
1. AVOID NSAIDS.
2. UTILIZE MORPHINE OR MORPHINE-LIKE MEDICATION.
3. PROVIDE MEDICATION THROUGH THE ORAL ROUTE.
4. UTILIZE DIAZEPAM.
5. SUGGEST DARVOCET.
6. PROVIDE MEDICATION THROUGH THE INTRAMUSCULAR ROUTE.
ANSWER: 1, 2, 3
, WHEN PROVIDING PAIN MEDICATION TO A GERIATRIC CLIENT, PAIN MANAGEMENT APPROACHES
INCLUDE THE UTILIZATION OF MORPHINE OR MORPHINE-LIKE MEDICATION TO CONTROL PAIN AND
PROVIDE MEDICATION USING THE ORAL ROUTE. NSAIDS SHOULD ALSO BE AVOIDED BECAUSE OF THE
RISK OF GASTROINTESTINAL BLEEDING.
DIAZEPAM SHOULD BE AVOIDED BECAUSE OF A LONG HALF-LIFE. DARVOCET SHOULD BE AVOIDED
BECAUSE OF TOXIC EFFECTS WITH RENAL INSUFFICIENCY. MEDICATION SHOULD NOT BE PROVIDED
USING THE INTRAMUSCULAR ROUTE BECAUSE OF MUSCLE WASTING AND LOSS OF FATTY TISSUE IN THE
ELDERLY CLIENT.
PTS: 1 DIF: APPLY REF: GERIATRIC CONSIDERATIONS
4. APATRONWITH SEVERE PAIN FROM SPINAL STENOSIS IS PRESCRIBED METHADONE. THE
NURSE REALIZES THAT THE ADVANTAGES OF THIS MEDICATION ARE WHAT? (SELECT ALL THAT
APPLY.)
1. DECREASE IN THE NEED FOR ANTIDEPRESSANT ADJUVANT MEDICATION
2. LESS FREQUENT DOSING SCHEDULE
3. LONG HALF-LIFE
4. INEXPENSIVE
5. CAN BE USED FOR INTERMITTENT PAIN
6. DOES NOT CAUSE RESPIRATORY DEPRESSION
ANSWER: 1, 2, 4
THE ADVANTAGES OF METHADONE INCLUDE THAT IT DECREASES THE NEED FOR ANTIDEPRESSANT
ADJUVANT MEDICATION BECAUSE IT INCREASES THE RELEASE OF SEROTONIN AND NOREPINEPHRINE,
DOSING IS EVERY 12 HOURS, AND IT IS INEXPENSIVE. DISADVANTAGES OF THIS MEDICATION INCLUDE:
IT HAS A LONG HALF-LIFE; IT CANNOT BE USED FOR INTERMITTENT PAIN MANAGEMENT; AND IT DOES
CAUSE RESPIRATORY DEPRESSION.
PTS:1DIF:ANALYZEREF:INTRACTABLE PAIN
5. THE NURSE IS USING THE PAINAID SCALE TO ASSESS A CLIENTS LEVEL OF PAIN. WHICH OF THE
FOLLOWING ARE ASSESSED WITH THIS PAIN SCALE? (SELECT ALL THAT APPLY.)
1. BREATHING RATE
2. ASSIGN A NUMBER TO THE DEGREE OF PAIN
3. NEGATIVE VOCALIZATIONS
4. ASSIGN A FACIAL EXPRESSION TO THE DEGREE OF PAIN
5. FACIAL EXPRESSION
6. BODY LANGUAGE
ANSWER: 1, 3, 5, 6
PRIORITIZATION,DELEGATION,AND ASSIGNMENT 6TH
EDITION
BY LINDA|CANDICE|SHIRLEY(CHAPTERS 1-22)LATEST
VERSION
,TABLE OF CONTENTS
CHAPTER 1. PAIN ........................................................................................................................................... 3
CHAPTER 2. CANCER.................................................................................................................................... 12
CHAPTER 3. IMMUNOLOGIC PROBLEMS ..................................................................................................... 21
CHAPTER 4. FLUID, ELECTROLYTE, AND ACID-BASE BALANCE PROBLEMS .................................................. 30
CHAPTER 5. SAFETY AND INFECTION CONTROL .......................................................................................... 39
CHAPTER 6. RESPIRATORY PROBLEMS ........................................................................................................ 47
CHAPTER 7. CARDIOVASCULAR PROBLEMS................................................................................................. 57
CHAPTER 8. HEMATOLOGIC PROBLEMS...................................................................................................... 64
CHAPTER 9. NEUROLOGIC PROBLEMS......................................................................................................... 70
CHAPTER 10. VISUAL AND AUDITORY PROBLEMS....................................................................................... 78
CHAPTER 11. MUSCULOSKELETAL PROBLEMS ............................................................................................ 87
CHAPTER 12. GASTROINTESTINAL AND NUTRITIONAL PROBLEMS ............................................................. 95
CHAPTER 13. DIABETES MELLITUS............................................................................................................. 104
CHAPTER 14. OTHER ENDOCRINE PROBLEMS ........................................................................................... 113
CHAPTER 15. INTEGUMENTARY PROBLEMS.............................................................................................. 119
CHAPTER 16. RENAL AND URINARY PROBLEMS ........................................................................................ 124
CHAPTER 17. REPRODUCTIVE PROBLEMS ................................................................................................. 133
CHAPTER 18. PROBLEMS IN PREGNANCY AND CHILDBEARING ................................................................ 142
CHAPTER 19. PEDIATRIC PROBLEMS ......................................................................................................... 150
CHAPTER 20. PHARMACOLOGY ................................................................................................................. 160
CHAPTER 21. EMERGENCIES AND DISASTERS............................................................................................ 168
CHAPTER 22. PSYCHIATRIC–MENTAL HEALTH PROBLEMS ........................................................................ 176
,CHAPTER 1. PAIN
MULTIPLE CHOICE
1.A PATRON TELLS THE NURSE THAT SHE RARELY EXPERIENCES PAIN, BUT WHEN SHE DOES, SHE SEEKS
MEDICAL ATTENTION. THE NURSE REALIZES THIS PATRON UNDERSTANDS THAT PAIN IS IMPORTANT
BECAUSE IT:
1. IS A PROTECTIVE SYSTEM.
2. INCLUDES THE AUTOMATIC WITHDRAWAL REFLEX.
3. CREATES SENSITIVITY TO PAIN.
4. HELPS WITH HEALING.
ANSWER: 1
PAIN IS A PROTECTIVE SYSTEM THAT INCLUDES PROTECTION FROM UNSAFE BEHAVIORS BY USE OF
REFLEXES, MEMORY, AND AVOIDANCE. EVEN THOUGH THE AUTOMATIC WITHDRAWAL REFLEX IS A
PART OF THE PAIN RESPONSE, IT DOES NOT EXPLAIN WHY PAIN IS IMPORTANT. PAIN DOES NOT
CREATE SENSITIVITY TO PAIN. PAIN DOES NOT HELP WITH HEALING.
PTS: 1 DIF: ANALYZE REF: DEFINITIONS AND IMPLICATIONS OF PAIN
2.A PATRONCOMPLAINS THAT THE BED SHEETS TOUCHING HIS SKIN ARE EXTREMELY PAINFUL. THE
NURSE REALIZES THISPATRONIS EXPERIENCING:
1. ALLODYNIA.
2. MODULATION.
3. KINESTHESIA.
4. PROPRIOCEPTION.
ANSWER: 1
ALLODYNIA OR HYPERALGESIA IS A STATE WHERE A SLIGHT OR NONPAINFUL STIMULUS IS
INTERPRETED AS VERY PAINFUL. KINESTHESIA IS THE AWARENESS OF MOVEMENT. PROPRIOCEPTION
IS THE AWARENESS OF BODY POSITION. MODULATION IS AN INFLUENCING FACTOR IN THE
PERCEPTION OF PAIN.
PTS: 1 DIF: ANALYZE REF: PERIPHERAL NERVOUS SYSTEM
,3.APATRONIS COMPLAINING OF SEVERE ABDOMEN PAIN. THE NURSE REALIZES THISPATRONIS
EXPERIENCING WHICH TYPE OF PAIN?
1. NEURALGIA
2. PATHOLOGICAL
3. SOMATIC
4. VISCERAL
ANSWER: 4
VISCERAL PAIN IS PAIN ARISING FROM THE BODY ORGANS OR GASTROINTESTINAL TRACT. SOMATIC PAIN
IS PAIN THAT ORIGINATES FROM THE BONE, JOINTS, MUSCLES, SKIN, OR CONNECTIVE PAIN. NEURALGIA
AND
PATHOLOGICAL PAIN ARE BOTH TYPES OF PAIN THAT RESULT FROM INJURY TO A NERVE OR
MALFUNCTION OF THE NEURONAL TRANSMISSION PROCESS OR DUE TO IMPAIRED REGULATION.
PTS:1DIF:ANALYZEREF:TYPES OF PAIN
4.A CLIENT, DIAGNOSED WITH ACUTE APPENDICITIS, IS EXPERIENCING ABDOMINAL PAIN. THE BEST WAY
FOR THE NURSE TO DESCRIBE THIS CLIENTS PAIN WOULD BE:
1. CHRONIC.
2. NEUROPATHIC.
3. REFERRED.
4. ACUTE.
ANSWER: 4
ACUTE PAIN ONSET IS SUDDEN AND OF SHORT DURATION. CHRONIC PAIN IS A SUDDEN OR SLOW
ONSET OF MILD TO SEVERE PAIN THAT LASTS LONGER THAN 6 MONTHS. REFERRED PAIN IS THE
RESULT OF THE TRANSFER OF VISCERAL PAIN SENSATIONS TO A BODY SURFACE AT A DISTANCE FROM
THE ACTUAL ORIGIN. NEUROPATHIC PAIN IS PAROXYSMAL PAIN THAT OCCURS ALONG THE
BRANCHES OF A NERVE.
PTS:1DIF:APPLYREF:TYPES OF PAIN
5. APATRONIS OBSERVED HOLDING A PILLOW OVER THE ABDOMINAL REGION WITH BOTH KNEES
FLEXED IN A SIDE- LYING POSITION. VITAL SIGNS ASSESSMENT REVEALS AN ELEVATED BLOOD PRESSURE
AND HEART RATE. WHICH OF THE FOLLOWING SHOULD THE NURSE SAY TO THIS CLIENT?
,1. CAN I GET YOU ANYTHING?
2. WOULD YOU LIKE SOMETHING FOR PAIN?
3. YOU LOOK COMFORTABLE.
4. YOUR BLOOD PRESSURE IS UP.
ANSWER: 2
SYMPATHETIC RESPONSES TO PAIN INCLUDE ELEVATED BLOOD PRESSURE AND HEART RATE. AND
SINCE THEPATRONIS HUGGING A PILLOW OVER THE ABDOMINAL REGION WITH BOTH KNEES FLEXED
IN A SIDE-LYING POSITION, THE BEST THING FOR THE NURSE TO SAY TO THISPATRONIS WOULD YOU
LIKE SOMETHING FOR PAIN? THE OTHER RESPONSES ARE INCORRECT BECAUSE THEY DO NOT
ACKNOWLEDGE THAT THEPATRONIS EXPERIENCING PAIN.
PTS: 1 DIF: APPLY REF: ASSESSING THE CLINICAL MANIFESTATIONS OF PAIN
6. APATRONEXPERIENCING CHRONIC PAIN ASKS THE NURSE WHY SHE IS NOT PRESCRIBED DEMEROL
LIKE SHE RECEIVED WHEN SHE HAD A TOTAL KNEE REPLACEMENT. WHICH OF THE FOLLOWING SHOULD
THE NURSE RESPOND TO THIS CLIENT?
1. YOU DONT NEED SOMETHING THAT STRONG.
2. THAT MEDICATION DOES NOT EXIST ANYMORE.
3. THAT MEDICATION DOES NOT LAST VERY LONG.
4. IT CAN CAUSE YOU HAVE HIGH BLOOD PRESSURE.
ANSWER: 3
MEPERIDINE IS NO LONGER A MAJOR DRUG FOR ACUTE OR CHRONIC PAIN DUE TO ITS SHORT
ANALGESIC DURATION OF 2 TO 3 HOURS AND THE POTENTIAL FOR ACCUMULATIVE TOXIC EFFECTS OF
ITS METABOLITE, NORMEPERIDINE. THE BEST RESPONSE FOR THE NURSE TO MAKE TO
THEPATRONWOULD BE THAT MEDICATION DOES NOT LAST VERY LONG. THE OTHER RESPONSES ARE
INACCURATE.
PTS:1DIF:APPLYREF:OPIOID ANALGESICS
7. APATRONIS INFORMED THAT A TRICYCLIC ANTIDEPRESSANT MEDICATION IS GOING TO HELP
CONTROL HIS CHRONIC PAIN. THE NURSE WOULD EXPECT THE PHYSICIAN TO PRESCRIBE:
1. AMITRIPTYLINE.
,2. BACLOFEN.
3. GABAPENTIN.
4. DIAZEPAM.
ANSWER: 1
AMITRIPTYLINE IS AN ANTIDEPRESSANT. GABAPENTIN IS AN ANTICONVULSANT. BACLOFEN IS A MUSCLE
RELAXANT. DIAZEPAM IS A BENZODIAZEPINE.
PTS: 1 DIF: ANALYZE REF: ADJUVANT MEDICATIONS
8. APATRONRECEIVING AROUND-THE-CLOCK MEDICATION FOR TERMINAL CANCER EXPERIENCES
ADDITIONAL PAIN WHEN PERFORMING ACTIVITIES OF DAILY LIVING. THE NURSE REALIZES
THISPATRONIS EXPERIENCING:
1. BREAKTHROUGH PAIN.
2. INTRACTABLE PAIN.
3. PSYCHOSOMATIC PAIN.
4. ACUTE PAIN.
ANSWER: 1
BREAKTHROUGH PAIN IS COMMONLY SEEN IN THE ADVANCED STAGES OF CANCER. IT IS
SPONTANEOUS, UNPREDICTABLE, AND CAN BE INITIATED BY CERTAIN ACTIVITIES SUCH AS DURING
ACTIVITIES OF DAILY LIVING. INTRACTABLE PAIN IS RESISTANT TO SOME OR ALL FORMS OF THERAPY.
PSYCHOSOMATIC PAIN IS THAT WHICH HAS A PSYCHOLOGICAL ORIGIN. THEPATRONIS DIAGNOSED
WITH TERMINAL CANCER. ACUTE PAIN HAS A SUDDEN ONSET AND RESOLVES WITHIN 6 MONTHS.
PTS:1DIF:ANALYZEREF:BREAKTHROUGH PAIN
9. APATRONRECOVERING FROM SURGERY TELLS THE NURSE THAT SHE IS NAUSEATED AND IS
EXPERIENCING AN INCREASE IN PAIN. WHICH OF THE FOLLOWING DOES THIS CLIENTS
SYMPTOMS SUGGEST TO THE NURSE?
1. THEPATRONIS BECOMING DEPENDENT UPON THE PAIN MEDICATION.
2. THE CLIENTS PAIN THRESHOLD IS LOWER WHEN EXPERIENCING NAUSEA.
3. THEPATRONIS EXPERIENCING WITHDRAWAL SYMPTOMS FROM PAIN MEDICATION.
4. THEPATRONIS EXPERIENCING REFERRED PAIN.
,.
ANSWER: 2
PAIN THRESHOLD IS INFLUENCED BY NAUSEA, FATIGUE, AND LACK OF SLEEP.
THEPATRONEXPERIENCING AN INCREASE IN PAIN DURING NAUSEA IS DEMONSTRATING AN
ALTERATION IN THE PAIN THRESHOLD. THEPATRONIS NOT BECOMING DEPENDENT UPON THE PAIN
MEDICATION. THEPATRONIS NOT EXPERIENCING WITHDRAWAL SYMPTOMS. THEPATRONIS ALSO NOT
EXPERIENCING REFERRED PAIN.
PTS: 1 DIF: ANALYZE REF: PAIN THRESHOLD AND PAIN TOLERANCE
10. APATRONWITH A HISTORY OF MALINGERING PAIN TELLS THE NURSE THAT HE NEEDS A
PRESCRIPTION FOR PAIN MEDICATION. WHICH OF THE FOLLOWING SHOULD THE NURSE DO FIRST
TO ASSIST THIS CLIENT?
1. ASK THE PHYSICIAN FOR A PAIN MEDICATION PRESCRIPTION FOR THE CLIENT.
2. REMIND THEPATRONTHAT HE DOES NOT HAVE PAIN BUT JUST WANTS THE MEDICATION.
3. THOROUGHLY ASSESS THEPATRONFOR PAIN.
4. SUGGEST THEPATRONSEEK COUNSELING FOR HIS PAIN MEDICATION-SEEKING BEHAVIOR.
ANSWER: 3
PAIN OF A PSYCHOLOGICAL ORIGIN IS WHEN AN INDIVIDUAL SEEKS TREATMENT FOR PAIN WHEN NO
ACTUAL PAIN EXISTS. THIS IS ALSO REFERRED TO AS MALINGERING OR PRETENDING PAIN. THE NURSE
SHOULD NOT ASSUME THAT THE PAIN DOES NOT EXIST BUT RATHER SHOULD CONDUCT A
THOROUGH PAIN ASSESSMENT TO RULE OUT AN ACTUAL PHYSIOLOGICAL PROBLEM. THE NURSE
SHOULD NOT IMMEDIATELY ASK THE PHYSICIAN FOR PAIN MEDICATION. THE NURSE SHOULD NOT
REMIND THEPATRONTHAT HE DOES NOT HAVE PAIN BUT JUST WANTS THE MEDICATION. THE NURSE
SHOULD ALSO NOT SUGGEST THEPATRONSEEK COUNSELING FOR PAIN MEDICATION- SEEKING
BEHAVIOR.
PTS: 1 DIF: APPLY REF: BOX 16-1 PAIN DESCRIPTIONS
11. THE NURSE IS IMPLEMENTING THE FIVE CS OF PAIN MANAGEMENT FOR A CLIENT. WHICH OF THE
FOLLOWING IS INCLUDED IN THIS INTERVENTION?
1. CARING FOR THEPATRONIN A HOLISTIC MANNER
2. CREATING A CALM ENVIRONMENT
3. COMPARING THE DEGREE OF PAIN REPORTED WITH PREVIOUS EPISODES
4. CONTINUOUSLY ASSESSING THE CLIENTS PAIN
,ANSWER: 4
THE FIVE CS OF PAIN MANAGEMENT INCLUDE COMPREHENSIVE ASSESSMENT, CONSISTENT USE OF
ASSESSMENT TOOLS, CONTINUOUS REASSESSMENT, CUSTOMIZE THE PLAN OF CARE, AND
COLLABORATE WITH OTHER HEALTH CARE PROVIDERS TO PLAN PAIN MANAGEMENT. THE OTHER
CHOICES ARE NOT INCLUDED IN THE FIVE CS OF PAIN MANAGEMENT.
PTS: 1 DIF: APPLY REF: PLANNING AND IMPLEMENTATION
12. A CLIENT, DIAGNOSED WITH ARTHRITIS, SHOULD BE INSTRUCTED TO AVOID THE USE OF
NSAIDS BECAUSE OF WHICH OF THE FOLLOWING PRESCRIBED MEDICATIONS?
1. PENICILLIN
2. COUMADIN
3. DIGOXIN
4. DIAZIDE
ANSWER: 2
PERSONS AT GREATEST RISK FOR ADVERSE REACTIONS TO NSAIDS INCLUDE THOSE WHO ARE PRESCRIBED
WARFARIN (COUMADIN) SINCE THE NSAID CAN INCREASE THE EFFECTS OF THE COUMADIN AND PROMOTE
BLEEDING.
PTS: 1 DIF: APPLY REF: BOX 16-2 GROUPS OF NSAID DRUGS MULTIPLE RESPONSE
1. PRIOR TO HOSPITALIZATION, APATRONHAD BEEN INGESTING HIGH DOSES OF
OXYCODONE. THE NURSE SUSPECTS THEPATRONIS EXPERIENCING SYMPTOMS OF WITHDRAWAL
WHEN WHICH OF THE FOLLOWING ARE ASSESSED? (SELECT ALL THAT APPLY.)
1. MUSCLE TWITCHING AND SPASMS
2. RESTLESSNESS
3. INCREASED HEART RATE
4. DROP IN BLOOD PRESSURE
5. INCREASE IN BLOOD PRESSURE
6. IRRITABILITY
ANSWER: 1, 2, 3, 5, 6
,WITHDRAWAL SYMPTOMS INCLUDE MYOCLONUS OR MUSCLE TWITCHING AND SPASMS, RESTLESSNESS,
IRRITABILITY, INCREASED HEART RATE, AND INCREASED BLOOD PRESSURE. A DECREASE IN BLOOD PRESSURE
IS NOT A SYMPTOM OF NARCOTIC MEDICATION WITHDRAWAL.
PTS:1DIF:ANALYZE
REF: POTENTIAL AND ACTUAL SIDE EFFECTS OF OPIOID ANALGESICS
2. THE NURSE WOULD BE CONCERNED THAT APATRONIS AT RISK FOR DEVELOPING CHRONIC
PAIN WHEN WHICH OF THE FOLLOWING HEALTH PROBLEMS ARE DIAGNOSED? (SELECT ALL THAT
APPLY.)
1. OSTEOARTHRITIS
2. OSTEOPOROSIS
3. HEART DISEASE
4. DIABETES MELLITUS
5. CHRONIC PULMONARY DISEASE
6. ANEMIA
ANSWER: 1, 2, 5
COMMON HEALTH PROBLEMS ASSOCIATED WITH CHRONIC PAIN INCLUDE OSTEOARTHRITIS,
OSTEOPOROSIS, AND CHRONIC PULMONARY DISEASE. HEART DISEASE, DIABETES MELLITUS, AND
ANEMIA ARE NOT ASSOCIATED WITH CHRONIC PAIN.
PTS:1DIF:ANALYZEREF:CHRONIC PAIN
3. AN 84-YEAR-OLDPATRONIS EXPERIENCING SEVERE ARTHRITIS PAIN. THE NURSE REALIZES
THAT WHICH OF THE FOLLOWING PAIN MANAGEMENT APPROACHES WOULD BE THE MOST
BENEFICIAL FOR THIS CLIENT? (SELECT ALL THAT APPLY.)
1. AVOID NSAIDS.
2. UTILIZE MORPHINE OR MORPHINE-LIKE MEDICATION.
3. PROVIDE MEDICATION THROUGH THE ORAL ROUTE.
4. UTILIZE DIAZEPAM.
5. SUGGEST DARVOCET.
6. PROVIDE MEDICATION THROUGH THE INTRAMUSCULAR ROUTE.
ANSWER: 1, 2, 3
, WHEN PROVIDING PAIN MEDICATION TO A GERIATRIC CLIENT, PAIN MANAGEMENT APPROACHES
INCLUDE THE UTILIZATION OF MORPHINE OR MORPHINE-LIKE MEDICATION TO CONTROL PAIN AND
PROVIDE MEDICATION USING THE ORAL ROUTE. NSAIDS SHOULD ALSO BE AVOIDED BECAUSE OF THE
RISK OF GASTROINTESTINAL BLEEDING.
DIAZEPAM SHOULD BE AVOIDED BECAUSE OF A LONG HALF-LIFE. DARVOCET SHOULD BE AVOIDED
BECAUSE OF TOXIC EFFECTS WITH RENAL INSUFFICIENCY. MEDICATION SHOULD NOT BE PROVIDED
USING THE INTRAMUSCULAR ROUTE BECAUSE OF MUSCLE WASTING AND LOSS OF FATTY TISSUE IN THE
ELDERLY CLIENT.
PTS: 1 DIF: APPLY REF: GERIATRIC CONSIDERATIONS
4. APATRONWITH SEVERE PAIN FROM SPINAL STENOSIS IS PRESCRIBED METHADONE. THE
NURSE REALIZES THAT THE ADVANTAGES OF THIS MEDICATION ARE WHAT? (SELECT ALL THAT
APPLY.)
1. DECREASE IN THE NEED FOR ANTIDEPRESSANT ADJUVANT MEDICATION
2. LESS FREQUENT DOSING SCHEDULE
3. LONG HALF-LIFE
4. INEXPENSIVE
5. CAN BE USED FOR INTERMITTENT PAIN
6. DOES NOT CAUSE RESPIRATORY DEPRESSION
ANSWER: 1, 2, 4
THE ADVANTAGES OF METHADONE INCLUDE THAT IT DECREASES THE NEED FOR ANTIDEPRESSANT
ADJUVANT MEDICATION BECAUSE IT INCREASES THE RELEASE OF SEROTONIN AND NOREPINEPHRINE,
DOSING IS EVERY 12 HOURS, AND IT IS INEXPENSIVE. DISADVANTAGES OF THIS MEDICATION INCLUDE:
IT HAS A LONG HALF-LIFE; IT CANNOT BE USED FOR INTERMITTENT PAIN MANAGEMENT; AND IT DOES
CAUSE RESPIRATORY DEPRESSION.
PTS:1DIF:ANALYZEREF:INTRACTABLE PAIN
5. THE NURSE IS USING THE PAINAID SCALE TO ASSESS A CLIENTS LEVEL OF PAIN. WHICH OF THE
FOLLOWING ARE ASSESSED WITH THIS PAIN SCALE? (SELECT ALL THAT APPLY.)
1. BREATHING RATE
2. ASSIGN A NUMBER TO THE DEGREE OF PAIN
3. NEGATIVE VOCALIZATIONS
4. ASSIGN A FACIAL EXPRESSION TO THE DEGREE OF PAIN
5. FACIAL EXPRESSION
6. BODY LANGUAGE
ANSWER: 1, 3, 5, 6
