NUR 224 FINAL EXAM STUDY GUIDE WITH COMPLETE
SOLUTION!!
1.What signs might suggest a patient's increasing pain is related to a
surgical complication rather than normal healing?: Increased pain not
relieved by med- ication, associated with tachycardia, hypotension,
restlessness, or a rigid abdomen may indicate hemorrhage, infection, or
dehiscence alterations requiring immediate medical attention.
2.A patient with peripheral vascular disease complains of calf pain when
walking. What alteration does this suggest?: Intermittent claudication due
to poor perfusion from arterial narrowing requires assessment of
circulation and pain management with underlying disease control
3.What are the 3 main categories of pharmacologic pain relief?: Non-
opioids - e.g., acetaminophen, NSAIDs
Opioids - e.g., morphine, hydromorphone
Adjuvants - e.g., antidepressants, anticonvulsants (for neuropathic pain)
4.What is the role of adjuvant medications in pain management?: They en-
hance the effect of analgesia or treat underlying causes of pain,
especially useful in neuropathic pain or chronic pain conditions
5.According to the WHO pain ladder, what is the next step if a non-opioid
fails to relieve moderate pain?: Add a weak opioid (e.g., codeine,
tramadol) ± non-opioid ± adjuvant
6.What distinguishes chronic pain from acute pain in terms of physiological
signs?: Chronic pain may not show obvious physiological responses
(e.g., ‘ HR or BP), while acute pain often triggers sympathetic responses
7.Why is it important to "stay ahead of the pain"?: Prevents pain
escalation by maintaining consistent analgesia, reducing the total
amount of meds needed and improving comfort and recovery.
8.What strategy should nurses use to maintain consistent pain relief
post-op?: Scheduled doses of analgesics, especially within the first 24-48
hrs, and assess pain before it becomes severe.
9.What is the most concerning side effect of opioids and how is it managed?
: Respiratory depression—monitor RR, sedation level; administer naloxon
if severe
10.How can opioid-induced constipation be prevented?: Prophylactic use
of laxatives, hydration, and activity (if possible)
11.What is naloxone and when should it be used?: Opioid antagonist used
in opioid overdose or severe respiratory depression. Must monitor for
rebound sedation after it wears off
12.Why are antiemetics used in pain management?: To treat opioid-
,induced nausea and vomiting, improving medication adherence and
patient comfort.
,13.Give two common antiemetics used with opioids: Ondansetron
(Zofran) - serotonin antagonist
Metoclopramide (Maxeran) - dopamine antagonist
14.What are the four key processes involved in the pain experience?:
Trans- duction - conversion of noxious stimulus into electrical signal at
the site of injury Transmission - movement of pain signal along
peripheral nerves to the spinal cord and brain
Perception - conscious awareness and interpretation of the pain in the
brain Modulation - inhibition or enhancement of the pain signal (e.g., via
endorphins or medications)
15.In acute nociceptive pain, which processes are most active?: The
body focuses more on transduction and transmission
Goal: Quickly detect and respond to injury (protective mechanism
16.In chronic nociceptive pain, which processes become dominant?:
The body shifts focus to modulation and perception
Pain is no longer just a signal t's now part of central sensitization and ho
the brain interprets ongoing pain
17.Why is this distinction between acute and chronic pain important
for treatment?: Because it guides the choice of interventions:
Acute pain: Focus on stopping the source and blocking transmission (e.g
NSAIDs, opioids)
Chronic pain: Focus on modulation and perception, so treatment may
include antidepressants, anticonvulsants, cognitive therapies, and
physical modalities
18. What systems are affected by the stress response triggered by poorly
man- aged pain?: Endocrine system - ‘ cortisol ’ worsens glucose
regulation, suppresses healing
Immune system - suppressed ’ ‘ risk of infection
Inflammatory system - increased cytokines ’ delays recovery, increases
inflammation
19.What vital signs should a nurse monitor in a patient with
superimposed pain?: Blood pressure - may be elevated due to stress
Respiratory rate - can increase due to pain or shallow breathing (esp.
post-op) Heart rate - tachycardia may indicate uncontrolled pain
20.What is the nursing implication of this information?: Nurses must
prioritize timely pain assessment and management, and recognize that
pain is more than a number—it affects the whole person, including their
recovery and quality of life
21.What is multimodal analgesia, and why is it recommended?: A strategy
, that combines two or more analgesics with different mechanisms of
action to achieve: Better pain control
Lower doses of each drug
SOLUTION!!
1.What signs might suggest a patient's increasing pain is related to a
surgical complication rather than normal healing?: Increased pain not
relieved by med- ication, associated with tachycardia, hypotension,
restlessness, or a rigid abdomen may indicate hemorrhage, infection, or
dehiscence alterations requiring immediate medical attention.
2.A patient with peripheral vascular disease complains of calf pain when
walking. What alteration does this suggest?: Intermittent claudication due
to poor perfusion from arterial narrowing requires assessment of
circulation and pain management with underlying disease control
3.What are the 3 main categories of pharmacologic pain relief?: Non-
opioids - e.g., acetaminophen, NSAIDs
Opioids - e.g., morphine, hydromorphone
Adjuvants - e.g., antidepressants, anticonvulsants (for neuropathic pain)
4.What is the role of adjuvant medications in pain management?: They en-
hance the effect of analgesia or treat underlying causes of pain,
especially useful in neuropathic pain or chronic pain conditions
5.According to the WHO pain ladder, what is the next step if a non-opioid
fails to relieve moderate pain?: Add a weak opioid (e.g., codeine,
tramadol) ± non-opioid ± adjuvant
6.What distinguishes chronic pain from acute pain in terms of physiological
signs?: Chronic pain may not show obvious physiological responses
(e.g., ‘ HR or BP), while acute pain often triggers sympathetic responses
7.Why is it important to "stay ahead of the pain"?: Prevents pain
escalation by maintaining consistent analgesia, reducing the total
amount of meds needed and improving comfort and recovery.
8.What strategy should nurses use to maintain consistent pain relief
post-op?: Scheduled doses of analgesics, especially within the first 24-48
hrs, and assess pain before it becomes severe.
9.What is the most concerning side effect of opioids and how is it managed?
: Respiratory depression—monitor RR, sedation level; administer naloxon
if severe
10.How can opioid-induced constipation be prevented?: Prophylactic use
of laxatives, hydration, and activity (if possible)
11.What is naloxone and when should it be used?: Opioid antagonist used
in opioid overdose or severe respiratory depression. Must monitor for
rebound sedation after it wears off
12.Why are antiemetics used in pain management?: To treat opioid-
,induced nausea and vomiting, improving medication adherence and
patient comfort.
,13.Give two common antiemetics used with opioids: Ondansetron
(Zofran) - serotonin antagonist
Metoclopramide (Maxeran) - dopamine antagonist
14.What are the four key processes involved in the pain experience?:
Trans- duction - conversion of noxious stimulus into electrical signal at
the site of injury Transmission - movement of pain signal along
peripheral nerves to the spinal cord and brain
Perception - conscious awareness and interpretation of the pain in the
brain Modulation - inhibition or enhancement of the pain signal (e.g., via
endorphins or medications)
15.In acute nociceptive pain, which processes are most active?: The
body focuses more on transduction and transmission
Goal: Quickly detect and respond to injury (protective mechanism
16.In chronic nociceptive pain, which processes become dominant?:
The body shifts focus to modulation and perception
Pain is no longer just a signal t's now part of central sensitization and ho
the brain interprets ongoing pain
17.Why is this distinction between acute and chronic pain important
for treatment?: Because it guides the choice of interventions:
Acute pain: Focus on stopping the source and blocking transmission (e.g
NSAIDs, opioids)
Chronic pain: Focus on modulation and perception, so treatment may
include antidepressants, anticonvulsants, cognitive therapies, and
physical modalities
18. What systems are affected by the stress response triggered by poorly
man- aged pain?: Endocrine system - ‘ cortisol ’ worsens glucose
regulation, suppresses healing
Immune system - suppressed ’ ‘ risk of infection
Inflammatory system - increased cytokines ’ delays recovery, increases
inflammation
19.What vital signs should a nurse monitor in a patient with
superimposed pain?: Blood pressure - may be elevated due to stress
Respiratory rate - can increase due to pain or shallow breathing (esp.
post-op) Heart rate - tachycardia may indicate uncontrolled pain
20.What is the nursing implication of this information?: Nurses must
prioritize timely pain assessment and management, and recognize that
pain is more than a number—it affects the whole person, including their
recovery and quality of life
21.What is multimodal analgesia, and why is it recommended?: A strategy
, that combines two or more analgesics with different mechanisms of
action to achieve: Better pain control
Lower doses of each drug
