Chapter 12: Pain Management
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical
Nursing, 13th Edition
MULTIPLE CHOICE
1. The nurse who is a member of the palliative care team is assessing a patient.
The patient indicates that he has been saving his PRN analgesics until the pain
is intense because his pain control has been inadequate. What teaching should
the nurse do with this patient?
A) Medication should be taken when pain levels are low so the pain is easier to reduce.
B) Pain medication can be increased when the pain becomes intense.
C) It is difficult to control chronic pain, so this is an inevitable part of the disease
process.
D) The patient will likely benefit more from distraction than pharmacologic
interventions.
ANS: A
Better pain control can be achieved with a preventive approach, reducing the
amount of time patients are in pain. Low levels of pain are easier to reduce or
control than intense levels of pain. Pain medication is used to prevent pain so
pain medication is not increased when pain becomes intense. Chronic pain is
treatable. Giving the patient alternative methods to control pain is good, but it
will not work if the patient is in so much pain that he cannot institute reliable
alternative methods.
2. Two patients on your unit have recently returned to the postsurgical unit after
knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain
scale, whereas the other patient is reporting a pain level of 3 to 4 on the same
pain scale. What is the nurse's most plausible rationale for understanding the
patients' different perceptions of pain?
A) Endorphin levels may vary between patients, affecting the perception of pain.
B) One of the patients is exaggerating his or her sense of pain.
, C) The patients are likely experiencing a variance in vasoconstriction.
D) One of the patients may be experiencing opioid tolerance.
ANS: A
Different people feel different degrees of pain from similar stimuli. Opioid
tolerance is associated with chronic pain treatment and would not likely apply to
these patients. The nurse should not assume the patient is exaggerating the pain
because the patient is the best authority of his or her existence of pain, and
definitions for pain state that pain is whatever the person says it is, existing
whenever the experiencing person says it does.
3. You are frequently assessing an 84-year-old woman's pain after she suffered a
humeral fracture in a fall. When applying the nursing process in pain
management for a patient of this age, what principle should you best apply?
A) Monitor for signs of drug toxicity due to a decrease in metabolism.
B) Monitor for an increase in absorption of the drug due to age-related changes.
C) Monitor for a paradoxical increase in pain with opioid administration.
D) Administer analgesics every 4 to 6 hours as ordered to control pain.
ANS: A
Older people may respond differently to pain than younger people. Because
elderly people have a slower metabolism and a greater ratio of body fat to
muscle mass compared with younger people, small doses of analgesic agents
may be sufficient to relieve pain, and these doses may be effective longer. This
fact also corresponds to an increased risk of adverse effects. Paradoxical effects
are not a common phenomenon. Frequency of administration will vary widely
according to numerous variables.
, 4. The nurse is assessing a patient's pain while the patient awaits a
cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When
asked, the patient rates his pain as a 2 at this time using a 0-to-10 pain scale.
How should the nurse best respond to this assessment finding?
A) Remind the patient that he is indeed experiencing pain.
B) Reinforce teaching about the pain scale number system.
C) Reassess the patient's pain in 30 minutes.
D) Administer an analgesic and then reassess.
ANS: B
The patient is physically exhibiting signs and symptoms of pain. Further
teaching may need to be done so the patient can correctly rate the pain. The
nurse may also verify that the same scale is being used by the patient and
caregiver to promote continuity. Although all answers are correct, the most
accurate conclusion would be to reinforce teaching about the pain scale.
5. You are creating a nursing care plan for a patient with a primary diagnosis of
cellulitis and a secondary diagnosis of chronic pain. What common trait of
patients who live with chronic pain should inform your care planning?
A) They are typically more comfortable with underlying pain than
patients without chronic pain.
B) They often have a lower pain threshold than patients without chronic pain.
C) They often have an increased tolerance of pain.
D) They can experience acute pain in addition to chronic pain.
ANS: D
It is tempting to expect that people who have had multiple or prolonged
experiences with pain will be less anxious and more tolerant of pain than those
who have had little experience with pain. However, this is not true for many
people. The more experience a person has had with pain, the more frightened he
or she may be about subsequent painful events. Chronic pain and acute pain are
not mutually exclusive.
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical
Nursing, 13th Edition
MULTIPLE CHOICE
1. The nurse who is a member of the palliative care team is assessing a patient.
The patient indicates that he has been saving his PRN analgesics until the pain
is intense because his pain control has been inadequate. What teaching should
the nurse do with this patient?
A) Medication should be taken when pain levels are low so the pain is easier to reduce.
B) Pain medication can be increased when the pain becomes intense.
C) It is difficult to control chronic pain, so this is an inevitable part of the disease
process.
D) The patient will likely benefit more from distraction than pharmacologic
interventions.
ANS: A
Better pain control can be achieved with a preventive approach, reducing the
amount of time patients are in pain. Low levels of pain are easier to reduce or
control than intense levels of pain. Pain medication is used to prevent pain so
pain medication is not increased when pain becomes intense. Chronic pain is
treatable. Giving the patient alternative methods to control pain is good, but it
will not work if the patient is in so much pain that he cannot institute reliable
alternative methods.
2. Two patients on your unit have recently returned to the postsurgical unit after
knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain
scale, whereas the other patient is reporting a pain level of 3 to 4 on the same
pain scale. What is the nurse's most plausible rationale for understanding the
patients' different perceptions of pain?
A) Endorphin levels may vary between patients, affecting the perception of pain.
B) One of the patients is exaggerating his or her sense of pain.
, C) The patients are likely experiencing a variance in vasoconstriction.
D) One of the patients may be experiencing opioid tolerance.
ANS: A
Different people feel different degrees of pain from similar stimuli. Opioid
tolerance is associated with chronic pain treatment and would not likely apply to
these patients. The nurse should not assume the patient is exaggerating the pain
because the patient is the best authority of his or her existence of pain, and
definitions for pain state that pain is whatever the person says it is, existing
whenever the experiencing person says it does.
3. You are frequently assessing an 84-year-old woman's pain after she suffered a
humeral fracture in a fall. When applying the nursing process in pain
management for a patient of this age, what principle should you best apply?
A) Monitor for signs of drug toxicity due to a decrease in metabolism.
B) Monitor for an increase in absorption of the drug due to age-related changes.
C) Monitor for a paradoxical increase in pain with opioid administration.
D) Administer analgesics every 4 to 6 hours as ordered to control pain.
ANS: A
Older people may respond differently to pain than younger people. Because
elderly people have a slower metabolism and a greater ratio of body fat to
muscle mass compared with younger people, small doses of analgesic agents
may be sufficient to relieve pain, and these doses may be effective longer. This
fact also corresponds to an increased risk of adverse effects. Paradoxical effects
are not a common phenomenon. Frequency of administration will vary widely
according to numerous variables.
, 4. The nurse is assessing a patient's pain while the patient awaits a
cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When
asked, the patient rates his pain as a 2 at this time using a 0-to-10 pain scale.
How should the nurse best respond to this assessment finding?
A) Remind the patient that he is indeed experiencing pain.
B) Reinforce teaching about the pain scale number system.
C) Reassess the patient's pain in 30 minutes.
D) Administer an analgesic and then reassess.
ANS: B
The patient is physically exhibiting signs and symptoms of pain. Further
teaching may need to be done so the patient can correctly rate the pain. The
nurse may also verify that the same scale is being used by the patient and
caregiver to promote continuity. Although all answers are correct, the most
accurate conclusion would be to reinforce teaching about the pain scale.
5. You are creating a nursing care plan for a patient with a primary diagnosis of
cellulitis and a secondary diagnosis of chronic pain. What common trait of
patients who live with chronic pain should inform your care planning?
A) They are typically more comfortable with underlying pain than
patients without chronic pain.
B) They often have a lower pain threshold than patients without chronic pain.
C) They often have an increased tolerance of pain.
D) They can experience acute pain in addition to chronic pain.
ANS: D
It is tempting to expect that people who have had multiple or prolonged
experiences with pain will be less anxious and more tolerant of pain than those
who have had little experience with pain. However, this is not true for many
people. The more experience a person has had with pain, the more frightened he
or she may be about subsequent painful events. Chronic pain and acute pain are
not mutually exclusive.
