Test Bank For Critical Care Nursing: Diagnosis and
Management 8th Edition By Linda D. Urden, DNSc, RN, CNS,
NE-BC, FAAN, Kathleen M. Stacy, PhD, RN, CNS, CCRN, PCCN,
CCNS and Ma 9780323447522 Chapter 1-41 Complete Guide .
Which statement best describes the concept of pain?
a.
Pain is an uncomfortable experience present only in the patient with an intact nervous system.
b.
Pain is an unpleasant experience accompanied by crying and tachycardia.
c.
Pain is activation of the sympathetic nervous system from an injury.
d.
Pain is whatever the patient experiencing it says it is, occurring when that patient says it does. -
ANSWER: ANS: D
Pain is described as an unpleasant sensory and emotional experience associated with actual or
potential tissue damage or described in terms of such damage. This definition emphasizes the
subjective and multidimensional nature of pain. More specifically, the subjective characteristic implies
that pain is whatever the person experiencing it says it is and that it exists whenever he or she says it
does.
What are the neural processes of encoding and processing noxious stimuli associated with pain
called?
a.
Perception
b.
Nociception
c.
Transduction
d.
Transmission - ANSWER: ANS: B
Nociception represents the neural processes of encoding and processing noxious stimuli necessary,
but not sufficient, for pain. Transduction refers to mechanical (eg, surgical incision), thermal (eg,
burn), or chemical (eg, toxic substance) stimuli that damage tissues. As a result of transduction, an
action potential is produced and is transmitted by nociceptive nerve fibers in the spinal cord that
reach higher centers of the brain. This is called transmission, and it represents the second process of
nociception. Pain sensation transmitted by the nervous system (NS) pathway reaches the thalamus,
and the pain sensation transmitted by the parasympathetic nervous system (PS) pathway reaches
brainstem, hypothalamus, and thalamus. These parts of the central nervous system (CNS) contribute
to the initial perception of pain.
C fibers are small-diameter, unmyelinated fibers that transmit what type of pain?
a.
Aching
b.
Sharp
c.
Prickling
d.
Concentrated - ANSWER: ANS: A
C fibers are implicated in the transmission of pain described as dull, diffuse, prolonged, and delayed.
Alpha fibers conduct the rapid acute pain sensation described as prickling, sharp, and fast. These
fibers are activated by mechanical and thermal stimuli and are carried by the neospinothalamic tract.
,Which assessment findings might indicate respiratory depression after opioid administration?
a.
Flushed, diaphoretic skin
b.
Shallow respirations with a rate of 24 breaths/min
c.
Tense, rigid posture
d.
Snoring - ANSWER: Answer: D. Snoring is a warning sign. It can be a sign of respiratory depression
associated with airway obstruction by the tongue, leading to hypoxemia and possibly to
cardiorespiratory arrest. A patient snoring after the administration of an opioid requires the critical
care nurse to observe closely.
The patient is admitted to the critical care unit with hemodynamic instability and an allergy to
morphine. The nurse anticipates that the practitioner will order which medication for severe pain?
a.
Hydromorphone
b.
Codeine
c.
Fentanyl
d.
Methadone - ANSWER: Answer: C. Fentanyl is a synthetic opioid preferred for critically ill patients
with hemodynamic instability or morphine allergy. Hydromorphone is a semisynthetic opioid that has
an onset of action and a duration similar to those of morphine. It is more potent than morphine.
Hydromorphone produces an inactive metabolite (ie, hydromorphone-3-glucuronide), making it the
opioid of choice for use in patients with end-stage renal disease. Codeine has limited use in the
management of severe pain. It is rarely used in critical care units. It provides analgesia for mild to
moderate pain. It is usually compounded with a nonopioid. Methadone is a synthetic opioid with
morphine-like properties but less sedation. It is longer acting than morphine and has a long half-life.
This makes it difficult to titrate in the critical care patient
Which combinations of drugs has been found to be effective in managing the pain associated with
musculoskeletal and soft tissue inflammation?
a.
Nonsteroidal antiinflammatory drugs (NSAIDs) and opioids
b.
NSAIDs and antidepressants
c.
Opioid agonists and opioid antagonists
d.
Adjuvants and partial agonists - ANSWER: ANS: A
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with opioids is indicated in
patients with acute musculoskeletal and soft tissue inflammation.
A patient underwent a thoracotomy 12 hours ago and has continuous epidural analgesia with
morphine. In addition to respiratory depression, the patient should be monitored for which
complications?
a.
Urinary retention, undue somnolence, itching, nausea, and vomiting
b.
Urinary incontinence, photophobia, headache, and skin rash
c.
Apprehension, anxiety, restlessness, sadness, anger, and myoclonus
d.
Gastric bleeding, nasal discharge, cerebrospinal fluid leak, and calf pain - ANSWER: ANS: A
, Epidural analgesia is commonly used in critical care units after major abdominal surgery,
nephrectomy, thoracotomy, and major orthopedic procedures. Monitor for adverse reactions,
including respiratory depression, urinary retention, undue somnolence, itching, seizures, nausea, and
vomiting.
A patient underwent a thoracotomy 12 hours ago and has continuous epidural analgesia with
morphine. In addition to closely monitoring the patient for side effects and complications, which
intervention might enhance the patient's pain control?
a.
Maintain her flat in bed during the infusion.
b.
Position her on her right side to encourage flow of the medication across the dura.
c.
Limit visitors and remove any distractions such as television and music.
d.
Consider administration of adjunct medication such as a nonsteroidal antiinflammatory agent. -
ANSWER: ANS: D
Positioning will not affect medication administration, distractions such as visitors and soothing music
can often enhance the effects of pharmacologic pain control, adjuvant medications can help decrease
anxiety, and nonopioid analgesics can provide greater pain relief at the peripheral and central levels.
Instruct and guide patient through nonpharmacologic measures (eg, relaxation therapy, guided
imagery, and biofeedback) to enhance pharmacologic effectiveness. The epidural space is filled with
fatty tissue and is external to the dura mater. The fatty tissue interferes with uptake, and the dura
acts as a barrier to diffusion, making diffusion rate difficult to predict.
Which statement accurately describes the duration of acute pain?
a.
Acute pain is associated with the injury to the joints and lasts about 9 months.
b.
Acute pain is associated with the healing process and should not exceed 6 months.
c.
Acute pain is persistent pain of more than 6 months after the healing process.
d.
Acute pain is associated with damage to the nervous system and is of infinite duration. - ANSWER:
ANS: B
Acute pain has a short duration, and it usually corresponds to the healing process (30 days) but should
not exceed 6 months. It implies tissue damage that is usually from an identifiable cause. If
undertreated, acute pain may bring a prolonged stress response and lead to permanent damage to
the patient's nervous system. In such instances, acute pain can become chronic.
A patient complains of pain at his incision site. The nurse is aware that four processes are involved in
nociception. In what order do the processes occur?
a.
Transmission, perception, modulation, and transduction
b.
Perception, modulation, transduction, and transmission
c.
Modulation, transduction, transmission, and perception
d.
Transduction, transmission, perception, and modulation - ANSWER: ANS: D
Four processes are involved in nociception: transduction, transmission, perception, and modulation.
Why use a specific pain intensity scale in the critical care unit?
a.
It eliminates the subjective component from the assessment.
b.
It focuses on the objective component of the assessment.
Management 8th Edition By Linda D. Urden, DNSc, RN, CNS,
NE-BC, FAAN, Kathleen M. Stacy, PhD, RN, CNS, CCRN, PCCN,
CCNS and Ma 9780323447522 Chapter 1-41 Complete Guide .
Which statement best describes the concept of pain?
a.
Pain is an uncomfortable experience present only in the patient with an intact nervous system.
b.
Pain is an unpleasant experience accompanied by crying and tachycardia.
c.
Pain is activation of the sympathetic nervous system from an injury.
d.
Pain is whatever the patient experiencing it says it is, occurring when that patient says it does. -
ANSWER: ANS: D
Pain is described as an unpleasant sensory and emotional experience associated with actual or
potential tissue damage or described in terms of such damage. This definition emphasizes the
subjective and multidimensional nature of pain. More specifically, the subjective characteristic implies
that pain is whatever the person experiencing it says it is and that it exists whenever he or she says it
does.
What are the neural processes of encoding and processing noxious stimuli associated with pain
called?
a.
Perception
b.
Nociception
c.
Transduction
d.
Transmission - ANSWER: ANS: B
Nociception represents the neural processes of encoding and processing noxious stimuli necessary,
but not sufficient, for pain. Transduction refers to mechanical (eg, surgical incision), thermal (eg,
burn), or chemical (eg, toxic substance) stimuli that damage tissues. As a result of transduction, an
action potential is produced and is transmitted by nociceptive nerve fibers in the spinal cord that
reach higher centers of the brain. This is called transmission, and it represents the second process of
nociception. Pain sensation transmitted by the nervous system (NS) pathway reaches the thalamus,
and the pain sensation transmitted by the parasympathetic nervous system (PS) pathway reaches
brainstem, hypothalamus, and thalamus. These parts of the central nervous system (CNS) contribute
to the initial perception of pain.
C fibers are small-diameter, unmyelinated fibers that transmit what type of pain?
a.
Aching
b.
Sharp
c.
Prickling
d.
Concentrated - ANSWER: ANS: A
C fibers are implicated in the transmission of pain described as dull, diffuse, prolonged, and delayed.
Alpha fibers conduct the rapid acute pain sensation described as prickling, sharp, and fast. These
fibers are activated by mechanical and thermal stimuli and are carried by the neospinothalamic tract.
,Which assessment findings might indicate respiratory depression after opioid administration?
a.
Flushed, diaphoretic skin
b.
Shallow respirations with a rate of 24 breaths/min
c.
Tense, rigid posture
d.
Snoring - ANSWER: Answer: D. Snoring is a warning sign. It can be a sign of respiratory depression
associated with airway obstruction by the tongue, leading to hypoxemia and possibly to
cardiorespiratory arrest. A patient snoring after the administration of an opioid requires the critical
care nurse to observe closely.
The patient is admitted to the critical care unit with hemodynamic instability and an allergy to
morphine. The nurse anticipates that the practitioner will order which medication for severe pain?
a.
Hydromorphone
b.
Codeine
c.
Fentanyl
d.
Methadone - ANSWER: Answer: C. Fentanyl is a synthetic opioid preferred for critically ill patients
with hemodynamic instability or morphine allergy. Hydromorphone is a semisynthetic opioid that has
an onset of action and a duration similar to those of morphine. It is more potent than morphine.
Hydromorphone produces an inactive metabolite (ie, hydromorphone-3-glucuronide), making it the
opioid of choice for use in patients with end-stage renal disease. Codeine has limited use in the
management of severe pain. It is rarely used in critical care units. It provides analgesia for mild to
moderate pain. It is usually compounded with a nonopioid. Methadone is a synthetic opioid with
morphine-like properties but less sedation. It is longer acting than morphine and has a long half-life.
This makes it difficult to titrate in the critical care patient
Which combinations of drugs has been found to be effective in managing the pain associated with
musculoskeletal and soft tissue inflammation?
a.
Nonsteroidal antiinflammatory drugs (NSAIDs) and opioids
b.
NSAIDs and antidepressants
c.
Opioid agonists and opioid antagonists
d.
Adjuvants and partial agonists - ANSWER: ANS: A
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with opioids is indicated in
patients with acute musculoskeletal and soft tissue inflammation.
A patient underwent a thoracotomy 12 hours ago and has continuous epidural analgesia with
morphine. In addition to respiratory depression, the patient should be monitored for which
complications?
a.
Urinary retention, undue somnolence, itching, nausea, and vomiting
b.
Urinary incontinence, photophobia, headache, and skin rash
c.
Apprehension, anxiety, restlessness, sadness, anger, and myoclonus
d.
Gastric bleeding, nasal discharge, cerebrospinal fluid leak, and calf pain - ANSWER: ANS: A
, Epidural analgesia is commonly used in critical care units after major abdominal surgery,
nephrectomy, thoracotomy, and major orthopedic procedures. Monitor for adverse reactions,
including respiratory depression, urinary retention, undue somnolence, itching, seizures, nausea, and
vomiting.
A patient underwent a thoracotomy 12 hours ago and has continuous epidural analgesia with
morphine. In addition to closely monitoring the patient for side effects and complications, which
intervention might enhance the patient's pain control?
a.
Maintain her flat in bed during the infusion.
b.
Position her on her right side to encourage flow of the medication across the dura.
c.
Limit visitors and remove any distractions such as television and music.
d.
Consider administration of adjunct medication such as a nonsteroidal antiinflammatory agent. -
ANSWER: ANS: D
Positioning will not affect medication administration, distractions such as visitors and soothing music
can often enhance the effects of pharmacologic pain control, adjuvant medications can help decrease
anxiety, and nonopioid analgesics can provide greater pain relief at the peripheral and central levels.
Instruct and guide patient through nonpharmacologic measures (eg, relaxation therapy, guided
imagery, and biofeedback) to enhance pharmacologic effectiveness. The epidural space is filled with
fatty tissue and is external to the dura mater. The fatty tissue interferes with uptake, and the dura
acts as a barrier to diffusion, making diffusion rate difficult to predict.
Which statement accurately describes the duration of acute pain?
a.
Acute pain is associated with the injury to the joints and lasts about 9 months.
b.
Acute pain is associated with the healing process and should not exceed 6 months.
c.
Acute pain is persistent pain of more than 6 months after the healing process.
d.
Acute pain is associated with damage to the nervous system and is of infinite duration. - ANSWER:
ANS: B
Acute pain has a short duration, and it usually corresponds to the healing process (30 days) but should
not exceed 6 months. It implies tissue damage that is usually from an identifiable cause. If
undertreated, acute pain may bring a prolonged stress response and lead to permanent damage to
the patient's nervous system. In such instances, acute pain can become chronic.
A patient complains of pain at his incision site. The nurse is aware that four processes are involved in
nociception. In what order do the processes occur?
a.
Transmission, perception, modulation, and transduction
b.
Perception, modulation, transduction, and transmission
c.
Modulation, transduction, transmission, and perception
d.
Transduction, transmission, perception, and modulation - ANSWER: ANS: D
Four processes are involved in nociception: transduction, transmission, perception, and modulation.
Why use a specific pain intensity scale in the critical care unit?
a.
It eliminates the subjective component from the assessment.
b.
It focuses on the objective component of the assessment.
