Test Bank For Critical Care Nursing- A Holistic Approach 11th
Edition By Patricia G. Morton; Dorrie K. Fontaine
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
Edition By Patricia G. Morton; Dorrie K. Fontaine
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
