Lewis Med Surg Ch. 9 – Pain Exam Practice Questions and Answers

Lewis Med Surg Ch. 9 – Pain Exam Practice Questions and Answers A 45-year-old woman who had abdominal surgery yesterday received IV pain medication 30 minutes ago. Which assessment by the nurse would most accurately determine the effectiveness of the medication? A. The patient is resting quietly with eyes closed and is not grimacing. B. The patient is talking with visitors and intermittently watching the television. C. The patient states the pain has decreased from an 8 to a 3 on a 0 to 10 pain scale. D. The patient's heart rate is 78 beats/minute with a blood pressure of 122/76 mm Hg. - Ans:-C. The patient states the pain has decreased from an 8 to a 3 on a 0 to 10 pain scale. Pain is a subjective experience. The patient is the best judge of his or her own pain and is the expert on the effectiveness of treatment of the pain. Which patient is most at risk for respiratory depression related to opioid administration for pain relief? ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/19 A. 82-year-old patient who had abdominal surgery 4 hours ago B. 24-year-old patient who had a vaginal delivery 12 hours ago C. 32-year-old patient with chronic neuropathic pain for 6 months D. 20-year-old patient with a closed reduction of a fractured right arm - Ans:-A. 82-year-old patient who had abdominal surgery 4 hours ago Patients most at risk for respiratory depression include those who are older, have underlying lung disease, have a history of sleep apnea, or are receiving other central nervous system depressants. For postoperative patients the greatest risk is in the first 24 hours after surgery. Respiratory depression related to opioid administration is higher in hospitalized patients who are opioid naïve. The registered nurse (RN) is caring for patients on a surgical unit. Which tasks may the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? A. Administer oral pain medications to a patient after abdominal surgery. B. Teach the patient how to use patient-controlled analgesia after surgery. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/19 C. Determine strategies for pain management as part of a patient's discharge plan. D. Evaluate whether the pain management plan is providing adequate pain control. - Ans:-A. Administer oral pain medications to a patient after abdominal surgery. An LPN/LVN may administer ordered pain medications, but depending on the state nurse practice act and agency policy, the LPN/LVN may not be able to administer medication by all routes. The tasks of teaching, evaluation, and discharge planning are within the scope of practice of an RN. A 68-year-old man has chronic pain because of lung cancer that has metastasized to the bone in his back and hip. The nurse is teaching the patient and his family about tolerance and physical dependence to opioid medications. Which statement, if made by the patient, indicates a need for further teaching? A. "High doses of the medication may cause more side effects than lower doses." B. "If I need higher doses of the drug to relieve pain, I have developed an addiction." C. "Physical dependence is expected when this drug is used for long periods of time." D. "I may eventually need a higher dose of the medication to get the same pain relief." - Ans:-B. "If I need higher doses of the drug to relieve pain, I have developed an addiction." ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/19 Tolerance and physical dependence are not indicators of addiction. Tolerance and physical dependence are normal physiologic responses to chronic exposure to opioids. Tolerance is the need for an increased opioid dose to maintain the same degree of analgesia. Physical dependence is manifested by a withdrawal syndrome that occurs when blood levels of the drug are abruptly decreased. Tolerance is a condition characterized by aberrant behaviors arising from a drive to obtain and take substances for reasons other than the prescribed therapeutic value. The nurse is developing a treatment regimen for an active 78-year-old woman who has osteoarthritis with chronic joint pain. Which modality would be the safest for this patient? A. Regular exercise program and acetaminophen as needed B. High-dose opioids titrated to reach an acceptable pain level C. Placebo to reduce the risk of adverse medication side effects D. Regularly scheduled doses of nonsteroidal antiinflammatory drugs - Ans:-A. Regular exercise program and acetaminophen as needed ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/19 Treatment regimens for older adults should include nondrug modalities such as exercise. Acetaminophen should be used whenever possible instead of nonsteroidal antiinflammatory drugs that have a high incidence of serious GI bleeding when used in older adults. In older adults, opioids should be initiated at low doses and titrated upward while monitoring carefully for side effects. The use of placebos in clinical practice to assess or treat pain outside of the situation of informed consent in research studies is unethical. Before administering celecoxib (Celebrex), the nurse will assess the patient's medical record for which medication that would increase the risk of adverse effects? A. Aspirin B. Scopolamine C. Theophylline D. Acetaminophen - Ans:-A. Aspirin Celecoxib is a nonsteroidal antiinflammatory drug (NSAID) of the cyclooxygenase-2 (COX-2) inhibitor type. Although celecoxib does not inhibit COX-1 and thus has a decreased risk of bleeding, bleeding is still of concern as an adverse effect. For this reason, the drug should not be taken with other drugs that increase risk of bleeding, such as aspirin. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 6/19 After administering acetaminophen and oxycodone (Percocet) for pain, which intervention would be of highest priority for the nurse to complete before leaving the patient's room? A. Leave the overbed light on at low setting. B. Ensure that the upper two side rails are raised. C. Offer to turn on the television to provide distraction. D. Ensure that documentation of intake and output is accurate. - Ans:-B. Ensure that the upper two side rails are raised