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[Osborn] chapter 15

Learning Outcomes [Number and Title]


Learning Outcome 1
Recognize pain as a distinct and frequently encountered human
problem in the health care field.
Learning Outcome 2
Compare and contrast the ethical and legal issues related to
pain and pain management.
Learning Outcome 3
Distinguish the sensory, cognitive, affective, and behavioral
components of pain.
Learning Outcome 4
Apply common pain assessment tools and strategies to elicit
details of the multidimensional pain experience.
Learning Outcome 5
Differentiate between acute, chronic, and cancer-related pain.
Learning Outcome 6
Describe and give examples of basic pharmacodynamic and
pharmacokinetic properties of commonly used pharmacologic
therapies, including the role of balanced analgesia in pain
management.
Learning Outcome 7
Examine the usefulness of nonmedication interventions to
alleviate pain in clinical practice.
Learning Outcome 8
Apply nursing pain management techniques in relation to
established theories and current research.
Learning Outcome 9
Specify the major patient-related barriers to adequate pain
management and demonstrate effective collaboration as a
nurse-member of a multidisciplinary team in the management
of pain.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

1. While caring for a nonverbal patient, which of the following ensures appropriate and
timely pain management?
1. Medicate the patient based on the pathologic condition, nonverbal cues, and pain
procedures.
2. Have the family medicate the patient, based on their knowledge of the patients
response to pain.
3. Administer non-narcotic analgesics around the clock, adding narcotic analgesia
when necessary.
4. Use the McGill pain questionnaire to determine the optimal pain management
plan.
Correct Answer: Medicate the patient based on the pathologic condition, nonverbal cues,
and pain procedures.
Rationale: Use of a behavioral pain assessment in addition to administering analgesics
based on what would be considered a painful condition or procedure to others is the
standard of practice. The family members most likely do not have knowledge of
pharmacology and physiologic parameters to make pain management decisions, and in
fact, out of concern, may over-read the presence of pain. The appropriate analgesic
should be used for the situation; a non-narcotic analgesic may be all that is needed. The
McGill questionnaire requires the clients input regarding pain and impact on ADLs and
therefore is not an appropriate screening tool.
Cognitive Level: Applying
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

2. The nurse in the emergency department is caring for a patient with a fractured tibia and
fibula who admits to regular heroin use. Which of the following should be used to
determine the presence of pain and need for pain medication?
1. The patient reports pain in the leg of an intensity of 10 out of 10 on the numeric
rating scale.
2. The shift report indicates the patient has been sleeping on and off.
3. The patient is angry he is in the hospital.
4. The patient has taken an opiate already today.
Correct Answer: The patient reports pain in the leg of an intensity of 10 out of 10 on the
numeric rating scale.
Rationale: The nurse should accept all patient pain reports as valid, but negotiate
treatment goals early in care. The clients report of pain is the best means of assessing
pain intensity. A client in pain may appear asleep or have closed eyes, but the quality of
sleep may be poor. Anger at the nursing staff does not reflect the presence or absence of
pain. A chronic opiate user/abuser will experience withdrawal symptoms if the usual or
base dose of opiate is not given and then additional medication added for pain.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

3. The nurse assessing a patient with chronic pain learns the patient is not able to sleep
throughout the night. The nurse realizes this patient is demonstrating:
1.
2.
3.
4.

Sleep deprivation because of poor pain control.


A side effect of chronic pain medication use.
The inability to cope with pain.
A way to be prescribed more pain medication without an identified need.

Correct Answer: Sleep deprivation because of poor pain control.


Rationale: Pain has been associated with agitation, decreased mobility, and sleep
deprivation. There is no evidence to suggest that this patient is experiencing a side effect
of pain medication use or does not have the ability to copy with pain. The nurse should be
nonjudgmental and not assume the patient is attempting to obtain more pain medication
without an identified need.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Health Promotion and Maintenance
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

4. The nurse is administering analgesic medication to a group of clients. Which of the


following is most correct regarding the ethical issues in pain management?
1.
2.
3.
4.

Pain should be managed to improve the patients quality of life.


Opiates are not recommended for patients with addiction issues.
Patients with psychiatric diseases should avoid opiates for malignant pain.
The nurse should be certain pain is present prior to administering opiates.

Correct Answer: Pain should be managed to improve the patients quality of life.
Rationale: The purpose of effective pain management is to relieve/reduce pain to improve
the quality of life. Opiates may be needed in clients with addiction issues if severe pain is
present; the dosage is adjusted to include the daily intake, plus additional medicine to
control pain. Patients with psychiatric disorders will still experience pain and are entitled
to equivalent pain relief of those without psychiatric disorders. If the nurse follows the
definition of pain as what the client describes, then the nurses role is to respond to the
clients report of pain.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

5. Which of the following represents an ethical/legal issue in pain management that


requires further assessment and investigation?
1. Withholding information from the supervisor that a narcotic was taken for
personal use by a staff member
2. Administering a higher-than-usual dose of an opiate analgesic to a patient with
malignant pain
3. Managing pain in a client with a history of narcotic addiction
4. Utilizing sedation with analgesia during the management of pain
Correct Answer: 1. Withholding information from the supervisor that a narcotic was
taken for personal use
Rationale: Diverting narcotics or controlled substances for personal use is illegal and
unethical. Impaired nurses should be reported to the supervisor so appropriate treatment
may be given. Clients with malignant pain may develop tolerance to opiates over time
and require more analgesic than the opiate-nave client. Clients with narcotic addiction
and abuse will still require analgesic medication if pain is present, following the
stepladder approach outlined by the World Health Organization. Using sedation with
analgesic medications is considered and adjunct in pain management and is acceptable
practice.
Cognitive Level: Analyzing
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

6. A patient says that she has pain every day but never asks her health care provider for
medication because she doesnt want to become addicted. Whish of the following is the
nurses best response to this patient?
1.
2.
3.
4.

There are many medications your doctor can prescribe that are not addicting.
I wouldnt want to become addicted either.
Its better to experience the pain than to cover it up.
Pain isnt always a bad thing to experience.

Correct Answer: There are many medications your doctor can prescribe that are not
addicting.
Rationale: This patients fear of becoming addicted to pain medication is evidence of
inaccurate consumer education and consumer fears. The nurse should suggest that the
patient talk with her health care provider regarding pain medication alternatives. The
nurse should not support the patients fears regarding addiction. The nurse should not
minimize the impact of the patients pain on her ability to function or experience the pain.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

7. When performing a complete pain assessment, which of the following data indicate
assessment of pain in the affective domain?
1.
2.
3.
4.

This pain is punishment for my misdeeds.


The pain is a 9 on a scale of 1 to 10.
The pain comes in waves in my abdomen.
The patient is pale and moaning.

Correct Answer: This pain is punishment for my misdeeds.


Rationale: The affective domain is the emotions or feeling associated with the pain. Pain
scales are tools to determine the severity of the pain. The quality of pain coming in waves
is a subjective report of the sensory component of pain. The patient appearing pale and
moaning is an objective finding.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

8. When assessing the sensory component of pain, __________ is a description indicative


of neuropathic pain.
1.
2.
3.
4.

Burning and shooting


Heavy and squeezing
Colicky coming in waves
Sore and tender

Correct Answer: Burning and shooting


Rationale: Neuropathic pain is described as tingling, burning, shooting, electric, or shocklike. Heavy, squeezing, colicky, and sore and tender are nociceptive types of pain.
Cognitive Level: Applying
Nursing Process: Assessing
Client Need: Physiological Integrity
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

9. A patient is seen resting quietly; however, when the nurse enters the room, the patient
begins to grimace and asks for more pain medication. Which of the following should the
nurse do?
1. Assess the level of pain and provide the requested pain medication.
2. Confront the patient and ask about the sudden demonstration of pain.
3. Tell the patient that medication cannot be provided at this time and leave the
room.
4. Refuse the medication and document that the patient appears to be faking the need
for pain medication.
Correct Answer: Assess the level of pain and provide the requested pain medication.
Rationale: The behavioral dimension of pain states that responses to pain can be
situational, developmental, or learned. Failure to respond to a patients complaint of pain
may lead to learned pain behaviors. The patient may have learned that unless she has an
open demonstration of pain, the complaint of pain might be ignored. The nurse should
assess the level of pain and provide the medication. The nurse should not confront the
patient, deny the medication, or document the patient faking the need for medication.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Psychosocial Integrity
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

10. The nurse is performing a multidimensional pain assessment. Which of the following
should be included in this type of assessment?
Select all that apply.
1.
2.
3.
4.
5.

How are you managing your daily activities?


Can you point to the area of pain?
How does the pain make you feel?
Can you rate the pains severity?
Is there a history of similar pain in your family?

Correct Answer:
1. How are you managing your daily activities?
2. Can you point to the area of pain?
3. How does the pain make you feel?
4. Can you rate the pains severity?
Rationale:
How are you managing your daily activities? A multidimensional pain assessment
tool assesses more than one dimension of pain, including the clients ability to participate
in ADLs and quality of life. Can you point to the area of pain? A multidimensional
pain assessment tool assesses more than one dimension of pain, including the area of
pain. How does the pain make you feel? A multidimensional pain assessment tool
assesses more than one dimension of pain, including the quality and characteristics of
pain. Can you rate the pains severity? A multidimensional pain assessment tool
assesses more than one dimension of pain, including pain intensity. Is there a history of
similar pain in your family? The client is the focus of the pain assessment, not the
family.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

11. The nurse is assessing a patient who is unable to supply a self-report of pain. Which
of the following should the nurse do to further assess the clients pain?
1.
2.
3.
4.

Use a proxy pain rating from the family or caregiver.


Document the clients pain using a numeric rating scale.
Document that the client cannot scale his pain.
Use the McGill pain questionnaire to assess the pain.

Correct Answer: Use a proxy pain rating from the family or caregiver.
Rationale: Using a proxy pain rating from caregivers and family is an acceptable
assessment strategy for at-risk patients. The client who cannot report his pain will be
unable to use the numeric rating scale. Documenting that the client cannot scale his pain
is not an assessment tool. The client must be aware and able to answer questions
regarding pain and quality of life to use the McGill pain questionnaire.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

12. The nurse is reviewing a patients completed pain assessment questionnaire that
provides information about the impact of pain on the ability to function. The pain
assessment tool the patient completed was most likely the:
1.
2.
3.
4.

Brief Pain Inventory.


Simple Verbal Descriptive Scale.
Visual Analog Scale.
Numeric Rating Scale.

Correct Answer: Brief Pain Inventory.


Rationale: The Brief Pain Inventory asks multiple questions regarding pain and its impact
on patient function and addresses the multidimensionality of the pain experience. The
Simple Verbal Descriptive Scale asks the patient to rate the pain from no pain to
excruciating. The Visual Analog Scale uses No Pain and Pain as Bad as It Can
Possibly Be as descriptors at either end of a horizontal line measuring 10 centimeters in
length. Each centimeter on the scale corresponds to a number from 0 to 10. The Numeric
Rating Scale uses a horizontal line and the patient is asked to rate pain on a scale from 0
to 10.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

13. When conducting a class on pain for a group of nursing students, the nurse teaches
that which of the following is typical of chronic pain?
1.
2.
3.
4.

The pain rating may be inconsistent with underlying pathology.


There is usually a clear physiologic cause.
Pain typically lasts 6 months or less.
The pain reported is usually less severe than acute pain.

Correct Answer: The pain rating may be inconsistent with underlying pathology.
Rationale: Chronic pain is typically of 3 to 6 months in duration and may not have an
identified physiologic cause. The client might not exhibit signs of pain such as elevations
in vital signs, grimacing, writhing, or moaning as adaptation to the pain occurring. There
is no indication that chronic pain is less severe than acute pain, although in some
instances it may be more diffuse.
Cognitive Level: Analyzing
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

14. The nurse is managing care for a group of clients with pain. Which of the following is
an example of a process that may cause acute pain?
1.
2.
3.
4.

Cholecystectomy
Phantom limb pain
Complex regional pain syndrome
Degenerative joint disease

Correct Answer: Cholecystectomy


Rationale: Surgical pain, such as after gallbladder removal, is considered acute pain
because it should have a duration of less than 6 months. The neuropathic pain associated
with amputation, phantom limb pain, may not begin immediately and may become a
chronic problem lasting more than 6 months. Complex regional pain syndrome is a
chronic exaggerated response to a painful stimulus. Degenerative joint disease is chronic
and though it may not progress, it does not usually improve.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

15. The nurse is planning care for a patient with chronic pain. Which of the following
would be the most appropriate pain control goal for this patient?
1.
2.
3.
4.

Reduce the focus on pain.


Reduce the sympathetic stress response.
Be completely pain free.
Improve patient outcomes.

Correct Answer: Reduce the focus on pain.


Rationale: Pain management goals for the patient with chronic pain include reducing the
focus on pain; optimizing comfort through the use of analgesics and alternative pain
control strategies; increasing participation in activities of daily living, work, and
relationships; and restoring a sense of joy and purpose despite the presence of pain.
Reducing the sympathetic pain response and improving patient outcomes would be
appropriate acute pain management goals. Being completely pain free might be an
unattainable goal for a patient with chronic pain.
Cognitive Level: Applying
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

16. The nurse is caring for a client with prostate cancer with metastasis to S-1 and the
adjacent nerve root. The client complains of unrelenting pain. When collaborating with
the provider, which of the following examples of balanced analgesia would the nurse
advocate for?
1. Use of an opioid for background pain and gabapentin (Neurontin) for the
neuropathic pain.
2. Use of an opioid around the clock rather than on an as-needed (PRN ) basis.
3. Use of escalating doses of a narcotic analgesic per the third step of the World
Health Organization (WHO) analgesic ladder.
4. Begin with the first step of the analgesic ladder as described by the World Health
Organization (WHO), and then evaluate the clients response.
Correct Answer: Use of an opioid for background pain and gabapentin (Neurontin) for
the neuropathic pain.
Rationale: Balanced analgesia or multimodal analgesia allows improved analgesia that is
not possible with a single medication; various medications and adjunctive therapies are
used to target specific types of pain and provide optimal relief in a safe manner. The use
of around-the-clock medication over PRN is appropriate; however, it does not address
balanced analgesia. The step approach according to the WHO that permits the provider to
begin at the lowest step and move through each step to reach the top is not necessary, nor
does it address balanced analgesia.
Cognitive Level: Applying
Nursing Process: Planning
Client Need: Safe, Effective Care Environment
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

17. The nurse is evaluating the client receiving hydromorphone (Dilaudid) for side effects
of the medication. Which of the following reflect side effects of this medication?
Select all that apply.
1.
2.
3.
4.
5.

Respiratory rate less than 12


Pruritis
Nausea
Tachypnea
Polyuria

Correct Answer:
1. Respiratory rate less than 12
2. Pruritis
3. Nausea
Rationale: Respiratory rate less than 12. Side effects of narcotic or opioid analgesics
include respiratory depression. Pruritis. Side effects of narcotic or opioid analgesics
include itching (pruritis). Nausea. Side effects of narcotic or opioid analgesics include
nausea and vomiting. Tachypnea. Tachypnea refers to rapid breathing, which is not
consistent with a side effect of respiratory depression. Polyuria. Polyuria, excessive urine
output, does not occur with opiates.
Cognitive Level: Analyzing
Nursing Process: Evaluation
Client Need: Physiological Integrity
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

18. A patient is prescribed ibuprofen for back pain. The nurse realizes this analgesic:
1. Is the first step in the World Health Organizations three-step approach to pain
management.
2. Should be used with caution in patients who consume more than three alcoholic
beverages per day.
3. Can be taken safely up to the day of a surgical procedure.
4. Needs to be taken at a higher dose if administered with an opioid.
Correct Answer: Is the first step in the World Health Organizations three-step approach
to pain management.
Rationale: Acetaminophen and nonsteroidal anti-inflammatory drugs such as ibuprofen
are considered the first step in the World Health Organizations three-step approach to
pain management. Acetaminophen should be used with caution in patients who consume
more than three alcoholic beverages per day. Nonsteroidal anti-inflammatory drugs
should be discontinued 1 to 2 weeks prior to a surgical procedure to reduce the risk of
bleeding. If a nonsteroidal anti-inflammatory drug is administered with an opioid, the
opioid dose can be reduced.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

19. The nurse plans to include nonpharmacologic pain management strategies when
caring for patients experiencing pain. Which of the following rationales best explains
why massage is helpful for pain relief?
1. Skin stimulation inhibits transmission of impulses from the spinal cord to the
brain.
2. Vasoconstriction due to heat application prevents prostaglandin release.
3. Friction from massage causes heat in the area, which distracts the patient from the
pain.
4. Massage will mask the symptoms of pain during the massage and for several
hours after.
Correct Answer: Skin stimulation inhibits transmission of impulses from the spinal cord
to the brain.
Rationale: According to the gate control theory of pain, stimulation of nerves that do not
transmit pain signals can interfere with signals from pain fibers, thereby inhibiting pain.
Massage stimulates the nonpain fibers and closes the gate to perception of painful
sensations. Heat application is not discussed in this scenario. Masking the symptoms of
pain is vague and not specific to the scientific rationale of the gate control theory of pain.
Cognitive Level: Applying
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 7

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

20. A client experiencing chronic back pain asks how a TENS unit works. Which of the
following should the nurse teach the patient?
1. The TENS unit produces a tingling or vibrating sensation, which stimulates
nonpain receptors.
2. The TENS unit alternates heat and cold to decrease inflammation and promote
vasodilation.
3. The TENS unit provides for a slow release of non-narcotic analgesic that is
absorbed through the skin.
4. The TENS unit promotes muscle relaxation through a biofeedback mechanism.
Correct Answer: The TENS unit produces a tingling or vibrating sensation that
stimulates nonpain receptors.
Rationale: The TENS unit is applied to the site of pain and emits a low-level electrical
stimulation that produces a tingling or vibrating sensation; this stimulates nonpain
receptors and interferes with pain perception. The TENS unit does not provide heat/cold,
release medications, or work through biofeedback.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 7

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

21. A patient tells the nurse that putting a small pillow under her knee and rubbing the
thigh helps reduce the hip pain. The nurse realizes this patient is describing:
1.
2.
3.
4.

A nonmedication intervention to reduce the hip pain.


A way to deny the presence of the hip pain.
A fear of taking pain medication.
A previous pain medication addiction.

Correct Answer: A nonmedication intervention to reduce the hip pain.


Rationale: Even though there is a lack of scientific evidence, complementary therapies
are often used in conjunction with medications, or alone, to control chronic pain. The
patient is not denying the presence of pain if a pillow is used along with tactile treatment.
The nurse should not assume that the patient is fearful of taking pain medication or has a
history of pain medication addiction.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 7

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

22. When carrying out the order morphine 2 mg IV every 3 hours PRN, the nurse
recognizes that which of the following interventions is most appropriate?
1. The nurse should assess pain every hour and routinely offer the drug.
2. For best results, the patient should receive the morphine every 3 hours.
3. The nurse should wait until the patient requests the morphine to administer the
drug.
4. The nurse should wait until the previous dose of morphine has worn off before
administering more.
Correct Answer: The nurse should assess pain every hour and routinely offer the drug.
Rationale: While around-the-clock dosing has been proven more effective than the asneeded (PRN) dosing, the nurse should educate the client about the medication, assess
pain frequently, and offer the drug hourly. Administering the medication every 3 hours
around the clock circumvents the nurses responsibility to assess the pain and administer
medication when the client needs it. Waiting for the client to request the drug may allow
too much time to elapse, resulting severe pain that will require more than the ordered
amount to relieve the pain. Waiting for a previous dose of medication to wear off will
cause a reduced blood level of analgesic; the client may need more than the ordered
amount to regain control over pain.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 8

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

23. A narcotic substance abuser complains of severe incisional pain 1 hour after receiving
4 mg of intravenous morphine. When collaborating with the provider, which statement by
the nurse indicates correct knowledge of pain management in opiate-tolerant patients?
1. I think the patient has a tolerance to opiates and needs a higher dose than
ordered.
2. The patient continually complains of pain to get more narcotics.
3. Perhaps administering a saline flush as a placebo will help the pain.
4. The patient should be getting ketorolac (Toradol) for pain, not morphine.
Correct Answer: I think the patient has a tolerance to opiates and needs a higher dose
than ordered.
Rationale: An opiate abuser will be tolerant to the effects of narcotics; it will take more
medication to gain the same level of relief than it would for a nontolerant client. If the
nurse accepts the patients definition of pain as the standard, the nurse would not judge
the patient as a drug seeker and infer the patient is not in pain. Placebos are considered
unethical and should not be used. Administering a non-narcotic pain reliever such as
ketoralac, an NSAID, will precipitate withdrawal symptoms, causing the patient further
discomfort.
Cognitive Level: Analyzing
Nursing Process: Implementation
Client Need: Safe, Effective Care Environment
LO: 8

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

24. The nurse asks a patient who refuses to take pain medication for chronic back pain to
explain his reasons for avoiding medication. This nurse is attempting to:
1.
2.
3.
4.

Identify a barrier to the patients pain control treatment plan.


Determine if the patient should remain in the hospital.
Decide if the patient is being argumentative.
Figure out if the patient should leave the hospital against medical advice.

Correct Answer: Identify a barrier to the patients pain control treatment plan.
Rationale: Identifying barriers to the pain control treatment plan can help with the
development of assessment tools and educational materials to help with compliance on
pain control. The nurse is not attempting to question the patients admission or stay in the
hospital, to decide if the patient is being argumentative, or if the patient should leave the
hospital against medical advice.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 8

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

25. The nurse is receiving a report on a client described as a clock watcher who
requests pain medication every 2 hours when it is due. Which of the following statements
made to the client indicates understanding of effective pain management?
1. You ask for this medication every 2 hours, when due. It seems as if your pain is
not well treated.
2. You will develop addiction if you take too much of this medication.
3. The doctor is not likely to continue giving you narcotics when you go home.
4. It does not seem like you are in pain. I saw you were visiting with your family
and napping.
Correct Answer: You ask for this medication every 2 hours, when due. It seems as if
your pain is not well treated.
Rationale: Clock watching is a symptom of pseudo-addiction or inadequate pain relief.
Addiction is a physiologic and psychologic process that develops in less than 3% of
individuals taking opiates. It is too soon to determine the type of pain management that
will be required upon discharge. Pain is what the client says it is; it is possible to
participate in ADLs and still be in pain.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 9

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

26. A client who has undergone abdominal surgery is refusing hyromorphone (Dilaudid)
because she has heard that people may become addicted. She is crying and rates her pain
as 10 of 10. Which of the following statements should the nurse include as part of the
patients education?
Select all that apply.
1.
2.
3.
4.
5.

Narcotics result in addiction in less than 1% to 3% of patients.


Untreated pain can result in poor wound healing.
Patients with uncontrolled pain have increased risk of blood clots.
Dehydration can result from poorly managed pain.
Family members will not want to visit patients with visible signs of pain.

Correct Answer:
1. Narcotics result in addiction in less than 1% to 3% of patients.
2. Untreated pain can result in poor wound healing.
3. Patients with uncontrolled pain have increased risk of blood clots.
Rationale:
Narcotics result in addiction in less than 1% to 3% of patients. Narcotic addiction
occurs in only 1% to 3% of the population. Untreated pain can result in poor wound
healing. Pain causes physiological consequences, including poor wound healing.
Patients with uncontrolled pain have increased risk of blood clots. Pain causes
physiological consequences, including coagulation leading to DVT or PE. Dehydration
can result from poorly managed pain. There is no evidence that poor pain relief will
cause dehydration. Family members will not want to visit patients with visible signs
of pain. There is no evidence that poor pain relief will cause family members to refuse to
visit.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 9

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

27. A patient tells the nurse that he wont fill the pain medication prescription when he
goes home. Which of the following should the nurse do to help this patient?
1. Ask the patient if there is a reason why he wont fill the prescription.
2. Tell the health care provider to not write a prescription for the pain medication.
3. Suggest that the patient purchase and use over-the-counter pain medication
instead.
4. Stop providing the patient with pain medication while he is still hospitalized.
Correct Answer: Ask the patient if there is a reason why he wont fill the prescription.
Rationale: The nurse needs to assess the patients affective, cognitive, and behavioral
dimensions of pain and should ask the patient to explain why the prescription will not be
filled. The nurse should not suggest that the health care provider stop writing out the
prescription, nor should the nurse suggest the patient take over-the-counter pain
medication. The nurse should not stop providing pain medication to the hospitalized
patient.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Safe, Effective Care Environment
LO: 9

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.

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