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Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 240

Chapter 12: Pain Management

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

Feedback:

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 nurses 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

Feedback:

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,

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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 womans 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

Feedback:

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 patients 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 patients pain in 30 minutes.

D) Administer an analgesic and then reassess.

Ans: B

Feedback:

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.

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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

Feedback:

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.

6. The nurse is caring for a 51-year-old female patient whose medical history includes chronic fatigue and
poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what
consequent health problem?

A) Anxiety

B) Skin breakdown

C) Depression

D) Hallucinations

Ans: C

Feedback:

Depression is associated with chronic pain and can be exacerbated by the effects of chronic fatigue.
Anxiety is also plausible, but depression is a paramount risk. Skin breakdown and hallucinations are
much less likely.

7. Your patient has just returned from the postanesthetic care unit (PACU) following left tibia open
reduction internal fixation (ORIF). The patient is complaining of pain, and you are preparing to
administer the patients first scheduled dose of hydromorphone (Dilaudid). Prior to administering the
drug, you would prioritize which of the following assessments?

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