Medical Surgical Nursing An Integrated Approach 3rd Edition by Lois White -Test Bank A+

$35.00
Medical Surgical Nursing An Integrated Approach 3rd Edition by Lois White -Test Bank A+

Medical Surgical Nursing An Integrated Approach 3rd Edition by Lois White -Test Bank A+

$35.00
Medical Surgical Nursing An Integrated Approach 3rd Edition by Lois White -Test Bank A+
  1. A client has sustained a gunshot wound to the left femoral artery. Which type of shock should the nurse watch for?
a.cardiogenicc.hypovolemic
b.neurogenicd.septic

ANS: C

Hypovolemic shock is characterized by a decreased circulating blood volume resulting in inadequate tissue perfusion and oxygenation for normal cell function. Hypovolemic shock is caused by an acute blood loss from trauma, fluid shifts, and/or loss from surgery, fluid loss from burns, vomiting, diarrhea, and severe electrolyte imbalances.

PTS: 1 DIF: Application REF: White (2013)

  1. Hypovolemic shock is a decrease in the client’s circulating blood volume that leads to inadequate tissue perfusion and then which of the following?
a.bradycardiac.hypotension
b.vasodilationd.hypoxia

ANS: D

Hypovolemic shock is a decrease in the client’s circulating blood volume that leads to inadequate tissue perfusion (the passage of blood through tissues or vasculature). Inadequate tissue perfusion deprives the cells from oxygen resulting in hypoxia, the inability of the cell to maintain normal metabolic activities including energy production and waste removal from a lack of oxygen. As a result, the body cells become injured and die, leading to organ damage and failure, and potentially the client’s death.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Severe shock results when the client has lost more than what percentage of the circulating blood volume?
a.less than 20%c.5%
b.between 20 and 40%d.more than 40%

ANS: D

The term mild hypovolemic shock is used when less than 20% of the circulating blood volume is lost. Moderate shock occurs when blood loss volume is between 20 to 40%, and severe shock results when the client has lost more than 40% of the circulating blood volume.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. What type of product would a physician most likely order for a client to treat hypovolemic shock?
a.0.9% normal salinec.nasoenteric feeding
b.oral rehydration fluidd.hypotonic IV fluid

ANS: A

Commonly prescribed fluids for hypovolemic shock include Lactated Ringers (LR) or normal saline (0.9% sodium chloride), which not only help correct the volume loss, but also help with electrolyte replacement.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. In the Emergency Department, a client has been given large amount of IV fluid to treat hypovolemic shock. Which electrolyte imbalance is MOST common after large amounts have been infused?
a.hyponatremiac.hypernatremia
b.hypokalemiad.hypocalcemia

ANS: B

Electrolyte replacement may be necessary, especially if large amount of fluids are needed to correct the client’s hypovolemia. Hypokalemia is common in this client population after large amounts of fluids have been infused. Also, either hyponatremia or hypernatremia may also occur, depending on the type of intravenous solution used. Less commonly, calcium imbalance may be present. The nurse should take care to remember that cardiac arrhythmias can occur as a result of electrolyte imbalance.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. This drug is a good choice for the treatment of hypovolemic shock because of its positive inotropic effects, ability to cause peripheral vasoconstriction with less tachycardia, resulting in increased cardiac output and improving hypotension. Which drug would the physician choose?
a.Dobutaminec.Neosynephrine
b.Dopamined.Epinephrine

ANS: D

Epinephrine and norepinephrine both have positive inotropic effects and cause peripheral vasoconstriction as well with less tachycardic effects than dopamine, resulting in increased cardiac output as well as improving hypotension, and make them a good choice for the treatment of hypovolemic shock.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Dopamine has been ordered for a client. Which is the best route for administration?
a.oralc.via central IV line
b.subcutaneousd.via peripheral IV

ANS: C

Central line administration rather than infusion through a peripheral vein is optimum for the administration of Dopamine and carries less risk of infiltration or extravasation.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. A common early sign of cardiogenic shock is:
a.weak, thready pulsec.cyanosis of the extremities
b.peripheral edemad.mild tachycardia

ANS: D

Common early signs and symptoms of cardiogenic shock are mild tachycardia, slight decrease in the client’s blood pressure, decreased urinary output, and anxiety, and restlessness. Later signs include weak, thready peripheral pulses, peripheral edema, cool extremities, and cyanosis of the extremities and circumoral areas.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Which staff member is the liaison between the entire healthcare team caring for a client with cardiogenic shock?
a.physicianc.head nurse coordinator
b.nursed.cardiologist

ANS: B

The nurse is often the liaison between the entire team and is responsible for much of the communication. The nurse provides the primary hands-on care for the client and communicates changes in vital signs, diagnostic tests, and client exam to the physician who gives the orders for the client’s care.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. A client in cardiogenic shock with significant hypotension is placed in which position?
a.trendelenbergc.prone
b.reverse trendelenbergd.side-lying

ANS: A

The client in cardiogenic shock with significant hypotension is placed either in supine or Trendelenburg position. Trendelenberg position encourages increased vascular return and blood flow toward the most vital organs, the brain and the heart.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. What is the relationship between age and the risk of sepsis?
a.risk decreases with agec.is greatest in middle age
b.risk stays the same with agingd.increases with age

ANS: D

A client’s risk of sepsis increases with age, and thus advanced age is a risk factor for developing sepsis. Other clients at risk are those that are immunocompromised, newborns and infants, malnourished or debilitated, and diabetics.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Upon entering the client’s room and performing an initial assessment, the nurse finds the client to have warm, flushed skin, fever above 100.4 degrees F, mild tachycardia, and a respiratory rate of 26. The nurse suspects the client is in which phase of septic shock?
a.earlyc.advanced
b.moderated.late

ANS: A

Early symptoms of septic shock include warm, flushed skin, fever above 100.4 degrees Fahrenheit, mild tachycardia and elevated respiratory rate above 20 breaths/minute, and a white blood cell count lower than 4,000 or greater than 10,000. At this point the client’s blood pressure and pulse oximetry are usually normal. As sepsis progresses the client may become anxious, start to show mild hypotension, hypoxia, higher fever and more significant mental status changes as well as worsening of tachycardia and metabolic acidosis occurs. As the sepsis progresses into septic shock, the client exhibits severe tachycardia, cool and clammy extremities, weak and thready peripheral pulses and significant hypotension as well as hypoxia and respiratory distress. The client may be unresponsive and have minimal urine output.

PTS: 1 DIF: Application REF: White (2013)

  1. After reporting the client’s signs and symptoms of early shock to the physician, the nurse is told that the physician will be ordering a specialist to consult on the case. Which type of specialist is the physician most likely to consult with on this client’s care?
a.hematologistc.cardiologist
b.infectious diseased.respiratory

ANS: B

Finding and treating the cause of septic shock is essential to the client’s long-term prognosis. Infectious disease specialists may be asked to consult on the case and assist the primary physician. The primary course of treatment is intravenous antibiotics, fluid resuscitation and vasopressors as well as supplemental oxygenation. The treatment of sepsis centers around identifying the cause and treating the pathogen as specifically as possible while supporting the body’s circulatory and respiratory symptoms.

PTS: 1 DIF: Application REF: White (2013)

  1. Neurogenic shock is a potential complication of a spinal cord injury. This is caused by the interruption of which part of the nervous system response?
a.central nervous systemc.sympathetic nervous system
b.parasympathetic nervous systemd.peripheral nervous system

ANS: C

Neurogenic shock is a potential complication of a spinal cord injury that results in hypotension, bradycardia, low perfusion and hypoxia to body tissues as a result of the interruption of the sympathetic nervous system response.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Symptoms of neurogenic shock can occur within which time frame?
a.within 30-60 minutes of the injuryc.within 24 hours of the injury
b.within 12 hours of the injuryd.within 48 hours of the injury

ANS: A

The client in neurogenic shock exhibits some of the same signs and symptoms as the other four types of shock such as weak and thready peripheral pulses, cool and clammy extremities, decreased urinary output, peripheral cyanosis and increased respiratory rate. Symptoms can occur as quickly as within 30 to 60 minutes of the injury.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Physiologic changes within the body in response to anaphylactic reactions include:
a.severe hypertensionc.hypervolemia
b.bronchoconstrictiond.bradycardia

ANS: B

Physiologic changes within the body in response to anaphylactic reactions include bronchoconstriction, severe hypotension, tachycardia, hypovolemia and tissue hypoperfusion as well as a febrile response. Symptoms of this type reaction include shortness of breath, coughing, chest tightness or chest pain, weakness and dizziness. Feelings of tightening of the throat and generalized itching or abdominal pain and headache can occur. Additional signs include hypotension, tachycardia, fever, hives, swelling of face and lips and generalized edema.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. The highest “at risk” clients for anaphylactic shock include clients with which type of medication allergy?
a.Benadrylc.Coumadin
b.Aspirind.Penicillin

ANS: D

The highest “at-risk” clients have Penicillin allergies and insect sting reactions.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Severe anaphylactic reactions that can lead to anaphylactic shock include which of the following?
a.itchingc.angioedema
b.hivesd.bronchoconstriction with wheezing

ANS: D

Mild anaphylactic reactions cause itching, hives, and some angioedema as well as nasal congestion, rhinorrhea, hoarseness, excessive salivation, headache, nausea and vomiting or diarrhea. More severe reactions leading to anaphylactic shock manifest in severe hypotension, tachycardia, bronchoconstriction with wheezing, tachypnea and cyanosis as well as chest pain and arrhythmias. Syncope, seizures and cardiac arrest may also occur.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. The most serious complication of anaphylactic shock is:
a.itching and hivesc.bronchoconstriction with wheezing
b.tachycardiad.death

ANS: D

The most serious complication of anaphylactic shock is death. Other complications are organ damage secondary to prolonged hypoperfusion and include renal failure, cerebral hypoxic changes, respiratory distress syndrome, cardiac ischemia or MI, ischemic gut syndrome, and possible hepatic failure.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. The drug of choice for an anaphylactic reaction is:
a.Ranitidinec.Epinephrine
b.Benadryld.oral corticosteroids

ANS: C

Epinephrine, which contains alpha and beta properties, is the drug of choice and can be administered intravenously, subcutaneously or via endotracheal tube. IV administration is the preferred route. Epinephrine causes vasoconstriction, decreased vascular permeability and reverses bronchoconstriction.

PTS: 1 DIF: Comprehension REF: White (2013)

MULTIPLE RESPONSE

  1. The nurse is preparing to teach a client how to administer an Epi-Pen. Which of the following would the nurse be sure to include in the teaching plan?
a.Keep Epi-Pen refrigerated at all times.
b.Do not inject Epi-Pen intravenously.
c.Do not inject Epi-Pen into the buttocks.
d.Do not expose the Epi-Pen to extreme heat or sunlight.
e.The thigh is the preferred location for injection of the Epi-Pen.
f.More than one dose of the Epi-pen may be needed.

ANS: B, C, D, E, F

An Epi-Pen is a commercially available subcutaneous, single pre-filled injection into the outer thigh for one-time use for anaphylactic reactions. Clients need a prescription for this and it can be purchased at most retail pharmacies. Do not inject the Epi-Pen intravenously or into the buttocks as it may not be effective for a severe reaction. Keep Epi-Pen at room temperature and do not expose to extreme heat or direct sunlight. More than one dose of the Epi-Pen may be needed.

PTS: 1 DIF: Application REF: White (2013)

  1. Which of the following are TRUE about shock? (Select all that apply.)
a.Shock is the body’s response to inadequate tissue perfusion.
b.If left untreated, the client progress initially into seizures.
c.All types of shock share hypotension, hypoperfusion and hypoxia.
d.The nurse should know signs and symptoms of shock.
e.The nurse should know the necessary assessment skills for shock.
f.It is not necessary for the nurse to know the appropriate treatment for each type of shock.

ANS: A, C, D, E, F

Shock is the body’s response to inadequate tissue perfusion, and if left untreated will progress into cell death, organ failure, and a life-threatening emergency. Hypovolemic, cardiogenic, septic, neurogenic, and anaphylactic shock share common manifestations of hypotension, hypoperfusion, and hypoxia. The nurse caring for a client experiencing shock must be knowledgeable of the signs and symptoms, necessary assessment skills, and appropriate treatment for each type of shock. Prompt nursing care is essential for a positive client outcome.

PTS: 1 DIF: Comprehension REF: White (2013)

Chapter 7—Pain Assessment and Management

MULTIPLE CHOICE

  1. Who is the MOST consistent health team member involved in client pain management?
a.anesthesiologistc.pharmacist
b.nursed.physician

ANS: B

Nurses can use a variety of tools to assess location, intensity, and quality of pain; factors precipitating and alleviating pain; and the impact of pain on a person’s quality of life.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Which of these data provide the MOST accurate information about the pain a client is experiencing?
a.objective changes in vital signs such as increased respiratory rate, heart rate, and blood pressure
b.the amount of tissue damage actually occurring or already present
c.facial expressions and level of mobility
d.self-report

ANS: D

Although many factors contribute to individual responses to pain, the nurse’s primary consideration when assessing pain is that the client is the only authority about the existence and nature of his or her pain.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. A client who had a myocardial infarction yesterday has pain medication ordered PRN for discomfort or agitation. The evening nurse’s initial assessment indicates the client has not received any pain medications all day. Vital signs are within normal limits, but the client is sweating profusely. Smiling, the client informs the nurse that he has been experiencing some pain since early morning. Which of these actions should the nurse take?
a.Administer the largest dose of pain medication allowed, since the client has not received it all day.
b.Administer the minimum dose of pain medication, and reassess the client’s level of pain 30 minutes after administration and again at the minimal time interval for repeat dosing.
c.Continue to withhold the ordered pain medication because vital signs are within normal limits and the client is smiling.
d.Encourage the client to continue to do without ordered pain medication to avoid addiction.

ANS: B

The measures the client thinks will be most effective should be used, including nontraditional measures such as folk remedies. Other interventions may be used on a trial-and-error basis until pain relief is achieved. The second principle is to use a preventive approach. This means that the nurse should seek to initiate interventions when the client’s pain is mild or when it is anticipated, rather than waiting until the pain becomes severe.

PTS: 1 DIF: Application REF: White (2013)

  1. Which of these statements about acute pain is TRUE?
a.It is most often described as dull, diffuse, and aching.
b.Its onset is sudden and of relatively short duration.
c.It increases as healing occurs.
d.It is usually nonspecific in nature.

ANS: B

Acute pain has a sudden onset and a comparatively short duration, ranging in intensity from mild to severe, with the intensity usually decreasing over time. This type of pain is usually localized and associated with some pathological change in the body, such as an injury. Acute pain experiences range from a simple headache to postoperative pain and include many other experiences that occur throughout the life span.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Which of these statements about chronic pain is TRUE?
a.It is accompanied by elevated heart rate, respiratory rate, and blood pressure.
b.It occurs for at least six months.
c.It is usually described as sharp but is difficult to pinpoint.
d.Its signs and symptoms are often similar to depression.

ANS: B

Chronic pain is persistent or recurrent and lasts for more than 6 months; it may continue after the initiating cause has been resolved. For example, low-back pain may linger after an initial back injury that occurred when the person lifted a heavy object. Chronic acute pain occurs on a daily basis over an extended time period, such as the pain associated with the pathophysiology of cancer.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. A nurse’s assessment of a client yields the following data: vital signs normal; client complains of exhaustion and recent weight loss; when asked, client states, “Yes, I am in pain”; client appears frail and withdrawn and moves slowly, avoiding movement of upper torso. The nurse would want to assess the client further for which of these?
a.acute painc.chronic pain
b.anorexiad.depression

ANS: C

Chronic pain is persistent or recurrent and lasts for more than 6 months; it may continue after the initiating cause has been resolved. For example, low-back pain may linger after an initial back injury that occurred when the person lifted a heavy object. Chronic acute pain occurs on a daily basis over an extended time period, such as the pain associated with the pathophysiology of cancer.

PTS: 1 DIF: Application REF: White (2013)

  1. What purpose does pain serve for individuals?
a.to provide gate controlc.to minimize noxious stimuli
b.to act as a protective mechanismd.to limit movement

ANS: B

The purpose of pain is twofold: it serves as a protective mechanism and a diagnostic tool. As a protective mechanism, pain can prevent injury (e.g., using the hand to test the bath water before placing a baby in a tub; if the water is too hot, the hand will retract and the caregiver can add cold water to moderate the temperature).

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Which theory of pain proposes that pain can be relieved by blocking the transmission of pain impulses to the brain by physical modalities and altering the individual’s thought processes, emotions, or other behaviors?
a.gate control theoryc.perception modulation
b.Kussmaul’s theoryd.transduction

ANS: A

The gate control pain theory was the first to recognize that psychological aspects of pain are as important as physiologic aspects. Its basic premise is that transmission of potentially painful nerve impulses to the cortex is modulated by a gating mechanism in the dorsal horn of the spinal cord and by central nervous system activity, altering the level of conscious awareness of the painful sensation.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. When objective and subjective data about a client’s pain are in conflict, which report should the nurse consider to be the primary source?
a.objective data
b.subjective data
c.combination of objective and subjective
d.objective data and reports of family members

ANS: B

A nurse should obtain subjective data about the client’s pain, including the client’s own description of the pain; its location (where pain occurs); onset and duration (when pain began, how long it has existed, and any pain patterns); quality (what the pain feels like); intensity (how severe the pain is); aggravating and alleviating factors (things that increase or decrease the pain); factors accompanying the pain (impact on daily activities such as sleep and nutrition); and the meaning of pain to the client.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. When assessing an older adult client for pain, the nurse should recognize which of these statements as TRUE?
a.Older clients often do not report pain for fear of being considered “complainers.”
b.Older clients request pain medication more frequently to prevent complications.
c.Older clients believe that taking pain medication will hasten death.
d.Older clients have little experience with the increased efficacy of current pain medications.

ANS: A

If the nurse perceives a discrepancy between objective and subjective data, she or he should address the discrepancy with the client. Often older adults do not report pain for fear of being considered “complainers.”

PTS: 1 DIF: Application REF: White (2013)

  1. A client returns to the unit following abdominal surgery. The client has an order for Demerol IM PRN for severe pain or Tylenol #3 PO PRN for mild to moderate pain. The nurse asks the client whether she is experiencing pain now, and the client says, “Yes, I am.” Which of these actions should the nurse take next?
a.Administer Demerol, since the client is less than 24 hours postoperative.
b.Administer Tylenol #3, and if pain is not relieved, administer Demerol.
c.Assess the client further as to the location and degree of pain.
d.Reposition the client, and suggest performing some relaxation exercises.

ANS: C

A nurse should obtain subjective data about the client’s pain, including the client’s own description of the pain; its location (where pain occurs); onset and duration (when pain began, how long it has existed, and any pain patterns); quality (what the pain feels like); intensity (how severe the pain is); aggravating and alleviating factors (things that increase or decrease the pain); factors accompanying the pain (impact on daily activities such as sleep and nutrition); and the meaning of pain to the client.

PTS: 1 DIF: Application REF: White (2013)

  1. When a nurse asks a client to describe what a particular pain feels like, the nurse is attempting to identify which of these aspects of the client’s pain experience?
a.aggravating factorsc.onset and duration
b.intensityd.quality

ANS: D

A nurse should obtain subjective data about the client’s pain, including the client’s own description of the pain; its location (where pain occurs); onset and duration (when pain began, how long it has existed, and any pain patterns); quality (what the pain feels like); intensity (how severe the pain is); aggravating and alleviating factors (things that increase or decrease the pain); factors accompanying the pain (impact on daily activities such as sleep and nutrition); and the meaning of pain to the client.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. A client’s estimate of the severity of pain, which allows the nurse to evaluate the effectiveness of pain relief measures by comparing these estimates before and after pain management interventions, describes which of the following aspects of the pain experience?
a.aggravating factorsc.onset and duration
b.intensityd.quality

ANS: B

A nurse should obtain subjective data about the client’s pain, including the client’s own description of the pain; its location (where pain occurs); onset and duration (when pain began, how long it has existed, and any pain patterns); quality (what the pain feels like); intensity (how severe the pain is); aggravating and alleviating factors (things that increase or decrease the pain); factors accompanying the pain (impact on daily activities such as sleep and nutrition); and the meaning of pain to the client.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. A client whose dislocated shoulder was reduced today is experiencing moderate pain at the site of injury and across the back. The nurse administers a prescribed oral pain medication, repositions the client, and applies an ice pack to the shoulder. The client still complains of pain and requests a cup of hot water to drink to “wash the pain” from the system. Which of these actions should the nurse take?
a.Call the health care provider to request an order for the water.
b.Give the client the water.
c.Inform the nursing supervisor that a client may need a psychiatric consultation.
d.Tell the client that water will not bring pain relief.

ANS: B

It may be necessary to use more than one type of pain relief measure before a client achieves pain relief. The measures the client thinks will be most effective should be used, including nontraditional measures such as folk remedies.

PTS: 1 DIF: Application REF: White (2013)

  1. Which type of drug has an additive effect to analgesics?
a.adjuvantsc.narcotics
b.anesthesiad.opiates

ANS: A

Adjuvants are medications that enhance the analgesic effects of opiates.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. A client returns from surgery with a PRN order for pain medication. The nurse recognizes the client will be experiencing pain for at least the first day or two after surgery and should take which of these actions?
a.Administer the PRN medication around the clock (ATC) within the time constraints of the order.
b.Administer the medication whenever the client asks for it.
c.Administer the PRN medication within the time constraints of the order during the day, and at night if pain awakens the client.
d.Ask the client if pain medication is desired, when making regular postoperative assessments.

ANS: A

The nurse is a key person in managing the client’s pain experience; for instance, the nurse notifies the client’s physician when medications prescribed for pain are not effective. A client who is postsurgical should have pain control administered medication around the clock (ATC) within the time constraints of the order.

PTS: 1 DIF: Application REF: White (2013)

  1. According to The Joint Commission, which of these statements about pain and its management is TRUE?
a.Clients are assumed to experience some degree of pain at all times.
b.Staff must take special courses to be competent in pain management.
c.Pain assessment is considered to be the “fifth” vital sign.
d.There must be evidence that the least expensive, most effective pain medications are used.

ANS: C

The Joint Commission’s Pain Management Standards of Care include that pain is assessed in all clients throughout their facility stay. Pain assessment is considered to be the “fifth” vital sign.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. For the client with cancer pain, what is the preferred route of providing pain medication?
a.intramuscularc.oral
b.intravenousd.transdermal

ANS: C

With cancer pain, the oral route is preferred. If the client is unable to take oral medications, rectal or transdermal are preferred because they are less invasive than other routes. In addition, tolerance develops at a slower rate with oral route compared to more invasive routes.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. In providing pain medication for the postoperative client, what is the preferred route of administration when the client is NPO?
a.epiduralc.intravenous
b.intramusculard.oral

ANS: C

With postoperative pain, the intravenous route is preferred as the route of administration for pain medications, as it allows for quicker affects.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Which route of pain medication administration provides the MOST rapid onset of pain relief?
a.intramuscularc.oral
b.intravenousd.transdermal

ANS: B

Some of these analgesics can be administered only orally; others can be administered by other routes (intramuscular, intravenous, patient-controlled analgesia pump, epidural, intrathecal, or transdermal). Intravenous medication administration provides the most rapid onset of pain relief.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Which of the following may occur as a side effect when administering opiates?
a.anxietyc.palpitations
b.diarrhead.respiratory depression

ANS: D

The nurse needs to remember that a major side effect when administering opiates is respiratory depression. Narcan should be kept at the client’s bedside, and respiratory rate should be assessed prior to administration of the next dose.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. A client states, “I can’t take the morphine now because I might need it later when the pain gets worse.” Which of these responses by the nurse would be BEST?
a.“If you’re afraid of becoming addicted, don’t worry. The dose can be increased if that happens.”
b.“I’m not going to stand here and let you suffer. You need to take the medication.”
c.“The dose of morphine can safely be increased if the effects lessen over time. There’s no need for you to suffer now.”
d.“You’re in charge of your pain management.”

ANS: C

Unlike NSAIDS, pure agonist opioids such as morphine are not subject to the ceiling effect. As the dosage increases, pain relief increases.

PTS: 1 DIF: Application REF: White (2013)

  1. Which of these statements about patient-controlled analgesia (PCA) is TRUE?
a.Clients receiving PCA must be monitored for overdose side effects.
b.Health care professionals allocate time for setting up and maintaining PCA when in use.
c.PCA can only be administered via the epidural route.
d.PCA can safely be used in pediatric and home health settings.

ANS: D

Clients receiving PCA do not experience overdose side effects due to the lockout intervals. The PCA is successful in many types of pain and in many settings, including pediatric and home health settings.

PTS: 1 DIF: Application REF: White (2013)

  1. Transdermal opioid administration is indicated for a client in which of the following situations?
a.The exact dosing of medication is required.
b.Oral medication cannot be tolerated.
c.Pain is predictable, as in postsurgical clients.
d.Pain is continuous, and high dosage is required.

ANS: D

Transdermal opioid administration allows for slow infusion through the skin and is indicated when pain is continuous and high dosage is required.

PTS: 1 DIF: Application REF: White (2013)

  1. According to the World Health Organization (WHO), the client who is experiencing mild cancer pain should receive which of these drugs?
a.a nonopioid
b.a nonopioid and an adjuvant
c.a strong opioid
d.a weak opioid, plus or minus a nonopioid, plus or minus an adjuvant

ANS: A

According to the World Health Organization (WHO) pain ladder, step 1 is for mild pain (a nonopioid and an adjuvant), step 2 is for moderate pain (a weak opioid, plus or minus a nonopioid, plus or minus an adjuvant), and step 3 is for severe pain (a strong opioid, plus or minus a nonopioid, plus or minus an adjuvant).

PTS: 1 DIF: Application REF: White (2013)

  1. Which method of noninvasive pain relief focuses the client’s attention on something other than the pain?
a.cutaneous stimulationc.guided imagery
b.distractiond.relaxation

ANS: B

Noninvasive interventions include cognitive-behavioral strategies (relaxation techniques, reframing, distraction, guided imagery, humor, biofeedback); physical modalities that use cutaneous stimulation (heat and cold applications, acupressure and massage, transcutaneous electrical nerve stimulation [TENS]); exercise; positioning; and psychotherapy.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. A client has the following order: “Apply cold or heat packs as needed for pain relief.” The nurse must recognize which of the following?
a.Heat often provides faster relief.
b.Combining the two therapies might provide the best relief.
c.Either method may cause peripheral nerve damage when used over an extended time frame (i.e., weeks, months).
d.Cold is often better tolerated.

ANS: C

When applying cold or heat packs for pain, the nurse needs to monitor for peripheral nerve damage when used over an extended time frame (i.e., weeks, months).

PTS: 1 DIF: Application REF: White (2013)

  1. Medication on demand (MOD) administration is indicated for a client in which of the following situations?
a.The client can manage his or her own medication routines.
b.Oral medication cannot be tolerated.
c.Pain is predictable, to reduce staffing time.
d.Pain is continuous, and high dosage is required frequently.

ANS: A

Medication on demand (MOD) administration is used for the client who can manage his or her own medication routines. The facility pharmacy places multiple doses of oral medication in the MOD that locks to an IV pole for easy client access.

PTS: 1 DIF: Application REF: White (2013)

  1. According to the World Health Organization (WHO), the client who is experiencing severe pain should receive which of these drugs?
a.a nonopioid
b.a nonopioid, plus or minus an adjuvant
c.a strong opioid, plus or minus an adjuvant
d.a strong opioid, plus or minus a nonopioid, plus or minus an adjuvant

ANS: D

According to the World Health Organization (WHO) pain ladder, step 1 is for mild pain (a nonopioid and an adjuvant), step 2 is for moderate pain (a weak opioid, plus or minus a nonopioid, plus or minus an adjuvant), and step 3 is for severe pain (a strong opioid, plus or minus a nonopioid, plus or minus an adjuvant).

PTS: 1 DIF: Application REF: White (2013)

MULTIPLE RESPONSE

  1. The nurse is caring for a client experiencing postoperative pain. Which of the following will affect the client’s pain level? (Select all that apply.)
a.cultured.marital status
b.type of housinge.previous experience
c.agef.body size

ANS: A, C, E

Although many factors contribute to individual responses to pain, the nurse’s primary consideration when assessing pain is that the client is the only authority about the existence and nature of his or her pain. Factors that influence a person’s response to pain include age, previous experience with pain, and cultural norms.

PTS: 1 DIF: Comprehension REF: White (2013)

  1. Which of the following statements about pain are TRUE?
a.Pain is measured by using objective measures ie: laboratory tests.
b.If pain is ignored, it will go away.
c.The client is the best judge of their own pain.
d.Clients taking pain medication will become addicted to the drug.
e.Pain control and relief measures are effective in lowering the pain level, which will help clients function more normally and comfortably.

ANS: C, E

The following statements about pain are true: Pain is a subjective experience; only the client can judge the level and severity of pain. Pain is a real experience that is appropriately treated with medical and nursing intervention. Pain control and relief measures are effective in lowering the pain level, which will help clients function more normally and comfortably. Most clients honestly report their perception of pain, both physical and emotional, and need effective intervention and teaching; physical responses vary greatly depending on experience and cultural norms, and visible expressions of pain are not always reliable indicators of its severity. Many clients do not ask for medication because they are afraid of side effects, do not want to bother the nurse, have cultural norms and beliefs against it, or believe pain is inevitable and untreatable. Addiction is unlikely when analgesics are carefully administered and closely monitored. Individuals’ perceptions of pain are subjective; the extent of tissue damage is not necessarily proportional to the extent of pain experienced.

PTS: 1 DIF: Comprehension REF: White (2013)

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