Brunner and Suddarth’s Textbook of Medical-Surgical Nursing: 13th Edition Test Bank – Hinkle
Brunner and Suddarth’s Textbook of Medical-Surgical Nursing: 13th Edition Test Bank – Hinkle
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
A) Medication should be taken when pain levels are low so the pain is easier to
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
D) The patient will likely benefit more from distraction than pharmacologic
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
nurse’s most plausible rationale for understanding the patients’ different perceptions of
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.
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, and definitions for pain state that pain is
“whatever the person says it is, existing whenever the experiencing person says it
3. You are frequently assessing an 84-year-old woman’s 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.
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 patient’s 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 patient’s pain in 30 minutes.
D) Administer an analgesic and then reassess.
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.
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
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.
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?
B) Skin breakdown
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 patient’s first scheduled dose of hydromorphone
(Dilaudid). Prior to administering the drug, you would prioritize which of the following
A) The patient’s electrolyte levels
B) The patient’s blood pressure
C) The patient’s allergy status
D) The patient’s hydration status
Before administering medications such as narcotics for the first time, the nurse should
assess for any previous allergic reactions. Electrolyte values, blood pressure, and
hydration status are not what you need to assess prior to giving a first dose of narcotics.
8. Your patient is receiving postoperative morphine through a patient-controlled analgesic
(PCA) pump and the patient’s orders specify an initial bolus dose. What is your priority
A) Assessment for decreased level of consciousness (LOC)
B) Assessment for respiratory depression
C) Assessment for fluid overload
D) Assessment for paradoxical increase in pain
A patient who receives opioids by any route must be assessed frequently for changes in
respiratory status. Sedation is an expected effect of a narcotic analgesic, though
severely decreased LOC is problematic. Fluid overload and paradoxical increase in pain
are unlikely, though opioid-induced hyperalgesia (OIH) occurs in rare instances.
9. Your patient is 12-hours post ORIF right ankle. The patient is asking for a breakthrough
dose of analgesia. The pain-medication orders are written as a combination of an opioid
analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is
the primary rationale for administering pain medication in this manner?
A) To prevent respiratory depression from the opioid
B) To eliminate the need for additional medication during the night
C) To achieve better pain control than with one medication alone
D) To eliminate the potentially adverse effects of the opioid
A multimodal regimen combines drugs with different underlying mechanisms, which
allows lower doses of each of the drugs in the treatment plan, reducing the potential for
each to produce adverse effects. This method also reduces, but does not eliminate,
adverse effects of the opioid. This regimen is not motivated by the need to prevent
respiratory depression or to eliminate nighttime dosing.
10. The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse
why he has had to keep getting larger doses of his pain medication, although they do
not seem to affect him. What is the nurse’s best response?
A) “Over time you become more tolerant of the drug.”
B) “You may have become immune to the effects of the drug.”
C) “You may be developing a mild addiction to the drug.”
D) “Your body absorbs less of the drug due to the cancer.”
Over time, the patient is likely to become more tolerant of the dosage. Little evidence
indicates that patients with cancer become addicted to the opioid medications. Patients
do not become immune to the effects of the drug, and the body does not absorb less of
the drug because of the cancer.
11. A 52-year-old female patient is receiving care on the oncology unit for breast cancer
that has metastasized to her lungs and liver. When addressing the patient’s pain in her
plan of nursing care, the nurse should consider what characteristic of cancer pain?
A) Cancer pain is often related to the stress of the patient knowing she has cancer
and requires relatively low doses of pain medications along with a high dose of
B) Cancer pain is always chronic and challenging to treat, so distraction is often the
C) Cancer pain can be acute or chronic and it typically requires comparatively high
doses of pain medications.
D) Cancer pain is often misreported by patients because of confusion related to their
Pain associated with cancer may be acute or chronic. Pain resulting from cancer is so
ubiquitous that when cancer patients are asked about possible outcomes, pain is
reported to be the most feared outcome. Higher doses of pain medication are usually
needed with cancer patients, especially with metastasis. Cancer pain is not treated with
anti-anxiety medications. Cancer pain can be chronic and difficult to treat so distraction
may help, but higher doses of pain medications are usually the best intervention. No
research indicates cancer patients misreport pain because of confusion related to their
12. The nurse caring for a 79-year-old man who has just returned to the medical–surgical
unit following surgery for a total knee replacement received report from the PACU.
Part of the report had been passed on from the preoperative assessment where it was
noted that he has been agitated in the past following opioid administration. What
principle should guide the nurse’s management of the patient’s pain?
A) The elderly may require lower doses of medication and are easily confused with
B) The elderly may have altered absorption and metabolism, which prohibits the use
C) The elderly may be confused following surgery, which is an age-related
phenomenon unrelated to the medication.
D) The elderly may require a higher initial dose of pain medication followed by a
The elderly often require lower doses of medication and are easily confused with new
medications. The elderly have slowed metabolism and excretion, and, therefore, the
elderly should receive a lower dose of pain medication given over a longer period time,
which may help to limit the potential for confusion. Unfortunately, the elderly are often
given the same dose as younger adults, and the resulting confusion is attributed to other
factors like environment. Opioids are not absolutely contraindicated and confusion
following surgery is never normal. Medication should begin at a low dose and slowly
increase until the pain is managed.
13. You are the nurse in a pain clinic caring for an 88-year-old man who is suffering from
long-term, intractable pain. At this point, the pain team feels that first-line
pharmacological and nonpharmacological methods of pain relief have been ineffective.
What recommendation should guide this patient’s subsequent care?
A) The patient may want to investigate new alternative pain management options
that are outside the United States.
B) The patient may benefit from referral to a neurologist or neurosurgeon to discuss
C) The patient may want to increase his exercise and activities significantly to create
D) The patient may want to relocate to long-term care in order to have his ADL
In some situations, especially with long-term severe intractable pain, usual
pharmacologic and nonpharmacologic methods of pain relief are ineffective. In those
situations, neurologic and neurosurgical approaches to pain management may be
considered. Investigating new alternative pain-management options that are outside the
United States is unrealistic and may even be dangerous advice. Increasing his exercise
and activities to create distractions is unrealistic when a patient is in intractable pain
and this recommendation conveys the attitude that the pain is not real. Moving into a
nursing home so others may care for him is an intervention that does not address the
issue of pain.
14. You are the home health nurse caring for a homebound client who is terminally ill. You
are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit
today. The family members will be taking care of the patient. What would your priority
nursing interventions be for this visit?
A) Teach the family the theory of pain management and the use of alternative
B) Provide psychosocial family support during this emotional experience.
C) Provide patient and family teaching regarding the operation of the pump,
monitoring the IV site, and knowing the side effects of the medication.
D) Provide family teaching regarding use of morphine, recognizing morphine
overdose, and offering spiritual guidance.
If PCA is to be used in the patient’s home, the patient and family are taught about the
operation of the pump as well as the side effects of the medication and strategies to
manage them. The family would also need to monitor the IV site and notify the nurse of
any changes, such as infiltration, that could endanger the patient. Teaching the family
the theory of pain management or the use of alternative therapies and the nurse
providing emotional support are important, but the family must be able to operate the
pump as well as know the side effects of the medication and strategies to manage them.
Offering spiritual guidance would not be a priority at this point and morphine is not the
only medication administered by PCA.
15. The mother of a cancer patient comes to the nurse concerned with her daughter’s safety.
She states that her daughter’s morphine dose that she needs to control her pain is getting
“higher and higher.” As a result, the mother is afraid that her daughter will overdose.
The nurse educates the mother about what aspect of her pain management?
A) The dose range is higher with cancer patients, and the medical team will be very
careful to prevent addiction.
B) Frequently, female patients and younger patients need higher doses of opioids to
C) The increased risk of overdose is an inevitable risk of maintaining adequate pain
control during cancer treatment.
D) There is no absolute maximum opioid dose and her daughter is becoming more
tolerant to the drug.
Patients requiring opioids for chronic pain, especially cancer patients, need increasing
doses to relieve pain. The requirement for higher drug doses results in a greater drug
tolerance, which is a physical dependency as opposed to addiction, which is a
psychological dependency. The dose range is usually higher with cancer patients.
Although tolerance to the drug will increase, addiction is not dose related, but is a
separate psychological dependency issue. No research indicates that women and/or
younger people need higher doses of morphine to be comfortable. Overdose is not an
16. You have just received report on a 27-year-old woman who is coming to your unit from
the emergency department with a torn meniscus. You review her PRN medications and
see that she has an NSAID (ibuprofen) ordered every 6 hours. If you wanted to
implement preventive pain measures when the patient arrives to your unit, what would
A) Use a pain scale to assess the patient’s pain, and let the patient know ibuprofen is
available every 6 hours if she needs it.
B) Do a complete assessment, and give pain medication based on the patient’s report
C) Check for allergies, use a pain scale to assess the patient’s pain, and offer the
ibuprofen every 6 hours until the patient is discharged.
D) Provide medication as per patient request and offer relaxation techniques to
One way preventive pain measures can be implemented is by using PRN medications
on a more regular or scheduled basis to allow for more uniform pain control. Smaller
drug doses of medication are needed with the preventive pain method when PRN
medications are given around the clock. Offering the medication is more beneficial than
letting the patient know ibuprofen is available.
17. A 60-year-old patient who has diabetes had a below-knee amputation 1 week ago. The
patient asks “why does it still feel like my leg is attached, and why does it still hurt?”
The nurse explains neuropathic pain in terms that are accessible to the patient. The
nurse should describe what pathophysiologic process?
A) The proliferation of nociceptors during times of stress
B) Age-related deterioration of the central nervous system
C) Psychosocial dependence on pain medications
D) The abnormal reorganization of the nervous system
At any point from the periphery to the CNS, the potential exists for the development of
neuropathic pain. Hyperexcitable nerve endings in the periphery can become damaged,
leading to abnormal reorganization of the nervous system called neuroplasticity, an
underlying mechanism of some neuropathic pain states. Neuropathic pain is not a result
of age-related changes, nociceptor proliferation, or dependence on medications.
18. You are the case manager for a 35-year-old man being seen at a primary care clinic for
chronic low back pain. When you meet with the patient, he says that he is having
problems at work; in the past year he has been absent from work about once every 2
weeks, is short-tempered with other workers, feels tired all the time, and is worried
about losing his job. You are developing this patient’s plan of care. On what should the
goals for the plan of care focus?
A) Increase the patient’s pain tolerance in order to achieve psychosocial benefits.
B) Decrease the patient’s need to work and increase his sleep to 8 hours per night.
C) Evaluate other work options to decrease the risk of depression and ineffective
D) Decrease the time lost from work to increase the quality of interpersonal
relationships and decrease anxiety.
Chronic pain may affect the patient’s quality of life by interfering with work,
interpersonal relationships, or sleep. Thus, the best set of goals would be to “decrease
time lost from work to increase the quality of interpersonal relationships, and decrease
anxiety.” Increasing pain tolerance is an unrealistic and inappropriate goal; exercise
could help, but would not be the focus of the plan of care. Decreasing the need to work
does not address his pain. Evaluating other work options to decrease the risk of
depression is a misdirected diagnosis.
19. An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is
complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse
that he thinks the patient is exaggerating and does not need pain medication. What is
the nurse’s best response?
A) “Pain often comes and goes with postsurgical patients. Please ask her about pain
again in about 30 minutes.”
B) “We need to provide pain medications because it is the law, and we must always
follow the law.”
C) “Unless there is strong evidence to the contrary, we should take the patient’s
report at face value.’”
D) “It’s not unusual for patients to misreport pain to get our attention when we are
A broad definition of pain is “whatever the person says it is, existing whenever the
experiencing person says it does.” Action should be taken unless there are demonstrable
extenuating circumstances. The other answers are incorrect.
20. The home health nurse is developing a plan of care for a patient who will be managing
his chronic pain at home. Using the nursing process, on which concepts should the
nurse focus the patient teaching?
A) Self-care and safety
B) Autonomy and need
C) Health promotion and exercise
D) Dependence and health
The patient will be at home monitoring his own pain management, administering his
own medication, and monitoring and reporting side effects. This requires the ability to
perform self-care activities in a safe manner. Creating autonomy is important, but need
is a poorly defined concept. Health promotion is an important global concept for
maintaining health, and exercise is an appropriate activity; however, self-care and
safety are the priorities. Dependence is not a concept used to develop a nursing plan of
care, and health is too broad a concept to use as a basis for a nursing plan of care.
21. You are the emergency department (ED) nurse caring for an adult patient who was in a
motor vehicle accident. Radiography reveals an ulnar fracture. What type of pain are
you addressing when you provide care for this patient?
Acute pain is usually of recent onset and commonly associated with a specific injury.
Acute pain indicates that damage or injury has occurred. Chronic pain is constant or
intermittent pain that persists beyond the expected healing time and that can seldom be
attributed to a specific cause or injury. Phantom pain occurs when the body experiences
a loss, such as an amputation, and still feels pain in the missing part. “Osteopenic” pain
is not a recognized category of pain.
22. The wife of a patient you are caring for asks to speak with you. She tells you that she is
concerned because her husband is requiring increasingly high doses of analgesia. She
states, “He was in pain long before he got cancer because he broke his back about 20
years ago. For that problem, though, his pain medicine wasn’t just raised and raised.”
What would be the nurses’ best response?
A) “I didn’t know that. I will speak to the doctor about your husband’s pain control.”
B) “Much cancer pain is caused by tumor involvement and needs to be treated in a
way that brings the patient relief.”
C) “Cancer is a chronic kind of pain so the more it hurts the patient, the more
medicine we give the patient until it no longer hurts.”
D) “Does the increasing medication dosage concern you?”
Much pain associated with cancer is a direct result of tumor involvement. Conveying
patient/family concerns to the physician is something a nurse does, but is not the best
response by the nurse. Cancer pain can be either acute or chronic, and you do not tell a
family member that you are going to keep increasing the dosage of the medication until
“it doesn’t hurt anymore.” The family member is obviously concerned.
23. You are part of the health care team caring for an 87-year-old woman who has been
admitted to your rehabilitation facility after falling and fracturing her left hip. The
patient appears to be failing to regain functional ability and may have to be readmitted
to an acute-care facility. When planning this patient’s care, what do you know about the
negative effects of the stress associated with pain?
A) Stress is less pronounced in older adults because they generally have more
sophisticated coping skills than younger adults
B) It is particularly harmful in the elderly who have been injured or who are ill.
C) It affects only those patients who are already debilitated prior to experiencing
D) It has no inherent negative effects; it just alerts the person/health care team of an
underlying disease process.
The widespread endocrine, immunologic, and inflammatory changes that occur with the
stress of pain can have significant negative effects. This is particularly harmful in
patients whose health is already compromised by age, illness, or injury. Older adults are
not immune to the negative effects of stress. Prior debilitation does not have to be
present in order for stress to cause potential harm.
24. You are the nurse caring for the 25-year-old victim of a motor vehicle accident with a
fractured pelvis and a ruptured bladder. The nurse’s aide (NA) tells you that she is
concerned because the patient’s resting heart rate is 110 beats per minute, her
respirations are 24 breaths per minute, temperature is 99.1°F axillary, and the blood
pressure is 125/85 mm Hg. What other information is most important as you assess this
patient’s physiologic status?
A) The patient’s understanding of pain physiology
B) The patient’s serum glucose level
C) The patient’s white blood cell count
D) The patient’s rating of her pain
The nurse’s assessment of the patient’s pain is a priority. There is no suggestion of
diabetes and leukocytosis would not occur at this early stage of recovery. The patient
does not need to fully understand pain physiology in order to communicate the
presence, absence, or severity of pain.
25. You are the nurse coming on shift in a rehabilitation unit. You receive information in
report about a new patient who has fibromyalgia and has difficulty with her ADLs. The
off-going nurse also reports that the patient is withdrawn, refusing visitors, and has
been vacillating between tears and anger all afternoon. What do you know about
chronic pain syndromes that could account for your new patient’s behavior?
A) Fibromyalgia is not a chronic pain syndrome, so further assessment is necessary.
B) The patient is likely frustrated because she has to be in the hospital.
C) The patient likely has an underlying psychiatric disorder.
D) Chronic pain can cause intense emotional responses.
Regardless of how patients cope with chronic pain, pain that lasts for an extended
period can result in depression, anger, or emotional withdrawal. Nowhere in the
scenario does it indicate the patient is upset about the hospitalization or that she has a
psychiatric disorder. Fibromyalgia is closely associated with chronic pain.
26. You are caring for a patient admitted to the medical-surgical unit after falling from a
horse. The patient states “I hurt so bad. I suffer from chronic pain anyway, and now it is
so much worse.” When planning the patient’s care, what variables should you consider?
Select all that apply.
A) How the presence of pain affects patients and families
B) Resources that can assist the patient with pain management
C) The influence of the patient’s cognition on her pain
D) The advantages and disadvantages of available pain-relief strategies
E) The difference between acute and intermittent pain
Ans: A, B, D
Nurses should understand the effects of chronic pain on patients and families and
should be knowledgeable about pain-relief strategies and appropriate resources to assist
effectively with pain management. There is no evidence of cognitive deficits in this
patient and the difference between acute and intermittent pain has no immediate
bearing on this patient’s care.
27. A patient is experiencing severe pain after suffering an electrical burn in a workplace
accident. The nurse is applying knowledge of the pathophysiology of pain when
planning this patient’s nursing care. What is the physiologic process by which noxious
stimuli, such as burns, activate nociceptors?
Transduction refers to the processes by which noxious stimuli, such as a surgical
incision or burn, activate primary afferent neurons called nociceptors. Transmission,
perception, and modulation are subsequent to this process.
28. A 74-year-old woman was diagnosed with rheumatoid arthritis 1 year ago, but has
achieved adequate symptom control through the regular use of celecoxib (Celebrex), a
COX-2 selective NSAID. The nurse should recognize that this drug, like other
NSAIDs, influences what aspect of the pathophysiology of nociceptive pain?
A) Distorting the action potential that is transmitted along the A-delta (d) and C
B) Diverting noxious information from passing through the dorsal root ganglia and
synapses in the dorsal horn of the spinal cord
C) Blocking modulation by limiting the reuptake of serotonin and norepinephrine
D) Inhibiting transduction by blocking the formation of prostaglandins in the
NSAIDs produce pain relief primarily by blocking the formation of prostaglandins in
the periphery; this is a central component of the pathophysiology of transduction.
NSAIDs do not act directly on the aspects of transmission, perception, or modulation of
pain that are listed.
29. You are the nurse caring for a postsurgical patient who is Asian-American who speaks
very little English. How should you most accurately assess this patient’s pain?
A) Use a chart with English on one side of the page and the patient’s native language
on the other so he can rate his pain.
B) Ask the patient to write down a number according to the 0-to-10 point pain scale.
C) Use the Visual Analog Scale (VAS).
D) Use the services of a translator each time you assess the patient so you can
document the patient’s pain rating.
Of the listed options, a language comparison chart is most plausible. The VAS requires
English language skills, even though it is visual. Asking the patient to write similarly
requires the use of English. It is impractical to obtain translator services for every pain
assessment, since this is among the most frequently performed nursing assessments.
30. A patient’s intractable neuropathic pain is being treated on an inpatient basis using a
multimodal approach to analgesia. After administering a recently increased dose of IV
morphine to the patient, the nurse has returned to assess the patient and finds the patient
unresponsive to verbal and physical stimulation with a respiratory rate of five breaths
per minute. The nurse has called a code blue and should anticipate the administration of
D) Acetylsalicylic acid
Severe opioid-induced sedation necessitates the administration of naloxone, an opioid
antagonist. Celecoxib, acetylcysteine, and acetylsalicylic acid are ineffective.
31. You are assessing an 86-year-old postoperative patient who has an unexpressive, stoic
demeanor. When you enter the room, the patient is curled into the fetal position and
your assessment reveals that his vital signs are elevated and he is diaphoretic. You ask
the patient what his pain level is on a 0-to-10 scale that you explained to the patient
prior to surgery. The patient indicates a pain level of “three or so.” You review your
pain-management orders and find that all medications are ordered PRN. How would
you treat this patient’s pain?
A) Treat the patient on the basis of objective signs of pain and reassess him
B) Call the physician for new orders because it is apparent that the pain medicine is
C) Believe what the patient says, reinforce education, and reassess often.
D) Ask the family what they think and treat the patient accordingly.
As always, the best guide to pain management and administration of analgesic agents in
all patients, regardless of age, is what the individual patient says. However, further
education and assessment are appropriate. You cannot usually treat pain the patient
denies having if the orders are PRN only. The scenario does not indicate the present
pain-management orders are not working for this patient. The family’s insights do not
override the patient’s self-report.
32. The nurse caring for a 91-year-old patient with osteoarthritis is reviewing the patient’s
chart. This patient is on a variety of medications prescribed by different care providers
in the community. In light of the QSEN competency of safety, what is the nurse most
concerned about with this patient?
B) Chronic illness
C) Inadequate pain control
D) Drug interactions
Drug interactions are more likely to occur in older adults because of the higher
incidence of chronic illness and the increased use of prescription and OTC medications.
The other options are all good answers for this patient because of the patient’s age and
disease process. However, they are not what the nurse would be most concerned about
in terms of ensuring safety.
33. You are caring for a patient with sickle cell disease in her home. Over the years, there
has been joint damage, and the patient is in chronic pain. The patient has developed a
tolerance to her usual pain medication. When does the tolerance to pain medication
become the most significant problem?
A) When it results in inadequate relief from pain
B) When dealing with withdrawal symptoms resulting from the tolerance
C) When having to report the patient’s addiction to her physician
D) When the family becomes concerned about increasing dosage
Tolerance to opioids is common and becomes a problem primarily in terms of
maintaining adequate pain control. Symptoms of physical dependence may occur when
opiates are discontinued, but there is no indication that the patient’s medication will be
discontinued. This patient does not have an addiction and the family’s concerns are
secondary to those of the patient.
34. You are admitting a patient to your rehabilitation unit who has a diagnosis of persistent,
severe pain. According to the patient’s history, the patient’s pain has not responded to
conventional approaches to pain management. What treatment would you expect might
be tried with this patient?
A) Intravenous analgesia
B) Long-term intrathecal or epidural catheter
C) Oral analgesia
D) Intramuscular analgesia
For patients who have persistent, severe pain that fails to respond to other treatments or
who obtain pain relief only with the risk of serious side effects, medication
administered by a long-term intrathecal or epidural catheter may be effective. The other
listed means of pain control would already have been tried in a patient with persistent
severe pain that has not responded to previous treatment.
35. You are caring for a 20-year-old patient with a diagnosis of cerebral palsy who has
been admitted for the relief of painful contractures in his lower extremities. When
creating a nursing care plan for this patient, what variables should the nurse consider?
Select all that apply.
A) Patient’s gender
B) Patient’s comorbid conditions
C) Type of procedure be performed
D) Changes in neurologic function due to the procedure
E) Prior effectiveness in relieving the pain
Ans: B, C, D, E
The nursing care of patients who undergo procedures for the relief of chronic pain
depends on the type of procedure performed, its effectiveness in relieving the pain, and
the changes in neurologic function that accompany the procedure. The patient’s
comorbid conditions will also affect care, but his gender is not a key consideration.
36. The nurse is caring for a male patient whose diagnosis of bone cancer is causing severe
and increasing pain. Before introducing nonpharmacological pain control interventions
into the patient’s plan of care, the nurse should teach the patient which of the following?
A) Nonpharmacological interventions must be provided by individuals other than
members of the healthcare team.
B) These interventions will not directly reduce pain, but will refocus him on positive
C) These interventions carry similar risks of adverse effects as analgesics.
D) Reducing his use of analgesics is not the purpose of these interventions.
Patients who have been taking analgesic agents may mistakenly assume that clinicians
suggest a nonpharmacolgical method to reduce the use or dose of analgesic agents.
Nonpharmacological interventions indeed reduce pain and their use is not limited to
practitioners outside the healthcare team. In general, adverse effects are minimal.
37. A nurse on an oncology unit has arranged for an individual to lead meditation exercises
for patients who are interested in this nonpharmacological method of pain control. The
nurse should recognize the use of what category of nonpharmacological intervention?
A) A body-based modality
B) A mind-body method
C) A biologically based therapy
D) An energy therapy
Meditation is one of the recognized mind-body methods of nonpharmacological pain
control. The other answers are incorrect.
38. A medical nurse is appraising the effectiveness of a patient’s current pain control
regimen. The nurse is aware that if an intervention is deemed ineffective, goals need to
be reassessed and other measures need to be considered. What is the role of the nurse in
obtaining additional pain relief for the patient?
A) Primary caregiver
B) Patient advocate
C) Team leader
D) Case manager
If the intervention was ineffective, the nurse should consider other measures. If these
are ineffective, pain-relief goals need to be reassessed in collaboration with the
physician. The nurse serves as the patient’s advocate in obtaining additional pain relief.
39. A nurse has cited a research study that highlights the clinical effectiveness of using
placebos in the management of postsurgical patients’ pain. What principle should guide
the nurse’s use of placebos in pain management?
A) Placebos require a higher level of informed consent than conventional care.
B) Placebos are an acceptable, but unconventional, form of nonpharmacological pain
C) Placebos are never recommended in the treatment of pain.
D) Placebos require the active participation of the patient’s family.
Broad agreement is that there are no individuals for whom and no condition for which
placebos are the recommended treatment. This principle supersedes the other listed
40. The nurse is accepting care of an adult patient who has been experiencing severe and
intractable pain. When reviewing the patient’s medication administration record, the
nurse notes the presence of gabapentin (Neurontin). The nurse is justified in suspecting
what phenomenon in the etiology of the patient’s pain?
C) Psychosomatic processes
The anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) are first-line
analgesic agents for neuropathic pain. Neuroplasticity is the ability of the peripheral
and central nervous systems to change both structure and function as a result of noxious
stimuli; this does not likely contribute to the patient’s pain. Similarly, psychosomatic
factors and misperception of pain are highly unlikely.
Brunner and Suddarth’s Textbook of Medical-Surgical Nursing: 13th Edition Test Bank – Hinkle