N 106-109

Pain is impervious to therapeutic interventions:
A) Acute pain
B) Intractable pain
C) Chronic pain
D) Neuropathic pain

Pain is related to tissue injury and will abate with healing:
A) Neuropathic pain
B) Chronic pain
C) Intractable pain
D) Acute pain

Pain lasts longer than 6 months and often limits normal functioning:
A) Chronic pain
B) Neuropathic pain
C) Intractable pain
D) Acute pain

Pain described as shooting or stabbing- results from a disorder of the peripheral or central nervous system:
A) Neuropathic pain
B) Radiating pain
C) Referred pain
D) Phantom pain

Pain perceived at the source and extends to nearby tissue:
A) Phantom pain
B) Radiating pain
C) Neuropathic pain
D) Referred pain

Painful sensation seeming in a missing body or paralyzed body part:
A) Neuropathic pain
B) Radiating pain
C) Referred pain
D) Phantom pain

Pain felt in a part of the body that is noticeable removed from the tissues affected:
A) Referred pain
B) Radiating pain
C) Neuropathic pain
D) Phantom pain

Which is the most accurate portrayal of pain:
A) Pain is always a sign that serious physiological problems exist.
B) Verbal reports of pain are not sufficient cause for treatment
C) You should try to delay pain medication to prevent drug dependence.
D) Pain is highly subjective and is whatever the client says it is.

Which statement about pain is true?
A) All pain sensations received by nociceptors pass the pain gate and are carried to the brain
B) Pain impulses may be transmitted to the brain thru fast pain or slow pain pathways-impulse is transmitted in the same fashion, but the speed of transmission id different.
C) The cerebral cortex is though to play a role in interpretation and localization of pain.
D) Fast pain fibers release substance patient, which is slow to build up at the synapse and slow to be destroyed.

According to the gate control theory, you could affect pain perception by ascending modulation.  What is consistent with this approach?
A) Use of options
B) Education and emotional support
C) Relaxation
D) Massage

Which of the following would be the least likely to affect pain?
A) Age
B) Ethnic and Cultural values
C) Expectation of significant others
D) Education level

Assessment of pain should be performed:
A) Immediately after administration of IV morphine
B) Once per day
C) And initiated by the nurse
D) Only when the patient states he/she is having pain

Chronic pain is often distinguished by:
A) Overt behavioral responses such as rocking, immobilization of the body part, or tossing and turning
B) Dull or piercing pain
C) Elevation of blood pressure, pulse and respiration
D) Absence of behavioral or physiologic response

What statement about opioids is true?
A) Respiratory depression is the most serious side effect of opioid analgesia
B) Physical dependence is not a sign of addiction
C) Constipation is a common side effect
D) All of the above

Preferred route of delivery for opioids is?
A) IV
B) Oral
C) IM
D) Transdermal

Which patient would be the most likely candidate for PCA?
A) A 20 year old woman with severe neurological deficits
B) A post-op patient who is A&O with pain
C) a 4 year old with pain from a fractured femur
D) A post-op patient with a diagnosis of Alzheimer's

Your patient is Post-op with severe pain and has received an opioid IM.  Which Nonpharmacologic independent pain management strategy could you implement to supplement pain relief?
A) TENS
B) Immobilization
C) Massage
D) Acupuncture

Pain threshold and pain tolerance are about the same in all patients:

a) True
b) False

All patients who are Post-op appendectomy have similar pain levels?

a) True
b) False

The Wong/Baker FACES pain scale is designed for children under 3?

a) True
b) False

Pain is classified as chronic when it persists for:
A) 3 months
B) 1-2 months
C) greater than 6 months
D) 3-5 months

Acute pain:
A) Responds well to placebos
B) Does not usually respond well to treatment
C) Is associated with a specific injury
D) Serves no useful purpose

A physiologic response not usually associated with acute pain is:
A) decreased cardiac output
B) altered insulin response
C) increased metabolic rate
D) retention of fluids

A chemical substance thought to inhibit the transmission of pain is:
A) Histamine
B) Enkephalin
C) Bradykinin
D) Acetylcholine

Chronic pain can be described as:
A) Separate from any central or peripheral pathology
B) Prolonged in duration
C) Rapidly occurring and subsiding with treatment
D) Attributable to a specific cause

An example of chronic benign pain is:
A) Sickle cell crisis
B) Low-back pain
C) Exacerbation of rheumatoid arthritis
D) A migraine headache

The following about endorphins are true EXCEPT:
A) They are endogenous neurotransmitters structurally similar to opioids
B) They are found in heavy concentration in the CNS
C) They represent the same mechanism of pain relief as non-narcotic analgesics
D) Their release inhibits the transmission of painful impulses

When assessing for pain, you should:
A) Doubt that pain exists if no physical origin can be found
B) Realize that patients frequently imagine pain
C) Believe a patient when he/she states that pain is present
D) All of the above

When you ask your patient to describe the quality of his pain, an expected descriptive term would be:
A) Chronic
B) Severe
C) Intermittent
D) Burning

A physiologic indicator of acute pain is:
A) Bradycardia
B) Diaphoresis
C) Decreased respiratory rate
D) Hypotension

A nursing measure to manage anxiety during the anticipation of pain should include:
A) Teaching about the nature of the impending pain and associated relief measures
B) Focusing the patient attention on another problem
C) Using an anxiety-reducing technique such as desensitization
D) Any or all of the above

Pain in the elderly requires careful assessment because older people
A) Have a increased sensory perception
B) Have a decreased pain threshold
C) Experience reduced sensory perception
D) Are expected to experience chronic pain

Admin. of analgesics to the elderly requires careful patient assessment because older people:
A) Have increased hepatic, renal and gastrointestinal function
B) Are more sensitive to drugs
C) Have lower ratios of body fat and muscle mass
D) Metabolize drugs more rapidly

A nursing plan of care for pain management should include:
A) Altering factors that influence the pain sensation
B) Selecting goals for nursing intervention
C) Determining responses to the patients behavior toward pain
D) all of the above

The advantage of using intraspinal infusion  to deliver analgesics is:
a) Reduced side effects of systemic analgesic
b) Reduced effects on pulse, respiration and blood pressure
c) Reduced need for frequent injections
d) all of the above

The preferred drug for epidural administration is:
A) Demerol
B) Morphine
C) Codeine
D) Dilaudid

The most worrisome adverse effect of epidural opioids is:
A) Tachycardia
B) Hypertension
C) Asystole
D) Bradypnea

With NSAIDs, a preventive approach to pain relief means that the medication is given
A) Before the pain is experienced
B) When the level of pain tolerance has been exceeded
C) When pain is at its peak
D) Before the pain becomes severe

Cutaneous stimulation is helpful in reducing painful sensations, because it
A) Provides distraction from the pain source and decreases awareness
B) Stimulates large nerve fibers and reduces the intensity of pain
C) Releases endorphins
D) Accomplishes all of the above

Your major area of assessment for a patient receiving PCA is assessment of the:
A) Cardiovascular system
B) Neurologic system
C) Respiratory system
D) Integumentary system

The patient is a 40 year old healthy adult who fell off his son's skateboard and struck his forehead on the cement sidewalk.  There was no LOC, but he did sustain a mild concussion and a hematoma that is 5 cm wide and protrudes outward about 5 cm.  He experienced acute pain at the site of injury and complained of a throbbing headache.  Based on Bob's description, an immediate assessment of the localized pain is that it should be:
A) Brief in duration
B) Persistent after healing has occurred
C) Mild in intensity
D) Recurrent for 3-4 months

During the assessment, the nurse attempts to determine Bob's physiologic and behavioral response to his pain experience.  A behavioral response indicative of acute pain is:
A) an expressionless face
B) clear verbalization stimulation
C) Muscle tension
D) physical inactivity

You use distraction to help Bob cope with his pain.  a suggested activity is:
A) using cutaneous stimulation
B) promoting relaxation
C) playing music or using a videotape
D) any and all of the above

After treatment Bob is discharged while still in pain.  You should:
A) Remind him that acute pain may persist for several days
B) Clarify that he knows what type of pain signals a problem
C) Review methods of pain management
D) All of the above

Assess cognitively impaired patients by
A) asking caregiver about recent changes in function, gait, mode, and behavior
B) Noting increased vocalization- moaning, groaning, and crying
C) Observing behavior grimacing, guarding, irritability, reluctance to move an extremity, etc
D) All of the above

To manage side effects with opioids use in an elderly patient:
A) Monitor for sedation, delirium, impaired cognitive function
B) Monitor for constipation, urinary retention
C) Monitor for respiratory depression
D) All of the above

Non-narcotic drugs and comfort measures are appropriate for:
A) Mild superficial pain
B) Deep pain
C) Chronic pain
D) Moderate acute pain

NSAIDs are appropriate for:
A) mild superficial pain
B) chronic pain
C) deep pain
D) somatic pain

Combination of narcotic and non-narcotic drugs are appropriate for:
A) Moderate acute pain
B) Mild superficial pain
C) Chronic pain
D) Deep pain

Narcotic drugs are appropriate for:
A) deep pain
B) chronic pain
C) somatic pain
D) mild superficial pain