chapter 21

Question 1

A patient reports to the nurse that he is experiencing a moderate amount of back pain rated 6
out of 10 on the pain scale. What should the nurse recognize about this assessment?
a. Pain is objective for the nurse.
b. Pain is easy to recognize.
c. Pain is subjective for the patient.
d. Pain is easily relieved if found early.

Answer 1

c. Pain is subjective for the patient.

Question 2

A patient has pain in the left arm secondary to coronary insufficiency. This is an example of
what type of pain?
a. Acute pain
b. Chronic pain
c. Referred pain
d. Subacute pain

Answer 2

c. Referred pain

Question 3

The nurse reassures a patient that most acute pain is intense and of short duration. How long
does can acute pain usually last?
a. 1 week
b. Less than 6 months
c. At least 9 months
d. More than 1 year

Answer 3

b. Less than 6 months

Question 4

What is the defining term for continuous or intermittent pain that does not serve as a
warning of tissue damage?
a. Acute
b. Unrelieved
c. Chronic
d. Subacute

Answer 4

c. Chronic

Question 5

The nurse is planning interventions for a patient experiencing pain. When the nurse assess
the patient, which of the following can act in a synergistic relationship?
a. Inflammatory process
b. Circulatory disorder
c. Food allergy
d. Fatigue

Answer 5

d. Fatigue

Question 6

The nurse is giving a backrub to a patient to relieve pain. What pain theory is the nurse
using?
a. Synergism
b. Gate control
c. Distraction
d. Guided imagery

Answer 6

b. Gate control

Question 7

A young athlete asks the nurse why he felt little pain when he broke his leg during a game.
Which of the following can have an effect on this patient’s perception of pain?
a. Hormones
b. Enzymes
c. Adrenaline
d. Endorphins

Answer 7

d. Endorphins

Question 8

When assessing pain which of the following is included in pain assessment?
a. The initial assessment
b. Discharge planning
c. Assessing vital signs
d. Care planning

Answer 8

c. Assessing vital signs

Question 9

Why should a nurse promptly administer a prescribed analgesic after a pain assessment?
a. The health care provider has ordered it.
b. It is an efficient use of time.
c. Unrelieved pain can cause setbacks.
d. It meets the goals of the nursing care plan.

Answer 9

c. Unrelieved pain can cause setbacks.

Question 10

The nurse obtains information from a patient about the site, severity, and duration of the
pain. What type of data is this considered?
a. Patient data
b. Objective data
c. Focused data
d. Subjective data

Answer 10

d. Subjective data

Question 11

The nurse is assessing pain reported by a Latino male patient. What is important for the nurse to take into consideration when observing objective data?
a. Latino men are suspicious of female caregivers.
b. Latino men have a cultural bias against use of narcotics.
c. Latino men believe pain is necessary for cure.
d. Latino men feel it is unmanly to admit to pain.

Answer 11

d. Latino men feel it is unmanly to admit to pain.

Question 12

Which documentation sample is the most helpful to share assessment findings and pain
relief interventions?
a. 1600: Patient reports chest pain. Medicated with morphine sulfate.
b. 1600: Patient reports sharp chest pain. Morphine sulfate given IM.
c. 1600: Patient reports sharp pain in left chest radiating to neck. Morphine sulfate 5
mg administered IM in right deltoid.
d. 1600: Patient requested medication for pain in left chest. Morphine sulfate 10 mg
PO given.

Answer 12

c. 1600: Patient reports sharp pain in left chest radiating to neck. Morphine sulfate 5
mg administered IM in right deltoid.

Question 13

The nurse teaches noninvasive pain relief techniques, such as guided imagery, biofeedback,
and relaxation. What is the primary advantage of these techniques?
a. Can be done any time.
b. Does not require a nurse.
c. Gives the patient some control.
d. Is most effective.

Answer 13

c. Gives the patient some control.

Question 14

The nurse explains that transcutaneous electric nerve stimulation (TENS) provides a
continuous mild electric current to the skin. How does the TENS unit act to reducepain?
a. Distracts the patient.
b. Blocks endorphin production.
c. Warms the skin.
d. Blocks pain impulses.

Answer 14

d. Blocks pain impulses.

Question 15

An American Indian patient requests that an egg yolk be placed in a saucer and put under
his bed to absorb the pain. What should the nurse do?
a. Explain that medication will relieve the pain better.
b. Place the egg in a saucer under the bed.
c. Ask the health care provider for permission.
d. Warn that housekeeping staff will remove the egg.

Answer 15

b. Place the egg in a saucer under the bed.

Question 16

The home health nurse is caring for a patient with an implanted pacemaker. What type of
pain management would be contraindicated?
a. Peripheral analgesics
b. A TENS unit
c. Opioid analgesics
d. Adjuvant analgesics

Answer 16

b. A TENS unit

Question 17

The nurse is trying to reassure a patient who is concerned about receiving addictive drugs.
What percentage of patients become addicted to analgesics?
a. Less than 0.1%
b. Less than 1%
c. Less than 5%
d. Less than 6%

Answer 17

b. Less than 1%

Question 18

The nurse is caring for a patient using patient-controlled analgesia (PCA). What is a major
advantage to this method?
a. Less expensive
b. More effective
c. Less addictive
d. Quicker

Answer 18

d. Quicker

Question 19

A patient tearfully declares the use of relaxation techniques does not work for her. What is
the best action for the nurse to implement?
a. Give up on the idea.
b. Encourage the patient to try again.
c. Assure the patient that not everyone is successful.
d. Give the patient a sedative.

Answer 19

b. Encourage the patient to try again.

Question 20

A patient is receiving an opioid narcotic. What common side effect should the nurse be
aware of when assessing this patient?
a. Addiction
b. Vomiting
c. Constipation
d. Diarrhea

Answer 20

c. Constipation

Question 21

A male patient reports to the home health nurse that he does not feel rested although he has
slept 8 hours. For what should the nurse assess?
a. Having vivid dreams
b. Eating a heavy meal before going to bed
c. Consuming an excessive amount of alcohol
d. Taking an anxiolytic medication

Answer 21

d. Taking an anxiolytic medication

Question 22

Although denying pain, a patient is irritable, responds slowly, and exhibits periods of
tachycardia. What should the nurse assess for in this patient?
a. Electrolyte imbalance
b. Allergic response
c. Sleep deprivation
d. Constipation

Answer 22

c. Sleep deprivation

Question 23

When preparing a patient for sleep, dimming the lights and decreasing the noise levels are
examples of nursing interventions. What are these interventions designed to do?
a. Mimic usual sleep patterns.
b. Decrease environmental stimuli.
c. Prepare the patient for sleep.
d. Provide for more rest.

Answer 23

b. Decrease environmental stimuli.

Question 24

What is the best approach for a nurse to use when planning pain relief measures?
a. Use a variety of pain relief methods.
b. Use only nonopioid analgesics.
c. Use at least three alternating methods.
d. Use only one method at a time.

Answer 24

a. Use a variety of pain relief methods.

Question 25

The nurse is trying to establish an effective relationship with a patient in pain. What is the
best statement for the nurse to make when beginning the assessment?
a. “I’ll check to see if you can have anything.”
b. “Let me give you a backrub and see if it helps.”
c. “I believe you are in pain.”
d. “When was your last medication for pain?”

Answer 25

c. “I believe you are in pain.”

Question 26

What action should the nurse take when evaluating the effectiveness of new or revised
therapies for pain relief?
a. Observe the patient performing activities of daily living.
b. Observe the patient’s facial expressions.
c. Frequently assess subjective data.
d. Perform evaluation of outcome goals.

Answer 26

d. Perform evaluation of outcome goals.

Question 27

The home health nurse is instructing the family of an older adult patient with arthritis about
sleep promotion. What intervention can best promote sleep for the older adult patient?
a. Giving nonsteroidal anti-inflammatory drugs (NSAIDs) in the mornings
b. Administering diuretics in the mornings
c. Encouraging daytime sleeping
d. Avoiding the stimulation of backrubs or warm drinks before bedtime

Answer 27

b. Administering diuretics in the mornings

Question 28

The nurse is using a pain scale of 0 to 10 to assess pain in a postoperative patient. What is
considered the maximum pain level at which a patient can usually function effectively?
a. 2
b. 3
c. 4
d. 5

Answer 28

c. 4

Question 29

A patient is receiving epidural analgesics. What should the nurse monitor closely in this
patient?
a. Temperature elevation from 98° to 99.2°F (36.6° to 37.3°C)
b. Increase in pulse rate from 88 to 99
c. Decrease in respirations from 16 to 14
d. Decrease in blood pressure from 120/80 to 110/68

Answer 29

c. Decrease in respirations from 16 to 14

Question 30

When should a nurse administer prescribed analgesic medication when treating a
postoperative patient?
a. Before activity
b. Only when requested by the health care provider
c. Only when requested by the family
d. Only when requested by the patient

Answer 30

a. Before activity

Question 31

What action should the nurse implement when assisting a postoperative patient with pain
control and comfort?
a. Pull the patient up in bed.
b. Lift the patient up in bed.
c. Tighten constricting bandages.
d. Restrict fluid and dietary intake.

Answer 31

b. Lift the patient up in bed.

Question 32

A nurse is caring for a patient who requires long-term management for severe pain. What
should be the drug of choice for this patient?
a. Aspirin
b. Morphine
c. Oxycodone
d. Acetaminophen

Answer 32

b. Morphine

Question 33

The pain relief intervention that stimulates large cutaneous nerve fibers to “close the gate” is
the unit.
a. PRI
b. TENS
c. CTG
d. UTI

Answer 33

b. TENS