final exam NURS 1385
Chapter 10: Pain
Test Bank
MULTIPLE CHOICE
1. A 45-year-old woman has breast cancer that has spread to her liver and spine. She has been
taking oxycodone (Percodan) and amitriptyline (Elavil) for pain control at home but now has
constant severe pain and is hospitalized for pain control and development of a pain-management
program. During assessment of the client, what information related to her pain is most important
for the nurse to obtain initially?
a. The pattern, area, intensity, and nature of her pain
b. Identification of trigger points of pain by palpation of painful areas
c. The schedule and total dosages of the drugs she is currently taking and when
breakthrough pain occurs
d. The presence of a sympathetic response, such as tachycardia, diaphoresis, and a
rise in blood pressure
ANS: A
Pain is a complex experience involving physiological, sensory (i.e., the perception of pain by the
individual that addresses the pain location, intensity, pattern, and quality), affective, behavioural,
and cognitive dimensions; therefore, the nurse needs to assess the pattern, area, nature, and
intensity of the pain immediately.
DIF: Cognitive Level: Application REF: p. 151
2. The physician plans to titrate narcotic analgesic to provide pain relief for a client with surgical
pain. What does the nurse’s role in analgesic titration include?
a. Monitoring the effects of continuous intravenous (IV) infusion of narcotic
analgesics
b. Teaching the client to try to increase the time between doses of pain medication
c. Assisting the client to plan the use of a specific total dose of analgesic over a 24-
hour period
d. Determining with the client the optimal analgesic dosage required for pain relief
with attention to the side effects produced
ANS: D
The goal of titration is to use the smallest dosage of analgesic that provides effective pain control
with the fewest side effects.
, DIF: Cognitive Level: Application REF: p. 161
3. It is determined that a step 3 drug as proposed by the World Health Organization (WHO) is
necessary for a client whose cancer pain is unrelieved by step 2 drugs. Which is an appropriate
drug and route for this client?
a. Oral codeine
b. Oral morphine
c. Intramuscular meperidine (Demerol)
d. Intravenous oxymorphone (Numorphan)
ANS: B
A step 2 drug that would be appropriate is morphine. Standard comparison for opioid analgesics
and sustained-release preparation (e.g., MS Contin).
DIF: Cognitive Level: Application REF: pp. 161, 164
4. A client using gabapentin (Neurontin) and ibuprofen (Motrin, Advil) for chronic neuropathic
pain of diabetic neuropathy has moderate, persistent pain. The physician plans to implement step
2 of the WHO analgesic ladder. What should the nurse anticipate that the client’s drug protocol
will include?
a. Continuing the gabapentin
b. Discontinuing the ibuprofen
c. Adding aspirin to the protocol
d. Adding oral methadone to the protocol
ANS: A
Gabapentin is an adjuvant drug and would be continued when implementing step 2 of the WHO
analgesic ladder.
DIF: Cognitive Level: Application REF: p. 165
5. The physician tells a client to use ibuprofen (Motrin, Advil) to relieve the pain after treating a
laceration on the client’s forearm from a dog bite. The client tells the nurse that he does not think
ibuprofen will control his pain. The nurse’s response is based on the knowledge that ibuprofen
interferes with the pain by decreasing what process?
a. Perception
b. Modulation
c. Transduction
d. Transmission
ANS: C
, Therapies directed at altering either the primary afferent nociceptor (PAN) environment or the
sensitivity of the PAN are used to prevent the transduction and initiation of an action potential.
An example is ibuprofen.
DIF: Cognitive Level: Application REF: p. 153
6. A postoperative client who has undergone extensive bowel surgery moves as little as possible
and does not use his incentive spirometer unless specifically reminded. He rates his pain severity
as an 8 on a 10-point scale but tells the nurse that he can “tough it out.” To encourage the client
to use pain medication, what should the nurse explain about the effects of withholding or
delaying analgesics?
a. Very few clients become addicted to opioids when using them for pain control.
b. He should not worry about side effects because these problems usually decrease
over time.
c. Multiple options of medications are available, and if one drug does not relieve his
pain, other drugs may be tried.
d. Unrelieved pain can be harmful because it impairs respiratory and gastrointestinal
function and can impair his recovery from surgery.
ANS: D
In the acutely ill client, unrelieved pain can result in increased morbidity as a result of respiratory
dysfunction, increased heart rate and cardiac workload, increased muscular contraction and
spasm, decreased gastrointestinal motility and transit, and increased catabolism.
DIF: Cognitive Level: Application REF: pp. 150–151
7. A client with a kidney stone in her right ureter has pain in her right flank area and also complains
of pain in her right inner thigh. She asks the nurse whether something is wrong with her leg. In
responding to the question, on what knowledge does the nurse base the client’s understanding of
pain?
a. Referred pain results when dorsal horn neurons receive input from both C fibres
and A-beta fibres.
b. Stimulation of the cerebral cortex by small C fibres causes muscle spasm, leading
to pain perception in large muscle groups.
c. Radiating type of pain results from activation of normally inactive receptors by
repetitive nociceptive signals to the dorsal horn.
d. Poor localization of pain occurs when primary afferent nociceptors release
neurotransmitters that inhibit nerve cells in the dorsal column.
ANS: A
, Inputs from both C fibres and A-beta fibres converge on the wide dynamic range (WDR)
neurons, and when the message is transmitted to the brain, the originating area of the body is
poorly localized. The concept of referred pain must be considered when interpreting the location
of pain reported by the person with injury to or disease involving visceral organs.
DIF: Cognitive Level: Application REF: p. 154
8. Following an automobile accident, a client is brought to the emergency department with multiple
fractures and lacerations. The client is dazed but oriented and denies severe pain. What is the
client’s decreased pain perception most likely related to?
a. The inability of the brain to recognize nociceptive input as pain as a result of head
trauma
b. The release of endogenous opioids in response to the physical and emotional stress
of the accident
c. The presence of spinal cord trauma, which prevents the transmission of pain
impulses to higher nervous centres
d. Damage of A-delta and C fibres at the injury sites, which results in a lack of
stimulus for the physiological pain process
ANS: B
This is modulation, which includes neurons originating in the brainstem descend to the spinal
cord and release substances (e.g., endogenous opioids) that inhibit nociceptive impulses.
Endogenous opioids also play an important role by binding to opioid receptors and blocking the
release of neurotransmitters, particularly substance P.
DIF: Cognitive Level: Application REF: pp. 152–153
9. Imipramine (Tofranil), a tricyclic antidepressant, is being administered to a client with chronic
cancer pain. What does the nurse recognize as the expected outcome of administration of this
drug?
a. Increased pain threshold by stimulating the release of endogenous enkephalins
b. Decreased perception of pain by blocking opiate receptors in the brain and
descending inhibitory nerves
c. Decreased transmission of pain impulses by altering serotonin and norepinephrine
activity at nerve synapses
d. Increased pain tolerance through relief of depression by increasing the amounts of
norepinephrine in the brain
ANS: C
Tricyclic antidepressants have analgesic properties at doses lower than those effective for
depression. They enhance the descending inhibitory system by preventing synaptic reuptake of
serotonin and norepinephrine, thereby decreasing the transmission of pain impulses.
