Priorities in Critical Care Nursing 7th Edition By Urden, Stacy, Lough- Test Bank

Priorities in Critical Care Nursing 7th Edition By Urden, Stacy, Lough- Test Bank

Chapter 08: Pain and Pain Management
Test Bank

MULTIPLE CHOICE

1. The subjective characteristic implies that pain is
a. an uncomfortable experience present only in the patient with an intact nervous system.
b. an unpleasant experience accompanied by crying and tachycardia.
c. activation of the sympathetic nervous system from an injury.
d. whatever the patient experiencing it says it is, occurring when that patient says it does.

ANS: D
Pain is described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. This definition emphasizes the subjective and multidimensional nature of pain. More specifically, the subjective characteristic implies that pain is whatever the person experiencing it says it is and that it exists whenever he or she says it does.

2. The neural processes of encoding and processing noxious stimuli necessary but not sufficient for pain is known as
a. perception.
b. nociception.
c. transduction.
d. transmission.

ANS: B
Nociception represents the neural processes of encoding and processing noxious stimuli necessary, but not sufficient, for pain. Transduction refers to mechanical (e.g., surgical incision), thermal (e.g., burn), or chemical (e.g., toxic substance) stimuli that damage tissues. As a result of transduction, an action potential is produced and is transmitted by nociceptive nerve fibers in the spinal cord that reach higher centers of the brain. This is called transmission, and it represents the second process of nociception. Pain sensation transmitted by the NS pathway reaches the thalamus, and the pain sensation transmitted by the PS pathway reaches brainstem, hypothalamus, and thalamus. These parts of the CNS contribute to the initial perception of pain.

3. Which of the following assessment findings might indicate respiratory depression after opioid administration?
a. Flushed, diaphoretic skin
b. Shallow respirations with a rate of 24 breaths/min
c. Tense, rigid posture
d. Sleep apnea

ANS: D
Opioids may cause this complication because they reduce the responsiveness of carbon dioxide chemoreceptors in the respiratory center located in the medulla.. Risk factors for opioid-induced respiratory depression include advanced age, obesity, sleep apnea, impaired kidney/lung/liver/heart function, patients in whom pain is controlled after a period of poor control, patients who are opioid naïve (i.e., receiving opioids for less than a week), concurrent use of central nervous system depressants, and postoperative day 1 were described. In addition to side effects common to all opioids, morphine may stimulate histamine release from mast cells, resulting in cardiac instability and allergic reactions.

4. The patient is admitted to the CCU with hemodynamic instability and an allergy to morphine. The nurse anticipates that the physician will order which medication for severe pain?
a. Hydromorphone
b. Codeine
c. Fentanyl
d. Methadone

ANS: C
Fentanyl is a synthetic opioid preferred for critically ill patients with hemodynamic instability or morphine allergy. Hydromorphone is a semisynthetic opioid that has an onset of action and a duration similar to those of morphine. It is more potent than morphine. Hydromorphone produces an inactive metabolite (i.e., hydromorphone-3-glucuronide), making it the opioid of choice for use in patients with end-stage renal disease. Codeine has limited use in the management of severe pain. It is rarely used in critical care units. It provides analgesia for mild to moderate pain. It is usually compounded with a nonopioid. Methadone is a synthetic opioid with morphine-like properties but less sedation. It is longer acting than morphine and has a long half-life. This makes it difficult to titrate in the critical care patient.

5. Which of the following combinations of drugs has been found to be effective in managing the pain associated with musculoskeletal and soft tissue inflammation?
a. Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids
b. NSAIDs and antidepressants
c. Opioid agonists and opioid antagonists
d. Adjuvants and partial agonists

ANS: A
The use of NSAIDs in combination with opioids is indicated in patients with acute musculoskeletal and soft tissue inflammation.