Questions Part 1

1. You are the charge nurse. A client with chronic pain reports to you that the nurses have not been responding to requests for pain medication. What is your initial action?

1.     Check the medication administration records (MARs) for the past several days.
2.     Ask the nurse educator to provide in-service training about pain management.
3.     Perform a complete pain assessment on the client and take a pain history.
4.     Have a conference with the nurses responsible for the care of this client.

2. Family members are encouraging your client to "tough out the pain" rather than risk drug addiction to narcotics. The client is stoically abiding. You recognize that the sociocultural dimension of pain is the current priority for the client. Which question will you ask?

1.     "Where is the pain located, and does it radiate to other parts of your body?"
2.     "How would you describe the pain, and how is it affecting you?"
3.     "What do you believe about pain medication and drug addiction?"
4.     "How is the pain affecting your activity level and your ability to function?"
5.     "What information do you need about pain, healing, and addiction?"

3. A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal anti-inflammatory drugs. Which medication will you advocate for first?

1.     Gabapentin (Neurontin)
2.     Corticosteroids
3.     Hydromorphone (Dilaudid)
4.     Lorazepam (Ativan)

4. Which client is most likely to receive opioids for extended periods of time?

1.     A client with fibromyalgia
2.     A client with phantom limb pain in the leg
3.     A client with progressive pancreatic cancer
4.     A client with trigeminal neuralgia

5. Which client has the most immediate need for IV access to deliver immediate analgesia with rapid titration?


1.     Client who has sharp chest pain that increases with cough and shortness of breath
2.     Client who reports excruciating lower back pain with hematuria
3.     Client who is having an acute myocardial infarction with severe chest pain
4.     Client who is having a severe migraine with an elevated blood pressure

6. When an analgesic is titrated to manage pain, what is the priority goal?

1.     Titrate to the smallest dose that provides relief with the fewest side effects.
2.     Titrate upward until the client is pain free.
3.     Titrate downward to prevent toxicity.
4.     Titrate to a dosage that is adequate to meet the client's subjective needs.

7. A client received PRN morphine, lorazepam (Ativan), and cyclobenzaprine (Flexeril). The UAP reports that the client has a respiratory rate of 10/min. What is the priority action?

1.     Call the physician to obtain an order for naloxone (Narcan).
2.     Assess the client's responsiveness and respiratory status.
3.     Obtain a bag-valve mask and deliver breaths at 20/min.
4.     Double-check the drug order to see what the client should have received

8. Which client is at greatest risk for respiratory depression while receiving opioids for analgesia?

1.     Elderly client with chronic pain who has a hip fracture
2.     Client with a heroin addiction and back pain
3.     Young female client with advanced multiple myeloma
4.     Child with an arm fracture and cystic fibrosis

9. A client is crying and grimacing but denies pain and refuses pain medication, because "my sibling is a drug addict and has ruined our lives." What is the priority intervention for this client?

1.     Encourage expression of fears and past experiences.
2.     Provide accurate information about the use of pain medication.
3.     Explain that addiction is unlikely among acute care clients.
4.     Seek family assistance in resolving this problem.

 10. For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?

1.     Closely assess for nonverbal signs such as grimacing or rocking.
2.     Obtain baseline behavioral indicators from family members.
3.     Look at the MAR and chart to note the time of the last dose of analgesic and the client's response.
4.     Give the maximum PRN dose within the minimum time frame for relief.