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LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankChapter 9

Question 1Type: MCSA

The nurse is assessing a patient’s response to pain. Why should the nurse do this for every patient situation?

1. Everyone has a unique tolerance to pain.

2. Everyone has the same pain threshold.

3. Everyone perceives painful stimuli at the same intensity.

4. Most people have the same the pain response to surgery.

Correct Answer: 1

Rationale 1: Each person’s pain tolerance is different and will need to be assessed on an individual basis.

Rationale 2: Everyone does not have the same pain threshold.

Rationale 3: Everyone perceives pain at a different intensity.

Rationale 4: Different people have a different pain response to surgery.

Global Rationale: Each person’s pain tolerance is different and will need to be assessed on an individual basis. Everyone does not have the same pain threshold or perceive pain at the same intensity. Different people have a different pain response to surgery.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Basic Care and ComfortQSEN Competencies: I.B.4. Assess presence and extent of pain and sufferingAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 1. Explain the neurophysiology of pain.MNL Learning Outcome: Page Number: 151


LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

After assessing a patient for pain, the nurse concludes that the pain is caused by a mechanical stimulus. What should the nurse consider as a possible cause of this patient’s pain?

1. muscle tear

2. burn

3. frostbite

4. myocardial infarction

Correct Answer: 1

Rationale 1: Mechanical causes of pain include spasm, compression, or extreme muscle stretch or contraction. A muscle tear creates pain from a mechanical source.

Rationale 2: A burn involves pain from a thermal source.

Rationale 3: Frostbite involves pain from a thermal source.

Rationale 4: Myocardial infarction involves pain from a chemical source.

Global Rationale: There are three types of painful stimuli: mechanical, chemical, and thermal. Mechanical causes of pain include spasm, compression, or extreme muscle stretch or contraction. A muscle tear creates pain from a mechanical source. Myocardial infarction involves pain from a chemical source. Burn and frostbite involve pain from a thermal source.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Basic Care and ComfortQSEN Competencies: I.B.4. Assess presence and extent of pain and sufferingAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 1. Explain the neurophysiology of pain.MNL Learning Outcome: Page Number: 154 Question 3Type: MCSA

The nurse is using the neuromatrix theory when determining a patient’s pain. What should the nurse consider when assessing a patient’s pain?

1. cultural and genetic factorsLeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

2. specificity

3. pattern

4. previous sensitization

Correct Answer: 1

Rationale 1: The neuromatrix theory of pain integrates cultural and genetic factors with basic neurophysiological function. According to this theory, the brain contains a body-self neuromatrix, a widely distributed network of neurons that are affected by both genetic factors and sensory experiences. The neuromatrix integrates multiple sources of input in addition to the stimuli of pain and touch. Other sensory systems that help interpret the input, such as attention, expectation, personality, culture, innate pain modulation systems, and components of stress-regulation systems, all contribute to the pain experience for the individual.

Rationale 2: Specificity theories describe nerve impulses of varying intensity terminating in pain centers in the forebrain.

Rationale 3: Pattern theories describe nerve impulses of varying intensity terminating in pain centers in the forebrain.

Rationale 4: According to the pain sensitization theory, painful signals create a cascade of changes in the nervous system, which increases the responsiveness of the peripheral and central neurons. These changes increase the response to future signals and amplify pain.

Global Rationale: The neuromatrix theory of pain integrates cultural and genetic factors with basic neurophysiological function. According to this theory, the brain contains a body-self neuromatrix, a widely distributed network of neurons that are affected by both genetic factors and sensory experiences. The neuromatrix integrates multiple sources of input in addition to the stimuli of pain and touch. Other sensory systems that help interpret the input, such as attention, expectation, personality, and culture, innate pain modulation systems, and components of stress-regulation systems, all contribute to the pain experience for the individual. Specificity and pattern theories describe nerve impulses of varying intensity terminating in pain centers in the forebrain. According to the pain sensitization theory, painful signals create a cascade of changes in the nervous system, which increases the responsiveness of the peripheral and central neurons. These changes increase the response to future signals and amplify pain.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Basic Care and ComfortQSEN Competencies: I.B.4. Assess presence and extent of pain and sufferingAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 1. Explain the neurophysiology of pain.


MNL Learning Outcome: Page Number: 153


A patient tells the nurse that he has had deep, burning muscle pain for most of his adult life. What does this information tell the nurse about how the patient’s pain is being transmitted in the body?

1. C fibers

2. A-delta fibers

3. endorphins

4. dynorphins

Correct Answer: 1

Rationale 1: The pain from deep body structures, such as muscles and viscera, is primarily transmitted by C fibers, producing diffuse burning or aching sensations.

Rationale 2: A-delta fibers are myelinated and transmit impulses rapidly. They produce what is called fast pain or first pain, which is sharp, well-defined pain typically accompanying cuts, electric shocks, or the impact of a blow.

Rationale 3: Endorphins are endogenous opioids that block the transmission of painful impulses.

Rationale 4: Dynorphins are endogenous opioids that block the transmission of painful impulses.

Global Rationale: The pain from deep body structures, such as muscles and viscera, is primarily transmitted by C fibers, producing diffuse burning or aching sensations. A-delta fibers are myelinated and transmit impulses rapidly. They produce what is called fast pain or first pain, which is sharp, well-defined pain typically accompanying cuts, electric shocks, or the impact of a blow. Endorphins and dynorphins are endogenous opioids that block the transmission of painful impulses.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Basic Care and ComfortQSEN Competencies: I.B.4. Assess presence and extent of pain and sufferingAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 1. Explain the neurophysiology of pain.MNL Learning Outcome: Page Number: 155 LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.


A patient asks the nurse why he felt pain prior to a myocardial infarction primarily in his left arm. How should the nurse respond?

1. “Pain in the arm related to cardiac tissue damage is a type of referred pain.”

2. “Cardiac pain is generally unexplainable.”

3. “Were you doing some physical activity with your arm just prior to the event?”

4. “What you are describing relates to psychogenic pain.”

Correct Answer: 1

Rationale 1: Referred pain is pain perceived in an area distant from the stimulus. Visceral sensory fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue areas of the body.

Rationale 2: Cardiac pain is explainable.

Rationale 3: Physical activity did not trigger the pain.

Rationale 4: Psychogenic pain occurs in the absence of a diagnosed physiological cause or event.

Global Rationale: Referred pain is pain perceived in an area distant from the stimulus. Visceral sensory fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue areas of the body. Cardiac pain is explainable. Physical activity did not trigger the pain. Psychogenic pain occurs in the absence of a diagnosed physiological cause or event.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom pain.MNL Learning Outcome: 6.4.1. Explain the incidence and pathophysiology for cardiac perfusion disorders.Page Number: 155 Question 6LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Type: MCSA

A patient is being treated for chronic pain. What should the nurse keep in mind when assessing this patient’s level of pain?

1. The pain rating may be inconsistent with the underlying pathology.

2. There is usually a clear, physiologic cause.

3. Pain typically lasts 2 months or less.

4. The pain reported is usually less severe than acute pain.

Correct Answer: 1

Rationale 1: The patient might not exhibit signs of pain such as elevations in vital signs, grimacing, writhing, or moaning.

Rationale 2: There may not be an identified physiologic cause.

Rationale 3: Chronic pain may persist for longer than 2 months.

Rationale 4: There is no indication that chronic pain is less severe than acute pain, although in some instances it may be more diffuse.

Global Rationale: The patient might not exhibit signs of pain such as elevations in vital signs, grimacing, writhing, or moaning. Chronic pain may persist for longer than 2 months and may not have an identified physiologic cause. There is no indication that chronic pain is less severe than acute pain, although in some instances it may be more diffuse.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom pain.MNL Learning Outcome: Page Number: 156 Question 7Type: MCSALeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

The nurse is managing care for a group of patients with pain. For which health problem should the nurse expect the patient to experience acute pain?

1. cholecystectomy

2. phantom limb pain

3. complex regional pain syndrome

4. degenerative joint disease

Correct Answer: 1

Rationale 1: Acute pain has a sudden onset, is usually self-limited, and is localized. The cause of acute pain generally can be identified. It generally results from tissue injury from trauma, surgery, or inflammation. Surgical pain such as after gallbladder removal is considered acute pain.

Rationale 2: The neuropathic pain associated with amputation, phantom limb pain, may not begin immediately and may become a chronic problem.

Rationale 3: Complex regional pain syndrome is a chronic exaggerated response to a painful stimulus.

Rationale 4: Degenerative joint disease is chronic; the accompanying joint pain is also chronic.

Global Rationale: Acute pain has a sudden onset, is usually self-limited, and is localized. The cause of acute pain generally can be identified. It generally results from tissue injury from trauma, surgery, or inflammation. Surgical pain such as after gallbladder removal is considered acute pain. The neuropathic pain associated with amputation, phantom limb pain, may not begin immediately and may become a chronic problem. Complex regional pain syndrome is a chronic exaggerated response to a painful stimulus. Degenerative joint disease is chronic; the accompanying joint pain is also chronic.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom, pain.MNL Learning Outcome: Page Number: 155 Question 8LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Type: MCSA

The nurse is planning care for a patient with chronic pain. Which pain control goal would be most appropriate for this patient?

1. Reduce the focus on pain.

2. Reduce the sympathetic stress response.

3. Be completely pain free.

4. Improve patient outcomes.

Correct Answer: 1

Rationale 1: With chronic pain, the pain itself becomes the problem, creating physical, psychosocial, and economic stresses on the affected individual and the family. Furthermore, emotional and psychologic factors can cause the pain itself or make it worse.

Rationale 2: Reducing the sympathetic pain response would be an appropriate acute pain management goal.

Rationale 3: Being completely pain free might be an unattainable goal for a patient with chronic pain.

Rationale 4: Improving patient outcomes would be an appropriate acute pain management goal.

Global Rationale: With chronic pain the pain itself becomes the problem, creating physical, psychosocial, and economic stresses on the affected individual and the family. Furthermore, emotional and psychologic factors can cause the pain itself or make it worse. Reducing the sympathetic pain response and improving patient outcomes would be appropriate acute pain management goals. Being completely pain free might be an unattainable goal for a patient with chronic pain.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfort.AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom, pain.MNL Learning Outcome: Page Number: 156 Question 9LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Type: MCSA

A patient scheduled for knee surgery tells the nurse, “I know I won’t feel as much pain with this knee surgery as I did with the other one when I was 20 years younger.” What should the nurse respond to this patient?

1. “There might be more pain, because the pain response can get worse with aging.”

2. “You are most likely correct.”

3. “It should not be quite as bad with the newer technology.”

4. “Pain responses diminish with age.”

Correct Answer: 1

Rationale 1: Pain tolerance decreases with aging, perhaps related to the prevalence of chronic pain in this population.

Rationale 2: The nurse should not agree that the patient will have less pain because this may not occur.

Rationale 3: The amount of pain may or may not be impacted by the use of newer technology.

Rationale 4: The pain response does not diminish with age.

Global Rationale: Pain tolerance decreases with aging, perhaps related to the prevalence of chronic pain in this population. The nurse should not agree that the patient will have less pain because this may not occur. The amount of pain may or may not be impacted by the use of newer technology. The pain response does not diminish with age.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 3. Discuss factors affecting individualized responses to pain.MNL Learning Outcome: 8.3.1. Examine the diagnosis and treatment of degenerative disorders.Page Number: 158



A female patient tells the nurse that at times the pain she has is so severe that she cannot move or get out of bed at home. What should the nurse realize is contributing to this patient’s pain?

1. gender

2. overuse of alcohol

3. overuse of pain medication

4. too much sleep and rest

Correct Answer: 1

Rationale 1: The pain threshold is the point at which a stimulus elicits a response. Clinical and animal studies show that women have a lower pain threshold and experience a higher intensity of pain than men.

Rationale 2: Alcohol may raise pain tolerance.

Rationale 3: Medications may raise pain tolerance.

Rationale 4: Sleep and rest may raise pain tolerance.

Global Rationale: The pain threshold is the point at which a stimulus elicits a response. Clinical and animal studies show that women have a lower pain threshold and experience a higher intensity of pain than men. Medications, alcohol, sleep, and rest may raise pain tolerance.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 3. Discuss factors affecting individualized responses to pain.MNL Learning Outcome: Page Number: 158 Question 11Type: MCSA

A patient diagnosed with depression tells the nurse that his pain has been “unrelenting” over the last several weeks. What should the nurse consider as contributing to this patient’s amount of pain?

1. Depression can cause an increase in pain sensations.LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

2. The pain medication has not been working.

3. Medication to treat the depression is interfering with the control of pain.

4. The patient is exaggerating the amount of pain.

Correct Answer: 1

Rationale 1: Depression is clearly linked to pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, leading to an increase in pain sensations.

Rationale 2: The nurse has no way of knowing if the patient’s pain medication is not controlling the pain.

Rationale 3: There is also no way of knowing if the medication used to treat the patient’s depression is interfering with the control of pain.

Rationale 4: The nurse cannot make the assumption that the patient is exaggerating the amount of pain.

Global Rationale: Depression is clearly linked to pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, leading to an increase in pain sensations. The nurse has no way of knowing if the patient’s pain medication is not controlling the pain. There is also no way of knowing if the medication used to treat the patient’s depression is interfering with the control of pain. The nurse cannot make the assumption that the patient is exaggerating the amount of pain.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 3. Discuss factors affecting individualized responses to pain.MNL Learning Outcome: Page Number: 159 Question 12Type: MCSA

A patient tells the nurse that she is unable to sleep through the night because of leg pain. What will the nurse most likely assess in this patient?

1. an increase in painLeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

2. a decrease in pain

3. a decrease in anxiety

4. an increase in concentration

Correct Answer: 1

Rationale 1: Pain interferes with a person’s ability to fall asleep and stay asleep and can induce fatigue. Fatigue can lower pain tolerance. The nurse will most likely assess an increase in pain in the patient who is unable to sleep.

Rationale 2: There will not be a decrease in pain.

Rationale 3: Anxiety may increase the perception of pain, and pain may cause more anxiety.

Rationale 4: The patient in pain often has difficulty concentrating.

Global Rationale: Pain interferes with a person’s ability to fall asleep and stay asleep and can induce fatigue. Fatigue can lower pain tolerance. The nurse will most likely assess an increase in pain in the patient who is unable to sleep. There will not be a decrease in pain. Anxiety may increase the perception of pain and pain may cause more anxiety. The patient in pain often has difficulty concentrating.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 3. Discuss factors affecting individualized responses to pain.MNL Learning Outcome:Page Number: 159


The nurse is caring for a patient recovering from surgery. Which intervention will provide the most pain relief for the patient?

1. Offer pain relief before the patient complains of pain.

2. Wait until the patient can describe the pain specifically.


3. Assess the pain level every 4 hours around the clock.

4. Allow the patient to “sleep off” the anesthesia, then offer pain medication.

Correct Answer: 1

Rationale 1: Anticipating a patient’s pain will ensure a more manageable pain experience than will waiting until the patient complains of pain.

Rationale 2: Pain management needs to be implemented before the patient describes specific postoperative pain.

Rationale 3: The patient should not be awakened to assess pain unless there are other significant nonverbal signs during sleep that indicate the patient is in pain. These can include grimacing, moaning, thrashing, or guarding of a surgical site.

Rationale 4: Pain management needs to be implemented before the patient “sleeps off” anesthesia.

Global Rationale: Anticipating a patient’s pain will ensure a more manageable pain experience than will waiting until the patient complains of pain. Pain management needs to be implemented before the patient describes specific postoperative pain or “sleeps off” anesthesia. The patient should not be awakened to assess pain unless there are other significant nonverbal signs during sleep that indicate the patient is in pain. These can include grimacing, moaning, thrashing, or guarding of a surgical site.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 163


A patient with severe nerve pain from spinal cord compression is considering surgery to sever the nerves and relieve the pain. What should the nurse encourage the patient to consider prior to having this surgery?

1. There may be loss of motor function associated with the nerves that will be severed.

2. The surgery will need to be repeated when the nerves regenerate.LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

3. Pain medication will still be needed after the surgery.

4. The patient will be a paraplegic after the surgery.

Correct Answer: 1

Rationale 1: Motor function loss is an unwelcome side effect of some surgeries, so the patient needs to consider the amount and degree of potential motor loss.

Rationale 2: The nerves will not regenerate, so surgery will not need to be repeated.

Rationale 3: Pain medication may or may not be needed after the surgery.

Rationale 4: Not all surgeries to sever nerves to control pain result in paraplegia.

Global Rationale: Motor function loss is an unwelcome side effect of some surgeries, so the patient needs to consider the amount and degree of potential motor loss. The nerves will not regenerate, so surgery will not need to be repeated. Pain medication may or may not be needed after the surgery. Not all surgeries to sever nerves to control pain result in paraplegia.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: 7.6.3. Examine the diagnosis and treatment of spinal cord disorders.Page Number: 166


A patient with chronic orthopedic pain is considering the use of a transcutaneous electrical nerve stimulator to reduce the pain. What advantages of using this device should the nurse review with the patient?

1. avoiding the adverse effects of pain medication

2. low cost

3. can be used by all patients


4. can relieve all types of pain

Correct Answer: 1

Rationale 1: A transcutaneous electrical nerve stimulator has the advantages of avoidance of adverse drug effects, patient control, and good interaction with other therapies.

Rationale 2: Disadvantages of this device are the cost and the need for expert training.

Rationale 3: This device is not effective at relieving pain for all patients. Patients with pacemakers should not use this device.

Rationale 4: This device is not effective at relieving all types of pain.

Global Rationale: A transcutaneous electrical nerve stimulator has the advantages of avoidance of adverse drug effects, patient control, and good interaction with other therapies. Disadvantages of this device are the cost and the need for expert training. This device is not effective at relieving all types of pain or for all patients. Patients with pacemakers should not use this device.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: 8.3.3. Examine the diagnosis and treatment of degenerative disorders.Page Number: 167


A patient is watching a comedy on the television and has not requested pain medication for over 6 hours. The nurse realizes that the patient is utilizing what as a form of pain control?

1. distraction

2. meditation

3. guided imagery

4. biofeedbackLeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Correct Answer: 1

Rationale 1: Distraction involves redirecting attention away from the pain and onto something the patient finds more pleasant. Participating in an activity that promotes laughter has been found to be highly effective in pain relief. Laughing for 20 minutes or more is known to produce an increase in endorphins that may continue to relieve pain even after the patient stops laughing.

Rationale 2: Meditation is a process of emptying the mind of all sensory data and, typically, concentrating on a single object, word, or idea. This activity produces a deeply relaxed state in which oxygen consumption decreases, muscles relax, and endorphins are produced.

Rationale 3: Guided imagery is use of the mind to create a scene or sensory experience that relaxes the muscles and moves the attention away from the pain experience.

Rationale 4: In biofeedback, electrodes placed on the skin transform data into visual cues so the patient learns to recognize stress-related responses and replace them with relaxation responses.

Global Rationale: Distraction involves redirecting attention away from the pain and onto something the patient finds more pleasant. Participating in an activity that promotes laughter has been found to be highly effective in pain relief. Laughing for 20 minutes or more is known to produce an increase in endorphins that may continue to relieve pain even after the patient stops laughing. Meditation is a process of emptying the mind of all sensory data and, typically, concentrating on a single object, word, or idea. This activity produces a deeply relaxed state in which oxygen consumption decreases, muscles relax, and endorphins are produced. Guided imagery is use of the mind to create a scene or sensory experience that relaxes the muscles and moves the attention away from the pain experience. In biofeedback, electrodes placed on the skin transform data into visual cues so the patient learns to recognize stress-related responses and replace them with relaxation responses.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approachesNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: 8.3.3. Examine the diagnosis and treatment of degenerative disorders.Page Number: 168



A patient is receiving a narcotic for severe acute pain. What should the nurse encourage the patient to consume in greater quantities due to the pain medication?

1. fiber

2. vitamin D

3. protein

4. carbohydrates

Correct Answer: 1

Rationale 1: Patients receiving narcotics are at risk for constipation. Increasing fiber in the diet will help to reduce this effect.

Rationale 2: Increasing vitamin D is not specifically related to the effects of a narcotic medication.

Rationale 3: Increasing protein is not specifically related to the effects of a narcotic medication.

Rationale 4: Increasing carbohydrates is not specifically related to the effects of a narcotic medication.

Global Rationale: Patients receiving narcotics are at risk for constipation. Increasing fiber in the diet will help to reduce this effect. Increasing vitamin D, protein, or carbohydrates is not specifically related to the effects of a narcotic medication.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: 11.8.3. Examine the diagnosis and treatment for disorders of intestinal motility.Page Number: 164 Question 18Type: MCSA

The nurse is planning to administer a pain medication to a patient who is 2 hours postoperative following bowel resection surgery. The patient has four standing orders for pain medication. Which medication should the nurse consider providing to the patient at this time? LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

1. The one that is to be administered intravenously by the patient and is under patient control

2. The one that will be given intramuscularly to work quickly

3. The one that is ordered on a prn basis

4. The one to be administered orally

Correct Answer: 1

Rationale 1: Patient-controlled analgesia allows self-management of pain and is a common method of administering postoperative pain medication. The advantages to this method are dose precision, timeliness, and convenience.

Rationale 2: The medication that is administered intramuscularly is not typically recommended for moderate-to-severe pain that will require more than one dose.

Rationale 3: A prn medication administered 2 hours after a major surgery would not be the most effective.

Rationale 4: An oral medication administered 2 hours after a major surgery would not be the most effective.

Global Rationale: Patient-controlled analgesia allows self-management of pain and is a common method of administering postoperative pain medication. The advantages to this method are dose precision, timeliness, and convenience. An oral medication or a prn medication administered 2 hours after a major surgery would not be the most effective. The medication that is administered intramuscularly is not typically recommended for moderate-to-severe pain that will require more than one dose.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: 11.10.3. Examine diagnosis and treatment of chronic inflammatory bowel disease.Page Number: 165 Question 19Type: MCMA


A patient recovering from abdominal surgery is refusing hydromorphone (Dilaudid) because she has heard that it may be addictive. She is crying and rates her pain at 10 out of 10. What statements should the nurse include as part of the patient’s education?

Standard Text: Select all that apply.

1. There is little to no risk of addiction when taking narcotics for pain.

2. Untreated pain can result in poor wound healing.

3. Patients with uncontrolled pain have an increased risk of blood clots.

4. Dehydration can result from poorly managed pain.

5. Family members will not want to visit patients showing visible signs of pain.

Correct Answer: 1,2,3

Rationale 1: A common myth among healthcare professionals is that using opioids for pain treatment poses a real threat of addiction. Actually, when the medications are used as recommended, there is little to no risk of addiction.

Rationale 2: Pain causes physiological consequences, including poor wound healing.

Rationale 3: Pain causes physiological consequences, including coagulation leading to DVT or PE.

Rationale 4: There is no evidence that poor pain relief causes dehydration.

Rationale 5: There is no evidence that poor pain relief causes family members to refuse to visit.

Global Rationale: A common myth among healthcare professionals is that using opioids for pain treatment poses a real threat of addiction. Actually, when the medications are used as recommended, there is little to no risk of addiction. Pain causes physiological consequences, including poor wound healing and coagulation leading to DVT or PE. There is no evidence that poor pain relief causes dehydration or refusal by family members to visit.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: Implementation


Learning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: 11.10.3. Examine diagnosis and treatment of chronic inflammatory bowel disease.Page Number: 158


A patient is refusing to take pain medication for chronic back pain. The nurse asks the patient to rate the pain on a scale from 0 to 10. What is the nurse attempting to do with this patient?

1. Assess the patient’s level of pain

2. Determine if the patient should remain in the hospital

3. Decide if the patient is being argumentative

4. Figure out if the patient should leave the hospital against medical advice

Correct Answer: 1

Rationale 1: The most reliable indicator of the presence and degree of pain is the patient’s own statements about the pain. Pain rating scales ensure consistent communication about the pain level.

Rationale 2: The nurse is not attempting to question the patient’s admission or stay in the hospital.

Rationale 3: The nurse is not attempting to decide if the patient is being argumentative.

Rationale 4: The nurse is not attempting to decide whether the patient should leave the hospital against medical advice.

Global Rationale: The most reliable indicator of the presence and degree of pain is the patient’s own statements about the pain. Pain rating scales ensure consistent communication about the pain level. The nurse is not attempting to question the patient’s admission or stay in the hospital, to decide if the patient is being argumentative, or decide whether the patient should leave the hospital against medical advice.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: Assessment


Learning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: 8.5.4. Utilize the nursing process in care of client.Page Number: 169-170


The nurse is assessing a patient’s vital signs. What should the nurse include in this assessment?

1. peripheral pulses

2. pain level

3. ability to ambulate

4. urine output

Correct Answer: 2

Rationale 1: Assessment of peripheral pulses is done to check for presence and strength; it is not routinely done to assess a pulse rate.

Rationale 2: Pain is increasingly being referred to as the “fifth vital sign,” with recommendations to include pain assessment in every vital signs assessment.

Rationale 3: Ambulation is not a vital sign.

Rationale 4: Urine output is not a vital sign.

Global Rationale: Pain is increasingly being referred to as the “fifth vital sign,” with recommendations to include assess pain assessment in every vital signs assessment. Assessment of peripheral pulses is done to check for presence and strength; it is not routinely done to assess a pulse rate. Ambulation and urine output are not vital signs.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

MNL Learning Outcome: Page Number: 151


The patient complaining of pain has been waiting for medication to relieve the pain. What should the nurse understand about this patient?

1. The patient’s pain is real.

2. The patient just wants medication.

3. The patient wants attention.

4. The patient is demanding.

Correct Answer: 1

Rationale 1: If the patient says he or she has pain, the patient is in pain. All pain is real.

Rationale 2: Nurses should not be judgmental when responding to a patient’s report of pain. This is a common bias and is a barrier to effective pain management.

Rationale 3: This is the nurse’s interpretation.

Rationale 4: This is the nurse’s interpretation.

Global Rationale: If the patient says he or she has pain, the patient is in pain. All pain is real. Nurses should not be judgmental when responding to a patient’s report of pain. This is a common bias and is a barrier to effective pain management. Concluding that the patient is demanding or just wants attention reflects a biased interpretation.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: DiagnosisLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 152 LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Question 23 Type: MCSA

A patient with a history of chronic pain tells the nurse, “I do a variety of things to make my body produce its own pain reliever.” What should the nurse realize this patient is describing?

1. a theory of denial

2. a belief in alternative methods

3. a reason to reduce the amount of pain medication prescribed

4. the body’s ability to make endorphins

Correct Answer: 4

Rationale 1: The patient is not denying the pain.

Rationale 2: Alternative methods have not been employed.

Rationale 3: There was no discussion of pain medication amounts.

Rationale 4: There is a pain inhibitory center within the dorsal horns of the spinal cord. The exact nature of this inhibitory mechanism is unknown. However, the most clearly defined chemical inhibitory mechanism is fueled by endorphins (endogenous morphines), which are naturally occurring opioid peptides that are present in neurons in the brain, spinal cord, and gastrointestinal tract. Endorphins work by binding with opiate receptors on the neurons to inhibit pain impulse transmission.

Global Rationale: There is a pain inhibitory center within the dorsal horns of the spinal cord. The exact nature of this inhibitory mechanism is unknown. However, the most clearly defined chemical inhibitory mechanism is fueled by endorphins (endogenous morphines), which are naturally occurring opioid peptides that are present in neurons in the brain, spinal cord, and gastrointestinal tract. Endorphins work by binding with opiate receptors on the neurons to inhibit pain impulse transmission. The patient is not denying the pain. Alternative methods have not been employed. There was no discussion of pain medication amounts.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: Assessment


Learning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 154


A 47-year-old female patient has a history of scoliosis and back pain. Which type of pain should the nurse realize this patient most likely is experiencing?

1. recurrent acute pain

2. ongoing time-limited pain

3. chronic malignant pain

4. chronic nonmalignant pain

Correct Answer: 4

Rationale 1: Recurrent acute pain is characterized by relatively well-defined episodes of pain interspersed with pain-free episodes.

Rationale 2: Ongoing time-limited pain is not a commonly used term for pain.

Rationale 3: Malignancy is not mentioned as a cause of the pain.

Rationale 4: Chronic nonmalignant pain is non-life-threatening pain that nevertheless persists beyond the expected time for healing. Chronic lower back pain falls into this category.

Global Rationale: Chronic nonmalignant pain is non-life-threatening pain that nevertheless persists beyond the expected time for healing. Chronic lower back pain falls into this category. Malignancy is not mentioned as a cause of the pain. Recurrent acute pain is characterized by relatively well-defined episodes of pain interspersed with pain-free episodes. Ongoing time-limited pain is not a commonly used term for pain.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: Diagnosis


Learning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom pain.MNL Learning Outcome: 7.6.2. Differentiate the manifestations of spinal cord disorders.Page Number: 156


A patient with a history of lumbar spinal cord nerve compression continues to complain of burning pain. Which type of pain should the nurse realize this patient is experiencing?

1. complex regional pain syndrome

2. myofascial pain syndrome

3. chronic postoperative pain

4. phantom limb pain

Correct Answer: 1

Rationale 1: Complex regional pain syndrome is a neuropathic pain that results from nerve damage. It is characterized by continuous severe, burning pain. These conditions follow peripheral nerve damage and present the symptoms of pain, vasospasm, muscle wasting, and vasomotor changes.

Rationale 2: Myofascial pain syndrome is a condition marked by injury to or disease of muscle and fascial tissue.

Rationale 3: This pain was not described as chronic.

Rationale 4: No amputation has been performed that might explain phantom limb pain.

Global Rationale: Complex regional pain syndrome is a neuropathic pain that results from nerve damage. It is characterized by continuous severe, burning pain. These conditions follow peripheral nerve damage and present the symptoms of pain, vasospasm, muscle wasting, and vasomotor changes. This pain was not described as chronic. No amputation has been performed that might explain phantom limb pain. Myofascial pain syndrome is a condition marked by injury to or disease of muscle and fascial tissue.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: DiagnosisLeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Learning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom pain.MNL Learning Outcome: 7.6.2. Differentiate the manifestations of spinal cord disorders.Page Number: 157 Question 26Type: MCSA

A patient with a long history of pain rarely appears to be in pain and often forgoes the use of pain medication. What does the nurse realize about this patient?

1. The patient has a high pain tolerance.

2. The patient has a low pain tolerance.

3. The patient is addicted to pain medication.

4. The patient does not really have pain.

Correct Answer: 1

Rationale 1: Pain tolerance describes the amount of pain a person can tolerate before outwardly responding to it. A patient with a high tolerance to pain would rarely report pain or need analgesic management.

Rationale 2: With a low tolerance, the patient would be verbalizing pain and requesting medication.

Rationale 3: If addicted, the patient would eventually need more medication, not less, to manage the pain.

Rationale 4: There is no evidence that the patient is not in pain.

Global Rationale: Pain tolerance describes the amount of pain a person can tolerate before outwardly responding to it. A patient with a high tolerance to pain would rarely report pain or need analgesic management. With a low tolerance, the patient would be verbalizing pain and requesting medication. If addicted, the patient would eventually need more medication, not less, to manage the pain. There no evidence that the patient is not in pain.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: DiagnosisLearning Outcome: 3. Discuss factors affecting individualized responses to pain.MNL Learning Outcome: LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Page Number: 158 Question 27Type: MCSA

A patient with chronic pain tells the nurse that she “rarely sleeps more than 3 hours a night.” The nurse recognizes that this patient is at risk for developing which health problem?

1. chronic insomnia

2. depression

3. high pain tolerance

4. adult attention deficit disorder

Correct Answer: 2

Rationale 1: There is no evidence to support the risk of chronic insomnia, although insomnia is associated with chronic pain.

Rationale 2: Depression is clearly linked to pain, and insomnia is an associated symptom of chronic pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, which leads to an increase in pain sensations.

Rationale 3: There is no evidence to support inferences concerning pain tolerance.

Rationale 4: There is no evidence to support the risk of adult attention deficit disorder.

Global Rationale: Depression is clearly linked to pain, and insomnia is an associated symptom of chronic pain. Serotonin, a neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed people, serotonin is decreased, which leads to an increase in pain sensations. There is no evidence to support the risk of chronic insomnia or adult attention deficit disorder, or inferences concerning pain tolerance.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: DiagnosisLearning Outcome: 3. Discuss factors affecting individualized responses to pain.MNL Learning Outcome: Page Number: 157 -158 LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.


A patient with chronic pain is desperately searching for something to relieve the pain. What should the nurse recommend for this patient?

1. A thorough analysis of the pain to determine if it is truly pain

2. Avoiding the use of narcotics

3. Evaluation by a psychiatrist to determine if the patient is depressed

4. A pain medication schedule to help avoid the onset of pain

Correct Answer: 4

Rationale 1: The pain has already been identified as being real and chronic in nature.

Rationale 2: Avoidance of narcotics may not meet the patient’s immediate needs.

Rationale 3: There is no mention of a depressed state, only the patient’s need to address the pain.

Rationale 4: It is now widely accepted that anticipating pain has a noticeable effect on the amount of pain a patient experiences. Offering pain relief before a pain event is well on its way can lessen the pain.

Global Rationale: It is now widely accepted that anticipating pain has a noticeable effect on the amount of pain a patient experiences. Offering pain relief before a pain event is well on its way can lessen the pain. The pain has already been identified as being real and chronic in nature. There is no mention of a depressed state, only the patient’s need to address the pain. Avoidance of narcotics may not meet the patient’s immediate needs.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 163

Question 29LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Type: MCSA

A patient has periodic severe nerve pain that is not well controlled with pain medication. The nurse thinks that this patient might benefit from which pain management approach?

1. a nonsteroidal anti-inflammatory drug (NSAID)

2. a narcotic

3. an antidepressant

4. a local anesthetic

Correct Answer: 3

Rationale 1: The NSAID group can have serious side effects, including bleeding tendencies, and would not be appropriate in a long-term situation.

Rationale 2: Other medications are prescribed before introducing narcotics.

Rationale 3: Antidepressants within the tricyclic and related chemical groups act on the production and retention of serotonin in the CNS, thus inhibiting pain sensation. They also promote normal sleeping patterns, which further alleviates the suffering of the patient in pain. They are useful with neuropathic pain.

Rationale 4: A local anesthetic would not be appropriate for long-term pain management.

Global Rationale: Antidepressants within the tricyclic and related chemical groups act on the production and retention of serotonin in the CNS, thus inhibiting pain sensation. They also promote normal sleeping patterns, which further alleviates the suffering of the patient in pain. They are useful with neuropathic pain. Other medications are prescribed before introducing narcotics. The NSAID group can have serious side effects, including bleeding tendencies, and would not be appropriate in a long-term situation. A local anesthetic would not be appropriate for long-term pain management.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: 7.6.3. Examine the diagnosis and treatment of spinal cord disorders.Page Number: 162 LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.


A patient who is receiving around-the-clock pain medication complains of an acute exacerbation of pain. What should the nurse do to help this patient?

1. Provide the medication ordered for breakthrough pain.

2. Talk the patient through the pain.

3. Encourage the patient to ignore the pain.

4. Give the patient a nonsteroidal anti-inflammatory drug (NSAID).

Correct Answer: 1

Rationale 1: Breakthrough pain (BTP) occurs in patients who are receiving long-acting analgesics for chronic pain. It is a transitory experience of moderate to severe pain that is often precipitated by coughing or movement but may occur spontaneously. Short-acting opioids for this type of pain should be administered as needed in addition to the ATC dose for chronic, persistent pain.

Rationale 2: The pain must be addressed; it is not appropriate to talk the patient through the pain.

Rationale 3: The pain must be addressed; it is not appropriate to encourage the patient to ignore the pain.

Rationale 4: NSAIDs can only be given with the physician’s order.

Global Rationale: Breakthrough pain (BTP) occurs in patients who are receiving long-acting analgesics for chronic pain. It is a transitory experience of moderate to severe pain that is often precipitated by coughing or movement but may occur spontaneously. Short-acting opioids for this type of pain should be administered as needed in addition to the ATC dose for chronic, persistent pain. The pain must be addressed; it is not appropriate to talk the patient through the pain or encourage the patient to ignore the pain. NSAIDs can only be given with the physician’s order.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: Implementation


Learning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 157 Question 31Type: MCSA

A patient with chronic pain is being started on a “patch.” What should the nurse instruct the patient about this pain-relieving delivery system?

1. It will not work as well as oral pain medications.

2. The dosage will be lower in the beginning.

3. The patient will never experience breakthrough pain.

4. The patient will never overdose with this delivery method.

Correct Answer: 2

Rationale 1: The transdermal, or patch, form of medication is increasingly being used because it is simple, painless, and delivers a continuous level of medication. The continuous dosage is an advantage over oral medications. Transdermal medications are easy to store and apply, and reapplying every 72 hours enhances compliance.

Rationale 2: Dosages for the “patch” start low and are increased as deemed necessary by the physician.

Rationale 3: Additional short-acting medication is often needed for breakthrough pain.

Rationale 4: Overdosage can occur with this route.

Global Rationale: Dosages for the “patch” start low and are increased as deemed necessary by the physician. The transdermal, or patch, form of medication is increasingly being used because it is simple, painless, and delivers a continuous level of medication. The continuous dosage is an advantage over oral medications. Transdermal medications are easy to store and apply, and reapplying every 72 hours enhances compliance. Additional short-acting medication is often needed for breakthrough pain. Overdosage can occur with this route.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsLeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 165 Question 32Type: MCSA

The nurse is helping a patient in pain by gently massaging the painful area. The nurse is utilizing which form of pain control with the patient?

1. acupuncture

2. biofeedback

3. guided imagery

4. cutaneous stimulation

Correct Answer: 4

Rationale 1: There is no mention of the use of acupuncture needles.

Rationale 2: Biofeedback does not involve massage.

Rationale 3: Guided imagery does not involve massage.

Rationale 4: It is believed that stimulation of the skin is effective in relieving pain because it prompts closure of the gate in the substantia gelatinosa. Cutaneous stimulation may be accomplished by massage, vibration, applying heat and cold, and therapeutic touch.

Global Rationale: It is believed that stimulation of the skin is effective in relieving pain because it prompts closure of the gate in the substantia gelatinosa. Cutaneous stimulation may be accomplished by massage, vibration, applying of heat and cold, and therapeutic touch. Touch was used, so biofeedback and guided imagery are not correct. There is no mention of the use of acupuncture needles.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Basic Care and ComfortQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Learning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 173


The nurse is assessing a patient’s pain perception. What should the nurse use to make this assessment?

1. FACES scale

2. psychological evaluation tool

3. PQRST guide

4. biofeedback rating

Correct Answer: 3

Rationale 1: The FACES scale is a pain rating tool.

Rationale 2: Use of a psychological evaluation tool is not indicated.

Rationale 3: A patient’s pain perception can be assessed by using the PQRST technique: P = What precipitated (triggered, stimulated) the pain? Has anything relieved the pain? What is the pattern of the pain? Q = What is the quality and quantity of the pain? Is it sharp, stabbing, aching, burning, stinging, deep, crushing, viselike, or gnawing? R = What is the region (location) of the pain? Does the pain radiate to other areas of the body? S = What is the severity of the pain? And T = What is the timing of the pain? When does it begin, how long does it last, and how is it related to other events in the patient’s life?

Rationale 4: A biofeedback rating would not address all areas of a pain assessment.

Global Rationale: A patient’s pain perception can be assessed by using the PQRST technique: P = What precipitated (triggered, stimulated) the pain? Has anything relieved the pain? What is the pattern of the pain? Q = What is the quality and quantity of the pain? Is it sharp, stabbing, aching, burning, stinging, deep, crushing, viselike, or gnawing? R = What is the region (location) of the pain? Does the pain radiate to other areas of the body? S = What is the severity of the pain? And T = What is the timing of the pain? When does it begin, how long does it last, and how is it related to other events in the patient’s life? The FACES scale is a pain rating tool. Use of a psychological evaluation tool is not indicated. A biofeedback rating would not address all areas of a pain assessment.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Basic Care and ComfortQSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs


AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 170


A patient is seen talking and laughing in the clinic’s waiting room yet complains of excruciating pain. What should the nurse realize this patient is demonstrating?

1. the desire for narcotics

2. denial

3. fake pain

4. inconsistent behavioral response to pain

Correct Answer: 4

Rationale 1: No mention is made of the patient requesting narcotics.

Rationale 2: Behavioral responses to pain may or may not coincide with the patient’s report of pain and are not very reliable cues to the pain experience.

Rationale 3: The nurse cannot decide if the patient’s pain is real.

Rationale 4: Behavioral responses to pain may or may not coincide with the patient’s report of pain and are not very reliable cues to the pain experience. The nurse needs to manage the pain if the patient verbalizes that it is present, even if the nonverbal signs are not congruent.

Global Rationale: Behavioral responses to pain may or may not coincide with the patient’s report of pain and are not very reliable cues to the pain experience. The nurse needs to manage the pain if the patient verbalizes that it is present, even if the nonverbal signs are not congruent. The nurse cannot decide if the patient’s pain is real. No mention is made of the patient requesting narcotics.

Cognitive Level: AnalyzingClient Need: Psychosocial IntegrityClient Need Sub:


QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needsAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: DiagnosisLearning Outcome: 3. Discuss factors affecting individualized responses to pain.MNL Learning Outcome: Page Number: 171 Question 35Type: MCHS

A patient is hospitalized with suspected gallstones and inflammatory gallbladder disease. Place an “X” over the area of the body where the nurse would expect the patient to locate the pain.

Correct Answer: LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Rationale: Referred pain is pain that is perceived in an area distant from the site of the stimuli. It commonly occurs with pain that originates in thoracic or abdominal viscera. Visceral sensory fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue areas of the body.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom pain.MNL Learning Outcome: 11.4.2. Differentiate the manifestations of gallbladder disorders.Page Number: 155 Question 36Type: MCHS

A patient with a history of high blood pressure and cardiac arrhythmias is admitted after having EKG changes consistent with a myocardial infarction. Place an “X” over the area of the body where the nurse would expect the patient to locate the pain.


Correct Answer:

Rationale: Referred pain is pain that is perceived in an area distant from the site of the stimuli. It commonly occurs with pain that originates in thoracic or abdominal viscera. Visceral sensory fibers synapse at the level of the spinal cord, close to fibers innervating other subcutaneous tissue areas of the body.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom pain.MNL Learning Outcome: 6.4.1. Explain the incidence and pathophysiology for cardiac perfusion disorders.Page Number: 155


The nurse is reviewing data for several patients. Which physiologic assessment findings should the nurse recognize are consistent with those of an adult experiencing acute pain?


I

1. Patients A and C

2. Patient A only

3. Patients B and D

4. Patient C only

Correct Answer: 3

Rationale 1: Equal pupillary response, respiratory changes, and normal skin assessment are not predictable physiological changes with acute pain.

Rationale 2: Equal pupillary response and respiratory changes are not predictable physiological changes with acute pain.

Rationale 3: Predictable physiologic changes occur in the presence of acute pain. These may include muscle tension; tachycardia; rapid, shallow respirations; increased blood pressure; dilated pupils; sweating; and pallor.

Rationale 4: Normal skin assessment is not a predictable physiological change with acute pain.

Global Rationale: Predictable physiologic changes occur in the presence of acute pain. These may include muscle tension; tachycardia; rapid, shallow respirations; increased blood pressure; dilated pupils; sweating; and


pallor. Equal pupillary response, respiratory changes, and normal skin assessment are not predictable physiological changes with acute pain.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom pain.MNL Learning Outcome: Page Number: 156 Question 38Type: MCSA

The nurse is reviewing the care provided to a group of patients. Which patient’s/patients’ symptoms are most likely side effects of an opioid pain medication treatment regimen?

1. Patients A and C

2. Patient C only

3. Patients B and DLeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

4. Patient D only

Correct Answer: 1

Rationale 1: Nausea and vomiting are common adverse effects of opioid analgesics, as is constipation.

Rationale 2: Another patient is also experiencing the effects of opioid analgesics.

Rationale 3: Opioids are not typically given for stomach pain prior to a meal. Bruising is not a common side effect of opioid administration.

Rationale 4: Bruising is not a common side effect of opioid administration.

Global Rationale: Opioid analgesics are CNS and respiratory depressants and tend to have similar unintended effects. They commonly produce sedation, drowsiness, and dizziness. Nausea and vomiting are common adverse effects, as is constipation. Opioids are not typically given for stomach pain prior to a meal. Bruising is not a common side effect of opioid administration.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 162


The nurse is evaluating the pain descriptions of a group of patients. Which patient’s/patients’ description is consistent with that of phantom pain?


1. Patients A and D

2. Patient A only

3. Patients B and D

4. Patient C only

Correct Answer: 4

Rationale 1: Patients A and D have a low risk of experiencing phantom pain.

Rationale 2: Patient A has a low risk of experiencing phantom pain.

Rationale 3: Patients B and D have a low risk of experiencing phantom pain.

Rationale 4: Patient C has an increased risk of experiencing phantom pain. Phantom pain is a type of neuropathic pain that occurs after amputations.

Global Rationale: Patient C has an increased risk of experiencing phantom pain. Phantom pain is a type of neuropathic pain that occurs after amputations.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings


NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom pain.MNL Learning Outcome: Page Number: 157

Question 40Type: FIB

A patient has been receiving morphine sulfate 10 mg intramuscularly every 4 hours for the past few days. The nurse is anticipating discharge and wants to calculate the oral dose necessary for this patient. Calculate the oral dosage range using the equianalgesic dosing formula: __________ mg.

Standard Text: Record your answer rounding to the nearest whole number, using a dash (“-“) to indicate the range.

Correct Answer: 30-60

Rationale: The PO dose is 3 to 6 times the IM dose.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 161

Question 41Type: FIB

A patient is prescribed a fentanyl patch to administer 100 mcg/hour. The patient uses one patch for 72 hours and then is changed to an intravenous infusion of morphine 8 hours into the second patch. If the patient had been receiving the morphine intravenously, how many mg of the medication would the patient have received from wearing the patch?


Standard Text: Record your answer rounding to the nearest whole number.

Correct Answer: 320 mg

Rationale: Fentanyl 100 mcg/hr is equivalent to 4 mg/hr morphine IV. If the first patch was for 72 hours and the second patch was for 8 hours, the patient wore the patch for a total of 80 hours. Multiply the equivalent dose of 4 mg × 80 = 320 mg.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 161 Question 42Type: SEQ

The nurse is ranking a patient’s prescribed pain medications according to their strengths. Using the WHO analgesic ladder, in what order, from weakest to strongest, should the nurse rank the medications?

Standard Text: Click and drag the options below to move them up or down.

Choice 1. Morphine sulfate 5 mg IV

Choice 2. Ibuprofen 400 mg PO with the anticonvulsant gabapentin (Neurontin) 300 mg PO

Choice 3. Propoxyphene HCL (Darvon) 250 mg. PO

Choice 4. Acetaminophen (Tylenol) 325 mg PO

Correct Answer: 4, 2, 3, 1

Rationale 1: Morphine is the strongest of these pain medications. It is an opioid.

Rationale 2: Ibuprofen is a nonopioid and is the second weakest of these medications.LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Rationale 3: Propoxyphene is the second strongest of these medications.

Rationale 4: Tylenol is the weakest of these medications.

Global Rationale: The nonopioid analgesics acetaminophen and ibuprofen are the least invasive, followed by the mild opioid analgesics with adjuvant therapy, and finally the opioids.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome:Page Number: 160 Question 43Type: SEQ

The nurse is explaining the pain response process to a patient experiencing chronic pain. In which order should the nurse identify the steps in the neural pain pathway?


Choice 1. In the thalamus and cerebral cortex, the pain impulse becomes pain when the sensation reaches conscious levels and is perceived and evaluated by the person experiencing the sensation.

Choice 2. Dorsal horn synapses relay impulses up the spinal cord. Spinal neurons transmit the impulses via axons that cross over to the spinothalamic tract.

Choice 3. The impulses ascend the spinothalamic tracts and pass through the medulla and midbrain to the thalamus.

Choice 4. A noxious stimulus is perceived by cutaneous nociceptors and then transmitted through A-delta (AΔ) and even smaller C nerve fibers to the spinal cord dorsal horn.

Correct Answer: 4,2,3,1

Rationale 1: This is the final step in the neural pain pathway.

Rationale 2: This is the second step in the neural pain pathway. LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Rationale 3: This is the third step in the neural pain pathway.

Rationale 4: This is the first step in the neural pain pathway.

Global Rationale: The neural pain pathway physiology follows this order: A noxious stimulus is perceived by cutaneous nociceptors and then transmitted through A-delta (AΔ) and even smaller C nerve fibers to the spinal cord dorsal horn. Dorsal horn synapses relay impulses up the spinal cord. Spinal neurons transmit the impulses via axons that cross over to the spinothalamic tract. The impulses ascend the spinothalamic tracts and pass through the medulla and midbrain to the thalamus. In the thalamus and cerebral cortex, the pain impulse becomes pain when the sensation reaches conscious levels and is perceived and evaluated by the person experiencing the sensation.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 1. Explain the neurophysiology of pain.MNL Learning Outcome: Page Number: 154 Question 44Type: SEQ

The nurse is preparing to apply a transdermal analgesic patch to a patient. In what order should the nurse administer this medication?


Choice 1. Choose a new site and cleanse and dry an upper torso location.

Choice 2. Clip chest hair and open the medication package.

Choice 3. Keep the patch intact for 72 hours.

Choice 4. Place the patch, making sure all edges are in contact with the skin.


Rationale 1: A transdermal patch is applied to a clean, dry area on the upper torso.

Rationale 2: If hair is present, it should be clipped before applying the patch. LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Rationale 3: The patch is effective for about 72 hours.

Rationale 4: Apply the patch immediately after opening the package, ensuring complete contact with the skin, especially around the edges.

Global Rationale: A transdermal patch is applied to a clean, dry area on the upper torso. If hair is present, it should be clipped before applying the patch. Apply the patch immediately after opening the package, ensuring complete contact with the skin, especially around the edges. The patch is effective for about 72 hours.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 165 Question 45Type: MCMA

A nurse is teaching pain management to a homebound hospice patient, already being treated with opioids. This patient has been diagnosed with metastatic breast cancer and expresses anxiety about keeping her pain under control. In which nonpharmacologic complementary methods might the nurse instruct the patient?


1. guided imagery

2. progressive muscle relaxation

3. distraction

4. acupuncture

5. regional pain management

Correct Answer: 1, 2, 3

Rationale 1: Guided imagery can be taught to the patient by the nurse.


Rationale 2: Progressive muscle relaxation can be taught to the patient by the nurse.

Rationale 3: Distraction can be taught to the patient by the nurse.

Rationale 4: Acupuncture cannot be taught to the patient by the nurse. Acupuncture can only be provided by persons with special training.

Rationale 5: Regional pain management is not an alternative complementary therapy.

Global Rationale: Guided imagery, progressive muscle relaxation, and distraction can be taught by the nurse. Acupuncture can only be provided by persons with special training. Regional pain management is not an alternative complementary therapy.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological Adaptation QSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: 13.1.4. Utilize the nursing process in care of client.Page Number: 168 Question 46Type: MCMA

The nurse is caring for older patients in a long-term-care facility. The nurse understands that which factors influence pain management in these patients?


1. Increased A fiber transmission increases the potential for addiction in older adults.

2. An increased risk of depression in older adults is related to chronic pain.

3. Less reporting of referred pain may mask myocardial infarction in older adults.

4. Assessment of pain in the cognitively impaired older adult is not possible.

5. Delirium should be evaluated as pain.

Correct Answer: 2, 3, 5LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Rationale 1: There is actually decreased fiber transmission and no greater risk of dependence with older adults.

Rationale 2: There is an increased risk of depression in the older patient experiencing chronic pain.

Rationale 3: Older adults are less likely to report referred pain, meaning they may present in a different manner than younger adults. This may lead to problems diagnosing patients appropriately.

Rationale 4: Research has shown the numeric rating, verbal descriptor, and FACES rating scales to be effective with older adults. These scales are also effective with cognitively impaired older adults, although the FACES scale is the preferred tool.

Rationale 5: The older adult may present with manifestations such as delirium rather than subjective reports of pain.

Global Rationale: In older adults there are decreased fiber transmission, no greater risk for addiction, and an increased risk of depression related to chronic pain. There is also a lower level of reported referred pain, so that the patient may not exhibit classic symptoms of myocardial infarction. Research has shown the numeric rating, verbal descriptor, and FACES rating scales to be effective with older adults. These scales are also effective with cognitively impaired older adults, although the FACES scale is the preferred tool. The older adult may present with manifestations such as delirium rather than subjective reports of pain.

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological Adaptation QSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 3. Discuss factors affecting individualized responses to pain.MNL Learning Outcome: Page Number: 158

Question 47Type: MCMA

A patient recovering from a broken leg asks why the pain is so sharp. What should the nurse explain about acute pain?


1. The pain signal releases catecholamines.2. The pain signal reduces blood flow to the gut.3. The pain signal travels along nerve fibers to the spinal cord.4. The pain signal travels up to the brain portion called the thalamus.


5. The pain signal spreads throughout the cortex, limbic system, and brainstem.


Rationale 1: The release of catecholamines explains the cardiovascular response to pain.

Rationale 2: The reduction of blood flow to the gut explains why nausea and vomiting occur with pain.

Rationale 3: With sharp local pain, nociceptors transmit pain stimuli along myelinated fibers to the spinal cord.

Rationale 4: With sharp local pain, nociceptors transmit pain stimuli along myelinated fibers to the spinal cord, where it travels via the neospinothalamic tract to the thalamus.

Rationale 5: With sharp local pain, the stimulus is distributed from the thalamus to the somatosensory cortex (perception and interpretation), the limbic system (emotional responses to pain), and brainstem centers (autonomic nervous system responses).

Global Rationale: With sharp local pain, nociceptors transmit pain stimuli along myelinated fibers to the spinal cord, where it travels via the neospinothalamic tract to the thalamus. From the thalamus, the stimulus is distributed to the somatosensory cortex (perception and interpretation), the limbic system (emotional responses to pain), and brainstem centers (autonomic nervous system responses). The release of catecholamines explains the cardiovascular response to pain. The reduction of blood flow to the gut explains why nausea and vomiting occur with pain.

Cognitive Level: ApplicationClient Need: Physiological IntegrityClient Need Sub: Physiological Adaptation QSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 1. Explain the neurophysiology of pain.MNL Learning Outcome: 8.1.2. Compare the manifestations of traumatic musculoskeletal injuries.Page Number: 156


A patient with bone pain complains that the pain is more intense when the patient is being repositioned in bed. For which type of pain should the nurse plan care?

1. Central2. Incident3. Nociceptive4. Neuropathic


Correct Answer: 2

Rationale 1: Central pain is caused by a lesion or damage in the brain or spinal cord.

Rationale 2: Incident or episodic pain is predictable, precipitated by an event or activity such as coughing, changing position, or being touched.

Rationale 3: Nociceptive pain is caused by stimulation of peripheral or visceral pain receptors.

Rationale 4: Neuropathic pain arises as a consequence of a lesion or disease affecting the somatosensory system.

Global Rationale: Incident or episodic pain is predictable, precipitated by an event or activity such as coughing, changing position, or being touched. Central pain is caused by a lesion or damage in the brain or spinal cord. Nociceptive pain is caused by stimulation of peripheral or visceral pain receptors. Neuropathic pain arises as a consequence of a lesion or disease affecting the somatosensory system.

Cognitive Level: ApplicationClient Need: Physiological IntegrityClient Need Sub: Physiological Adaptation QSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 2. Compare and contrast definitions and characteristics of acute, chronic, central, and phantom pain.MNL Learning Outcome: 8.1.2. Compare the manifestations of traumatic musculoskeletal injuries.Page Number: 157


After completing an assessment, the nurse determines that a patient experiencing pain should avoid taking NSAIDs. What information caused the nurse to make this determination?


1. The patient takes medication for peptic ulcer disease.2. The patient has a pacemaker inserted for atrial fibrillation.3. The patient had a total hip and total knee replacement a year ago.4. The patient takes medication and vitamin K for a clotting disorder.5. The patient performs peritoneal self-dialysis for chronic kidney failure.


Rationale 1: NSAIDs are not recommended for use in people with peptic ulcer disease.


Rationale 2: A pacemaker would not be a contraindication for using NSAIDs.

Rationale 3: Total joint replacements are not a reason to contraindicate NSAIDs.

Rationale 4: NSAIDs are not recommended for use in people with bleeding disorders.

Rationale 5: NSAIDs are not recommended for use in people with kidney or liver disease.

Global Rationale: NSAIDs are not recommended for use in people with kidney or liver disease, bleeding disorders, or peptic ulcer disease. A pacemaker would not be a contraindication for using NSAIDs. Total joint replacements are not a reason to contraindicate NSAIDs.

Cognitive Level: AnalysisClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: DiagnosisLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 160


A patient with chronic pain is prescribed an anticonvulsant medication. What should the nurse instruct the patient to expect when taking this medication?


1. Less nausea 2. Reduced pain3. Improved sleep4. Improved mobility5. Reduced urine output

Correct Answer: 2, 3

Rationale 1: Anticonvulsants are not prescribed to reduce nausea.

Rationale 2: Anticonvulsants are frequently used with opioids in pain control because these drugs reduce pain.

Rationale 3: Anticonvulsants are frequently used with opioids in pain control because these drugs reduce sleep disruption.LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Rationale 4: Anticonvulsants are not prescribed to improve mobility.

Rationale 5: Anticonvulsants should not adversely affect renal functioning.

Global Rationale: Anticonvulsants are frequently used with opioids in pain control because these drugs reduce pain and sleep disruption. Anticonvulsants are not prescribed to reduce nausea or improve mobility. They should not adversely affect renal functioning.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome:Page Number: 162


A patient is prescribed hydrocodone (Vicodin) for severe tooth pain. What should the nurse instruct the patient about taking this mediation?


1. Avoid all alcohol. 2. Do not operate machinery. 3. Expect some respiratory depression. 4. Increase the intake of fluids and fiber. 5. Do not take with over-the-counter medications.


Rationale 1: The nurse should instruct the patient to avoid drinking alcohol while taking this medication.

Rationale 2: The nurse should instruct the patient to use caution or avoid driving when taking this medication.

Rationale 3: Respiratory depression can occur when taking this medication; however, it is not an expected effect and should be reported to the healthcare provider.

Rationale 4: The nurse should instruct the patient to increase the intake of fluids and fiber to prevent constipation. LeMone/Burke/Bauldoff/Gubrud, Medical-Surgical Nursing 6th Edition Test BankCopyright 2015 by Pearson Education, Inc.

Rationale 5: The nurse should instruct the patient not to take over-the-counter medications unless approved by the healthcare provider.

Global Rationale: The nurse should instruct the patient to avoid drinking alcohol while taking this medication, to use caution or avoid driving, to increase the intake of fluids and fiber to prevent constipation, and not to take over-the-counter medications unless approved by the healthcare provider. Respiratory depression can occur when taking this medication; however, it is not an expected effect and should be reported to the healthcare provider.

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesQSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfortAACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventionsNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 4. Describe interprofessional care for the patient in pain, including medications, surgery, transcutaneous electrical nerve stimulation, and complementary therapies.MNL Learning Outcome: Page Number: 164


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