Module 3

Question 1

When doing a pain assessment for a client who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the client’s pain?

a. “How long have you had this pain?”
b. “How would you describe your pain?”
c. “How much medication do you take for the pain?”
d. “How many times a day do you medicate for pain?”

Answer 1

b. “How would you describe your pain?”

Question 2

. A client who uses a fentanyl patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0–10 scale) and requests “something for pain that will work quickly.” Which of the following types of pain is the most appropriate for the nurse to document for this client?

a. Somatic pain
b. Referred pain
c. Neuropathic pain
d. Breakthrough pain

Answer 2

d. Breakthrough pain

Question 3

. A postoperative client asks the nurse how the prescribed ibuprofen will control the incisional pain. The nurse will teach the client that ibuprofen interferes with the pain process by decreasing which of the following physiological responses?

a. Modulating effect of descending nerves
b. Sensitivity of the brain to painful stimuli
c. Production of pain-sensitizing chemicals
d. Spinal cord transmission of pain impulses

Answer 3

c. Production of pain-sensitizing chemicals

Question 4

. A postoperative client asks the nurse how the prescribed ibuprofen will control the incisional pain. The nurse will teach the client that ibuprofen interferes with the pain process by decreasing which of the following physiological responses?

a. Modulating effect of descending nerves
b. Sensitivity of the brain to painful stimuli
c. Production of pain-sensitizing chemicals
d. Spinal cord transmission of pain impulses

Answer 4

c. Production of pain-sensitizing chemicals

Question 5

The nurse is caring for a client who is taking an opioid for postoperative pain. Which of the following interventions should the nurse include in the clients plan of care to manage possible adverse effects of opioids?
a. Ensure the medication is given PRN only.
b. Administer the prescribed stool softener OD.
c. Ensure the administration route maximizes drug concentration at the site of the adverse effect.
D. Request a prescription for a different classification of medication

Answer 5

b. Administer the prescribed stool softener OD.

Question 6

A client with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. Which of the following reasons provide the basis for the nurse’s response in relation to the effectiveness of these strategies?

a. Impact the cognitive and affective components of pain.
b. Increase the modulating effect of the efferent pathways.
c. Prevent transmission of nociceptive stimuli to the cortex.
d. Slow the release of transmitter chemicals in the dorsal horn.

Answer 6

a. Impact the cognitive and affective components of pain.

Question 7

A client who is receiving sustained-release morphine sulphate every 12 hours for chronic pain experiences level 9 (0–10 scale) breakthrough pain and anxiety. Which of these prescribed medications should the nurse anticipate administering?

a. Lorazepam 1 mg orally
b. Amitriptyline 10 mg orally
c. Ibuprofen 400–800 mg orally
d. Immediate-release morphine 30 mg orally

Answer 7

d. Immediate-release morphine 30 mg orally

Question 8

The nurse is caring for a client with chronic back pain who has arrived at the pain clinic for a follow-up appointment. In order to evaluate whether the pain management is effective, which of the following questions is most appropriate for the nurse to ask?

a. “Can you describe the quality of your pain?”
b. “Has there been a change in the pain location?”
c. “How would you rate your pain on a 0–10 scale?”
d. “Does the pain keep you from doing things you enjoy?”

Answer 8

d. “Does the pain keep you from doing things you enjoy?”

Question 9

A client with second-degree burns has been receiving morphine through patient-controlled analgesia (PCA) for a week. The client wakes up frequently during the night complaining of pain. Which of the following actions should the nurse implement?

a. Administer a dose of morphine every 1–2 hours from the PCA machine while the client is sleeping.
b. Consult with the health care provider about using a different treatment protocol to control the client’s pain.
c. Request that the health care provider order a bolus dose of morphine to be given when the client awakens with pain.
d. Teach the client to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.

Answer 9

b. Consult with the health care provider about using a different treatment protocol to control the client’s pain.

Question 10

The nurse is caring for a client who is receiving epidural morphine. Which of the following information obtained by the nurse indicates that the client may be experiencing an adverse effect of the medication?

a. The client has cramping abdominal pain.
b. The client becomes restless and agitated.
c. The client has not voided for over 10 hours.
d. The client complains of a “pounding” headache.

Answer 10

c. The client has not voided for over 10 hours.

Question 11

The nurse visits a hospice client and assesses a respiratory rate of 8 breaths/minute and the client states “I am having severe pain.” Which of the following interventions should the nurse implement at this time?

a. Inform the client that increasing the morphine will cause the respiratory drive to fail.
b. Administer a nonopioid analgesic, such as a nonsteroidal anti-inflammatory drug (NSAID), to improve client pain control.
c. Tell the client that additional morphine can be administered when the respirations are 12.
d. Titrate the prescribed morphine dose upward until the client indicates adequate pain relief.

Answer 11

d. Titrate the prescribed morphine dose upward until the client indicates adequate pain relief.

Question 12

The nurse is admitting a client to hospital with a history of chronic cancer pain. When reviewing the client’s home medications, which of the following medications should be of most concern?

a. Amitriptyline 50 mg at bedtime
b. Oxycodone 80 mg twice daily
c. Ibuprofen 800 mg three times daily
d. Meperidine 25 mg every 4 hours

Answer 12

d. Meperidine 25 mg every 4 hours

Question 13

The nurse is caring when caring for a client with cancer pain that the client describes as at “level 8 (0–10 scale), deep, and aching.” Which of the following prescribed medications should the nurse administer first?

a. Fentanyl patch
b. Ketorolac tablets PO
c. Hydromorphone IV
d. Acetaminophen suppository

Answer 13

c. Hydromorphone IV

Question 14

The nurse is caring for a client with diabetes who has chronic burning leg pain even when taking oxycodone twice daily. Which of the following prescribed medications is the most appropriate choice for the nurse to administer as an adjuvant to decrease the client’s pain?

a. Acetylsalicylic acid
b. Dextroamphetamine
c. Amitriptyline
d. Acetaminophen

Answer 14

c. Amitriptyline

Question 15

The nurse is preparing a client for discharge who has been receiving morphine 10 mg IV for pain and will continue to take morphine PO at home. Which of the following dosages is an equianalgesic oral dose for this client?

a. 10 mg
b. 20 mg
c. 30 mg
d. 40 mg

Answer 15

c. 30 mg

Question 16

These medications are prescribed by the health care provider for a client who uses long-acting morphine for chronic back pain, but still has ongoing pain. Which of the following medications should the nurse question?

a. Morphine
b. Pentazocine
c. Celecoxib
d. Dexamethasone

Answer 16

b. Pentazocine

Question 17

The nurse assesses a postoperative client who is receiving morphine through patient-controlled analgesia (PCA). Which information is most important to report to the health care provider?

a. The client complains of nausea after eating.
b. The client’s respiratory rate is 10 breaths/minute.
c. The client has not had a bowel movement for 3 days.
d. The client has a distended bladder and has not voided

Answer 17

b. The client’s respiratory rate is 10 breaths/minute.

Question 18

The nurse is caring for a client who has just started taking sustained-release morphine sulphate for chronic pain and is nausea with abdominal fullness. Which of the following interventions is the most appropriate for the nurse to implement?
a. Administer the ordered antiemetic medication.
b. Tell the client that the nausea will subside in about a week.
C. Order the client a clear liquid diet until the nausea decreases.
d. Consult with the health care provider about using a different opioid.

Answer 18

a. Administer the ordered antiemetic medication.

Question 19

The nurse is caring for a client diagnosed with tendinitis in the outpatient clinic and advises that the client use a topical ointment to assist with pain relief. The client informs the nurse that they have never used a topical ointment for pain relief before so the nurse provides education related to the correct use of the ointment. Which of the following information should the nurse include in the teaching plan?

a. Apply the ointment after a 20-minute massage of the area.
b. Use moist heat for 10 minutes to the area prior to applying the ointment.
c. Test the ointment on a small area of the skin for adverse effects.
d. Use EMLA to the area prior to applying the ointment.

Answer 19

c. Test the ointment on a small area of the skin for adverse effects.

Question 20

The nurse is caring for a client who is using fentanyl patch and immediate-release morphine for chronic cancer pain who develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which of the following actions is the priority for the nurse to implement?

a. Remove the fentanyl patch.
b. Notify the health care provider.
c. Continue to monitor the client’s status.
d. Give the prescribed PRN naloxone.

Answer 20

a. Remove the fentanyl patch.

Question 21

These medications are ordered for an older-adult client with arthritis in both hips who is complaining of level 3 (0–10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy? a. Acetylsalicylic acid 650 mg orally

b. Naproxen 200 mg orally
c. Oxycodone 5 mg orally
d. Acetaminophen 650 mg orally

Answer 21

d. Acetaminophen 650 mg orally

Question 22

The health care provider plans to titrate a patient-controlled analgesia (PCA) machine to provide pain relief for a client with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time? (Select all that apply.)

a. Assessing for signs that the client is becoming addicted to the opioid
b. Monitoring for therapeutic and adverse effects of opioid administration
c. Emphasizing that the risk of some opioid adverse effects increases over time
d. Educating the client about how analgesics improve postoperative activity level
e. Teaching about the need to decrease opioid doses by the second postoperative day

Answer 22

b. Monitoring for therapeutic and adverse effects of opioid administration
d. Educating the client about how analgesics improve postoperative activity level

Question 23

To which patient will the nurse plan to provide teaching on managing acute pain?

a. Patient with arthritis
b. Patient with fibromyalgia
c. Patient with kidney stones
d. Patient with low back pain

Answer 23

c. Patient with kidney stones

Question 24

The nurse is teaching students about the older adult population and normal aging. Which statement by a nursing student indicates an understanding of older adults and pain?

a. “Older adults must learn to tolerate pain.”
b. “Pain is a normal process of aging and is to be expected.”
c. “Pain is not a normal process of aging and can indicate injury.”
d. “Older adults perceive pain to alI lesser deg. compared with younger individuals.”

Answer 24

c. “Pain is not a normal process of aging and can indicate injury.”

Question 25

A patient states that the pain medication is “not working” and rates his postoperative pain at a 10 on a 1-to-10 scale. Which of these assessment findings indicates an acute pain response to poorly controlled pain?

a. Confusion
b. Hyperventilation
c. Increased blood pressure and pulse
d. Depression

Answer 25

c. Increased blood pressure and pulse

Question 26

When assessing a patient’s pain, the nurse knows that the most reliable indicator of pain would be the: a. Patient’s vital signs.

b. Physical examination findings.
c. Results of a computed tomography (CT) scan.
d. Subjective report by the patient.

Answer 26

d. Subjective report by the patient.

Question 27

A patient has had arthritic pain in her hips for several years since she suffered a hip fracture. She is walking around in her room with no sign of discomfort. However, when asked, she states that her pain is “bad this morning” and rates it at an 8 on a 1-to-10 scale. What does the nurse suspect? The patient:

a. Is addicted to her pain medications and cannot obtain pain relief.
b. Does not want to trouble the nursing staff with her complaints.
c. Is not in pain but rates it high to receive pain medication.
d. Has experienced chronic pain for years and has adapted to it

Answer 27

d. Has experienced chronic pain for years and has adapted to it

Question 28

The nurse is reviewing the principles of pain. Which type of pain is caused by an abnormal processing of the pain impulse through the peripheral or central nervous system?

a. Visceral
b. Referred
c. Cutaneous
d. Neuropathic

Answer 28

d. Neuropathic

Question 29

When assessing the quality of a patient’s pain, which question should the nurse ask?

a. “When did the pain start?”
b. “Is the pain a stabbing pain?”
c. “Is it a sharp pain or dull pain?”
d. “What does your pain feel like?”

Answer 29

d. “What does your pain feel like?”

Question 30

When assessing a patient’s pain, the nurse knows that an example of visceral pain would be:

a. Hip fracture.
b. Cholecystitis.
c. Second-degree burns.
d. Pain after a leg amputation.

Answer 30

b. Cholecystitis.

Question 31

The nurse is reviewing the principles of nociception. During which phase of nociception does the conscious awareness of a painful sensation occur?

a. Perception
b. Modulation
c. Transduction
d. Transmission

Answer 31

a. Perception

Question 32

When assessing the intensity of a patient’s pain, which question by the nurse is appropriate?

a. “What makes your pain better or worse?”
b. “How much pain do you have now?”
c. “How does pain limit your activities?”
d. “What does your pain feel like?”

Answer 32

b. “How much pain do you have now?”

Question 33

A patient is complaining of severe knee pain after twisting it during a basketball game and is requesting pain medication. Which action by the nurse is appropriate?

a. Completing the physical examination first and then giving the pain medication
b. Telling the patient that the pain medication must wait until after the x-ray images are completed
c. Evaluating the full range of motion of the knee and then medicating for pain
d. Administering pain medication and then proceeding with the assessment

Answer 33

d. Administering pain medication and then proceeding with the assessment

Question 34

A patient has been admitted to the hospital with vertebral fractures related to osteoporosis. She is in extreme pain. This type of pain would be classified as:

a. Referred
b. Cutaneous
c. Visceral
d. Deep somatic

Answer 34

d. Deep somatic

Question 35

During assessment of a patient’s pain, the nurse is aware that certain nonverbal behaviours are associated with chronic pain. Which of these behaviours are associated with chronic pain? (Select all that apply.)

a. Sleeping
b. Moaning
c. Diaphoresis
d. Bracing
e. Restlessness
f. Rubbing

Answer 35

a. Sleeping
d. Bracing
f. Rubbing

Question 36

During an admission assessment of a patient with dementia and recent falls, the nurse will assess for pain by: (Select all that apply.)

a. Asking the family to identify any patterns the patient demonstrates to express pain.
b. Examining the patient’s facial expressions and behaviours for pain cues.
c. Asking the patient to describe the pain.
d. Having the patient rate pain on a 1-to-10 scale.
e. Assessing for sudden onset of acute confusion in the patient.

Answer 36

a. Asking the family to identify any patterns the patient demonstrates to express pain.
b. Examining the patient’s facial expressions and behaviours for pain cues.
e. Assessing for sudden onset of acute confusion in the patient.

Question 37

When working with Indigenous children, the nurse recognizes that they: (Select all that apply.)

a. Express pain through their facial expressions.
b. Silently suffer through their pain
c. Cry easily when in pain.
d. Are reluctant to express their pain vocally.
e. Are at increased risk for pain.

Answer 37

b. Silently suffer through their pain
d. Are reluctant to express their pain vocally.
e. Are at increased risk for pain.

Question 38

A patient admitted to the hospital does not speak or understand English or French. What is this patient at risk for experiencing?

a. Racism
b. Deportation
c. Equity
d. Safety

Answer 38

a. Racism

Question 39

Nursing students are discussing the inequities in the health status of the Indigenous peoples. What was one of the discriminatory practices implemented to assimilate Indigenous peoples into the dominant Canadian society?

a. Promoting voting rights for the Indigenous people
b. Outlawing land appropriation
c. Making the work of Indigenous traditional healers illegal.
d. Banning the use of residential schools

Answer 39

c. Making the work of Indigenous traditional healers illegal.

Question 40

When working with a family of Indigenous background, what is important for the nurse to be aware of?

a. There is no difference in the health of Indigenous or non-Indigenous peoples in Canada.
b. There is inequity in the health status of Indigenous peoples compared with that of most of the Canadian population.
c. The current state of health of Indigenous peoples is solely attributable to living off the reserves.
d. The average life expectancy of Indigenous peoples is greater than that of the Canadian population.

Answer 40

b. There is inequity in the health status of Indigenous peoples compared with that of most of the Canadian population.

Question 41

The nurse manager is explaining culturally competent care during a staff meeting. Which of the following best describes the concept of culturally competent care?

a. Treating patients of different ethnicities with discrimination
b. Making assumptions about patients based on their race
c. Developing personal relationships with patients of the same culture
d. Maximizing respectful relationships with patients different from us

Answer 41

d. Maximizing respectful relationships with patients different from us

Question 42

The nurse is working with non–English-speaking Asian immigrants, who have been in Canada for 1 year. What might be a concern the nurse should assess the clients for?

a. Significant lack of physical exercise
b. Capability to access and use health care services
c. Limited use of seat belts and helmets
d. Constant overuse of emergency room services

Answer 42

b. Capability to access and use health care services

Question 43

The nurse encounters a young male who is questioning his gender. The nurse is aware that this young person:

a. May be at increased risk for breast cancer because of population differences
b. May encounter increased job opportunities
c. May be at risk for poor health because of difficulty with health care accessibility as a result of stigmatization
d. May experience greater health equity

Answer 43

c. May be at risk for poor health because of difficulty with health care accessibility as a result of stigmatization

Question 44

When conducting a health assessment, the nurse should assess for:

a. Willingness to comply with recommended treatment
b. Participation in research trials
c. Use of alternative therapies
d. Allopathic medical treatment preferences

Answer 44

c. Use of alternative therapies

Question 45

During a class on religion and spirituality, the nurse is asked to define spirituality. Which of the following descriptions is correct?

a. A personal search to discover a supreme being
b. An organized system of beliefs concerning the cause, nature, and purpose of the universe
c. A belief that each person exists forever in some form, such as a belief in reincarnation or the afterlife
d. Arises out of each person’s unique life experience and his or her personal effort to find purpose in life

Answer 45

d. Arises out of each person’s unique life experience and his or her personal effort to find purpose in life

Question 46

The nurse is teaching nursing students about cultural competence. What knowledge will they need to develop? (Select all that apply.)

a. Awareness of the social, economic, and cultural contexts influencing care
b. Making decisions based on one’s personal assumptions about different ethnicities
c. Understanding the culture of the health care system one is currently working in
d. Emphasizing perceived differences and discriminating against other
e. Understanding one’s own personal ethnocultural and social background

Answer 46

a. Awareness of the social, economic, and cultural contexts influencing care
c. Understanding the culture of the health care system one is currently working in
e. Understanding one’s own personal ethnocultural and social background

Question 47

A patient diagnosed with migraine headache is experiencing what type of pain?

a. Acute pain
b. Persistent pain
c. Vascular pain
d. Phantom pain

Answer 47

c. Vascular pain

Question 48

A patient is in the recovery room following abdominal surgery. He is groggy but reports severe pain around his incision. What is the most important factor for the nurse to consider during her patient assessment before administering a dose of morphine sulphate?

a. Temperature
b. Respiration rate
c. Appearance of the incision
d. Time of last bowel movement

Answer 48

b. Respiration rate

Question 49

A patient who has been treated for lung cancer for 3 years has noticed that over the past few months the opioid analgesic that is being used is not helping as much, and says that taking more medication is needed for the same pain relief. What is this patient experiencing?

a. Opioid toxicity
b. Addiction
c. Opioid tolerance
d. Abstinence syndrome

Answer 49

c. Opioid tolerance

Question 50

A patient is to receive acetylcysteine as part of treatment for an acetaminophen overdose. Which action by the nurse is appropriate when administering this medication?

a. Giving the medication undiluted for full effect
b. Avoiding the use of a straw when giving the medication
c. Disguising the flavour with a soft drink or flavoured water
d. Preparing to give the medication via a nebulizer

Answer 50

c. Disguising the flavour with a soft drink or flavoured water

Question 51

A 57-year-old patient has been on a transdermal narcotic analgesic as part of the management of pain for end-stage breast cancer. Lately, she has experienced ―breakthrough‖ pain. How should this pain be addressed?

a. She should be given NSAIDs.
b. Her current therapy should not be changed.
c. The baseline dose of the narcotic may need to be increased in increments.
d. The narcotic route should be changed to the rectal route, to increase absorption.

Answer 51

c. The baseline dose of the narcotic may need to be increased in increments.

Question 52

One patient has cancer of the bone; a second patient has cancer in the connective tissues of the leg muscles; and a third patient has cancer in the vascular tissues. Which type of tumour is common to these patients?

a. Sarcoma
b. Leukemia
c. Carcinoma
d. Lymphoma

Answer 52

a. Sarcoma

Question 53

A patient has had a first course of antineoplastic therapy and is experiencing gastrointestinal adverse effects, including anorexia and nausea. Which is an appropriate goal for the patient dealing with these adverse effects?

a. To eat three balanced meals a day within 4 days
b. To return to the normal eating pattern within 1 month
c. To maintain normal weight by consuming healthy snacks as tolerated
d. To maintain a diet of six frequent feedings with a nutritional supplement as a snack for 2 weeks

Answer 53

d. To maintain a diet of six frequent feedings with a nutritional supplement as a snack for 2 weeks

Question 54

A patient is at risk for infection due to neutropenic effects of antineoplastic drug therapy. Which statement by the patient indicates the need for further teaching about this care?

a. I can‘t wait to go to the buffet restaurant for supper.
b. I should eat plenty of fresh fruit to improve my nutrition.
c. I should report a sore throat, cough, or low-grade temperature.
d. It is important for both my family and me to practise good hand washing

Answer 54

a. I can‘t wait to go to the buffet restaurant for supper.

Question 55

A patient is receiving the antineoplastic drug methotrexate (Metoject). What important instructions should the nurse give the patient in regard to this drug? (Select all that apply.) Express your answer in small letters followed by a comma and a space (e.g., a, b, c, d).
a. Report black, tarry stools.
b. Perform oral care with mouthwash.
c. Do not expect hair loss from this drug.
d. Prepare for hair loss by deciding whether to use a wig, a hairpiece, or a hat.
e. Avoid eating raw seafood.
F. Discontinue contraceptive measures as soon as chemotherapy is completed.
g. Avoid foods that are hot or that are rough in texture.
h. Avoid exposure to the sun.

Answer 55

a. Report black, tarry stools.
d. Prepare for hair loss by deciding whether to use a wig, a hairpiece, or a hat
e. Avoid eating raw seafood.
g. Avoid foods that are hot or that are rough in texture.
h. Avoid exposure to the sun.

Question 56

Leucovorin rescue, during which leucovorin enters and ―rescues‖ normal cells from the toxic effects of antineoplastic agents, is useful during therapy with which drug?

a. cisplatin
b. methotrexate (Metoject® )
c. mercaptopurine (6-MP)
d. cyclophosphamide

Answer 56

b. methotrexate (Metoject® )