chapter 11 - Jarvis 3rd edition- test bank - for final exam PDF

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Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

Chapter 11: Pain Assessment Jarvis: Physical Examination & Health Assessment, 3rd Canadian edition MULTIPLE CHOICE 1. 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 ANS: C

Acute pain is of short duration and dissipates after the injured tissue has healed, for example, in a patient with kidney stones. The other conditions are examples of chronic pain during which the pain continues for 6 months or longer and does not stop even after the injured tissue has healed. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 2. 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? “Older adults must learn to tolerate pain.” “Pain is a normal process of aging and is to be expected.” “Pain is not a normal process of aging and can indicate injury.” “Older adults perceive pain to a lesser degree compared with younger individuals.”

a. b. c. d.

ANS: C

Pain indicates a pathological condition or an injury and should never be considered something that an older adult should expect or tolerate. Pain is not a normal part of aging, and no evidence suggests that pain perception is reduced with aging. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 3. A 4-year-old boy is brought to the emergency department by his mother. She says he points to

his stomach and says, “It hurts so bad.” Which pain assessment tool would be the best choice when assessing this child’s pain? a. Descriptor Scale b. Numeric rating scale c. Brief Pain Inventory d. Faces Pain Scale—Revised (FPS-R) ANS: D

Rating scales can be introduced at age 4 or 5 years. The FPS-R is designed for use with children and asks the child to choose a face that shows “how much hurt (or pain) you have now.” Young children should not be asked to rate pain by using numbers. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank 4. 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 ANS: C

Responses to poorly controlled acute pain include tachycardia, elevated blood pressure, and hypoventilation. Confusion and depression are associated with poorly controlled chronic pain. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 5. During assessment, a 68-year-old patient informs the nurse about the analgesics she uses to

manage her arthritis pain. What should the nurse caution the patient about? Use of warm packs Dislike of using ibuprofen Occasional use of a multivitamin Frequent combined use of acetaminophen and prescribed Tylenol 3

a. b. c. d.

ANS: D

Many medications are combined with acetaminophen to achieve a synergistic effect (Percocet, which contains both acetaminophen and oxycodone; Tylenol 1, 2, and 3, which contain combinations of acetaminophen with varying amounts of codeine; and Tramacet, which contains paracetamol and tramadol). Acetaminophen is well tolerated; however, the maximum daily dosage in a healthy patient should not exceed 4 g per day from all sources combined. The maximum daily dosage is best decreased for older patients and for those with impaired liver function. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 6. When assessing a patient’s pain, the nurse knows that the most reliable indicator of pain

would be the: Patient’s vital signs. Physical examination findings. Results of a computed tomography (CT) scan. Subjective report by the patient.

a. b. c. d.

ANS: D

The subjective report by the patient is the most reliable indicator of pain. Physical examination findings can lend support, but the clinician cannot base the diagnosis of pain solely on physical assessment findings. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank 7. 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. ANS: D

Persons with chronic pain typically try to give little indication that they are in pain and, over time, adapt to the pain. As a result, they are at risk for underdiagnosis. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. 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 ANS: D

Neuropathic pain implies an abnormal processing of the pain message. The other types of pain are named according to their sources. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. 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?” ANS: D

To assess the quality of a person’s pain, the patient should be asked to describe the pain in his or her own words. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. 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. ANS: B

Visceral pain originates from the larger interior organs, such as the gallbladder, liver, or kidneys.

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. 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 ANS: A

Perception is the third phase of nociception and indicates the conscious awareness of a painful sensation. During this phase, the sensation is recognized by higher cortical structures and identified as pain. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 12. 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?” ANS: B

Asking the patient “How much pain do you have?” is an assessment of the intensity of a patient’s pain; various intensity scales can be used. Asking what makes one’s pain better or worse assesses alleviating or aggravating factors. Asking whether pain limits one’s activities assesses the degree of impairment and quality of life. Asking “What does your pain feel like” assesses the quality of pain. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 13. 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 ANS: D

The American Pain Society (1992) has stated: “In cases in which the cause of acute pain is uncertain, establishing a diagnosis is a priority, but symptomatic treatment of pain should be given while the investigation is proceeding. With occasional exceptions, (e.g., the initial examination of the patient with an acute condition of the abdomen), it is rarely justified to defer analgesia until a diagnosis is made. In fact, a comfortable patient is better able to cooperate with diagnostic procedures.” DIF: Cognitive Level: Analyzing (Analysis)

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 14. The nurse is assessing a 6-month-old infant. What does the nurse know to be true regarding

the pain experienced by infants? a. Pain in infants can only be assessed by physiological changes, such as an increased

heart rate. b. The FPS-R can be used to assess pain in infants. c. A procedure that induces pain in adults will also induce pain in the infant. d. Infants feel pain less compared with adults. ANS: C

If a procedure or disease process causes pain in an adult, then it will also cause pain in an infant. Physiological changes cannot be exclusively used to confirm or deny pain because other factors, such as medications, fluid status, or stress, may cause physiological changes. The FPS-R can be used starting at age 4 years. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 15. 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: Referred Cutaneous Visceral Deep somatic

a. b. c. d.

ANS: D

Deep somatic pain comes from such sources as the blood vessels, joints, tendons, muscles, and bone. Referred pain is felt at one site but originates from another location. Cutaneous pain is derived from the skin surface and subcutaneous tissues. Visceral pain originates from the larger, interior organs. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort MULTIPLE RESPONSE 1. 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 ANS: A, D, F

Behaviours that have been associated with chronic pain include bracing, rubbing, diminished activity, sighing, and changes in appetite. In addition, those with chronic pain may sleep in an attempt at distraction. The other behaviours are associated with acute pain.

Physical Examination and Health Assessment CANADIAN 3rd Edition Jarvis Test Bank

DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 2. During an admission assessment of a patient with dementia and recent falls, the nurse will

assesses 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. ANS: A, B, E

Intellectually/cognitively impaired persons, such as patients with dementia, may have a limited ability to communicate information about pain, which places them at high risk for undertreatment of pain. Discussion with the family or other health care team members can help you identify patterns that may indicate that a patient is experiencing pain. Be attentive to behavioural cues of pain, by examining facial expressions or changes in appetite, daily activities, involvement in social activities, or sleep–wake cycles. Assess any sudden onset of acute confusion or delirium because it may indicate poor control of pain. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort 3. When working with Indigenous children, the nurse recognizes that they: (Select all that

apply.) Express pain through their facial expressions. Silently suffer through their pain. Cry easily when in pain. Are reluctant to express their pain vocally. Are at increased risk for pain.

a. b. c. d. e.

ANS: B, D, E

Indigenous children and youth feel and experience pain just like anyone else, but many tend not to express it outwardly through words, facial expressions, or crying. They just manage it and suffer silently. This response to pain is thought to be a result of cultural traditions and the effects of the residential school system. Indigenous children have higher rates of dental pain, ear infections, and juvenile rheumatoid arthritis. Understanding that this population is at a higher risk for pain and is also more likely to be stoic about pain expression should prompt health care providers to have open discussions with Indigenous patients about experiences that may cause them pain: both bodily and spiritually. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort...