A client with a bowel obstruction describes deep, cramping abdominal pain that is hard to pinpoint. Which type of pain is this?
Visceral
✓
Somatic
Neuropathic
Phantom
Correct Answer
Visceral
Visceral pain arises from internal organs and is typically deep, dull or cramping and poorly localized. Somatic pain comes from skin, bone or muscle and is usually sharp and easy to locate. Neuropathic pain comes from damaged nerves and feels burning, tingling or shooting. Phantom pain is felt in a body part that has been amputated.
Category: Pain Types and Assessment
Question 2
A client having a heart attack reports pain in the jaw and left shoulder rather than the chest. This is an example of which type of pain?
Neuropathic pain
Referred pain
✓
Somatic pain
Phantom limb pain
Correct Answer
Referred pain
Referred pain is pain from an internal organ that is felt in a different area of the body, such as myocardial infarction felt in the jaw or shoulder or pancreatic injury felt in the back. Neuropathic pain arises from damaged nerves. Somatic pain comes from skin, bone or muscle at the site of injury. Phantom limb pain is felt in an amputated limb.
Category: Pain Types and Assessment
Question 3
Which pain scale is best suited for assessing pain in a preschool-age child?
0 to 10 numeric rating scale
Verbal descriptor scale
Wong-Baker FACES scale
✓
McGill Pain Questionnaire
Correct Answer
Wong-Baker FACES scale
The Wong-Baker FACES scale uses drawings of faces from smiling to crying, so young children and people with language barriers can point to how they feel. The 0 to 10 numeric rating scale requires an understanding of numbers that a young child usually lacks. A verbal descriptor scale depends on vocabulary for pain words. The McGill Pain Questionnaire is a detailed written tool designed for adults.
Category: Pain Types and Assessment
Question 4
For a client who cannot report pain verbally, which observations help the nurse assess pain?
Hair texture and nail color
Blood glucose and temperature
Urine color and output
Facial grimacing and guarding
✓
Correct Answer
Facial grimacing and guarding
When self-report is not possible, physical signs such as facial expression, muscle tension, guarding and body movement help the nurse judge pain. Hair texture and nail color reflect nutrition and circulation, not pain. Blood glucose and temperature do not indicate pain. Urine color and output reflect hydration and kidney function.
Category: Pain Types and Assessment
Question 5
After giving an oral analgesic, how does the nurse evaluate whether it worked?
Reassess pain with the same rating scale
✓
Ask a family member to rate the pain
Check the client's blood glucose
Wait until the next scheduled dose
Correct Answer
Reassess pain with the same rating scale
Pain is reassessed after the drug has had time to act, using the same scale as the baseline rating so the two scores can be compared. Ask a family member to rate the pain replaces the client's own report, which is the standard. Check the client's blood glucose does not measure pain relief. Wait until the next scheduled dose leaves the response unevaluated.
Category: Pain Types and Assessment
Question 6
Which substances act as the body's own opioids to dampen pain signals during modulation?
Substance P and bradykinin
Enkephalins and endorphins
✓
Histamine and prostaglandins
Cytokines and leukotrienes
Correct Answer
Enkephalins and endorphins
During modulation, enkephalins and beta-endorphins bind opioid receptors and inhibit pain transmission, which is the same action opioid drugs mimic. Substance P and bradykinin intensify pain. Histamine and prostaglandins promote inflammation and sensitize nerve endings. Cytokines and leukotrienes are inflammatory mediators, not natural opioids.
Category: Pain Physiology
Question 7
A client who takes acetaminophen regularly should avoid which substance because it adds to the risk of liver injury?
Grapefruit juice
Dairy products
Alcohol
✓
Caffeine
Correct Answer
Alcohol
Acetaminophen is metabolized by the liver, and regular alcohol use increases its toxic metabolite and depletes the liver's protective stores, raising the risk of hepatotoxicity. Grapefruit juice affects drugs such as some statins, not acetaminophen's liver risk. Dairy products do not interact with acetaminophen. Caffeine is included in some acetaminophen combination products and does not carry this liver warning.
Category: Nonopioid Analgesics
Question 8
Which finding after an acetaminophen overdose suggests liver injury?
Ringing in the ears
Pinpoint pupils
Excessive thirst and urination
Yellowing of the skin and eyes
✓
Correct Answer
Yellowing of the skin and eyes
Jaundice, along with nausea and fatigue, signals hepatotoxicity, the major danger of acetaminophen overdose, which is treated with acetylcysteine. Ringing in the ears is a sign of salicylate toxicity from aspirin. Pinpoint pupils suggest opioid effect. Excessive thirst and urination suggest high blood glucose.
Category: Nonopioid Analgesics
Question 9
Why should a client taking apixaban avoid aspirin for pain relief?
It adds to the risk of bleeding
✓
It blocks apixaban absorption
It causes rebound clotting
It raises blood pressure sharply
Correct Answer
It adds to the risk of bleeding
Aspirin inhibits platelet function, so combining it with an anticoagulant such as apixaban or warfarin increases the risk of bleeding and bruising. It blocks apixaban absorption is not the interaction. It causes rebound clotting is incorrect because aspirin reduces clotting. It raises blood pressure sharply is not a known effect of this combination.
Category: Nonopioid Analgesics
Question 10
Ibuprofen is contraindicated in a client with which history?
Seasonal allergic rhinitis
Asthma triggered by aspirin
✓
Hypothyroidism
Type 2 diabetes
Correct Answer
Asthma triggered by aspirin
People with aspirin-sensitive asthma can have severe bronchospasm with other NSAIDs as well, so ibuprofen and naproxen are avoided. Seasonal allergic rhinitis is not a contraindication. Hypothyroidism is not a contraindication to ibuprofen. Type 2 diabetes is not a contraindication, although kidney function is considered.
Category: Nonopioid Analgesics
Question 11
Because tramadol lowers the threshold for convulsions, caution is needed in a client with which history?
Hypertension
Glaucoma
Epilepsy
✓
Gout
Correct Answer
Epilepsy
Tramadol is a weak opioid agonist that also inhibits norepinephrine and serotonin reuptake, and it lowers the seizure threshold, so it is used with caution in epilepsy. Hypertension is not the concern linked to its seizure risk. Glaucoma is a caution with anticholinergic drugs. Gout is not related to tramadol's convulsion risk.
Category: Opioid Agonists
Question 12
Which drug is classified as an adjuvant analgesic for neuropathic pain?
Naproxen
Hydromorphone
Acetaminophen
Amitriptyline
✓
Correct Answer
Amitriptyline
Amitriptyline is a tricyclic antidepressant whose primary use is not pain, but at low doses it relieves neuropathic pain, which makes it an adjuvant analgesic along with drugs such as duloxetine, carbamazepine and lidocaine. Naproxen is an NSAID, a primary analgesic for inflammatory pain. Hydromorphone is an opioid agonist. Acetaminophen is a primary nonopioid analgesic and antipyretic.
Category: Adjuvant Analgesics
Question 13
Opioid analgesics produce their effects by binding to which receptors?
Mu, kappa and delta receptors
✓
Alpha-1, alpha-2 and beta-1 receptors
H1, H2 and H3 receptors
D1, D2 and D3 receptors
Correct Answer
Mu, kappa and delta receptors
Opioids act on mu, kappa and delta receptors throughout the central nervous system, which relieves pain and also causes adverse effects such as respiratory depression. Alpha-1, alpha-2 and beta-1 receptors are adrenergic receptors. H1, H2 and H3 receptors are histamine receptors. D1, D2 and D3 receptors are dopamine receptors.
Category: Opioid Agonists
Question 14
A client using a transdermal opioid patch for chronic pain should be taught to avoid which activity?
Showering with the patch on
Placing a heating pad over the patch
✓
Wearing loose cotton clothing
Drinking water throughout the day
Correct Answer
Placing a heating pad over the patch
Heat increases blood flow to the skin and speeds fentanyl absorption from the patch, which can cause an overdose with respiratory depression. Showering with the patch on is allowed with normal water temperatures. Wearing loose cotton clothing does not change absorption. Drinking water throughout the day is safe and helps prevent constipation.
Category: Opioid Agonists
Question 15
Before giving IV morphine, which assessment helps the nurse detect the drug's most dangerous adverse effect?
Bowel sounds in all quadrants
Urine output for the shift
Respiratory rate and level of sedation
✓
Skin turgor on the forearm
Correct Answer
Respiratory rate and level of sedation
Respiratory depression is the most dangerous opioid effect, and increasing sedation often comes before it, so breathing and sedation are checked before and after each dose. Bowel sounds in all quadrants relate to constipation, a common but less dangerous effect. Urine output for the shift relates to urinary retention. Skin turgor on the forearm assesses hydration.
Category: Opioid Agonists
Question 16
Why is meperidine avoided in older adults with poor kidney function?
It cannot be given by injection
It has no pain-relieving effect
It causes severe hearing loss
A toxic metabolite can build up and cause seizures
✓
Correct Answer
A toxic metabolite can build up and cause seizures
Meperidine's metabolite normeperidine accumulates when the kidneys cannot clear it and can cause delirium and seizures, so the drug is not used routinely for pain. It cannot be given by injection is wrong because meperidine is given IM, subcutaneously or IV. It has no pain-relieving effect is wrong because it is an opioid analgesic. It causes severe hearing loss is not a known effect.
Category: Opioid Agonists
Question 17
Opioid agonists are contraindicated in a client with which condition?
Paralytic ileus
✓
Osteoarthritis
Kidney stones
Hypertension
Correct Answer
Paralytic ileus
Opioids slow gut motility, so they can worsen a paralytic ileus or GI obstruction; other contraindications include significant respiratory depression and severe asthma. Osteoarthritis pain may be treated with opioids in some cases. Kidney stones often cause severe pain that opioids relieve. Hypertension is not a contraindication.
Category: Opioid Agonists
Question 18
A client has a documented allergy to morphine. Because cross-sensitivity with morphine is low, which opioid may be an option for this client?
Codeine
Fentanyl
✓
Hydromorphone
Oxycodone
Correct Answer
Fentanyl
Fentanyl is a fully synthetic opioid with a chemical structure unlike morphine's, so cross-sensitivity is low and it can usually be used when a client is allergic to morphine. Codeine is converted to morphine in the body, so it is not a safe substitute. Hydromorphone is a semisynthetic derivative of morphine with a similar structure. Oxycodone is also a semisynthetic opioid built on the same structure as morphine.
Category: Opioid Agonists
Question 19
Nalbuphine can relieve pain on its own but can also reverse the depressant effects of full agonists. How is it classified?
Pure opioid antagonist
Full opioid agonist
Mixed opioid agonist-antagonist
✓
Benzodiazepine receptor antagonist
Correct Answer
Mixed opioid agonist-antagonist
Nalbuphine activates some opioid receptors while blocking others, so it is an analgesic that can also reverse or blunt the effects of full agonists and precipitate withdrawal. A pure opioid antagonist such as naloxone has no analgesic effect. A full opioid agonist such as morphine fully activates mu receptors. A benzodiazepine receptor antagonist such as flumazenil reverses benzodiazepines.
Category: Mixed Agonist-Antagonists
Question 20
A client whose genetic testing shows ultrarapid CYP2D6 metabolism is prescribed codeine. Which risk does this create?
Little or no pain relief
Severe liver injury
A sharp rise in blood pressure
Life-threatening respiratory depression
✓
Correct Answer
Life-threatening respiratory depression
Codeine is a prodrug that CYP2D6 converts to morphine, so an ultrarapid metabolizer can build up morphine quickly and develop dangerous sedation and respiratory depression, which is why codeine carries a boxed warning about this. Little or no pain relief is the problem in poor metabolizers, who convert too little codeine to morphine. Severe liver injury is the major danger of acetaminophen overdose, not of CYP2D6 variation. A sharp rise in blood pressure is not an effect of rapid codeine metabolism.
Category: Opioid Agonists