Chapter 08: Pain and Pain Management

Chapter 08: Pain and Pain Management

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. The subjective characteristic implies that pain is

ANS:  D

Pain is described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. This definition emphasizes the subjective and multidimensional nature of pain. More specifically, the subjective characteristic implies that pain is whatever the person experiencing it says it is and that it exists whenever he or she says it does.

2. The neural processes of encoding and processing noxious stimuli necessary but not sufficient for pain is known as

ANS:  B

Nociception represents the neural processes of encoding and processing noxious stimuli necessary, but not sufficient, for pain. Transduction refers to mechanical (e.g., surgical incision), thermal (e.g., burn), or chemical (e.g., toxic substance) stimuli that damage tissues. As a result of transduction, an action potential is produced and is transmitted by nociceptive nerve fibers in the spinal cord that reach higher centers of the brain. This is called transmission, and it represents the second process of nociception. Pain sensation transmitted by the NS pathway reaches the thalamus, and the pain sensation transmitted by the PS pathway reaches brainstem, hypothalamus, and thalamus. These parts of the CNS contribute to the initial perception of pain.

3. Which of the following assessment findings might indicate respiratory depression after opioid administration?

ANS:  D

Opioids may cause this complication because they reduce the responsiveness of carbon dioxide chemoreceptors in the respiratory center located in the medulla..  Risk factors for opioid-induced respiratory depression include advanced age, obesity, sleep apnea, impaired kidney/lung/liver/heart function, patients in whom pain is controlled after a period of poor control, patients who are opioid naïve (i.e., receiving opioids for less than a week), concurrent use of central nervous system depressants, and postoperative day 1 were described. In addition to side effects common to all opioids, morphine may stimulate histamine release from mast cells, resulting in cardiac instability and allergic reactions.

4. The patient is admitted to the CCU with hemodynamic instability and an allergy to morphine. The nurse anticipates that the physician will order which medication for severe pain?

ANS:  C

Fentanyl is a synthetic opioid preferred for critically ill patients with hemodynamic instability or morphine allergy. Hydromorphone is a semisynthetic opioid that has an onset of action and a duration similar to those of morphine. It is more potent than morphine. Hydromorphone produces an inactive metabolite (i.e., hydromorphone-3-glucuronide), making it the opioid of choice for use in patients with end-stage renal disease. Codeine has limited use in the management of severe pain. It is rarely used in critical care units. It provides analgesia for mild to moderate pain. It is usually compounded with a nonopioid. Methadone is a synthetic opioid with morphine-like properties but less sedation. It is longer acting than morphine and has a long half-life. This makes it difficult to titrate in the critical care patient.