Page 125 Complete Your CE Test Online - Click Here PAIN ASSESSMENT AND CARE: A CRITICAL CHALLENGE Self-Evaluation Exercises Questions are located throughout the course. You do not need to submit the self-evaluation exercise with your final examination sheet. 1. Answer - D. Rationale: The person is experiencing acute, nociceptive pain caused by noxious stimuli (the bee sting) resulting in minor tissue injury. It is not pathologic, neuropathic, or visceral pain. Pathologic pain is seen in chronic pain conditions. Neuropathic pain is associated with abnormal neural activity in the nervous system. Visceral pain is associated with viscera, usually in internal organs, which results in a deep and dull sensation. This pain is also physiologic in nature because it starts with tissue injury and has a protective nature that will cause the person to be cautious of bee stings in the future. It is somatic pain as well because it is pain resulting from injury to skin tissue. 2. Answer - A. Rationale: A delta fibers are myelinated, quickly transmitted via the neospinothalamic tract, and result in sharp pain that can be easily pinpointed. C fibers are unmyelinated and travel more slowly through the paleospinothalamic tract with more synapses that is harder to localize. 3. Answer - B. Rationale: Distraction is thought to work by altering the perception of pain. 4. Answer - D. Rationale: A pain assessment should be performed on the initial visit and should be reassessed, depending on the policy of the workplace, not necessarily every four hours. Although a fall risk assessment should be performed routinely and can help identify patients who may be more apt to fall (especially if taking opioid medications for pain) it is not part of the pain assessment. The pain scale used for assessment should be the most appropriate, depending on the needs of a particular patient, and may not be appropriate for all patients throughout the medical institution. A pain assessment should include exacerbating and relieving factors, as well as quality, intensity, onset, and location. 5. Answer - C. Rationale: Typically, during times of acute pain, the sympathetic nervous system is stimulated causing an elevation of blood pressure, heart rate, respiratory rate, blood glucose levels, and gastric secretions that may cause nausea. 6. Answer - D. Rationale: The first line of therapy in patients with neuropathic pain is anticonvulsant medication and antidepressants. Opioid therapy is second-line medication to be used only in certain patients for whom first-line medications are not effective. 7. Answer - C. Rationale: Hydromorphone is 7 times more potent than morphine. All of the other statements about opioids are true. 8. Answer - D. Rationale: Diazepam can be used to lessen effects of opioid withdrawal. But if used long term, it carries the risk for addiction. 9. Answer - D. Rationale: All of the statements are accurate and should be considered before implementing a plan of care for the elderly patient experiencing pain. 10. Answer - A. Rationale: The main source for prescription misuse of opioid medication is physician prescriptions, not the Internet.