Geriatrics 5 Flashcards
An older patient with a history of severe arthritis has not received pain medication for over 18 hours. The patient is currently complaining of severe pain in both legs. What will the nurse attribute as being the reason for the patient’s increase in pain?
- Dependency on narcotics
- Over-exaggeration of the amount of pain
- Need for alternative measures for pain relief
- Untreated pain resulting in lower pain threshold
4: With untreated pain, the nociceptors become sensitive and more responsive to stimuli resulting in a lowered pain threshold. This patient experienced a long period of time between administrations of pain medication, and this causes an increase in the pain experienced.
The nurse is caring for two patients. An older patient reports abdominal pain as being 5 out of 10 on the pain rating scale, whereas a younger patient reports left lower quadrant abdominal pain as being 10 out 10 on the scale. What would the nurse identify as reason for the discrepancy between the two patients’ measurements of pain?
- Younger patients tend to be more dramatic when complaining of pain.
- Visceral pain is less severe in older patients and may be reported as mild.
- Visceral pain is more severe in older patients, but they are less likely to complain.
- Visceral pain is less severe in younger patients but is reported as high in intensity.
2: Visceral pain is often less severe in the older patient and reported with vague complaints. This often is an explanation for the higher incidence of silent myocardial infarctions and less dramatic presentations of abdominal problems requiring surgery in older adults.
An older patient living at home with cancer reports having to take twice as much pain medication over the last 24 hours. What should the nurse do with this information?
- Adjust the medication as needed.
- Discuss options to treat breakthrough pain.
- Try alternative methods for pain relief instead of pain medication.
- Talk with the physician to change the medication because of opioid tolerance.
2: If the patient experiences breakthrough pain on a consistent basis, the nurse should notify the patient’s provider so that the dose of the long-acting, sustained-release preparation can be increased to more effectively control the pain.
An older patient with headaches, dizziness, and ataxia takes meperidine for arthritic pain. What impact does this medication have on this patient’s health problems?
- This medication is not causing the patient’s symptoms.
- This medication is not effective in older patients for pain relief.
- This medication is more effective to treat pain than aspirin or acetaminophen.
- This medication causes toxic side effects similar to what the patient is experiencing.
4: Meperidine is not recommended for treatment of persistent pain in older persons because it tends to cause accumulations of toxic metabolites that can cause delirium, ataxia, and dizziness.
The nurse is caring for an older patient with chronic pain caused by arthritis and uterine cancer. What is the best approach for the nurse to take when managing this patient’s pain?
- Administering the pain medication around the clock
- Administering the medication when the patient requests it
- Consulting the physician to order intravenous pain medication
- Administering the medication sparingly to avoid narcotic addiction
1: Pain medication is best when it is administered around the clock.
An older patient asks why sustained-release pain medication cannot be chewed. How should the nurse respond to this patient?
Standard Text: Select all that apply.
1. Chewing deactivates the medication.
2. The medication is damaging to the teeth and gums.
3. Chewing destroys their controlled-release properties.
4. The saliva in the mouth breaks the medication down and makes it toxic.
5. Chewing causes a rapid absorption of the entire dose and a possible overdose.
3: Chewing sustained-release preparations of analgesics destroys their controlled-release properties.
5: Chewing sustained-release preparations of analgesics causes rapid absorption of the entire dose, resulting in possible overdose.
An older patient with a speech deficit from a previous stroke is admitted for a repair of a hip fracture. Which techniques will the nurse use to assess this patient’s pain level?
Standard Text: Select all that apply.
1. Ask to describe the level of pain.
2. Observe for tense body posturing.
3. Listen for sounds such as groaning.
4. Notice changes in appetite or sleep.
5. Observe facial expressions such as grimacing.
2: Tense body posturing is a pain behavior that the patient who is unable to speak might demonstrate.
3: Sounds such as groaning are pain behaviors that the patient who is unable to speak might demonstrate.
4: Changes in appetite or sleep are pain behaviors that the patient who is unable to speak might demonstrate.
5: Grimacing is a pain behavior that the patient who is unable to speak might demonstrate.
An older patient recovering from surgery is prescribed morphine sulfate 2 to 6 mg every 4 hours prn for pain. What approach will the nurse take to manage this patient’s pain?
- Administer the lowest dose of 2 mg.
- Administer the highest dose of 6 mg.
- Avoid the narcotic for risk of addiction.
- Administer the dose only when the patient asks for the medication.
1: Older patients usually have more sensitivity to opioid analgesics, and most often these patients are started on smaller doses to avoid toxicity. The dose is then titrated upward until effective pain relief is achieved without adverse effects.
An older patient with a history of constipation is prescribed an opioid analgesic for postoperative pain. What should the nurse include in this patient’s plan of care to avoid the pain management complication of constipation?
Standard Text: Select all that apply.
1. Mix psyllium in 4 ounces of water.
2. Provide stool softeners as prescribed.
3. Monitor for adequate daily fluid intake.
4. Increase ingestion of fresh fruit each day.
5. Offer senna tea each evening before sleep.
2: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Stool softeners should be provided as prescribed.
3: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. The patient should be encouraged to increase the oral fluid intake.
4: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Fruits may also be helpful to prevent constipation.
5: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Senna tea may also be helpful to prevent constipation.
The nurse is planning to implement nonpharmacological approaches with an older patient with chronic osteoarthritis pain. What should the nurse keep in mind when implementing these approaches?
- The effectiveness of nonpharmacological approaches is questionable.
- Nonpharmacological approaches are less effective in the older patient.
- Nonpharmacological approaches are more effective in the older patient.
- Nonpharmacological approaches are effective when used with pharmacological therapy.
4: Greater reductions in pain are seen when pharmacological and
nonpharmacological techniques are combined.
An older patient is prescribed topical capsaicin for joint pain. What should the nurse instruct the patient about the use of this medication?
Standard Text: Select all that apply.
1. Avoid getting the medication in the eyes.
2. This medication will react with other medications.
3. It will cause a burning sensation when first applied.
4. Do not permit the medication to touch an open wound.
5. The burning sensation will decrease with subsequent uses.
1: The patient should be instructed to avoid getting capsaicin in the eyes as this will cause burning.
3: The patient should be instructed that this medication will cause a burning sensation when first applied.
4: The patient should be instructed to avoid getting capsaicin in an open wound since it will cause burning.
5: The patient should be instructed that the burning sensation from capsaicin will decrease when applied frequently.
The nurse learns that an older patient with chronic pain is not a candidate for the nonpharmacological pain management approach of massage. For which health problems is massage contraindicated? Standard Text: Select all that apply. 1. Cancer 2. Fractures 3. Bleeding disorders 4. Low platelet counts 5. Deep vein thrombosis
2: Massage is contraindicated in patients with fractures.
3: Massage is contraindicated in patients with bleeding disorders.
4: Massage is contraindicated in patients with low platelet counts.
5: Massage is contraindicated in patients with deep vein thrombosis.
An older patient, experiencing severe pain from diabetic neuropathy, is having minimal pain relief from opioid analgesics. Which adjuvant medications should the nurse ask the healthcare provider to consider helping this patient's pain? Standard Text: Select all that apply. 1. Calcitonin 2. Muscle relaxants 3. Topical analgesics 4. Tricyclic antidepressant 5. Antianxiety medications
3: Topical analgesics are helpful for the pain of diabetic neuropathy.
4: Tricyclic antidepressants are helpful for the pain of diabetic neuropathy.
A terminally ill older patient with ongoing pain is prescribed an increased dose of morphine. What should the nurse consider when providing this dose of pain medication to the patient?
- The ultimate goal for the patient is to control pain.
- The organization’s attorney should be made aware of the physician’s order.
- The nurse may be charged with a crime for administering the medication dose.
- It is more important to ensure the patient does not experience respiratory depression.
1: Management of pain in terminal conditions may call for higher doses of opioids; however, pain should be treated aggressively to maximize comfort, even if the unintended effect of treatment results in the hastening of death.
An older patient with renal disease and advanced cancer pain asks for stronger pain medication. What does the nurse need to take into consideration when determining which prescribed pain medication to provide to this patient?
- Methadone is a viable option for this patient.
- Meperidine is the most versatile opioid available.
- Oral morphine may be a starting point to be considered for this patient.
- Fentanyl is often the first opioid tried because of the low incidence of side effects.
3: Morphine is a commonly used and versatile opioid for the treatment of moderate to severe pain. Short- and long-acting formulations exist, and the drug can be delivered via many routes including oral form.
