H. CH 9 Pain Management Flashcards
The nurse who is a member of the palliative care team is assessing a patient. The patient indicates thathe has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate. What teaching should the nurse do with this patient?
a) Medication should be taken when pain levels are low so the pain is easier to reduce.
b) Pain medication can be increased when the pain becomes intense.
c) It is difficult to control chronic pain, so this is an inevitable part of the disease process.
d) The patient will likely benefit more from distraction than pharmacologic interventions.
a) Medication should be taken when pain levels are low so the pain is easier to reduce.
Two patients on your unit have recently returned to the postsurgical unit after knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurses most plausible rationale for understanding the patients different perceptions of pain?
a) Endorphin levels may vary between patients, affecting the perception of pain.
b) One of the patients is exaggerating his or her sense of pain.
c) The patients are likely experiencing a variance in vasoconstriction.
d) One of the patients may be experiencing opioid tolerance.
a) Endorphin levels may vary between patients, affecting the perception of pain.
You are frequently assessing an 84-year-old womans pain after she suffered a humeral fracture in a fall. When applying the nursing process in pain management for a patient of this age, what principle should you best apply?
a) Monitor for signs of drug toxicity due to a decrease in metabolism.
b) Monitor for an increase in absorption of the drug due to age-related changes.
c) Monitor for a paradoxical increase in pain with opioid administration.
d) Administer analgesics every 4 to 6 hours as ordered to control pain.
a) Monitor for signs of drug toxicity due to a decrease in metabolism
The nurse is assessing a patients pain while the patient awaits a cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at this time using a 0-to-10 pain scale. How should the nurse best respond to this assessment finding?
a) Remind the patient that he is indeed experiencing pain.
b) Reinforce teaching about the pain scale number system.
c) Reassess the patients pain in 30 minutes.
d) Administer an analgesic and then reassess.
b) Reinforce teaching about the pain scale number system.
You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of patients who live with chronic pain should inform your care planning?
a) They are typically more comfortable with underlying pain than patients without chronic pain.
b) They often have a lower pain threshold than patients without chronic pain.
c) They often have an increased tolerance of pain.
d) They can experience acute pain in addition to chronic pain.
d) They can experience acute pain in addition to chronic pain.
The nurse is caring for a 51-year-old female patient whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem?
Anxiety
Skin breakdown
Depression
Hallucinations
Depression
Your patient has just returned from the postanesthetic care unit (PACU) following left tibia open reduction internal fixation (ORIF). The patient is complaining of pain, and you are preparing to administer the patients first scheduled dose of hydromorphone (Dilaudid). Prior to administering the drug, you would prioritize which of the following assessments?
A) The patients electrolyte levels
B) The patients blood pressure
C) The patients allergy status
D) The patients hydration status
C) The patients allergy status
Your patient is receiving postoperative morphine through a patient-controlled analgesic (PCA) pump and the patients orders specify an initial bolus dose. What is your priority assessment?
Assessment for decreased level of consciousness (LOC) Assessment for respiratory depression
Assessment for fluid overload
Assessment for paradoxical increase in pain
Assessment for respiratory depression
Your patient is 12-hours post ORIF right ankle. The patient is asking for a breakthrough dose of analgesia. The pain-medication orders are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner?
To prevent respiratory depression from the opioid
To eliminate the need for additional medication during the night
To achieve better pain control than with one medication alone
To eliminate the potentially adverse effects of the opioid
To achieve better pain control than with one medication alone
The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse why he has had to keep getting larger doses of his pain medication, although they do not seem to affect him. What is the nurses best response?
Over time you become more tolerant of the drug.
You may have become immune to the effects of the drug.
You may be developing a mild addiction to the drug. Your body absorbs less of the drug due to the cancer.
Over time you become more tolerant of the drug.
A 52-year-old female patient is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the patients pain in her plan of nursing care, the nurse should consider what characteristic of cancer pain?
A) Cancer pain is often related to the stress of the patient knowing she has cancer and requires relatively low doses of pain medications along with a high dose of anti-anxiety medications.
B) Cancer pain is always chronic and challenging to treat, so distraction is often the best intervention.
C) Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications.
D) Cancer pain is often misreported by patients because of confusion related to their disease process.
C) Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications.
The nurse caring for a 79-year-old man who has just returned to the medicalsurgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurses management of the patients pain?
A) The elderly may require lower doses of medication and are easily confused with new medications.
B) The elderly may have altered absorption and metabolism, which prohibits the use of opioids.
C) The elderly may be confused following surgery, which is an age-related phenomenon unrelated tothe medication.
D) The elderly may require a higher initial dose of pain medication followed by a tapered dose.
A) The elderly may require lower doses of medication and are easily confused with new medications.
The nurse in a pain clinic caring for an 88-year-old man who is suffering from long-term, intractable pain. At this point, the pain team feels that first-line pharmacological and nonpharmacological methods of pain relief have been ineffective. What recommendation should guide this patients subsequent care?
A) The patient may want to investigate new alternative pain management options that are outside theUnited States.
B) The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options.
C) The patient may want to increase his exercise and activities significantly to create distractions.
D) The patient may want to relocate to long-term care in order to have his ADL needs met.
B) The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options.
the home health nurse caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will be taking care of the patient. What would your priority nursing interventions be for this visit?
A) Teach the family the theory of pain management and the use of alternative therapies.
B) Provide psychosocial family support during this emotional experience.
C) Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.
D) Provide family teaching regarding use of morphine, recognizing morphine overdose, and offering spiritual guidance.
C) Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.
An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the patient is exaggerating and does not need pain medication. What is the nurses best response?
A) Pain often comes and goes with postsurgical patients. Please ask her about pain again in about 30minutes.
B) We need to provide pain medications because it is the law, and we must always follow the law.
C) Unless there is strong evidence to the contrary, we should take the patients report at face value.
D) Its not unusual for patients to misreport pain to get our attention when we are busy.
C) Unless there is strong evidence to the contrary, we should take the patients report at face value.
