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NUR 333 > pain > Flashcards

pain Flashcards

1
Q

pt post-op for nephrectomy. Receiving IV morphine for pain through PCA, uses ABCDE acronym for pain management. Choose from the following

A

A: ask regularly about pain
B: Believe pt about pain
C: choose pain control options apprp to pt

rationale
A:
Ask about pain regularly. Assess pain systematically.

B:
Believe patient and family in their report of pain and what relieves it.

C:
Choose pain control options appropriate for the patient, family, and setting.

D:
Deliver interventions in a timely, logical, and coordinated fashion.

E:
Empower patients and their families. Enable them to control their course to the greatest extent possible.

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2
Q

what true regarding nonpharmacologic pain interventions

A

useful for pt who cannot tolerate pain meds

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3
Q

best tolerated and safest analgesic (non opioid)?

A

acetaminophen

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4
Q

true for opiates for pain management?

A

hydromorphone is both PO and IV

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5
Q

which pain management is cold application

A

cutaneous stimulation

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6
Q

which depresses CNS?

A

fentanyl

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7
Q

which adjunct drug relieves pain caused by inflammation and bone metastasis?

A

corticosteroids

these relive pain caused by inflammation and bone metastasis. NSAIDs are not adjunct drugs

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8
Q

which class pain management drug interferes with bowel or bladder function

A

opioid analgesics

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9
Q

why prescribe acetylcysteine?

A

overdose acetaminophen

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10
Q

highest risk renal insufficiency out of fentanyl, ibuprofen, acetaminophen or hydromorphone?

A

ibuprofen

acetaminophen = hepatoxicity
fentanyl/hydromorphone = opioid SE
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11
Q

mild musculoskeletal pain, which most likely to give? ASA, naproxen, ibuprofen, acetaminophen?

A

acetaminophen

NSAIDs incr risk GI bleeding

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12
Q

opioid management

A

check RR rate most often

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13
Q

pain sensation in infants

A

infants learn to perceive pain by experiencing the first unpleasant stimulus

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14
Q

pain management preferred for relieving chronic cancer pain?

A

epidural analgesia

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15
Q

SNS response to pain

A

incr HR
incr BG
decr GI motility

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16
Q
  1. Which of the following signs or symptoms in a patient who is opioid-naïve is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid?
A
  1. Difficulty arousing the patient
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17
Q
  1. A health care provider writes the following order for a patient who is opioid-naïve who returned from the operating room following a total hip replacement: “Fentanyl patch 100 mcg, change every 3 days.” On the basis of this order, the nurse takes the following action:
A
  1. Calls the health care provider and questions the order
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18
Q
  1. A patient is being discharged home on an around-the-clock (ATC) opioid for postoperative pain. Because of this order, the nurse anticipates an additional order for which class of medication?
A
  1. Stool softeners
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19
Q
  1. A new medical resident writes an order for oxycodone CR 10 mg PO q2h prn. Which part of the order does the nurse question?
A
  1. The time interval
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20
Q
  1. The nurse reviews a patient’s medical administration record (MAR) and finds that the patient has received oxycodone/acetaminophen (5/325), two tablets PO every 3 hours for the past 3 days.
A
  1. The amount of daily acetaminophen
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21
Q
  1. When using ice massage for pain relief, which of the following is correct? (Select all that apply.)
A
  1. Apply ice using firm pressure over the skin.
  2. Apply ice for 5 minutes or until numbness occurs.
  3. Use a slow, circular steady massage.
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22
Q
  1. A patient with a 3-day history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The patient had been taking hydrocodone/APAP 5/325 up to four tablets/day before her stroke for the past year to manage her arthritic pain. The health care provider’s order reads as follows: “Hydrocodone/APAP 5/325 1 tab, per gastrostomy tube, q4h, prn.” Which action by the nurse is most appropriate?
A
  1. Request to have the order changed to around the clock (ATC) for the first 48 hours.
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23
Q
  1. Place the following steps in the correct order for administration of patient-controlled analgesia:
A
  1. Demonstrate to patient how to push medication demand button.
  2. Instruct patient to notify a nurse for possible side effects or changes in the severity or location of pain.
  3. Apply clean gloves. Check infuser and patient-control module for accurate labeling or evidence of leaking.
  4. Insert drug cartridge into infusion device and prime tubing.
  5. Attach needleless adapter to tubing adapter of patient-controlled module.
  6. Wipe injection port of maintenance IV line vigorously with antiseptic swab for 15 seconds and allow to dry.
  7. Insert needleless adapter into injection port nearest patient.
  8. Secure connection and anchor PCA tubing with tape.
  9. Program computerized PCA pump as ordered to deliver prescribed medication dose and lockout interval.
    1099
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24
Q
  1. When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which of the following represent an accurate description of the nonpharmacological therapy? (Select all that apply.)
A
  1. TENS works peripherally and centrally on nerve receptors.
  2. Remove any skin preparations before attaching TENS electrodes.
  3. Placing electrodes directly over or near the pain site works best.
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25
Q

match

A

acute pain

  • has protective effect
  • usually identifiable cause
  • eventually resolves w or w/out tx

chronic pain

  • last more than 3-6 months
  • dram affects quality of life
  • viewed as a disease
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26
Q

A nurse is conducting a pain assessment using the SOCRATES acronym. Which concept reflects the meaning of the letter “T” in SOCRATES?

A

Time course

The “T” in SOCRATES stands for time course, which has to do with determining whether or not there is a pattern of the pain, such as if the pain occurs after a specific activity or after meals.

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27
Q

The nurse assesses the patient’s pain using the SOCRATES acronym. Which additional question would be relevant to the pain assessment?

A

“What are your past pain experiences?”

Asking about past pain experiences provides a more thorough understanding of the patient’s pain, as this question is not part of the SOCRATES assessment.

28
Q

Which patient cues are indicative of chronic pain?

A

Constricted pupils
Constricted pupils are a sign of chronic pain, whereas acute pain causes dilated pupils.

Decreased heart rate
Decreased heart rate is a sign of chronic pain, whereas acute pain causes increased heart rate.

Decreased systolic blood pressure
Decreased systolic blood pressure is a sign of chronic pain, whereas acute pain causes increased systolic blood pressure.

29
Q

Which cues are relevant to the adult patient’s acute pain experience?

A

Dilated pupils
Relevant cues relate to essential data about pain and the patient’s unique pain experience, which the nurse obtains from the complete assessment, including history, physical assessment, and tools used to assess pain. Dilated pupils reflect relevant data indicative of pain.

Heart rate of 120
Relevant cues relate to essential data about pain and the patient’s unique pain experience, which the nurse obtains from the complete assessment, including history, physical assessment, and tools used to assess pain. An increased heart rate reflects relevant data indicative of pain.

Pain rated 7 on 0–10 pain scale
Relevant cues relate to essential data about pain and the patient’s unique pain experience, which the nurse obtains from the complete assessment, including history, physical assessment, and tools used to assess pain. Pain rating of 7 on a 0–10 scale reflects relevant data indicative of pain.

30
Q

Which action allows the nurse to begin collecting cues about a burn patient’s pain experience?

A

Taking the patient’s vital signs

The first step when assessing a patient’s pain is assessment of the patient’s vital signs.

31
Q

Which questions would the nurse ask when conducting a pain assessment for a trauma patient?

A

“What makes the pain worse or better?”
Part of the pain assessment is finding out what makes the pain better or worse.

“Does the pain radiate anywhere?”
Part of the pain assessment is finding out if the pain radiates anywhere.

“Where is the pain located?”
Part of the pain assessment is finding out the location of the pain from the patient.

32
Q

The nurse working in an urgent care office assesses a patient who presents with a possible broken ankle that is edematous. The patient rates the pain a 9 on a 0–10 scale. The nurse obtains vital signs and notices that the patient grimaces every time the affected foot moves. Which cue reflects subjective data?

A

Pain rating of 9 on a 0–10 scale
The pain rating of 9 out of 10 is a subjective piece of data. There is no direct way to obtain this information; the patient determines what the number is on the pain scale.

33
Q

The nurse asks a patient experiencing painful kidney stones to rate the pain on a scale from 0 to 10. The patient rates the pain as a 7. Which phrase describes the patient’s level of pain indicated by the rating?

A

Severe pain

Severe pain correlates to a self-reported pain number from 7 to 10.

34
Q

Which statement reflects how the gastrointestinal system responds to pain?

A

Decreases intestinal motility

When a person feels pain, intestinal motility decreases, which causes constipation.

35
Q

Which statement describes how pain experienced by postoperative patients increases the risk for development of pneumonia?

A

Causes a reluctance to breathe deeply
Pain causes a reluctance to breathe deeply, thereby increasing the risk for atelectasis and pneumonia. This is why patients are encouraged to cough and breathe deeply after surgery.

36
Q

A patient with diabetes presents at the emergency department with a broken arm and pain rated 8 on a 0–10 pain scale. Which effect on the patient’s blood glucose would be anticipated?

A

Increased blood glucose level
Increased blood glucose is anticipated in a patient with diabetes who is experiencing pain. Hyperglycemia occurs as a result of the body’s ineffective use of glucose during pain and stress.

37
Q

Which cue reflects that the patient is experiencing pain?

A

Decreased urine output
Decreased urine output is an indicator of pain. The release of certain hormones in response to pain causes urine output to decrease.

38
Q

Which cues are psychological expressions of pain?

A

Depression
Depression is a psychological cue of pain.

Helplessness
Helplessness is a psychological cue of pain.

Fear
Fear is a psychological cue of pain.

39
Q

Which statement reflects the purpose of the Rights of Medication Administration?

A

Prevent medication errors

The purpose of the Rights of Medication Administration is the prevention of medication errors.

40
Q

The health care provider prescribes an oral analgesic every 4 hours as needed for pain. At hour 3, the patient still complains of severe pain rated 8 on a 0–10 scale and verbalizes feelings of frustration as a result of lack of pain relief. Which action is most effective for the nurse to take while awaiting a prescription for an increase in pain medication?

A

Implementing massage and positioning techniques
Massage and repositioning are nonpharmacologic strategies that can supplement medication administration to relieve pain. Massage promotes relaxation, stress reduction, and pain relief, so it is the most appropriate strategy at this time.

41
Q

A patient who is in labor reports intense, painful contractions and feels very nauseous. The patient wants to proceed without the use of medication. Which nonpharmacologic interventions can the nurse implement for this patient?

A

Repositioning the patient
Positioning enhances comfort and relaxation.

Massaging the patient’s back
Massage promotes relaxation and decreases muscle tension.

Assisting with deep breathing exercises
Deep breathing exercises promote relaxation and distraction from the pain.

42
Q

A patient has a broken femur and is in excruciating pain. The health care provider prescribes an intravenous opioid and acetaminophen combination for pain relief. Which statement explains why the two medications are prescribed for pain?

A

The mixture of medications produces fewer side effects.
Using multimodal methods to relieve pain can decrease the likelihood of the patient experiencing side effects.

Multimodal analgesia requires lower doses for effective pain relief.
Combining medications with different mechanisms of action requires lower doses of each medication.

The combination of medications is more effective than just the opioid alone.
Using a combination is more likely to get relief, and for a longer duration, if multiple pathways are used for pain management.

43
Q

A patient is prescribed a nonsteroidal antiinflammatory drug (NSAID) for arthritis. The nurse would educate the patient about which potential side effects?

A

Increased bleeding
NSAIDs have anti-platelet capabilities, making it easier for the patient to bleed.

Gastrointestinal upset
Gastrointestinal upset and bleeding are significant side effects of NSAIDs.

Cardiac complications
NSAIDs can cause cardiac complications, such as myocardial infarction.

44
Q

The nurse provides literature to a patient about side effects and activities to avoid while taking a prescribed medication. Which nursing action is demonstrated when the nurse asks the patient to repeat back the information?

A

Assessing
Assessing is the correct term. The nurse assesses and validates patient understanding by asking the patient to repeat back or teach back information learned.

45
Q

Which statement by the new nurse indicates understanding of the nurse’s role in pain management?

A

“I will be sure to educate the patient about pain treatment options.”
Nurses provide education to the patient about pain medication and other relief options to formulate a personalized plan of care.

“I will remember to assess for pain as a part of my initial assessment.”
Assessing pain establishes a baseline for treatments and medications as prescribed by the health care provider.

“I must advocate for adequate pain relief for my patient if current therapies seem ineffective.”
Nurses must advocate for patients if they are not receiving adequate pain relief.
Correct

“I must evaluate the patient’s response to interventions to deliver focused patient care.”
Continuous evaluation is required to determine intervention effectiveness, or to adjust as necessary to better alleviate the pain.

46
Q

The nurse tells a patient that oxycodone can cause itchiness and sleepiness and that it must be taken only as prescribed. The nurse also recommends taking a stool softener with this medication as it may cause constipation. Which action is the nurse demonstrating?

A

Education
The nurse is demonstrating education in this scenario. The nurse provides patient education about prescribed pain management strategies included in the plan of care and potential side effects or adverse reactions.

47
Q

A patient is 2 days post–knee surgery. The pain management plan includes pharmacologic treatment, but the patient also requests nonpharmacologic methods, so the nurse brings the patient an ice pack. Which statement by the nurse indicates an understanding of the use of cold therapy to treat pain?

A

“Rest periods from cold therapy should be provided to prevent tissue injury.”

Cryotherapy should be applied for only 15 minutes at a time to avoid tissue injury. It may be reapplied, alternating with 15- to 20-minute rest periods.

48
Q

A patient who presents to the emergency department with mild leg strain requests nonpharmacologic pain treatment. Which alternative therapies would the nurse suggest?

A

Yoga
Yoga provides relaxation and increases flexibility.

Meditation
Meditation provides relaxation and decreases stress.

Biofeedback
Biofeedback teaches patients to have voluntary control over the body and the ability to relieve muscle tension.

49
Q

A patient rates pain a 9 on a 0–10 scale and requests pain medication. The nurse reviews the medication administration record (MAR) and finds oxycodone, ibuprofen, acetaminophen, and ketorolac are prescribed. Which medication would the nurse administer?

A 
Oxycodone
Opioid medications (agonist analgesics) are most effective for severe pain rated 7–10 on a 0–10 pain scale.
50
Q

The nurse gives a patient a dose of intravenous morphine for pain relief. A few minutes later, the patient’s respiratory rate is 5 breaths/min. Which medication would the nurse administer to reverse the effects of the opioid?

A

Naloxone

Naloxone is an opioid reversal agent used to reverse respiratory depression caused by opioids.

51
Q

Which action is eliminated by the use of patient-controlled analgesia (PCA) pumps?

A

Waiting for the nurse to administer pain medication

Medication delivers immediately when the patient activates a button, so there is no waiting for the nurse.

52
Q

A patient is admitted to the hospital with a broken hip, and the health care provider prescribes a patient-controlled analgesia (PCA) system to manage the pain. Which patient statement reflects understanding of education about the use of PCA provided by the nurse?

A

“This infusion pump is programmed to give me a set dose of medication at a set time interval.”

The machine is programmed to administer a set amount of medication within a set amount of time. Bolus doses are given in timed increments.

53
Q

Which cues reflect behavioral responses to pain?

A

Grimaces
Grimacing is a behavioral response to pain.

Clenched teeth
Clenching teeth is a behavioral response to pain.

54
Q

The nurse is providing care for a patient with Alzheimer disease. Which factors would the nurse consider when conducting a pain assessment on a patient with a cognitive disorder?

A

The patient may not be able to express the location of pain.
Patients with Alzheimer disease or other cognitive disorders may not be able to express the location of pain.

The patient is able to experience pain.
Patients with cognitive disorders are able to experience pain.

55
Q

Which theory of pain was based on studies of phantom limb pain in amputees and proposes that pain cannot be explained solely by physical factors?

A

Neuromatrix theory
The Neuromatrix theory states that perception of painful stimuli results from the neuromatrix, a unique genetically controlled network of neurons affected by an individual’s subjective physical, psychological, cognitive, and life experiences. The theory was introduced in 2001 by Ronald Melzack after working with amputee patients experiencing phantom limb pain in well-healed areas.

56
Q

Which step of nociception involves translation of nerve signals?

A

Perception

Perception occurs when the brain translates afferent nerve signals as pain.

57
Q

Which intervention demonstrates psychological factors that influence pain?

A

Using guided imagery
Psychological factors affecting pain include the amount of attention the patient focuses on pain, anxiety and fear, and coping style. Pain-relief interventions such as relaxation and guided imagery help patients focus on other stimuli, reducing pain perception.

58
Q

A patient has suffered burn injuries related to a house fire and is in the burn center for pain control and dressing changes. Which function does pain serve when it is associated with a thermal injury?

A

Response

Pain occurs as a response to the thermal injury.

59
Q

Which statement regarding nociception is accurate?

A

The process begins with conversion of a stimulus to an electrical impulse.
The process of nociception begins with the conversion of the noxious stimuli (injury) to an electrical impulse.

60
Q

Which step of nociception involves recognition of a painful stimulus and conversion of the stimulus to an electrical impulse?

A

Transduction

Transduction occurs when nociceptors identify pain stimuli and convert it into an electrical impulse.

61
Q

Based on the density of nociceptors throughout the body, which condition would the nurse expect to require the most analgesia?

A

Burn

The highest density of nociceptors is found in the skin, making it extremely sensitive to pain.

62
Q

Immune cells release which neurotransmitter during the inflammatory response?

A

Histamine

Histamine is an amine released by immune cells in response to inflammation.

63
Q

A patient having a heart attack feels pain in the jaw. Which type of pain is the patient experiencing?

A

Referred pain

Referred pain originates in internal organs but is felt in other locations.

64
Q

Match each type of pain with its description.

A 
Nociceptors encounter harmful stimuli.
- Nociceptive 
Nerves are injured or impaired.  
-Neuropathic 
No physical source of pain is evident
- Psychogenic
65
Q

Which characteristics describe acute pain?

A

Quick onset
Acute pain has a fast onset.

Lasts less than 3 months
Acute pain has a short duration (less than 3 months).

Linked to injury or trauma
Acute pain has an identifiable cause and is generally associated with acute injury or trauma.

66
Q

A patient is taking a prescribed sedative that affects the patient’s pain perception. Which type of influencing factor reflects this patient’s experience?

A

Physiologic factor
Medications that affect the nervous system (such as sedatives, analgesics, and anesthetics) affect neurologic function and the individual’s pain perception and response. This is a type of physiologic factor.

67
Q

Match each type of factor that can influence an individual’s perception of pain with its example.

A

Presence of parent to provide support for child experiencing pain
- Social
Acknowledgment of pain as a weakness for men
-Cultural
Influence of genetics on pain tolerance
-Physiologic
Ability to cope with pain and perceived loss of control
-Psychological

NUR 333 (14 decks)

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