Test 6 Ch 12 Flashcards
- What types of drugs have the main purpose of relieving pain?
a. Anticholinergics
b. Antagonists
c. Analgesics
d. Agonists
ANS: C
Analgesics have the specific purpose of relieving pain either by changing the patient’s perception of pain or by reducing painful stimulation at its source. Although some analgesics are opioid agonists, the term agonist is not specific for a pain-relieving drug.
- An adult patient has returned to the unit from an operative procedure. The healthcare provider asks you to rate a patient’s postoperative pain. What is your best response?
a. “He is asleep now, so his pain level is acceptable.”
b. “I will ask the patient to rate his own pain.”
c. “His wife says he can still feel the incision when he turns or coughs.”
d. “Since he received 15 mg of morphine an hour ago, his pain is probably minimal.”
ANS: B
Pain is always a subjective experience; that is, pain is a sensation the patient feels and that cannot be felt or measured by someone else. Accurate pain assessment is best measured by the patient, if he or she is not unconscious or confused. Being asleep does not mean that pain is relieved.
- You are caring for a female patient who is paralyzed from the waist down and has a large open wound on her right heel. When asked about her pain in that foot, she tells you it is a 0 on a 0 to 10 pain rating scale. What does this response indicate?
a. The patient’s paralysis prevents the patient’s brain from perceiving the pain.
b. The patient has chronic pain that does not trigger the stress response.
c. The patient has demonstrated substance misuse behaviors from taking pain drugs too often.
d. The patient’s acute pain has been effectively managed by the prescribed pain drug.
ANS: A
Pain is felt or perceived in the brain rather than in the body area where it occurs. When a body part is injured, this injury stimulates pain nerve endings in the thumb that then send (transmit) electrical nerve impulses as a signal from the injury site along nerves to the spinal cord. At the spinal cord, the original signal is transferred to special pain nerve tracts up the spinal cord to the area of the brain where pain in that body site is perceived. Paralysis from the waist down in the spinal cord prevents the transmission of a pain signal from the foot so that pain is not perceived no matter how deep or bad the heel wound is.
- A nursing student assigned to work with you asks you to explain why natural and synthetic opioids are considered “high-alert drugs?” What is your best response?
a. “Opioids have an increased risk for causing a patient harm if given in error.”
b. “Opioids have a relatively high potential for addiction or abuse.”
c. “There is wide variation in the dosages between opioid types.”
d. “High-alert drugs are those that can be given by a variety of routes.”
ANS: A
Although opioids can cause addiction or abuse, have different dosages ranges, and can be given by the oral, intravenous, intramuscular, and transdermal routes, these are not the reasons they are categorized as high-alert drugs. All natural and synthetic opioids are high-alert drugs because they have an increased risk for causing patient harm if given in error.
- The RN has given 2 mg of hydromorphone intravenously to a patient for severe pain. When you assess the patient’s pain level an hour after receiving the drug you find the patient asleep with a respiratory rate of 10 breaths/min. What is your best first action?
a. Give naloxone intravenously.
b. Document the finding as the only action.
c. Notify the healthcare provider immediately.
d. Assess the patient’s oxygen saturation with pulse oximetry.
ANS: D
Many patients have a reduced respiratory rate after receiving a dose of a strong morphine agonist. Although 10 breaths/min may be a little lower than normal, it is not low enough to either notify the healthcare provider or give naloxone without further assessment.
The best assessment is oxygen saturation by pulse oximetry to determine the effectiveness of the current respiratory rate. If oxygen saturation is lower than 94% or the patient’s usual percentage, awaken the patient and assess whether the patient’s respiratory rate increases.
- A patient being discharged to home is prescribed an oxycodone–acetaminophen combination for pain management. Which statement regarding a precaution is most important to teach this patient?
a. “If you still need this drug after 48 hours, notify your healthcare provider immediately.”
b. “Always go to bed immediately after taking a dose of this drug.”
c. “Avoid drinking alcohol while taking this drug.”
d. “Be sure to drink plenty of water and eat foods high in fiber to prevent constipation.”
ANS: D
Drinking alcohol while on a morphine agonist will make side effects worse and increase the risk for respiratory depression. Although preventing constipation is important, preventing respiratory depression is more important.
- You accidentally give a patient 30 mg orally of hydromorphone (Dilaudid) instead of the 30 mg of oral hydrocodone ordered. What is your first best action?
a. Notify the RN in charge immediately.
b. Induce the patient to vomit immediately.
c. Assess the patient’s vital signs immediately.
d. Follow your agency’s policy for documenting a drug error.
ANS: A
The 30 mg oral dose of hydromorphone is six times the normal dose and could cause dangerous or even lethal effects. Get the RN to assess this patient immediately to determine the best course of action (naloxone or transporting the patient to the emergency department). The patient should not be made to vomit up the drug because he or she may already be so unalert that the risk for aspiration is increased. Assessing vital signs is important but having the RN perform a full assessment is more important. You can assess the vital signs after you call the RN. It is important to document the drug error, but this is not the first priority until the possible results to the patient have been addressed.
- When assessing the blood pressure of a patient receiving pentazocine (Talwin) 30 mg orally for pain control two days after surgery, the reading is 166/100, which is much higher than the patient’s presurgical blood pressure. What is your best action?
a. Assess the patient for other symptoms of addiction or dependency.
b. Give the next dose of the drug as prescribed.
c. Assess the patient for other cardiac changes.
d. Document the change as the only action.
ANS: C
Pentazocine is an opioid agonist-antagonist that can have serious cardiac reactions. Assessing the cardiac status is critical in preventing a heart attack or blood pressure crisis.
- A patient with chronic pain asks you to explain how tramadol works to help control pain. What is your best response?
a. “Tramadol works by binding to opioid receptors in the brain to reduce pain the perception.” b. “Tramadol works by reducing inflammation to inhibit the actual cause of the pain.”
c. “Tramadol acts by blocking neurotransmitters in the spinal cord and brain.”
d. “Tramadol acts by inhibiting nerve impulses in peripheral sensory nerves to decrease pain.”
ANS: C
Tramadol only weakly binds to opioid receptors and does not reduce pain in this way. Instead, tramadol works for pain management by blocking some neurotransmitter in spinal cord and brain, decreasing the perception of pain.
- A patient with chronic arthritis pain reports taking acetaminophen 4 to 6 g/day for arthritis pain. Which health problem should you teach this patient that can occur as a result of taking this acetaminophen therapy?
a. “Chronic acetaminophen use can invoke asthma attacks.”
b. “Diabetes is a complication that can result from long-term acetaminophen use.”
c. “Liver toxicity can result as a result of high acetaminophen doses.”
d. “The use and overuse of acetaminophen can result in excessive bleeding.”
ANS: C
When taken at higher doses or for prolonged periods, acetaminophen is toxic to the liver, which can be damaged or destroyed. The drug has a maximum daily dose to prevent liver toxicity and should not be taken with alcohol or other liver toxic drugs.
- The postoperative orders for an adult patient who has just arrived on your unit after major abdominal surgery reads morphine 15mg IM every 4 to 6 hours as needed for pain. What is the best schedule for pain relief during the first postoperative day for this patient?
a. Ask the patient every 4 to 6 hours whether any drug for pain is needed.
b. Give the drug automatically every 4 hours around the clock for the 24 hours.
c. Give the drug automatically every 6 hours around the clock for the first 24 hours.
d. Wait until the patient rates the pain at an 8 or higher on a 0 to 10 pain rating scale before giving any dose of the prescribed drug.
ANS: B
Although asking a patient to rate the intensity of the pain is good, the day of abdominal surgery usually results in intense acute pain. The patient may be groggy from anesthesia. Starting analgesics on a regular around-the-clock schedule provides the best pain management.
- Which of the following assessments is most important to perform on a patient newly prescribed to take cyclobenzaprine for severe muscle pain?
a. Respiratory rate
b. Deep tendon reflexes
c. Blood pressure and heart rate
d. Muscle strength and coordination
ANS: C
Cyclobenzaprine can cause serious cardiac dysrhythmias, prolonged cardiac conduction, and high blood pressure.
- Which patient should be assessed closely for complications of pain management with methocarbamol?
a. 75-year-old man with benign prostatic hyperplasia
b. 55-year-old woman with type 2 diabetes
c. 34-year-old woman with a peanut allergy
d. 17-year-old teenager who is near-sighted
ANS: A
Methocarbamol often causes urinary retention, which could cause serious complications in a person who has difficulty emptying the bladder.
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- Some analgesics are considered to be strong opioid agonists. Indicate which of the following analgesics are considered strong opioid agonists. (Select all that apply.)
a. Codeine
b. Fentanyl
c. Hydrocodone
d. Hydromorphone
e. Morphine
f. Oxycodone
ANS: B, D, E
Morphine is a strong opioid agonist against which all other analgesics are compared. Fentanyl and hydromorphone are more powerful than morphine. Codeine, hydrocodone, and oxycodone are weaker opioid agonists.
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3. Which of the following drugs are considered to have a role in pain management? (Select all that apply.)
a. Antibiotics
b. Anticholinergics
c. Anticonvulsants
d. Antidepressants
e. Antihistamines
f. Anti-inflammatories
ANS: C, D, F
Anticonvulsants, antidepressants, and anti-inflammatories have all been found to reduce some types of pain effectively. Antibiotics, anticholinergics, and antihistamines have not been found to have a role in pain management.
