Chapter 44. Pain Management/Pain Management & the Nursing Process EAQ – Flashcards
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A registered nurse is teaching a nursing student about various nonpharmacological pain management interventions. Which of the nursing student's statements indicates a need for further teaching? 1 "Biofeedback can help change a patient's perception of pain." 2 "Music therapy can be used in combination with pharmacological measures." 3 "Guided imagery provides effective pain relief for a patient who has acute appendicitis." 4 "Therapeutic touch is a complementary and alternative medicine pain relief method."
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3 Acute pain cannot be effectively managed by nonpharmacological pain management interventions alone, so the nursing student requires further teaching to understand that guided imagery alone will be inadequate for a patient experiencing acute appendicitis. The remaining statements indicate understanding. Cognitive-behavioral interventions like biofeedback can change a patient's perception of pain. Any nonpharmacological intervention like music therapy can be used in combination with pharmacological interventions to provide pain relief. Therapeutic touch is a complementary and alternative pain relief method.
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What is the immediate intervention if a patient on oxycodone 10 mg/mL infusion therapy experiences respiratory depression? 1 Administering acetylcysteine 2 Reducing the dose of oxycodone to 5 mg/mL 3 Decreasing the rate of infusion 4 Administering 0.4 mg of naloxone
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4 Respiratory depression is a serious side effect of opioid administration. Naloxone counters the effects of opioids, so this drug would be used to treat respiratory depression resulting from oxycodone administration. Acetylcysteine is used to counter acetaminophen, not opioid, overdose. Decreasing the dose or rate of infusion may be done to decrease less serious side effects like drowsiness or nausea.
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A group of nursing students is learning about nociceptive and neuropathic pain. What are examples of neuropathic pain? Select all that apply. 1 Aching muscles 2 Diabetic neuropathy 3 Trigeminal neuralgia 4 Nerve root compression 5 Throbbing pain at knee joint
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2, 3, 4 Neuropathic pain arises when there is abnormal processing of sensory input by the peripheral or central nervous system. Pain felt along the distribution of many peripheral nerves as in diabetic neuropathy is a neuropathic pain. Pain felt partly along the distribution of a damaged nerve such as in nerve root compression is also an example of neuropathic pain. Pain associated with trigeminal neuralgia is also a neuropathic pain. Aching muscles and a throbbing pain at the knee joint are examples of nociceptive pain.
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A patient has had arthritic pain for 8 years. Which questions should the nurse ask to assess the patient's pain? Select all that apply. 1 "Which factors relieve your pain?" 2 "How would you describe the pain?" 3 "Are you having any trouble passing stools?" 4 "Are you allergic to any food item or medication?" 5 "On a scale of 0 to10, how high would you rate the pain?"
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1, 2, 5 To assess the pain completely and accurately, the nurse needs to assess its onset, palliative factors, quality, radiation, severity, and time factors related to the pain. Asking about palliative factors helps to determine the factors that influence the pain. A description of the pain helps to understand the nature and location of the pain. Asking a patient to rate the pain on a pain scale helps to assess the intensity of the pain. Asking questions regarding elimination and allergies does not help in pain assessment.
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Which pain management drug is considered the best tolerated and safest analgesic? 1 Fentanyl 2 Tramadol 3 Acetylcysteine 4 Acetaminophen
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4 Acetaminophen is considered the best tolerated and safest analgesic used in pain management. Fentanyl and tramadol are opioids, which have the potential for significant side effects and often result in patients building a tolerance to them. Acetylcysteine is not an analgesic; rather, it is used to treat acetaminophen overdose.
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A patient is in the first postoperative day following a nephrectomy. The patient is receiving morphine through a patient-controlled analgesia (PCA) device for management of pain. The patient is apprehensive about being given opioid drugs and is afraid of becoming addicted to the drug. The patient is also afraid of chronic side effects. What explanation should the nurse give the patient? Select all that apply. 1 Opioids can be used safely in cases of moderate to severe pain. 2 Opioids can be given only after surgery or for postsurgical pain. 3 Slow titration prevents potentially dangerous opioid-induced side effects. 4 The drug is administered carefully, because its action cannot be reversed. 5 In case of any adverse effects, opioid antagonist drugs can be given to reverse the effects.
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1, 3, 5 There are many misconceptions about the use of opioid drugs. Opioids can be safely given to people for management of moderate to severe pain. Opioids are given in slow titration to prevent the appearance or development of any side effects. In rare cases, there may be respiratory depression as an adverse effect of opioid drugs. In such cases, an opioid antagonist drug can be administered to the patient to reverse the effects of opioids. It is not mandatory to give opioids only after surgery. They can be administered to relieve pain of any origin. The action of opioids can be reversed with the proper antagonist drug.
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The registered nurse and a nursing student are discussing opioid pain management therapy and naloxone (Narcan). Which of the nursing student's statements indicate a need for further teaching? Select all that apply. 1 "The infusion rate of an intravenous push of naloxone should be 0.5 mL for 1 minute." 2 "0.4 mg of naloxone should be diluted with 15 mL saline." 3 "Opioid-naïve patients should be closely monitored for sedation." 4 "Administering naloxone faster than the recommended rate may cause severe pain." 5 "If an adult patient experiences respiratory depression, naloxone should be administered."
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1, 2 Naloxone (Narcan) is used to reverse the effects of opioids, especially in cases of overdose. While administering naloxone, the intravenous (IV) push should be at a rate of 0.5 mL every 2 minutes, not for 1 minute, until the respiratory rate is greater than eight breaths/min. Generally, 0.4 mg of naloxone is diluted with 9 mL, not 15 mL, saline. The remaining statements are correct. Opioid-naïve patients should be closely monitored for sedation, which occurs before respiratory depression. If naloxone is administered too quickly, the patient may experience severe pain and other serious complications. If an adult patient who is on pain management therapy with opioid analgesics experiences respiratory depression, naloxone should be administered.
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The registered nurse is teaching a patient about the use of cold therapy in acute pain management. Which of the patient's statements indicates a need for further teaching? 1 "I will apply ice two to five times a day." 2 "I will apply ice with a lightweight cover, with firm pressure to my skin." 3 "I will apply ice within a 6-inch circular area near where I have pain." 4 "I will place ice between my thumb and index finger if I have shoulder pain."
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4 Cold is effective for tooth or mouth pain, not shoulder pain, when the ice is placed on the web of the hand between the thumb and index finger. This is an acupressure point that influences nerve pathways to the face and head. The remaining statements indicate understanding: Ice can be applied two to five times a day with firm pressure to the skin, covered with a lightweight cloth. Ice should also be applied within a 6-inch circular area near the site of pain.
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A patient has had arthritic pain for 8 years and has surgery to remove a buildup of septic fluid. Postoperative, the patient received morphine through a patient-controlled analgesia (PCA) device for the management of pain. What is the advantage of PCA that the nurse should teach the patient? 1 PCA allows self-administration of analgesics. 2 PCA is associated with a risk of overdose. 3 PCA does not allow administration of opioids. 4 PCA allows intramuscular administration of medications.
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1 PCA allows the patient to self-administer analgesic medication whenever needed. There is no risk of overdosage due to the programming. Opioids can be safely administered using PCA. It allows intravenous or subcutaneous administration of medications.
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A student nurse is reading about the mode of action of nonsteroidal anti-inflammatory drugs (NSAIDS). The NSAID drug decreases the level of a chemical that is known to increase pain sensitivity. With which chemical does the NSAID react? 1 Renin 2 Serotonin 3 Prostaglandin 4 Diclofenac sodium
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3 Prostaglandins are generated from the breakdown of phospholipids of the cell membrane and are known to increase pain sensitivity. NSAIDs act by decreasing the levels of such compounds in the blood. Renin is involved in balancing water and electrolytes in the body. Neurotransmitters such as serotonin inhibit the transmission of pain. Diclofenac sodium is a painkiller that reduces pain sensitivity.
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While treating a patient, the primary health care provider encourages the patient to watch funny videos. This is an example of which pain management technique? 1 Relaxation 2 Distraction 3 Acupressure 4 Music therapy
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2 Patients who are bored or in isolation may think more frequently about their pain, thus perceiving it more acutely. Watching videos may direct the patient's attention to something other than pain, reducing awareness of it. This is an example of using distraction to manage pain. Relaxation techniques include meditation, yoga, guided imagery, and progressive relaxation exercises. Acupressure is applying pressure to specific points on the body in order to influence nerve pathways to decrease pain perception. Like distraction, music therapy works by taking the patient's attention away from the pain, but this is done with music, not videos.
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A patient took more than the prescribed amount of acetaminophen and is experiencing hepatotoxicity. Which drug might the nurse anticipate the health care provider to use to treat this patient? 1 Naloxone 2 Tramadol 3 Oxycodone 4 Acetylcysteine
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4 Overdose of acetaminophen may lead to hepatotoxicity, which is treated with acetylcysteine. Naloxone is used to reverse the adverse effects of opioids, not acetaminophen. Tramadol and oxycodone are used to manage pain, not to treat acetaminophen overdose.
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A patient is in the first postoperative day following a nephrectomy. The patient is receiving morphine through a patient-controlled analgesia (PCA) device for management of pain. The nurse decides to use the ABCDE approach while assessing and managing pain for this patient. What are the correct components of the ABCDE approach? Select all that apply.
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1, 3, 4 The ABCDE approach helps in accurately assessing pain and its management. A stands for "Ask regularly about the pain." B stands for "Believe the patient and family in the report of pain." C stands for "Choose pain control options appropriate for the patient." D stands for "Deliver interventions in an orderly and coordinated fashion." E stands for "Empower patients and their families."
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A patient is in the first postoperative day following a nephrectomy. The patient is receiving morphine through a patient-controlled analgesia (PCA) device for management of pain. The patient complains of pain in the shoulders. The nurse understands that it is a referred pain. What explanation should the nurse give to the patient regarding the referred pain? 1 It is a pain that occurs sporadically over time. 2 It is a moderate pain that occurs for more than 6 months constantly. 3 It is a pain that is sensed at a site away from its actual origin or pathology. 4 It is neuropathic pain that is caused generally after cancer or a tumor.
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3 A pain that is sensed at a site away from its actual origin or pathology is known as referred pain. A pain that occurs sporadically over time is known as chronic episodic pain. A moderate pain that occurs constantly for more than 6 months is known as chronic or persistent noncancerous pain. A cancer pain is neuropathic pain that is caused generally after cancer or a tumor.
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Which class of pain management drugs may interfere with bowel or bladder function? 1 Anticonvulsants 2 Opioid analgesics 3 Nonopioid analgesics 4 Nonsteroidal antiinflammatory drugs
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2 Opioid analgesics are effective when used for pain management, but a common side effect is disruption of bowel or bladder function. Anticonvulsants are more commonly associated with side effects like dizziness, fatigue, and confusion than with disrupted bowel and bladder function. Nonopioid analgesics and nonsteroidal antiinflammatory drugs more commonly result in gastric bleeding, hypertension, and nausea than in disruption of bowel and bladder function.
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The nurse is caring for a patient who is on opioid therapy. For which findings is the nurse carefully observing the patient? Select all that apply. 1 Decreased pulse rate 2 Increased respiratory rate 3 Decreased blood pressure 4 Pupil dilatation 5 Peripheral edema
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1, 3, 5 Potential adverse effects of opioids include bradycardia (decreased pulse rate), hypotension (decreased blood pressure), and peripheral edema due to the accumulation of fluids. Decreased, not increased, respiratory rate may occur with opioid administration. Pupil constriction may occur with the use of opioids, but pupil dilatation is an effect of opioid withdrawal.
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A physician put a postoperative patient on a patient-controlled opioid analgesic pump to be used around the clock for a week. Which assessment should the nurse make at regular intervals? 1 Liver enzymes 2 Blood pressure 3 Respiratory rate 4 Body temperature
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3 While there is little risk for overdose with patient-controlled analgesic pumps, respiratory depression is a side effect associated with opioids, so while the patient is on opioid pain management, the nurse should regularly check respiratory rate. A nurse may check liver enzymes in a patient who is taking acetaminophen, not opioids, because acetaminophen can adversely affect the liver. Whereas blood pressure and body temperature may be checked regularly, it is unlikely that the nurse is doing this to monitor for side effects of opioid pain management.
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Which drug is unsafe for the central nervous system as a supplement to epidural anesthesia? 1 Aspirin 2 Naproxen 3 Ibuprofen 4 Oxycodone
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4 Because opioid analgesics like oxycodone depress the central nervous system, they are not safe in combination with epidural anesthesia because of possible additive central nervous system adverse effects. Aspirin, naproxen, and ibuprofen are nonsteroidal antiinflammatory drugs (NSAIDs) which do not affect the central nervous system.
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The nurse is assessing a patient with acute pain. Which statements are true about acute pain? Select all that apply. 1 Acute pain is not protective. 2 Acute pain has an identifiable cause. 3 Acute pain has limited tissue damage. 4 Acute pain results in prolonged hospitalization. 5 Patients with acute pain seek numerous health care providers.
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2, 3, 4 Acute pain has an identifiable cause, limited tissue damage, and an emotional response. Acute pain results in prolonged hospitalization as it seriously threatens a patient's recovery, so the health team members treat it aggressively. Acute pain is protective, unlike chronic pain, which is not protective. A patient with chronic pain may seek numerous health care providers because of its unknown cause.
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Which statement is true regarding nonpharmacological pain interventions? 1 Nonpharmacological interventions should only be used alone. 2 Nonpharmacological interventions are useful for patients who cannot tolerate pain medications. 3 Nonpharmacological interventions have a clear set of guidelines regarding intensity and duration. 4 Nonpharmacological interventions should be used in place of pharmacological therapies for acute pain.
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2 Nonpharmacological pain relief can be useful for patients who cannot tolerate pain medications. The remaining statements, however, are false. Nonpharmacological interventions may be used alone, but they can also be used in combination with pharmacological therapies. Depending on the nonpharmacological therapy, research is still in progress to determine clear guidelines for intensity and duration. For acute pain, nonpharmacological therapy should never replace pharmacological therapy.
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The nurse is teaching pain management to a group of caregivers. Which information should be included? Select all that apply. 1 Chronic pain is often psychological. 2 Only hospitalized patients experience severe pain. 3 Psychogenic pain is not real. 4 Regular administration of analgesics will not lead to addiction. 5 Patients with minor illnesses may also experience severe pain.
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4, 5 Misconceptions about pain often lead to poor nursing care. Therefore, it is important to know these misconceptions in order to promote appropriate pain management in patients. Regular administration of analgesics does not lead to addiction. Therefore, analgesics should be administered whenever the need arises. Although a patient may suffer from minor illness, he or she may experience severe pain that should not be ignored. A common misconception is that chronic pain is often psychological. However, chronic pain may have a pathological origin. Another misconception is that only hospitalized patients experience pain. Patients who are not hospitalized may also experience pain that needs to be addressed. Another misconception is that psychogenic pain is not real.
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The human body has a mechanism to reduce pain perception by inhibitory neurotransmitters. What are the inhibitory neurotransmitters of pain in the brain? Select all that apply. 1 Serotonin 2 Histamine 3 Substance P 4 Norepinephrine 5 Gamma aminobutyric acid
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1, 4, 5 During the process of pain modulation, endogenous opioids, serotonin, norepinephrine, and gamma aminobutyric acid (GABA) are some of the inhibitory neurotransmitters released to inhibit the pain impulse. This happens in the fourth and final phase of the nociceptive process. Histamine and substance P have no role in pain modulation. Histamine is released by mast cells and plays a major role in the inflammatory process. Substance P transmits pain impulses from the periphery to higher brain centers.
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Which adjuvant drugs are preferred for treating neuropathic pain? Select all that apply. 1 Corticosteroids 2 Anticonvulsants 3 Opioid analgesics 4 Nonopioid analgesics 5 Tricyclic antidepressants
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2, 5 Anticonvulsants and tricyclic antidepressants can be effective for treating chronic pain, especially neuropathic pain. Corticosteroids are typically used to relieve pain from inflammation and bone metastasis. Opioid and nonopioid analgesics are not adjuvant drugs.
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The registered nurse is teaching a nursing student about applying transcutaneous electrical nerve stimulation (TENS) to a patient. Which of the nursing student's statements indicate a need for further teaching? Select all that apply. 1 "I should set the frequency to no more than 50 Hz." 2 "I should use TENS on patients who have chronic cancer pain." 3 "I should place TENS electrodes directly over or near the site of pain." 4 "I should apply hair or skin preparations before placing TENS electrodes." 5 "I should remove TENS electrodes if the patient feels a buzzing or tingling sensation."
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2, 4, 5 Transcutaneous electrical nerve stimulation (TENS) is effective in treating acute, emergent, and postsurgical and procedural pain control, but not chronic conditions, like cancer pain. The nurse should not apply any hair or skin preparations before attaching the TENS electrodes. Buzzing or tingling sensations are normal, and do not require the nurse to remove electrodes. The other statements indicate understanding. The range of frequency of TENS is 10 Hz to 50 Hz. The TENS electrodes should be placed directly over or near the site of pain.
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Which drugs may provide relief from bone pain? Select all that apply. 1 Calcitonin 2 Gabapentin 3 Nortriptyline 4 Bisphosphonates 5 Infusional lidocaine
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1, 4 Calcitonin and biphosphates are effective in relieving bone pain. Gabapentin, nortriptyline, and infusional lidocaine are typically used to treat neuropathic pain, not bone pain.
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The nurse is teaching a group of nursing students about pain sensations in infants. Which information should be included in the teaching about pain sensation in infants? 1 Infants do not perceive pain sensation immediately after birth. 2 Nurses cannot accurately assess pain in infants. 3 Infants cannot express pain sensation in the first month of life. 4 Infants learn to perceive pain by experiencing the first unpleasant stimulus.
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4 Some common misconceptions about pain sensation in infants exist, of which the nurse should be aware. Infants immediately respond to pain on experiencing the first noxious stimulus. Infants feel pain from birth; a functional processing of pain is developed by mid to late gestation. Nurses can use behavioral changes and alterations in vital signs to assess pain in infants. Although infants cannot verbalize pain, they can express pain by crying.
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The nursing instructor asks the student nurse to differentiate between A and C peripheral nerve fibers. Which statement made by the student nurse indicates effective learning? 1 "The A fibers are myelinated and the C fibers are unmyelinated." 2 "The A fibers are smaller in diameter and the C fibers are larger in diameter." 3 "The A fibers transmit signals slowly and the C fibers transmit signals rapidly." 4 "The A fibers cause diffuse sensation and the C fibers cause localized sensations."
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1 The A fibers are myelinated, whereas the B fibers are unmyelinated. The A fibers are larger in diameter, whereas the B fibers are smaller in diameter. Because A fibers are larger in diameter, they transmit signals to the central nervous system (CNS) more rapidly than the smaller C fibers. The sensations caused by the stimulation of the A fibers are localized, whereas the sensations caused by the stimulation of the B fibers are diffuse.
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The nurse is teaching a group of caregivers about the concept of pain in older adults. What should the nurse include in the teachings? Select all that apply. 1 Older patients underreport pain. 2 Sleeping indicates pain relief. 3 Opioids are safe to use in older patients. 4 Older adults tend to perceive more pain. 5 Older adults with cognitive impairment do not experience less pain.
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1, 3, 5 Older patients underreport pain with the fear of losing their independence, and do not want to alarm loved ones. Opioids are safe to use with proper monitoring of the patient to note any side effects. There is no evidence that cognitively impaired older adults experience less pain compared to individuals with intact cognitive function. Sleeping does not indicate pain relief. It indicates exhaustion, and in fact, pain may prevent the patient from having a good sleep. Age does not dull the sensitivity to pain. Older adults perceive pain as much as young adults.
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While taking a patient's medical history, a nurse records that the patient has asthma. Which medications for pain management might the physician avoid prescribing? Select all that apply. 1 Tramadol 2 Naproxen 3 Ibuprofen 4 Oxycodone 5 Hydromorphone
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2, 3 Some patients who have asthma or an allergy to aspirin are also allergic to other nonsteroidal antiinflammatory drugs (NSAIDs). Naproxen and ibuprofen are NSAIDs, so the physician may avoid prescribing these medicines to the patient for pain management. Tramadol, oxycodone, and hydromorphone are opioid analgesics, which may be less risky for allergic reaction in this patient.
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Which statement about transcutaneous electrical nerve stimulation (TENS) is incorrect? 1 TENS is helpful in reducing pain perception. 2 TENS is effective for chronic and postsurgical pain control. 3 A TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. 4 TENS requires a health care provider's order that identifies the site(s) for electrode placement.
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2 Transcutaneous electrical nerve stimulation (TENS) is effective for acute, emergent, and postsurgical and procedural pain control but not for chronic pain. The remaining statements are correct. TENS is helpful in reducing pain perception. A TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. TENS requires a health care provider's order that identifies the site(s) for electrode placement.
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A nurse administers epidural anesthesia to a patient in the terminal stages of cancer for pain relief. Which nursing intervention is then necessary? 1 Administering supplemental doses of opioid 2 Assessing vitals once every hour after administering the first dose 3 Administering anticoagulant medications with the epidural 4 Notifying the health care provider if the patient develops pain at the epidural insertion site
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4 The nurse should notify the health care provider if the patient develops pain at the epidural insertion site, because it may indicate development of an epidural hematoma. Administering supplemental opioids could lead to dangerous additive central nervous system adverse effects. The nurse should monitor vital signs and respiratory rate once every 15 minutes after the administration of epidural anesthesia to ensure stable vitals; once every hour is not enough. Anticoagulants and antiplatelet drugs should not be administered to the patient, because they may increase the risk of hematoma formation.
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Which statements about opioid analgesics for pain management are correct? Select all that apply. 1 Opioid analgesics act on higher centers of the brain. 2 Use of opioid analgesics will increase libido in male patients. 3 Opioid analgesics are prescribed for relieving mild forms of pain. 4 The short-acting forms of opioids provide pain relief for approximately 4 hours. 5 Prolonged use of opioid analgesics will increase patient tolerance to depression of the central nervous system
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1, 4 Opioid analgesics act on higher centers of the brain and spinal cord by binding with opiate receptors. The short-acting forms of opioid analgesics provide pain relief for approximately 4 hours. Opioid analgesics will decrease the testosterone levels in male patients, decreasing, not increasing, libido. Opioid analgesics are prescribed to relieve moderate to severe levels of pain; other drugs are more appropriate for mild pain. Prolonged use of opioid analgesics will increase patient tolerance to most opioid side effects except central nervous system depression.
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Which topical analgesic is effective for relieving postherpetic neuralgia in adults? 1 Capsaicin 2 ELA-Max/LMX 3 Lidoderm patch 4 Eutectic mixture of local anesthetics (EMLA)
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3 The Lidoderm patch is effective for treating postherpetic neuralgia, a cutaneous neuropathic pain. Capsaicin is more appropriate for relieving minor aches and pains of the muscles and joints. ELA-Max/LMX and a eutectic mixture of local anesthetics (EMLA) are more often used to treat children.
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A 65-year-old patient is experiencing mild musculoskeletal pain. Which drug is the primary health care provider most likely to prescribe? 1 Aspirin 2 Naproxen 3 Ibuprofen 4 Acetaminophen
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4 A physician may first recommend acetaminophen to this patient because the pain is mild, and acetaminophen is relatively safe and widely available over the counter for musculoskeletal pain. The physician may prescribe aspirin, naproxen, or ibuprofen, but these may be second-choice drugs because they are nonsteroidal antiinflammatory drugs which carry a risk for bleeding, especially in older adults, and may not be necessary if the pain is mild.
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A primary health care provider prescribes 10 mg of codeine every 4 hours to a patient who has chronic pain from cancer. However, after taking a second dose of the prescribed drug, the nurse notices that the patient is very drowsy and nauseous. Which dose alteration may provide effective pain relief while improving the drowsiness and nausea? 1 5 mg codeine every 4 hours 2 10 mg codeine every 8 hours 3 20 mg codeine every 8 hours 4 5 mg codeine every 12 hours
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1 Because codeine is short-acting, relief is likely only attainable with administration every 4 hours. If 5 mg is not enough, or the side effects remain, the patient may require a different opioid. Even at every 8 hours, 10-mg and 20-mg doses are too much for the patient to tolerate without adverse side effects. A 5-mg dose every 12 hours is probably too long of an interval for this patient to obtain relief from the pain.
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A registered nurse is teaching a nursing student about using nonsteroidal antiinflammatory drugs (NSAIDs) for pain management. Which of the nursing student's statements indicates a need for further teaching? 1 "NSAIDs work by depressing the central nervous system." 2 "NSAIDs act by inhibiting the synthesis of prostaglandins." 3 "Patients allergic to aspirin are more likely to be allergic to other NSAIDs." 4 "Use of NSAIDS in older adults may result in increased risk of adverse events."
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1 Opioids, not nonsteroidal antiinflammatory drugs (NSAIDs), depress the central nervous system. The other statements indicate effective teaching: NSAIDs inhibit prostaglandin synthesis, which inhibits cellular responses to inflammation; this helps relieve pain. An allergy to aspirin may be indicative of an allergy to other NSAIDs, and NSAIDs may put older adults at an increased risk for gastrointestinal bleeding.
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Why would a primary health care provider prescribe acetylcysteine to a patient who is on pharmacological pain management therapy? 1 Overdose of aspirin 2 Overdose of fentanyl 3 Overdose of morphine 4 Overdose of acetaminophen
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4 Dangerous hepatotoxic overdoses of acetaminophen are treated with acetylcysteine. Antiulcer drugs may be prescribed to treat gastric bleeding caused by overdose of aspirin. Overdoses of fentanyl and morphine may be treated with naloxone.
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The nurse is assessing the touch, pain, and temperature sensation of a patient who is diagnosed with diabetic neuropathy. Arrange in ascending order the parts of the central nervous system through which pain sensation is carried. 1. Cerebrum 2. Thalamus 3. Spinal cord 4. Medulla, pons, midbrain
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3, 4, 2, 1 Spinal cord, Medulla, pons, midbrain, Thalamus, Cerebrum Pain sensation is transmitted from afferent fibers to the spinal cord. From the spinal cord, the pain sensation is carried to medulla, pons, and midbrain. From here it continues through the spinothalamic tract to the thalamus and then to the cerebrum.
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The nurse is caring for a patient on pain management therapy. Which types of therapy cause a release of endorphins that can block the transmission of painful stimuli? Select all that apply. 1 Massage 2 Opioid analgesics 3 Cold application 4 Nonsteroidal antiinflammatory drugs (NSAIDs) 5 Transcutaneous electrical nerve stimulation (TENS)
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1, 3, 5 Cutaneous stimulation releases endorphins, which block the transmission of painful stimuli. Massage, cold application, or transcutaneous electrical nerve stimulation (TENS) all stimulate the skin, which may be helpful in reducing pain perception via endorphin release. Opioid analgesics reduce pain by binding with opiate receptors to modify pain perception, not by releasing endorphins. Nonsteroidal antiinflammatory drugs (NSAIDs) reduce pain by inhibiting prostaglandin synthesis, which inhibits the body's cellular response to inflammation.
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The nurse is assessing a patient who has sustained severe injuries in a motor vehicle accident. The patient is in severe pain and is diaphoretic. On assessment, the patient's heart rate is increased, pupils are dilated, and blood pressure is decreased. Which finding is caused by the stimulation of the parasympathetic nervous system? 1 Diaphoresis 2 Dilation of pupils 3 Increased heart rate 4 Decrease in blood pressure
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4 Superficial pain or mild-to-moderate pain stimulates the sympathetic nervous system. The parasympathetic nervous system is stimulated by continuous, deep, or severe pain involving visceral organs. Stimulation of the parasympathetic nervous system has an inhibitory effect on the body systems and causes a decrease in blood pressure. The sympathetic nervous system prepares the body for a fight-or-flight response. Diaphoresis, dilation of pupils, and increased heart rate are caused by the stimulation of the sympathetic system.
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The physician tells the nurse to administer a second drug to a patient already on oxycodone. Which drug would be safe for this patient? 1 Fentanyl 2 Morphine 3 Codeine 4 Acetaminophen
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4 Acetaminophen is safe to use in combination with opioids like oxycodone for pain relief. A health care provider may do so to lower the opioid dose. Fentanyl, morphine, and codeine are also opioids, so combining them with another opioid would have potentially dangerous synergistic effects.
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A patient with rheumatoid arthritis reports acute joint pain in the hand. Which intervention is inappropriate for providing pain relief? 1 Encouraging the patient to listen to music or watch television 2 Collaborating with an occupational therapist to provide assistive devices for grooming 3 Administering ordered analgesics around the clock for 24 to 48 hours 4 Applying cool compresses to the patient's joints with the prescriber's approval
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2 The nurse may collaborate with an occupational therapist to provide assistive devices to the patient for grooming, but this is not done to relieve pain; rather, this is an intervention to help the patient dress and prepare for the day if the joint pain is making this difficult. The remaining interventions are appropriate for pain relief. Music and television can help relieve pain by taking the patient's attention away from it. Analgesic administration is a pharmacological therapy method to provide pain relief. Cool compresses may also help soothe the pain caused by rheumatoid arthritis.
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A primary health care provider recommends ibuprofen to a patient in pain. Which statements about this medication are correct? Select all that apply. 1 It depresses the central nervous system in order to relieve pain. 2 It acts by inhibiting the synthesis of prostaglandins. 3 It is highly recommended for older adults experiencing pain. 4 It is the most effective prescription drug available for pain relief. 5 One of its serious side effects is gastrointestinal bleeding.
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2, 5 Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, act by inhibiting prostaglandin synthesis, thereby inhibiting cellular response to inflammation and thus reducing pain. Gastrointestinal bleeding is a major adverse effect of NSAIDs. The remaining statements are incorrect. Opiates, not NSAIDs, depress the central nervous system to relieve pain. Because of the risk for gastrointestinal bleeding, ibuprofen and other NSAIDs are not frequently the first choice for treating pain in older adults. Ibuprofen is not a prescription drug; it is widely available over the counter.
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Which type of pain management is cold application? 1 Relaxation 2 Distraction 3 Cutaneous stimulation 4 Acupressure
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3 Cold application stimulates the skin, which helps reduce pain perception, perhaps by releasing endorphins or activating large, fast-transmitting A-beta sensory nerve fibers. Relaxation techniques include meditation, yoga, guided imagery, and progressive relaxation exercises. Distraction works by diverting the patient's attention to something other than pain, thus reducing awareness of it. Acupressure involves the application of pressure, not cold.
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The nurse is learning about the effects of pain on the sympathetic system. What are the manifestations of sympathetic stimulation in response to the pain? Select all that apply. 1 Increased heart rate 2 Rapid, irregular breathing 3 Increased glucose level 4 Decreased blood pressure 5 Decreased gastrointestinal motility
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1, 3, 5 The stimulation of the sympathetic branch of the autonomous nervous system causes an increased heart rate, an increased glucose level, and decreased gastrointestinal motility. Stimulation of the parasympathetic branch results in rapid, irregular breathing and decreased blood pressure.
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Which nonpharmacological techniques pose a risk of injury to the patient if the patient has a history of diabetic neuropathy? Select all that apply. 1 Yoga 2 Massage 3 Hot bath 4 Cold application 5 Relaxation exercises
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3, 4 A patient who has diabetic neuropathy may not be able to adequately monitor temperature in areas affected by nerve damage, so application of any heat or cold may place this patient at a higher risk for injury. If done safely and properly, yoga, massage, and relaxation exercises should not place a patient with diabetic neuropathy at a higher risk for injury than any other patient.
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The nurse works in a postsurgical ward. Which statements by the nurse indicate common misconceptions about pain? Select all that apply. 1 Psychogenic pain is not real. 2 Chronic pain is not psychological. 3 Patients who cannot speak can feel pain. 4 Administering analgesics regularly leads to drug addiction. 5 Patients who abuse substances overreact to discomfort.
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1, 4, 5 Psychogenic pain is real and requires intervention. Regular administration of analgesics does not lead to drug addiction. However, some analgesics such as morphine should not be overused. The patients who abuse substances do not overreact to discomfort; their discomfort may be real. Chronic pain is not psychological; it may be real and can have an impact on daily activities. Patients who do not speak can still feel pain and need intervention.
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The nurse is assessing a patient who complains of back pain. After taking the patient's history, the nurse does not expect the physician to recommend acetaminophen. Which of the patient's statements led the nurse to this conclusion? 1 "I drink alcohol occasionally." 2 "I have been constipated for 3 days." 3 "I am allergic to penicillin." 4 "Two months ago, I was diagnosed with hepatitis B."
answer
4 Because acetaminophen can cause hepatotoxicity, and a patient who has hepatitis B has a compromised liver, the nurse may expect the physician to avoid recommending acetaminophen to this patient. Acetaminophen is safe for a patient who consumes alcohol occasionally, but it should be used with caution for a patient who frequently drinks alcohol. Occasional alcohol intake might not affect the administration of acetaminophen. Nonsteroidal antiinflammatory drugs, not acetaminophen, may aggravate constipation. An allergy to penicillin will not necessarily predispose a patient to an allergy to acetaminophen.
question
The nurse is teaching a group of nursing students about concepts of pain in infants. Which information should the nurse include in the teaching? Select all that apply. 1 Infants cannot express pain. 2 Absorption of drugs is faster than expected. 3 Infants are less sensitive to pain than adults are. 4 Preterm neonates have greater sensitivity to pain than older children do. 5 Assessment of pain involves behavioral cues and physiological indicators.
answer
2, 4, 5 Absorption of drugs in infants is faster than expected. The drugs that are excreted by the kidneys should be administered in a lower dosage. Preterm neonates have greater sensitivity than term neonates or older children. Using behavioral cues such as facial expression and physiological indicators such as changes in vital signs provide proper assessment of pain. Infants cannot verbalize pain but respond with behavioral changes. Term neonates have the same sensitivity to pain as older children.
question
During a preoperative assessment, a patient reports history of a heart attack and use of anticoagulant medications. If epidural anesthesia is administered to the patient for the surgery, for which possible complication should the nurse look? 1 Synergistic effects 2 Hematoma 3 Allergic reaction 4 Respiratory depression
answer
2 Because anticoagulants reduce the action of the blood's platelets, hematoma is a possible complication when epidural anesthesia is administered to a patient on anticoagulants. Anticoagulants and anesthesia have different actions, so a synergistic effect is not a concern. Anticoagulants do not predispose a patient to an allergic reaction to epidural anesthesia. Respiratory depression is an adverse effect of opioids, but anticoagulants do not make it more likely.
question
The nurse has conducted an informative session on discouraging pseudoaddiction to a group of people in a community. Which group of patients should be the main target for the nurse's teachings? 1 Patients with a history of taking over-the-counter medicines 2 Patients with a history of drinking coffee for more than 5 years 3 Patients who say that heroin increases concentration 4 Patients who repeatedly seek multiple medical opinions for chronic pain relief
answer
4 When a patient with chronic pain seeks pain medication from multiple primary health care providers, the patient is called a drug seeker but not an illicit drug abuser. This kind of addiction is called pseudoaddiction. Such drug seekers should be referred to pain specialists. Pseudoaddiction is not related to a history of taking over-the-counter medicines or the history of drinking coffee for more than 5 years. The patients who say that heroin increases concentration do not have pseudoaddiction.
question
Which pain management method is considered a nonpharmacological complementary and alternative intervention? 1 Distraction 2 Biofeedback 3 Guided imagery 4 Therapeutic touch
answer
4 Therapeutic touch is a nonpharmacological complementary and alternate pain management intervention. Distraction, biofeedback, and guided imagery, music are nonpharmacological, but considered cognitive-behavioral, not alternative and complementary, interventions.
question
The nurse explains patient-controlled analgesia to a patient. If the patient has understood this information, what would be the patient's most appropriate statement? 1 The device reduces the risk of an overdose of medication. 2 The caregivers can operate the device if the patient is unable to do so. 3 The patient will be lying in a prone position during the procedure. 4 The patient will decide about the loading dose of the analgesic drug.
answer
1 The nurse should teach about the use of patient-controlled analgesia (PCA) to a patient before any procedure. It is important to tell the patient that PCA reduces any risk of overdose. It should be emphasized to the patient that the patient-controlled analgesia device (PCA device) should not be operated by the caregivers. The caregivers are not able to perceive the patient's pain and thus cannot decide the amount of drug required. The patient should be placed in a comfortable position in which the IV line is accessible. The prone position is not likely to be a comfortable position for the patient. The patient does not decide the loading dose of the drug; the loading dose is prescribed before use.
question
The nurse concludes that a patient has radiating pain. Which assessment findings support the nurse's conclusion? 1 The patient has pain from a small cut or laceration. 2 The patient has pain in the back accompanied by pain in the leg. 3 The patient has a crushing sensation with pain in the chest. 4 The patient has a burning sensation with severe stomach pain.
answer
2 Pain extending from the initial site of injury to another body part is radiating pain. Therefore, because the patient has pain in the back accompanied by pain in the leg, it indicates radiating pain. Pain resulting from stimulation of the skin is cutaneous pain. A patient with pain from a small cut or laceration has cutaneous pain. If the patient has pain at one site but injury at a different site, it indicates referred pain. A patient experiencing a crushing sensation with pain in chest and a burning sensation with severe stomach pain indicates referred pain.
question
A postoperative patient reports pain at the site of surgery. On examination, the nurse finds that the incision is healing well and there are no signs of infection. The nurse instructs a student nurse to give a placebo drug to the patient. Which action would be the most appropriate action for the student nurse to take? 1 Follow the instructions given by the nurse. 2 Question the action of the placebo prescription. 3 Administer another analgesic drug. 4 Administer the placebo and inform the primary health care provider immediately.
answer
2 A placebo for pain does not have any analgesic properties. If a placebo is ordered, it must be questioned. The student should not blindly follow the instructions without knowing the purpose of administering the placebo. The student cannot directly administer another analgesic drug without an appropriate order to do so.
question
A new medical resident writes an order for oxycodone SR 10 mg PO q12 hours prn. Which part of the order does the nurse question? 1 The drug 2 The time interval 3 The dose 4 Prn
answer
4 Controlled- or extended-release opioid formulations such as oxycodone are available for administration every 8 to 12 hours around the clock (ATC). Health care providers should not order these long-acting formulations prn.
question
The nurse asks a patient to rate his pain from no pain to unbearable pain. Which pain rating scale is the nurse using for pain assessment? 1 Oucher scale t2 Numeric rating scale (NRS) 3 Visual analogue scale (VAS) 4 Verbal descriptor scale
answer
3 The VAS assesses the pain level in the patient by rating the pain along a 10-centimeter line in 1-centimeter increments from no pain to unbearable pain. The Oucher scale requires the patient to look at six faces with different expressions and point at the face that best matches the pain he or she is experiencing. With the NRS, the nurse asks the patient to choose a number to rate the level of pain. With the verbal descriptor scale, the nurse asks the patient to describe his or her feelings about the intensity of pain.
question
A patient complains of nausea after receiving the first dose of morphine for pain. What should the nurse do? 1 Treat nausea with an anti-nausea medication and continue to use morphine 2 Request an order for a nonsteroidal anti-inflammatory drug (NSAID) instead of morphine. 3 Encourage the patient to wait as long as possible for the next dose. 4 Withhold the next dose of morphine until reevaluated by the health care provider.
answer
1 Opioids can cause nausea and vomiting because of the action on the brainstem centers. This side effect decreases with repeated use, but until then, treatment for nausea should be instituted. Decreasing the dose may be ineffective for pain relief. Asking the patient to wait for pain relief is unethical. Withholding the dose may increase the pain.
question
During the subjective data collection for pain assessment, the nurse asks the patient, "Can you tell me what your discomfort feels like?" What is the reason for this question? 1 The nurse wants the patient to identify the quality of pain. 2 The nurse wants the patient to identify the severity of pain. 3 The nurse wants the patient to identify the duration of pain. 4 The nurse wants the patient to indentify the intensity of pain.
answer
1 The nurse asks questions such as, "Can you tell me what your discomfort feels like?" to assess the quality of pain. To identify the severity of pain, the nurse can ask, "On a scale of 0 to 10, how bad is your pain now?" To identify the onset and duration of pain the nurse can ask, "When did your pain start?" To identify the intensity of pain the nurse can ask, "How much pain do you have now?"
question
The nurse is assessing a patient who had been administered morphine for pain relief. The nurse finds that the patient's respiratory rate is 5 breaths/minute. Which drug would be the most helpful in reversing this adverse effect? 1 Meperidine 2 Naloxone 3 Flumazenil 4 Metoclopramide
answer
2
question
A patient with bronchial carcinoma reports constipation for the past 2 months. The patient has been on meperidine and ibuprofen for pain relief for the past 6 months. The patient has also been taking metformin and captopril for the past 10 years. What could be the most probable reason for constipation in the patient? 1 Side effects of the opioid 2 Side effects of the captopril 3 Interaction of metformin and captopril 4 Metastasis of cancer to other organs
answer
1 Constipation is a common side effect of opioids that are used for pain relief. Captopril is an ACE-inhibitor drug that is used to treat hypertension. Cough is the common side effect of captopril. Metformin is an oral hypoglycemic drug. Interaction between metformin and captopril does not cause constipation. It is unlikely that metastasis of cancer caused the constipation.
question
The nurse has given one unit of transmucosal fentanyl to an opioid-tolerant patient with breakthrough pain. The patient is still not feeling pain relief. How many more units of the drug can the nurse administer before notifying the primary health care provider? Record your answer using a whole number. ___ unit(s)
answer
1 One transmucosal fentanyl unit is given to patients with breakthrough pain. It is swabbed over the buccal mucosa and gums to be dissolved in the mouth. It should not be chewed. The nurse has given one unit of fentanyl already; if the pain persists, the nurse can administer one more unit of fentanyl. A patient can be given a total of 2 units of transmucosal fentanyl per episode of breakthrough pain. If the patient's pain is not relieved, then the nurse should notify the primary health care provider.
question
After having received 0.2 mg of naloxone intravenous push (IVP), a patient's respiratory rate and depth are within normal limits. The nurse now plans to implement which actions? 1 Discontinue all ordered opioids. 2 Close the room door to allow the patient to recover. 3 Administer the remaining naloxone over 4 minutes. 4 Assess patient's vital signs every 15 minutes for 2 hours.
answer
4 Every 15 minutes for 2 hours following drug administration reassess patients who receive naloxone because the duration of the opioid may be longer than the duration of the naloxone, and respiratory depression may return.
question
The nurse is planning effective pain management for a patient. What patient barriers prevent pain management? Select all that apply. 1 Lack of money 2 Fear of legal repercussions 3 Difficulty in filling prescriptions 4 Extensive documentation requirements 5 Belief that patients need to learn to live with pain
answer
1, 3, 4 Lack of money prevents access to appropriate resources for pain medications. Difficulty in filling prescriptions can prevent the patient from using pain medications. A requirement of extensive documentation makes the process tedious, interfering with the prescriber's directions for effective pain management. The fear of legal repercussions and a belief that patients need to learn to live with pain are barriers erected by health care providers.
question
A patient who is on aspirin therapy for pain relief reports that there has been no change in the pain even after taking the drug. On assessment, the nurse finds that the patient had a history of a bleeding gastric ulcer and obstructive sleep apnea. What immediate action should the nurse take? 1 Add an opioid analgesic. 2 Stop the aspirin administration. 3 Increase the dose of aspirin. 4 Stop the aspirin and give ibuprofen.
answer
2 The nurse should be aware of some of the common contraindications of analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) should not be given to a patient with a history of gastrointestinal bleeding or renal insufficiency. Therefore, administration of aspirin should be stopped for this patient. Opioids should not be given to a patient with a history of obstructive sleep apnea, because they cause respiratory depression. Increasing the dose of aspirin would further worsen the gastrointestinal bleeding. Ibuprofen is also an NSAID and, therefore, should be avoided in this patient.
question
The patient rates his pain as a 6 on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. The patient's wife says that he can't be in that much pain, because he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain? 1 The patient's wife is the best resource for determining the level of pain, because she has been with him continually for the entire day. 2 The patient's report of pain is the best method for assessing the pain. 3 The patient's health care provider has the best knowledge of the level of pain that the patient that should be experiencing. 4 The nurse is the most experienced at assessing pain.
answer
2 A patient's self-report of pain is the single most reliable indicator of the existence and intensity of pain.
question
When performing pain assessment, the nurse shows a series of photographs to a child and asks the child to point to the face that shows how he or she feels. Which pain-rating scale is the nurse using for pain assessment? 1 Oucher scale 2 Numeric rating scale (NRS) 3 Visual analogue scale (VAS) 4 Verbal descriptor scale
answer
1 The Oucher scale consists of six cartoon faces of a child ranging from a smiling face to less happy faces, to a final sad, tearful face. The child is asked to point to the face that best matches his or her pain. With the NRS, the nurse asks the child to choose a number to rate the level of pain. The VAS has the patient assess the pain on a 10-centimeter line, ranging from no pain to severe pain. With the verbal descriptor scale, the nurse asks the child to describe his or her feelings about the intensity of pain.
question
The nurse attending to a postoperative patient finds that the patient's pain medications have been changed from morphine to ibuprofen. What are the possible reasons for the change in medication by the health care provider? Select all that apply. 1 The patient's pain has increased. 2 Morphine is known to cause seizures. 3 The patient experienced clinical respiratory depression. 4 Ibuprofen does not affect the central nervous system the way morphine does. 5 Ibuprofen does not interfere with bowel and bladder function.
answer
3, 4, 5 Opioids (morphine) can cause respiratory depression in some patients who are not used to them. Secondly, unlike nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, opioids interfere with the activity of the central nervous system and affect the bowel and the bladder function. Opioids are generally prescribed when pain is severe. NSAIDs are useful for mild to moderate pain. Morphine is not known to cause seizures.
question
After assessing pain in a 9-year-old child using a numeric rating scale (NRS), the nurse documents the score as 5. What does the nurse interpret from this score? 1 The child has no pain. 2 The child has mild pain. 3 The child has severe pain. 4 The child has moderate pain.
answer
4 The score range of 4 to 6 indicates moderate pain. A score of 0 indicates that the child is relaxed and comfortable without any pain. The score range of 1 to 3 indicates that the child has mild pain. The score range of 7 to 10 indicates that the child has severe pain.
question
The nurse advises a patient with neuropathic pain to undergo guided imagery therapy to alleviate pain. Which pharmacological treatment interventions would be beneficial to the patient for pain management? Select all that apply. 1 Corticosteroids 2 Anticonvulsants 3 Antidepressants 4 Muscle relaxants 5 Bisphosphonates
answer
2, 3 The nonpharmacological interventions that are usually recommended for pain relief in a patient with neuropathic pain include relaxation and guided imagery. This allows patients to alter affective-motivational and cognitive pain perception. The pharmacological pain management therapies that would be beneficial to a patient with neuropathic pain include anticonvulsants such as gabapentin and antidepressants such as nortriptyline. Gabapentin acts on the supraspinal region to stimulate noradrenaline-mediated descending inhibition to reduce neuropathic pain. Nortriptyline alleviates neuropathic pain by altering neurotransmitter levels. Corticosteroids relieve pain associated with inflammation and bone metastasis. Muscle relaxants have no analgesic effect. Bisphosphonates are prescribed for bone pain.
question
A postoperative patient is currently asleep. Which statement is correct? 1 The sedative administered may have helped him sleep, but assessment of pain is still needed. 2 The intravenous (IV) pain medication is effectively relieving his pain. 3 Pain assessment is not necessary. 4 The patient can be switched to the same amount of medication by the oral route.
answer
1 Sedatives, antianxiety agents, and muscle relaxants have no analgesic effect; however, they can cause drowsiness impaired coordination, judgment, and mental alertness and contribute to respiratory depression. It is important to avoid attributing these adverse effects solely to the opioid. You need to conduct a thorough reassessment.
question
The nurse is attending to a postsurgical patient who underwent a nephrectomy. What observations would tell the nurse the patient is in severe pain? Select all that apply. 1 The patient is motionless. 2 The patient has a reduced attention span. 3 The patient is constantly asking for pain relief medication. 4 The patient has clenched teeth and is biting his or her lips. 5 The patient is talking incessantly for a long time.
answer
2, 3, 4 A patient in acute pain may not be able to concentrate on anything. The patient may have a reduced attention span and may focus only on pain relief. The nurse may observe the patient clenching teeth or biting his or her lips to tolerate or suppress the pain. These patients are usually physically restless due to pain and they do not interact or talk incessantly.
question
The nurse is assessing a hospitalized patient with acute pain. Which questions should the nurse ask the patient for an appropriate assessment? Select all that apply. 1 "How bad is your pain now?" 2 "What makes your pain worse?" 3 "Describe your pain." 4 "What is the worst pain you have had in past 24 hours?" 5 "Show me where you are hurt. Does it stay there or does it spread?"
answer
2, 3, 5 When assessing a patient with acute pain, the questions should be specific. The questions should aim to determine the intensity, location, and quality of pain. Ask provocative questions such as, "What makes the pain worse?" Ask about the region of the pain and the radiation of pain. Asking how bad the pain is may not yield specific details. Instead, the patient should be asked to rate the pain on a scale of 0 to 10. Other details can be asked once the patient is comfortable.
question
The nurse is caring for a patient who has severe pain due to muscle cramps. How does the nurse interpret this pain? 1 Visceral pain 2 Somatic pain 3 Referred pain 4 Cutaneous pain
answer
2 Muscle cramps indicate that the patient has initiation of pain from musculoskeletal tissues. Therefore, the patient has somatic pain. If the pain arises from internal organs such as the gastrointestinal (GI) tract or pancreas, it indicates visceral pain. If the patient has pain at a particular site and injury at a different site, it indicates referred pain. If the patient has pain due to damage to the skin's surface, it indicates cutaneous pain.
question
A patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication? 1 Stool softener 2 Stimulant laxative 3 H2 receptor blocker 4 Proton pump inhibitor
answer
2 Patients usually become tolerant to the side effects of opioids, with the exception of constipation. Routinely administering stimulant laxatives, not simple stool softeners, will prevent and treat constipation in these patients.
question
When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information should the nurse include? 1 TENS works by causing distraction. 2 TENS therapy does not require a health care provider's order. 3 A TENS unit must remain plugged in at all times 4 TENS electrodes are applied near or directly on the site of pain.
answer
4 TENS involves stimulation of the skin with a mild electrical current passed through external electrodes. The therapy requires a health care provider order. The TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. Place the electrodes directly over or near the site of pain.
question
The primary health care provider (PHP) administers epidural anesthesia to a patient with chronic cancer pain. The PHP instructs the nurse to monitor the patient every 15 minutes. Which intervention does the nurse implement to prevent complications? 1 Inspect the catheter for breaks. 2 Administer antiemetics as ordered. 3 Change the infusion tubing every 24 hours. 4 Assess for bladder and bowel distention.
answer
2 A patient with chronic cancer pain is usually administered epidural anesthesia for pain management. This patient has to be monitored for side effects every 15 minutes. Nausea and vomiting are common side effects associated with epidural anesthesia. To prevent such undesirable complications, the nurse administers antiemetics as ordered. To maintain catheter function, the nurse inspects the catheter for breaks. The nurse changes the infusion tubing every 24 hours to prevent infection. To maintain urinary and bowel function, the nurse assesses for bladder and bowel distension.
question
An opioid-naïve patient is on naloxone for respiratory depression caused by methadone overdose. The nurse is instructed to reassess the patient every 15 minutes for 2 hours following drug administration. What is the reason behind the schedule of reassessment of the patient? 1 The half-life of naloxone is greater than that of methadone. 2 Duration of the action of naloxone is less than that of methadone. 3 Naloxone acts as an agonist to methadone after 2 hours of administration. 4 Naloxone can cause methadone withdrawal symptoms in an opioid-naïve patient.
answer
2 The duration of action or half-life of naloxone is less than that of methadone. Therefore, recurrence of respiratory depression by the relatively long action of methadone can be prevented by reassessing the patient every 15 minutes for 2 hours after naloxone administration. Methadone has a greater half-life than naloxone. Therefore, the effect of methadone is more prolonged than that of naloxone. Naloxone is an opioid-antagonist drug. Naloxone does not act as an agonist to morphine after 2 hours. Opioid-naïve patients are patients who have not taken opioid medications for at least a week. Naloxone causes morphine withdrawal symptoms only in patients who are physically dependent on morphine, not the patients who are opioid naïve.
question
During emotional pain assessment, the patient reports numbness and tingling sensations interspersed with shooting or electric-like pain. What does the nurse infer from the patient's report? 1 The patient is experiencing idiopathic pain. 2 The patient is experiencing neuropathic pain. 3 The patient is experiencing nociceptive visceral pain. 4 The patient is experiencing nociceptive somatic pain.
answer
2 Neuropathic pain is characterized by burning, shooting, or electric-like pain accompanied by a tingling sensation. Idiopathic pain is chronic pain in the absence of an identifiable physical or psychological cause. When idiopathic pain is present, it is generally more than what would be expected for the organic pathological condition. Nociceptive pain originating from visceral sites is described as aching or cramping, or as aching or throbbing when it originates from somatic sites.
question
When using ice massage for pain relief, which procedures are correct? Select all that apply. 1 Apply ice using firm pressure over the skin. 2 Apply ice until numbness occurs and remove the ice for 5 to 10 minutes. 3 Apply ice until numbness occurs and discontinue application. 4 Apply ice for no longer than 10 minutes. 5 The ice is applied directly to the surface of the skin.
answer
1, 2 Cold therapies are particularly effective for pain relief. Ice massage involves applying a frozen cup of ice firmly over the skin, which is covered with a lightweight cloth. When numbness occurs, remove the ice for usually 5 to 10 minutes.
question
The nurse has to administer opioids to a female patient after a surgical procedure. Which conditions may require special consideration before administration of opioids? Select all that apply. 1 Breastfeeding 2 Dialysis 3 Respiratory disease 4 History of orthopedic surgery 5 Chronic headache
answer
1, 2, 3 Special considerations such as a breastfeeding mother, a patient on dialysis, and any respiratory conditions should be assessed carefully before administering opioids. Opioids may pass into the breast milk. It is excreted through the kidneys, and a patient on dialysis may require adjustment of the dose. Opioids tend to depress the respiratory system. Therefore, a preexisting respiratory disease may become aggravated. A history of orthopedic surgery and chronic headaches do not affect opioid administration.
question
The patient complains of intermittent back pain that travels down the left leg. What is this type of pain called? 1 Visceral 2 Referred 3 Radiating 4 Superficial
answer
3 Intermittent or constant pain that travels down or along a body part is called radiating pain. Deep or visceral pain results from the stimulation of internal organs. It is diffuse and radiates in several directions. Referred pain is in a part of the body separate from the source of pain. Superficial pain is of short duration and is localized.
question
Which signs or symptoms in an opioid-naïve patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid? 1 Oxygen saturation of 95% 2 Difficulty arousing the patient 3 Respiratory rate of 10 breaths/minute 4 Pain intensity rating of 5 on a scale of 0 to 10
answer
2 Opioid-naïve patients may develop a rare adverse effect of respiratory depression. Sedation always occurs before respiratory depression. The change in the level of consciousness supersedes oxygen saturation of 95% and moderate pain.
question
The nurse notices that a patient has received oxycodone/acetaminophen (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most? 1 The patient's level of pain 2 The potential for addiction 3 The amount of daily acetaminophen 4 The risk for gastrointestinal bleeding
answer
3 The major adverse effect of acetaminophen is hepatotoxicity. The maximum 24-hour dose is 4 g. It is often combined with opioids (e.g., oxycodone) because it reduces the dose of opioid needed to achieve successful pain control.
question
The primary health care provider prescribes intravenous (IV) opioid medication for flank pain associated with a kidney stone in the ureter. On the follow-up visit, the patient reports thigh pain to the nurse. What does the nurse infer from patient's report? 1 The patient is experiencing referred pain. 2 The patient is experiencing neuropathic pain. 3 The patient has acute pain progressing to chronic pain. 4 The patient has pain perception due to previous opioid medication.
answer
1 Flank pain is associated with kidney stones in the ureter. The spread of pain to uninjured tissue is referred pain. Here, the pain spreads to the uninjured thigh tissue. Neuropathic pain refers to pain caused by nerve damage rather than by tissue injury or damage. When pain is short term and associated with an acute event such as a kidney stone, it is acute pain, not chronic pain. IV opioid administration would decrease the perception of pain intensity of the kidney stone but would be unrelated to the new complaint of thigh pain.
question
A patient with diabetes who is on metformin has been taking morphine and nortriptyline for the past week to treat neuropathic pain. The patient is diagnosed with an upper respiratory tract infection and is prescribed antibiotics. Which drug taken by the patient is an adjuvant pain medication? 1 Antibiotic 2 Morphine 3 Metformin 4 Nortriptyline
answer
4 The primary purpose of an adjuvant drug such as an antiepileptic, muscle relaxant, sedative, or anxiolytic is to treat conditions other than pain. Some of these drugs have analgesic properties and reduce pain effectively when used with or without pain medications. The diabetic patient takes nortriptyline, which is an antidepressant. It is also used as an adjuvant analgesic to morphine, which is an opioid analgesic in pain management. Morphine is the primary drug that provides pain relief. Antibiotics and metformin do not have an analgesic affect. Antibiotics are used to treat infections and do not have an analgesic effect. Metformin is an oral hypoglycemic drug and does not have any effect on pain relief.
question
The electrocardiogram of an elderly male patient who had chest pain shows signs of myocardial infarction. What are the likely sites for referred pain for a male patient with myocardial infection? Select all that apply. 1 Jaw 2 Groin 3 Left ear 4 Left arm 5 Left shoulder
answer
1, 4, 5 When pathological changes in one part cause pain at a distant site on the body, then the pain is called referred pain. Pathological changes in the heart often cause referred pain in the jaw, left arm, and left shoulder, but they do not usually cause pain in the groin or left ear.
question
What is recommended on the World Health Organization (WHO) analgesic ladder while caring for a patient with cancer pain? 1 Transitioning use of adjuvants with nonsteroidal anti-inflammatory drugs (NSAIDs) to opioids 2 Using acetaminophen for refractory pain 3 Limiting the use of opioids because of the likelihood of side effects 4 Avoiding total sedation regardless of how severe the pain is
answer
1 The WHO analgesic ladder transitions from the use of nonopioids (NSAIDs) with or without adjuvants to opioids with or without adjuvants. Acetaminophen is recommended for lesser levels of pain. Side effects related to the use of opioids may be unavoidable but are treatable. Treatment for severe pain may result in some level of sedation.
question
The nurse is teaching a patient the use of patient-controlled analgesia (PCA). Which interventions should the nurse perform? Select all that apply.
answer
1, 2, 3 The nurse should teach the patient about PCA and evaluate the patient's understanding by asking the patient to repeat what the nurse has taught. The patient should control the administration of the medication based on the pain. The device is programmed to prevent overdose. The family members should not operate the PCA device for the patient because the dose depends on the patient's perception of pain. The patient should be taught the use of the device before the procedures in order to be ready to administer the analgesia after awakening from sedation.
question
A patient has had arthritic pain for 8 years and has surgery to remove a buildup of septic fluid. Postoperative, the patient received morphine through a patient-controlled analgesia (PCA) device for the management of pain. After a while, the patient starts getting drowsy and symptoms of respiratory depression begin to appear. The nurse is ordered to administer naloxone. What is the rate of administering naloxone? 1 Intravenous push at the rate of 1 mL every 1 minute 2 Intravenous push at the rate of 1 mL every 2 minutes 3 Intravenous push at the rate of 0.5 mL every 1 minute 4 Intravenous push at the rate of 0.5 mL every 2 minutes
answer
4 Naloxone is an antidote for respiratory depression caused by opioids. The dosage of naloxone is 0.4 mg diluted by 9 mL saline. This is administered by intravenous push at the rate of 0.5 mL every 2 minutes. This dosage is optimal for reversal of respiratory depression. Doses larger than this can cause severe pain and other serious complications.
question
A patient who is in the terminal stages of liver cancer reports continuous vomiting after taking oral opioid analgesics. The patient's weight is 85 pounds. The nurse applies a transdermal fentanyl patch to the patient. The next day, the patient informs the nurse that the pain is not alleviated. What could be the possible reason for this? 1 The dose of pain medication is not enough. 2 The number of patches used is not enough. 3 The route of administration of the analgesic is not correct. 4 The patient needs to wait longer for the medication to act.
answer
3 Fentanyl is an opioid analgesic and is available for intravenous or transdermal administration. It is 100 times more potent than morphine. However, transdermal patches are not effective in patients weighing less than 100 pounds, because these patients have very little subcutaneous tissue for absorption. Therefore, the nurse should discuss a more appropriate analgesic drug with the primary health care provider. The dose and the number of patches for the therapeutic action are predetermined. The duration of drug action is about 48 to 72 hours.
question
A patient returning to the nursing unit after knee surgery is verbalizing pain at the surgical site. What is the nurse's first action? 1 Call the patient's health care provider. 2 Administer pain medication as ordered. 3 Check the patient's vital signs. 4 Assess the characteristics of the pain.
answer
4 It is necessary to monitor pain on a regular basis along with other vital signs. It is important for the nurse to understand that pain assessment is not simply a number.
question
The registered nurse is evaluating the performance of a student nurse who is performing a back massage for a patient with back pain. Which action by the student nurse needs correction? 1 Using long, gliding strokes along the muscles of the spine 2 Beginning at the sacral area and massaging in a circular motion 3 Kneading the skin by gently grasping tissue between the thumb and fingers 4 Kneading downward along one side of the spine from the shoulders to the buttocks
answer
4 The nurse should knead upward along one side of the spine from buttocks to shoulders, not downward from the shoulders to the buttocks. The nurse should massage each body part for at least 10 minutes and use long, gliding strokes along the muscles of the spine. The massage should begin at the sacral area and progress in a circular motion while moving upward from the buttocks to the shoulders. The nurse should knead the skin by gently grasping tissue between the thumb and fingers.
question
The primary health care provider (PHP) prescribes a patient-controlled analgesia (PCA) pump to a postoperative patient for pain relief. The nurse reviews the PHP's order for the patient's name, the name of the medication, dose, frequency of medication, and lockout period. Why does the nurse perform this review? 1 To prevent medication errors 2 To ensure that the patient receives the correct medications 3 To ensure that the medication is administered safely 4 To avoid placing the patient at risk for allergic reactions
answer
3 The nurse checks the computer printout with the PHP's order for the patient's name, the name of medication, dose, frequency of medication, and lockout period to ensure that the medication is administered safely. A second registered nurse confirms the PHP's order and correct setup of the PCA pump to prevent medication errors. To ensure that the patient receives the correct medications, the nurse checks the patient's prescription. The nurse checks the patient's history for drug allergies to avoid placing the patient at risk for allergic reactions.
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Which pain characteristics might the nurse suspect in a patient with kidney stones? 1 The pain is of short duration and localized. 2 The pain is diffuse and radiates in several directions. 3 The pain radiates from the site of the injury to another body part. 4 The pain is in a part of the body separate from the source of pain.
answer
4 Kidney stones cause groin pain, an example of referred pain, which occurs in a part of the body separate from the source of pain. Superficial or cutaneous pain, for example from a needle stick or small cuts, is of short duration and is localized. Deep or visceral pain, for example from angina pectoris, is diffuse and radiates in several directions. Radiating pain travels down from the site of injury to another body part, for example in sciatica.
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A health care provider writes the order for an opioid-naïve patient who returned from the operating room following a total hip replacement. The order states, "Fentanyl patch 100 mcg, change every 3 days." Based on this order, the nurse plans to implement which actions? 1 The nurse calls the health care provider and questions the order. 2 The nurse applies the patch on the third postoperative day. 3 The nurse applies the patch as soon as the patient reports pain. 4 The nurse places the patch as close to the hip dressing as possible.
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1 Fentanyl is 100 times more potent than morphine and not recommended for acute postoperative pain.
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A patient is on a lidocaine patch for neuropathic pain. How should the lidocaine be given to the patient to achieve adequate pain control and avoid lidocaine toxicity? 1 12-hours-on, 12 hours-off schedule 2 12-hours on, 6 hours-off schedule 3 48-hours -on, 12 hours-off schedule 4 24-hours-on, 12 hours-off schedule
answer
1 The lidocaine patch is a topical analgesic and is used for cutaneous neuropathic pain control in adults. Three patches of the appropriate size are placed over and around the pain site. To avoid lidocaine toxicity, the 12-hours-on, 12-hours-off schedule is used. All the other schedules such as the 12-hours-on, 6-hours-off schedule; 48-hours-on, 12-hours-off schedule; and the 24-hours-on, 12-hours-off schedule may cause toxicity.
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A patient with a history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The health care provider's order reads, "Hydrocodone/acetaminophen 1 tab, per tube, q4 hours, prn." Which action by the nurse is most appropriate? 1 No action is required by the nurse because the order is appropriate. 2 Request to have the ordered changed to ATC (around the clock) for the first 48 hours. 3 Ask for a change of medication to meperidine 50 mg IVP, q3 hours, prn. 4 Begin the hydrocodone/acetaminophen when the patient shows nonverbal symptoms of pain.
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2 The American Pain Society (2003) states that if you anticipate pain for most of the day, you should consider ATC administration. Insertion of a gastrostomy tube is painful. This patient will most likely experience pain for at least the next 48 hours.
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Which instructions are crucial for the nurse to give to both family members and the patient who is about to be started on patient-controlled analgesia (PCA) of morphine? 1 Only the patient should push the button. 2 Do not use the PCA until the pain is severe. 3 The PCA prevents constipation. 4 Notify the nurse when the button is pushed.
answer
1 Patient preparation and teaching are critical to the safe and effective use of PCA devices. Patients need to understand PCA and be physically able to locate and press the button to deliver the dose. Be sure to instruct family members not to push the button for the patient.
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What should be the maximum 24-hour dose of acetaminophen for an adult patient whose liver and kidney function tests are normal? Record your answer using a whole number, and please note that no comma is needed. ___ mg
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4000 Acetaminophen is one of the safest analgesics available. However, its mode of action is unknown. The maximum 24-hour dose given to an adult with no kidney or liver diseases is 4000 mg.
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The nursing instructor is teaching a student nurse about using a patient-controlled analgesia (PCA) pump. Which intervention does the student nurse follow to establish the route of medication and rapid administration of the medication? 1 Administer the loading dose of analgesia as prescribed. 2 Attach the drug reservoir to the infusion device and prime the tubing. 3 Insert and secure a needleless adapter into the injection port nearest the patient. 4 Attach a needleless adapter to the tubing adapter of the patient-controlled module.
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3 A needleless adapter is inserted into the injection port nearest the patient to establish the route of medication and facilitate continuous delivery of the medication. The nurse administers the loading dose of analgesia as prescribed by giving one-time doses manually or programming it into the PCA pump. Attaching the drug reservoir to the infusion device and prime tubing locks the system and prevents air from infusing into the intravenous (IV) tubing. Attaching a needleless adapter to the tubing adapter of a patient-controlled module is done to connect with the IV line. It does not facilitate continuous delivery of the medication.
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A patient with chronic low back pain who took an opioid around-the-clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking, chills, abdominal cramps, and joint pain. What does the nurse recognize as these symptoms? 1 Addiction 2 Tolerance 3 Pseudoaddiction 4 Physical dependence
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4 Physical dependence is a state of adaptation that is manifested by a drug-class specific withdrawal syndrome produced by abrupt cessation of the drug, rapid dose reduction, decreasing blood levels of the drug, and/or the administration of an antagonist.
