SPC Level 2 Exam 1- Pain Treatment and Management Adaptive Quiz
The nurse is teaching a patient about application of the prescribed fentanyl patch. Which statement by the patient indicates the need for additional instruction? -"I can put this patch on my abdomen." -"I should rotate sites of patch application." -"If the patch falls off, I will put a new one on." -"I should not put this patch over skin that is broken."
-"If the patch falls off, I will put a new one on." A transdermal patch cannot be replaced safely if it falls off. This is because the medication is released slowly through the patch and into the skin. A new patch will increase the patient's risk for toxicity and overdose because the medication level on a new patch is higher than the one that fell off. The patch can be placed on the abdomen and sites should be rotated. The patch should be placed on intact skin. p. 118
A nursing student working on a pain-control unit is discussing gender differences concerning pain with the nursing instructor. Which statement by the nursing student requires clarification? -"Men use alternative treatments for their pain less often than women." -"Women generally report that they can control their pain better than men." -"Men are less likely than women to report pain when they experience it." -"Women are more likely to receive a diagnosis of nonspecific somatic disorder as an explanation for their pain."
-"Women generally report that they can control their pain better than men." Men report the ability to control pain more often than women; thus the statement that women report being able to control pain more often than men would need correction. Women are more likely to use alternative treatments than men. Men are less likely to report pain, and women are more likely to receive a nonspecific diagnosis for their pain. p. 103
A patient is hospitalized with multiple lacerations and four fractured ribs after a fall. Which intervention is the highest priority in the nursing plan of care? -Performing meticulous oral hygiene -Providing a high-protein, high-calcium diet -Performing range-of-motion exercises to all extremities -Administering analgesics and encouraging breathing exercises
-Administering analgesics and encouraging breathing exercises Administering analgesics is the highest priority action to achieve patient comfort and thereby to facilitate performance of breathing exercises to prevent respiratory complications, such as atelectasis and pneumonia. Oral hygiene is a basic activity of daily living but not a priority and can be performed when the patient's pain is relieved. A high-protein, high-calcium diet will assist with wound and fracture healing. Range-of-motion exercises may be performed after the patient is medicated for pain. p. 106
Which manifestations would the nurse attribute to adverse effects of morphine sulfate? Select all that apply. -Bradypnea -Constipation -Urinary retention -Nausea and vomiting -Increased blood pressure
-Bradypnea -Constipation -Urinary retention -Nausea and vomiting The patient can develop a slowed respiratory rate from depression of the central nervous system. Morphine acts on the cholinergic receptors, causing urinary retention and constipation. Morphine sulfate promotes nausea and vomiting by directly stimulating the chemoreceptor-trigger zone in the medulla. Blood pressure would decrease, not increase, because of pain control and possible sedation. p. 114
How are health care organizations changing practice to address a patient's pain? -By utilizing pain rating scales -By adopting The Joint Commission's guidelines on pain -By initiating policy and procedures for pain management -By increasing the use of nonpharmacologic comfort measures
-By adopting The Joint Commission's guidelines on pain One major step in institutionalizing pain management is the development and adoption of the The Joint Commission's guidelines on pain. Policy and procedure for pain management, utilizing pain scales, and increasing nonpharmacologic comfort measures have been previously integrated into delivery of care. p. 122
Which health care facility requirements are included in The Joint Commission's guidelines on pain? Select all that apply. -Promote nonpharmacologic intervention. -Identify possible causes of pain before discharge. -Educate patients and their families about pain management. -Educate health care providers about pain assessment and pain management. -Recognize the patient's right to appropriate assessment and pain management.
-Educate patients and their families about pain management. -Educate health care providers about pain assessment and pain management. -Recognize the patient's right to appropriate assessment and pain management. Under The Joint Commission's guidelines on pain, health care facilities are required to educate patients and their families about pain management, educate health care providers about pain assessment and pain management, and recognize the patient's right to appropriate pain assessment and pain management. The promotion of nonpharmacologic interventions is not a Joint Commission guideline. Identifying pain in patients during their initial assessment and as needed, during ongoing periodic reassessments, is a Joint Commission guideline, but identifying the causes of pain is not listed as a requirement. p. 122
How does the concept of "analgesic ceiling" relating to nonsteroidal antiinflammatory drugs (NSAIDs) apply to planning care for a patient in pain? Select all that apply. -Increasing the dose of the drug will not provide greater analgesia. -Increasing the dose will produce deleterious effects on body systems. -The maximum dose of the medication depends on the patient's pain level. -There is a greater likelihood of effects related to drug interactions with NSAIDs. -NSAIDs are ineffective if the drug dosage is increased beyond a particular limit.
-Increasing the dose of the drug will not provide greater analgesia. -Increasing the dose will produce deleterious effects on body systems. NSAIDs have an analgesic ceiling, which means that increasing the dose of the drug beyond a certain limit will not accentuate the analgesic effect of the drug. Overdose of certain NSAIDs has been reported to have deleterious effects. The term "analgesic ceiling" is not associated with drug interactions. The analgesic property of the NSAIDs is not lost if the dosage is increased. There is a safe maximum dose that has been established for all medications. p. 111
A nurse is preparing to teach a patient with cancer about pain management. Which information would the nurse include in the teaching plan? Select all that apply. -Nonpharmacologic pain relief therapies -Mechanism of action of the pain medications -Pathophysiology of the development of pain in cancer -Side effects and complications associated with medications -Adjustments in drug dosages that may be required over time
-Nonpharmacologic pain relief therapies -Side effects and complications associated with medications -Adjustments in drug dosages that may be required over time The goal of a teaching plan about pain management is to ensure a safe and effective delivery of drugs and adequate pain relief. Nonpharmacologic therapies are preferable to drugs meant for pain relief because there is a smaller chance of side effects and adverse reactions. Side effects and complications associated with analgesic use should be taught to the patient. The patient should be instructed to tell the health care provider if these effects are present. The analgesic effect of the drugs may decrease over time, and dosages may need to be adjusted for effective pain relief. The mechanism of the action of drugs or the pathophysiology of the development of pain in cancer need not be addressed while teaching pain management. p. 121
The nurse is caring for four patients who are receiving analgesia in a health care setting. Which patient is receiving medication by a route that will provide excellent steady-state analgesia levels in the blood? -Patient 1: Topical -Patient 2: Subcutaneous -Patient 3: Intraspinal -Patient 4: Intravenous (IV) infusion
-Patient 4: Intravenous (IV) infusion Pain medications are delivered through various routes of administration. Each route has specific advantages and disadvantages. IV infusion (Patient 4) is the best route because it provides excellent steady-state analgesia through stable blood levels. This method is used for immediate analgesia and rapid titration. Creams and lotions are available forms of topical analgesics (Patient 1). They are applied on the skin to exert a therapeutic effect but will not maintain steady-state blood levels. Subcutaneous infusions (Patient 2) are effective for pain management at the end of life but do not maintain stable blood levels. Analgesics that are administered through a catheter placed in the epidural space or subarachnoid space (Patient 3) do not maintain stable blood levels. p. 113
Following a bowel resection, the patient is able to receive morphine sulfate 1 mg every 10 minutes by a patient-controlled analgesia (PCA) pump. Which assessment data would require the nurse to take immediate action? -Pupillary dilation, blood pressure 130/98 mm Hg -Blood pressure 108/64 mm Hg, pulse 104 beats/min -Respiratory rate 8 breaths/min, pupillary constriction -Respiratory rate 12 breaths/min, pulse 62 beats/min
-Respiratory rate 8 breaths/min, pupillary constriction To protect the patient from the adverse effects of respiratory depression caused by this medication, the nurse should alert the health care provider as soon as the respiratory rate drops below 12 breaths per minute. Pupillary dilation is not associated with overdose or toxicity. A high or low normal blood pressure is not indicative of overdose. A respiratory rate of 12 breaths per minute is still within normal limits, and the patient should be monitored. p. 119
Which clinical manifestation would prompt the nurse to question a patient's prescription for acetaminophen and oxycodone? -Severe jaundice -Oral candidiasis -Increased urine output -Elevated blood glucose
-Severe jaundice Acetaminophen and oxycodone are the ingredients in Percocet. Because acetaminophen is metabolized in the liver, the patient could develop acetaminophen toxicity in the presence of severe liver disease (evidenced by jaundice). The prudent nurse would question the prescription before administration. Oral candidiasis, increased urine output, and elevated blood glucose are not clinical manifestations a nurse should question with this prescription. p. 112
A patient who has had surgery for breast cancer reports constant moderate pain with short periods of severe pain during dressing changes. Which conclusion would the nurse consider when planning care for this patient? -The patient is probably exaggerating the report of pain. -The patient needs a referral for surgical treatment of the pain. -The pain would be best treated with both a long-acting and short-acting opioid. -The pain would be best treated with scheduled short-acting opioids plus acetaminophen.
-The pain would be best treated with both a long-acting and short-acting opioid. Moderate to severe pain usually requires an opioid analgesic. Constant, moderate pain is treated with a long-acting opioid; procedural severe pain is treated with a short-acting opioid. The nurse has no place in determining whether a patient is in pain. The patient does not need surgical treatment of the pain. Short-acting opioids will not likely help with the constant pain. p. 111