Chapter 12 Med Surg - Pain Management
You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of patients who live with chronic pain should inform your care planning?
D) They can experience acute pain in addition to chronic pain.
The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse why he has had to keep getting larger doses of his pain medication, although they do not seem to affect him. What is the nurse's best response?
A) "Over time you become more tolerant of the drug."
Two patients on your unit have recently returned to the postsurgical unit after knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most plausible rationale for understanding the patients' different perceptions of pain?
A) Endorphin levels may vary between patients, affecting the perception of pain.
The nurse who is a member of the palliative care team is assessing a patient. The patient indicates that he has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate. What teaching should the nurse do with this patient?
A) Medication should be taken when pain levels are low so the pain is easier to reduce.
You are frequently assessing an 84-year-old woman's pain after she suffered a humeral fracture in a fall. When applying the nursing process in pain management for a patient of this age, what principle should you best apply?
A) Monitor for signs of drug toxicity due to a decrease in metabolism
The home health nurse is developing a plan of care for a patient who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the patient teaching?
A) Self-care and safety
The nurse caring for a 79-year-old man who has just returned to the medical-surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurse's management of the patient's pain?
A) The elderly may require lower doses of medication and are easily confused with new medications.
A patient is experiencing severe pain after suffering an electrical burn in a workplace accident. The nurse is applying knowledge of the pathophysiology of pain when planning this patient's nursing care. What is the physiologic process by which noxious stimuli, such as burns, activate nociceptors?
A) Transduction
You are the nurse caring for a postsurgical patient who is Asian-American who speaks very little English. How should you most accurately assess this patient's pain?
A) Use a chart with English on one side of the page and the patient's native language on the other so he can rate his pain.
You are caring for a patient with sickle cell disease in her home. Over the years, there has been joint damage, and the patient is in chronic pain. The patient has developed a tolerance to her usual pain medication. When does the tolerance to pain medication become the most significant problem?
A) When it results in inadequate relief from pain
You are caring for a patient admitted to the medical-surgical unit after falling from a horse. The patient states "I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse." When planning the patient's care, what variables should you consider? Select all that apply.
ABD A) How the presence of pain affects patients and families B) Resources that can assist the patient with pain management D) The advantages and disadvantages of available pain-relief strategies
You are part of the health care team caring for an 87-year-old woman who has been admitted to your rehabilitation facility after falling and fracturing her left hip. The patient appears to be failing to regain functional ability and may have to be readmitted to an acute-care facility. When planning this patient's care, what do you know about the negative effects of the stress associated with pain?
B) It is particularly harmful in the elderly who have been injured or who are ill.
You are admitting a patient to your rehabilitation unit who has a diagnosis of persistent, severe pain. According to the patient's history, the patient's pain has not responded to conventional approaches to pain management. What treatment would you expect might be tried with this patient?
B) Long-term intrathecal or epidural catheter
A patient's intractable neuropathic pain is being treated on an inpatient basis using a multimodal approach to analgesia. After administering a recently increased dose of IV morphine to the patient, the nurse has returned to assess the patient and finds the patient unresponsive to verbal and physical stimulation with a respiratory rate of five breaths per minute. The nurse has called a code blue and should anticipate the administration of what drug?
B) Naloxone
The wife of a patient you are caring for asks to speak with you. She tells you that she is concerned because her husband is requiring increasingly high doses of analgesia. She states, "He was in pain long before he got cancer because he broke his back about 20 years ago. For that problem, though, his pain medicine wasn't just raised and raised." What would be the nurses' best response?
B) "Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the patient relief."
A nurse on an oncology unit has arranged for an individual to lead meditation exercises for patients who are interested in this nonpharmacological method of pain control. The nurse should recognize the use of what category of nonpharmacological intervention?
B) A mind-body method
You are the emergency department (ED) nurse caring for an adult patient who was in a motor vehicle accident. Radiography reveals an ulnar fracture. What type of pain are you addressing when you provide care for this patient?
B) Acute
Your patient is receiving postoperative morphine through a patient-controlled analgesic (PCA) pump and the patient's orders specify an initial bolus dose. What is your priority assessment?
B) Assessment for respiratory depression
A medical nurse is appraising the effectiveness of a patient's current pain control regimen. The nurse is aware that if an intervention is deemed ineffective, goals need to be reassessed and other measures need to be considered. What is the role of the nurse in obtaining additional pain relief for the patient?
B) Patient advocate
The nurse is assessing a patient's pain while the patient awaits a cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at this time using a 0-to-10 pain scale. How should the nurse best respond to this assessment finding?
B) Reinforce teaching about the pain scale number system.
You are the nurse in a pain clinic caring for an 88-year-old man who is suffering from long-term, intractable pain. At this point, the pain team feels that first-line pharmacological and nonpharmacological methods of pain relief have been ineffective. What recommendation should guide this patient's subsequent care?
B) The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options.
You are caring for a 20-year-old patient with a diagnosis of cerebral palsy who has been admitted for the relief of painful contractures in his lower extremities. When creating a nursing care plan for this patient, what variables should the nurse consider? Select all that apply.
BCDE B) Patient's comorbid conditions C) Type of procedure be performed D) Changes in neurologic function due to the procedure E) Prior effectiveness in relieving the pain
An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the patient is exaggerating and does not need pain medication. What is the nurse's best response?
C) "Unless there is strong evidence to the contrary, we should take the patient's report at face value."
You are assessing an 86-year-old postoperative patient who has an unexpressive, stoic demeanor. When you enter the room, the patient is curled into the fetal position and your assessment reveals that his vital signs are elevated and he is diaphoretic. You ask the patient what his pain level is on a 0-to-10 scale that you explained to the patient prior to surgery. The patient indicates a pain level of "three or so." You review your pain-management orders and find that all medications are ordered PRN. How would you treat this patient's pain?
C) Believe what the patient says, reinforce education, and reassess often.
A 52-year-old female patient is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the patient's pain in her plan of nursing care, the nurse should consider what characteristic of cancer pain?
C) Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications.
You have just received report on a 27-year-old woman who is coming to your unit from the emergency department with a torn meniscus. You review her PRN medications and see that she has an NSAID (ibuprofen) ordered every 6 hours. If you wanted to implement preventive pain measures when the patient arrives to your unit, what would you do?
C) Check for allergies, use a pain scale to assess the patient's pain, and offer the ibuprofen every 6 hours until the patient is discharged.
The nurse is caring for a 51-year-old female patient whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem?
C) Depression
A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical patients' pain. What principle should guide the nurse's use of placebos in pain management?
C) Placebos are never recommended in the treatment of pain.
You are the home health nurse caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will be taking care of the patient. What would your priority nursing interventions be for this visit?
C) Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.
Your patient has just returned from the postanesthetic care unit (PACU) following left tibia open reduction internal fixation (ORIF). The patient is complaining of pain, and you are preparing to administer the patient's first scheduled dose of hydromorphone (Dilaudid). Prior to administering the drug, you would prioritize which of the following assessments?
C) The patient's allergy status
Your patient is 12-hours post ORIF right ankle. The patient is asking for a breakthrough dose of analgesia. The pain-medication orders are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner?
C) To achieve better pain control than with one medication alone
You are the nurse coming on shift in a rehabilitation unit. You receive information in report about a new patient who has fibromyalgia and has difficulty with her ADLs. The off-going nurse also reports that the patient is withdrawn, refusing visitors, and has been vacillating between tears and anger all afternoon. What do you know about chronic pain syndromes that could account for your new patient's behavior?
D) Chronic pain can cause intense emotional responses.
You are the case manager for a 35-year-old man being seen at a primary care clinic for chronic low back pain. When you meet with the patient, he says that he is having problems at work; in the past year he has been absent from work about once every 2 weeks, is short-tempered with other workers, feels tired all the time, and is worried about losing his job. You are developing this patient's plan of care. On what should the goals for the plan of care focus?
D) Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety.
The nurse caring for a 91-year-old patient with osteoarthritis is reviewing the patient's chart. This patient is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this patient?
D) Drug interactions
A 74-year-old woman was diagnosed with rheumatoid arthritis 1 year ago, but has achieved adequate symptom control through the regular use of celecoxib (Celebrex), a COX-2 selective NSAID. The nurse should recognize that this drug, like other NSAIDs, influences what aspect of the pathophysiology of nociceptive pain?
D) Inhibiting transduction by blocking the formation of prostaglandins in the periphery
The nurse is accepting care of an adult patient who has been experiencing severe and intractable pain. When reviewing the patient's medication administration record, the nurse notes the presence of gabapentin (Neurontin). The nurse is justified in suspecting what phenomenon in the etiology of the patient's pain?
D) Neuropathy
The nurse is caring for a male patient whose diagnosis of bone cancer is causing severe and increasing pain. Before introducing nonpharmacological pain control interventions into the patient's plan of care, the nurse should teach the patient which of the following?
D) Reducing his use of analgesics is not the purpose of these interventions.
A 60-year-old patient who has diabetes had a below-knee amputation 1 week ago. The patient asks "why does it still feel like my leg is attached, and why does it still hurt?" The nurse explains neuropathic pain in terms that are accessible to the patient. The nurse should describe what pathophysiologic process?
D) The abnormal reorganization of the nervous system
You are the nurse caring for the 25-year-old victim of a motor vehicle accident with a fractured pelvis and a ruptured bladder. The nurse's aide (NA) tells you that she is concerned because the patient's resting heart rate is 110 beats per minute, her respirations are 24 breaths per minute, temperature is 99.1°F axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as you assess this patient's physiologic status?
D) The patient's rating of her pain
The mother of a cancer patient comes to the nurse concerned with her daughter's safety. She states that her daughter's morphine dose that she needs to control her pain is getting "higher and higher." As a result, the mother is afraid that her daughter will overdose. The nurse educates the mother about what aspect of her pain management?
D) There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.
