Pain Management Ch. 36 Yoost & Crawford

A nurse in an oncology outpatient clinic has been seeing a woman and her husband since the woman was diagnosed with breast cancer. The nurse decides to reassess the psychosocial condition of the patient and her husband after conflicting observations of the patient's spouse are noted. Which question best elicits needed psychosocial information? 1 "In what way does the pain you have affect you on a daily basis?" 2 "Describe to me what you eat in a typical day." 3 "Tell me how you think you and your husband are dealing with your cancer." 4 "Are the two of you having any relational difficulties because of your cancer?"

"Tell me how you think you and your husband are dealing with your cancer." The open-ended question is one that coaches the patient and husband into telling their story and explaining what is important to them. This is accomplished when the nurse says, "Tell me how you think you and your husband are dealing with your cancer." "In what way does the pain you have affect you on a daily basis?" and "Describe to me what you eat in a typical day" do not elicit psychosocial information. "Are the two of you having any relational difficulties because of your cancer?" is a closed-ended question that does not prompt a full story.

A patient has chronic arthritis. Which questions would the nurse ask in order to assess the patient's pain? Select all that apply. 1 "Which factors palliate 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 0-10, how would you rate the pain?"

1 "Which factors palliate your pain?" 2 "How would you describe the pain?" 5 "On a scale of 0-10, how would you rate the pain?" To assess the pain completely and accurately, the nurse would assess its onset, palliative factors, quality, radiation, severity, and time of pain. Asking about palliative factors helps determine what influences the pain. A description of the pain helps understand the nature and location of the pain. Asking a patient to rate the pain on a pain scale helps assess the intensity of the pain. Asking questions regarding elimination and allergies does not help in pain assessment.STUDY TIP: Use the "OPQRST" mnemonic to recall what should be assessed about pain. Each letter stands for a pain characteristic and follows the sequence in the alphabet. A description of the pain is implied by the Q for quality. R can stand for radiation as well as rating.

Which patient would be a candidate for application of acupuncture therapy? Select all that apply. 1 A patient with back pain 2 A patient with a skin infection 3 A patient with myofascial pain 4 A patient with a bleeding disorder 5 A patient with a migraine headache

1 A patient with back pain 3 A patient with myofascial pain 5 A patient with a migraine headache Acupuncture therapy regulates the vital energy, which flows like a river through the body in channels that form a system of pathways. Back pain, myofascial pain, and migraine headaches are chronic conditions believed to be caused by a disruption to flow of energy in the body. Acupuncture helps realign the flow of energy and relieve symptoms of back pain, myofascial pain, and migraine headaches. Acupuncture therapy is contraindicated for clients who have a skin infection or bleeding disorder.

The nurse is teaching a patient the use of patient-controlled analgesia (PCA). Which interventions should the nurse perform? Select all that apply. 1 Ask the patient to explain the purpose of the PCA device. 2 Emphasize that the patient controls medication delivery. 3 Explain that the pump decreases the risk of overdose. 4 Tell family members to operate the PCA device for the patient. 5 Teach the use of PCA after the patient awakens from sedation.

1 Ask the patient to explain the purpose of the PCA device. 2 Emphasize that the patient controls medication delivery. 3 Explain that the pump decreases the risk of overdose. The nurse should teach the patient about PCA and evaluate the patient's understanding by asking the patient to explain it back. The patient should be the one controlling the administration of the medication based on the pain. The health care provider orders a specific lockout time between patient doses to avoid overdosing. The family members should not operate the PCA device for the patient because the dose depends on the pain perception by the patient. The patient should be taught the use of the device before the procedures so that when the patient awakens from sedation, the patient can administer the analgesia.Test-Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously.

An elderly patient complains of severe pain in both lower extremities. The patient becomes tearful when describing the pain and states that it is intolerable. The nurse develops a healing relationship with the patient by incorporating which concepts of healing? Select all that apply. 1 By inquiring how the pain is affecting the patient's daily routine 2 By telling the patient about various pain-relieving interventions 3 By encouraging the patient to be strong and deal with the pain positively 4 By asking the family to help the patient cope with pain and anxiety 5 By administering pain medications and encouraging the patient to exercise

1 By inquiring how the pain is affecting the patient's daily routine 2 By telling the patient about various pain-relieving interventions 4 By asking the family to help the patient cope with pain and anxiety To establish a healing relationship and a helping role, the nurse should not just look at the patient's leg pain as a medical problem. The nurse should also try to understand how it affects patient's daily life and spirituality, and work to improve the patient's overall well-being. By informing the patient about various methods to alleviate pain, the nurse mobilizes hope in the patient. The nurse should also help the patient use social resources, such as friends and family, who can help the patient deal with his or her health condition. Asking the patient to be strong and deal with the pain may decrease spirituality and increase stress and anxiety. The nurse should focus on more than just medications and exercise to develop a healing relationship.Test-Taking Tip: Were you tempted to also pick the choice about administering pain medications? If so, you needed to reread the specifics of the question. The question does not ask how to eliminate the pain. Instead, it asks how to develop a healing relationship with the patient. Be sure to read the question carefully and thoroughly.

A nursing student 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

1 Increased heart rate 2 Rapid, irregular breathing 3 Increased glucose level 5 Decreased gastrointestinal motility The stimulation of the sympathetic branch of the autonomic nervous system causes increased heart rate, rapid and irregular breathing, increased glucose level, and decreased gastrointestinal motility. Stimulation of the parasympathetic branch results in rapid, irregular breathing and decreased blood pressure.Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes.

The nurse is caring for a patient who is administered dezocine. Which side effects would the nurse expect in this patient? Select all that apply. 1 Itching 2 Nausea 3 Anxiety 4 Drowsiness 5 Hypertension

1 Itching 2 Nausea 4 Drowsiness Dezocine is an agonist-antagonist analgesic useful in treating moderate to severe pain. Side effects include itching, nausea, drowsiness, dizziness, vomiting, and respiratory depression. During intravenous administration of dezocine, histamines are released at the site of administration that result in itching. Dezocine slows down central nervous system function and causes nausea and drowsiness. Anxiety and hypertension are symptoms of withdrawal from opioid drugs, not dezocine.

A patient is in the first postoperative day following a nephrectomy and is receiving morphine through a patient-controlled analgesia device for management of pain. The patient is apprehensive about being given opioid drugs because of addiction possibilities and possible chronic side effects. What explanation should a 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 for postsurgical pain. 3 Adverse effects can be treated. 4 The drug is administered carefully as its action cannot be reversed. 5 In case of overdose, opioid antagonist drugs can be given to reverse the effects.

1 Opioids can be used safely in cases of moderate to severe pain. 3 Adverse effects can be treated. 5 In case of overdose, opioid antagonist drugs can be given to reverse the effects. There are many misconceptions about the use of opioid drugs. Opioids can be safely given to people for management of moderate to severe pain. Treatment for adverse effects is the same as that for the adverse effects associated with agonist analgesics. Antagonist analgesics, such as naloxone, are used for the treatment of opioid analgesic overdose. They compete with opioids at the opioid receptor sites, decreasing the side effects of opioids. They are administered intravenously, intramuscularly, or subcutaneously every 2 to 3 minutes until symptoms of opioid overdose subside. Signs of opioid withdrawal, such as vomiting, hypertension, and anxiety, may occur up to 2 hours after administration. It is not mandatory to give opioids only after surgery. They can be administered to relieve pain of any origin.

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.

1 Psychogenic pain is not real. 4 Administering analgesics regularly leads to drug addiction. 5 Patients who abuse substances overreact to discomfort. 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. 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 impact on daily activities. Patients who do not speak can still feel pain and need intervention.

The nurse is caring for a patient who underwent surgery and has a diagnosis of acute pain. Which clinical manifestations does the nurse expect to find in this patient? Select all that apply. 1 Tachycardia 2 Bradycardia 3 Hypertension 4 Hypotension 5 Constipation

1 Tachycardia 3 Hypertension 5 Constipation Surgery may cause acute pain (pain that lasts for less than 6 months). Acute pain causes an increase in the sympathetic nerve activity; thus it causes an increase in heart rate (tachycardia) and an increase in blood pressure (hypertension). Pain normally affects the gastrointestinal tract by decreasing gastric motility and thereby causes constipation. Chronic pain causes a decreased heartbeat (bradycardia) and a decrease in blood pressure (hypotension).

The nurse is assessing a patient with acute pain. Which statements are true about acute pain? Select all that apply. 1 Patients with acute pain are more likely to experience depression and fatigue. 2 Acute pain has an identifiable cause. 3 Acute pain lasts less than 6 months. 4 Anxiety increases the severity of acute pain. 5 Patients with acute pain seek numerous health care providers.

2 Acute pain has an identifiable cause. 3 Acute pain lasts less than 6 months. 4 Anxiety increases the severity of acute pain. Acute pain has an identifiable cause. The duration of acute pain is less than 6 months, whereas chronic pain is longer than 6 months. In acute pain, the presence of anxiety increases the severity of the pain experienced, reduces the individual's tolerance to pain, and decreases the ability to cope with pain. Individuals with chronic pain are more likely to experience depression and fatigue and are more likely to attempt suicide. A patient with chronic pain may seek numerous health care providers if the pain has an unknown cause.Test-Taking Tip: Have confidence in your initial response to a question; it is more than likely the correct answer.

Which herbs have pain-relieving properties? Select all that apply. 1 Senna 2 Ginger 3 Rosehips 4 Aloe vera 5 Black cohosh

2 Ginger 3 Rosehips 4 Aloe vera 5 Black cohosh Ginger, rosehips, aloe vera, and black cohosh have pain-relieving (analgesic) properties. Ginger acts on serotonin receptors and thus relieves pain. Rosehips relieve pain by inhibiting the functioning of nociceptors. Aloe vera helps alleviate pain related to superficial burns. Black cohosh acts as a selective estrogen receptor modulator; it relieves pain by the serotonergic pathway. Senna is an herb that can be useful in treating constipation.

A patient with a history of a stroke, confusion, and aphasia returns to the unit following placement of a gastrostomy tube. The health care provider prescribed "Vicodin 1 tab, per tube, every 4 hours, prn." Which action by the nurse is most appropriate? 1 No action is required by the nurse because the prescription is appropriate. 2 Request to have the prescription changed to around the clock (ATC) for the first 48 hours. 3 Ask for a change of medication to meperidine 50 mg IVP, q3 hours, prn. 4 Begin the Vicodin when the patient shows nonverbal signs of pain.

2 Request to have the prescription changed to around the clock (ATC) for the first 48 hours. The American Pain Society (2003) states that if pain is anticipated for most of the day, the provider 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. The nurse should contact the health care provider and request an ATC administration for the first 48 hours postop. The health care provider ordered an appropriate medication; therefore no change in medication is needed. The pain medication should be administered before the onset of pain, as breakthrough pain is difficult to control.

The nurse is collecting data on a group of patients. Which patient does the nurse conclude has referred pain? 1 A patient with a deep aching and throbbing pain from burns to the skin 2 A patient with thoracic pain caused by gastroesophageal reflux disease 3 A patient with a shoulder fracture who reports a deep prickling sensation 4 A patient with acute appendicitis and severe pain in the umbilical area

A patient with acute appendicitis and severe pain in the umbilical area Referred pain is pain that is sensed at a different location than that of the injury. A patient with acute appendicitis has an inflamed appendix in the lower right quadrant of the abdomen; however, the patient may experience pain in the umbilical area. A patient who has deep aching and throbbing pain due to skin burns has somatic pain. The patient who has thoracic pain due to gastroesophageal reflux disease has radiating pain. The patient with a shoulder fracture has somatic pain.STUDY TIP: If you have ever been referred to another physician or professional, that professional is at a different location than the current professional. Referred pain is felt at a different location than its source. Think of physician referrals to help you recall the definition of referred pain.

The nurse is caring for a patient who reports mild headache and fever. Which medication does the nurse expect the health care provider to recommend for this patient? 1 Docusate 2 Naloxone 3 Atenolol 4 Acetaminophen

Acetaminophen is an analgesic drug that helps in relieving mild to moderate pain at various locations of body; therefore it can also help in relieving a mild headache. Acetaminophen also acts as an antipyretic and is used to reduce fever. Docusate is useful in treating constipation. Naloxone is useful in treating respiratory depression caused by an overdose of opioid analgesics. Atenolol is a drug that is useful in treating hypertension.

Complementary and alternative therapies are helpful in treating different disease conditions. Which therapy involves the insertion of thin needles in a specific body region? 1 Reiki therapy 2 Acupuncture 3 Acupressure 4 Chiropractic medicine

Acupuncture Acupuncture therapy involves the insertion of thin needles in specific body regions. This traditional Chinese treatment method is used to realign the flow of vital energy (qi) in the body into specific channels that form a system of pathways called meridians. Reiki therapy, acupressure, and chiropractic medicine do not involve the insertion of thin needles into a specific body region.Test-Taking Tip: The distinguishing feature between acupuncture and acupressure is that acu puncture uses needles. Think of the word puncture to help you remember that.

A patient reports severe pain when the nurse palpates the radial pulse. Which sensory impairment does the nurse infer in this situation? 1 Allodynia 2 Dysesthesia 3 Hyperalgesia 4 Hyperpathia

Allodynia Allodynia is a type of sensory impairment in which a patient experiences pain even from a noninjurious stimulus such as being touched. Dysesthesia is a type of impaired sensation in which the patient experiences unpleasant and abnormal sensations to touch. Hyperalgesia and hyperpathia are impaired sensations in which the patient experiences an exaggerated intensity of pain from painful stimuli.STUDY TIP: Although the real meaning of the Greek word part all/o is other, such as in a condition differing from the normal, you can think of all/o in this case meaning all; all stimuli produce pain (-dynia). - p. 855

Which drug does the nurse expect the health care provider to prescribe a patient who is recovering from a myocardial infarction? 1 Aspirin 2 Naloxone 3 Oxycodone 4 Acetaminophen

Aspirin A myocardial infarction occurs due to the aggregation of platelets in the arteries. Aspirin is a nonsteroidal antiinflammatory drug that acts against blood clots formed due to platelet aggregation. Naloxone is useful in treating respiratory depression caused by overdose of opioid analgesics. Oxycodone is an agonist analgesic that is useful in treating severe pain. Acetaminophen is useful in treating mild headaches and fever.STUDY TIP: Say this sentence aloud to help your memory, emphasizing the A's: "Aspirin Acts Against Aggregation of plAtelets." You can even pronounce each A as a long A (as in cake) to make it sound funnier and more memorable.

The nurse is instructed to give a massage to a patient who has body aches. The patient has a history of angina and deep vein thrombosis. Which area, if massaged, can lead to complications in the patient? 1 Back 2 Shoulders 3 Calf muscles 4 Thigh muscles

Calf muscles Performing a massage for 20 minutes has been shown to reduce tension and anxiety in patients with cardiac problems. The patient has a history of deep vein thrombosis; therefore the calf muscles should not be massaged because the risk of dislodging a vascular clot increases in this patient. Massage to the back, shoulders, and thighs is not associated with any health-related risk and helps induce relaxation.

A patient is admitted to the hospital for multiple injuries and is put on an intravenous (IV) analgesia. After a couple of hours, the patient is still in severe pain, and the nurse finds that the skin around the IV catheter is red and swollen. Which response should the nurse take immediately? 1 Notify the health care provider. 2 Change the pain medication. 3 Change the intravenous access line. 4 Increase the dose of pain medication.

Change the intravenous access line. The nurse should continuously monitor the IV access line to check its patency. Pain medication or analgesics are effective only if the IV access is patent. The swelling around the IV catheter indicates that the IV line is not patent. Therefore the nurse should first change the IV access line. If there is no improvement in the patient's condition after changing the IV line, then the nurse would notify the health care provider. The health care provider may change the analgesic or increase the dose of the analgesic drug if necessary.Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on the identified priority for action.

When planning patient education, it is important to remember that patients with which diseases or disorders often find relief in complementary therapies? 1 Lupus and diabetes 2 Ulcers and hepatitis 3 Heart disease and pancreatitis 4 Chronic back pain and arthritis

Chronic back pain and arthritis Evidence supports the use of many complementary therapies for chronic pain syndromes, particularly pain that is unremitting and unresponsive to conventional allopathic therapies. Chronic back pain and arthritis may find relief in complementary therapies. Complementary therapies would not offer relief to lupus, diabetes, ulcers, hepatitis, heart disease, or pancreatitis.

Which neurotransmitter regulates the process of inflammation? 1 Cytokines 2 Serotonin 3 Substance P 4 Prostaglandins

Cytokines enhance interactions and communications between the cells that hasten the process of inflammation. Serotonin is released from the brain stem and dorsal horn and plays a major role in the inhibition of pain transmission. Substance P transports pain impulses from the periphery to the central nervous system. Prostaglandins stimulate the pain receptors, thereby increasing sensitivity to pain.STUDY TIP: Serotonin helps you stay serenely pain free; seriously, it does!

A patient with terminal pancreatic cancer is receiving morphine via patient-controlled analgesia. After finding the patient nonresponsive, the nurse elevates the head of the bed, prepares naloxone, goes to the nurses' station to call for help, and informs the health care provider about the patient's situation. Which nursing action indicates the need for the nurse to develop skills in emergency management? 1 Elevating the head end of the patient's bed 2 Notifying the health care provider 3 Going to the nurses' station to call for help 4 Preparing to administer an opioid-reversing agent

Going to the nurses' station to call for help Opioid overdose may cause sleepiness in the patient. If the patient cannot be aroused, the nurse should not leave the patient's bedside. The nurse should elevate the head of the patient's bed unless contraindicated and notify the health care provider. Raising the head of the bed promotes lung expansion. The nurse should also prepare for the administration of an opioid-reversing agent to recover the patient from drowsiness.Test-Taking Tip: Look for answers that support safety! This question is an excellent example. It asks for what the nurse did incorrectly, which was to leave the patient's bedside.

A patient received morphine for pain 30 minutes ago. The nurse is assessing the patient and finds a respiratory rate of 5 breaths/minute. Which drug would the nurse anticipate administering immediately? 1 Meperidine 2 Naloxone 3 Flumazenil 4 Metoclopramide

Naloxone Morphine is an opioid and the low respiratory rate suggests respiratory depression due to opioid overdose. Therefore the patient should be given naloxone, which is an opioid-antagonist drug. This drug reverses the adverse effects of opioid drugs and therefore normalizes respiratory function. Meperidine is an opioid. Flumazenil is an antidote for benzodiazepines, and metoclopramide is an antiemetic. Administration of flumazenil would worsen the respiratory depression. An antiemetic would be administered to the patient only if the patient has nausea.STUDY TIP: When making a study sheet for a medication, include a section for the name of its antagonist drug.

A patient has undergone surgery to treat septic collection in the knee joints and is receiving morphine through a patient-controlled analgesia (PCA) device for management of pain. Several hours postop, the patient starts getting drowsy, and symptoms of respiratory depression start appearing. At which rate should the nurse administer the prescribed naloxone? 1 Administer naloxone 0.5 to 2 mg every 2 to 3 minutes to a maximum of 10 mg to increase the respiratory rate to more than 10 per minute. 2 Administer naloxone 2 to 4 mg every 4 to 6 minutes to a maximum of 10 mg to increase the respiratory rate to more than 10 per minute. 3 Administer naloxone 4 to 6 mg every 2 to 3 minutes to a maximum of 10 mg to increase the respiratory rate to more than 10 per minute. 4 Administer naloxone 0.4 to 2 mg every 2 to 3 minutes to a maximum of 10 mg to increase the respiratory rate to more than 10 per minute.

Naloxone is an antidote for respiratory depression caused by opioids. Administer naloxone 0.4 to 2 mg every 2 to 3 minutes to a maximum of 10 mg to increase the respiratory rate to more than 10 per minute. This dosage is optimal for reversal of respiratory depression. Naloxone 0.4 to 2 mg every 2 to 3 minutes to a maximum of 10 mg to increase the respiratory rate to more than 10 per minute is the preferred rate—not 0.5 to 2 mg every 2 to 3 minutes, 2 to 4 mg every 4 to 6 minutes, or 4 to 6 mg every 2 to 3 minutes.

During an assessment, the nurse asks the patient, "What does your pain feel like?" The patient states, "I have numbness and a tingling sensation interspersed with shooting pain." Which type of pain does the nurse infer from the patient's response? 1 Neuropathic pain 2 Breakthrough pain 3 Nociceptive visceral pain 4 Nociceptive somatic pain

Neuropathic pain is characterized by aching, crushing, stabbing, numbing, burning, shooting, and tingling sensations; therefore the nurse infers that this patient's pain is neuropathic. Pain that occurs between doses of long-acting narcotics is termed breakthrough pain. The pain originating from the soft internal organs such as the appendix, pancreas, and bladder is called nociceptive visceral pain. The pain originating from somatic sites such as skin, bone, tissues, and joints is called nociceptive somatic pain.

Which type of pain does a patient experience after undergoing minor surgery? 1 Chronic pain 2 Referred pain 3 Nociceptive pain 4 Psychogenic pain

Nociceptive pain Nociceptors are present on the sensory neurons on the skin and internally in the tissues and organs. These receptors carry sensory stimuli, including pain stimuli, from the site of injury to the cerebral cortex. Surgery involves cutting the patient's skin and the tissues that contain nociceptors, so a patient who has undergone minor surgery experiences nociceptive pain. Chronic pain refers to pain that lasts for a long period of time, approximately 3 months for surgical patients and longer than 6 months during a normal healing period. This type of pain is observed in conditions such as arthritis, fibromyalgia, and neuropathy. The patient would not likely experience chronic pain after minor surgery. Referred pain is observed in a patient who has pain at one particular site, but the perception of pain is felt at another site. It is observed in cases of appendicitis and myocardial infarction. Pain after surgery would be perceived at the site of the operation. Psychogenic pain occurs due to persistent mental and emotional factors, and there is no physical cause for the pain.

The nurse is caring for a patient with menstrual pain. Which classification of drugs does the nurse expect to find in the prescription? 1 Sedatives 2 Opioid analgesics 3 Nonopioid analgesics 4 Nonsteroidal antiinflammatory drugs

Nonsteroidal antiinflammatory drugs Menstrual pain originates in the uterus and therefore is considered visceral pain. Nonsteroidal antiinflammatory drugs are most effective in relieving menstrual pain. Sedatives are given to help patients relax. Opioid analgesics are administered for acute and cancer pain. Nonopioid analgesics such as acetaminophen are given for headaches and fever.

A patient will begin patient-controlled analgesia (PCA) of morphine. Which instruction is crucial for the nurse to give to family members and the patient regarding this route of medication administration? 1 Only the patient should push the button. 2 Do not use the PCA until the pain is severe. 3 The PCA prevents overdoses. 4 Notify the nurse when the button is pushed.

Only the patient should push the button. PCA is a system in which an electronically controlled infusion pump immediately delivers a prescribed amount of analgesia to the patient when he or she activates a button. Patient preparation and teaching are crucial when teaching safe and effective use of PCA devices. Patients should understand how the PCA works and be physically able to locate and press the button to deliver the dose. Family members should be instructed not to push the button for the patient. A patient should not wait until the pain is severe before pushing the PCA button. Breakthrough pain is more difficult to get under control; therefore the patient should be taught to press the button when he or she first begins to feel pain. The PCA can prevent overdosing due to its lockout effect. However, this is not crucial information for the patient or family members. The PCA pump records the number of times the patient presses the button and records the amount of medication delivered. The nurse will check the machine at least once a shift and chart the PCA information. The physician will review this documented information and make dosing decisions based on this recorded data.

Drug administration would be considered palliative in which situation? 1 Thyroid hormone replacement for a menopausal patient 2 Pain management for a patient with terminal cancer 3 Antibiotic therapy for a patient with a bacterial infection 4 Iron supplements for the treatment of iron-deficiency anemia

Pain management for a patient with terminal cancer Palliate means to alleviate without curing. Palliation therapy is typically used for patients with end-stage disease or illness to make them as comfortable as possible. An example is pain management for the terminally ill. Hormone replacement is used to prevent symptoms related to hormone deficiency. It may not be used as a curative therapy in all conditions. Hormone replacement is used as palliative therapy in menopausal women. Antibiotic therapy and iron supplementation are not typically palliative therapies; these are curative therapies.

Which concept do many complementary and alternative therapies share? 1 The use of herbs is a cornerstone of good health. 2 Touch should be used to relieve pain and reduce anxiety. 3 Patients are capable of decision making and should be a part of the health care team. 4 Patients should place the responsibility for their health and healing in the hands of alternative healers.

Patients are capable of decision making and should be a part of the health care team. The emphasis of alternative and complementary therapies is that the patient is viewed as a whole being, capable of decision making and an integral part of the health care team. The patient should be aware that proper nutrition, adequate rest, relaxation, exercise, and emotional health, not herbs, are cornerstones of good health. The use of touch has many forms and is used for a multitude of purposes such as increasing circulation, decreasing edema, promoting lymphatic drainage, relieving muscle tension, and improving the functioning of certain body systems. The road to healing is an individual journey; patients are encouraged to take responsibility for their own health and healing.Test-Taking Tip: Read the question carefully before looking at the answers. Determine what the question is really asking; look for key words. Read each answer thoroughly and see if it completely covers the material asked by the question. Narrow the choices by immediately eliminating answers you know are incorrect.

A patient with chronic low back pain who took an opioid around the clock for the past year decided to abruptly stop the medication for fear of addiction. The patient is now experiencing shaking chills, abdominal cramps, and joint pain. Which condition is this patient experiencing? 1 Addiction 2 Tolerance 3 Pseudoaddiction 4 Physical dependence

Physical dependence Physical dependence is a state of adaptation that is manifested by a drug class-specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Addiction is a psychological or emotional dependence on a prescribed medication or illicit drug. Tolerance is an adaptation to the medication which eventually leads to less effective pain relief. Pseudoaddiction is a term used to describe patient behaviors that may occur when pain is left untreated.Test-Taking Tip: Physical dependence has physical symptoms.

The nurse is caring for a patient who reports severe headaches. While interacting with the patient, the nurse learns that the patient lost his life partner and has a very stressful job. Which type of pain is the patient likely experiencing? 1 Visceral pain 2 Somatic pain 3 Psychogenic pain 4 Neuropathic pain

Psychogenic pain may result in headaches, stomach pain, and back pain. Psychogenic pain occurs due to mental, emotional, or behavioral factors. Visceral pain occurs in particular organs of the body and may be caused by conditions such as appendicitis or bladder distention. Somatic pain may occur due to injury to the skin, bone, muscle, and joints, including sunburn, lacerations, and fractures. Neuropathic pain results from damage to the peripheral or central nervous system.

Which energy therapy involves hand placement to correct or balance energy fields? 1 Reiki therapy 2 Hypnosis 3 Magnet therapy 4 Biofeedback

Reiki therapy Reiki therapy involves the use of hand placement to correct or balance energy fields, which restores health by restoring communication among cells, thereby diminishing pain. When utilizing Reiki therapy, the practitioner places hands on or above the body area and transfers universal life energy. It provides strength, harmony, and balance to treat a patient's health disturbances. Hypnosis, magnet therapy, and biofeedback can be used to diminish pain but do not involve hand placement to correct or balance energy fields.

The nurse asks the patient, "Are you experiencing any pain? If so, how would you rate your pain on a scale of 0 to 10?" Which aspect of a pain assessment is the nurse seeking? 1 Quality of pain 2 Severity of pain 3 Duration of pain 4 Precipitating factors of pain

Severity of pain The numeric rating scale is a pain assessment tool that determines the severity of pain by asking patients to rate their own pain on a scale from 1 to 10. Ratings of 1, 2, and 3 are considered mild pain; 4 through 7 are considered moderate pain; and 8 to 10 are considered severe or chronic pain. The nurse can assess the quality of pain by asking, "What does your pain feel like?" The nurse can assess the onset and duration of pain by asking, "When did your pain start?" To assess the precipitating factors of pain, the nurse can ask, "Does anything make the pain worse or better?"

The nurse is caring for a patient with severe pain due to muscle cramps. Which type of pain is the patient experiencing? 1 Somatic pain 2 Visceral pain 3 Referred pain 4 Radiating pain

Somatic pain refers to the localized pain caused by the activation of nociceptors. Muscle cramping refers to localized pain caused by the involuntary contraction of muscles, which contain nociceptors. Therefore muscle cramps can be categorized as somatic pain. Viscera refers to the soft internal organs of the body, such as those in the digestive, respiratory, urogenital, endocrine, and cardiovascular systems. The pain caused in these organs is known as visceral pain. If a patient has an injury at a particular site, but the pain is exhibited at another site, it is called referred pain. If a patient has pain at a site that extends to adjacent areas, it is called radiating pain.

Which neurotransmitter transports pain impulses from the periphery to the central nervous system? 1 Cytokines 2 Serotonin 3 Bradykinin 4 Substance P

Substance P is a proteinaceous neurotransmitter synthesized and packed in a perikaryon of a neuron that is then transported to the terminals by the axoplasmic transport process. This process carries pain impulses from the peripheral nervous system to the central nervous system. Cytokines are also proteinaceous neurotransmitters secreted by the immune system, but are involved in regulating the inflammation process. Serotonin is released from the brain stem and dorsal horn; it plays a major role in inhibiting pain transmission. Bradykinin is a peptide that acts on pain receptors and stimulates them. Bradykinins are produced in the blood and play an important role in mediating the inflammatory response.STUDY TIP: Substance P trans Ports Pain.

Which pain therapy involves the application of low-intensity current via skin electrodes in order to relieve pain? 1 Cordotomy 2 Sympathectomy 3 Spinal cord stimulation 4 Transcutaneous electrical nerve stimulation (TENS)

TENS is a type of neurosurgical pain therapy that consists of a small pocket-sized machine that has two electrodes and a battery. These electrodes, when connected to the skin, interfere with the transmission of pain impulses from the nerve fibers to the brain, thereby reducing the perception of the pain. A cordotomy is a surgical procedure that involves disabling the pain-conducting tracts in the spinal cord, thereby reducing the perception of severe or chronic pain. A sympathectomy is a surgical dissection in which the sympathetic ganglions conducting pain impulses are removed, thereby reducing the perception of pain. Spinal cord stimulation involves the implantation of a device into the epidural space that exerts pulsed electrical signals to treat chronic neurologic pain.Test-Taking Tip: Notice the word root in complex terms. For this question, cutane/o means skin in the word transcutaneous. Trans- means through, and the electrical signals of TENS are transmitted through the skin. With this observation, you can connect the description in the question, "via skin..." with the correct choice.

The nurse explains patient-controlled analgesia (PCA) to a patient. Which statement is best when determining whether the education was effective? 1 The device reduces the risk of overdose of medication. 2 The caregivers can operate the device if the patient is unable to do so. 3 The patient will be lying down in a prone lying position during the procedure. 4 The patient will decide about the loading dose of the analgesic drug.

The device reduces the risk of overdose of medication. A nurse should teach about the use of PCA to a patient before any procedure. It is important to tell the patient that PCA reduces the risk of overdose. It should be emphasized to the patient that the PCA device should not be operated by caregivers. The caregivers are not able to perceive the patient's pain and thus cannot decide if the medication is needed. The patient would be placed in a comfortable position in which the IV line is accessible. The prone position (face down) would not be a position of choice and would not be considered a comfortable position. The patient does not decide the loading dose of the drug. This is prescribed by the health care provider.

The nurse is caring for a patient who is receiving intravenous (IV) administration of patient-controlled narcotic analgesia. Which condition does the nurse monitor to ensure the patient safety? 1 Anxiety 2 Seizures 3 Hypertension 4 Respiratory depression

The most common route of administration of patient-controlled analgesia is the IV route. Respiratory depression is a safety concern with IV-administered narcotics and should be carefully monitored. Seizures are an adverse effect of agonist analgesics. Patient-controlled analgesia helps deliver only the required amount of analgesic; hence, the occurrence of these seizures is not likely in this patient. Anxiety and hypertension are signs of withdrawal from opioid drugs and need not be monitored during administration.

A postoperative patient, who was given an opioid one hour ago, is currently asleep. Which understanding of patient care would the nurse consider regarding this patient? 1 The opioid administered may have helped him sleep, but assessment of pain is still needed. 2 The intravenous 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.

The opioid administered may have helped him sleep, but assessment of pain is still needed. Sedatives, antianxiety agents, and muscle relaxants have no analgesic effect; however, they can cause drowsiness and impaired coordination, judgment, and mental alertness and contribute to respiratory depression. It is important to avoid attributing these adverse effects solely to the opioid. The nurse needs to conduct a thorough reassessment.

The nurse assesses that a patient is experiencing phantom pain. Which cause of pain is most likely? 1 The patient has a diagnosis of cancer. 2 The patient has an amputated extremity. 3 The patient had a myocardial infarction. 4 The patient has gastroesophageal reflux

The patient has an amputated extremity. Phantom pain occurs after a patient experiences a limb amputation. This pain occurs as the brain continues to receive messages from the area of an amputation. This phenomenon often subsides after several weeks, and the pain eventually dissipates. Visceral pain is associated with soft internal organs and is often related to cancer. Referred pain may occur due to myocardial infarction. Patients with gastroesophageal reflux and myocardial infarction may experience radiating pain.STUDY TIP: To recall that phantom pain is the result of an amputation, think of the "ghost" (phantom) of the amputated limb as the source of the pain. Even though the removed limb no longer exists, the pain is real to the patient!

The nurse assesses that a patient is experiencing phantom pain. Which cause of pain is most likely? 1 The patient has a diagnosis of cancer. 2 The patient has an amputated extremity. 3 The patient had a myocardial infarction. 4 The patient has gastroesophageal reflux.

The patient has an amputated extremity. Phantom pain occurs after a patient experiences a limb amputation. This pain occurs as the brain continues to receive messages from the area of an amputation. This phenomenon often subsides after several weeks, and the pain eventually dissipates. Visceral pain is associated with soft internal organs and is often related to cancer. Referred pain may occur due to myocardial infarction. Patients with gastroesophageal reflux and myocardial infarction may experience radiating pain.STUDY TIP: To recall that phantom pain is the result of an amputation, think of the "ghost" (phantom) of the amputated limb as the source of the pain. Even though the removed limb no longer exists, the pain is real to the patient!

After assessing a patient's pain level using the numeric rating scale, the nurse documents the score as 5. Which interpretation would the nurse make about this score? 1 The patient has no pain. 2 The patient has mild pain. 3 The patient has severe pain. 4 The patient has moderate pain

The patient has moderate pain A numeric rating scale is a 10-point pain scale used to verbally assess the intensity of pain. A score of 4 to 6 indicates that the patient has moderate pain. A score of 0 indicates that the patient is relaxed and comfortable without any pain. A score from 1 to 3 indicates mild pain, and a score of 7 to 10 indicates severe pain.STUDY TIP: Moderate pain is in the Middle (4 to 6) of the numeric scale (0 to10).

A patient who has a severe burning pain in the thighs has been prescribed a nonsteroidal antiinflammatory drug (NSAID). During the follow-up visit, the nurse notices the symptoms are still present and determines that the NSAIDs are not effective in alleviating the patient's symptoms. Which type of pain is the patient experiencing? 1 The patient has visceral pain. 2 The patient has cutaneous pain. 3 The patient has neuropathic pain. 4 The patient has breakthrough pain.

The patient has severe burning pain in the thighs, which indicates that the patient has neuropathic pain occurring as a result of damaged nerve endings. This leads to abnormal processing of pain messages from the site of injury to the cerebral cortex. NSAIDs reduce pain by decreasing prostaglandin levels, but they do not act by interfering with the transmission of painful stimuli. Therefore NSAIDs do not effectively relieve neuropathic pain. Visceral pain, cutaneous pain, and breakthrough pain can be treated effectively with NSAIDs because these are types of nociceptive pain. A patient who has visceral pain will experience deep squeezing pressure with local tenderness. A patient who has cutaneous pain will have a localized, dull aching pain. A patient with breakthrough pain will have episodic pain with the symptoms of acute pain.

Which description defines energy-based therapies? 1 The use of pharmaceutical stimulants to speed up healing 2 The use of muscle strength to quicken the healing process 3 The use of connections between thoughts and physiologic functioning using emotion 4 The use of a person's energy field to facilitate healing

The use of a person's energy field to facilitate healing Energy-based therapies include a disruption in the flow of energy resulting in symptoms of physical or psychological illness. Balancing and returning the optimal flow of energy facilitates healing. The use of pharmaceutical therapies is known as allopathy. Body-based and manipulative methods use muscle strength for healing. Mind-body interventions use connections between thoughts, emotion, and physiologic functioning to influence health and well-being.Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. In this question about energy-based therapies, the correct answer is the only one with the word "energy" included.

A patient asks the nurse about therapeutic touch. Which description of therapeutic touch does the nurse include when providing patient education? 1 Therapeutic touch balances energy fields and restores health by restoring communication among cells, thereby diminishing pain. 2 Therapeutic touch intentionally heals specific diseases or corrects certain symptoms. 3 Therapeutic touch is overwhelmingly effective in many conditions. 4 Therapeutic touch is completely safe and does not warrant any special precautions.

Therapeutic touch balances energy fields and restores health by restoring communication among cells, thereby diminishing pain. Therapeutic touch is focused on healing the whole person and providing energy to the body that supports innate healing responses. Hand placement to correct or balance energy fields restores health by restoring communication among cells, thereby diminishing pain. Systematic analyses claim that the research designs are too weak for any conclusive evidence to be identified with confidence that therapeutic touch possesses healing powers. Although therapeutic touch is relatively safe and there have been very few negative events associated with its use, all therapies (complementary or conventional) should be used with caution in certain populations.

A patient who has been using relaxation for pain desires a better response. The nurse recommends the addition of biofeedback. What is an expected outcome for biofeedback? 1 To eat less food 2 To control diabetes 3 To live longer with acquired immunodeficiency syndrome (AIDS) 4 To learn how to control some autonomic nervous system responses

To learn how to control some autonomic nervous system responses Biofeedback is a mind-body technique that teaches self-regulation and voluntary control over specific physiologic responses, including autonomic nervous system response. Control of body responses to pain is achieved via voluntary control over physiologic body activities, such as relieving muscle tension. Biofeedback does not cause a patient to eat less food, nor does it control diabetes. Biofeedback may be used to help relieve anxiety and muscle tension in patients with AIDS; however, there is no evidence that biofeedback increases the life span of those with AIDS.

A patient complains of nausea after receiving the first dose of morphine for pain. Which action by the nurse is appropriate? 1 Treating nausea with adjunctive medications 2 Administering half of the prescribed dose of morphine the next time 3 Encouraging the patient to wait as long as possible for the next dose 4 Withholding the next dose of morphine until the patient is evaluated by the health care provider

Treating nausea with adjunctive medications Opioids can cause nausea and vomiting because of the action on the brainstem centers. This side effect decreases with repeated use; however, treatment for nausea should be instituted. Adjunctive medications, or coanalgesic medications, work synergistically with standard pain medications to enhance pain relief and to treat side effects of the medication. Antiemetics are often administered with opioid analgesics to counteract the nausea and vomiting. 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.Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have increased the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.

During an assessment, the nurse asks the patient to describe the intensity of the pain perceived. Which pain-rating tool is the nurse using to assess the pain? 1 Numeric rating scale 2 Verbal descriptor scale 3 Noncognitive pain scale 4 Health assessment question box

Verbal descriptor scale The verbal descriptor scale is used to assess the intensity of pain by asking the patient to verbally describe the level of pain perceived. In the numeric rating scale, the nurse asks the patient to choose a number to rate the level of pain. The noncognitive pain scale is used for assessing pain in a nonverbal patient with a cognitive impairment. The health assessment question box contains a sample of questions concerning the location, intensity, and duration of pain.