Ch 12: Pain Management

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 patients pain? A)Treat the patient on the basis of objective signs of pain and reassess him frequently. B)Call the physician for new orders because it is apparent that the pain medicine is not working. C)Believe what the patient says, reinforce education, and reassess often. D)Ask the family what they think and treat the patient accordingly.

Ans: C Feedback: As always, the best guide to pain management and administration of analgesic agents in all patients, regardless of age, is what the individual patient says. However, further education and assessment are appropriate. You cannot usually treat pain the patient denies having if the orders are PRN only. The scenario does not indicate the present pain-management orders are not working for this patient. The family's insights do not override the patients self-report.

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. B)Pain medication can be increased when the pain becomes intense. C)It is difficult to control chronic pain, so this is an inevitable part of the disease process. D)The patient will likely benefit more from distraction than pharmacologic interventions.

Ans:A Feedback:Better pain control can be achieved with a preventive approach, reducing the amount of time patients arein pain. Low levels of pain are easier to reduce or control than intense levels of pain. Pain medication isused to prevent pain so pain medication is not increased when pain becomes intense. Chronic pain istreatable. Giving the patient alternative methods to control pain is good, but it will not work if thepatient is in so much pain that he cannot institute reliable alternative methods.

You are the nurse caring for a post surgical patient who is Asian-American who speaks very littleEnglish. How should you most accurately assess this patients pain? A)Use a chart with English on one side of the page and the patients native language on the other so he can rate his pain. B)Ask the patient to write down a number according to the 0-to-10 point pain scale. C)Use the Visual Analog Scale (VAS). D)Use the services of a translator each time you assess the patient so you can document the patients pain rating.

Ans:A Feedback:Of the listed options, a language comparison chart is most plausible. The VAS requires English language skills, even though it is visual. Asking the patient to write similarly requires the use of English. It is impractical to obtain translator services for every pain assessment, since this is among the most frequently performed nursing assessments.

You are frequently assessing an 84-year-old womans 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. B)Monitor for an increase in absorption of the drug due to age-related changes. C)Monitor for a paradoxical increase in pain with opioid administration. D)Administer analgesics every 4 to 6 hours as ordered to control pain.

Ans:A Feedback:Older people may respond differently to pain than younger people. Because elderly people have a slowermetabolism and a greater ratio of body fat to muscle mass compared with younger people, small doses ofanalgesic agents may be sufficient to relieve pain, and these doses may be effective longer. This fact alsocorresponds to an increased risk of adverse effects. Paradoxical effects are not a common phenomenon.Frequency of administration will vary widely according to numerous variables.

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 nurses best response? A)Over time you become more tolerant of the drug. B)You may have become immune to the effects of the drug. C)You may be developing a mild addiction to the drug. D)Your body absorbs less of the drug due to the cancer.

Ans:A Feedback:Over time, the patient is likely to become more tolerant of the dosage. Little evidence indicates that patients with cancer become addicted to the opioid medications. Patients do not become immune to the effects of the drug, and the body does not absorb less of the drug because of the cancer.

The nurse caring for a 79-year-old man who has just returned to the medicalsurgical unit followingsurgery for a total knee replacement received report from the PACU. Part of the report had been passedon from the preoperative assessment where it was noted that he has been agitated in the past followingopioid administration. What principle should guide the nurses management of the patients pain? A)The elderly may require lower doses of medication and are easily confused with new medications. B)The elderly may have altered absorption and metabolism, which prohibits the use of opioids. C)The elderly may be confused following surgery, which is an age-related phenomenon unrelated tothe medication. D)The elderly may require a higher initial dose of pain medication followed by a tapered dose.

Ans:A Feedback:The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and, therefore, the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion.Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors like environment. Opioids are not absolutely contraindicated and confusion following surgery is never normal. Medication should begin at a low dose and slowly increase until the pain is managed.

The home health nurse is developing a plan of care for a patient who will be managing his chronic painat home. Using the nursing process, on which concepts should the nurse focus the patient teaching? A)Self-care and safety B)Autonomy and need C)Health promotion and exercise D)Dependence and health

Ans:A Feedback:The patient will be at home monitoring his own pain management, administering his own medication, and monitoring and reporting side effects. This requires the ability to perform self-care activities in a safe manner. Creating autonomy is important, but need is a poorly defined concept. Health promotion is an important global concept for maintaining health, and exercise is an appropriate activity; however, self-care and safety are the priorities. Dependence is not a concept used to develop a nursing plan of care, and health is too broad a concept to use as a basis for a nursing plan of care.

You are caring for a patient with sickle cell disease in her home. Over the years, there has been jointdamage, and the patient is in chronic pain. The patient has developed a tolerance to her usual painmedication. When does the tolerance to pain medication become the most significant problem?A)When it results in inadequate relief from pain B)When dealing with withdrawal symptoms resulting from the tolerance C)When having to report the patients addiction to her physician D)When the family becomes concerned about increasing dosage

Ans:A Feedback:Tolerance to opioids is common and becomes a problem primarily in terms of maintaining adequate pain control. Symptoms of physical dependence may occur when opiates are discontinued, but there is no indication that the patients medication will be discontinued. This patient does not have an addiction and the family's concerns are secondary to those of the patient.

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 patients nursing care.What is the physiologic process by which noxious stimuli, such as burns, activate nociceptors? A)Transduction B)Transmission C)Perception D)Modulation

Ans:A Feedback:Transduction refers to the processes by which noxious stimuli, such as a surgical incision or burn, activate primary afferent neurons called nociceptors. Transmission, perception, and modulation are subsequent to this process.

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 nurses aide (NA) tells you that she is concerned because the patients 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 patients physiologic status? A)The patients understanding of pain physiology B)The patients serum glucose level C)The patients white blood cell count D)The patients rating of her pain

Ans:D Feedback:The nurses assessment of the patients pain is a priority. There is no suggestion of diabetes and leukocytosis would not occur at this early stage of recovery. The patient does not need to fully understand pain physiology in order to communicate the presence, absence, or severity of 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 patients care, what variables should you consider? Select all that apply. A)How the presence of pain affects patients and families B)Resources that can assist the patient with pain management C)The influence of the patients cognition on her pain D)The advantages and disadvantages of available pain-relief strategies E)The difference between acute and intermittent pain

Ans:A, B, D Feedback:Nurses should understand the effects of chronic pain on patients and families and should be knowledgeable about pain-relief strategies and appropriate resources to assist effectively with pain management. There is no evidence of cognitive deficits in this patient and the difference between acute and intermittent pain has no immediate bearing on this patients care.

Two patients on your unit have recently returned to the postsurgical unit after knee arthroplasty. Onepatient is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other patient is reporting a painlevel of 3 to 4 on the same pain scale. What is the nurses most plausible rationale for understanding thepatients different perceptions of pain? A)Endorphin levels may vary between patients, affecting the perception of pain. B)One of the patients is exaggerating his or her sense of pain. C)The patients are likely experiencing a variance in vasoconstriction. D)One of the patients may be experiencing opioid tolerance.

Ans:AFeedback:Different people feel different degrees of pain from similar stimuli. Opioid tolerance is associated with chronic pain treatment and would not likely apply to these patients. The nurse should not assume the patient is exaggerating the pain because the patient is the best authority of his or her existence of pain, and definition for patient state that pain is whatever the person says it is existing, whenever the experiencing person says it does.

Your patient is receiving postoperative morphine through a patient-controlled analgesic (PCA) pumpand the patients orders specify an initial bolus dose. What is your priority assessment?A)Assessment for decreased level of consciousness (LOC) B)Assessment for respiratory depression C)Assessment for fluid overload D)Assessment for paradoxical increase in pain

Ans:B Feedback:A patient who receives opioids by any route must be assessed frequently for changes in respiratory status. Sedation is an expected effect of a narcotic analgesic, though severely decreased LOC is problematic. Fluid overload and paradoxical increase in pain are unlikely, though opioid-induced hyperalgesia (OIH) occurs in rare instances.

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? A)Chronic B)Acute C)Intermittent D)Osteopenic

Ans:B Feedback:Acute pain is usually of recent onset and commonly associated with a specific injury. Acute pain indicates that damage or injury has occurred. Chronic pain is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributed to a specific cause or injury.Phantom pain occurs when the body experiences a loss, such as an amputation, and still feels pain in the missing part. Osteopenic pain is not a recognized category of pain.

You are admitting a patient to your rehabilitation unit who has a diagnosis of persistent, severe pain.According to the patients history, the patients pain has not responded to conventional approaches to painmanagement. What treatment would you expect might be tried with this patient?A)Intravenous analgesia B)Long-term intrathecal or epidural catheter C)Oral analgesia D)Intramuscular analgesia

Ans:B Feedback:For patients who have persistent, severe pain that fails to respond to other treatments or who obtain pain relief only with the risk of serious side effects, medication administered by a long-term intrathecal or epidural catheter may be effective. The other listed means of pain control would already have been tried in a patient with persistent severe pain that has not responded to previous treatment.

A medical nurse is appraising the effectiveness of a patients current pain control regimen. The nurse isaware that if an intervention is deemed ineffective, goals need to be reassessed and other measures needto be considered. What is the role of the nurse in obtaining additional pain relief for the patient?A)Primary caregiver B)Patient advocate C)Team leader D)Case manager

Ans:B Feedback:If the intervention was ineffective, the nurse should consider other measures. If these are ineffective, pain-relief goals need to be reassessed in collaboration with the physician. The nurse serves as the patients advocate in obtaining additional pain relief.

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 non-pharmacological methods of pain relief have been ineffective. What recommendation should guide this patients subsequent care? A)The patient may want to investigate new alternative pain management options that are outside theUnited States. B)The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options. C)The patient may want to increase his exercise and activities significantly to create distractions. D)The patient may want to relocate to long-term care in order to have his ADL needs met.

Ans:B Feedback:In some situations, especially with long-term severe intractable pain, usual pharmacologic and non-pharmacologic methods of pain relief are ineffective. In those situations, neurologic and neurosurgical approaches to pain management may be considered. Investigating new alternative pain-management options that are outside the United States is unrealistic and may even be dangerous advice.Increasing his exercise and activities to create distractions is unrealistic when a patient is in intractable pain and this recommendation conveys the attitude that the pain is not real. Moving into a nursing home so others may care for him is an intervention that does not address the issue of pain.

A nurse on an oncology unit has arranged for an individual to lead meditation exercises for patients who are interested in this non-pharmacological method of pain control. The nurse should recognize the use of what category of non-pharmacological intervention? A)A body-based modality B)A mind-body method C)A biologically based therapy D)An energy therapy

Ans:B Feedback:Meditation is one of the recognized mind-body methods of non-pharmacological pain control. The other answers are incorrect.

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? A)I didn't know that. I will speak to the doctor about your husbands pain control. B)Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the patient relief. C)Cancer is a chronic kind of pain so the more it hurts the patient, the more medicine we give the patient until it no longer hurts. D)Does the increasing medication dosage concern you?

Ans:B Feedback:Much pain associated with cancer is a direct result of tumor involvement. Conveying patient/family concerns to the physician is something a nurse does, but is not the best response by the nurse. Cancer pain can be either acute or chronic, and you do not tell a family member that you are going to keep increasing the dosage of the medication until it doesn't hurt anymore. The family member is obviously concerned.

A patients 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? A)Acetylcysteine B)Naloxone C)Celecoxib D)Acetylsalicylic acid

Ans:B Feedback:Severe opioid-induced sedation necessitates the administration of naloxone, an opioid antagonist.Celecoxib, acetylcysteine, and acetylsalicylic acid are ineffective.

The nurse is assessing a patients 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-10pain scale. How should the nurse best respond to this assessment finding? A)Remind the patient that he is indeed experiencing pain. B)Reinforce teaching about the pain scale number system. C)Reassess the patients pain in 30 minutes. D)Administer an analgesic and then reassess.

Ans:B Feedback:The patient is physically exhibiting signs and symptoms of pain. Further teaching may need to be doneso the patient can correctly rate the pain. The nurse may also verify that the same scale is being used bythe patient and caregiver to promote continuity. Although all answers are correct, the most accurateconclusion would be to reinforce teaching about the pain scale.

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 patients care, what do you know about the negative effects of the stress associated with pain? A)Stress is less pronounced in older adults because they generally have more sophisticated coping skills than younger adults B)It is particularly harmful in the elderly who have been injured or who are ill. C)It affects only those patients who are already debilitated prior to experiencing pain. D)It has no inherent negative effects; it just alerts the person/health care team of an underlying disease process.

Ans:B Feedback:The widespread endocrine, immunologic, and inflammatory changes that occur with the stress of pain can have significant negative effects. This is particularly harmful in patients whose health is already compromised by age, illness, or injury. Older adults are not immune to the negative effects of stress.Prior debilitation does not have to be present in order for stress to cause potential harm.

You are caring for a 20-year-old patient with a diagnosis of cerebral palsy who has been admitted for therelief 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. A)Patients gender B)Patients comorbid conditions C)Type of procedure be performed D)Changes in neurologic function due to the procedure E)Prior effectiveness in relieving the pain

Ans:B, C, D, E Feedback:The nursing care of patients who undergo procedures for the relief of chronic pain depends on the typeof procedure performed, its effectiveness in relieving the pain, and the changes in neurologic function that accompany the procedure. The patients c morbid conditions will also affect care, but his gender is not a key consideration.

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 non-steroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner? A)To prevent respiratory depression from the opioid B)To eliminate the need for additional medication during the night C)To achieve better pain control than with one medication alone D)To eliminate the potentially adverse effects of the opioid

Ans:C Feedback:A multimodal regimen combines drugs with different underlying mechanisms, which allows lower doses of each of the drugs in the treatment plan, reducing the potential for each to produce adverse effects.This method also reduces, but does not eliminate, adverse effects of the opioid. This regimen is not motivated by the need to prevent respiratory depression or to eliminate nighttime dosing.

Your patient has just returned from the postanesthetic care unit (PACU) following left tibia openreduction internal fixation (ORIF). The patient is complaining of pain, and you are preparing toadminister the patients first scheduled dose of hydromorphone (Dilaudid). Prior to administering thedrug, you would prioritize which of the following assessments? A)The patients electrolyte levels B)The patients blood pressure C)The patients allergy status D)The patients hydration status

Ans:C Feedback:Before administering medications such as narcotics for the first time, the nurse should assess for any previous allergic reactions. Electrolyte values, blood pressure, and hydration status are not what you need to assess prior to giving a first dose of narcotics.

A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of post-surgical patients pain. What principle should guide the nurses use of placebos in pain management? A)Placebos require a higher level of informed consent than conventional care. B)Placebos are an acceptable, but unconventional, form of non-pharmacological pain management. C)Placebos are never recommended in the treatment of pain. D)Placebos require the active participation of the patients family.

Ans:C Feedback:Broad agreement is that there are no individuals for whom and no condition for which placebos are there commended treatment. This principle supersedes the other listed statements

You are the home health nurse caring for a homebound client who is terminally ill. You are delivering apatient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will betaking care of the patient. What would your priority nursing interventions be for this visit? A)Teach the family the theory of pain management and the use of alternative therapies. B)Provide psychosocial family support during this emotional experience. C)Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication. D)Provide family teaching regarding use of morphine, recognizing morphine overdose, and offering spiritual guidance.

Ans:C Feedback:If PCA is to be used in the patients home, the patient and family are taught about the operation of the pump as well as the side effects of the medication and strategies to manage them. The family would also need to monitor the IV site and notify the nurse of any changes, such as infiltration, that could end anger the patient. Teaching the family the theory of pain management or the use of alternative therapies and the nurse providing emotional support are important, but the family must be able to operate the pump as well as know the side effects of the medication and strategies to manage them. Offering spiritual guidance would not be a priority at this point and morphine is not the only medication administered byPCA.

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? A)Use a pain scale to assess the patients pain, and let the patient know ibuprofen is available every 6hours if she needs it. B)Do a complete assessment, and give pain medication based on the patients report of pain. C)Check for allergies, use a pain scale to assess the patients pain, and offer the ibuprofen every 6hours until the patient is discharged. D)Provide medication as per patient request and offer relaxation techniques to promote comfort.

Ans:C Feedback:One way preventive pain measures can be implemented is by using PRN medications on a more regular or scheduled basis to allow for more uniform pain control. Smaller drug doses of medication are needed with the preventive pain method when PRN medications are given around the clock. Offering the medication is more beneficial than letting the patient know ibuprofen is available.

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 patients pain in her plan of nursing care, the nurse should consider what characteristic of cancer pain? A)Cancer pain is often related to the stress of the patient knowing she has cancer and requires relatively low doses of pain medications along with a high dose of anti-anxiety medications. B)Cancer pain is always chronic and challenging to treat, so distraction is often the best intervention. C)Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications. D)Cancer pain is often misreported by patients because of confusion related to their disease process.

Ans:C Feedback:Pain associated with cancer may be acute or chronic. Pain resulting from cancer is so ubiquitous that when cancer patients are asked about possible outcomes, pain is reported to be the most feared outcome.Higher doses of pain medication are usually needed with cancer patients, especially with metastasis.Cancer pain is not treated with anti-anxiety medications. Cancer pain can be chronic and difficult to treat so distraction may help, but higher doses of pain medications are usually the best intervention. No research indicates cancer patients misreport pain because of confusion related to their disease process.

An unlicensed nursing assistant (NA) reports to the nurse that a post surgical 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 nurses best response? A)Pain often comes and goes with post surgical patients. Please ask her about pain again in about 30minutes. B)We need to provide pain medications because it is the law, and we must always follow the law. C)Unless there is strong evidence to the contrary, we should take the patients report at face value. D)Its not unusual for patients to misreport pain to get our attention when we are busy.

Ans:C Feedback:A broad definition of pain is whatever the person says it is, existing whenever the experiencing person says it does. Action should be taken unless there are demonstrable extenuating circumstances. The other answers are incorrect.

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? A)Anxiety B)Skin breakdown C)Depression D)Hallucination

Ans:CFeedback:Depression is associated with chronic pain and can be exacerbated by the effects of chronic fatigue.Anxiety is also plausible, but depression is a paramount risk. Skin breakdown and hallucinations are much less likely.

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? A)The proliferation of nociceptors during times of stress B)Age-related deterioration of the central nervous system C)Psychosocial dependence on pain medications D)The abnormal reorganization of the nervous system

Ans:D Feedback:At any point from the periphery to the CNS, the potential exists for the development of neuropathic pain. Hyper excitable nerve endings in the periphery can become damaged, leading to abnormal reorganization of the nervous system called neuroplasticity, an underlying mechanism of some neuropathic pain states.Neuropathic pain is not a result of age-related changes, nociceptor proliferation, or dependence on medications.

The nurse is accepting care of an adult patient who has been experiencing severe and intractable pain.When reviewing the patients medication administration record, the nurse notes the presence of gabapentin (Neurontin). The nurse is justified in suspecting what phenomenon in the etiology of the patients pain? A)Neuroplasticity B)Misperception C)Psychosomatic processes D)Neuropathy

Ans:DFeedback:The anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) are first-line analgesic agents for neuropathic pain. Neuroplasticity is the ability of the peripheral and central nervous systems to change both structure and function as a result of noxious stimuli; this does not likely contribute to the patients pain. Similarly, psychosomatic factors and misperception of pain are highly unlikely.

You are the case manager for a 35-year-old man being seen at a primary care clinic for chronic low backpain. When you meet with the patient, he says that he is having problems at work; in the past year he hasbeen absent from work about once every 2 weeks, is short-tempered with other workers, feels tired allthe time, and is worried about losing his job. You are developing this patients plan of care. On whatshould the goals for the plan of care focus?A)Increase the patients pain tolerance in order to achieve psychosocial benefits. B)Decrease the patients need to work and increase his sleep to 8 hours per night. C)Evaluate other work options to decrease the risk of depression and ineffective coping. D)Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety.

Ans:D Feedback:Chronic pain may affect the patients quality of life by interfering with work, interpersonal relationships, or sleep. Thus, the best set of goals would be to decrease time lost from work to increase the quality of interpersonal relationships, and decrease anxiety. Increasing pain tolerance is an unrealistic and inappropriate goal; exercise could help, but would not be the focus of the plan of care. Decreasing the need to work does not address his pain. Evaluating other work options to decrease the risk of depression is a misdirected diagnosis.

The nurse caring for a 91-year-old patient with osteoarthritis is reviewing the patients chart. This patientis on a variety of medications prescribed by different care providers in the community. In light of theQSEN competency of safety, what is the nurse most concerned about with this patient?A)Depression B)Chronic illness C)Inadequate pain control D)Drug interactions

Ans:D Feedback:Drug interactions are more likely to occur in older adults because of the higher incidence of chronic illness and the increased use of prescription and OTC medications. The other options are all good answers for this patient because of the patients age and disease process. However, they are not what the nurse would be most concerned about in terms of ensuring safety.

You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis and a secondarydiagnosis of chronic pain. What common trait of patients who live with chronic pain should inform yourcare planning? A)They are typically more comfortable with underlying pain than patients without chronic pain. B)They often have a lower pain threshold than patients without chronic pain. C)They often have an increased tolerance of pain. D)They can experience acute pain in addition to chronic pain.

Ans:D Feedback:It is tempting to expect that people who have had multiple or prolonged experiences with pain will be less anxious and more tolerant of pain than those who have had little experience with pain. However, this is not true for many people. The more experience a person has had with pain, the more frightened he or she may be about subsequent painful events. Chronic pain and acute pain are not mutually exclusive.

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? A)Distorting the action potential that is transmitted along the A-delta (d) and C fibers B)Diverting noxious information from passing through the dorsal root ganglia and synapses in the dorsal horn of the spinal cord C)Blocking modulation by limiting the reuptake of serotonin and norepinephrine D)Inhibiting transduction by blocking the formation of prostaglandins in the periphery

Ans:D Feedback:NSAIDs produce pain relief primarily by blocking the formation of prostaglandins in the periphery; this is a central component of the pathophysiology of transduction. NSAIDs do not act directly on the aspects of transmission, perception, or modulation of pain that are listed.

her daughters 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? A)The dose range is higher with cancer patients, and the medical team will be very careful to prevent addiction. B)Frequently, female patients and younger patients need higher doses of opioids to be comfortable. C)The increased risk of overdose is an inevitable risk of maintaining adequate pain control duringcancer treatment. D)There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.

Ans:D Feedback:Patients requiring opioids for chronic pain, especially cancer patients, need increasing doses to relieve pain. The requirement for higher drug doses results in a greater drug tolerance, which is a physical dependency as opposed to addiction, which is a psychological dependency. The dose range is usually higher with cancer patients. Although tolerance to the drug will increase, addiction is not dose related, but is a separate psychological dependency issue. No research indicates that women and/or younger people need higher doses of morphine to be comfortable. Overdose is not an inevitable risk.

The nurse is caring for a male patient whose diagnosis of bone cancer is causing severe and increasing pain. Before introducing non-pharmacological pain control interventions into the patients plan of care, the nurse should teach the patient which of the following? A)Non-pharmacological interventions must be provided by individuals other than members of the healthcare team. B)These interventions will not directly reduce pain, but will refocus him on positive stimuli. C)These interventions carry similar risks of adverse effects as analgesics. D)Reducing his use of analgesics is not the purpose of these interventions.

Ans:D Feedback:Patients who have been taking analgesic agents may mistakenly assume that clinicians suggest a non-pharmacolgical method to reduce the use or dose of analgesic agents. Non-pharmacological interventions indeed reduce pain and their use is not limited to practitioners outside the healthcare team.In general, adverse effects are minimal.

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 patients behavior? A)Fibromyalgia is not a chronic pain syndrome, so further assessment is necessary. B)The patient is likely frustrated because she has to be in the hospital. C)The patient likely has an underlying psychiatric disorder. D)Chronic pain can cause intense emotional responses.

Ans:D Feedback:Regardless of how patients cope with chronic pain, pain that lasts for an extended period can result in depression, anger, or emotional withdrawal. Nowhere in the scenario does it indicate the patient is upset about the hospitalization or that she has a psychiatric disorder. Fibromyalgia is closely associated with chronic pain.