Pain Management

A nurse is providing discharge teaching for a patient with a fractured humerus. The patient is going home with hydrocodone. Which important patient education does the nurse provide? a. "You need to drink plenty of fluids and eat a diet high in fiber." b. "Narcotics can be addictive, so do not take them unless you are in severe pain." c. "Be sure to eat a meal high in fat before taking the medication, to avoid a stomach ulcer." d. "As your pain severity lessens, you will begin to give yourself once-daily intramuscular injections."

a. "You need to drink plenty of fluids and eat a diet high in fiber." A common side effect of opioid analgesics is constipation. Therefore, the nurse encourages the patient to drink fluids and eat fiber to prevent constipation. Although medications can be irritating to the stomach, eating a diet high in fat does not prevent gastric ulcers. To best manage pain, the patient needs to take pain medication before painful procedures or activities or before pain becomes severe. As the patient's pain gets better, the strength of the medications will decrease. IM, IV, and topical analgesics are used for more severe and chronic pain.

A nurse is caring for a group of patients. Which patient will the nurse see first? a. A patient who received morphine and has a pulse of 62 beats/min, respirations 10 breaths/min, and blood pressure 110/60 mm Hg. b. A patient lying very still in bed who reports no pain but is pale with warm, dry skin. c. A patient with severe pain who is nauseated and feels like he or she is about to vomit. d. A patient writhing and moaning from abdominal pain after abdominal surgery

a. A patient who received morphine and has a pulse of 62 beats/min, respirations 10 breaths/min, and blood pressure 110/60 mm Hg. A respiratory rate of 10 indicates respiratory depression. A rare adverse effect of opioids in opioid-naïve patients (patients who have used opioids around the clock for less than approximately 1 week) is respiratory depression. Naloxone (Narcan) may be administered. While the other patients are experiencing pain and do needto be seen, they are not the priority since respirations are not affected.

The nurse is caring for a group of patients. Which task may the nurse delegate to the nursing assistive personnel (NAP)? a. Administer a back massage to a patient with pain. b. Assessment of pain for a patient reporting abdominal pain. c. Administer patient-controlled analgesia for a postoperative patient. d. Assessment of vital signs in a patient receiving epidural analgesia.

a. Administer a back massage to a patient with pain. A massage may be delegated to an NAP. Pain assessment is a nursing function and cannot be delegated to anNAP. Administration of patient-controlled analgesia (PCA) cannot be delegated to an NAP. Assessment of vital signs is a licensed nursing function; the NAP can take vital signs for a patient receiving epidural analgesia.

A patient admitted with metastatic lung cancer is ordered to receive morphine sulfate for pain. You should assess for which of the following common adverse reactions to this medication? a. Constipation b. Agitation c. Diarrhea d. Urinary incontinence

a. Constipation Morphine sulfate is an opioid analgesic that can lead to constipation as a side effect. It is very important to use countermeasures, such as increased fiber and fluids in the diet, whenever possible, to prevent this side effect.

You are caring for a postoperative patient receiving epidural fentanyl for pain relief. For which of the following common side effects will you monitor the patient (Select all that apply)? a. Nausea b. Itching c. Urinary retention d. Ataxia

a. Nausea b. Itching Common side effects of intraspinal opioids include nausea, itching, and urinary retention. Ataxia is a common side effect of intraspinal clonidine.

The nurse is administering ibuprofen (Advil) to an older patient. Which of the following assessment data causes the nurse to hold the medication? (Select all that apply.) a. Past medical history of gastric ulcer. b. Patient states last bowel movement was 4 days ago. c.Stated allergy to aspirin. d. Patient states has 2/10 intermittent joint pain. e. Patient experienced respiratory depression after administration of an opioid medication

a. Past medical history of gastric ulcer. c.Stated allergy to aspirin. NSAIDs can cause bleeding, especially in the gastrointestinal (GI) tract; therefore,NSAIDs are most likely contraindicated in this patient. Patients with an allergy to aspirin or have asthma are sometimes also allergic to other NSAIDs. The nurse needs to verify that the health care provider is aware of the history of GI bleeding and of allergy to aspirin before administering ibuprofen. NSAIDs do not interfere with bowel function and are used for the treatment of mild to moderate acute intermittent pain. NSAIDs also do not suppress the central nervous system by causing respiratory depression.

A nurse is caring for a patient with rheumatoid arthritis who is now going to be taking 2 acetaminophen (Tylenol) tablets every 6 hours to control pain. Which part of the patient's social history is the nurse most concerned about? a. Patient drinks 1 to 2 glasses of wine every night. b. Patient smokes 2 packs of cigarettes a day. c. Patient occasionally smokes marijuana. d. Patient takes antianxiety medications.

a. Patient drinks 1 to 2 glasses of wine every night. The major adverse effect of acetaminophen is hepatotoxicity (liver toxicity). Because both alcohol and acetaminophen are metabolized by the liver, when taken together, they can cause liver damage. Smoking cigarettes and smoking marijuana are not healthy behaviors, but their effects on health are not affected by acetaminophen. Antianxiety medications can be taken with acetaminophen.

You would question an order written for Percocet for a patient exhibiting which of the following clinical manifestations? a. Severe jaundice b. Oral candidiasis c. Increased urine output d. Elevated blood glucose

a. Severe jaundice Acetaminophen and oxycodone are the ingredients in Percocet. Because acetaminophen is metabolized in the liver, the patient could develop acetaminophen toxicity in the presence of severe liver disease (evidenced by jaundice). The prudent nurse would question the order before administration.

To reduce the risk of adverse effects, you should do which of the following when caring for a patient receiving morphine sulfate via patient-controlled analgesia (PCA)? a. Teach the caregiver not to push the button for the patient. b. Instruct the patient not to push the button too frequently. c. Ask the patient to do deep breathing exercises every hour. d. Administer medications to prevent the occurrence ofdiarrhea.

a. Teach the caregiver not to push the button for the patient. It is important to teach the caregiver not to push the button for the patient because it is only the patient who can determine the need for the medication. If the caregiver pushes the button, the patient could receive more of a dose than is actually needed, and this increases the risk of adverse effects.

The nurse is caring for a patient who suddenly experiences chest pain. What is the nurse's first priority? a. Call the rapid response team. b. Ask the patient to rate and describe the pain. c. Raise the head of the bed. d. Administer pain relief medications.

b. Ask the patient to rate and describe the pain. The nurse's ability to establish a nursing diagnosis, plan and implement care, and evaluate the effectiveness of care depends on an accurate and timely assessment. The other responses are all interventions; the nurse cannot know which intervention is appropriate until the nurse completes the assessment.

Which of the following nursing interventions is most appropriate when preparing to administer an opioid analgesic agent? a. Give the medication on an empty stomach. b. Count the number of doses on hand before administration. c. Give the medication with a glass of juice or other cold beverage. d. Assess the patient for allergies to aspirin before administration.

b. Count the number of doses on hand before administration. Because opioid analgesics are controlled substances, the nurse needs to count the number of doses and check that it matches the number recorded before removing and administering the medication.

After administering acetaminophen and oxycodone (Percocet) for complaints of pain, which of the following interventions would be of highest priority for the nurse to complete before leaving the patient's room? a. Leave the overbed light on at low setting. b. Ensure that the upper two side rails are raised. c. Offer to turn on the television to provide distraction. d. Ensure that documentation of intake and output is accurate.

b. Ensure that the upper two side rails are raised. Percocet has acetaminophen and oxycodone (a class III controlled substance) as ingredients. Since the medication contains an opioid analgesic with sedative properties, the nurse must ensure patient safety before leaving the room, such as leaving the top two bedrails raised. This will help prevent the patient from falling from bed, while not restraining the patient (as four side rails would do).

A patient is receiving opioid medication through an epidural infusion. Which action will the nurse take? a. Restrict fluid intake. b. Label the tubing that leads to the epidural catheter. c. Apply a gauze dressing to the epidural catheter insertion site. d. Ask the nursing assistive personnel to check on the patient at least once every 2 hours.

b. Label the tubing that leads to the epidural catheter. To reduce the accidental administration of IV medications into the epidural catheter, the tubing that leads to the epidural catheter needs to be labeled clearly. The epidural insertion site needs to be covered by a transparent dressing to prevent infection and allow the nurse to assess the site. Patients receiving epidural anesthesia need to be monitored every 15 minutes until stabilized and then at least hourly for 12 to 24 hours.

A nurse is caring for a patient who fell on the ice and has connective tissue damage in the wrist and hand. What does type of pain does the nurse document that the patient has? a. Visceral pain b. Somatic pain c. Peripherally generated pain d. Centrally generated pain

b. Somatic pain Somatic pain comes from bone, joint, connective tissue, or muscle. Visceral pain arises from the visceral (internal) organs such as the GI tract and pancreas. Peripherally generated pain in the peripheral nerves can be caused by polyneuropathies or mononeuropathies. Centrally generated pain results from injury to the central or peripheral nervous system, causing deafferentation or sympathetically maintained pain.

When assessing a patient receiving morphine sulfate 2 mg every 10 minutes via PCA pump, the nurse should take action as soon as the patient's respiratory rate would drop down to or below which of the following parameters? a. 16 Breaths/min b. 14 Breaths/min c. 12 Breaths/min d. 10 Breaths/min

c. 12 breaths/min To protect the patient from adverse effects of respiratory depression from this medication, the nurse should alert the physician as soon as the respiratory rate drops down to or below 12 breaths/min.

You should teach a patient to avoid which of the following medications while taking ibuprofen? a. Morphine sulfate (generic) b. Nitroglycerin (Nitro-Bid) c. Aspirin d. Furosemide (Lasix)

c. Aspirin The patient should not take aspirin while taking ibuprofen because the combination could increase the risk of GI bleeding.

Which of the following is the best way for the nurse to manage pain for a patient with chronic pain from arthritis? a. Administer pain medication before any activity. b. Provide intravascular bolus as needed for breakthrough pain. c. Give medications around-the-clock. d. Administer pain medication only when nonpharmacological measures have failed.

c. Give medications around-the-clock. When a patient with arthritis has chronic pain, the best way to manage pain is to take medication regularly throughout the day to maintain constant pain relief. "Before any activity" is nonspecific, and the medication may not have time to work before activity. If the patient waits until having pain (7/10) to take the medication, pain relief takes longer. Nonpharmacological measures are used in conjunction with medications unless requested otherwise by the patient.

Which of the following assessments is of highest priority for you to complete before administration of morphine? a. Pain rating b. Blood pressure c. Respiratory rate d. Level of consciousness

c. Respiratory rate Decreased respirations below a rate of 12/min are a sign of opioid toxicity. Using the ABC approach in prioritization of care, a patent airway is always the first priority and is important to assess as a baseline before and during the administration of morphine.

The nurse should instruct a patient receiving NSAIDs to report which of the following adverse effects? a. Blurred vision b. Nasal stuffiness c. Urinary retention d. Black or tarry stools

d. Black or tarry stools Black, tarry stools could indicate GI bleeding, which is a risk associated with NSAIDs. For this reason, the patient should be taught to report this sign and other signs of bleeding immediately.

Which of the following clinical manifestations would you attribute to adverse effects of morphine sulfate administered via PCA? a. Urinary incontinence b. Increased blood pressure c. Diarrhea d. Nausea and vomiting

d. Nausea and vomiting Morphine sulfate promotes nausea and vomiting by directly stimulating the chemoreceptor trigger zone in the medulla. Other common side effects include constipation, sedation, respiratory depression, and pruritus.