Ch. 4

The nurse is assessing a patient who receiving opioid medication via a patient-controlled analgesia device. The patient is very drowsy and difficult to arouse. What should the nurse do first?

Stay with the patient and discontinue the basal rate

The nurse is assessing the patient for chronic pain or discomfort. Which is the best question to use to elicit the quality of the pain?

"How would you describe your pain"

The nurse is interviewing a patient who frequently comes to the clinic to obtain medication for chronic back pain. The patient states, "I know you guys think I am faking, but I hurt and I am really sick of your attitude." What is the best response?

"Sir, tell me about your pain and how it is affecting your life"

The health care provider prescribes 7 mg morphine IV as needed (PRN). The nursing student prepares the medication and shows the syringe to the nursing instructor. What should the nursing instructor do first?

.7 mL- Ask the student to demonstrate the calculations and steps required to prepare the dose.

Which patient is least likely to be a good candidate for patient-controlled analgesia?

25 year old female with intermittent lucidity after a severe head injury

Which patient is having pain that is unlikely to respond to first-line opioid and nonopioid medication?

70-year-old woman with postherpetic neuralgia

Which patient is most likely to receive a prescription for gabapentin?

A patient who has persistent burning and tingling sensation in the lower extremities.

A nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen (Advil) for discomfort associated with osteoarthritis and notifies the health care provider. Which drug does the nurse expect with MOST likely be prescribed instead of the Advil?

Acetaminophen (Tylenol)

Based on evidence-based practice, what is the best choice for managing chronic pain for a 73-year old female with osteoarthritis?

Acetaminophen is the primary drug of choice

The nurse is reviewing the patient's medication list and sees that acetaminophen and celecoxib are scheduled to be administered at the same time. What should the nurse do?

Administer the medications as ordered because they can be given together without ill effects.

Based on the concept of comfort, what is the expected physiologic consequence of taking a mu opioid agonist?

An increase in dosage yields an increase in pain relief

What is the best way to schedule medication for a client with constant pain?

Around-the-clock

A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do?

Assess the client's pain before increasing the dose of the morphine

A client received "as needed" (PRN) morphine, lorazepam (Ativan), and cyclobenzaprine (Flexeril). The UAP reports that the client has a respiratory rate of 10/min. What is the priority action?

Assess the client's responsiveness and respiratory status.

On the first day after surgery, a client receiving an analgesic via PCA pump reports that the pain control is inadequate. What is the first action you should take?

Assess the pain for location, quality, and intensity.

A new, inexperienced nurse sees that the patient is receiving around-the-clock medication but also has orders for pre analgesic every 4-6 hours as needed. How will the new nurse determine when a pen dose is given?

Assess the patient for breakthrough pain and anticipate painful procedures

The nurse is caring for a patient of the first postoperative day. The patient denies pain, but his blood pressure and pulse are elevated and he is diaphoretic and anxious. What should the nurse do first?

Assess the patient for postoperative complications or barriers to reporting pain.

The nurse is assessing a patient with severe dementia who resides in a long-term care facility A score of 9 is obtained using the Pain Assessment in Advanced Dementia Scale. Based on assessment findings, which action will the nurse take?

Assess the patient for the source of the pain and immediately inform the health care provider

The nurse is performing a pain assessment on a patient who has abdominal surgery. He was just transferred from the intensive care unit to medical surgical unit. Which question would the nurse ask?

Can you tell me about any pain or discomfort you are having?

The nurse is assessing a client who has been receiving opioid medication via patient-controlled analgesia. What is an early sign that alerts the nurse to a possible adverse opioid reaction?

Client is more difficult to arouse

In application of the principles of pain treatment, what is the first consideration?

Client's perception of pain must be accepted

The nurse is giving discharge instructions about multimedia analgesia to a daughter who will care for her elderly father at home while he recovers from surgery. The daughter suggests that the single best medication should be recommended for convenience and to save money. What is the best response?

Combining different analgesics gives greater relief with lower doses and fewer side effects

Which assessment would the nurse perform to determine if a patient would be an appropriate candidate for using imagery as a distraction therapy?

Confirm that the patient can follow a logical and sustained conversation.

A client who had abdominal surgery is receiving patient-controlled analgesia (PCA) intravenously to manage pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the client with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is still experiencing pain. What should the nurse do FIRST?

Determine the integrity of the intravenous delivery system

The health care provider informs the nurse that a young patient should receive morphine for severe pain but that caution is needed because the patient is opioid naïve. Which consideration is the most important in caring for and observing the patient?

Excessive sedation can progress to clinically significant respiratory depression

What is the best type of pain scale to use for children or for adult patients who have language barrier or reading problems?

FACES (smile to frown)

Which drug can cause adverse effects, particularly in an older adult, because of an accumulation of toxic metabolites?

Meperidine

The nurse is assessing an elderly patient who has "pain all over." Which strategy would the nurse use to help the patient identify which areas of the body are painful?

Focus on the hand and fingers of one extremity.

A client with diabetic neuropathy reports a burning, electrical-type pain in the lower extremities that is worse at night and not responding to nonsteroidal anti-inflammatory drugs. Which medication will you advocate for first?

Gabapentin

A client receiving morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate?

Naloxone administration

Based on the client's reported pain level, the nurse administers 8mg of the prescribed morphine. The medication is available in a 10mg syringe. Wasting of the remaining 2mg of morphine should be done by the nurse and a witness. Who should be the witness?

Licensed practical nurse (LPN)

Which behavior exemplifies the nurse's primary role in assessing and managing the patient's pain?

Listens to and accepts the self-report of pain and assess patient's preferences and values.

In assessing pain in an older adult patient, what is a major barrier to accurate assessment?

Many older adults are reluctant to report pain.

In the PACU it is reported that the client received intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as pert of the client's INITIAL 24-hour postoperative care?

Monitoring of respiratory rate hourly

The nurse is caring for patient who has an epidural catheter for pain management. Which information is appropriate in the care of this patient?

Morphine and hydromorphone may be used with a local anesthetic such as bupivacaine.

The nurse is caring for a postoperative client who reports pain. Based on recent evidence-based guidelines, which approach would be best?

Multimodal strategies

The nurse is reviewing the medication list for a patient who had open heart surgery. The nurse is likely to quests the prescription for which medication because prostaglandin inhibition is associated with adverse cardiovascular effects?

Naproxen

Acetaminophen is the first-line medication for which patient?

Needs relief from pain related to a minor surgical procedure

An older patient requires an NSAID for inflammatory pain. The nurse would seek an order for what type of additional medication to accompany the NSAID therapy?

Nonopioid analgesic, such as lansoprazole

The nursing student is using the Wong-Baker FACES pain rating scale to assess the pain of a 4-year-old child. The nurse would intervene if the student performed which action?

Observes the child's facial expression and matches it to a face on the scale

For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take?

Obtain baseline behavioral indicators from family members.

A client reports severe pain 2 days after surgery. Which initial action should the nurse take after assessing the character of the pain?

Obtain vital signs

The patient reports that he has chronic lower back pain that is not relieved by the prescribed medication and that the primary care provider is unwilling to prescribe anything stronger. Who should the nurse consult first?

Pain resource nurse

A patient with chronic leg pain reports pain level at 7/10, so the nurse administers a prn medication. Which observation best suggests that the function goal of therapy is being met?

Patient ambulates independently down the hall without distress.

The nurse is assessing the patient's use of transdermal fentanyl and discovers that the patient is making several errors. Which behavior is most likely to result in fentanyl-induced respiratory depression?

Patient is placing a heating pad over the patch

The patient reports pruritus related to taking an opioid medication. What medication prescription would the obtain to help the patient to manage this side effect?

Reduced opioid dose

Which concept is most closely aligned with how a transcutaneous electrical nerve stimulation (TENS) unit works to decrease pain?

Sensory perception

The patient reports a vivid childhood memory of having severe pain during a and after a dental procedure and expresses reluctance to visit the dentist even for routine cleanings? What should the nurse do?

Suggest talking to a dentist about current pain management techniques.

Despite the nurse's best efforts, the patient's wife continuously asks the nurse to reassess her husband's pain and to give him additional medication. What is the best rational for using the concept of "self-report"

The patient is the only one who can describe his experience of pain.

When an analgesic is titrated to manage pain, what is the priority goal?

Titrate to the smallest dose that provides relief with the fewest side effects.

Family members are encouraging your client to "tough out the pain" rather than risk drug addiction to narcotics. The client is stoically abiding. You recognize that the sociocultural dimension of pain is the current priority for the client. Which question will you ask?

What do you believe about pain medication and drug addiction?

The post anesthesia care unit reports to the nurse in the medical-surgical unit hat the patient received 2 mg of intravenous morphine with relief. When is the patient likely to be transitioned to oral analgesics?

What the patient is able to tolerate oral intake

A patient needs morphine 2 mg IV push. The drug is available as 5mg/mL. How many mL would the nurse administer? ______ mL of morphine

0.4 mL

A nurse is caring for a client after a total knee replacement who is requesting Vicodin in addition to the patient-controlled analgesia (PCA). The client reports having taken 2 Vicodin tablets every 4 hours for several weeks before surgery. If each tablet contains 500mg of acetaminophen, how much acetaminophen had the client been ingesting per day?

6000 mg (12 tablets)

Which patient has the highest risk for inadequate pain management?

78-year-old woman who was transferred to a nursing home after hip surgery.

Which patient has chronic non cancer pain?

A 48-year-old female who has persistent pain related to interstitial cystitis

A client with an inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit, which nursing action is appropriate?

Adjust the dial on the unit until the client states the pain is relieved.

The home health nurse is visiting a 73-yeal-old diabetic patient who was recently discharged after surgery. While reviewing a list of the patient's medications, the nurse sees that there are several different classes of analgesics listed. Which action is the nurse most likely to take?

Assesses patient's understanding of the multimodal treatment plan and ability to comply

In the care of clients with pain and discomfort, which task is most appropriate to delegate to the UAP?

Assisting the client with preparation of a sitz bath

The patient is receiving the first dose of transdermal fentanyl, and the health care provider informs the nurse that the dosage will be titrated until the patient experiences adequate pain control. How much time does the nurse expect will pass between dosage changes?

At least 24 hours before the next dose

A modified -release opioid is ordered for a patient who is currently NPO and receiving nutrition and fluids through a small-bore nasogastric tube. What should the nurse do?

Contact the health care provider for an order to administer the medication rectally

What is a nurse's responsibility when administering prescribed opioid analgesics?

Count the client's respirations Document the intensity of the client's pain Verify the number of doses in the locked cabinet before administering the prescribed dose

What are physiologic responses that indicate a patient is experiencing acute pain? Select all that apply.

Diaphoresis Tachycardia Dilated pupils

A patient with chronic cancer pain has been taking opioids for several months and now reports needing increasing doses to achieve pain relief. What is the most likely explanation of the need for increasing amounts of medication for this patient?

Disease is progressing

The older patient tells the home health nurse that he took two tablets of arthritis-strength extended release acetaminophen at 6:00 am and two tablets of hydrocodone at 2:00 pm and that he plans to take one does of an over-the-counter product that contains acetaminophen, doxylamine succinate, and dextromethorphan to sleep at night. What would the nurse do first?

Educate the patient about the acetaminophen in each product and the maximum dosage/day

The patient reports that he has been taking hydrocodone as prescribed by his provider and uses over-the-counter acetaminophen whenever he needs additional pain relief. Which laboratory test indicates the adverse and additive effects of these two medications?

Elevated liver enzymes

A patient is prescribed morphine sulfate. Which nursing interventions decrease the risk of constipation? Select all that apply

Encourage an increase in water and fluid intake Administer a stool softener every morning Encourage movement, activity, and walking` Teach to keep a record of bowel movements

A patient develops a physical dependence after taking an opioid as prescribed for post surgical pain. What is the recommended approach for dealing with the dependence?

Gradual reduction of the opioid as pain decreases

What patient is most likely to report pain that would be considered acute?

Has a history of of peripheral vascular disease; foot is suddenly cold and blue

The nurse is working at a walk-in clinic and has interviewed several patients. Which patient has the most common reason for seeking medical care?

Has a personal history of chronic pain

The home health nurse is reviewing the older adult's medication and sees that naproxen is prescribed. Which question is the nurse most likely to ask in order to assess for adverse effects?

Have you had any gastric discomfort, vomiting, bleeding, or bruising?

The patient has a history of rheumatoid arthritis and is also being treated for acute pain from a wrist fracture. Which medication is most likely to be prescribed to reduce the pain and discomfort caused by inflammation?

Ibuprofen

The nurse knows that acute pain serves a biologic purpose. How does the nurse apply this knowledge in caring for a patient with a history of cardiac problems who now reports severe chest pain?

Immediately administers supplemental oxygen

The patient has a severe burn on the hand and forearm and reports pain that is severe and escalating. The nurse anticipates that pain medication will be administer via which route?

Intravenous

A client with arthritis increases the dose of ibuprofen to abate joint discomfort. After several weeks the client becomes increasingly weak. The health care provider determines that the client is severely anemic and admits the client to the hospital. What clinical indicators does the nurse expect to identify when performing an admission assessment? select all.

Melena (blood in the stool) Tachycardia

What are the desired outcomes that the nurse expects when administering a nonsteroidal antiinflammatory drug (NSAID)? (select all that apply)

Pain relief Antipyresis Reduced inflammation

The nurse is assisting a surgical patient with pain management. Which outcome statement best demonstrates that the short-term goal is being met 45 minutes after receiving pain medication?

Patient tolerates the dressing change without grimacing.

The nurse asks the patient with cancer, "Sir, where is your pain?" The patient repeatedly responds, "It hurts all over." What is the best rationale for taking the extra time to help the patient to identify specific areas that hurt?

Patient understands the origin, and new or increasing pain raises the suspicion of metastasis.

The nurse is caring for several patients who will receive pain mediation. Which patient is most likely to receive around-the-clock oral opioids?

Patients with chronic cancer pain

Nociception involves the normal function of physiologic systems and four processes. When the nurse suggests listening to music as a distraction, which process is the target of the intervention?

Perception

A client's family member comes to the nurse's station and says, "He needs more pain medicine. He is still having a lot of pain." What is the nurse's best response?

Please tell him that I will be right there to check on him

Using the concept of comfort, which application creates the greatest concern related to the use of the patient-controlled analgesia (PCA) infusion device?

Proxy

A patient with rheumatoid arthritis reports having chronic pain for years with an exacerbation that started in the morning. Which observation indicates the patient has a physiological adaptation to pain?

Pulse rate is 70/min

The patient with chronic cancer pain has been taking oral morphine for several months. The health care provider suggests a very low dose of nalbuphine for relief of opioid-induced pruritus. What would the nurse frequently asses for?

Severe pain or withdrawal symptoms

A client who had a total hip replacement asks the nurse about the continuous regional analgesia being used. What information should the nurse include when explaining the benefits of the treatment over conventional methods to control pain?

Systemic side effect are minimal

The nurse sees that during the night the patient received lorazepam for anxiety, promethazine for nausea, and hydromorphone for pain. Which assessment is the mot important to conduct?

Use the Pasero Opioid Induced Sedation Scale and check respiratory statue

Which nursing action indicates that the nurse is performing the first step of the Hierarchy of Pain measures?

Uses a standard pain assessment tool