Chapter 10. Nursing Care of Patients in Pain

A nurse is preparing an order for grain of morphine IM. It is supplied as 10 mg per mL. How many mL should the nurse administer? Round to the nearest 10th mL. ________________ mL

ANS: 1.5 grain 60 mg 1 mL = 1.5 mL 1 grain 10 mg

The nurse is preparing to assess a patients pain level. Which definition of pain should the nurse use to guide practice? a. Pain is whatever the experiencing person says it is. b. Pain is an unpleasant sensation caused by physical injury. c. Pain is a sensation that causes the patient to avoid its source. d. Pain is discomfort manifested by elevated vital signs and grimacing.

ANS: A All the definitions can be true, but however pain is whatever the experiencing person says it is because pain is subjective, and nurses must trust the patients report of pain as true in order to treat it appropriately.

A nurse provides an opioid antidote to a patient experiencing opioid toxicity. Which outcome should the nurse expect after providing this medication? a. Pain b. Sedation c. Confusion d. Tachypnea

ANS: A An opioid antagonist removes the effect of the opioid, including the pain relief. B. C. D. Tachypnea, confusion, and sedation would not be expected.

A patient with chronic pain is on a sustained-release opioid that is ordered every 12 hours. After 6 hours, the patient complains of increasing pain. Which intervention by the nurse is appropriate? a. Obtain an order for an immediate-release opioid for breakthrough pain. b. Teach the patient a relaxation technique to use until the next dose is due. c. Assess the patients vital signs, and administer the next dose of opioid early. d. Explain to the patient that the medication being administered lasts for 12 hours.

ANS: A Breakthrough pain is treated with immediate-release agents. D. It is unethical to not treat the patients pain. B. A relaxation exercise might help for a short period of time but not for 6 hours. C. Giving the next dose early does not follow physicians orders and will only help one time. The patient needs an order for future use also.

A patient comes into the emergency department after vomiting blood. The nurse should be most concerned if the patient reports taking which medication? a. Aspirin b. Codeine c. Meperidine (Demerol) d. Acetaminophen (Tylenol)

ANS: A Gastrointestinal bleeding is a side effect of aspirin and NSAIDs. B. C. D. These medications do not cause bleeding.

A nursing home resident complains of joint pain. Which medication should the nurse choose first to relieve the patients pain? a. Ibuprofen (Motrin) b. Acetaminophen (Tylenol) c. Acetaminophen/oxycodone (Vicodin) d. Acetaminophen/codeine (Tylenol no. 3)

ANS: A NSAIDs are effective anti-inflammatory agents and are the best choice for joint pain. B. C. D. These medications do not reduce inflammation.

The nurse is preparing to provide an opioid medication for a patients postoperative pain. Which action should the nurse take first? a. Determine the respiratory rate. b. Observe the patients skin color. c. Take the patients oral temperature. d. Ask the patient when he last ate something.

ANS: A Opioids are respiratory depressants, and respiratory function is a priority. B. C. D. Skin color, temperature, and oral intake may be helpful, but they are not the most important when providing this medication.

The nurse is having difficulty assessing the pain of a mentally impaired patient who has an approximate functional level of a 4-year-old child. Which method should the nurse use to determine the patients pain level? a. Use the Faces scale. b. Ask are you hurting? c. Observe the patients facial expression. d. Explain to the patient how to use a 0-to-10 pain scale, with 0 being no pain, and 10 being the worst possible pain.

ANS: A The faces scale was developed for use in children and would be appropriate for someone functioning at a 4-year-old level. D. The 0-to-10 scale is too complex for a 4-year-old. B. C. Facial expression and the response to Are you hurting? may be helpful, but they are not as objective as using a research-validated scale.

A patient has been requesting hydrocodone/acetaminophen (Vicodin) for pain every 4 hours for several days. Now the patient calls the nurse after only 3 hours and says, I need more Vicodin. The pain is worse. On which initial assumption should the nurse base a decision about what to do next? a. The patient is in pain. b. The patient is becoming addicted to Vicodin. c. The patient is exhibiting drug-seeking behavior. d. The patient is physically dependent on Vicodin.

ANS: A The majority of patients ask for analgesics because they are in pain. B. C. D. If there are signs that the patient is becoming addicted or is drug-seeking, the nurse should consult with the physician, not assume that the patient is not in pain.

A patient is prescribed acetaminophen to help with pain control. How many grams of acetaminophen can the nurse safely administer to the patient each day? a. 4 grams b. 5 grams c. 6 grams d. 7 grams

ANS: A The maximum daily dose of acetaminophen is 4 g. B. C. D. Over 4 grams of acetaminophen can lead to liver damage.

A patient receiving large doses of opioids is lethargic and difficult to arouse, with a respiratory rate of 6 per minute and constricted pupils. Which medication should the nurse anticipate being prescribed? a. Naloxone (Narcan) b. Furosemide (Lasix) c. Diazepam (Valium) d. Flumazenil (Romazicon)

ANS: A The patient is exhibiting signs of opioid overdose. Narcan is an opioid antagonist. C. Valium is a benzodiazepine that could further depress the patients level of consciousness. B. Lasix is a diuretic. D. Romazicon is the antidote to benzodiazepine overdose.

The nurse is providing care for a patient being discharged on opioid therapy. What should the nurse include when teaching the patient about this medication? (Select all that apply.) a. You may feel sleepy when you take this medication. b. If you experience nausea, stop taking the medication. c. Avoid driving or operating machinery for a few days. d. It is important to drink 8 to 10 glasses of fluid each day. e. Fiber or bulk laxatives may be needed to prevent constipation. f. You should wait as long as possible to take your pain medication to prevent addiction

ANS: A, C, D, E Nausea and constipation are common side effects with opioids, and preventive measures should be recommended. Pain should be well controlled by providing pain medications before pain becomes severe. Patients must be aware of potential sedation. Driving and operating machinery are avoided until the effects of the drug are known. B. Nausea usually subsides after a few days. F. Medications should be continued if possible.

A patient is prescribed a nonopioid medication for pain. Which characteristics of nonopioid drugs should the nurse keep in mind when caring for this patient? (Select all that apply.) a. They work peripherally. b. They produce tolerance. c. They have a ceiling effect. d. They are used for acute and chronic pain. e. They work in the central nervous system. f. They can be safely increased to treat increasing pain.

ANS: A, D Nonopioids are peripheral agents that have a ceiling effect and are effective for acute and chronic pain. B. E. F. Opioids work in the central nervous system (CNS), produce tolerance, and can be safely increased to treat increasing pain.

The nurse is reviewing medications prescribed for a patient experiencing pain. Which medications should the nurse realize are being used as adjuvant agents for this patients pain? (Select all that apply.) a. Steroids b. Antibiotics c. Cox 2 inhibitors d. Anticonvulsants e. Benzodiazepines f. Tricyclic antidepressants

ANS: A, D, E, F Steroids reduce inflammation. Tricyclic antidepressants help treat neuropathic pain. Benzodiazepines help relieve anxiety and muscle spasms. Anticonvulsants are used to relieve sharp or cutting pain related to peripheral nerve syndromes. B. Antibiotics treat infection, not pain. C. Cox 2 inhibitors are NSAIDs, not adjuvants.

A patient has been on opioids for 3 months to control pain caused by injuries from a motor vehicle crash. The patient asks about the risk of withdrawal symptoms when the drugs are no longer needed. How should the nurse respond to the patient? a. Ask your doctor for a sedative to get you through the worst of the withdrawal symptoms. b. As long as you taper the drug dose down slowly, you should not experience withdrawal symptoms. c. You would have to be on these drugs much longer than 3 months to have problems with withdrawal. d. You were using the drugs for legitimate pain, so you will not have to go through withdrawal when you stop them.

ANS: B After 3 months of use, some withdrawal symptoms are likely; these can be minimized or eliminated by slowly tapering the dose. A. Sedatives are not usually necessary and may be addictive. C. The nurse has no way of knowing the patients potential response to withdrawing from the medication. D. The reason for the medication is not important.

The nurse enters the room of a patient who is moaning loudly and thrashing around in bed. What action should the nurse take first? a. Ask the patient to quiet down. b. Ask the patient what is wrong. c. Go and get a dose of the patients prn pain medication. d. Administer a sedative, and then assess the patients pain after it has taken effect.

ANS: B Assessment is always the first step in the problem-solving process. A. C. D. Asking the patient to quiet down or administering a medication first both skips the assessment stage.

A patient with terminal cancer describes a pain rating of 7 on a 0-to-10 scale. The nurse notes that the patients vital signs are unchanged and recalls that vital signs may be elevated with pain. What is the best explanation for this? a. The patient is not really in pain. b. The patient has adapted to chronic pain. c. Acute pain is not associated with elevated vital signs. d. The patients vital signs are not responding because of the cancer.

ANS: B Because of the bodys ability to adapt, patients with chronic nonmalignant pain or chronic cancer pain may not appear to be in pain. C. D. The physiological responses that accompany acute pain, such as elevated heart rate and blood pressure, cannot be sustained without harm to the body, so the body adapts, and the vital signs return to normal. A. If the patient says he or she is in pain, the patient must be believed.

A large family of a patient with terminal cancer pain is constantly calling to report that the patient is in pain or needs to be moved or needs a drink. The nurse is having difficulty caring for other patients because this family is so demanding. What is the best way to deal with this situation? a. Ask the family to leave. b. Teach the family how to help provide for the patients basic needs. c. Show the family the hospital policy stating that only two visitors are allowed in the room at a time. d. Negotiate with the family that if they avoid using the call light, the nurse will check on the patient every 30 minutes.

ANS: B It is difficult for family members to see loved ones in pain. Including them in the planning helps them feel that they can help make the patient more comfortable. A. C. D. Asking them to leave or limit their visits will make them even more anxious as would limiting nursing care.

A patient with chronic back pain has a new order for a fentanyl (Duragesic) patch. As the nurse applies the patch, the patient states, Im really glad to get that patch on. I am really hurting bad. Which response by the nurse is correct? a. You should feel some relief of your pain within about half an hour. b. The patch may take a while to work. Would you like a pain shot in the meantime? c. Other analgesics cant be given while the patch is on, so try to bear it until it takes effect. d. Because it is absorbed right through the skin, you will feel relief within minutes after I apply this patch.

ANS: B It may take up to 3 days for a patch to provide an effective level of pain relief, and the patient may require an immediate-release form of pain medication until that time. It is appropriate to administer a short-acting agent while waiting for the patch to take effect. A. D. Pain will not be relieved with a minute or half of an hour. C. Other pain medications can be provided while the patch is in place.

A patient has abdominal pain after gallbladder surgery. For which type of pain should the nurse provide care? a. Chronic b. Nociceptive c. Neuropathic d. Non-physiological

ANS: B Nociception refers to the bodys normal or physiological reaction to noxious stimuli, such as tissue damage (e.g., surgery), with the release of pain-producing substances. C. Neuropathic pain is associated with injury to either the peripheral or central nervous system. A. Surgery is associated with acute, not chronic, pain. D. Surgical pain has a physiological cause.

A patient admitted with liver disease complains of pain in his right shoulder. What should the nurse use as explanation for this patients site of pain? a. The patient hurt his shoulder. b. The patient is experiencing referred pain. c. The patient is tense because of concern about the possible diagnosis. d. The patient is pretending to have more pain to obtain more analgesics.

ANS: B Nociceptive pain in the visceral organs may be referred to other parts of the body. A. C. D. These explanations are possible but not most likely.

The mother of an adolescent recovering from surgery for a fractured leg asks if all pain medication can be non-narcotic, because she does not want her child to become addicted. What should the nurse respond to the mother? a. All pain medication is addicting. b. Addiction to opioids is uncommon when taken for pain. c. I will give the medication that you request to your child. d. Teenagers are more likely to become addicted to pain medication than other patients.

ANS: B One myth about pain medication is that teenagers are more likely to become addicted than older patients. The fact is addiction to opioids is very uncommon in all age groups when taken for pain by patients without a prior drug abuse history. A. All pain medication is not addicting. C. The nurse needs to provide the patient with pain medication based upon the findings of a pain assessment. D. The patient is not more likely to become addicted to pain medication than other patients.

The nurse is questioning if a patient is experiencing pain. Which myth should the nurse recall when determining this patients pain level? a. A patient can sleep and still experience severe pain. b. A patient who is laughing and talking is not in pain. c. Respiratory depression can occur in patients receiving opioids. d. Oral pain medication can be as effective as injected medication.

ANS: B Patients can laugh and talk while in painit is an effective coping mechanism. A. C. D. These statements are all true and are not myths.

A patient is determined to be physically dependent on prescribed pain medication. How should the nurse interpret this patients dependency? a. The patient is addicted to pain medication. b. Stopping the drug causes symptoms of withdrawal. c. The patient requests pain medication more often than it is ordered. d. It takes more medication than previously to relieve the patients pain.

ANS: B Patients who are physically dependent on a drug will have symptoms of withdrawal if the drug is taken away suddenly. A. Addiction includes a psychological component. C. Requesting pain medication more often than it is ordered describes a patient whose pain is not adequately treated. D. Tolerance is taking more medication that previously needed to relieve the patient.

The nurse is admitting a patient with pancreatitis. What should the nurse include in the patients pain history? (Select all that apply.) a. How much alcohol does the patient drink each day? b. Is the patient having difficulty sleeping, eating, or working? c. How does the patient describe the pain in his or her own words? d. Are there any aggravating or alleviating factors that alter the pain? e. How has the pain affected the patients ability to perform activities of daily living? f. Is the patient experiencing any nausea, vomiting, or anorexia associated with the pain?

ANS: B, C, D, E, F Each of these factors is important to the pain assessment and history. A. Alcohol history is important for pancreatitis but not for a pain history.

The nurse is determining equivalent doses of pain medication for a patient. Which dose is equivalent to a 10-mg dose of subcutaneous morphine? (Select all that apply.) a. 5 mg IV morphine b. 10 mg IV morphine c. 25 mg IM morphine d. 15 mg IM morphine e. 30 mg oral morphine f. 10 mg oral morphine

ANS: B, E Because oral morphine is partially metabolized before it binds to receptors, it takes a higher dose to achieve the same pain relief as a smaller IV dose. The conversion factor for converting parenteral morphine to oral doses of morphine is 3, so three times more medication is equivalent in oral form. All forms of parenteral narcotic are equivalent, so 10 mg subcutaneous morphine is equivalent to 10 mg of morphine given IV or IM. A. F. This is not enough medication. C. D. This would be too much medication.

The nurse notes that a patient experiencing a pain level of 9 on a scale from 0 to 10 has a change in vital signs. What type of pain should the nurse realize this patient is experiencing? a. Cancer pain b. Neuropathic pain c. Acute pain from trauma d. Chronic nonmalignant pain

ANS: C Acute pain is associated with elevated heart rate and blood pressure. A. B. D. These types of pain are more chronic, and adaptive mechanisms allow vital signs to remain more normal.

The nurse is determining a pain management plan for a patient with chronic pain. What should the nurse identify as the best analgesic schedule for this patient? a. Prn b. Qid c. Around the clock d. Only when pain is severe, to prevent tolerance

ANS: C Around-the-clock pain management prevents pain. A. B. D. Any other schedule allows pain to recur between doses, and pain can get out of control and more difficult to manage.

A patient with peripheral neuropathy states, I dont know why the doctor put me on an antidepressant. I am not depressed! Which response by the nurse is best? a. Depression is often a factor in pain. Treating the depression helps treat the pain. b. Maybe you are more depressed than you realize. Would you like to talk about it? c. Antidepressants are sometimes used to treat nerve pain such as you are experiencing. d. Why dont you try it for a while, and if you dont feel better, you can ask your doctor if you can stop it?

ANS: C Certain antidepressants have been shown to relieve pain related to neuropathy. A. B. Depression is not necessarily a factor in neuropathy. D. Antidepressants may take several weeks to be effective, so they should not be stopped prematurely.

A patient receiving opioid medication for cancer pain is experiencing increasing pain when being repositioned and changing bed linen. What should the nurse consider is occurring with this patient? a. Tolerance b. Addiction c. Hyperalgesia d. Breakthrough pain

ANS: C Hyperalgesia is increased sensitivity to pain. Patients with hyperalgesia have pain at the slightest touch, such as the moving of sheets, and require further medical intervention. A. Tolerance is a normal biological adaptation and means that it takes a larger dose to provide the same level of pain relief. B, Addiction or psychological dependence is a disease of the brain that causes the compulsive pursuance of a substance, or behavior, in order to obtain reward or relief. D. Breakthrough pain is transient pain that arises during generally effective pain control and is seen most often in patients receiving timed-controlled pain medication.

A patient requesting pain medication asks that the medication be provided in the form of an injection because it works better. The patient is prescribed oral pain medication. What should the nurse respond to this patient? a. Injected medications last longer than oral medications. b. Injected medications work better than oral medications. c. Injected medications are painful and dont absorb consistently from the muscle. d. Ill contact your physician to get an order for the medication to be given as an injection.

ANS: C Intramuscular (IM) injections are not recommended because they are painful, have unreliable absorption from the muscle, and have a lag time to peak effect and rapid falloff compared with oral administration. A. Oral administration is the first choice if possible, or whenever the IV route is not an option. B. The IV route has the most rapid onset of action and is the preferred route for postoperative administration. D. The physician does not need to be contacted for an order change.

A patient receiving morphine sulfate 5 mg IV every 4 hours around the clock and acetaminophen PO every 4 hours reports intense itching. Assuming all are ordered, which prn medication should the nurse administer? a. Ibuprofen (Motrin) b. Fentanyl (Duragesic) c. Nalbuphine (Nubain) d. Methadone (Dolophine)

ANS: C Nalbuphine (Nubain) is an agonist-antagonist that can be used to treat itching and nausea that may accompany the administration of opioids. A smaller dose can be given so that the analgesia is not reversed completely along with the reversal of the adverse effect. B. D. Fentanyl and methadone are opioids that may worsen itching. A. Motrin is an NSAID and will not be helpful.

The nurse enters a room just as a patients daughter pushes the button of his intravenous (IV) patient-controlled analgesia (PCA) pump. Which response by the nurse is appropriate? a. Thanks for helping out your dad. Is he too weak to push the button? b. If you need to push the button for your dad, first be sure his respiratory rate is higher than 10. c. It is dangerous for anyone but your dad to push the button. Remind him to push it himself if he needs it. d. It is against hospital policy for anyone but the patient to push the button. If I see you pushing it again, I will have to call the supervisor.

ANS: C No one should push the button except the patient. PCA is safe if it is controlled by the patient and appropriately monitored. Family members can help by reminding their loved one to use the PCA if they think the person is in pain. A. B. The safety of IV PCA is affected if someone other than the patient administers the dose. D. Admonishing the daughter is unnecessaryshe needs to be educated, not scolded.

The nurse is determining the effective of pain medication provided to a patient. What is the best way for the nurse to measure effectiveness of pain medication? a. The patient goes to sleep. b. The patient stops groaning. c. The patient states the pain is relieved. d. The patients vital signs return to normal.

ANS: C Pain is subjective, and the best measure is the patients self-report. A. Patients can sleep while

A patient who has just returned from abdominal surgery states, I learned relaxation exercises, so I wont need any drugs. Which statement about relaxation therapy should the nurse use to guide care for this patient? a. Relaxation therapy works much the same as a placebo. b. Relaxation therapy is not useful for postoperative patients or for severe pain. c. Relaxation therapy is an excellent adjunct treatment for pain when used with analgesics. d. Effective use of relaxation therapy can eliminate the need for analgesics postoperatively.

ANS: C Relaxation is an adjunct treatment for any type of pain but should not be expected to replace pain medication. B. It can help the patient feel more in control. A. Relaxation therapy does not work the same as a placebo. D. The use of relaxation cannot eliminate the need for analgesics after surgery.

A 91-year-old nursing home resident has been receiving meperidine (Demerol) injections for right shoulder pain. During the morning assessment, the nurse finds the resident irritable and jumpy. Which nursing actions and rationales is appropriate? a. Administer a dose of Demerol because the patient is exhibiting signs of withdrawal. b. Administer a dose of Demerol because these are symptoms of pain in an older adult patient. c. Notify the registered nurse (RN) or physician that the resident may be experiencing toxic effects of Demerol. d. Assess the patients pain level before determining the appropriate dose of Demerol to administer.

ANS: C The RN or physician should be notified and a different analgesic ordered. Meperidine (Demerol), when broken down in the body, produces a toxic metabolite called normeperidine. Normeperidine is a cerebral irritant that can cause adverse effects ranging from dysphoria and irritable mood to seizures in the older adult. A. B. C. Administering a dose of Demerol will worsen the symptoms.

A patient of Asian American descent recovering from abdominal surgery refuses all pain medication. What can the nurse do to ensure for this patients comfort? a. Provide a cup of tea. b. Offer to pray with the patient. c. Offer pain medication to promote healing. d. Document that pain medication is refused.

ANS: C The nurse needs to take the patients culture into consideration. For the patient of Asian-American descent, the nurse should offer the pain medication as a method to promote healing. A. Offering tea might be helpful for the patient of Hispanic-American descent. B. Praying with the patient might be helpful for the patient of African-American descent. D. The nurse needs to do more than document that the patient is refusing pain medication.

A patient recovering from surgery for a ruptured appendix yesterday has an order for morphine 4 mg q 6 hours prn. Every 5 hours and 55 minutes, the patient puts on the call light and asks for the morphine. A staff member comments that the patient is drug-seeking. Which action by the nurse is most appropriate first? a. Administer the morphine every 4 hours instead of every 6 hours. b. Explain to the staff member that labeling the patient as drug seeking is inappropriate. c. Consult with the RN or physician about ordering a higher or more frequent dose of morphine. d. Explain to the patient that weaning off the morphine as soon as possible is essential to reduce the risk of addiction.

ANS: C The patient has acute postsurgical pain that is not being controlled effectively with a q 6 hour schedule. The nurse should consult with the RN or physician for a change in orders. D. The patient just had surgery yesterday, so it is not reasonable to wean off the opioid yet. A. The morphine cannot be given every 4 hours without an order. B. Educating the staff member may be appropriate, but treating the patients pain is the first priority.

A patient is experiencing neuropathic pain. What class of medications should the nurse expect to be prescribed for this patient? a. Opioids b. Beta blockers c. Tricyclic antidepressants d. NSAIDs

ANS: C Tricyclic antidepressants such as amitriptyline, imipramine, desipramine, and doxepin have been shown to relieve pain related to neuropathy and other painful nerve-related conditions. A. D. These medications are less effective for neuropathic pain. B. Beta blockers do not treat pain.

A patient taking hydromorphone for cancer pain is experiencing constipation. What should the nurse teach to help this patient? a. Take a mild laxative. b. How to self-administer a Fleet enema. c. Slowly decrease the dose of hydromorphone. d. Eat a high-fiber diet and increase fluid intake.

ANS: D A high-fiber diet and fluids are the first line of defense because they help prevent constipation. A. B. Laxatives and enemas treat constipation after it becomes a problem. C. It is inappropriate to encourage a patient with cancer pain to decrease analgesia, because pain will recur.

A patient describes abdominal pain as my belly feels as if a watermelon is stuck in it. What is the best way for the nurse to document this information? a. Patient feels bloated. b. Patients abdomen is distended. c. Patient has acute pain related to distended abdomen. d. Patient states his belly feels as if a watermelon is stuck in it.

ANS: D A patients description of pain is subjective data and should be recorded as the patient stated it. A. B. C. Documenting distention, bloating, or acute pain is making assumptions that may or may not be true.

A patient is given a prescription for oxycodone/acetaminophen (Vicodin), two tablets to be taken every 4 to 6 hours as needed for pain. What should the nurse include when teaching about this medication? a. You shouldnt take this more than every 4 hours, because oxycodone will cause respiratory depression. b. Be careful not to take this more than every 4 hours, because Vicodin always relieves pain for at least 4 hours. c. Oxycodone and acetaminophen interact to form a dangerous metabolite if they are taken less than 4 hours apart. d. It is important to not to take this more often than prescribed, because acetaminophen can cause dangerous side effects if taken more frequently.

ANS: D Acetaminophen has a ceiling effect, so there is a dose beyond which there is no improvement in the analgesic effect, and there may be an increase in adverse effects. When used in combination with opioids, care must be taken to ensure that the dose of the nonopioid drug does not exceed the maximum safe dose for a 24-hour period. A. Respiratory depression occurs when doses of opioids are raised too quickly, not at specific doses or time intervals. C. Oxycodone does not form a dangerous metabolite when given with acetaminophen. B. No analgesic always relieves pain.

A patient is experiencing phantom limb pain. For which type of pain should the nurse plan care for this patient? a. Acute pain b. Cancer pain c. Intermittent pain d. Chronic nonmalignant pain

ANS: D Chronic nonmalignant pain persists beyond the time when healing usually takes place. Examples include low back pain, the pain accompanying arthritis, and phantom limb pain. A. B. C. Acute or cancer pain is not present after healing takes place.

The nurse answers a patients call for pain medication, only to find the patient laughing and joking with visitors. Which response by the nurse is appropriate? a. You don't need this pain medication after all, do you? b. Ill bring your medication back later after your visitors are gone. c. I can see your pain is better. Call again when you need your medication. d. Would you like your visitors to step out while I give you your pain medication?

ANS: D Distraction (by the patients visitors) is an effective adjuvant treatment but does not replace analgesics for pain. The nurse should administer the analgesic. A. B. C. These actions withhold the pain medication and the patient may be in increased pain after the visitors leave, which will be more difficult to control.

A physician writes an order to give a saline injection to a patient who has been requesting frequent meperidine (Demerol) shots. Which initial response by the LPN is best? a. Tell the patient that the physician has ordered a placebo. b. Administer the saline and carefully document the patients response. c. Tell the patient that a pain shot is being administered, without revealing exactly what it is. d. Tell the physician of feeling uncomfortable administering saline if the patient thinks it is Demerol.

ANS: D If a placebo is ordered for a patient, discuss concerns with the physician and nurse supervisor. A. Use of placebos is unethical and inappropriate unless the patient has given written consent. B. C. The use of placebos is a denial of the patients report of pain.

A nursing assistant, observing the licensed practical nurse (LPN) prepare medication for a patient asks why so much morphine is being provided since patients have quit breathing after receiving such a high dose. The patient has been receiving the same dose of medication for several days without respiratory compromise. Which response by the LPN is best? a. I am a licensed professional and am able to decide what a safe dose is for my patient. b. You are correct; several days of this high a dose could be cumulative and cause problems. c. As long as I monitor the patient closely after giving the dose, breathing will not be affected. d. As long as the dose is increased gradually, patients develop tolerance to the side effects of morphine.

ANS: D Morphine is an opioid agonist. Opioid doses can be escalated (titrated upward) indefinitely as needed as the patients pain increases. B. As long as it is titrated slowly, tolerance to respiratory depression will develop. C. Monitoring may identify respiratory depression, but it will not prevent it. A. This statement blocks communication and does not take advantage of a teaching opportunity.

A patient with a gastrostomy tube is prescribed a sustained-released opioid medication. What should the nurse do when preparing to provide this medication to the patient? a. Provide the medication orally for the patient to swallow b. Crush the medication and administer it through the tube c. Dissolve the medication in water and administer it through the tube d. Ask the physician to prescribe the medication as an elixir for tube administration

ANS: D The nurse should ask the physician to prescribe the medication as an elixir for tube administration, because a time-release tablet should never be crushed. B. A controlled- or time-release tablet should never be crushed. Because the tablet is designed to deliver a dose of medication over time, crushing it could deliver the entire dose at once, resulting in overdose. C. Dissolving the medication in water and administering it through the tube could also cause an overdose. A. The patient has a gastrostomy tube for a reason. Oral intake is probably compromised. This patient is unable to take oral medications.