Nurs 309 CH 4 Pain

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

Stay with pt and dc basal rate

In the postanesthetic care unit 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 part of the client's initial 24 hour postoperative care?

monitoring of respiratory rate hourly

The nurse is caring for a postop client who reports pain. Based on recent evidence bases guidelines, which approach would be best

multimodal strategies

for a cognitively impaired client who cannot accurately report pain, what is the first action that the nurse should take

obtain baseline behavioral indicators from family members

The client reports severe pain two days after surgery. Which initial action should the nurse take after assessing the character off the pain

obtain vital signs

Noiception involves the normal function of the physiologic system 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 hi I will be right there to check on him.

A pt with chronic leg pain report pain level at a 7/10, so the nurse administers a PRN medication. Which observation suggest that the functional goal of therapy id being met?

pt ambulates independently without distress

The nurse is assessing the pt's use of transdermal fentanyl and discovers that the pt is making several errors. which behavior is most likely to result from fentanyl induced respiratory depression?

pt is placing a heating pad over the patch

The nurse is assisting a surgical pt with pain management. which outcome statement best demonstrates that the short term goal is being met 45 min after receiving pain medication?

pt tolerates dressing change without grimacing

The nurse is caring for several pt who will receive pain medication. Which pt is most likely to receive around the clock oral opioids?

pt with chronic cancer pain

The pt reports pruritus related to taking an opioid medication. What medication prescribed would the nurse obtain to help the pt to manage side effects?

reduced opioid dose

the nurse asks a pt with cancer "sir, where is your pain?" the pt repeatedly responds " it hurts all over". What is the best rational for taking extra time to identify specific areas that hurt?

so the pt understands the origin and new or increasing pain raises the suspicion of metastasis

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 this treatment over conventional methods to control pain.

systemic side effects are minimal

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

titrate to the smallest dose that provides relief with the least amount of side effects.

the postanesthsia care unit reports to the nurse in the medical surgical unit that the pt received 2mg of iv morphine with relief. When is the pt likely to be transitioned to oral analgesics?

when the pt is able to tolerate oral intake

The nurse is giving discharge instructions about multi-modal 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 save money. What is the best response?

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

pt need morphine 2 mg IV push, The drug is available as 5mg/ml, How many ml would the nurse administer?

0.4ml

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

1. Count the client's respirations 2. document the intensity of the client's pain 3. verify the number of doses in the locked cabinet before administering the prescribed dose.

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 on admission assessment? SATA

1. melena 2. tachycardia

What are the desired outcomes that the nurse expects when administering a nonsteroidal anti-inflammatory drug (NSAID) SATA

1. pain relief 2. antipyresis 4. reduced inflammation

which pt is least likely to be a good candidate for PCA?

25 y.o. with intermittent lucidity after a severe head injury

Which pt has chronic non-cancer pain?

48 y.o. F who has persistent pain related to interstitial cystitis

which pt is having pain that is unlikely to respond to first-line opioid and non-opioid medication?

70 y.o. F with podtherpetis neuraligia

Which pt has the highest risk fro inadequate pain management?

78 y.o. woman who was transferred to the nursing home after hip surgery

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

Acetaminophen

Based on evidence based practice, what is the best choice fro managing chronic pain for a 73 y.o. F with osteoarthritis?

Acetaminophen is the primary drug of choice

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

Acetaminophen/ Tylenol

A client with an inflamed sciatic nerve is to have a conventional transcutaneous electric 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

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

An increase in dosage yields an increase in comfort

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

How would you describe you pain?

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 comfort level. What should the nurse do?

Assess the clients pain before increasing the dose of morphine.

A new, inexperienced nurse sees that the pt is recieving around the clock medication but also has orders for prn analgesic every 4-6 hrs as needed. How will the new nurse determine when a prn dose is given?

Assess the pt for breakthrough pain and anticipate painful procedures

The home health nurse is visiting a 73 y.o. Diabetic pt who was recently discharged after surgery. While reviewing a list of pt medications the nurse sees that there are several different classes of analgesics listed. Which action is the nurse most likely to take?

Assesses pt understanding of multi-modal tx plan and ability to comply

The nurse in performing a pain assessment on a pt who had abdominal surgery. He was just transferred from the intensive care unit to the 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.

A modified release opioid is ordered fro a pt who is currently NPO and receiving nutrition and fluids through a small bore NG Tube. What should the nurse do?

Contact the health care provider and have it ordered rectally

what are physiologic responses that indicate a pt is experiencing acute pain?

Diaphoresis, Tachycardia, Restlessness, Dilated pupils

The pt reports that he has been taking hydrocodone as prescribed by his provider and uses OTC acetaminophen whenever he needs additional pain relief. Which lab value indicates the adverse and additive effects of these two medications?

Elevated liver enzymes

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

Excessive sedation can progress to clinically significant respiratory depression

what is the best type of pain scale to use for children or for adults who have language barriers or reading problems?

Faces ( smile to frown)

The nurse is assessing an elderly patient who has "pain all over". which strategy would the nurse use to help the pt identify which area 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 the nurse advocate for first?

Gabapentin

A pt develops a physical dependence after taking an opioid as prescribed fro postsugical pain. what is the recommended approach for dealing with dependence

Gradual reduction of opioid as pain decreases

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

IV

The pt has hx of RA and is also being tx for acute pain from a wrist fracture. which medication is most likely to be prescribed to reduce pain and disconformt caused by inflammation?

Ibuprofen

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 8 mg of the prescribed morphine. The medication is available in a 10 mg syringe Wasting of the remaining 2 mg of morphine should be done by the nurse and a witness. Who would be the witness?

LPN

Which behavior exemplifies the nursing primary role in assessing and managing the pt pain?

Listens to and accepts the self report of pain and assesses pt preferences and values

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

Many older adults are reluctant to report pain

the nurse is caring fro a pt who has an epidural catheter for pain management. WHich information is appropriate in the care of this pt.

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

The nurse is reviewing the medication list of a pt who had pen heart surgery. The nurse is likely to query the prescription fro which medication because prostaglandin inhibitor is associated with adverse cardiovascular effects?

Naproxen

Acetaminophen is the first lien medication for which pt?

Needs relief from pain related to minor surgical procedures

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

Nonopioid analgesics, such as acetaminophen

The nursing student is using the wong-backer FACES pain rateing scale to assess the pain of a 4 y.o. Child. The nurse would intervene if the student preformed which action?

Observe the childs facial expression and match it to the faces on the scale

The pt reports that he has chronic lower back pain that is not relieved by the prescribed medication and the pcp is unwilling to prescribe anything stronger. Who would the nurse consult first?

Pain resource Nurse

using the concept of comfort which application creates the greatest concern related to the use of PCS infusion devices?

Proxy

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

Pt has a tolerance for opioids

A pt with RA reports having chronic pain for years with an exacerbation that started. Which observation indicates the pt has a physiologic adaption to pain?

Pulse rate is 70 bpm

The nurse is interviewing a pt who frequently comes to the clinic to obtain medication fro chronic back pain. THe pt states "i know you guys think in faking, but I hurt and I am really sick of your attitude". HWat is the best response.

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

Which concept is most closely aligned with how a transcutaneous electrical nerve stimulation unit?

Sensory perception

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

Server pain or withdrawal symptoms

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

Suggest talking with the dentist abut current pain management techniques

despite the nurses best efforts the pt wife continuously asks the nurse to reassess her husband's pain and give him medications. What is the best rational for use the concept of "Self-report"?

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

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

Use the pasero opioid induced sedation scale and check respiratory status

Which nursing action indicates that the nurse is preforming the first step of hierarchy of pain measures?

Uses standard pain assessment tool

Family members are encouraging the client to tough out the pain rather than risk drug addiction to opioids. The client is stoically abiding. The nurse recognizes that the sociocultural dimension of pain is the current priority for the client. Which question will the nurse implement

What do you believe about pain medication and drug addiction?

which pt is most likely to receive a prescription for gabapentin?

a pt who has persistent burning and tingling in the lower extremities

The nurse is reviewing the pt 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

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

around the clock

A client received as needed morphine, lorazepam and cyclobenzaprine. The unlicensed assistive personnel reports that the client has a RR of 10 breaths per min. What is the priority.

assess the client's responsiveness and respiratory status

On the first day after surgery, a client receiving an analgesic via patient- controlled analgesia pump reports that the pain control is inadequate. What is the first action that the nurse should take

assess the pain for location, quality, and intensity

The nurse is caring for a pt on the first-day post-op. The pt denies pain but has blood pressure and pulse are elevated and he is diaphoretic and anxious. What should the nurse do first?

assess the pt for post-op complications or barriers to report pain

The nurse is assessing a pt with severe dementia who resides in a long term care facility. A score of 9 is obtained using pain assessment in advanced dementia scale. Based on the assessment findings, which action will the nurse take?

assess the pt for the source of the pain and immediately inform the health care provider

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

assisting the client with preparation of a sitz bath

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

at least 24 hrs between each dose

In application of the principles of pain treatment, which is the first consideration

client's perception of pain must be accepted

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

confirm the the pt can follow 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 lockout time frame of ten 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 older pt tells the home health nurse that he took two tablets of arthritis strength extended release acetaminophen at 6 am and two tablets of hydrocodone at 1400 and that he plan to take an otc medication that contains acetaminophen to sleep at night. What should the nurse do first?

educate the pt on acetaminophen in each product and the maximum dose per day

A pt is prescribed morphine sulfate. Which nursing intervention decreases the risk of constipation.

encourage an increase in water and fluid, administer stool softeners, encourage movement and activity, teach to keep record of bowel movements

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 desire to avoid pain or injury during exercise

Which pt is most likely to report pain that would be considered acute?

has a history of peripheral vascular disease, foot is suddenly is cold and blue

The home health nurse is reviewing the older adults 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 nurse know acute pain serves a purpose. How the the nurse apply this knowledge in caring fro a pt with cardiac problems who now reports severe chest pain?

immediately administer oxygen