Pain Management

The client takes naproxen (Aleve) for arthritic pain and is now prescribed warfarin (Coumadin) for persistent atrial fibrillation. Due to the interactions of the medications, the nurse a) Assesses the client's stool for color b) Teaches the client to ingest foods high in vitamin K c) Informs the client to decrease alcohol to one glass each day d) Administers both medications with food to increase absorption

a) Assesses the client's stool for color Clients who take NSAIDs, such as naproxen, with warfarin may experience gastrointestinal bleeding. The nurse will need to monitor for this. Clients are to ingest a consistent level of vitamin K. Administering the medications with food does not increase absorption. Ingesting food with the medications may decrease gastrointestinal upset. Clients are instructed to not ingest alcohol.

The nurse observes the anesthesiologist administer a single-dose, extended release drug in an epidural catheter for a patient undergoing a major surgical procedure. What drug does she understand is being administered? a) Depodur b) Dilaudid c) Demerol d) Codeine

a) Depodur Epidural analgesia is administered by clinician-administered bolus, continuous infusion (basal rate), and patient-controlled epidural analgesia (PCEA). The most common opioids administered intraspinally are morphine, fentanyl, and hydromorphone (Dilaudid). Morphine sulfate (DepoDur) is an extended-release injectable medication that may administered via an epidural catheter. These are usually combined with a local anesthetic, most often ropivacaine (Naropin) or bupivacaine (Marcaine), to improve analgesia and produce an opioid dose-sparing effect (Pasero, Quinn et al., 2011).

The advance nurse practitioner treating a patient diagnosed with neuropathic pain decides to start adjuvant analgesic agent therapy. Which of the following medications is appropriate for the nurse practitioner to prescribe? a) Gabapentin (Neurontin) b) Hydromorphone (Dilaudid) c) Tramadol (Ultracet) d) Ketamine (Ketalar)

a) Gabapentin (Neurontin) The anticonvulsants gabapentin (Neurontin) is a first-line analgesic agent for neuropathic pain. Tramadol (Ultracet) is designated as a second-line analgesic agent for the treatment of neuropathic pain. Ketamine (Ketalar) is used as a third-line analgesic agent for refractory acute pain. Hydromorphone (Dilaudid) is a first-line opioid not used as an analgesic agent for neuropathic pain.

Lily was admitted with generalized abdominal pain, nausea, vomiting, and hypotension. She says that she has not passed stool in over 1 week and has been in pain for the past 4 days. Which type of pain would you expect her to be experiencing? a) Visceral pain b) Chronic pain c) Neuropathic pain d) Deeper somatic pain

a) Visceral pain Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Visceral pain usually is diffuse, poorly localized, and accompanied by autonomic nervous system symptoms such as nausea, vomiting, pallor, hypotension, and sweating. Neuropathic pain is pain that is processed abnormally by the nervous system. This is not the type of pain that Lily is experiencing. Deeper somatic pain such as that caused by trauma produces localized sensations that are sharp, throbbing, and intense, which is different from the type of pain Lily is experiencing. Chronic pain has a duration longer than 6 months. Lily's pain has been present for less than 1 week.

A female client with sickle-cell disease is hospitalized for pain management. The client's BUN is 24 mg/dL and creatinine is 1.6 mg/dL. To assist with management of the pain, the nurse a) Places the lower extremities in a dependent position b) Applies warm soaks to the extremities c) Obtains cold packs to place on the joints d) Administers meperidine (Demerol) intravenously

b) Applies warm soaks to the extremities Warm soaks may help to alleviate pain in the client with sickle-cell disease. Meperidine is not recommended in clients experiencing renal dysfunction. This client's renal studies show some dysfunction. Cold will cause the blood cells to lump even more and constrict blood vessels, increasing pain. Lowering the extremity to a dependent position will encourage blood to pool, particularly in the joints, increasing pain.

Which of the following is the appropriate intervention to avoid physical dependence on drugs in a client? a) Administer subtherapeutic doses. b) Discontinue drugs gradually. c) Increase dosage of the drug. d) Administer adjuvant drugs along with the prescribed drug.

b) Discontinue drugs gradually. To avoid withdrawal symptoms, drugs that are known to cause physical dependence are discontinued gradually. The most appropriate nursing action to avoid tolerance is to consult with the physician for an increased dosage of the drug. Subtherapeutic dosages and adjuvant drugs are not needed to avoid physical dependence of drugs in a client.

A patient has been prescribed a Fentanyl patch for pain control. The nurse understands that this patch should be replaced how often? a) Every 24 hours b) Every 72 hours c) Every 48 hours d) Every 36 hours

b) Every 72 hours Fentanyl patches should be replaced every 72 hours. The other timeframes are incorrect.

About which of the following issues should the nurse inform patients who use pain medications on a regular basis? a) Minimize the intake of fiber during the therapy. b) Inform the primary health care provider about the use of salicylates before any procedure, and avoid OTC analgesics consistently without consulting a physician. c) Consume the medications just before or along with meals. d) Avoid harsh sunlight for 2 hours after administering analgesic agents or salicylates.

b) Inform the primary health care provider about the use of salicylates before any procedure, and avoid OTC analgesics consistently without consulting a physician. Patients should be advised to inform the primary health care provider or dentist before any procedure when they use pain medications, especially salicylates or nonsteroidal anti-inflammatory agents, on a regular basis. OCT analgesic agents, such as aspirin, ibuprofen, or acetaminophen, should not be avoided consistently to treat chronic pain without consulting a physician. Pain medications administered 30 to 45 minutes before meals may enable the patient to consume an adequate intake, while a high-fiber diet may help ease constipation related to narcotic analgesics. Patients need not avoid harsh sunlight after administering analgesic agents because these drugs do not cause photosensitivity.

A client, who had an above the knee amputation of the left leg related to peripheral vascular disease from uncontrolled diabetes, complains of pain in the left lower extremity. What type of pain is the client experiencing? a) Visceral pain b) Neuropathic pain c) Referred pain d) Breakthrough pain

b) Neuropathic pain An example of neuropathic pain is phantom limb pain or phantom limb sensation, in which individuals with an amputated arm or leg perceive that the limb still exists and that sensation such as burning, itching, and deep pain are located in tissues that have been surgically removed. Chronic pain sufferers may have periods of acute pain, which is referred to as breakthrough pain. Visceral pain arises from internal organs such as the heart, kidneys, and intestine that are diseased or injured. Referred pain is a term used to describe discomfort that is perceived in a general area of the body but not in the exact site where an organ is anatomically located.

A client is reporting her pain as "8" on a 0-to-10 pain intensity scale. Then, the client states the pain is "3." Before the nurse leaves the room, the client states her pain is "6." The best action of the nurse is to a) Record each of the numbers the client stated for her pain. b) Obtain a pain scale with faces for the client to measure her pain. c) Medicate the client for pain based on the highest number of "8." d) Average the numbers and report that number as the client's level of pain.

b) Obtain a pain scale with faces for the client to measure her pain. Various scales are helpful to clients trying to describe pain intensity. If the client cannot use one scale, such as the numeric pain intensity scale, the nurse uses another pain intensity scale that the client finds easy to understand and use. The nurse does not average the numbers, medicate based on the highest number, nor record each of the numbers the client stated.

Which phase of pain transmission occurs when the one is made aware of pain? a) Modulation b) Perception c) Transmission d) Transduction

b) Perception Problems that may develop with opioid and opiate therapy include Risk for Impaired Gas Exchange related to respiratory depression, Constipation related to slowed peristalsis, and Risk for Injury related to drowsiness and unsteady gait.

Which of the following, approved by the U.S. Food and Drug Administration, is the only use for lidocaine 5% (Lidoderm) patch? a) Diabetic neuropathy b) Postherpetic neuralgia c) Epidural anesthesia d) General anesthesia

b) Postherpetic neuralgia A lidocaine 5% (Lidoderm) patch has been shown to be effective in postherpetic neuralgia. Lidoderm has not been approved for epidural anesthesia, general anesthesia, or diabetic neuropathy.

The nurse is visiting a client at home with intractable cancer pain. The client has a transdermal fentanyl patch on her right chest area. It is most important for the nurse to a) Assess for the date of the client's last bowel movement. b) Remove the heating pad present on the chest area. c) Inform the client about use of alcohol with fentanyl. d) Instruct the client to note fatigue or extreme sleepiness.

b) Remove the heating pad present on the chest area. A heating pad over the transdermal patch will increase release of the medication, exposing the client to an overdose. The nurse will also perform the other options listed.

What does the nurse understand is the advantage of using intraspinal infusion to deliver analgesics? (Select all that apply.) a) It is easily accessible by the nurse. b) The need for injections decreases in frequency. c) Side effects of systemic analgesia are reduced. d) Effects on pulse, respirations, and blood pressure are reduced. e) Higher doses may be administered.

b) The need for injections decreases in frequency. c) Side effects of systemic analgesia are reduced. d) Effects on pulse, respirations, and blood pressure are reduced. Some of the more invasive methods used to manage pain are accomplished via catheter techniques such as intraspinal analgesia, sometimes referred to as "neuraxial" analgesia. Delivery of analgesic agents by the intraspinal routes is accomplished by inserting a needle into the subarachnoid space (for intrathecal [spinal] analgesia) or the epidural space and injecting the analgesic agent, or threading a catheter through the needle and taping it in place temporarily for bolus dosing or continuous administration (Pasero, Quinn et al., 2011). Intrathecal catheters for acute pain management are used most often for providing anesthesia or a single bolus dose of an analgesic agent. Temporary epidural catheters for acute pain management are removed after 2 to 4 days. Epidural analgesia is administered by clinician-administered bolus, continuous infusion (basal rate), and patientcontrolled epidural analgesia (PCEA). The most common opioids administered intraspinally are morphine, fentanyl, and hydromorphone (Dilaudid).

For which of the following reasons are nonpharmacologic pain management techniques employed? Select all that apply. a) They can successfully replace pain medications. b) They help decrease the sensation of pain. c) They lower the risk of patients' becoming addicted to pain medications. d) They help decrease the distress the patient experiences from pain. e) They allow patients to match the technique to their own individual and cultural preferences.

b) They help decrease the sensation of pain. d) They help decrease the distress the patient experiences from pain. e) They allow patients to match the technique to their own individual and cultural preferences. Nonpharmacologic pain management techniques are usually used in conjunction with medications and help to decrease the sensation of pain and the distress the patient experiences from pain. Nonpharmacologic methods are used to complement, not replace, pharmacologic methods. Many patients find that the use of nonpharmacologic methods helps them cope better with their pain and feel greater control over the pain. Nonpharmacologic methods do not have any relationship to a patient's risk of becoming addicted to pain medications. A variety of techniques allows them to match the technique to their own individual and cultural preferences.

A client is recovering from abdominal surgery. The statement by the client that most indicates the nurse needs to educate the client about pain and pain control is a) "Pain relief may promote a quicker recovery." b) "Pain medication can control pain." c) "I should expect to have pain." d) "I will report to you when I am experiencing pain."

c) "I should expect to have pain." The nurse needs to educate the client about common concerns and misconceptions about pain and pain control. Clients may experience pain after surgery. However, medication is prescribed to control the pain, and there are interventions by the nurse to assist in alleviating the pain. This is what the nurse needs to educate the client about. The other options are positive statements by the client and true statements about pain and pain control.

A client informs the nurse that he has been taking ibuprofen every 6 hours for 3 weeks to help alleviate the pain of arthritis. The client has a history of a gastric ulcer and is taking a proton pump inhibitor for the treatment of this disorder. What should the nurse instruct the client about the use of the ibuprofen? a) "You should never take ibuprofen; it can cause considerable problems." b) "Don't you know that you can cause bleeding when you take that medication so often?" c) "It would be best to contact the physician prior to take any over-the-counter medications." d) "Ibuprofen is contraindicated when taking a proton pump inhibitor."

c) "It would be best to contact the physician prior to take any over-the-counter medications." Clients should not use an over-the-counter analgesic agent, such as aspirin, ibuprofen, or acetaminophen, consistently to treat chronic pain without first consulting a physician. Ibuprofen is not contraindicated when taking a proton pump inhibitor. Option D is accusatory and not a therapeutic response.

A teenage client is undergoing a dressing change to burns on the thigh. The client refuses pain medication and states, "I do not hurt, and I don't need it." He is withdrawn, grimaces, and turns away during the dressing change. He was last medicated 8 hours ago. The best statement by the nurse is a) "You are so brave to not take your pain medication when the dressing change will hurt." b) "If you need pain relief, I can give you some medication when I have completed the dressing change." c) "Please explain why you say you do not hurt when I see you grimacing during the dressing change." d) "You are so right to not take your pain medication. You can become dependent on the medication."

c) "Please explain why you say you do not hurt when I see you grimacing during the dressing change." The nurse needs to explore the reason a client denies pain when pain is expected during a treatment, as with a dressing change to burns, and when the client grimaces during the dressing change. The nurse needs to educate clients about effects of pain on recovery. The nurse also cannot ignore that pain relief will hasten recovery. The nurse should not allow the client to associate pain with his dressing changes.

A client is postoperative and has not taken her pain medication. The nurse is performing an assessment at the beginning of her shift and determines that sensitization has occurred. The first nursing intervention is to a) Educate the client about notifying the nurse about pain before the pain becomes intense. b) Provide alternative measures, such as a back rub, for pain relief. c) Administer the prescribed intravenous opioid. d) Medicate with naloxone (Narcan) for reversal of sensitization.

c) Administer the prescribed intravenous opioid. Sensitization occurs when the client waits too long to report pain and the pain is so intense that it is difficult to relieve. The first action of the nurse is to relieve the client's pain through administration of the prescribed intravenous opioid. Then the nurse can provide other alternative measures for pain relief. Once the pain is relieved, the nurse can educate the client about notifying the nurse when pain occurs. Naloxone is administered for opioid-induced respiratory depression. It is not needed in this client's situation.

The client is prescribed 2 mg of intravenous morphine every 2 hours as needed for pain. The nurse administers the medication. Thirty minutes later, the client reports the pain level remains at a "6" on a pain intensity scale of 0 to 10. The nurse first a) Teaches the client about guided imagery and distraction b) States that "You received the full dose. I can give you no more." c) Assesses the client's mental status and vital signs d) Contacts the physician to report the ineffectiveness of the medication

c) Assesses the client's mental status and vital signs The nurse is to reassess the client after administration of a medication for pain. Reassessment includes a pain rating scale, mental status, and vital signs. If the reassessment of the client demonstrates the client is alert, has satisfactory vital signs, and reports unrelieved pain, the nurse then consults with the physician. The listed statement of the nurse is nontherapeutic. It is not appropriate to teach the client about guided imagery or distraction when the client has pain. It should be done prior to pain onset.

When administering a fentanyl patch, the last dose of sustained-release morphine should be administered at what point? a) There are no administration requirements b) 1 hour after c) At the same time the first patch is applied d) 1 hour prior

c) At the same time the first patch is applied Because it takes 12 to 24 hours for the fentanyl levels to gradually increase from the first patch, the last dose of sustained-release morphine should be administered at the same time the first patch is applied. The other timeframes are incorrect.

Which of the following is a misconception about pain and analgesia? a) It is rare for chronic pain patients to misrepresent their symptoms. b) The stress of managing the chronic pain may lead to depression. c) Chronic pain is due to a psychological disturbance. d) No evidence exists that stress causes pain.

c) Chronic pain is due to a psychological disturbance. There is a misconception that chronic pain is due to a psychological disturbance. There is no evidence that stress causes pain. It is rare for chronic pain patients to misrepresent their symptoms. The stress of managing chronic pain may lead to depression.

Choose the most likely reason why a nurse should question the use of Demerol for pain management in an elderly patient? There is (are): a) Increased susceptibility to nervous system depression. b) Decreased metabolism of medications. c) Decreased binding of meperidine by plasma protein. d) Changes in renal metabolism.

c) Decreased binding of meperidine by plasma protein. Meperidine (Demerol) may not be administered because its active neurotoxic metabolite, normeperidine, is more likely to accumulate and cause CNS excitation and seizures. Refer to Table 7-1 in the text.

When taking a patient history, the nurse notes that the patient is taking herbal remedies in addition to acetaminophen. Which herb, when taken in conjunction with acetaminophen, enhances the risk of bleeding? a) Echinacea b) Willow c) Gingko d) Kava

c) Gingko Gingko when taken with acetaminophen enhances the bleeding risk. Echinacea, willow, and kava when taken with acetaminophen increase the potential for hepatotoxicity and nephrotoxicity.

A client is scheduled for abdominal surgery and states that he is afraid of postoperative pain. The best nursing action is to inform the client a) About activities that would distract him from pain b) How anxiety could increase his pain perception c) That medication will be prescribed for pain relief d) That the nurse will notify the surgeon of his fear

c) That medication will be prescribed for pain relief Pain is expected postoperatively, and the client should be reassured that medication will be prescribed to relieve pain. The client may have less pain knowing that measures will be taken to reduce it. Diversional activities may be used in addition to analgesics. Anxiety about pain could increase the client's perception of pain. Another nursing activity is being an advocate for the client and notifying his surgeon of the client's fear.

The nurse applies a transdermal patch of fentanyl for a patient with pain due to cancer of the pancreas. The patient puts the call light on 1 hour later and tells the nurse that it has not helped. What is the best response by the nurse? a) "You have probably developed a tolerance to the medication." b) "It should have begun working 30 minutes ago. I will call the doctor and let him know you need something stronger." c) "It will take about 24 hours for the medication to work. I can't give you anything else or you will overdose." d) "It will take approximately 12 to 18 hours for the medication to begin to work, so I will give you something else now to relieve the pain."

d) "It will take approximately 12 to 18 hours for the medication to begin to work, so I will give you something else now to relieve the pain." Its lipophilicity makes fentanyl ideal for drug delivery by transdermal patch (Duragesic) for long-term opioid administration and by the oral transmucosal (Actiq) and buccal (Fentora) routes for BTP treatment in patients who are opioid tolerant. Following application of the transdermal patch, a subcutaneous depot of fentanyl is established in the skin near the patch. After absorption from the depot into the systemic circulation, the drug distributes to fat and muscle. When the first patch is applied, 12 to 18 hours are required for clinically significant analgesia to be obtained; attention must be paid to providing adequate supplemental analgesia during that time.

When receiving epidural opioids, respiratory depression generally peaks within which time frame? a) 18 to 24 hours b) 4 to 6 hours c) 1 to 3 hours d) 6 to 12 hours

d) 6 to 12 hours Respiratory depression generally peaks 6 to 12 hours after epidural opioids are administered, but it can occur earlier or up to 24 hours after the first injection.

The nurse is obtaining data regarding the medication that the client is taking on a regular basis. The client states he is taking duloxetine (Cymbalta), an antidepressant for the treatment of neuropathic pain. What type of therapy does the nurse understand the client is receiving? a) Withdrawal therapy b) Alternate drug therapy c) Replacement drug therapy d) Adjuvant drug therapy

d) Adjuvant drug therapy Adjuvant drugs are medications that are ordinarily administered for reasons other than treating pain. Cymbalta is used to treat depression but is being used for neuropathic pain for this client. The other answers are distractors with no relation to the question.

A client is receiving morphine sulfate intravenously (IV) every 4 hours as needed for the relief of pain related to a surgical procedure the client had 3 days previously. The physician is discontinuing the IV and will be starting the patient on oral pain medication. What would provide the client with optimal pain relief when discontinuing the IV dose? a) Administer a higher dose of the medication by mouth. b) Administer a lower dose so the client does not get addicted to the medication. c) The client should be ordered the medication to be administered intramuscularly (IM) instead of by mouth. d) Administer an equianalgesic dose.

d) Administer an equianalgesic dose. When changing from a parenteral to an oral route, it is best to administer an equianalgesic dose, an oral dose that provides the same level of pain relief as when the drug is given by a parenteral route. Administering a lower dose of the medication will not provide the client with an adequate pain relief. Administering an IM dose may decrease the absorption and not provide the client with adequate relief. Administering a higher dose may cause side effects that would be detrimental to the client.

A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain? a) Provide patient-controlled analgesia. b) Administer oral opioids as needed. c) Administer pain medication through a transdermal patch. d) Administer analgesics around the clock.

d) Administer analgesics around the clock. Because assessing pain medication needs in a client with end-stage dementia is difficult, analgesics should be administered around the clock. Clients at this stage of dementia typically can't request oral pain medications when needed. They're also unable to use patient-controlled analgesia devices. Transdermal patches are used to manage chronic pain; not postoperative pain.

A client who is prescribed morphine for undiagnosed abdominal pain reports that he is allergic to morphine. The nurse questions the client about his allegic reaction; the client responds that when he took it in the past, he experienced itching. The nurse plans to a) Refuse to administer the morphine. b) Obtain an order for a skin cream to minimize itching. c) Notify the physician that the client is allergic to morphine. d) Administer prescribed diphenhydramine (Benadryl).

d) Administer prescribed diphenhydramine (Benadryl). Pruritus or itching is a frequent side effect of morphine. It does not mean the client is allergic to morphine. Administering an antihistamine, such as diphenhydramine, may relieve the itching, and the client could still receive morphine. A skin cream would not be effective in minimizing the itching.

The client, newly admitted to the hospital, has a list of home medications, which includes a transdermal fentanyl patch. It is most important for the nurse to a) Ask about constipation. b) Remove the old patch. c) Teach about adverse reactions. d) Check the dose.

d) Check the dose. The dosage of any medication should be checked for correctness. This is basic medication administration to prevent error. The nurse will also perform the other options listed.

A client being treated for rheumatoid arthritis has been prescribed a type of drug that is commonly used for joint inflammation. The nurse will administer an initial dose as an injection, and the client will continue taking an oral form of the medication. Which type of analgesic drug will the nurse administer? a) Narcotic b) Opioid c) Antidepressant d) Corticosteroid

d) Corticosteroid Corticosteroids are used to treat pain that involves inflammation, such as that related to rheumatoid arthritis. Opioids are morphine-like synthetic narcotics that produce the same effects as drugs derived from the opium poppy. Narcotics are highly addictive analgesic drugs derived from opium or similar compounds. They can cause significant alterations of mood and behavior. Antidepressants can assist in pain management by blocking the reuptake of serotonin and norepinephrine. They are not used as a primary treatment for inflammatory conditions.

The client is scheduled for surgery. The nurse is reviewing with the client about postoperative pain management. The client states her goal after receiving treatment is "0." The first action of the nurse is to a) Ensure the client is prescribed large doses of opioids postoperatively. b) Plan to use medication and nonpharmacologic interventions. c) Notify the surgeon of the client's goal of "0." d) Educate the client that this goal may not be achievable.

d) Educate the client that this goal may not be achievable. The client's goal of complete elimination of pain may be unrealistic. The nurse needs to first teach the client about setting an achievable goal. The nurse will plan to use a combination of pharmacologic and nonpharmacologic interventions for pain relief. The nurse may need to notify the surgeon of the client's goal of "0" for pain relief. The nurse does not ensure large doses of opioids are prescribed for the client. Many factors go into the prescription of medication for pain relief, including the client's response to the medication.

The nurse needs to carefully monitor a patient with traumatic injuries. How often should the nurse check and document the patient's pain? a) An hour after analgesics are administered b) On admission and discharge of the patient c) After every meal consumed by the patient d) Every time the patient's vital signs are assessed

d) Every time the patient's vital signs are assessed The nurse should check and document the patient's pain every time the patient's temperature, pulse, respirations, and blood pressure are assessed. The American Pain Society (APS) has proposed that pain assessment should be considered the fifth vital sign. Pain does not need to be assessed an hour after analgesics are administered or after every meal consumed by the patient. Pain should not be assessed only on admission and discharge of the patient.

A client is recovering from abdominal surgery and sleeping. The client had received an opioid medication 3 hours ago. The client's son requests pain medication for the client, stating "I do not want her to wake up in pain." The first nursing action is a) Refuse to administer the pain medication. b) Wake the client and ask about her pain rating. c) Administer the prescribed medication. d) Instruct the son about lack of client consent.

d) Instruct the son about lack of client consent. One of the client's rights is to participate in management of his or her own care. The nurse follows the nursing process by assessing the client's perception of pain but does not awaken the client to do this. The nurse can administer the pain medication only after assessment. The nurse does not administer the pain medication but does take the opportunity to educate the son.

An older adult has been medicated with an oral opioid for postoperative pain. To make the pain medication more effective, the nurse first a) Consults with the physician to include hydroxyzine (Vistaril) with the opioid b) Administers the client's regular diet to prevent nausea with opioid ingestion c) Assists the client to a high Fowler's position in a chair d) Provides the client with a fresh gown and changes the bed linens

d) Provides the client with a fresh gown and changes the bed linens Clients are usually more comfortable and pain relief measures are increased when physical needs are met. Nursing interventions would include providing a fresh gown, changing bed linens, placing the client in a more comfortable position, brushing teeth, and combing hair. Hydroxyzine may be given with opioid analgesics. However, elderly clients are more susceptible to adverse reactions of this medication, and other alternative measures should be tried first. A high Fowler's position in a chair may not be more comfortable. Ingesting food with an opioid medication does not make the medication more effective.

Which of the following is a heightened response seen after exposure to a noxious stimulus? a) Pain threshold b) Dependence c) Pain tolerance d) Sensitization

d) Sensitization Sensitization is a heightened response seen after exposure to a noxious stimulus. Pain tolerance is the maximum intensity or duration of pain that a person is willing to endure. Pain threshold is the point at which a stimulus is perceived as painful. Dependence occurs when a patient who has been taking opioids experiences a withdrawal syndrome when opioids are discontinued.

A client reports abdominal pain as "8" on a pain intensity scale of 0-10 30 minutes after receiving an opioid intravenously. Her past medical history includes partial-thickness burns to approximately 60% of her body several years ago. The nurse assesses a) That the client has become dependent on drugs from her previous experience of burns b) That based on her past experiences the client's perception of pain should be less c) That the client is experiencing pain relating to the burn injuries from several years ago d) That the client's past experiences with pain may influence her perception of current pain

d) That the client's past experiences with pain may influence her perception of current pain Clients who have had previous experiences with pain are usually more frightened about subsequent painful events, as in the client who experienced partial-thickness burns to more than 60% of her body. The clients in these situations are less able to tolerate pain. Insufficient data in the stem support that the client is dependent on drugs or that this current pain is related to the client's previous burn injuries.

The client is taking oxycodone (Oxycontin) for chronic back pain and reports decreased pain relief when he began taking a herb to improve his physical stamina. The nurse asks if the herb is a) chamomile b) valerian c) kava-kava d) ginseng

d) ginseng Ginseng may inhibit the analgesic effects of an opioid, such as oxycodone. The other herbs listed (valerian, kava-kava, and chamomile) may increase central nervous system depression.