Pain Med Questions
A (Calls the health care provider, and questions the order) (Fentanyl is 100 times more potent than morphine and not recommended for acute postoperative pain.)
A health care provider writes the following order for an opioidnaive patient who returned from the operating room following a total hip replacement. "Fentanyl patch 100 mcg, change every 3 days." Based on this order, the nurse takes the following action: A) Calls the health care provider, and questions the order B) Applies the patch the third postoperative day C) Applies the patch as soon as the patient reports pain D) Places the patch as close to the hip dressing as possible
B (The time interval) (Controlled- or extended-release opioid formulations such as OxyContin are available for administration every 8 to 12 hours ATC. Health care providers should not order these long-acting formulations prn.)
A new medical resident writes an order for OxyContin SR 10 mg PO q12 hours prn. Which part of the order does the nurse question? A) The drug B) The time interval C) The dose D) The route
d (Eardrops are administered with the ear positioned upward and outward for patients greater than 3 years of age.)
A nurse is administering eardrops to an 8-year-old patient with an ear infection. How does the nurse pull the patient's ear when administering the medication? A) Outward B) Back C) Upward and back D) Upward and outward
B (Pain rating of 9 on a scale of 0 to 10) (The client's self-report of pain using a standardized pain scale is the most reliable indicator of pain. Vital signs, nonverbal communication, and other actions may be indicators of pain, but are not the most reliable.)
A nurse is caring for a postoperative client. Which of the following assessment findings is the most reliable indicator that the client is experiencing pain? A. Blood pressure of 166/90 mm Hg B. Pain rating of 9 on a scale of 0 to 10 C. Client grimaces when bed is moved D. Client refuses to eat breakfast
b
A patient has a history of severe chronic pain. One of the most important guidelines associated with providing nursing care to this patient is: A. Determining the level of function that can be performed without pain B. Focusing on pain management intervention before pain is excessive C. Providing interventions that do not precipitate pain D. Asking what is an acceptable level of pain
B (Stimulant laxative) (Patients usually become tolerant to the side effects of opioids, with the exception of constipation. Routinely administer stimulant laxatives, not simple stool softeners, to prevent and treat constipation.)
A patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication? A) Stool softener B) Stimulant laxative C) H 2 receptor blocker D) Proton pump inhibitor
c (A nursing responsibility is to collaborate with community resources when patients have home care needs or difficulty understanding their medications.)
A patient is transitioning from the hospital to the home environment. A home care referral is obtained. What is a priority in relation to safe medication administration for the discharge nurse? A) Set up the follow-up appointments with the physician for the patient. B) Ensure that someone will provide housekeeping for the patient at home. C) Ensure that the home care agency is aware of medication and health teaching needs. D) Make sure that the patient's family knows how to safely bathe him or her and provide mouth care.
B (Request to have the ordered changed to ATC for the first 48 hours.) (The American Pain Society (2003) states that, if you anticipate pain for most of the day, you should consider ATC administration. Insertion of a gastrostomy tube is painful. This patient will most likely experience pain for at least the next 48 hours.)
A patient with a history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The health care provider's order reads as follows: "Vicodin 1 tab, per tube, q4 hours, prn." Which action by the nurse is most appropriate? A) No action is required by the nurse because the order is appropriate. B) Request to have the ordered changed to ATC for the first 48 hours. C) Ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3 hours, prn. D) Begin the Vicodin when the patient shows nonverbal symptoms of pain.
D (Physical dependence.) (Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.)
A patient with chronic low back pain who took an opioid around-the-clock (ATC) for the past year decided to abruptly stop the medication for fear of addiction. He is now experiencing shaking chills, abdominal cramps, and joint pain. The nurse recognizes that this patient is experiencing symptoms of: A) Addiction. B) Tolerance. C) Pseudoaddiction. D) Physical dependence.
d
A postoperative patient is receiving morphine sulfate via PCA. The nurse assesses that the patient's respirations are depressed. The effects of the morphine sulfate can be classified as A. Allergic. B. Idiosyncratic. C. Therapeutic. D. Toxic.
D (Assess patient's vital signs every 15 minutes for 2 hours) (Reassess patients who receive naloxone every 15 minutes for 2 hours following drug administration because the duration of the opioid may be longer than the duration of the naloxone and respiratory depression may return.)
After having received 0.2 mg of naloxone (Narcan) intravenous push (IVP), a patient' s respiratory rate and depth are within normal limits. The nurse now plans to implement the following action: A) Discontinue all ordered opioids B) Close the room door to allow the patient to recover C) Administer the remaining naloxone over 4 minutes D) Assess patient's vital signs every 15 minutes for 2 hours
Transduction
Begins in the periphery when a pain-producing stimulus sends an impulse across a peripheral nerve fiber (nociceptor), initiating an action potential.
PNS
Continuous, severe or deep visceral pain will activate which brach of the nervous system? Resulting in - Pallor - Muscle Tension - Decreased HR and BP - Tachypnea + Irregular
Association cortex
Determines how we feel about pain
a
Found in pain neurons of the dorsal horn(excitatory peptide). Needed to transmit pain impulses from the periphery to higher brain centers. Causes vasodilation and edema. A. Substance p B. Bradykinin C. Histamine D. Serotonin
a
Instill eardrops at ____________ to prevent vertigo, dizziness, or nausea. A. room temperature B. below room temperature C. above room temperature D. at patient's desired temperature
Chronic
Identify the Pain Not protective Greater than 6 months Can not always identify the cause of pain Delays healing Interrupts life High rates of correlating depression Pseudoaddiction Holistic therapies
Acute
Identify the Pain Protective Less than 6 months Can identify cause of pain Delays healing
b ( filtered needle prevents glass particles from being drawn into the syringe)
It is most important for the nurse to use a filtered needle when preparing parenteral medication that: A. Has to be reconstituted B. Is supplied in an ampule C. Appears cloudy in a vial D. Is to be mixed with another medication
a
Medications whose early or delayed administration of maintenance doses more than 30 minutes before or after the scheduled dose most likely will cause harm or will result in subtherapeutic responses in a patient. A. Time-critical medications B. Non-time-critical medications
a
Method of injection prevents deposit of medication into sensitive tissue.The needle remains inserted for 10 seconds to allow the medication to disperse evenly rather than channeling back up the track of the needle. Place the ulnar side of the nondominant hand just below the site, and pull the overlying skin and subcutaneous tissues approximately 2.5 to 3.5 cm (1 to 1 1/2 inches) laterally or downward. Hold the skin in this position until you administer the injection. Release the skin after withdrawing the needle. This leaves a zigzag path that seals the needle track where tissue planes slide across one another. The medication cannot escape from the muscle tissue. Injections using this technique result in less discomfort and decrease the occurrence of lesions at the injection site A. Z-track method B. IM method C. S way D. MIR method
c
Minimum blood serum concentration before next scheduled dose A. Onset B. Plateau C. Trough D. Duration
b
Nurses are legally required to document medications that are administered to patients. The nurse is mandated to document which of the following? A. Medication before administering it B. Medication after administering it C. Rationale for administering it D. Prescriber rationale for prescribing it
Modulation
Once the brain perceives the pain, inhibitory neurotransmitters work to stop the transmission of pain and help produce an analgesic effect
Transmission
Pain impulse travels to nervous system with the help of some excitatory neurotransmitters: Prostglandins Bradykinin Substance P Histamine
c
Produced my mast cells causing capillary dilation and increase capillary permeability. A. Substance p B. Bradykinin C. Histamine D. Serotonin
Breakthrough Pain
Pain that extends beyond treated steady chronic pain
Incident Pain
Pain that is predictable and elicited by specific behaviors
Spontaneous Pain
Pain that is unpredictable and not associated with any activity or event
End-of-dose Failure Pain
Pain that occurs toward the end of the usual dosing interval of a regularly scheduled analgesic
Perception
Point at which a person is aware of pain
b
Point at which blood serum concentration is reached and maintained A. Onset B. Plateau C. Trough D. Duration
b
Released from plasma that leaks from surrounding blood vessels at the site of injury. Binds to receptors on peripheral nerves, increasing pain stimuli, Binds to cells that cause the chain reaction producing prostaglandins. A. Substance p B. Bradykinin C. Histamine D. Serotonin
d
The instructions with a medication states to use the Z-track technique when administrating the injection. Therefore, the nurse should: A. Pinch the site throughout the injection B. Massage the site after the needle is removed C. Remove the needle immediately after the medication is injected D. Change the needle after the medication is drawn into the syringe
a (Enteric-coated or sustained-release capsules should not be crushed; the nurse needs to contact the prescriber to change the medication to a form that is liquid or can be crushed.)
The nurse is administering a sustained-release capsule to a new patient. The patient insists that he cannot swallow pills. What is the nurse's next best course of action? A) Ask the prescriber to change the order B) Crush the pill with a mortar and pestle C) Hide the capsule in a piece of solid food D) Open the capsule and sprinkle it over pudding
a
The nurse is administrating an intradermal injection. The nurse inserts the needle at: A. 15 degree angle B. 30 degree angle C. 45 degree angle D. 90 degree angle
d
The nurse is assessing a patient in pain. Which characteristic is more common with acute pain than with chronic pain? A. Self-focusing B. Sleep disturbances C, Guarding behaviors D. Variations in vital signs
c
The nurse must administer an intradermal injection. The technique uniquely related to the administration of an intradermal injection is: A. Utilizing air-bubble technique B. Pinching the skin during needle insertion C. Inserting the needle with the bevel up D. Massaging the area after the fluid is instilled
a (Obvious response to pain is not always apparent)
The nurse needs to remember that when assessing pain: A. The lack of expression of pain does not always equate with the pain being experienced B. Pain medication can significantly increase a patient's pain tolerance C. The majority of cultures value the concept of suffering in silence D. Most people experience approximately the same pain tolerance
C (The amount of daily acetaminophen) (The major adverse effect of acetaminophen is hepatotoxicity. The maximum 24-hour dose is 4 g. It is often combined with opioids (e.g., oxycodone [Percocet]) because it reduces the dose of opioid needed to achieve successful pain control.)
The nurse notices that a patient has received oxycodone/acetaminophen (Percocet) (5/325) two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most? A) The patient's level of pain B) The potential for addiction C) The amount of daily acetaminophen D) The risk for gastrointestinal bleeding
c
The nurse teaches a patient about taking a sublingual nitroglycerine tablet. The nurse evaluates that the patient understands the teaching when the patient states, "I should place it: A. On my skin." B. Inside my cheek." C. Under my tongue." D. In the lower lid of my eyelid."
B (The patient's report of pain is the best method for assessing the pain.) (A patient's self-report of pain is the single most reliable indicator of the existence and intensity of pain.)
The patient rates his pain as a 6 on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. The patient's wife says that he can't be in that much pain since he has been sleeping for 30 minutes. Which is the most accurate resource for assessing the pain? A) The patient's wife is the best resource for determining the level of pain since she has been with him continually for the entire day. B) The patient's report of pain is the best method for assessing the pain. C) The patient's health care provider has the best knowledge of the level of pain that the patient that should be experiencing. D) The nurse is the most experienced at assessing pain.
Somatic, Visceral
Two types of Nociceptive Pain
B, D (Serotonin and endorphins are natural substances within the body that decrease pain transmission. Substance P, bradykinin, and histamine all increase pain transmission.)
When caring for clients experiencing pain, a nurse should recognize that which of the following substances decrease pain transmission. (Select all that apply.) A. Substance P B. Serotonin C. Bradykinin D. Endorphins E. Histamine
D (TENS electrodes are applied near or directly on the site of pain.) (TENS involves stimulation of the skin with a mild electrical current passed through external electrodes. The therapy requires a health care provider order. The TENS unit consists of a battery-powered transmitter, lead wires, and electrodes. Place the electrodes directly over or near the site of pain.)
When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which information do you include? A) TENS works by causing distraction. B) TENS therapy does not require a health care provider's order. C) TENS requires an electrical source for use. D) TENS electrodes are applied near or directly on the site of pain.
A, B (Cold therapies are particularly effective for pain relief. Ice massage involves applying a frozen cup of ice firmly over the skin. When numbness occurs, remove the ice for usually 5 to 10 minutes.)
When using ice massage for pain relief, which of the following are correct? (Select all that apply.) A) Apply ice using firm pressure over skin. B) Apply ice until numbness occurs and remove the ice for 5 to 10 minutes. C) Apply ice until numbness occurs and discontinue application. D) Apply ice for no longer than 10 minutes.
B (Difficulty arousing the patient) (Opioid-naive patients may develop a rare adverse effect of respiratory depression, and sedation always occurs before respiratory depression.)
Which of the following signs or symptoms in an opioid-naïve patient is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid? A) Oxygen saturation of 95% B) Difficulty arousing the patient C) Respiratory rate of 10 breaths/min D) Pain intensity rating of 5 on a scale of 0 to 10
B, C, D (Nociceptive pain is usually localized, responds well to opioid analgesics, and may result in referred pain. Neuropathic pain arises from damaged pain nerves and is associated with phantom limb pain.)
Which of the following statements describes nociceptive pain? (Select all that apply.) A. Arises from nerves by damaged pain B. Usually well localized C. Responds well to opioid analgesics D. May result in referred pain E. Associated with phantom limb pain
A (Only the patient should push the button.) (Patient preparation and teaching are critical to the safe and effective use of PCA devices. Patients need to understand PCA and be physically able to locate and press the button to deliver the dose. Be sure to instruct family members not to "push the button" for the patient.)
Which one of the following instructions is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine? A) Only the patient should push the button. B) Do not use the PCA until the pain is severe. C) The PCA prevents overdoses from occurring. D) Notify the nurse when the button is pushed.
A (Transitioning use of adjuvants with nonsteroidal antiinfl ammatory drugs "NSAIDs" to opioids.) (The WHO analgesic ladder transitions from the use of nonopioids "NSAIDS" with or without adjuvants to opioids with or without adjuvants. Acetaminophen is recommended for lesser levels of pain. Side effects related to the use of opioids may be unavoidable but are treatable. Treatment for severe pain may result in some level of sedation.)
While caring for a patient with cancer pain, the nurse knows that the World Health Organization (WHO) analgesic ladder recommends: A) Transitioning use of adjuvants with nonsteroidal antiinfl ammatory drugs (NSAIDs) to opioids. B) Using acetaminophen for refractory pain. C) Limiting the use of opioids because of the likelihood of side effects. D) Avoiding total sedation, regardless of how severe the pain is.
d
You are caring for a patient who has diabetes complicated by kidney disease. You need to make a detailed assessment when administering medications because this patient may experience problems with A. Absorption. B. Biotransformation. C. Distribution. D. Excretion