Chapter 18: Pain Management, Comfort, Rest and Sleep
A 52 year old patient admitted for deep vein thrombosis of the left internal iliac vein complains of excruciating pain in his left leg. What is the most appropriate response by the nurse? 1.) Pain is what you say it is; I will assist you in whatever way I can 2.) Your pain is an unpleasant sensation caused by inflammation of the vein and difficult to control 3.) Your pain is one of the cardinal signs of inflammation 4.) I know you are in pain, but it is important that we guard against possible addiction to opioids
1
A patient with diabetes who previously reported a tingling, burning sensation in the lower extremities now reports that the prescribed opioid dose dos not seem to provide the same relief for his acute pain that it did when he first started to take the medication 4 weeks ago. Based on the nurse's knowledge of pharmacology, the nurse recognizes that the patient has developed: 1.) a physical tolerance 2.) A psychological dependence 3.) An addiction 4.) chronic pain
1
Research indicates that the risk of clinically significant opioid-induced respiratory depression is 1.) less than 1% 2.) 5% 3.) 20% 4.) 30%
1
The nurse is talking to a patient who wants to try transcutaneous electric nerve stimulation (TENS). The nurse would alert the health care provider if the patient reveals he has a: 1.) Cardiac Pacemaker device 2.) Hearing aid 3.) Metallic hip joint 4.) History of a broken back
1
What drug delivery system is used to control pain via a portable computer pump with a chamber for a syringe? 1.) Patient controlled analgesia 2.) Transcutaneous electric nerve stimulation 3.) A venous access device 4.) An intrathecal delivery system
1
Which nursing intervention demonstrates the application of the gate control theory of pain? 1.) Performs a back massage using warmed lotion 2.) Administers a placebo to release endorphins 3.) Obtains an order for opioid medication 4.) Advocates for patient controlled analgesia
1
An older adult patient diagnosed with osteoarthritis suffers from chronic pain. Based on the patient's age and condition, which pain medication(s) will the health care provider most likely avoid? (Select all that apply) 1.) Meperidine 2.) ACetaminophen 3.) Morphine Sulfate 4.) Nonsteroidal antiinflammatory drugs 5.) Combinations
1 3 4 5
The nursing student is discussing the gate control theory of pain. Which statement by the student indicates the need for further instruction? (Select all that apply) 1.) The gates of the pain pathways can be opened with therapeutic massage and heat treatments 2.) Pain has exclusive use of the pathways ahead of other stimuli, according to the theory 3.) Distraction is beneficial in pain management 4.) Pain is a manifestation of an intricate chain of electrochemical events 5.) Memories and feelings may alter gating mechanisms
1, 2, 4
A patient was admitted to the orthopedic section for acute back pain. The health care provider is planning to use cutaneous stimulation management. Which is an example of this pain control method? 1.) Epidural analgesia 2.) Transcutaneous electric nerve stimulation (TENS) 3.) Nonsteroidal antiinflammatory drugs (NSAIDs) 4.) Patient controlled analgesia
2
The nursing student reports to the nurse that a postoperative patient is asking for pain medication. What is the most important question that the nurse will ask the student to answer? 1.) Can you give the medication yourself 2.) What did the patient tell you about his pain? 3.) Did you try any nonpharmacological interventions 4.) What do you know about the ordered medication
2
The patient had a surgical procedure this morning and is requesting pain medication. The nurse assesses the patient's vital signs and decides to withhold opioid medication based on the finding of: 1.) Pulse: 90 2.) Respiration: 10 3.) BP: 130/80 4.) Temp: 99 (rectally)
2
What is the physiological rationale for avoiding use of meperidine (Demorol) for patients with sickle cell disease? 1.) There is a direct action that causes sickling of blood cells 2.) Renal insufficiency will be present to some degree 3.) Underlying respiratory distress results in respiratory depression 4.) Patients with sickle cell disease are more prone to seizures
2
A 63 year old patient underwent a lower anterior bowel resection yesterday. What common central nervous system analgesic is often prescribed for control pain? 1.) Aspirin 2.) Acetaminophen (Tylenol) 3.) Morphine 4.) Ibuprofen (Motrin)
3
Following surgery for a total knee replacement, a patient was given an epidural catheter for fentanyl epidural analgesia. What is the most important nursing intervention? 1.) Administer additional analgesic medications as needed 2.) Change the epidural dressing every shift 3.) Assess respiratory rate 4.) Encourage ambulation
3
The health care provider orders 1000 mg acetaminiophen every 4 hours as needed for pain. What should the nurse do? 1.) Assess the patient every 4 hours and give medication as needed 2.) Give the medication as needed during the daytime hours only 3.) Call the health care provider and ask for clarification of the order 4.) Call the pharmacy and ask if the medication comes in 1000 mg tablets
3
The nurse is caring for a patient who has arthritis. Which medication does the nurse anticipate the health care provider will prescribe? 1.) Proproxyphene (Darvon) 2.) DIphenhydramine (Benadryl) 3.) Ibuprofen (Motrin) 4.) Morphine (MS Contin)
3
The nurse is caring for several patients who are receiving morphine. Which patient is most likely to have respiratory depression? 1.) Patient with a history of chronic back pain who is receiving epidural morphine for an acute exacerbation 2.) Elderly patient who is postoperative for a fractured hip and is receiving patient controlled analgesia 3.) Child who received an intramuscular injection prior to having fracture reduction of the forearm 4.) Elderly patient with end stage uterine cancer who is receiving an oral form of morphine
3
The nurse is caring for two patients with similar injuries. One patient expresses severe pain and the other reports feeling fine with low levels of pain. Which statement is most correct? 1.) The patient having more intense reports of pain has dysfunction endorphins 2.) The patient having lesser levels of pain has a higher level of endorphins 3.) The patient experiencing intense pain has lower levels of endorphins 4.) The patient having elevated levels of pain has an alteration in recognition of endorphins by the hypothalamus of the brain
3
The nurse is talking to an older adult who reports feeling tired and not getting enough sleep. Which question related to the question's medication is most relevant to designing interventions for the patient's problem? 1.) Which NSAID medication has the health care provider suggested? 2.) Has there been a recent increase in the dosage of your opioid medication? 3.) What time of the day do you usually take your diuretic medication? 4.) Are you taking your antiemetic medication before or after meals?
3
The nurse listens attentively while the patient describes her angina pectoris pain as radiating down her left inner arm to the little finger upward to the jaw and the shoulder. What term is used to classify this type of pain? 1.) Precisely localized 2.) Referred 3.) Intermittent 4.) Chronic
3
The patient agrees to try guided imagery as a noninvasive method of pain relief. Before they begin the therapy, which instructions is the nurse most likely to give? 1.) I'll use a combination of firm and light strokes during the therapy 2.) The skin will be stimulated with a mild electric current that reduces pain 3.) Tell me about a place and time where you felt relaxed and peaceful 4.) We have to use specialized equipment to identify your biological responses
3
The patient is receiving an epidural opioid. The nurse is alert for a complication of this treatment and observes the patient for: 1.) Diarrhea 2.) Hypertension 3.) Urinary Retention 4.) Increased respiratory Rate
3
What is the priority responsibility of the nurse related to pain? 1.) Leave the patient alone to rest 2.) Help the patient appear to not be in pain 3.) Believe what the patient says about pain 4.) Assume responsibility for eliminating the patient's pain
3
What statement unrelieved pain is the most correct? 1.) Unrelieved pain is a normal expectation after major surgery 2.) Patient's with cancer diagnosis can expect to experience unrelieved pain 3.) Physiological and psychological complications can result from unrelieved pain. 4.) Although unrelieved pain is stressful and annoying, it is not as important as other physical care needs.
3
Which nursing action demonstrates that the nursing is complying with the Joint Commission (TJC) standards of pain management? 1.) Documents that medication is given after the patient receives it 2.) Incorporates knowledge of the patient's culture in pain management 3.) Assesses the patient's pain and reassesses pain after interventions 4.) Stays current with the latest information about pain therapies
3
Which opioid is no longer a drug of choice for managing pain because of its toxic complications, such as causing seizures? 1.) Codeine 2.) Morphine 3.) Meperidine 4.) Fentanyl
3
Which route is most appropriate for treating rapidly escalating severe pain? 1.) Oral 2.) Intramusuclar (IM) 3.) Intravenous (IV) 4.) Transdermal
3
A patient admitted with severe cellulitis of the left breast states, :I have a severe burning pain, and it feels like my breast is on fire." She rates her pain as a 7/10. How would this collection of data by the nurse in assessing the patient's pain be classified? 1.) Deductive 2.) Speculative 3.) Objective 4.) Subjective
4
The home health nurse sees an order for meperidine (Demerol) for a 63 year old patient with cancer who requires long term opioid treatment. What is the best rationale for the nurse to question this medication order? 1.) Meperidine (Demerol) is an older drug that is now rarely prescribed for any condition 2.) The patient cannot be continuously monitored for adverse effects in the home setting 3.) The patient is not young nor healthy and is therefore more likely to suffer side effects 4.) Repeated administration of meperidone (Demoerol) increases the risk of accumulation
4
The nurse hears the report that the patient with diabetes has reported a tingling, burning sensation in the lower extremities. Which drug it the nurse likely to administer for this type of discomfort? 1.) ketorolac thromethamine (Toradol) 2.) tramadol (Ultram) 3.) acetaminophen (tylenol) 4.) duloxetine (cymbalta)
4
The nurse is assessing the patient's description of his back pain. He states that it is "immobilizing, intense, and on a scale of 0 to 10, it is a 8." What type of pain assessment scale is the patient using? 1.) Visual analog 2.) Categorical 3.) Functional 4.) Numerical
4
What is the greatest advantage of using noninvasive pain management techniques as an adjunct to pain medication? 1.) Inexpensive and easy to perform 2.) Based on the gate control theory 3.) Low risk and few side effects 4.) Gives patients some control over pain
4
What is the recommended dosage of acetaminophen?
4000 mg (4g) within 24 hours
Acute pain is intense and of short duration, usually lasting less than ____ months
6
Patient-controlled analgesia (PCA)
A drug delivery system that dispenses a preset intravenous dose of an opioid analgesic into a patient's vein when the patient pushes a switch on an electric cord
Noxious
A stimulation of the sensory nerve endings that is harmful, injurious, or dentrimental to physical health
Transcutaneous electric nerve stimulation (TENS)
A type of pain control that is managed with a pocket-sized, battery-operated device that provides a continuous, mild electrical current to the skin via electrodes
Synergistic
Action of two or more substances or organs to achieve an effect of which each is capable
What type of pain provides a warning to the individual of actual or potential tissue damage
Acute Pain
____ is intense and of short duration, usually lasting less than 6 months
Acute Pain
______ is intense and short duration, usually lasting less than 6 months.
Acute Pain
Visual Analog Scale
An objective means of assessing pain severity; it consists of a straight line, representing a continuum of intensity, and has visual descriptors at each end
What are possible emotional consequences of pain?
Anxiety Depression Irritability Inability to enjoy life
Endorphins
Any one of the neuropeptides composed of many amino acids, elaborated by the pituitary gland and acting on the central and peripheral nervous system to reduce pain
Patients with ______ pain often described pain for which little or no tissue damage can be found
Chronic Nonmalignant
What type of pain does not serve as a warning of tissue damage in process; rather it signals that such damage has occurred
Chronic Pain
_____ is generally characterized as pain lasting longer than 6 months
Chronic Pain
What is the most common side effect of opioids?
Constipation
Where are the proposed location of the gates (of the gate control theory)?
Dorsal horn of the spinal cord
Pain relief measures such as transcutaneous electric nerve stimulation (TENS), acupuncture and placebos, are believed to cause the release of ______
Endorphins
The body produces morphine-like substances called _____
Endorphins
True or False: Morphine and other opioid analgesics are the most widely available and frequently used analgesic group
False Acetaminophen and nonsteroidal anti inflammatories
True or False: Older adults require sleep than younger people, but they are more likely to take naps
False Older adults require the same amount of sleep than younger people
True or False: A predictable relationship exists between identifiable tissue injury and the sensation of pain
False There is no predicable relationships exists between identifiable tissue injury and the sensation of pain
True or False: Approximately 10% of people who suffer moderate to severe pain will continue to suffer, primarily because nurses fail to assess pain
False 50%
Pain causes:
Fatigue and decreases the patient's ability to cope physically, emotionally, and mentally.
What theory of pain suggests that pain impulses are regulated and even blocked by gating mechanisms located along the central nervous system (CNS)
Gate Control Theory
Acute Pain
Having a short and relatively severe course; a disease process characterized by a relatively short duration of signs and symptoms that are usually severe and begin abruptly
What is the best route for administering opioid analgesics after major surgery?
IV
Patient-controlled analgesic devices and epidural analgesia give pain control with _____ of over dose
Low risk
Define comfort
Means to give strength and hope, to cheer ad to ease the grief, pain, or trouble of another
Injurious to physical health
Noxious
Pain is an unpleasant sensation caused by _____ stimulation of the sensory nerve endings
Noxious
Non-rapid eye movement
One of two highly individualized sleeping states divided into four stages through which a sleeper progresses during a typical sleeping cycle; represents three fourths of a period of typical sleep
Rapid Eye Movement (REM)
One of two highly individualized sleeping states that follows NREM state. May last from a few minutes to a half an hour and alternate with NREM periods; dreaming occurs during this time
_____ decrease the perception of pain by binding to pain receptor sites in CNS
Opioids
What is one of the most common reasons that patients seek out a health care provider?
Pain
How does the International Association for the Study of Pain and the American Pain Society define "Pain"?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
How does McCaffery and Pasero in 2003 define pain?
Pain is whatever the experiencing person says it is, existing whenever he says it does
Chronic Pain
Pain lasting longer than 6 months; can be as intense as acute pain; can be continuous or intermittent
What is an example of referred pain?
Pain of coronary artery insufficiency that in some cases is felt in the left shoulder, the left arm, or the jaw
Referred Pain
Pain that is felt at a site other than in the injured or diseased organ or part of the body
The combination of fatigue, sleep disturbance, and depression has the potential to markedly change a person's ______ of pain
Perception
Pain is often a _____ mechanism that warns of tissue injury
Protective
_____ is felt at a site other than the injured or diseased organ or part of the body
Referred Pain
Demerol has a potential to induce
Seizures
What activates endorphins?
Stress and pain
Gate control theory
Suggests that pain impulses can be regulated or even blocked by gating mechanisms located along the central nervous system
It is possible that fatigue, sleep disturbance, and depression act in a type of _____ relationship, in which the actions of two or more substances or organs achieve an effect that cannot be achieved by an individual substance or organ
Synergistic
Considering pain in the 5th vital sign helps ensure:
That pain is monitored on a regular basis
What is one of the greatest challenges in nursing?
To provide comfort to the patient
TENS
Transcutaneous electric nerve stimulation
A special pain relief system, _____, entails the use of a pocket-sized, battery operated device that provides a continuous, mild electric current to the skin via electrodes that are attached to a simulator by flexible wires
Transcutaneous electric nerve stimulation (TENS)
True or False: Bedrest doe snot necessarily mean a patient is resting
True
Who is TENS typically used for?
patients suffering postoperative of chronic pain
Pain is largely a ____ experience
subjective
