CHp 8 pain

The patient has an order for meperidine 75 mg intravenous push (IVP) q3-4hr as needed (PRN) for pain. On hand are prefilled syringes of meperidine labeled 50 mg/mL. How many mL should the nurse draw up and administer for a 75 mg dose? 1 0.5 mL 2 0.75 mL 3 1.25 mL 4 1.5 mL

4: 1.5 Using ratio and proportion, multiply 50 by x and multiply 75 × 1 to yield 75 = 50x. Divide 75 by 50 to yield 1.5 mL.

A patient with chronic back pain has learned to control the pain with the use of imagery and hypnosis. The patient's spouse asks the nurse how these techniques work. Which response by the nurse is accurate? a. "The strategies work by affecting the perception of pain." b. "These techniques block the pain pathways of the nerves." c. "These strategies prevent transmission of stimuli from the back to the brain." d. "The therapies slow the release of chemicals in the spinal cord that cause pain."

A Cognitive therapies affect the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.

The nurse should teach a patient to avoid which medication while taking ibuprofen? Aspirin Furosemide Nitroglycerin Morphine sulfate

Aspirin Rationale: The patient should not take aspirin while taking ibuprofen because the combination could increase the risk of gastrointestinal bleeding.

Best explanation for term tolerance

It is a diminished response to a drug so that more medications is required to achieve the same effect

A patient is receiving morphine sulfate via patient-controlled analgesia (PCA). What nursing action is most effective to reduce the risk of adverse effects? Tell the patient not to push the button too frequently. Teach the caregiver not to push the button for the patient. Ask the patient to do deep breathing exercises every hour. Administer medications to prevent the occurrence of diarrhea.

Teach the caregiver not to push the button for the patient. Rationale: It is important to teach the caregiver not to push the button for the patient because it is only the patient who can determine the need for the medication. If the caregiver pushes the button, the patient could receive more of a dose than is needed, and this increases the risk of harm and adverse effects. The patient will be unable to successfully push the button too frequently because the medication will be locked out from administration with the pump programmed. The patient may have difficulty following the direction of deep breathing exercises every hour because they will be sedated from the morphine. Constipation, not diarrhea, is a side effect of morphine.

A patient asks the nurse why a dose of hydromorphone (Dilaudid) by IV push is given before starting the medication via PCA. Which response is most appropriate? "PCA will never be effective unless a loading dose is given first." "The IV push dose will enhance the effects of the PCA for the next 8 hours." "The IV push dose will provide for immediate pain relief, which can be maintained by using the PCA." "PCA takes at least 2 hours to begin working, so the IV push dose will provide pain relief in the interim."

"The IV push dose will provide for immediate pain relief, which can be maintained by using the PCA." Rationale: An IV push loading dose of an opioid analgesic provides an effective opioid level in the body, which results in immediate pain control. The PCA medication doses may be smaller and can be used more frequently to maintain pain control when the loading dose begins to wear off.

The patient is experiencing breakthrough pain and a dose of hydromorphone 2 mg intravenous (IV) is prescribed. Available is a vial containing 5 mg/mL of solution. How many mL should be drawn up to give the dose? 1 0.25 mL 2 0.4 mL 3 0.6 mL 4 1.25 mL

0.4 Using the medication-calculation equation of dose desired (2 mg) divided by dose on hand (5 mg) and multiplied by the quantity (1 mL), the answer is 0.4 mL.

Before administering celecoxib, the nurse should assess the patient's medical record for which medication that would increase the risk of adverse effects? 1 Aspirin 2 Scopolamine 3 Theophylline 4 Acetaminophen

1 Celecoxib is a nonsteroidal antiinflammatory drug (NSAID) of the cyclooxygenase-2 (COX-2) inhibitor type. Although celecoxib does not inhibit COX-1 and thus has a decreased risk of bleeding, bleeding is still of concern as an adverse effect. For this reason, the drug should not be taken with other drugs that increase the risk of bleeding, such as aspirin. Scopolamine, theophylline, and acetaminophen are not of concern in this instance.

The nurse should prepare to administer which medication for the patient experiencing respiratory depression following intravenous administration of morphine? 1 Naloxone 2 Atropine 3 Flumazenil 4 Activated charcoal

1 Naloxone is a reversal agent for opioids used to reverse the effects of morphine, including respiratory depression. Atropine will not be effective in reversing the effects of morphine; it will elevate the heart rate. Flumazenil is a reversal agent for benzodiazepines. Activated charcoal can be used to remove toxic medications administered orally only.

A nurse educator is delivering a lecture on nociception to a group of nursing students. The nurse educator states that chemicals such as hydrogen ion and substance P play an important role in the pain pathway. What would also be appropriate for the educator to include in the teaching? 1 "These chemicals stimulate the nociceptors." 2 "These chemicals inhibit pain by acting on the anterior horn cells of the spinal cord." 3 "These chemicals increase the sensitivity and hyperexcitability of the neurons in the thalamus." 4 "These chemicals inhibit transmission of the pain signal by binding to the γ-aminobutyric acid (GABA) receptors."

1 Noxious stimuli cause the release of chemicals such as hydrogen ion and substance P. These substances stimulate the nociceptors. Therefore these substances play a major role in transduction. Substance P has a stimulatory effect on anterior horn cells. Endogenous opioids like enkephalin and endorphin bind to the γ-aminobutyric acid (GABA) receptors and inhibit pain transmission. These chemicals are not known to increase the sensitivity of neurons present in the thalamus.

A patient with osteoarthritis has been taking ibuprofen 400 mg every eight hours. The patient states that the drug does not seem to work as well as it used to in controlling the pain. The most appropriate response to the patient is based on what knowledge? 1 Another nonsteroidal antiinflammatory drug (NSAID) may be indicated because of individual variations in response to drug therapy. 2 It may take several months for NSAIDs to reach therapeutic levels in the blood and thus be effective. 3 If NSAIDs are not effective in controlling symptoms, systemic corticosteroids are the next line of therapy. 4 The patient probably is not compliant with the drug therapy and therefore the nurse must initially assess the patient's knowledge base and initiate appropriate teaching.

1 Patients vary in their response to medications, so when one nonsteroidal antiinflammatory drug (NSAID) does not provide relief, another should be tried. The timeframe is not the issue in this case. Systemic corticosteroids are not the next in line for therapy; a different NSAID should be tried first. There is no evidence to ascertain any noncompliance with drug therapy.

A patient in pain is anxious, fearful, and angry. Which pain dimension is this patient demonstrating? 1 Affective 2 Cognitive 3 Behavioral 4 Physiologic

1 The biopsychosocial model of pain includes five dimensions of pain: physiologic, affective, cognitive, behavioral, and sociocultural. The affective dimension involves emotional responses to pain including anger, anxiety, fear, and depression. The cognitive dimension involves beliefs, attitudes, memories, and meaning attributed to the pain. The behavioral dimension involves the use of observable actions such as grimacing and irritability to express or control pain. The physiologic dimension involves genetic, anatomic, and physical determinants of pain.

During the nursing assessment of a patient with acute pain in the shoulders, which characteristics of acute pain would the nurse expect to find? Select all that apply. 1 The pain is moderate in severity. 2 The patient is pale and has diaphoresis. 3 The duration of pain is more than three months. 4 The heart rate and blood pressure are elevated. 5 There are intervals of increasing and decreasing pain.

1,2,4 During the nursing assessment of the patient with acute pain, the nurse may find that the pain is moderate in severity. The activation of the sympathetic nervous system may manifest as increased heart rate and blood pressure, and also pallor and diaphoresis. When the duration of pain is more than three months, it is called chronic pain. Chronic pain does not go away and is characterized by periods of increasing and decreasing pain.

When assessing a patient receiving morphine sulfate 2 mg every 10 minutes via PCA pump, the nurse should act as soon as the patient's respiratory rate drops down to or below which parameter? 10 breaths/min 12 breaths/min 14 breaths/min 16 breaths/min

12 breaths/min Rationale: To protect the patient from adverse effects of respiratory depression from this medication, the nurse should alert the health care provider as soon as the respiratory rate drops down to or below 12 breaths/min.

A patient who has had difficulty with the gastrointestinal side effects of nonsteroidal antiinflammatory drugs (NSAIDs) asks the nurse if there are any NSAIDS which have less of an impact on the gastrointestinal system. Which medication would the nurse suggest to the patient's primary care provider? 1 Ketorolac 2 Celecoxib 3 Naproxen 4 Diclofenac K

2 Celecoxib is an NSAID which causes fewer gastrointestinal side effects than other NSAIDs, including ketorolac, naproxen, and diclofenac K, although the risk is still present.

Which process of nociception involves the activation of descending pathways that exert inhibitory or excitatory effects on the transmission of pain? 1 Perception 2 Modulation 3 Transduction 4 Transmission

2 Nociception involves four processes. Modulation is the last process, which involves the activation of descending pathways that exert inhibitory or excitatory effects on the transmission of pain. Transduction is the first process; it involves the conversion of a noxious mechanical, thermal, or chemical stimulus into an electrical signal, called an action potential. Transmission occurs after transduction; in this process, pain signals are relayed from the periphery to the spinal cord and then to the brain. Perception is the third process, when pain is recognized, defined, and assigned meaning by the individual experiencing pain.

A patient with chronic abdominal pain has pain relief with an opioid analgesic. Which type of pain is the patient experiencing? 1 Central pain 2 Visceral pain 3 Deep somatic pain 4 Deafferentation pain

2 If the patient's abdominal pain is relieved with an opioid analgesic, the patient has visceral pain arising from the gastrointestinal tract (GI tract). Visceral pain is a nociceptive pain, which is responsive to nonopioid or opioid analgesics. Central pain is a type of neuropathic pain characterized by abnormal processing of sensory input, and it is treated with adjuvant analgesics. Poststroke pain and pain associated with multiple sclerosis are examples of central pain. Deep somatic pain is a type of nociceptive pain that arises from muscles, fasciae, bones, and tendons but not from visceral organs such as the GI tract. Deafferentation pain is a type of neuropathic pain that results from a loss of afferent input and is treated with adjuvant analgesics.

The nurse is caring for a patient who is receiving morphine sulfate via patient-controlled analgesia (PCA). Which patient assessment data demonstrates the most therapeutic effect of this medication? 1 Pain rating 3/10, awake and alert, respirations 24 2 Pain rating 2/10, awake and alert, respirations 18 3 Pain rating 2/10, drowsy but arousable, respirations 18 4 Pain rating 1/10, drowsy but arousable, respirations 16

2 Effective pain management is achieved when there is adequate pain control (rating of 3 or less on a scale of 0 to 10), with normal respirations (12-20 breaths/minute) and an absence of sedation. A pain rating of 2/10, awake and alert, and respirations 18 exhibit the best effectiveness of the pain medication in all of these areas. A pain rating of 3/10 is adequate and awake and alert is good, but respirations at 24 is abnormal. A pain rating of 2/10 is adequate, respirations 18 is normal, but drowsy indicates the pain management is not effective. A pain rating of 1/10 is adequate, respirations 16 is normal, but drowsy indicates the pain management is not effective.

A patient has a prescription to receive oxycodone for pain. Before administering this medication, the nurse would check for which allergy that could pose a risk to the patient? 1 Penicillin 2 Morphine 3 Ibuprofen 4 Theophylline

2 Oxycodone is contraindicated in patients who are allergic to morphine because of possible hypersensitivity to this drug as well. There is no cross-sensitivity between oxycodone and penicillin, ibuprofen, or theophylline

A nurse is assessing a patient who has been diagnosed with sciatica. The patient states that the pain usually starts in the back and then goes to the buttocks, posterior thigh, posterior leg, and the foot. The nurse interprets the findings as which type of pain? 1 Referred pain 2 Radiating pain 3 Persistent pain 4 Breakthrough pain

2 Sciatica is a type of peripheral neuropathy that is caused by compression of or damage to the sciatic nerve. Pain in sciatica is radiating and occurs along the course of the sciatic nerve. Pain usually starts in the back and radiates downward to the buttocks, posterior thigh, posterior leg, and to the foot. A referred pain is the one in which the pain is felt in a location different from the origin of the pain. A persistent pain is less responsive to pain management therapies. A breakthrough pain is a transient, moderate to severe pain, occurring in patients who otherwise have mild to moderate pain that is fairly well controlled.

A postoperative patient has been started on patient-controlled analgesia with morphine sulfate intravenously (IV). The nurse would re-evaluate the pain-management plan if the patient required more than how many rescue doses in a 24-hour period? 1 One 2 Two 3 Three 4 Four

2. If pain-management strategies are effective, the patient should not require more than two rescue doses of an opioid analgesic in a 24-hour period. If the patient needs more than two doses, the pain-management plan should be re-examined. Needing one rescue dose indicates adequate pain management. Topics

A patient rates pain as being severe on a pain thermometer. What score should the nurse assign this patient's pain? 1: 2 2: 3 3: 4 4: 5

2: score of 3 A pain thermometer is used to indicate the severity or intensity of pain on a scale from 0 to 5. A score of 3 indicates severe pain. A score of 2 indicates moderate pain. A score of 4 indicates extreme pain. A score of 5 indicates pain as bad as it could be.

Which assessment is of highest priority for the nurse to complete before administration of morphine? 1 Pain rating 2 Blood pressure 3 Respiratory rate 4 Level of consciousness

3 A decreased respiratory rate below 12/minute is a sign of opioid toxicity. Using the airway, breathing, circulation (ABC) approach in prioritization of care, a patent airway is always the first priority and is important to assess as a baseline before and during the administration of morphine. Pain rating, blood pressure, and level of consciousness are all lower priorities for the nurse.

A patient is hospitalized with multiple lacerations and four fractured ribs after a fall. The nurse, creating a plan of care, recognizes that which action is the highest priority? 1 Providing a high-protein, high-calcium diet 2 Performing range-of-motion exercises during morning care 3 Administering analgesics and encourage breathing exercises 4 Keeping the patient NPO and performing oral hygiene at least every four hours

3 Administering analgesics is the highest priority action to achieve patient comfort, and thereby facilitate performance of breathing exercises to prevent respiratory complications such as atelectasis and pneumonia. A high-protein, high-calcium diet will assist with wound and fracture healing. Range-of-motion exercises may be performed after the patient is medicated for pain. The patient does not need to be on nothing-by-mouth status unless there is a specific reason.

A patient asks the nurse why a dose of hydromorphone administered intravenous (IV) push is given before starting the medication via patient-controlled analgesia (PCA). Which response is most appropriate? 1 "PCA will never be effective unless a loading dose is given first." 2 "The IV push dose will enhance the effects of the PCA for the next eight hours." 3 "The IV push dose will provide for immediate pain relief, which can be maintained by using the PCA." 4 "PCA takes at least two hours to begin working, so the IV push dose will provide pain relief in the interim."

3 An intravenous (IV) push loading dose of an opioid analgesic provides an effective opioid level in the body, which results in immediate pain control. The patient-controlled analgesia (PCA) medication doses may be smaller and can be used more frequently to maintain pain control when the loading dose begins to wear off. Stating that the PCA dose will never be effective unless a loading dose is given first, or that the IV push dose will enhance the effects of the PCA for the next eight hours, or that the PCA takes at least two hours to begin working, are not appropriate responses by the nurse.

Which clinical manifestation should the nurse attribute to adverse effects of morphine sulfate administered via patient-controlled analgesia (PCA)? 1 Diarrhea 2 Urinary incontinence 3 Nausea and vomiting 4 Increased blood pressure

3 Morphine sulfate promotes nausea and vomiting by directly stimulating the chemoreceptor trigger zone in the medulla. Other common side effects include constipation, sedation, respiratory depression, decreased blood pressure, and pruritus.

Which structure of the brain is responsible for the localization and characterization of pain? 1 The limbic system 2 The cortical system 3 The somatosensory system 4 The reticular activating system

3 Several brain structures are involved in the perception of pain. The somatosensory system is responsible for localization and characterization of pain. The limbic system is responsible for emotional and behavioral responses to pain. The cortical structures are involved in constructing the meaning of the pain. The reticular activating system is responsible for warning the individual to attend to the pain stimulus.

Which pain assessment technique should the nurse use when caring for a patient with advanced dementia? 1 Use a modified pain scale with large print. 2 Wait for the patient to express pain verbally. 3 Observe for patient behaviors that indicate pain. 4 Help the patient to use the pain thermometer scale.

3 When assessing pain in a patient with advanced dementia, the nurse should observe the patient's behavior that indicates pain. It may include grimacing, frowning, rubbing a painful area, groaning, and restlessness. The patient may have varied levels of cognitive impairment and may not be able to express pain verbally. Advanced dementia may make the patient unable to use any pain scales for rating the pain; therefore, use of pain scales or modified pain scales may not be helpful.

The nurse should instruct a patient receiving nonsteroidal antiinflammatory drugs (NSAIDs) to report which effect? 1 Blurred vision 2 Nasal stuffiness 3 Urinary retention 4 Black or tarry stools

4 Black, tarry stools could indicate gastrointestinal (GI) bleeding, which is a risk associated with nonsteroidal antiinflammatory drugs (NSAIDs). For this reason, the patient should be taught to report this sign and other signs of bleeding immediately. Blurred vision, nasal stuffiness, and urinary retention are not effects that need to be reported to the nurse.

Which health problem is associated with deafferentation pain? 1 Arthritis 2 Pancreatitis 3 Multiple sclerosis 4 Post-mastectomy discomfort

4 Deafferentation pain is a type of neuropathic pain that results from a loss of afferent input secondary to either peripheral nerve injury or central nervous system damage. A mastectomy is the surgical removal of breast tissue; this procedure results in a loss of afferent input. Arthritic pain arises from the bones and muscles and is an example of deep somatic pain. Pancreatitis is associated with visceral pain. Multiple sclerosis is associated with central pain.

The hospice nurse is providing an opioid to a dying patient who is experiencing severe cancer pain. Which of these statements is true? 1 Opioids in this situation may cause addiction. 2 The opioids likely will hasten the person's death. 3 The opioids probably will be ineffective for pain relief. 4 Administering opioids in this situation is an appropriate nursing action.

4 Opioids for chronic, severe cancer pain are an appropriate intervention for a dying patient, and the opioids may be titrated upward many times over the course of therapy to maintain adequate pain control. Opioids in this situation will not cause addiction nor will they hasten the patient's death. The opioids will likely be more effective than a nonopioid.

A patient who is a known narcotic abuser just has been admitted to the Medical-Surgical floor following an appendectomy. The health care provider prescribed a narcotic analgesic for pain. What is the best action for the nurse to take? 1 Remember that pain can be observed in patients. 2 Relieve this patient's pain to avoid adverse consequences. 3 Be sure the patient is really in pain before giving the analgesic. 4 Conduct a complete assessment and manage the patient's pain.

4 Patients with addictive disease and pain have the right to be treated with dignity, respect, and the same quality of pain assessment and management as all other patients. For an addict, severe pain should be treated with a single opioid at much higher doses than those used with drug-naïve patients. Observation of pain is not always evident. The stress of unrelieved pain may contribute to increased drug use and in the patient actively abusing drugs.

Which statement about referred pain is correct? 1 The pain arises from skin and mucous membranes. 2 Referred pain is prolonged pain after the original noxious stimuli ends. 3 Referred pain includes painful responses to normally innocuous stimuli. 4 Referred pain is pain perceived at a location other than the site of noxious stimuli.

4 Referred pain is described as location of pain distant from the location of a stimulus. During pain assessment, the nurse assesses the referred pain in order to locate the pain. If the pain is arising from the skin and mucus membranes, then it is considered as superficial somatic pain, but not referred pain. Allodynia is described as the production of painful responses to normally innocuous stimuli. Persistent pain is described as pain lasting for longer periods after the original noxious stimuli ends.

Which assessment finding in a patient receiving intravenous (IV) morphine sulfate for pain management would cause the nurse to notify the provider? 1 Pupillary constriction 2 Hypoactive bowel sounds 3 Blood pressure 160/96 mm Hg 4 Respiratory rate 8 breaths/minute

4 The nurse would notify the health care provider that the patient is experiencing respiratory depression from morphine sulfate if the respiratory rate drops below 12 breaths/minute. Pupillary constriction is an expected result of morphine administration. Blood pressure may decrease with morphine sulfate administration, so a BP of 160/96 is not cause for concern. Constipation may occur normally, which may result in hypoactive bowel sounds and would not be an emergency situation.

A patient has been prescribed fentanyl patches for the treatment of severe chronic pain. The nurse should instruct the patient to immediately report which signs of drug overdose? Select all that apply. 1 Diarrhea 2 Cramping pain 3 Allergic rashes 4 Difficulty breathing 5 Excessive sleepiness

4,5 Fentanyl patches may cause death due to overdose. The nurse should educate the patient about the warning signs related to drug overdose. Overdose of fentanyl may cause difficulty in breathing, lethargy, excessive drowsiness, and cognitive depression. Diarrhea, cramping pain, and allergic rashes are not associated with fentanyl overdose.

A patient with osteoarthritis has been taking ibuprofen 400 mg every 8 hours. The patient states that the drug does not seem to work as well as it used to in controlling the pain. The most appropriate response to the patient is based on what knowledge? Another NSAID may be indicated because of individual variations in response to drug therapy. It may take several months for NSAIDs to reach therapeutic levels in the blood and thus be effective. If NSAIDs are not effective in controlling symptoms, systemic corticosteroids are the next line of therapy. The patient may not be taking the drug correctly, so the nurse must assess the patient's knowledge base and provide teaching.

Another NSAID may be indicated because of individual variations in response to drug therapy. Rationale: Patients vary in their response to medications, so when one NSAID does not provide relief, another should be tried. There is no evidence to ascertain any noncompliance to drug therapy. It does not take several months for the medication to reach therapeutic levels, and it should begin working after the first dose.

The patient's neuropathic pain is not well controlled with the opioid analgesic prescribed. What medications may be added for a multimodal approach to treat the patient's pain? (Select all that apply.) Fentanyl Antiseizure drugs β-Adrenergic agonists Tricyclic antidepressants Nonsteroidal antiinflammatory drugs

Antiseizure drugs Tricyclic antidepressants Rationale: Antiseizure drugs, tricyclic antidepressants, selective norepinephrine reuptake inhibitors, transdermal lidocaine, and α2-adrenergic agonists are used for multimodal treatment when opioid analgesics alone do not control neuropathic pain.

The nurse is preparing to administer celecoxib to a patient. What medication taken by the patient should the nurse monitor because of an increased risk of adverse effects? Aspirin Scopolamine Theophylline Acetaminophen

Aspirin Rationale: Celecoxib is a nonsteroidal antiinflammatory drug (NSAID) of the cyclooxygenase-2 (COX-2) inhibitor type. Although celecoxib does not inhibit COX-1 and thus has a decreased risk of bleeding, bleeding is still of concern as an adverse effect. For this reason, the drug should not be taken with other drugs that increase risk of bleeding, such as aspirin.

While caring for the cognitively impaired client who cannot report pain what is the first action of the nurse?

Assess for nonverbal signs of pain such as groaning and grimacing

The postoperative patient is receiving epidural fentanyl for pain relief. For which common side effects should the nurse monitor the patient? (Select all that apply.) Ataxia Itching Nausea Urinary retention Gastrointestinal bleeding

Ataxia Nausea Urinary retention Rationale: Common side effects of intraspinal opioids include nausea, itching, and urinary retention. Ataxia is a common side effect of intraspinal clonidine.

Which question asked by the nurse will give the most information about the patient's metastatic bone cancer pain? a. "How long have you had this pain?" b. "How would you describe your pain?" c. "How often do you take pain medication?" d. "How much medication do you take for the pain?"

B Because pain is a multidimensional experience, asking a question that addresses the patient's experience with the pain will elicit more information than the more specific information asked in the other three responses. All of these questions are appropriate, but the response beginning "How would you describe your pain?" is the best initial question.

A patient with a deep partial thickness burn has been receiving hydromorphone through patient-controlled analgesia (PCA) for 1 week. The nurse caring for the patient during the previous shift reports that the patient wakes up frequently during the night complaining of pain. What action by the nurse is appropriate? a. Administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping. b. Consult with the health care provider about using a different treatment protocol to control the patient's pain. c. Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain. d. Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.

B PCAs are best for controlling acute pain. This patient's history indicates a need for a pain management plan that will provide adequate analgesia while the patient is sleeping. Administering a dose of morphine when the patient already has severe pain will not address the problem. Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a patient through PCA.

A patient has been prescribed a nonsteroidal antiinflammatory medication (NSAID). Which effect should the nurse teach the patient to immediately report? Blurred vision Nasal stuffiness Urinary retention Black or tarry stools

Black or tarry stools Rationale: Black, tarry stools could indicate gastrointestinal bleeding, which is a risk associated with NSAIDs. For this reason, the patient should be taught to report this sign and other signs of bleeding immediately. Blurred vision, nasal stuffiness, and urinary retention are not common side effects of NSAIDS.

A nurse assesses a patient with chronic cancer pain who is receiving imipramine (Tofranil) in addition to long-acting morphine (MS Contin). Which statement, if made by the patient, indicates to the nurse that the patient is receiving adequate pain control? a. "I'm not anxious during the day." b. "Every night I get 8 hours of sleep." c. "I can accomplish activities without much discomfort." d. "I feel less depressed since I've been taking the Tofranil."

C Imipramine is being used in this patient to manage chronic pain and improve functional ability. Although the medication is also prescribed for patients with depression, insomnia, and anxiety, the evaluation for this patient is based on improved pain control and activity level.

The nurse teaches a student nurse about the action of ibuprofen. Which statement, if made by the student, indicates that teaching was effective? a. "The drug decreases pain impulses in the spinal cord." b. "The drug decreases sensitivity of the brain to painful stimuli." c. "The drug decreases production of pain-sensitizing chemicals." d. "The drug decreases the modulating effect of descending nerves."

C Nonsteroidal antiinflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by NSAIDs.

The nurse assesses that a patient receiving epidural morphine has not voided for more than 10 hours. What action should the nurse take initially? a. Place an indwelling urinary catheter. b. Monitor for signs of narcotic overdose. c. Ask if the patient feels the need to void. d. Encourage the patient to drink more fluids.

C Urinary retention is a common side effect of epidural opioids. Assess whether the patient feels the need to void. Because urinary retention is a possible side effect, there is no reason for concern of overdose symptoms. Placing an indwelling catheter requires an order from the health care provider. Usually an in- and-out catheter is performed to empty the bladder if the patient is unable to void because of the risk of infection with an indwelling catheter. Encouraging oral fluids may lead to bladder distention if the patient is unable to void, but might be useful if a patient who is able to void has a fluid deficit.

A patient admitted with metastatic lung cancer is ordered to receive morphine sulfate for pain. Which side effect of this medication should the nurse try to prevent with oral intake and medication? Diarrhea Agitation Constipation Urinary frequency

Constipation Rationale: Morphine sulfate is an opioid analgesic that can lead to constipation as a side effect, and tolerance to opioid-induced constipation does not develop. It is very important to use measures, such as increased fiber and fluids in the diet, and exercise when possible, to prevent this side effect. A gentle stimulant laxative plus a stool softener are also frequently needed to prevent constipation in a patient who is likely to develop this side effect.

Which nursing intervention is most appropriate when preparing to administer an opioid analgesic agent to a patient in pain? Give the medication on an empty stomach. Count the number of doses on hand before administration. Give the medication with a glass of juice or cold beverage. Assess the patient for allergies to aspirin before administration.

Count the number of doses on hand before administration. Rationale: Because opioid analgesics are controlled substances, the nurse needs to count the number of doses and check that it matches the number recorded before removing and administering the medication. The medication is better tolerated with a small meal or snack before taking it to decrease the effect of gastrointestinal upset. The medication can be taken with any type of beverage, and it does not have to be juice or a cold beverage. Opioid analgesics do not usually have any type of aspirin products, so it is unnecessary to inquire about allergy to aspirin.

A patient who has had good control for chronic pain using a fentanyl (Duragesic) patch reports rapid onset pain at a level 9 (0 to 10 scale) and requests "something for pain that will work quickly." How will the nurse document the type of pain reported by this patient? a. Somatic pain b. Referred pain c. Neuropathic pain d. Breakthrough pain

D Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system. Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.

A patient with chronic neck pain is seen in the pain clinic for follow-up. To evaluate whether the pain management is effective, which question is best for the nurse to ask? a. "Has there been a change in pain location?" b. "Can you describe the quality of your pain?" c. "How would you rate your pain on a 0 to 10 scale?" d. "Does the pain keep you from activities that you enjoy?"

D The goal for the treatment of chronic pain usually is to enhance function and quality of life. The other questions are also appropriate to ask, but information about patient function is more useful in evaluating effectiveness.

A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which action by the nurse is appropriate for treating this change in assessment? a. Suggest amitriptyline 10 mg orally. b. Administer lorazepam (Ativan) 1 mg orally. c. Give ibuprofen (Motrin) 400 to 800 mg orally. d. Offer immediate-release morphine 30 mg orally.

D The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid, such as the immediate-release morphine. Lorazepam and amitriptyline may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of antianxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.

The patient is receiving fentanyl patch for control of chronic cancer pain. What should the nurse observe for in the patient as a potential life-threatening adverse effect of this medication? Tachycardia Hypertension Pupillary dilation Decreased respiratory rate

Decreased respiratory rate Rationale: Respiratory depression is a potentially life-threatening adverse effect of fentanyl (Duragesic), which is an opioid analgesic, via any route.

The nurse is preparing to administer celecoxib 200 mg orally for pain relief. Available are capsules containing 100 mg. How many capsules should the nurse administer? Record your answer using a whole number. ___ capsules.

Dose ÷ availability = number of capsules to administer. Therefore, 200 mg ÷ 100 mg = 2 capsules.

After administering acetaminophen with oxycodone (Percocet) for pain, which intervention would be of highest priority for the nurse to complete before leaving the patient's room? Ensure that the side rails are raised. Leave the overbed light on at low setting. Offer to turn on the television to provide distraction. Ensure that documentation of intake and output is accurate.

Ensure that the side rails are raised. Rationale: Percocet has acetaminophen and oxycodone as ingredients. Because the medication contains an opioid analgesic with sedative properties, the nurse must ensure patient safety before leaving the room, such as leaving the bedrails raised. This will help prevent the patient from falling from bed. Leaving the light or television on will not provide a positive environment for healing sleep.

The nurse is caring for a patient receiving morphine sulfate 10 mg IV push when necessary for pain. Upon assessment, the nurse finds the patient obtunded with a respiratory rate of 8 breaths/min. Which medication would the nurse prepare to administer to treat these symptoms? Atropine Naloxone Protamine sulfate Neostigmine bromide

Naloxone Rationale: Naloxone is the antidote or reversal agent for opioid analgesics, such as morphine. Excessive sedation and respiratory depression are symptoms of overdose or severe adverse effects that must be reversed for patient safety.

Which manifestation should the nurse attribute to adverse effects of morphine sulfate administered via PCA? Diarrhea Urinary frequency Nausea and vomiting Increased blood pressure

Nausea and vomiting Rationale: Morphine sulfate promotes nausea and vomiting by directly stimulating the chemoreceptor trigger zone in the medulla. Other common side effects include constipation, sedation, respiratory depression, decreased blood pressure, and pruritus.

The nurse is caring for a patient receiving morphine sulfate via PCA. Which patient assessment data demonstrate the most therapeutic effect of this medication? Pain rating 3/10, awake and alert, respirations 24 Pain rating 2/10, awake and alert, respirations 18 Pain rating 2/10, drowsy but arousable, respirations 18 Pain rating 1/10, drowsy but arousable, respirations 16

Pain rating 2/10, awake and alert, respirations 18 Rationale: Effective pain management is achieved when there is adequate pain control (rating of 3 or less on a scale of 0 to 10) with normal respirations and an absence of sedation. These data exhibit the best effectiveness of the pain medication in all areas.

A nurse is reviewing the assessment data from the admission assessment of a patient admitted from the emergency department. What specific element of a pain assessment is missing from the documentation? Tab 1 General Survey Trembling Doubled over Tab 2 Subjective information Right upper quadrant "belly pain." Pain radiates to back. More comfortable bent forward than in bed. Similar pain in the past but only for 2 hr. "This is the worst pain ever!" Pain started after eating fish and chips at a fast food restaurant 4 hr ago. Tab 3 Abdominal assessment Abdomen bloated and tender on examination Skin warm and moist

Quality Rationale: The quality or characteristics of the pain is missing (e.g., cramping, stabbing, throbbing). The pattern includes the onset and duration (after eating fish and chips 4 hours ago). The intensity is "the worst pain ever!" The location is the right upper quadrant of the abdomen with radiation to the back.

Which assessment is of highest priority for the nurse to complete before administering morphine? Pain rating Blood pressure Respiratory rate Level of consciousness

Respiratory rate Rationale: A decreased respiratory rate below 12 breaths/min is a sign of opioid toxicity. Using the ABC approach in prioritizing care, a patent airway is always the first priority and is important to assess as a baseline before and during the administration of morphine. Although pain rating, blood pressure, and level of consciousness are important parts of the assessment of a patient receiving an opioid analgesic, the medication should not be administered if the respiratory rate is depressed.

The nurse should question an order written for acetaminophen with oxycodone for a patient exhibiting which clinical manifestation? Severe jaundice Oral candidiasis Increased urine output Elevated blood glucose

Severe jaundice Rationale: Acetaminophen and oxycodone are the ingredients in Percocet. Because acetaminophen is metabolized in the liver, the patient could develop acetaminophen toxicity in the presence of severe liver disease (evidenced by jaundice). The prudent nurse would question the order before administration.

The patient with a documented history of opioid use just had surgery. The nurse is concerned about the high dose of opioid analgesic prescribed for this patient. What is the best action for the nurse to take? Remember that pain can be observed in patients. Relieve this patient's pain to avoid adverse consequences. Be sure the patient is really in pain before giving the analgesic. This patient has the right to appropriate assessment and management of pain.

This patient has the right to appropriate assessment and management of pain. Rationale: Patients with substance use disorder (SUD) and pain have the right to be treated with dignity, respect, and the same quality of pain assessment and management as all other patients. For a patient with SUD, severe pain should be treated with a single opioid at much higher doses than those used with drug-naïve patients. Observation of pain is not always evident. The stress of unrelieved pain may contribute to increased drug use in the patient with SUD.

When assessing a patient receiving morphine sulfate 2 mg every 10 minutes via patient-controlled analgesia (PCA) pump, the nurse should take action as soon as the patient's respiratory rate drops down to or below which parameter? 1 16 breaths/min 2 14 breaths/min 3 12 breaths/min 4 10 breaths/min

To protect the patient from adverse effects of respiratory depression from this medication, the nurse should alert the physician as soon as the respiratory rate drops down to or below 12 breaths/minute. If the respiratory rate is at 16 or 14 breaths/minute, it is still above the 12 breaths/minute point at which the nurse should alert the physician. If the rate is at 10 breaths/minute, the nurse should already have taken action.

Initial nursing history of a client who is experiencing pain related to bone cancer, what is important information to gather i this initial assesssment

clients self report of the pain experience

dose of morphine 60 mg IM every 4 hrs, usual dose is 10-15mg

contact PCP to verify the order

The client is eligible for PCA pump when

the client has the ability to self dose

Safest technique for the nurse to use when assisting a blind person in ambulating to the bathroom is to

walk slightly ahead of the patient, allowing the patient to hold the patients elbow