1235 Pain EAQ

A client is prescribed 4 mg of hydromorphone intravenously (IV) every 4 hours, as needed. Hydromorphone is supplied at 10 mg/mL. How many milliliters of hydromorphone will the nurse administer per dose?

0.4 mL

A client has and intravenous (IV) solution of 5% dextrose in water (D 5W) 250 mL to which 100 mg of morphine is added. The health care provider prescribes 14 mg of morphine per hour for end-of-life palliative treatment of a client. At how many milliliters per hour will the nurse set the IV pump?

35 mL/h

Which property would the nurse understand that the medication is being used primarily for when aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis?

Anti-inflammatory RATIONALE: The anti-inflammatory action of aspiring reduces joint inflammation. It can relieve pain and prevent abnormal clotting; however, although these effects can be beneficial, these are not the primary reasons that it is prescribed for rheumatoid arthritis . Aspirin reduces fever, but this is not the rationale for prescribing it for clients with rheumatoid arthritis

Which response would the nurse give when an adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations?

By acknowledging that the pain is real and administering medication to relieve it. RATIONALE: Pain medication is required, along with intensive supportive nursing care. To the client the pain is real, requiring pain medication; addiction is not a concern at this time. Explaining that the pain is psychological in origin does not help relieve the pain; medication and emotional support are required. The pain may not recede within a few days; pain medication should be administered.

The nurse applies a cold pack to relieve musculoskeletal pain. Which rationale explain the analgesic properties of cold therapy?

Causes local vasoconstriction, preventing edema and muscle spasms RATIONALE: Cold causes vessels to constrict, which reduces leakage of fluid into the tissues and prevents swelling and muscle spasms. Cold does promote analgesia but not circulation. It may numb but does not dilate blood vessels. Cold therapy also may numb the nerves and surrounding tissues, thus reducing pain.

Which benefit would be provided by administering patient-controlled analgesia (PCA) to a client after surgery?

Client is able to self-administer pain-relieving medications as necessary Decreases client dependency Increases client sense of autonomy RATIONALE: The purpose of patient-controlled analgesia is to give the client the ability to self-administer pain-relieving medications as necessary; usually smaller amounts of analgesics are used with self-administration. The amount and dosage of the medication are programmed to prevent accidents or abuse. Medication levels are kept in a maintenance range, and pain relief is achieved without extreme fluctuations. The client isn't dependent of the nurse availability to administer medication. This increases the client's sense of autonomy. The nurse is not absolved of responsibility when PCA is used; monitoring the client for effectiveness, refilling the apparatus with the prescribed narcotic, and charting the amount administered and the client's response are required.

When developing the plan of care for a client with rheumatoid arthritis, which client consideration would the nurse include?

Comfort RATIONALE: Because pain is an all-encompassing and often demoralizing experience, the nurse would want to keep the client as pain-free as possible. Surgery corrects deformities and facilitates movement, which is not an immediate need. Concentration and motivation are difficult when a client is in severe pain.

Which outcome would the nurse use to determine the effectiveness of sublingual nitroglycerin?

Relief of anginal pain RATIONALE: Cardiac nitrates relax muscles of the coronary arteries; they dilate and deliver more blood to heart muscle, relieving ischemic pain. Although cardiac output may improve because of improved oxygenation of the myocardium, improved cardiac output is not a basis for evaluating the effectiveness of sublingual nitroglycerin. Although dilation of blood vessels and a subsequent drop in blood pressure is a reason why intravenous (IV) nitroglycerin may be administered, decreased blood pressure is not the basis for evaluating the effectiveness of sublingual nitroglycerin, which is indicated for pain relief. Ease in respiratory effort is not the basis for evaluating the medication's effectiveness.

An adult client with low functioning Down syndrome (trisomy 21) appears in the emergency department via ambulance after an accident. Which assessment method would be the best instrument to use when determining this client's level of pain?

Using the Wong-Baker FACES Pain Rating Scale RATIONALE: An adult client with limited mental capacity may not understand the concept of numbers as an indicator of levels of pain; the Wong-Baker FACES Pain Rating Scale uses pictures to which the individual can relate. The client, irrespective of mental capacity, is the primary source from whom to obtain information about pain because it is a personal experience. Body language provides some information, but may not accurately reflect the client's level of pain. A client with limitations in mental functioning may not understand the concept of numbers.

Which intervention would the nurse recommend for post-cesarean gas pain?

Walking around the room RATIONALE: Walking around as much as possible can help expel excess gas after a cesarean birth. The client also may be advised to lie on the left (not the right) side and rock in a rocking chair. The client should avoid using a straw when drinking water or other fluids. Supporting the incision when moving relieves incisional pain, but does not promote expulsion of gas.