EAQ-Pain Management Chapter 44

When would the nurse evaluate pain in a patient who is on oral analgesics?

Every 60 minutes

Which analgesic drug depresses the central nervous system?

Fentanyl

While assessing a patient in the terminal stages of prostate cancer, the health care provider understand that the patient is opioid tolerant. Which drug may provide adequate pain lief for this patient?

Fentanyl

While assessing a patient who has breast cancer, the nurse finds that then body temperature is 102 F (38.9 C). Which medication administration through transdermal route is contraindicated in this patient?

Fentanyl

The nurse is evaluating the statements made by nursing student about pain. Which statement by the nursing student is true?

"Intensity of the pain does not accurately indicate the tissue damage"

Which action by the nurse prevents air formation is the intravenous tube for a patient who is on patient-controlled analgesia (PCA)?

Inserting the drug cartridge into the infusion device

The nurse is teaching a patient with acute pain about transcutaneous electrical nerve stimulation (TENS). Which statement by the patient indicates a need for further teaching?

"TENS can be applied at frequency of my choice"

The nursing student is providing cutaneous stimulation to a patient who has a non healing arm fracture. Which action performed by the nursing student indicates a need for correction?

Using cutaneous stimulation on the skin that is covering the fracture

The registered nurse is teaching a nursing student about the possibility of respiratory depression with opioid therapy. Which statement by the nursing student indicates the need for further teaching?

"Opioid antagonists should be rapidly administered to the patient"

While assessing a patient who is taking morphine, the nurse notices that the patient is developing sign of respiratory depression. Which drug should be immediately administered to this patient?

Naloxone

Which type of pain is desc robed by the patient that complains of intermittent back pain that travels down the left leg?

Radiating

A registered nurse is teaching a nursing student about acetaminophen for pain management. Which statement by the nursing student indicates the need for further teaching? Select all the apply.

"Naloxone is an acetaminophen antagonist" "The maximum 24 hour dose of acetaminophen is 325 mg"

A patient is on a lidocaine patch for neuropathic pain. Which medication schedule would the nurse follow for the patient to achieve adequate pain control and avoid lidocaine toxicity?

!2 hours on, 12 hours off schedule

A nursing instructor asks a nursing student about fatigue. Which student statement indicates a need for further teaching?

"Fatigue decreases the perception of pain and coping abilities"

A health care provider put postoperative patient on a patient-controlled opioid analgesic pump to be used around the clock for a week. Which assessment would the nurse make art regular intervals?

Respiratory rate

The nurse is counseling a patient who was prescribed morphine for pain. Which statement by the patient indicates the need for further teaching?

"I should avoid eating foods that are rich in fiber" (Morphine can cause constipation)

A registered nurse is teaching a nursing student about the use of cold therapy to relieve dental pain. Which statement by the nursing student indicates effective learning? Select all that apply

"I should suggest that the patient apply ice two to five times a day" "I should instruct the patient to stop applying cold if there is numbness"

Which intervention is most appropriate for a patient who was prescribed an epidural analgesic?

Securing the catheter outside of the skin

The heart care provider prescribed transcutaneous electrical nerve stimulation (TENS) with a frequency of 30 hz to a patient who has next pain. Arrange the steps involved in this procedure ins order.

1. Identifying then site for the TENS electrode placement 2. Removing hair near the neck before attaching the electrodes 3. Placing the electrode near the neck 4. Turning then transmitter on to the prescribed frequency

Which amount would be the maximum 24 hour dose of acetaminophen for an adult patient whose liver and kidney function test are normal?

4000 mg

Which nursing intervention I necessary after the health care provider administers epidural anesthesia to a patient in the terminal stages of. cancer for pain relief?

Notifying the health care provider if the patient develops pain at the epidural insertion site

The patient who has chronic back pain is on analgesic treatment reports, then medication. isn't helping my back pain. I am not getting any relief". Which immediate nursing action would be beneficial?

Seeking the health care provider's shall to obtain an alternative treatment

Which nursing process step is involved when observing for symptoms of nausea in a patient undergoing treatment using patient-controlled analgesia (PCA)?

Evaluation

Which recommendation by the World Health Organization (WHO) analgesic ladder would the nurse follow while caring for a patient with cancer pain?

Transitioning use of adjuvants with nonsteroidal anti-inflammatory drugs (NSAIDs) to opioids

Which action performed by the patient using ice massage for acute pain relief would result inane effective outcome? Select all that apply.

Using a slow, circular, steady massage Applying ice using firm pressure over the skin Applying ice for 5 minutes or until numbness occurs

Which nursing action facilitates visual inspection of intravenous site?

Using a transparent dressing to secure the catheter

Which information is obtained by referring to the morphine equianalgesic chart? Select all that apply

"Morphine (oral route) dose equivalent to hydromorphone (oral route) dose" "Morphine (oral route) dose equivalent to fentanyl transdermal patch" "Morphine (intravenous routes) dose equivalent to fentanyl transdermal patch

A registered nurse is teaching a nursing student about using nonsteroidal antiinflammatory drugs (NSAIDs) for pain management. Which statement by the student indicates a need for further teaching?

"NSAIDs work by depressing the central nervous system"

The nursing instructor asked the student nurse to differentiate between A-delta and C peripheral nerve fibers. Which statement by the student nurse indicates effective learning?

"The A-delta fibers are myelinated, and the C fibers are unmyelinated"

A registered nurse is teaching a nursing student about the administration of transdermal fentanyl to a patient in the terminal stages of cancer. Which statement by the nursing student indicates the need for further teaching

"Topical application of heat on then transdermal patch will be beneficial to the patient"

A young patient reports short intense pain that lasts a few minutes after administration analgesia. Which distraction activity would the nurse suggest to the patient? select all that apply

"you should play games" "you can offer prayers to your god" "you can sign songs of your choice"

The nurse is assessing a patient who is receiving opioid analgesia. Which finding indicate the patient should be administered naloxone?

Patient is experiencing dyspnea

Which patient is likely to suffer from painful mononeuropathy?

Patient who has nerve root compression

The nurse has conducted an informative session on discouraging pseudoaddiction to a group of people in a community. Which group of patients would be the main target for the nurses teachings?

Patients who repeatedly seek multiple medical opinions for chronic pain relief

Which type of pain is associated with trigeminal neuralgia?

Peripherally generated pain

After reviewing the patient's medical record, the nurse avoids teaching relaxation technique. Which condition of the patient led the nurse to make this decision?

A patient who has acute discomfort

Which pain management drug is considered the best-tolerated and safest analgesic?

Acetaminophen

Which medication is administered to treat acetaminophen toxicity?

Acetylcysteine

A nurse is caring for a patient who has psychosis, is injured , and is unable to communicate effectively. Which action would the nurse take to determine this patient's level of pain? Select all that apply

Administer nonopioid analgesics around the clock for the patient with mild-to-moderate pain. Observe the patient's facial expression, body movements, and mental Check the sources of pain to determine if they are related to prolonged pressure on any body parts

A nursing student is providing icing cold therapy for a patient who has painful and inflamed joints. Which action performed by the nursing student indicates a need for the further learning? Select all that apply

Applying an Ince pack directly on the inflamed joint Providing massage with ice cubes for 10 to 15 minutes

The nurse is caring for a patient who is scheduled for an x-ray for an injured right leg. Which intervention may help reduce the patient's pain?

Applying ice near the site of the pain

The nurse is assessing a patient who complains of pain in the abdomen. Which method is MOST appropriate to assess the intensity of pain

Asking the patient to describe the pain using a pain scale

Which action would be first for the nurse when a patient returns to then nursing unit after knee surgery and is verbalizing pain at the surgical site?

Assess the characteristics of the pain

Which plan would the nurse implement when caring for a patient that has a respiratory rate and depth within normal limits, after receiving 0.2 mg of naloxone intravenous push?

Assess the patient's vital signs every 15 min Utes for 2 hours

The nursing student is caring for patient who has chronic pain. The nursing student is attempting to minimize the patient's environmental stimuli. Which action performed by the nursing student requires correction

Avoiding repositioning the patient anatomically

The nurse is counseling a patient on how to use patient-controlled analgesia (PCA). Which nursing action is inappropriate?

Encouraging a family member to push the button on the PCA pump

While assessing a 70 year old patient who has chronic pain, the nurse finds that the patient is opioid tolerant and may require transdermal fentanyl for effective pain management. Which assessment finding is contraindicated for the use for transdermal fentanyl therapy?

Body temperature

Which condition may require special consideration before then administration of opioids to a female patient after a surgical procedure? Select all apply

Breastfeeding Dialysis Respiratory disease

A patient is admitted to the hospital for multiple injuries and is put on intravenous (IV) analgesia. After a couple of hours, the patient is still in severe pain. The nurse finds that the skin around the IV catheter is red and swollen. The nurse finds no other changes in the patient's condition. With action would the nurse take immediately?

Change the IV access line

The patient receiving morphine via patient-controlled analgesia (PCA) complains of continued pain. Which nursing intervention is appropriate?

Checking the functioning of the PCA

Which symptom is associated with opioid withdrawal? Select all that apply

Chills Joint pain Excessive yawning

Which drug class is most likely to be used to treat pain related to bone metastasis?

Corticosteroids

Which type of pain management is cold application?

Cutaneous Stimulation

The nurse is assessing a patient who has sustained severe injuries in a motor vehicle accident. The patient is in severe pain and is diaphoretic. On assessment, the patient[s heart rate is increased, pupils are dilated, and blood pressure is decreased. Which finding is caused by then stimulation of the parasympathetic nervous system?

Decrease in blood pressure

While treating a patient, the health care provider encourages the patient to watch funny videos. Which pain management technique is this an example of?

Distraction

Which side effect of opioid administration is common for patients with underlying psychiatric issues? select all that apply

Dizziness Confusion Hhallucinations

Which type of pain-management therapy is preferred for relieving chronic cancer pain?

Epidural analgesia

A patient who is in then terminal stages of pancreatic cancer is on opioids for pain control. The nurse that is the patient is not responding to any external stimuli. The nurse immediately goes to the nurse station to call for help and informs the health care provider about the patient's situation. The nurse then elevates the head of the ebed and prepares for the administration of an opioid reversing agent. Which nursing action indicates the need for the nurse to develop skills in emergency management?

Going to the nurse's station to call for help

During a preoperative assessment, a patient reports a history of a heart attack and use of anticoagulant medications. Which complication would the nurse look for epidural anesthesia administered to the patient for the surgery?

Hematoma

The nurse is teaching the patient how to use patient-controlled analgesia (PCA). Patient teaching is an example of which step of the nursing process?

Implementation

A health care provider idea recommends ibuprofen to a patient in pain. Which statement about this medication is correct? select all that apply

It acts by inhibiting the synthesis of prostaglandins One of its serious side effects is gastrointestinal bleeding

Which statement is true about music therapy? Select all that apply

It helps in pain management It helps reduce muscle tension It creates a relaxation response

The nurse is assessing patients who have different conditions. Which patient does the nurse suspect to have referred pain? Select all that apply

Kidney calculi Angina pectoris Myocardial infarction

The nurse plans to give a massage to a patient who has body aches. The patient has a history of angina and deep vein thrombosis. Which are, if massaged, can lead to complications in the patient?

Leg muscles

Which medication does then nurse anticipate a health care provider to prescribe for a patient diagnosed with postherpetic neuralgia?

Lidocaine

The nursing student is massaging the patient who has peripheral vascular disease to provide relaxation by reducing pain. Which action by the nursing student indicates a need for correction?

Massaging the patient's legs and calf muscle

Which nursing action can increase the risk of dislodging a vascular clot?

Massaging the patient's legs and calf muscles

For which complication would the nurse monitor when a patient is receiving an epidural infusion of morphine? Select all that apply.

Nausea Pruritus Respiratory Depression

During a pain assessment, the patient reports numbness and tingling sensations interspersed with shooting or electric-like pain. Which type of pain does the nurse infer that the patient is experiencing?

Neuropathic

Which statement is true regarding nonpharmacological pain interventions?

Nonphharmacological interventions are useful for patients who cannot tolerate pain medications

The nurse is assessing the pain for an adult patient who has cognitive impairment. Which nursing ac ion is most appropriate?

Observing the facial expressions and body movement for any pain behavior

Which condition in a patient is opioid treatment contraindicated for?

Obstructive sleep apnea

Which instruction 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?

Only the patient should push the button

Which reason would a health care provider have for prescribing acetylcysteine to a patient who is on pharmacological pain management therapy?

Overdose of actaminophen

Which drug is unsafe for the central nervous system as a supplement to epidural anesthesia?

Oxycodone

A patient with chronic low back pain who took an opioid around-the-clock for the past year decided to abruptly stop the medication for fear of addiction. The patient is now experiencing shaking, chills, abdominal cramps, and joint pain. The nurse recognizes these symptoms as manifestations of which condition

Physical dependence

Which statement by the patient who is under treatment for cocaine dependence indicates a need for further teaching?

Physical dependence was withdrawal symptoms like chills and stomach pain

Which chemical do nonsteroidal anti-inflammatory drugs (NSAIDs) react with?

Prostaglandin

The registered nurse is evaluating the actions of a nursing student who is providing massage therapy to a patient. Which action performed by the nursing student indicates a need for further teaching?

Providing firm and gentle strokes to then calf muscle

A 60-year-old patient with acute pain from arthritis keeps visiting multiple health care providers to ask for pain killers. for adequate relief. Which condition. might the nurse suspect this patient has?

Pseudoaddiction

Which statement by the nurse that works in post surgical ward, indicates a common misconception about pain? Select all that apply

Psychogenic pain is not real Administering analgesics regularly leads to drug addition Patients who abuse substances overact to discomfort

Which nursing action is MOST likely to induce pain?

Pulling the patient into the side-lying position

A postoperative patient reports pain at the site of surgery. On examination, the nurse finds that the incision is healing well and there are no signs of infection. The nurse instructs a student nurse to give a placebo drug to the patient. Which action would be the most appropriate action for then student nurse to take?

Question the action of the placebo prescription

The nursing student is providing care for a patient receiving patient controlled analgesia (PCA) under the supervision of the registered nurse. Which action performed by the nursing student requires further teaching?

Rechecking the PCA pump stetting with a peer

Which nursing action is most appropriate while providing transcutaneous electrical nerve e stimulation (TENs) to a patient for pain relief?

Removing any hair at the site before attaching the electrodes

Which inhibitory neurotransmitter of pain is in the brain? Select all that apply

Serotonin Norepinephrine Gamma-aminobutyric acid (GABA)

The nurse is caring for a patient who has severe pain caused by muscle cramps. The nurse recognizes this as which type of pain?

Somatic

A nurse administers nonopioid analgesics and adjuvant analgesics to a patient who has chronic cancer pain. Which step of the World Health Organization (WHO) analgesic ladder would include this drug administration

Step 1

Which class of medication would the nurse anticipate a prescription for a patient that is being discharged home on an around-the-clock opioid for chronic back pain?

Stimulant laxative

The nurse is caring for patient receiving hydromorphone via patient-controlled analgesia (PCA) infusion. After 1 hour, then nurse finds that then patient is difficult to arouse and breathing rate is 8 breaths/min. Which action would the nurse take first?

Stopping the PCA infusion pump

A nurse caring for a patient is the terminal stage of cancer administers a drug as recommend in Step 3 of the World Health Organization (WHO) analgesic ladder to relieve the pain. Which drug class might have been administered to the patient?

Strong opioid drug

While caring for a patient on fentanyl infusion therapy, the nurse monitors vital signs and pulse oximetry every 1 to 2 hours for the first 24 hours. Which rationale explains this nursing action?

To prevent the risk of respiratory depression

Which drug would be administered in combination wit acetaminophen to produce the desired pain relief at a reduced dose? Select all that apply

Tramadol Oxycodone Hydrocodone

The nursing student is proving instruction on patient controlled analgesia (PCA) to then patient. Which action if made by the nursing student requires correction?

Telling then family members to operate the PCA device for the patient

The nurse notices that a patient has received oxycodone/acetaminophen (5mg/325 mg), two tablets PO every 3 hours for the past 3 days. Which information concerns the nurse the most?

The amount of daily acetaminophen

Which assessment finding supports the nurse's conclusion that the patient has radiating pain?

The patient has pain in the back accompanied by pain in the leg

The nurse is initiating patient-controlled analgesia (PCA) per the health care provider's prescription to a patient who has myalgia. The nurse inserts the needless adapter at the Y0site of the intravenous (IV) tubing. Which statement describes the purpose of this nursing action?

The route for medication administration into the IV line is established

Which statement is correct regarding a postoperative patient who is currently asleep?

The sedative administered may have helped the patient sleep, but assessment of pain is still needed.

What pain management method is considered a nonpharmacological complementary and alternative intervention?

Therapeutic touch

The nurse administers 250 mg of acetaminophen along with 5 mg of hydrocodone to a patient in pain. Which reason explains why acetaminophen is part of this protocol?

To decrease the dose of opioid required for pain control

The nurse is initiating patient-controlled analgesia (PCA) for the postoperative patient. The nurse inserts the drug cartridge into the infusion pump and primes the PCA tubing. Which rationale explains this action?

To establish flow and prevent air from infusing

The nurse is providing to a patient receiving a peripheral infusion of morphine for pain control. The nurse assesses the infusion site dressing for discharge and swelling. Which rationale explains this intervention?

To maintain optimal catheter function