Med-Surg 1: Ch.5-3 EAQ: Pain Management
Which information would the nurse provide to the patient regarding the benefits of PCA?
"Patients who use PCA may receive a continuous dose of opioid analgesic."
The nurse observes a family member pushing the PCA button for a sleeping patient. Which statement by the nurse is appropriate?
"Please allow the patient to push the button when needed."
Which instruction would the nurse give a patient with lower back pain and hypothyroidism who has been prescribed acetaminophen?
"Schedule regular renal and LFTs."
Which instruction will the nurse give to the patient who has mild ABD pain and is prescribed ibuprofen?
"Stop taking the medication if you notice any blood in your stool."
How will the nurse respond to a patient being discharged after hip replacement who states, "I am going to use hypnosis instead of medication to manage my pain; I believe in mind over body"?
"That sounds like a great plan; can you tell me more about it?"
A patient with chronic arthritis pain tells the nurse, "I take two arthritis-strength acetaminophen (650 mg) every 8 hours." Which response will the nurse make?
"You will need to have routine liver and kidney function laboratory tests."
Which initiative did the American Chronic Pain Association establish?
10-Step Program from Patient to Patient
Which intervention will the nurse perform for a patient who received epidural analgesia for ABD surgery?
Assist the patient to step out of bed and determine the degree of weakness in the legs
The nurse is preparing a plan of care for a patient who has received a prescription for fentanyl through a PCA pump. The nurse would question the prescription if the patient has a history of what?
COPD
Which nonpharmacologic cognitive-behavioral technique may relieve anxiety in a patient experiencing chronic pain?
Distraction
Which group of medications includes fentanyl?
Opioid analgesics
Which class of medication includes naloxone?
Opioid antagonists
Which route is preferred for the administration of analgesics?
PO
Which action will the nurse take next when caring for a postoperative patient who is receiving epidural analgesia and reports itching?
Reduces the analgesic dose
When caring for a patient who is receiving morphine, the nurse prioritizes assessing for which medication side effect?
Respiratory depression
Which information will the nurse include when advising a patient about the administration of a prescribed liquid form of acetaminophen?
Take (a maximum up to) 4000 mg per day
Which pain scale is most appropriate for the nurse to use when assessing pain in a 6-year-old child?
Wong-Baker FACES Pain Rating Scale
The nurse offers some immediate nonpharmacologic advice for pain management for a patient with inflammatory pain caused by RA. Which is the most effective advice for the patient?
Cold applications
Which action will the nurse take when the terminally ill patient receiving IV morphine is experiencing ineffective analgesia?
Consider opioid rotation
How does chronic back pain cause a significant financial impact?
Increases length of hospital stay
Which drug is categorized as hydrophilic?
Morphine
When a patient with extensive burn injuries is being weaned from long-term narcotic use, which type of opioid dependence does the nurse expect the pt to experience?
Physical dependence
The nurse manager for an oncology unit is evaluating a newly hired staff nurse. Which action by the nurse is of greatest concern to the nurse manager?
Preparing to administer a placebo to a patient with chronic back pain
Which medication education will the nurse provide to the patient with colon cancer regarding self-administration of prescribed modified-release oxycodone?
Swallow the medication whole
Which nursing assessment would have prompted the HCP to reduce the postsurgical patient's dose of morphine from 15 mg to 4 mg?
The patient drifted off to sleep during conversation
Which explanation would the nurse have for a patient who has been undergoing opioid medication therapy and has become demanding, persistently asking for an increase in the dose, even before it is time for the next dose?
The patient has developed a pseudoaddiction to opioids
Which term best describes the condition where continuous exposure to a drug leads to a decrease in the drug's effects over time?
Tolerance
Deep somatic pain
Typically described as dull, aching, or cramping
A nurse is discussing at-home care with the family of a patient who is experiencing pain from terminal cancer. Which statement by a family member indicates the need for further teaching?
We should stick to the regimented analgesic plan and never increase the dosage."
Which action will the nurse take when a patient with cancer who is taking pain medication states, "I am still having pain" without any physical manifestations of pain?
Which action will the nurse take when a patient with cancer who is taking pain medication states, "I am still having pain" without any physical manifestations of pain?
Neuropathic pain
common descriptions include shooting, burning, and fiery
Which intervention is recommended for the patient who reports increasing pain during dressing changes? Select all that apply.
→ Distraction → Music therapy → Premedication
Which benefit does acetaminophen have? Select all that apply.
→ It is available in liquid form → It can be taken on an empty stomach → It is preferred in postoperative patients → It has no effect on platelet aggregation
The nurse recognizes which medication as being included among the adjuvant analgesics? Select all that apply.
→ Lidocaine → Nortriptyline
Which instruction by the PCP is given to ensure patient safety for an older adult who is experiencing severe pain after an injury?
"Do not give meperidine."
Which PRN medication will the nurse administer to a postoperative patient who reports, "I have pain from a mild headache"?
Acetaminophen
Which analgesic medication will the nurse anticipate administering to the patient who has a history osteoarthritis and PUD?
Acetaminophen
Which quality is characteristic of nociceptive deep somatic pain?
Aching
Which intervention will the nurse anticipate the HCP to prescribe for the patient with chronic pain who feels no relief with high-dose opioids and says, "I just can't manage living right now"?
Adding duloxetine as adjuvant therapy
Which action will the nurse implement immediately when caring for a patient whose respiratory rate dropped from 18 BPM to 8 BPM after 10 minutes of receiving a dose of hydromorphone?
Administer naloxone
When caring for a patient receiving an opioid analgesic medication via PCA, which action will the nurse implement immediately when witnessing the patient's spouse activate the PCA button?
Advise the patient and the spouse that only the patient may activate the PCA
After administering a dose of opioids, the nurse evaluates the patient using the POSS and documents a 1. Which patient behavior does this indicate?
Awake and alert
Which benefit will celecoxib have for long-term use for a patient with chronic osteoarthritis?
Decreased risk for GI bleeding
Which action will the nurse take to prevent constipation in a patient who is receiving morphine for bone cancer pain?
Encourage foods high in bulk and roughage
Which nursing action will the nurse delegate to a NA for a hospitalized patient with chronic pain caused by fibromyalgia?
Engagement in conversation about the patient's family to distract the patient
Which action will the nurse take when caring for a patient after a tonsillectomy who reports pain at 8 on a 0-to-10 scale and requests medication?
Give a full dose of prescribed medication
A postoperative patient is vomiting and states, "I am having a lot of pain—about a 7 on a scale of 0 to 10." Which route of administration will the nurse choose to administer an analgesic to the patient?
IV
A hospitalized patient expresses satisfaction after using a recommended CAM therapy, saying that pain was diminished and anxiety was reduced. Which CAM did the patient most likely use?
Imagery
A nurse is guiding a patient with chronic pain through visualizing being on a peaceful beach. This is an example of which type of nonpharmacologic anxiety management?
Imagery
Which CAM therapy might the nurse offer to a patient who anticipates a daily painful dressing change?
Imagery
Which behavior observed in a patient on opioid therapy is most important for the nurse to report to the PCP?
Impaired control over use
Which term refers to subarachnoid analgesia?
Intrathecal rationale: Subarachnoid analgesis is also called intrathecal analgesia because the subarachnoid space is also called the intrathecal space
Which factor is considered a disadvantage of the transdermal route of opioid administration?
It needs to be supplemented with other analgesic initially
The nurse recognizes which medication as being included among the adjuvant analgesics?
Lidocaine Notriptyline rationale: Adjuvant analgesics include local anesthetics, such as lidocaine, and some antidepressants, such as notriptyline
Which intervention will the nurse make after administering opioids for pain management and assessing the patient's response and determining a 3 on the Pasero Opioid-Induced Sedation Scale (POSS)?
Monitor the patient's respiratory status
Which drug is considered the gold-standard opioid for management of both acute and chronic pain?
Morphine
Which type of chronic noncancer pain do veterans of recent wars most often experience?
Musculoskeletal
A patient with a history of opioid abuse experiences ABD cramps, muscle twitching, nausea, and vomiting. The nurse recognizes that the administration of which medication, an opioid reversal agent, is the likely cause of the patient's symptoms?
Naloxone
Which drug would be administered to reverse opioid-induced respiratory depression?
Naloxone
Which intervention will the nurse implement for a patient who is receiving home care pain management after discharge?
Offer flexibility in home management of the patient's current regimen
For which patient would the nurse in ER limit opioid analgesic use? Patient A: Terminal pancreatic cancer Patient B: Acute renal failure Patient C: Joint replacement Patient D: PAD
Patient B
Which patient in the ER would a prescription for ibuprofen be appropriate? Patient A: Renal failure; glomerular filtration rate=63 mL/min Patient B: HTN; BP=160/100 mm Hg Patient C: Hepatitis; alanine aminotransferase=76 units/L Patient D: RA; C-reactive protein=1.6 mg/dL
Patient D
Which precaution is needed when caring for a patient receiving an epidural analgesia? Select all that apply.
→ An antiemetic relieves the associated nausea and vomiting → The patient's respiration and sedation levels are monitored at frequent intervals
Which intervention would the nurse perform for an older patient with chronic liver disease? Select all that apply.
→ Ask the patient to only report currently existing pain → Suggest using a pillbox to organize patient daily medications → Teach the caregiver about the adverse effects of acetaminophen
A patient is taking opioids for chronic pain relief, and the nurse suspects the patient has become addicted. Which action by the patient supports this suspicion? Select all that apply.
→ Craving the medication → Using the medication without control → Using the medication even if it is affecting the body
Which nonpharmacologic intervention is commonly used for pain management? Select all that apply.
→ Distraction → Acupuncture → Guided imagery → Therapeutic touch
Which aspect is characteristic of a multimodal analgesic approach? Select all that apply.
→ Makes use of two or more classes of analgesics → Prevents analgesic gaps that may lead to worsening of pain → Involves lower doses of drug administration in the treatment plan
Which cognitive-behavioral distraction can be useful in reducing a patient's focus on pain? Select all that apply.
→ Meditation → Biofeedback → Guided imagery
Which order of nursing action is correct for a patient who has been administered an intraspinal analgesic for the treatment of cancer pain?
→ Operating the infusion device → Replacing the empty drug reservoirs → Discontinuing the therapy → Removing catheters
When explaining the risks and benefits of multimodal analgesia, the pharmacist will include which information in the teaching? Select all that apply.
→ Prevention of analgesic gaps → Reduction in medication doses
Which statement about gabapentin is correct? Select all that apply.
→ Primary side effects are sedation and dizziness → It is an anticonvulsant drug given for persistent neuropathic pain
Which information will the nurse provide when teaching a patient about self-management of analgesics? Select all that apply.
→ The purpose and action of the drugs → The importance of correct dosing and dosing intervals → Technical skills required to administer analgesics
