MS 3 Final Part 3
When assessing the need for psychological support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information?
"Can you tell me what has been helpful to you in the past when coping with stressful events?"
A patient with chronic back pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask?
"Does the pain keep you from doing things you enjoy?"
When doing a pain assessment for a patient who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the patient's pain?
"How would you describe your pain?"
A patient with second-degree burns has been receiving morphine through patient controlled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. The most appropriate action by the nurse is to
. consult with the health care provider about using a different treatment protocol to control the patient's pain.
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 of these prescribed medications will be best for the nurse to administer?
. immediate-release morphine 30 mg orally
After receiving change-of-shift report, which of these patients should the nurse assess first?
24-year-old who is receiving neck radiation and has blood oozing from the neck
1. The nurse at the clinic is interviewing a 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening
ANS: A, C, D, E The patient's age, gender, and history indicate a need for screening and/or teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy.
1. The health care provider plans to titrate a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time (select all that apply)? a. Assessing for signs that the patient is becoming addicted to the opioid b. Monitoring for therapeutic and adverse effects of opioid administration c. Emphasizing that the risk of some opioid side effects increases over time d. Educating the patient about how analgesics improve postoperative activity level e. Teaching about the need to decrease opioid doses by the second postoperative day
ANS: B, D Monitoring for pain relief and teaching the patient about how opioid use will improve postoperative outcomes are appropriate actions when administering opioids for acute pain. Although postoperative patients usually need decreasing amount of opioids by the second postoperative day, each patient's response is individual. Tolerance may occur, but addiction to opioids will not develop in the acute postoperative period. The patient should use the opioids to achieve adequate pain control, and so the nurse should not emphasize the adverse effects.
Which nursing action should the nurse delegate to nursing assistive personnel (NAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain?
Check the respiratory rate every 2 hours.
Which finding in a patient who is receiving interleukin-2 indicates a need for rapid action by the nurse?
Crackles heard at the lower scapular border
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for cancer of the colon. Which information about the patient is most indicative of a need for a change in therapy?
Increase in CEA
A patient who is using a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first?
Remove the fentanyl patch.
When caring for a patient who is pancytopenic, which action by nursing assistive personnel (NAP) indicates a need for the RN to intervene?
The NAP assists the patient to use dental floss after eating
When caring for a patient with a temporary radioactive cervical implant, which action by nursing assistive personnel (NAP) indicates that the RN should intervene?
The NAP stands by the patient's bed for 30 minutes talking with the patient.
. When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication?
The patient has not voided for over 10 hours.
A patient with chronic cancer pain is receiving imipramine (Tofranil) in addition to longacting morphine for pain control. Which information is the best indicator that the imipramine is effective?
The patient states, "The pain is manageable, and I can accomplish my desired activities.
A patient who has chronic musculoskeletal pain tells the nurse, "I feel depressed because I ache too much to play golf." The patient says the pain is usually at a level 7 (0 to 10 scale). Which patient goal has the highest priority when the nurse is developing the treatment plan?
The patient will be able to play 1 to 2 rounds of golf.
The nurse assesses a postoperative patient who is receiving morphine through patient controlled analgesia (PCA). Which information is most important to report to the health care provider?
The patient's respiratory rate is 10 breaths/minute.
When the nurse visits a hospice patient, the patient has a respiratory rate of 8 breaths/minute and complains of severe pain. Which action is best for the nurse to take?
Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.
Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider?
WBC count of 1700/μl
A patient who uses extended-release morphine sulfate (MS Contin) for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone (Vicodin) tablets, but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take?
Wake the patient and administer the hydrocodone.
A patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first?
a. Administer the prescribed PRN immediate-acting morphine.
. These medications are ordered for an 86-year-old patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy?
acetaminophen (Tylenol) 650 mg orally
A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic pain complains of nausea and abdominal fullness. The best initial action by the nurse is to
administer the ordered antiemetic medication.
The nurse is caring for a diabetic patient who has chronic burning leg pain even when taking oxycodone (OxyContin) twice daily. Which of these prescribed medications is the best choice for the nurse to administer as an adjuvant to decrease the patient's pain?
amitriptyline (Elavil)
A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0 to 10 scale) and requests "something for pain that will work quickly." The nurse will document this as
breakthrough pain
Which of these prescribed therapies should the nurse use first when caring for a patient with cancer pain that the patient describes as a "level 8 (0 to 10 scale), deep, and aching."
hydromorphone (Dilaudid) IV
A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. The nurse's reply is based on the information that these strategies
impact the cognitive and affective components of pain
A patient with a history of chronic cancer pain is admitted to the hospital. When reviewing the patient's home medications, which of these will be of most concern to the admitting nurse?
meperidine (Demerol) 25 mg every 4 hours
These medications are prescribed by the health care provider for a patient who uses longacting morphine (MS Contin) for chronic back pain, but still has ongoing pain. Which medication should the nurse question?
pentazocine (Talwin)
A postoperative patient asks the nurse how the prescribed ibuprofen (Motrin) will control the incisional pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing the
production of pain-sensitizing chemicals.
