Question 1

A patient who had an appendectomy for a ruptured appendix yesterday has an order for morphine 4 mg q 6 hours prn. Every 5 hours and 55 minutes, the patient puts on the call light and asks for the morphine. A staff member comments that the patient is drug-seeking. Which action by the nurse is most appropriate first?

Accepted Answer

The nurse should first consult with the RN or physician to assess the patient's pain management needs and consider adjusting the medication order to better manage the patient's pain.

Question 2

The nurse is caring for a patient with terminal cancer pain. His family is very supportive; there are always at least six or seven family members in the room. They constantly call the nurse in to report that the patient is in pain or needs to be moved or needs a drink. The nurse is having difficulty caring for other patients because this family is so demanding. What is the best way to deal with this situation?

Accepted Answer

The best way to deal with this situation is to teach the family how to help provide for the patient's basic needs. This will empower the family to participate in the patient's care while also alleviating some of the nurse's workload. It is important for the nurse to communicate clearly and compassionately with the family in order to establish a trusting relationship and to ensure that the patient's needs are being met. Additionally, the nurse can provide education on pain management techniques and other ways in which the family can support the patient during this difficult time. Simply asking the family to leave or showing them hospital policies may escalate the situation and damage the relationship between the nurse and the family. Negotiating with the family to avoid using the call light may not be effective if the patient's needs are more frequent than every 30 minutes.

Question 3

A patient comes into the emergency department after vomiting blood. The nurse would be most concerned if the patient reported taking which of the following medications?

Accepted Answer

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding in the stomach and intestines, leading to vomiting blood. Acetaminophen, codeine, and meperidine are not typically associated with this type of bleeding.

Question 4

A patient receiving morphine sulfate 5 mg IV every 4 hours around the clock and acetaminophen PO every 4 hours reports intense itching. Assuming all are ordered, which prn medication should the nurse administer?

Accepted Answer

Nalbuphine (Nubain) is an opioid antagonist and can be given to relieve itching caused by opioid medications. Fentanyl and methadone are also opioids and are unlikely to relieve itching. Ibuprofen is not effective for itching.

Question 5

Which of the following drugs are adjuvant agents used in the management of pain? (Select all that apply.?

Accepted Answer

The answer of Which of the following drugs are adjuvant...

Question 6

What type of pain is most often associated with a change in vital signs?

Accepted Answer

Acute pain from trauma is most often associated with a change in vital signs, such as an increase in heart rate and blood pressure. Chronic nonmalignant pain, cancer pain, and neuropathic pain may not necessarily cause a significant change in vital signs.

Question 7

A nursing home resident complains of joint pain. Orders are on the chart for all of the following medications. Which should the nurse choose first to relieve the patient's pain?

Accepted Answer

Ibuprofen (Motrin) is a nonsteroidal anti-inflammatory drug (NSAID) that is effective in relieving pain and inflammation. It is the first-line choice for pain relief in nursing home residents because it is well-tolerated and has a low risk of side effects.

Question 8

A patient has been requesting hydrocodone/acetaminophen (Vicodin) for pain every 4 hours for several days. Now the patient calls the nurse after only 3 hours and says, "I need more Vicodin. The pain is worse." On which initial assumption should the nurse base a decision about what to do next?

Accepted Answer

The nurse should assume that the patient is in pain and assess the intensity and quality of the pain before determining the appropriate course of action. It is not appropriate to assume addiction or drug-seeking behavior without further assessment. The possibility of physical dependence on the medication should also be considered, but this should not be the initial assumption.

Question 9

In what category of pain is phantom limb pain?

Accepted Answer

Phantom limb pain is a type of chronic nonmalignant pain that occurs after amputation of a limb. It is not acute pain as it continues over a long period of time, and it is not cancer pain as it is not caused by cancer. It is also not intermittent pain as it is often constant or episodic in nature.

Question 10

A patient admitted with liver disease complains of pain in his right shoulder. Which of the following explanations for this is most likely to be true?

Accepted Answer

Referral pain occurs when an organ in a certain area is affected, but the pain radiates to a different area of the body. In this case, the liver is located in the upper right abdomen, and when it malfunctions due to disease, it can cause pain to be felt in the right shoulder.

Question 11

The nurse is providing care for a patient being discharged on opioid therapy. Which of the following statements should be included in the discharge teaching? (Select all that apply.?

Accepted Answer

Opioid therapy can cause constipation, so adequate fluid intake and possibly laxatives are recommended. Patients should avoid driving due to potential drowsiness. Sleepiness is a common side effect.

Question 12

The nurse is admitting a new patient to a medical unit with pancreatitis. Which of the following would be included in the pain history? (Select all that apply.?

Accepted Answer

When assessing pain in a patient with pancreatitis, it is important to ask about how the pain is affecting the patient's daily life (A, B), if there are any factors that make the pain worse or better (C), if there are any associated symptoms such as nausea or vomiting (D), and how the patient is describing their pain (E). Asking about alcohol consumption (F) may be important in determining the cause of the pancreatitis, but it is not directly related to assessing the patient's pain.

Question 13

What class of medications is most likely to be effective for the treatment of pain with a neuropathic component?

Accepted Answer

Tricyclic antidepressants are the most commonly prescribed class of medications for neuropathic pain. They work by blocking the reuptake of norepinephrine and serotonin, which may help to decrease the sensitivity of pain receptors in the central nervous system. Opioids can be effective for acute pain, but may not be as effective for chronic neuropathic pain and can have significant side effects. Nonsteroidal anti-inflammatory drugs are not effective for neuropathic pain, as they mainly target inflammation. Beta blockers are primarily used for heart conditions and high blood pressure, and are not typically used for pain management.

Question 14

Which of the following statements is a myth about the management of pain?

Accepted Answer

Pain is subjective and can be experienced differently by each individual. Just because a patient is able to engage in conversation or laughter does not mean they are not experiencing pain.

Question 15

Which of the following are characteristics of nonopioid drugs? (Select all that apply.?

Accepted Answer

Nonopioid drugs have a ceiling effect, meaning there is a maximum dose beyond which no additional therapeutic effect is achieved. They primarily work peripherally rather than in the central nervous system. They are used for both acute and chronic pain management.

Question 16

What is the best analgesic schedule for a patient with chronic pain?

Accepted Answer

Around the clock dosing provides consistent pain relief and better control of chronic pain compared to as-needed (prn) dosing. Qid dosing may be too frequent and increase the risk of side effects, while only taking analgesics when pain is severe may result in poor pain control and increase the risk of developing tolerance.

Question 17

A patient is given a prescription for oxycodone/acetaminophen (Vicodin), two tablets to be taken every 4 to 6 hours as needed for pain. Which of the following statements should be included in the teaching?

Accepted Answer

Option A correctly identifies that acetaminophen can cause dangerous side effects if taken more frequently than prescribed. Option B is incorrect because while oxycodone can cause respiratory depression, the frequency of dosing should be based on the prescribed interval rather than a minimum time frame. Option C is incorrect as there is no evidence to suggest that oxycodone and acetaminophen interact to form a dangerous metabolite. Option D is incorrect because pain relief duration can vary between individuals and the prescribed dosing interval should be followed regardless of pain relief duration.

Question 18

Which of the following best describes "physical dependence"?

Accepted Answer

Physical dependence is the body's adaptation to a drug, where it requires the drug to function normally. Stopping the drug suddenly causes withdrawal symptoms, such as nausea, tremors, and seizures. This is different from addiction, which is when a person continues to use a drug despite negative consequences. Choice A refers to addiction, while choices B and D relate to tolerance and increased use, respectively.

Question 19

Which of the following is equivalent to a 10-mg dose of subcutaneous morphine? (Select all that apply.?

Accepted Answer

The answer of Which of the following is equivalent to...

Question 20

What is the priority instruction for a patient experiencing constipation while taking hydromorphone for cancer pain?

Accepted Answer

The answer of What is the priority instruction for a...

Quiz 10: Nursing Care of Patients in Pain