Question 1

When planning care for the older adult patient with a history of persistent pain,the nurse acknowledges the effects of the mind-body connection by including:

Accepted Answer

Some mind-body therapies include meditation,relaxation,guided imagery,and cognitive behavioral counseling.The other actions are appropriate but not related to mind-body therapies.

Question 2

An older patient is hospitalized for the first time.After giving a dose of hydromorphone (Dilaudid),what assessment takes priority?

Accepted Answer

Respiratory depression is common with opioid analgesics.All assessments are appropriate;however,respiratory assessment takes priority.

Question 3

A patient has just had surgery.What pain control strategy is best?

Accepted Answer

After surgery the patient is expected to have pain.The best way to control acute pain is through round-the-clock dosing (at least at first)to keep the patient's pain from getting out of control.The nurse should assess the patient's preferences,but should assess preferences for pain levels,because the patient may not be experienced in receiving pain medications.Opioids are expected for acute pain from surgery.

Question 4

An older patient who lives alone is brought to the clinic by an adult child who reports the patient has become "depressed" and no longer wants to go out of the home.What action by the nurse is best?

Accepted Answer

Many older adults have pain that goes untreated.Consequences of untreated pain are numerous and include depression and withdrawal.The nurse should first assess for pain.Assessing for depression or elder abuse may be warranted as well.Asking "why" questions is not therapeutic,as patients tend to become defensive.

Question 5

An older adult who injured her knee several years ago tells the nurse that she has been managing the resulting intermittent pain with a prescription for propoxyphene (Darvon).The nurse is concerned with this treatment plan,primarily because:

Accepted Answer

The nurse needs to complete a full assessment to determine what type of pain the patient is experiencing and if a narcotic is the best alternative for the patient.Other medications may be more beneficial.

Question 6

A director of nursing in a long-term care facility was concerned after reading that as many as 80% of residents have untreated pain.What action by the director is best?

Accepted Answer

Nursing begins with assessment.The director should implement a protocol for routine assessments of pain in both cognitively impaired and intact residents.A "pain plan" cannot be created without this assessment data.Family members should be encouraged to provide input.The staff may or may not need to have education on assessment.

Question 7

The nurse is caring for an older adult patient with terminal cancer who is receiving medication via patient-controlled analgesic (PCA)pump.The nurse shows an understanding of primary end-of-life concerns when asking the patient:

Accepted Answer

Terminally ill patients generally identify their main concern as pain control.The other questions do not address this issue.

Question 8

The nurse caring for an older adult patient experiencing carpal tunnel syndrome anticipates the patient will best achieve pain control when prescribed a(n):

Accepted Answer

Neuropathic pain results from a pathophysiologic process involving the peripheral or central nervous system.These types of pain respond to unconventional analgesic drugs,such as tricyclic antidepressants.Carpal tunnel syndrome is caused by nerve injury.

Question 9

When planning care for the older adult experiencing pain,the nurse bases interventions on the realization that:

Accepted Answer

Pain is underrecognized,highly prevalent,and undertreated among older adults.

Question 10

An older adult patient is prescribed an analgesic to manage the joint pain resulting from stiffness in his right shoulder.When the patient asks about alternative therapy techniques that might be helpful,the nurse suggests:

Accepted Answer

Heat is useful in decreasing pain and discomfort resulting from joint stiffness by increasing the elasticity of muscles.Ice is better for acute exacerbations.Massage may or may not help but would be more expensive.Electrical nerve stimulation is not warranted.

Question 11

Acetaminophen (Tylenol)is prescribed for a 70-year-old with chronic pain.When the patient reports to the nurse that the maximum daily dose of medication does not control the pain,the nurse responds:

Accepted Answer

The patient needs a comprehensive review of pain strategies,which will probably include changing pain medication.Using the maximum dose of acetaminophen long term can cause liver damage,which is another reason the patient should switch medications if it is not working.

Question 12

An older patient is observed grimacing whenever walking and getting in and out of bed.When assessed,the patient regularly denies having any pain.To best provide the patient with effective pain control,the nurse initially:

Accepted Answer

Older adult patients actually underreport pain and are therefore at risk for undertreatment of pain,which may cause unnecessary suffering,exacerbation of the underlying disease,and reduction in activities of daily living (ADLs)and quality of life.Without this information the patient is unlikely to take the prn medication."Why" questions are not therapeutic,as they place people on the defensive.The symptoms should be documented,but this should not be the only action.

Question 13

An older adult lives alone at home and is being treated for chronic pain.The home health care nurse notes the adult is disheveled and has dirty dishes piled up in the sink.What action by the nurse is best?

Accepted Answer

Although all actions might be appropriate depending on circumstances,because the patient is being treated for pain and has a functional decline,the nurse should assess first for unrelieved pain.

Question 14

The nurse is performing a pain assessment when the older adult patient reports pain in his left shoulder that radiates down into the forearm.The nurse immediately:

Accepted Answer

Assessment is essential in differentiating acute life-threatening pain from longstanding chronic pain.Otherwise,disease progression and acute injury may go unrecognized and be attributed to preexisting disease or illness.The patient may or may not be experiencing cardiac ischemia,the rapid response team does not need to be called,and the nurse can assess for other symptoms after determining if this pain is new or not.

Question 15

The nurse caring for an older cognitively impaired patient with osteoarthritis in both hands assesses the patient for hand pain by:

Accepted Answer

Cognitively impaired patients in pain may not portray any visible signs of pain or distress or may be unable to communicate their pain.Pain may result in agitation,as well as increased pulse,respiration,blood pressure,and confusion.The other options are not as indicative of pain in the cognitively impaired older adult.

Question 16

The nurse is discussing pain control with an older patient who has been prescribed an opiate.When the patient expresses concerns about the diminishing effect that the medication has had on the pain,the nurse responds:

Accepted Answer

Tolerance is defined as the diminished effect of a drug while maintaining the same dosage over time.It is a characteristic of opiates when given over time.With opiates,some individuals might need higher and higher doses of a drug to maintain effectiveness.This should not be confused with addiction.

Question 17

An older patient is being treated for arthritic pain with a nonsteroidal anti-inflammatory drug (NSAID).Which question best assesses for side effects of this medication class?

Accepted Answer

The most common complaint associated with NSAIDs is indigestion.Indigestion may be reduced with antacid use or food consumption timed to coincide with analgesic intake.

Question 18

The nurse is caring for a 78-year-old with a history of chronic depression.The patient currently reports persistent left shoulder pain since having a fall a year ago.To best address the patient's pain,the nurse initially determines:

Accepted Answer

Persistent depression affects a person's ability to cope with the pain,so it must be treated.The nurse should also assess fall risk but that is secondary to determining why the pain has lasted so long and if the patient is able to cope.

Question 19

A confused patient is admitted to the hospital after suffering a fall.When asked about pain,the patient does not respond.What action by the nurse is best?

Accepted Answer

In some situations,the nurse cannot rely on the patient's report of pain,so as a second method of assessment,the nurse looks to the patient's nonverbal behaviors.The nurse should be aware,however,that the lack of specific "pain behaviors" does not indicate a lack of pain.The other options may be helpful for individual patients.

Question 20

An older adult patient has been prescribed an opioid to manage chronic pain resulting from a shoulder injury.To eliminate a common barrier to opioid drug compliance,the nurse:

Accepted Answer

Older adults have a high rate of discontinuation of opiates because of the resulting constipation.The treatment for constipation,especially that which is opioid induced,is readily available and should be provided as a preventive measure before starting narcotic pain medication.The other actions do not address this issue.

Quiz 14: Pain