Question 1

A nursing student caring for a patient with cancer tells the nurse that the patient seems to be exaggerating when reporting the degree of pain. Which statement by the nurse is an appropriate response to this concern?

A) "Evaluation of the patient's vital signs can help you tell if this patient is exaggerating."
B) "It is important to give pain medication as ordered for the degree of pain the patient reports."
C) "We may need to evaluate the patient for the development of metastasis or infection."
D) "You should monitor this patient's behavior and facial expressions for a more accurate assessment."

Accepted Answer

The patient's description of his or her pain is the cornerstone of assessment. Pain is a personal experience,and caregivers must act on what the patient says,even if they suspect the patient is exaggerating or not telling the truth. Evaluation of vital signs can be used to monitor responses to pain medication,as can assessments of behaviors and facial expressions,but they are not determinants of the level of pain in initial assessments. Patients with pain in new locations should be evaluated for metastases or infection or other causes.

Question 2

Which nonpharmacologic therapies are effective in reducing cancer pain? (Select all that apply.)&#10;A) Acupuncture&#10;B) Cold&#10;C) Exercise&#10;D) Heat&#10;E) Transcutaneous electrical nerve stimulation (TENS)

Accepted Answer

Cold,heat,and exercise have been shown to reduce pain. Acupuncture and TENS have not been demonstrated to be effective,although in theory they should work.

Question 3

A patient who has cancer reports pain as &#34;burning&#34; and &#34;shooting&#34; alternating with feelings of numbness and coldness. The nurse will contact the provider to discuss the use of which medication?&#10;A) Acetaminophen&#10;B) Ibuprofen&#10;C) Imipramine [Tofranil]&#10;D) Oxycodone [OxyContin]

Accepted Answer

This patient is describing neuropathic pain,which results from injury to peripheral nerves. This type of pain responds poorly to opioid analgesics but does respond to adjuvant analgesics,which include antidepressants such as imipramine. Acetaminophen and ibuprofen are used for mild nociceptive pain,and oxycodone is used for more severe nociceptive pain.

Question 4

An older adult patient who has cancer and Alzheimer's disease is crying but shakes her head "no" when asked about pain. The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do?

A) Administer 4 mg of morphine and monitor this patient's verbal and nonverbal responses.
B) Give 2 mg of morphine for pain to avoid increasing this patient's level of confusion.
C) Request an order for a nonopioid analgesic or an antidepressant adjuvant analgesic.
D) Withhold any analgesic at this time and reassess the patient in 30 to 60 minutes.

Accepted Answer

Older adult patients often are undertreated for pain,because assessing pain is difficult in patients with cognitive impairment and because practitioners often believe that reduced dosages are necessary to alleviate side effects. This patient does not verbalize pain,but her nonverbal cue (crying)indicates that pain is present. The nurse should give the higher dose,especially because the dosing interval has already been exceeded,and then monitor the patient's response to the medication. Giving 2 mg to avoid side effects is not indicated; patients with Alzheimer's disease will continue to have confusion unrelated to the opioid. Nonopioid analgesics and antidepressants are not indicated. Withholding pain medication is not appropriate,because this patient shows nonverbal signs of pain.

Question 5

Over time,patients taking opioid analgesics develop tolerance to which side effects? (Select all that apply.)&#10;A) Constipation&#10;B) Euphoria&#10;C) Physical dependence&#10;D) Respiratory depression&#10;E) Sedation

Accepted Answer

With continuous use,tolerance develops to most side effects of opioids,except to constipation and physical dependence.

Question 6

A patient newly diagnosed with cancer reports having pain at a level of 7 to 8 on a scale of 10. Which type of pain management will be used initially to treat pain in this patient?&#10;A) Acetaminophen [Tylenol]&#10;B) Ibuprofen [Motrin]&#10;C) Nonpharmacologic measures&#10;D) Opioid analgesics

Accepted Answer

Traditionally,patients have been given opioid analgesics only after a trial with nonopioids has failed. NCCN guidelines recommend selecting drugs based on pain intensity,even in newly diagnosed patients. Patients reporting pain in the 4 to 10 range should be given an opioid.

Question 7

An 8-year-old child with advanced cancer has an order for oxycodone [OxyContin] PO,PRN for moderate to severe pain. The nurse notes that the child is constantly playing computer games and repeatedly denies having pain. What will the nurse do?

A) Administer the oxycodone at regular intervals around the clock.
B) Contact the provider to discuss using patient-controlled analgesia (PCA).
C) Reassure the child's parent that the child will ask for pain medication as needed.
D) Tell the child to notify the nurse when pain is present.

Accepted Answer

For a number of reasons,even children who can verbalize pain correctly often underreport it. The child may fear that reporting pain may lead to painful procedures or may worry caregivers,or the child may be unaware that pain can be alleviated. Children involved in activities such as computer games may actually be using the activity to distract themselves from the pain,so such an activity is not an indication that the child is comfortable. This child has advanced cancer and is likely to have severe pain. A PCA device would give the child control and provide adequate pain relief. The oxycodone order is for PRN dosing,so the nurse cannot administer it around the clock without a prescriber's order to do so. Also,because this child is more likely to have severe pain,a PCA would be more effective. Reassuring the parent that the child will report pain and asking the child to report pain do not take into account the fact that children often hide pain for the reasons previously mentioned.

Question 8

A patient who has had cancer for 1 year uses a fentanyl transdermal patch for pain relief. The patient reports having three or four episodes of pain (which she rates as 8 or 9 on a scale of 1 to 10)each day,and each episode lasts 15 to 30 minutes. The nurse will contact the provider to:

A) discuss the use of an adjuvant analgesic.
B) request an order for an NSAID.
C) request a strong, short-acting opioid PRN.
D) suggest increasing the dose of fentanyl.

Accepted Answer

Breakthrough pain can occur in patients who otherwise have well-controlled pain,and it should be managed with extra doses of short-acting,strong opioids. This pain is moderate to severe and is not neuropathic,so adjuvant analgesics or NSAIDs are not useful. Increasing the dose of the long-acting opioid would not alleviate breakthrough pain.

Question 9

A patient with cancer who has been receiving an opioid analgesic reports having pain at a new location even though the previous pain is well controlled. The nurse will contact the provider to discuss:&#10;A) breakthrough pain.&#10;B) drug-seeking behavior.&#10;C) infection or metastasis.&#10;D) tolerance to drug therapy.

Accepted Answer

Caregivers should be alert for new pain; this usually results from a new cause,such as metastasis,infection,or fracture,and should be investigated. Breakthrough pain is pain that occurs even when adequate levels of analgesics are given. Drug-seeking behavior refers to patients who use drugs for euphoric effects instead of for intended effects. Tolerance occurs when more drug is required to receive the same effect.

Question 10

A nurse is teaching a group of nursing students about the differences between pure opioid agonists and agonist-antagonist opioids. Which statement by a student indicates understanding of the teaching?&#10;A) &#34;Agonist-antagonist opioids act as agonists at mu receptors only.&#34;&#10;B) &#34;Agonist-antagonist opioids are effective for treating cancer pain.&#34;&#10;C) &#34;Agonist-antagonist opioids enhance the effects of pure agonists.&#34;&#10;D) &#34;Pure agonists act as agonists at both mu receptors and kappa receptors.&#34;

Accepted Answer

Pure agonists are agonists at mu and kappa receptors. Agonist-antagonist opioids are agonists at kappa,not mu,receptors. At mu receptors,agonist-antagonists act as antagonists. Agonist-antagonists are not recommended for treating cancer pain; because of their antagonist effect,they block access of the pure agonists to mu receptors and thus block their actions.

Question 11

A patient with bone cancer has recently undergone chemotherapy and radiation therapy to reduce the size of the tumor. The patient is taking a large dose of an opioid analgesic,along with acetaminophen and an antidepressant. The nursing student caring for this patient is concerned that the patient is showing drug-seeking behaviors,because the individual requested an increased dose of the opioid. The student discusses this concern with the nurse. Which statement by the student indicates a need for further teaching?

A) "It would probably help this patient more to give a larger antidepressant dose."
B) "Patients often need more drug to achieve the same effect."
C) "Radiation and chemotherapy can damage bone tissue and cause increased pain."
D) "The patient's description of pain is the most important part of the assessment of pain."

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Accepted Answer

The answer of A patient with bone cancer has recently...

Question 12

A patient is taking hydrocodone and ibuprofen for cancer pain and is admitted to the hospital for chemotherapy. The nurse anticipates that the prescriber will ____ ibuprofen.&#10;A) reduce the dose of&#10;B) discontinue the&#10;C) increase the dose of&#10;D) order aspirin (ASA) instead of

Accepted Answer

The answer of A patient is taking hydrocodone and ibuprofen...

Question 13

A nursing student asks the nurse why the provider has ordered a combination product containing an opioid analgesic and an NSAID for a patient who has cancer. Which response by the nurse is correct?&#10;A) &#34;There are decreased effects of NSAIDs on the GI tract when a combination product is used.&#34;&#10;B) &#34;There are fewer adverse effects from both drugs when used in a combination product.&#34;&#10;C) &#34;There is a decreased likelihood of opioid dependence when it is given in combination with an NSAID.&#34;&#10;D) &#34;There is increased pain relief with the combination than when either product is used alone.&#34;

Accepted Answer

The answer of A nursing student asks the nurse why...

Question 14

A patient with cancer is admitted to the hospital. The nurse obtains an admission history and learns that the patient has been taking oxycodone and a nonsteroidal anti-inflammatory drug (NSAID)for a year. The patient reports a recent increase in the intensity of pain,along with a new pain described as "burning" and "shooting." The nurse anticipates that the prescriber will order:

A) a combination opioid/NSAID and an adjunctive analgesic.
B) a fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic.
C) an increase in the oxycodone and NSAID doses.
D) intramuscular morphine sulfate and acetaminophen.

Accepted Answer

The answer of A patient with cancer is admitted to...

Question 15

A patient who has cancer asks the nurse about using acupuncture to manage cancer pain. What will the nurse tell this patient?&#10;A) &#34;Acupuncture is not an effective treatment for cancer pain and should not be used.&#34;&#10;B) &#34;Studies to date do not clearly indicate effectiveness of acupuncture for alleviating cancer pain.&#34;&#10;C) &#34;Transcutaneous electrical nerve stimulation (TENS) has been shown to be more effective than acupuncture.&#34;&#10;D) &#34;There is good evidence to suggest that acupuncture is an effective adjunct treatment for cancer pain.&#34;

Accepted Answer

The answer of A patient who has cancer asks the...

Question 16

A patient who is taking a fixed-dose combination drug with an opioid and acetaminophen for cancer pain reports increased muscular pain. The patient asks the nurse if the pain medication dose can be increased. What will the nurse tell this patient?

A) An adjuvant analgesic medication will probably be used to help with this pain.
B) An additional dose of acetaminophen can be used to enhance pain relief.
C) Increasing the dose is possible, because there is no ceiling to opioid pain relief.
D) The provider will prescribe separate dosing of the opioid and acetaminophen.

Accepted Answer

The answer of A patient who is taking a fixed-dose...

Question 17

A patient newly diagnosed with cancer is admitted to the hospital,and the provider orders oxycodone [OxyContin] every 4 to 6 hours PRN pain. The patient requests pain medication whenever he reports pain as a 7 or 8 on a scale of 1 to 10 (10 being the worst pain),but he tells the nurse the medication is not working well. The nurse will contact the provider to discuss:

A) a fixed dosing schedule for the oxycodone.
B) intramuscular meperidine [Demerol].
C) intravenous morphine sulfate.
D) transdermal fentanyl.

Accepted Answer

The answer of A patient newly diagnosed with cancer is...

Deck 29: Pain Management in Patients with Cancer