Question 1

A client who is being treated for cancer tells the nurse that she is still having trouble getting to the toilet without experiencing significant pain. The nurse plans care for this client based on which goal?

A) Eliminating all pain in clients with chronic pain
B) Allowing the client to perform activities of daily living
C) Preventing the client from becoming addicted to the medication
D) Allowing the nurse to assess if the treatment is successful

Allowing the client to perform activities of daily living

Accepted Answer

Rationale 1: The goal with all clients is pain management, not necessarily pain relief.
Rationale 2: The goal for clients with chronic pain is to be able to perform activities of daily living comfortably.
Rationale 3: In this situation, the primary goal is not to prevent addiction, but for the client to be able to function.
Rationale 4: In pain management, both client and health care providers assess treatment.

Question 2

The nurse is interviewing the client before minor surgery. The client is worried about pain management: "I have a history of addiction; I have to be careful what I get for pain." What is the best response from the nurse?

A) "Maybe you should put off having surgery until you don't have the urge to abuse drugs."
B) "We will have to use only complementary therapies for you. I am afraid you may still have some pain."
C) "We can use nonopioid drugs, which have a very low risk of dependency."
D) "How long have you been drug-free? If it has been more than two years, we can use opioids."

"We can use nonopioid drugs, which have a very low risk of dependency."

Accepted Answer

Rationale 1: This does not address the client's need for pain management. Nonopioid drugs have a low risk of dependency, and are ideal for this client.
Rationale 2: Complementary therapies might not completely relieve pain. This client certainly can also use nonopioid drugs with a low dependency risk.
Rationale 3: Nonopioid analgesics have a very low rate of dependency, and might be the ideal drug choice for this client.
Rationale 4: Clients with a history of addiction do not have a time period when they are not at risk again for addiction.

Question 3

The nurse has just taken a job in a hospital that cares for an ethnically diverse population and is concerned about being culturally sensitive. How should the nurse plan to manage caring for clients in pain?

A) Treat all clients alike.
B) Listen carefully as the client's comments about pain are translated.
C) Show respect for the client's preferences even if they are very different from the nurse's.
D) Ask questions about the client's beliefs and customs regarding pain management.
E) Watch how other nurses provide care to their clients.

Listen carefully as the client's comments about pain are translated.
Show respect for the client's preferences even if they are very different from the nurse's.
Ask questions about the client's beliefs and customs regarding pain management.

Accepted Answer

Rationale 1: Not all clients respond identically to interventions.
Rationale 2: Even if the nurse has to use the services of a translator, careful listening is an important step in providing culturally sensitive care.
Rationale 3: Showing respect is important in providing culturally sensitive care in all areas, including pain management.
Rationale 4: The nurse cannot practice what the nurse does not know. Asking questions is the method used to gain information to facilitate sensitive care.
Rationale 5: Other nurses may not be providing the care needed for this nurse's clients.

Question 4

The client rings pain medication from the nurse. Upon assessment, the nurse finds the client sitting up in a chair, watching television with her husband. Vital signs are normal and the client's skin is warm and dry. Which nursing actions are appropriate?

A) Ask the client to rate his pain on the pain scale.
B) Tell the client that he does not look as if he is in pain.
C) Have the client go back to bed and ask the visitor to leave.
D) Check to see when the client last received pain medication.
E) Have another nurse assess the client.

Accepted Answer

Rationale 1: When the client complains of pain, the nurse should always ask for a pain rating.
Rationale 2: Clients respond to pain differently. For example, this client may be trying to hide the intensity of pain from her husband.
Rationale 3: Having the client go back to bed and asking the visitor to leave is punitive and could be interpreted as the nurse not believing the client. Being active and having diversions can help with pain management.
Rationale 4: The nurse should check to see when the client last had pain medication, what drug was given, what dose was given, and by what route it was administered.
Rationale 5: There is no reason to have another nurse assess the client. This action may imply that the nurse does not trust the client.

Question 5

The client is prescribed morphine sulfate (MS Contin) for chronic back pain resulting from inoperable disk degeneration. What nursing actions are indicated?&#10;A) Use the prn order of docusate (Dulcolax) routinely every night.&#10;B) Ask the dietary department to add bran cereal to the client's breakfast trays.&#10;C) Ask the health care provider to write an order for an indwelling urinary catheter.&#10;D) Review the trending of the client's hemoglobin and hematocrit levels.&#10;E) Check the medical record for a prn order for an antiemetic.&#10;

Accepted Answer

Rationale 1: One of the adverse effects of morphine therapy is constipation. The nurse should be proactive by giving the docusate every night.
Rationale 2: Intake of additional fibre, as long as sufficient fluid is taken, is useful in preventing the constipation that is common with the use of morphine.
Rationale 3: While morphine may promote urinary retention, other methods of controlling this adverse effect should be used initially.
Rationale 4: Morphine should not be administered to those who are hypovolemic due to the risk of hypotension.
Rationale 5: Nausea and vomiting are adverse effects of the use of morphine. Until the client becomes tolerant of this effect, an antiemetic may be necessary.

Question 6

The client has been keeping a &#34;headache diary&#34; of her migraines. Upon review of this diary, the nurse notes that the headaches are described as mild and have happened four times in the last 3 months. The client reports that she &#34;generally just lies down until they pass&#34; but that her new job will not allow that time. She is requesting information about pain medication. What medications would the nurse expect to be prescribed?&#10;A) Ibuprofen&#10;B) Acetaminophen and caffeine&#10;C) Sumatriptan (Imitrex)&#10;D) Ergotamine (Ergostat)&#10;E) Amitriptyline (Elavil)&#10;

Accepted Answer

Rationale 1: NSAIDs are often effective for the mild migraines this client experiences.
Rationale 2: Acetaminophen and caffeine together are used for treatment of mild migraines.
Rationale 3: Sumatriptan is a serotonin receptor agonist and is usually used only for moderate to severe migraines.
Rationale 4: Ergotamine is an ergot alkaloid that is a serotonin receptor agonist. This drug is used only with moderate to severe migraines.
Rationale 5: Amitriptyline is used to prevent migraines, not to reduce pain once they occur.

Question 7

The nurse and the client have established this goal: "The client will verbalize safety considerations for use of tramadol (Ultram) before being dismissed from the hospital." Which client statements would support evaluation that this goal has been achieved?

A) "I will not drive until I know how I am going to react to the tramadol."
B) "I will limit my alcohol intake to a couple of glasses of wine with dinner."
C) "I will avoid taking my regular dose of kava while I am on this drug."
D) "I will not eat aged cheese while taking tramadol."
E) "I will work with my health care provider to taper off the dose of this medication when it is no longer needed."

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Accepted Answer

Rationale 1: Symptoms such as confusion and visual impairment can occur with tramadol use.
Rationale 2: Ethanol combined with tramadol may result in death.
Rationale 3: Caution should be observed when using herbs such as kava that may have an additive CNS depressant effect.
Rationale 4: There is no contraindication to eating aged cheese with tramadol.
Rationale 5: If tramadol is abruptly discontinued, symptoms of opioid withdrawal may occur.

Question 8

A client has been treated for a migraine headache, given a prescription for sumatriptan (Imitrex), and is being dismissed from the clinic. Which client statements would the nurse evaluate as meeting the goal that, prior to dismissal, the client will verbalize symptoms that indicate the need to contact the health care professional?

A) "I should report any tightness in my chest."
B) "I should expect some dizziness and blurred vision until I get acclimated to this drug, so that should not be reported."
C) "If I get a headache after drinking alcoholic beverages, I should notify my health care provider."
D) "If I get a really bad headache, I should report it."
E) "If I notice a rash when I have a headache, I should report it."

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Accepted Answer

Rationale 1: Triptans and ergot alkaloids cause vasoconstriction. Persons at risk for cardiovascular disease need close monitoring.
Rationale 2: Dizziness, light-headedness, or blurred vision should be reported immediately as it is impossible to determine if the symptoms are drug related, related to the migraine, or signal cerebral ischemia.
Rationale 3: Alcoholic beverages are a known migraine trigger. It is not necessary to notify the health care provider.
Rationale 4: Changes in severity, character, or duration of headaches should be reported because they may not be migraines.
Rationale 5: Fever, rash, or stiff neck may indicate meningitis.

Question 9

A nurse is preparing to give pentazocine (Talwin) to her client. A student asks her to explain the classification and how it works. How does the nurse respond?&#10;A) &#34; Talwin is an opiate agonist that activates both kappa and mu receptors.&#34;&#10;B) &#34; Talwin is a mixed agonist antagonist opiate that works by activating mu receptors and inhibiting kappa receptors.&#34;&#10;C) &#34; Talwin is a mixed agonist antagonist opiate that activates kappa receptors and inhibits mu.&#34;&#10;D) &#34;Talwin is a mixed agonist antagonist opiate that inhibits kappa and activates delta and mu receptors&#10;

Accepted Answer

Rationale 1. Talwin has both agonist and antagonist actions.
Rationale 2: Talwin is a mixed opiate that has agonist and antagonist actions that work on two of the most common opiate receptors.
Rationale 3. Talwin is a mixed opiate that has agonist and antagonist actions that work on two of the most common opiate receptors
Rationale 4. Talwin is a mixed opiate that has agonist and antagonist actions that work on two of the most common opiate receptors

Deck 10: Pharmacotherapy of Pain and Migraine