Question 1

A patient with second-degree burns has been receiving hydromorphone through patient-controlled analgesia (PCA)for a week.The patient wakes up frequently during the night complaining of pain.What action by the nurse is most appropriate?

Accepted Answer

PCAs are best for controlling acute pain.This patient's history indicates chronic pain and a need for a pain management plan that will provide adequate analgesia while the patient is sleeping.Administering a dose of morphine when the patient already has severe pain will not address the problem.Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression.It is illegal for the nurse to administer the morphine for a patient through PCA.

Question 2

When visiting a hospice patient,the nurse assesses that the patient has a respiratory rate of 11 breaths/minute and complains of severe pain.Which action is best for the nurse to take?

Accepted Answer

The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression.A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly.The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's respiratory rate.

Question 3

Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP)when caring for a patient who is using a fentanyl (Duragesic)patch and a heating pad for treatment of chronic back pain?

Accepted Answer

Obtaining the respiratory rate is included in UAP education and scope of practice.Assessment for sedation,pain control,and skin integrity requires more education and scope of practice.

Question 4

The nurse reviews the medication administration record in order to choose the most appropriate pain medication for a patient with cancer who describes the pain as "deep,aching and at a level 8 on a 0 to 10 scale".Which medication should the nurse administer?

Accepted Answer

The patient's pain level indicates that a rapidly acting medication such as an IV opioid is needed.The other medications also may be appropriate to use,but will not work as rapidly or as effectively as the IV hydromorphone.

Question 5

A patient with chronic neck 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?

Accepted Answer

The goal for the treatment of chronic pain usually is to enhance function and quality of life.The other questions are also appropriate to ask,but information about patient function is more useful in evaluating effectiveness.

Question 6

A patient who has just started taking sustained-release morphine sulfate (MS Contin)for chronic arthritic joint pain following a traumatic injury complains of nausea and abdominal fullness.Which action should the nurse take initially?

Accepted Answer

Nausea is frequently experienced with the initiation of opioid therapy,and antiemetics usually are prescribed to treat this expected side effect.There is no indication that a different opioid is needed,although if the nausea persists,the health care provider may order a change of opioid.Although tolerance develops and the nausea will subside in about a week,it is not appropriate to allow the patient to continue to be nauseated.A clear liquid diet may decrease the nausea,but the best choice would be to administer the antiemetic medication and allow the patient to eat.

Question 7

The nurse assesses that a patient receiving epidural morphine has not voided for over 10 hours.What action should the nurse take initially?

Accepted Answer

Urinary retention is a common side effect of epidural opioids.Assess whether the patient feels the need to void.Since urinary retention is a possible side effect,there is no reason for concern of withdrawal symptoms.Placing an indwelling catheter requires an order from the health care provider.Usually an in and out catheter is performed to empty the bladder if the patient is unable to void because of the risk of infection with an indwelling catheter.Urinary retention does not indicate that this reaction is an allergic reaction.

Question 8

The nurse teaches a student nurse about the action of ibuprofen.Which statement,if made by the student,indicates that teaching was effective?

Accepted Answer

Nonsteroidal antiinflammatory drugs (NSAIDs)provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury.Transmission of impulses through the spinal cord,brain sensitivity to pain,and the descending nerve pathways are not affected by NSAIDs.

Question 9

The nurse is completing the medication reconciliation form for a patient admitted with chronic cancer pain.Which medication is of most concern to the nurse?

Accepted Answer

Meperidine is contraindicated for chronic pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods.The ibuprofen,amitriptyline,and oxycodone are all appropriate medications for long-term pain management.

Question 10

A patient who uses a fentanyl (Duragesic)patch for chronic cancer pain suddenly complains of rapid onset pain at a level 9 (0 to 10 scale)and requests "something for pain that will work now." How will the nurse document the type of pain reported by this patient?

Accepted Answer

Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain.Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS).Somatic pain is localized and arises from bone,joint,muscle,skin,or connective tissue.Referred pain is pain that is localized in uninjured tissue.

Question 11

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 action by the nurse is best?

Accepted Answer

The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid,such as the immediate-release morphine.Lorazepam and amitriptyline may be appropriate to use as adjuvant therapy,but they are not likely to block severe breakthrough pain.Use of antianxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.

Question 12

The nurse is caring for a 1-day postoperative patient who is receiving morphine through patient-controlled analgesia (PCA).What action by the nurse is a priority?

Accepted Answer

The patient's respiratory rate is the highest priority of care while using PCA medication because of the possible respiratory depression.The other information may also require intervention but is not as urgent to report as the respiratory rate.

Question 13

The nurse is caring for a patient who has diabetes and complains of chronic burning leg pain even when taking oxycodone (OxyContin)twice daily.When reviewing the orders,which prescribed medication is the best choice for the nurse to administer as an adjuvant to decrease the patient's pain?

Accepted Answer

The patient's pain symptoms are consistent with neuropathic pain and the tricyclic antidepressants are effective for treating this type of pain.The other medications are more effective for nociceptive pain.

Question 14

A patient with terminal 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?

Accepted Answer

The patient's pain requires rapid treatment and the nurse should administer the immediate-acting morphine.Increasing the MS Contin dose and use of alternative therapies may also be needed,but the initial action should be to use the prescribed analgesic medications.

Question 15

The following medications are prescribed by the health care provider for a middle-aged patient who uses long-acting morphine (MS Contin)for chronic back pain,but still has ongoing pain.Which medication should the nurse question?

Accepted Answer

Opioid agonist-antagonists can precipitate withdrawal if used in a patient who is physically dependent on mu agonist drugs such as morphine.The other medications are appropriate for the patient.

Question 16

A patient who uses a fentanyl (Duragesic)patch 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?

Accepted Answer

Because patients with chronic pain frequently use withdrawal and decreased activity as coping mechanisms for pain,sleep is not an indicator that the patient is pain free.The nurse should wake the patient and administer the hydrocodone.

Question 17

A patient who has fibromyalgia 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?

Accepted Answer

For chronic pain,patients are encouraged to set functional goals such as being able to perform daily activities and hobbies.The patient has identified playing golf as the desired activity,so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment.The nurse should also assess for depression,but the patient has identified the depression as being due to the inability to play golf,so the goal of being able to play 1 or 2 rounds of golf is the most appropriate.

Question 18

A nurse assesses a patient with chronic cancer pain who is receiving imipramine (Tofranil)in addition to long-acting morphine.Which statement,if made by the patient,indicates to the nurse that the patient is receiving adequate pain control?

Accepted Answer

Imipramine is being used in this patient to manage chronic pain and improve functional ability.Although the medication is also prescribed for patients with depression,insomnia,and anxiety,the evaluation for this patient is based on improved pain control and activity level.

Question 19

A patient with chronic back pain has learned to control the pain with the use of imagery and hypnosis.The patient's spouse asks the nurse how these techniques work.Which response by the nurse is best?

Accepted Answer

Cognitive therapies affect the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.

Question 20

Which question asked by the nurse will give the most information about the patient's metastatic bone cancer pain?

Accepted Answer

Because pain is a multidimensional experience,asking a question that addresses the patient's experience with the pain will elicit more information than the more specific information asked in the other three responses.All of these questions are appropriate,but the response beginning "How would you describe your pain?" is the best initial question.

Quiz 4: Pain Management

A patient with second-degree burns has been receiving hydromorphone through patient-controlled analgesia (PCA) for a week.The patient wakes up frequently during the night complaining of pain.What action by the nurse is most appropriate?

When visiting a hospice patient,the nurse assesses that the patient has a respiratory rate of 11 breaths/minute and complains of severe pain.Which action is best for the nurse to take?

Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain?

The nurse reviews the medication administration record in order to choose the most appropriate pain medication for a patient with cancer who describes the pain as "deep,aching and at a level 8 on a 0 to 10 scale".Which medication should the nurse administer?

A patient with chronic neck 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?

A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic arthritic joint pain following a traumatic injury complains of nausea and abdominal fullness.Which action should the nurse take initially?

The nurse assesses that a patient receiving epidural morphine has not voided for over 10 hours.What action should the nurse take initially?

The nurse teaches a student nurse about the action of ibuprofen.Which statement,if made by the student,indicates that teaching was effective?

The nurse is completing the medication reconciliation form for a patient admitted with chronic cancer pain.Which medication is of most concern to the nurse?

A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain suddenly complains of rapid onset pain at a level 9 (0 to 10 scale) and requests "something for pain that will work now." How will the nurse document the type of pain reported by this patient?

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 action by the nurse is best?

The nurse is caring for a 1-day postoperative patient who is receiving morphine through patient-controlled analgesia (PCA) .What action by the nurse is a priority?

The nurse is caring for a patient who has diabetes and complains of chronic burning leg pain even when taking oxycodone (OxyContin) twice daily.When reviewing the orders,which prescribed medication is the best choice for the nurse to administer as an adjuvant to decrease the patient's pain?

A patient with terminal 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?

The following medications are prescribed by the health care provider for a middle-aged patient who uses long-acting morphine (MS Contin) for chronic back pain,but still has ongoing pain.Which medication should the nurse question?

A patient who uses a fentanyl (Duragesic) patch 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?

A patient who has fibromyalgia 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?

A nurse assesses a patient with chronic cancer pain who is receiving imipramine (Tofranil) in addition to long-acting morphine.Which statement,if made by the patient,indicates to the nurse that the patient is receiving adequate pain control?

A patient with chronic back pain has learned to control the pain with the use of imagery and hypnosis.The patient's spouse asks the nurse how these techniques work.Which response by the nurse is best?

Which question asked by the nurse will give the most information about the patient's metastatic bone cancer pain?