Question 1

The patient has received ketamine for its analgesic effects.The patient suddenly states,"I feel like I am floating and can see everything you are doing.I am not in control." The nurse is aware that this is caused by the ketamine and is known as the

Accepted Answer

Before administering ketamine,the dissociative state should be explained to the patient.Dissociative state refers to the feelings of separateness from the environment,loss of control,hallucinations,and vivid dreams.The use of benzodiazepines (e.g.,midazolam)can reduce the incidence of this unpleasant effect.

Question 2

Using a specific pain intensity scale in the CCU

Accepted Answer

Many CCUs use a specific pain intensity scale because a single tool provides consistency of assessment and documentation.A pain intensity scale is useful in the critical care environment.Asking the patient to grade his or her pain on a scale of 0 to 10 is a consistent method and aids the nurse in objectifying the subjective nature of the patient's pain.However,the patient's tool preference should be considered.

Question 3

A patient underwent a thoracotomy 12 hours ago.The patient currently has an epidural catheter in place and is receiving continuous epidural analgesia with morphine.In addition to closely monitoring the patient for side effects and complications,which of the following interventions might enhance her pain control?

Accepted Answer

Positioning will not affect medication administration,distractions such as visitors and soothing music can often enhance the effects of pharmacologic pain control,adjuvant medications can help decrease anxiety,and nonopioid analgesics can provide greater pain relief at the peripheral and central levels.Instruct and guide patient through nonpharmacologic measures (e.g.,relaxation therapy,guided imagery,and biofeedback)to enhance pharmacologic effectiveness.The epidural space is filled with fatty tissue and is external to the dura mater.The fatty tissue interferes with uptake,and the dura acts as a barrier to diffusion,making diffusion rate difficult to predict.

Question 4

A patient complains of pain at his incision site.The nurse is aware that four processes are involved in nociception.The proper order of the processes is

Accepted Answer

Four processes are involved in nociception: transduction,transmission,perception,and modulation.

Question 5

The use of PCA infusion pumps allows the patient to

Accepted Answer

The patient can self-administer a bolus of medication the moment the pain begins,acting preemptively.Allowing the patient to self-administer opioid doses does not diminish the role of the critical care nurse in pain management.The nurse advises about necessary changes to the prescription and continues to monitor the effects of the medication and doses.The patient is closely monitored during the first 2 hours of therapy and after every change in the prescription.If the patient's pain does not respond within the first 2 hours of therapy,a total reassessment of the pain state is essential.If the patient is pressing the button to bolus medication more often than the prescription,the dose may be insufficient to maintain pain control.Naloxone must be readily available to reverse adverse opiate respiratory effects.

Question 6

Which of the following patients is MOST likely to be experiencing a life-threatening opioid side effect?

Accepted Answer

Although no universal definition of respiratory depression exists,it is usually described in terms of decreased respiratory rate (fewer than 8 or 10 breaths/min),decreased SpO₂ levels,or elevated ETCO₂ levels.A change in the patient's level of consciousness or snoring is a warning sign.It can be a sign of respiratory depression associated with airway obstruction by the tongue,leading to hypoxemia and possibly to cardiorespiratory arrest.A patient snoring after the administration of an opioid requires the critical care nurse to observe closely.

Question 7

A patient states that he has been taking Demerol 50 mg tablets four times a day for the past 5 years,but they are not working like they use to.The nurse is concerned that the patient has developed

Accepted Answer

Addiction is defined by a pattern of compulsive drug use that is characterized by an incessant longing for an opioid and the need to use it for effects other than pain relief.Tolerance is defined as a diminution of opioid effects over time.Physical dependence and tolerance to opioids may develop if the medication is given over a long period.Physical dependence is manifested by withdrawal symptoms when the opioid is abruptly stopped.

Question 8

A patient underwent a thoracotomy 12 hours ago.The patient currently has an epidural catheter in place and is receiving continuous epidural analgesia with morphine.In addition to respiratory depression,the patient should be monitored for which of the following complications?

Accepted Answer

Epidural analgesia is commonly used in critical care units after major abdominal surgery,nephrectomy,thoracotomy,and major orthopedic procedures.Monitor for adverse reactions,including respiratory depression,urinary retention,undue somnolence,itching,seizures,nausea,and vomiting.

Question 9

Which of the following assessment findings might indicate respiratory depression after opioid administration?

Accepted Answer

Snoring is a warning sign.It can be a sign of respiratory depression associated with airway obstruction by the tongue,leading to hypoxemia and possibly to cardiorespiratory arrest.A patient snoring after the administration of an opioid requires the critical care nurse to observe closely.

Question 10

C fibers are small-diameter,unmyelinated fibers that transmit what type of pain?

Accepted Answer

C fibers are implicated in the transmission of pain described as dull,diffuse,prolonged,and delayed.Alpha fibers conduct the rapid acute pain sensation described as prickling,sharp,and fast.These fibers are activated by mechanical and thermal stimuli and are carried by the neospinothalamic tract.

Question 11

The subjective characteristic implies that pain is

Accepted Answer

Pain is described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.This definition emphasizes the subjective and multidimensional nature of pain.More specifically,the subjective characteristic implies that pain is whatever the person experiencing it says it is and that it exists whenever he or she says it does.

Question 12

Which of the following statements are true regarding pain assessment and management?

Accepted Answer

Appropriate pain assessment is the foundation of effective pain treatment.Because pain is recognized as a subjective experience,the patient's self-report is considered the most valid measure for pain and should be obtained as often as possible.Unfortunately,in critical care,many factors,such as the administration of sedative agents,the use of mechanical ventilation,and altered levels of consciousness,may impact communication with patients.These obstacles make pain assessment more complex.Meperidine (Demerol)is a less potent opioid with agonist effects similar to those of morphine.It is considered the weakest of the opioids,and it must be administered in large doses to be equivalent in action to morphine.Because the duration of action is short,dosing is frequent.Equianalgesic means approximately the same pain relief.Dosages in the equianalgesic chart for moderate to severe pain are not necessarily starting doses.The doses suggest a ratio for comparing the analgesia of one medication with another.

Question 13

The neural processes of encoding and processing noxious stimuli necessary but not sufficient for pain is known as

Accepted Answer

Nociception represents the neural processes of encoding and processing noxious stimuli necessary,but not sufficient,for pain.Transduction refers to mechanical (e.g.,surgical incision),thermal (e.g.,burn),or chemical (e.g.,toxic substance)stimuli that damage tissues.As a result of transduction,an action potential is produced and is transmitted by nociceptive nerve fibers in the spinal cord that reach higher centers of the brain.This is called transmission,and it represents the second process of nociception.Pain sensation transmitted by the NS pathway reaches the thalamus,and the pain sensation transmitted by the PS pathway reaches brainstem,hypothalamus,and thalamus.These parts of the CNS contribute to the initial perception of pain.

Question 14

Relaxation,distraction,guided imagery,and music therapy are all examples of

Accepted Answer

Using the cortical interpretation of pain as the foundation,several interventions can reduce the patient's pain report.These modalities include cognitive techniques such as relaxation,distraction,guided imagery,and music therapy.

Question 15

The patient is sedated and breathing with the use of mechanical ventilation.The patient is unable to communicate any aspects of his pain to the nurse.The nurse knows that the best tool for pain assessment for this patient is

Accepted Answer

The BPS and the CPOT are supported by experts in critical care and are suggested for use in medical,postoperative,and nonbrain trauma critically ill adults unable to self-report in the clinical guidelines of the Society of Critical Care Medicine (SCCM).FLACC is a pediatric pain assessment tool.The Wong-Baker FACES tool requires the patient to associate a level of pain to a facial representation.BIS is as an objective measure of sedation levels during neuromuscular blockade in the ICU.

Question 16

The patient is admitted to the CCU with hemodynamic instability and an allergy to morphine.The nurse anticipates that the physician will order which medication for severe pain?

Accepted Answer

Fentanyl is a synthetic opioid preferred for critically ill patients with hemodynamic instability or morphine allergy.Hydromorphone is a semisynthetic opioid that has an onset of action and a duration similar to those of morphine.It is more potent than morphine.Hydromorphone produces an inactive metabolite (i.e.,hydromorphone-3-glucuronide),making it the opioid of choice for use in patients with end-stage renal disease.Codeine has limited use in the management of severe pain.It is rarely used in critical care units.It provides analgesia for mild to moderate pain.It is usually compounded with a nonopioid.Methadone is a synthetic opioid with morphine-like properties but less sedation.It is longer acting than morphine and has a long half-life.This makes it difficult to titrate in the critical care patient.

Question 17

A nurse is administering naloxone to a patient experiencing respiratory depression.Which of the following interventions must be observed when using naloxone?

Accepted Answer

Naloxone is normally given intravenously very slowly (0.5 mL over 2 minutes)while the patient is carefully monitored for reversal of the respiratory signs.Naloxone administration can be discontinued as soon as the patient is responsive to physical stimulation and able to take deep breaths.However,the medication should be kept nearby.Because the duration of naloxone is shorter than most opioids,another dose of naloxone may be needed as early as 30 minutes after the first dose.The benefits of reversing respiratory depression with naloxone must be carefully weighed against the risk of a sudden onset of pain and the difficulty achieving pain relief.To prevent this from occurring,it is important to provide a nonopioid medication for pain relief.Moreover,the use of naloxone is not recommended after prolonged analgesia because it can induce withdrawal and may cause nausea and cardiovascular complications (e.g.,dysrhythmias).

Question 18

Which of the following combinations of drugs has been found to be effective in managing the pain associated with musculoskeletal and soft tissue inflammation?

Accepted Answer

The use of NSAIDs in combination with opioids is indicated in patients with acute musculoskeletal and soft tissue inflammation.

Question 19

The nurse is aware that the use of a pain flow sheet in the critical care setting allows for

Accepted Answer

The use of a pain flow sheet in critical care settings allows for a visible and ongoing pain assessment before and after an intervention for pain that is accessible to all clinicians involved in the assessment and management of pain.

Question 20

Acute pain usually corresponds to

Accepted Answer

Acute pain has a short duration,and it usually corresponds to the healing process (30 days)but should not exceed 6 months.It implies tissue damage that is usually from an identifiable cause.If undertreated,acute pain may bring a prolonged stress response and lead to permanent damage to the patient's nervous system.In such instances,acute pain can become chronic.

Quiz 9: Pain and Pain Management