Question 1

Which medication order will provide the most immediate relief of the patient's acute pain?

Accepted Answer

The IV route of administration allows for the quickest onset of action for medications.IV hydromorphone will provide the most immediate relief of the patient's pain.Morphine sulfate will provide relief when given orally but not as fast as IV.Buprenorphine transdermal patch,and oxymorphone extended-release are formulations that will take longer to work.

Question 2

Which medication order will provide the most consistent control of the patient's chronic pain?

Accepted Answer

The fentanyl transdermal patch provides consistent release of the medication for 3 days.IV administration of pain medication works quickly but also wears off quickly.Morphine sulfate liquid and the fentanyl oral lozenge are used to treat breakthrough pain as they are short-acting medications.

Question 3

Which is the highest priority nursing diagnosis for a patient with a spinal cord injury and no pain sensation below the waist?

Accepted Answer

The patient is at high risk of injury to the lower body due to the inability to feel pain or other sensations.The patient will not be able to tell when a body part is being pinched or burned before significant damage occurs.Risk for injury is higher priority than the patient's psychosocial needs for body image,self-care,or loneliness.

Question 4

Which is an appropriate goal for a patient's preoperative teaching?

Accepted Answer

An appropriate goal of preoperative teaching is that the patient will verbalize understanding of the pain-management techniques to be used after surgery.The patient has not undergone surgery yet so current pain assessment is not a goal of preoperative teaching.Demonstration of the PCA pump and providing written materials are interventions rather than goals.

Question 5

The nurse is caring for a patient who is having a heart attack.The patient tells the nurse that the pain is down his left arm rather than in his chest.What type of pain is the patient experiencing?

Accepted Answer

Referred pain is when the patient experiences discomfort at an area other than the source of the pain.In this case,the patient has left arm pain even though the source of the pain is the heart.Psychogenic pain is discomfort that is associated with psychological disorders.Peripheral pain is a type of neuropathic pain due to damaged peripheral nerves of the hands and feet.A heart attack is an example of acute pain rather than chronic pain.

Question 6

Which is an example of an adjuvant medication for pain management?

Accepted Answer

Adjuvant medications enhance the properties of analgesic medications.Gabapentin is an anticonvulsant and is a type of adjuvant medication.Fentanyl transdermal patch and morphine sulfate liquid are examples of narcotic pain medications.Naloxone is used to reverse symptoms of narcotic overdose.

Question 7

The nurse is caring for a patient who just underwent knee-replacement surgery.The patient complains of pain at the operative site but it is too soon for the nurse to administer the next dose of pain medication.What is the appropriate action of the nurse?

Accepted Answer

Nonpharmaceutical methods are often effective for relieving musculoskeletal pain.Elevation of the joint and ice should be applied before contacting the surgeon.The next dose of pain medication should not be given early without the physician's approval.

Question 8

The patient expresses frustration about not being able to function as the family breadwinner any longer due to chronic severe pain.Which psychosocial nursing diagnosis is most appropriate for this patient's concern?

Accepted Answer

Interrupted family processes is the appropriate nursing diagnosis because the patient no longer fills the role of family breadwinner.This has led to a change in the functioning of the family.The scenario does not indicate risk for loneliness,disturbed sensory perception,or moral distress.

Question 9

Which assessment finding leads the nurse to clarify the patient's order for morphine sulfate controlled release 60 mg PO every 12 hours?

Accepted Answer

Morphine sulfate controlled release is an extended-release tablet that may not be crushed.This assessment finding leads the nurse to clarify the order.Allergies to latex and NSAIDs,normal platelet count and lack of an IV line are not contraindications for administration of morphine sulfate controlled release.

Question 10

A patient has a morphine sulfate patient-controlled analgesia (PCA)to control postoperative pain.When the nurse enters the room,the patient complains of pain.The nurse's first response is which of the following?

Accepted Answer

Nurses need to assess the patient first.Next,assess the lines,catheter,and infusion pump.Notify the physician or health care provider or follow protocols should a problem exist.Speaking in a calm voice demonstrates caring behavior.

Question 11

Which instruction will the nurse give to the patient about proper use of patient-controlled analgesia (PCA)?

Accepted Answer

The patient should be instructed not to let anyone else push the PCA pain button to avoid overdosage.One family member or significant other can be the patient's primary pain manager and is allowed to push the PCA button.The patient should not wait until the pain becomes severe to push the PCA button.The PCA will have preset time limitations to determine how frequently the patient will receive a dose of pain medication no matter how often the button is pushed.The PCA will not continue to administer medication until the pain is completely relieved.

Question 12

Why is acute pain particularly dangerous for a patient having a heart attack?

Accepted Answer

Acute pain of low-to-moderate intensity and superficial pain cause the fight-or-flight response from the sympathetic branch of the autonomic nervous system and elevates pulse.Endorphins are natural morphine-like substances that decrease pain.Substance P helps transmit pain impulses from periphery to higher brain centers and causes vasodilation and edema.Prostaglandins increase sensitivity to pain.

Question 13

The nurse is caring for a patient who continues to have severe pain at the site of a fracture long after it healed.The patient's physicians can find no rationale for the pain.What is the most likely cause of the patient's discomfort?

Accepted Answer

An example of idiopathic pain is complex regional pain syndrome.Idiopathic pain is chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition.There is no evidence that the patient is trying to obtain unneeded pain medications,is in denial,or is experiencing referred pain from another fracture.

Question 14

Which is an example of nociceptive pain?

Accepted Answer

Nociceptive pain is due to damaged tissues such as bones,skin,and organs.An example of nociceptive pain would be pain resulting from rheumatoid arthritis joint damage.Neuropathy,phantom pain,and chronic nerve pain are all examples of neuropathic pain.

Question 15

Which pain relieving option should be avoided by a patient with chronic back pain who must continue to work as a truck driver?

Accepted Answer

Tramadol is a controlled substance that can cause seizures,hallucinations,and sedation.Tramadol should not be taken before driving a vehicle or operating machinery.TENS units,NSAIDs such as naproxen sodium,and hot/cold packs are all acceptable options for the truck driver.

Question 16

The patient takes morphine sulfate controlled release every 12 hours for chronic severe cancer pain.The last dose was 8 hours ago.The patient is presently moaning and states that the pain is very bad.Which is the best action of the nurse?

Accepted Answer

Morphine sulfate controlled release is an extended-release medication that provides pain relief for 8 to 12 hours.The patient is experiencing breakthrough pain and needs a dose of short-acting pain medication right away to relieve the immediate discomfort.The next dose of morphine sulfate controlled release should not be administered early as it is not ordered and will take many hours to take effect.The patient's pain is so bad that repositioning and waiting an hour is inappropriate.

Question 17

The nurse observes a postoperative patient trying to take a friend's oxycodone pain pills in addition to the pain medication administered by the nurse.Which is the priority nursing diagnosis for this patient?

Accepted Answer

The patient is at risk for overdose of pain medication by taking the friend's medication as well as what is administered by the nurse.The nurse needs to institute safety precautions to prevent the patient from taking excessive amounts of pain medications.Low self-esteem,impulse control,and enhanced comfort may be addressed after the risk for poisoning has been resolved.

Question 18

Which is the appropriate goal for a nonverbal,confused patient with the nursing diagnosis chronic pain related to widespread tissue damage?

Accepted Answer

Objective assessments of discomfort may be used when the patient is unable to verbalize sensations or rate pain on a scale.The absence of moaning or grimacing is objective and the nurse is able to determine whether or not the goal has been met.Pain assessment is an intervention rather than a goal.Minimal pain is not objective.The nonverbal confused patient will not be able to rate pain using a 0-to-10 pain scale.

Question 19

Which nonpharmacological pain-relief technique is appropriate for a confused,nonverbal patient?

Accepted Answer

Massage therapy is appropriate for use with nonverbal,confused patients as it promotes relaxation and healing without the need for the patient to follow directions.A confused,nonverbal patient will not be able to follow the directions required for tai chi,biofeedback,or guided imagery.

Question 20

Which assessment question enables the nurse to determine provocative factors of the patient's pain?

Accepted Answer

The comprehensive assessment of pain aims to gather information about the cause of a person's pain and determine its effect on his or her ability to function.
· Palliative or provocative factors-What makes your pain worse or better?
· Quality-How do you describe your pain?
· Relief measures-What do you take at home to gain pain relief?
· Region (location)-Show me where you hurt.
· Severity-On a scale of 0 to 10,with 10 being worst,how bad is your pain now?
· Timing (onset,duration,and pattern)-Is your pain constant,intermittent,or both?
· U (effect of pain on patient)-What are you unable to do because of your pain?

Quiz 34: Pain Management