Chapter 8 Pain

62問 • 1年前

問題一覧

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

"How would you describe your pain?"

A patient who has had good control for chronic pain using a fentanyl (Duragesic) patch reports rapid onset pain at a level 9 (0 to 10 scale) and requests "something for pain that will work quickly." How will the nurse document the type of pain reported by this patient?

Breakthrough pain

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

"The drug decreases production of pain-sensitizing chemicals."

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

"I can accomplish activities without much discomfort."

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 accurate?

"The strategies work by affecting the perception of pain."

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 appropriate for treating this change in assessment?

Offer immediate-release morphine 30 mg orally.

A patient with chronic neck pain is seen in the pain clinic for follow-up. To evaluate whether the pain management is effective, which question is best for the nurse to ask?

"Does the pain keep you from activities that you enjoy?"

A patient with a deep partial thickness burn has been receiving hydromorphone through patient-controlled analgesia (PCA) for 1 week. The nurse caring for the patient during the previous shift reports that the patient wakes up frequently during the night complaining of pain. What action by the nurse is appropriate?

Consult with the health care provider about using a different treatment protocol to control the patient's pain.

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

Ask if the patient feels the need to void.

The nurse assesses that a home hospice patient with terminal cancer who complains of severe pain has a respiratory rate of 11 breaths/min. Which action should the nurse take?

Titrate the prescribed morphine dose up until the patient indicates adequate pain relief.

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?

Meperidine (Demerol) 25 mg every 4 hours*

Which medication should the nurse administer for a patient with cancer who describes the pain as "deep, aching and at a level 8 on a 0 to 10 scale"?

Hydromorphone (Dilaudid) IV

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

Amitriptyline

A patient who uses a fentanyl (Duragesic) patch for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone tablets, but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take?

Wake the patient and administer the hydrocodone.

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?

Pentazocine (Talwin)

The nurse is caring for a patient who had abdominal surgery yesterday and is receiving morphine through patient-controlled analgesia (PCA). What action by the nurse is a priority?

Checking the respiratory rate

A patient who has fibromyalgia reports pain at level 7 (0 to 10 scale). The patient tells the nurse, "I feel depressed because I ache too much to play golf." Which patient goal has the highest priority when the nurse is developing the treatment plan?

The patient will be able to play a round of golf.

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

Administer the ordered antiemetic medication.

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?

Administer the prescribed PRN immediate-acting morphine.

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?

Count the respiratory rate every 2 hours.

A patient who is using both a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first?

Remove the fentanyl patch.

The nurse reviews the medication orders for an older patient with arthritis in both hips who reports level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse offer as initial therapy?

Acetaminophen 650 mg orally

The nurse on a surgical inpatient unit is caring for several patients. Which patient should the nurse assess first?

Patient who was treated for pain just prior to return from the postanesthesia care unit

The health care provider orders a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids before. Which nursing actions regarding opioid administration are appropriate at this time (select all that apply)?

Monitor for therapeutic and adverse effects of opioid administration., Teach the patient about how analgesics improve postoperative activity levels.

A nurse assesses a postoperative patient 2 days after chest surgery. What findings indicate that the patient requires better pain management (select all that apply)?

Confusion, Poor cough effort, Shallow breathing, Elevated temperature

A patient with chronic pain who has been receiving morphine sulfate 20 mg IV over 24 hours is to be discharged home on oral sustained-release morphine (MS Contin) administered twice a day. What dosage of MS Contin will be needed for each dose to obtain an equianalgesic dose for the patient? (Morphine sulfate 10 mg IV is equianalgesic to morphine sulfate 30 mg orally.)

MS Contin 30 mg/dose

Which words are often used to describe pain arising from skin, mucous membranes, and subcutaneous tissue? Select all that apply.

Sharp, Prickly, Burning, Stabbing, Electric shock-like

A nurse is preparing a teaching plan about pain management for a cancer patient. What information should be included in the teaching plan? Select all that apply.

Nonpharmacologic pain relief therapies, Side effects and complications associated with medications, Adjustments in drug dosages that may be required over a period of time

A postoperative patient is receiving intravenous morphine. The nurse finds that the patient is drowsy and is not responding to verbal stimulation. Which actions should the nurse take? Select all that apply.

Monitor respiratory status, Monitor sedation level, Consider administering naloxone

The nurse suspects that a patient is experiencing early opioid withdrawal syndrome. Which findings did the nurse use to make this determination? Select all that apply.

Rhinorrhea, Diaphoresis, Lacrimation

Which nursing interventions, according to the Pasero Opioid-Induced Sedation Scale (POSS) with Interventions, are beneficial to the patient who is drowsy and drifts to sleep during conversation following opioid therapy? Select all that apply.

Decreasing opioid dose 25% to 50%, Administering opioid-sparing nonopioid to the patient, Monitoring the patient's respiratory status continuously

A nurse has applied a transdermal fentanyl patch to a patient with bone cancer. The drug is expected to provide pain relief for 72 hours. The patient reports severe pain two days after the patch was applied. What intervention is appropriate for this patient?

Administer a higher dosage of the fentanyl.

A nurse is caring for a patient who has undergone internal fixation surgery for fracture of the tibial shaft. The patient is on opioid drugs postsurgery to relieve postsurgical pain. On observation, the nurse finds that the patient's respiratory rate is 7 breaths per minute and the patient looks extremely drowsy. Which actions should the nurse take to prevent respiratory failure in this patient? Select all that apply.

Administer oxygen to the patient., Make attempts to arouse the patient., Obtain a prescription to reduce the dosage of opioid medications.

The patient is due for a scheduled medication of phenytoin 50 mg intravenously (IV). The nurse should administer the dose over a minimum of how many minutes?

1 minute

The patient states he or she hopes to be able to tolerate physical therapy today without getting too tired. How can the nurse best determine whether the patient's goal is met?

Help the patient establish a number system to rate his or her fatigue goal.

A patient has been prescribed fentanyl patches for the treatment of severe chronic pain. The nurse should instruct the patient to immediately report which signs of drug overdose? Select all that apply.

Difficulty breathing, Excessive sleepiness

A patient is receiving a patient-controlled analgesia (PCA) opioid infusion after back surgery. The patient is sleeping but awakens when the nurse speaks to the patient in a normal tone of voice. However, during the conversation, the patient drifts back to sleep. Respirations are 8 breaths/minute. What is the most appropriate nursing action in this situation?

If prescribed, decrease the opioid dose 25% to 50%

A patient with a history of stroke is experiencing neuropathic pain with dramatic changes in skin color and warmth over the affected limb. What other findings should the nurse expect to assess in this patient? Select all that apply.

Intense burning pain, Increased skin sensitivity, Swelling of the affected limb

A nurse is caring for a patient who has undergone an appendectomy. Which route of drug delivery should the nurse use to administer the opioid analgesics to treat postoperative pain?

Intravenous

To reduce the risk of adverse effects, what should the nurse do when caring for a patient receiving morphine sulfate via patient-controlled analgesia (PCA)?

Teach the caregiver not to push the button for the patient.

Which statement should the nurse include in information used to teach a patient about pain management?

Pain needs to be reported if it is not relieved to tolerable levels

A patient status postabdominal surgery is in pain and has a prescription for hydromorphone 2 mg intravenous (IV) q3hr as needed (PRN). To avoid adverse effects, the nurse injecting the dose at 0800 would finish injecting the medication no earlier than which time?

0803

The nurse is preparing to administer medications to a patient for the management of chronic nonmalignant and cancer pain. What medications does the nurse anticipate administering? Select all that apply.

Duloxetine, Venlafaxine, Amitriptyline

The nurse is reviewing the prescriptions for a patient who is experiencing mild pain. Which of these are appropriate nonopioid analgesics for mild pain? Select all that apply.

Ibuprofen, Acetaminophen

A nurse is assessing a patient who has been diagnosed with 89% blockage in the left main coronary artery. Which statements by the patient indicate referred pain of angina? Select all that apply.

"I usually get a pain in the jaws.", "Moving my neck is very painful.", "The pain seems to radiate through my left arm."

A nursing student is learning about pain medications. What does the term "analgesic ceiling" relating to nonsteroidal antiinflammatory drugs (NSAIDs) mean? Select all that apply.

Increasing the dose of the drug will not provide greater analgesia., Increasing the dose will produce deleterious effects on body systems.

The nurse is caring for a patient who has been receiving intravenous (IV) hydromorphone every two hours as needed for control of pain. Upon assessing the patient, the family reports that the patient has had frequent periods of drowsiness and keeps falling asleep while they are talking. What should the nurse's plan include according to the Pasero Opioid-Induced Sedation Scale (POSS)? Select all that apply.

Consider administering a nonsedating opioid-sparing nonopioid, such as acetaminophen or ibuprofen., Monitor respiratory status and sedation level closely until sedation level is stable (less than 3) and respiratory status is satisfactory., Decrease the opioid dose by 25%-50% or contact the primary care provider for orders to determine dose reduction for the opioid.

The Joint Commission's guideline on pain requires health care facilities to do what? Select all that apply.

Educate patients and their families about pain management, Educate health care providers about pain assessment and management of pain, Recognize the patient's right to appropriate assessment and management of pain

A patient who has had difficulty with the gastrointestinal side effects of nonsteroidal antiinflammatory drugs (NSAIDs) asks the nurse if there are any NSAIDS which have less of an impact on the gastrointestinal system. Which medication would the nurse suggest to the patient's primary care provider?

Celecoxib

Pain has been defined as "whatever the person experiencing the pain says it is, existing whenever the patient says it does." This definition is problematic for the nurse when caring for which type of patient?

A patient with decreased cognitive function

On the first postoperative day following a bowel resection, the patient complains of abdominal and incisionalpain rated 9 on a scale of 0 to 10. Postoperative orders include morphine, 4 mg IV q2 hr, for pain and may repeat morphine, 4 mg IV, for breakthrough pain. The nurse determines that it has been only 2 hours since the last dose of morphine and wants to wait a little longer. What effect does the nurse's action have on the patient?

Contributes to unnecessary suffering and physical and psychosocial dysfunction

List and briefly describe the five dimensions of pain.

Physiologic, Affective, Cognitive, Behavioral, Sociocultural

Once generated, what may block the transmission of an action potential along a peripheral nerve fiber to the dorsal root of the spinal cord?

The transmission may be interrupted by drugs such as local anesthetics.

A patient comes to the clinic with a complaint of a dull pain in the anterior and posterior neck. On examination, the nurse notes that the patient has full range of motion (ROM) of the neck and no throat redness or enlarged head or neck lymph nodes. What will be the nurse's next appropriate assessment indicated by these findings?

Palpation of the liver

While caring for an unconscious patient, the nurse discovers a stage 2 pressure ulcer on the patient's heel. During care of the ulcer, what is the nurse's understanding of the patient's perception of pain?

The area should be treated as a painful lesion, using gentle cleansing and dressing.

List in order the nociceptive processes that occur to communicate tissue damage to the CNS. No. 1 is the first process and No. 4 is the last process. a. Perception b. Modulation c. Transmission d. Transduction

1.Transduction, 2.Transmission, 3.Perception, 4.Modulation

A patient with trigeminal neuralgia has moderate to severe burning and shooting pain. In helping the patient to manage the pain, the nurse recognizes what about this type of pain?

Treatment includes the use of adjuvant analgesics

A patient with colorectal cancer has continuous, poorly localized abdominal pain at an intensity of 5 on a scale of 0 to 10. How does the nurse teach the patient to use pain medications?

On an around-the-clock schedule

A patient who has been taking ibuprofen (Motrin) and imipramine (Tofranil) for control of cancer pain is having increased pain. What would the health care provider recommend as an appropriate change in the medication plan?

Add PO oxycodone (Oxycontin) to the other medications

A postoperative 68-year-old opioid-naive patient is receiving morphine by patient-controlled analgesia (PCA) for postoperative pain. What is the rationale for not initiating the PCA analgesic with a basal dose of analgesic as well?

Adverse respiratory outcomes

A patient with multiple injuries resulting from an automobile accident tells the nurse that he has "bad" pain but that he can "tough it out" and does not require pain medication. To gain the patient's participation in pain management, what should the nurse explain to the patient?

Unrelieved pain has many harmful effects on the body that can impair recovery.

The patient has chronic pain that is no longer relieved with oral morphine. Which medication would the nurse expect to be ordered to provide better pain relief for this patient?

Duragesic

study

ユーザ名非公開 · 61問 · 1年前

study