Deck 27: Pain and Comfort

Question 1

An older adult is admitted to the hospital after a serious fall. When noting that the client has been prescribed meperidine (Demerol) for muscle pain, the nurse:

A) administers the medication so as to prevent the client from developing the fear of pain.
B) questions the client and family concerning any allergies to analgesic medications.
C) calls the physician to question the appropriateness of this medication order.
D) conducts a pain assessment and determines the client's need for an analgesic medication.

Answer 1

calls the physician to question the appropriateness of this medication order.

Question 2

An older aphasic client has severe osteoarthritis, bilateral contractures of the lower extremities, and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around-the-clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective? (Select all that apply.)

A) "Client slept throughout the night."
B) "Client winces only when turned and repositioned."
C) "Client slept during dressing change."
D) "Client cooperative during morning care."
E) "Client ate 80% of breakfast, 70% of lunch, and 100% of dinner."

Answer 2

"Client slept throughout the night."
"Client slept during dressing change."
"Client cooperative during morning care."
"Client ate 80% of breakfast, 70% of lunch, and 100% of dinner."

Question 3

Compared with acute pain, persistent pain requires the nurse to:

A) monitor vital signs more frequently.
B) document the character of the pain as burning.
C) administer analgesics at least every 4 hours.
D) educate the client to the benefit of specific lifestyle changes.

Answer 3

educate the client to the benefit of specific lifestyle changes.

Question 4

When educating a client on the use of an adjuvant medication, which statement best demonstrates the nurse's understanding of this therapy?

A) "These medications are used instead of opioids to decrease the likelihood of addiction."
B) "Adjuvant medications are prescribed because they seldom cause any significant side effects."
C) "These types of medications are used to eliminate the side effects of opioid medications."
D) "These drugs are used in combination with analgesics to increase the effect of the analgesics."

Question 5

An older adult is currently prescribed both aspirin (81 mg) and ibuprofen daily. What instructions are most important for the nurse to provide to assure the expected outcomes for this client?

A) The medications should be taken together to ensure the effectiveness of both medications
B) Take ibuprofen 30 minutes after the aspirin so as to not interfere with its effectiveness
C) The aspirin will negatively affect the analgesic effect of the ibuprofen
D) The medications should be taken at least 4 hours apart to minimize risk of gastric irritation

Question 6

When performing a pain assessment on a client who is aphasic, the nurse should consider:

A) reports from the family or staff at the nursing home about changes in functional status.
B) that the patient is lying quietly in bed so she is not likely to be experiencing pain.
C) that the patient's previous stroke interrupted pain pathways so she does not feel pain.
D) that older adults do not tolerate opioid analgesics well and may exhibit side effects.

Question 7

An older adult is seen in the emergency department after falling and sustaining substantial soft tissue bruising. The assessment interview notes a history of arthritic pain in several joints. The client is prescribed 650 mg of acetaminophen (Tylenol) four times per day and 800 mg of ibuprofen (Motrin) four times per day for control of the persistent arthritic pain. When providing discharge teaching, the nurse includes information regarding the signs and symptoms of: (Select all that apply.)

A) gastrointestinal bleeding.
B) renal impairment.
C) medication interactions.
D) confusion.
E) increased anxiety.

Question 8

An older client who was recently admitted to the subacute setting after having a knee replacement is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement?

A) Share with the patient that it's important to get out of bed and that there is pain medication available if it does hurt.
B) Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain.
C) Offer pain medication, administer the medication, and wait 20 minutes before getting her out of bed.
D) Allow the patient to remain in bed, but share that getting up will be required at least twice a day starting the next morning.

Question 9

An older adult is being treated for severe pain resulting from a history of osteoarthritis. In her discharge teaching, which information is most important to relay for the successful management of the pain?

A) Check for incompatibilities before taking any new medications.
B) Arrange to take a dose of analgesic prior to physical activity.
C) Take the analgesic around-the-clock as prescribed.
D) Be alert for the signs of overdose toxicity.

Question 10

An older adult with gastric cancer with bone metastases is being discharged from the hospital after beginning a regimen of opioid analgesics to control the metastatic pain. What should be included in the discharge teaching plan?

A) The development of a plan to prevent constipation
B) Benefits of grief counseling
C) Increasing calories in the diet
D) Preventing pressure ulcers

Question 11

A nurse is caring for an older adult with cognitive impairment who recently had hip surgery. The nurse assesses the client for pain. The nurse would suspect that the client is in pain when the client demonstrates which of the following? (Select all that apply.)

A) The client ate all of her meals.
B) The client pushes caregivers away when they attempt to change the dressing on her hip.
C) The client rocks back and forth repetitively when sitting in a chair.
D) The client sleeps soundly throughout the night.
E) The client cries out repeatedly when anyone approaches her.

Question 12

The initial step to effect the safe management of mild to moderate acute pain that has not been controlled with over-the-counter medications is to:

A) begin acetaminophen (Tylenol) every 4 hours for 24 hours.
B) supplement with nonpharmacological interventions.
C) administer a single low dose of short-acting opioid and monitor for relief.
D) titrate dosage of a short-acting opioid upward over 24 hours to achieve relief.

Question 13

An older client with a history of hypertension and osteoarthritis who has recently fallen and fractured two ribs is prescribed extra strength Tylenol for the pain. What statement by the client requires further evaluation by the nurse?

A) "I find that when I drink herbal tea and then take my Tylenol at bedtime, I sleep through the whole night."
B) "I heard that meditation may help me deal with the pain without taking all that Tylenol."
C) "Two extra strength Tylenol tablets (500 mg/tablet) every 4 hours around-the-clock and my pain is gone."
D) "I make sure that I take my Tylenol with breakfast when I first get up."

Question 14

When individualizing pain management for a client hospitalized after major surgery, the nurse will: (Select all that apply.)

A) titrate the prescribed analgesic medication to provide effective pain management.
B) assess the client for cultural beliefs that affect individual expression of pain.
C) reassure the client that pain medication is available whenever he or she expresses a need for it.
D) anticipate the client's need for pain medications.
E) implement nonpharmacological pain management interventions whenever possible.