Question 1

The nurse is assigned to care for a patient with chronic low back pain.What adjustment in pain management does the nurse expect to make?

Accepted Answer

Adaptation to the presence of chronic pain is physiologic,not psychological.Thus the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain.

Question 2

Which statement about pain is true?

Accepted Answer

How we feel and react to pain depends on our emotional makeup along with our previous experiences with pain.Issues like culture,age,gender,and our interactions with society also affect our responses to pain.As a result,no two people perceive pain in exactly the same way.

Question 3

A patient taking oxycodone with acetaminophen (Percocet)for pain at home 3 days after fracturing an ankle reports constipation and continuing moderate to severe pain.What is the nurse's best advice?

Accepted Answer

This patient still needs the Percocet.Most patients taking opioids for 2 days or longer have constipation.Urge the patient to drink plenty of fluids.Increasing fiber intake,either with food containing fiber or with over-the-counter fiber supplements,can help reduce constipation.Although increasing activity can help reduce constipation,walking for 30 minutes with a fractured ankle is not permitted at this time.

Question 4

Pain is considered to be the "fifth vital sign." How does this principle affect nursing care?

Accepted Answer

Pain is common in patients and undertreated pain remains a major yet avoidable health problem.More frequent and more accurate assessment can improve pain management.Making pain assessment the "fifth vital sign" assists nurses to both recognize the presence of pain and see how the patient responds to drugs and other interventions.These actions increase the likelihood of appropriate pain management.

Question 5

Which statement by a patient indicates the need for more teaching about pain and pain control?

Accepted Answer

One cause of underreporting pain and undertreating it is that many patients and health care providers believe that pain is a normal part of aging.Pain may occur more frequently among older adults,but is never considered "normal." Patients of any age with pain for any reason deserve to have their pain reduced to a manageable level.

Question 6

How do morphine and other opioid pain medications relieve a patient's pain?

Accepted Answer

Morphine and other opioid agonists do nothing to change the cause or transmission of pain.They bind to naturally occurring opioid receptor sites and alter a patient's perception of the painful experience.

Question 7

A patient is taking acetaminophen (Tylenol).Which precaution is most important for the nurse to teach the patient?

Accepted Answer

Acetaminophen can cause severe liver damage and even liver failure when taken at high doses or too often.This adverse reaction is much more likely to occur in people who drink alcoholic beverages while on acetaminophen therapy.

Question 8

The nurse prepares to give a patient the next scheduled dose of an opioid analgesic.The patient arouses easily but the respiratory rate remains at 10 breaths per minute.What is the nurse's best first action?

Accepted Answer

Many people experience mild respiratory depression with opioid analgesics.If the patient is easily arousable and the oxygen saturation is at normal levels,it is not necessary to apply oxygen,call the Rapid Response Team,or prepare to administer an opioid antagonist.If the patient's oxygen saturation level is acceptable and he or she is in pain,it is alright to give the next scheduled opioid dose.Checking the patient's normal respiratory rate is also a good idea.Most people have a usual respiratory rate that is at least 12 breaths per minute,but some patients may have a usual rate of only 10 breaths per minute.Although this is not a customary response and you should document it in the nursing notes,check other indicators of breathing adequacy before notifying the prescriber.

Question 9

How do nonsteroidal anti-inflammatory drugs (NSAIDs)relieve a patient's pain?

Accepted Answer

When pain mediators are released from damaged tissue,especially substance P and bradykinin (which is also an inflammatory mediator),they bind to the nociceptors and activate them.NSAIDs reduce pain by suppressing some part of the inflammatory pathway and reducing the amounts of pain-mediating chemicals,especially bradykinin,present.With less bradykinin present,less stimulation of the nociceptors occurs.As a result,pain is reduced.

Question 10

A patient who is paralyzed from the waist down as a result of an injury that completely severed the spinal cord has an open wound on the right heel.Why is this patient unaware of any pain caused from this wound?

Accepted Answer

Pain is perceived in the brain,not in the area of tissue injury.When the nociceptors are stimulated by tissue damage,the impulse must be transmitted to the brain before it can be "felt" as pain.With a completely severed spinal cord,the pain impulses are not transmitted to the brain.

Question 11

The nurse checks a patient for pain relief 1 hour after administering 15 mg of morphine intramuscularly.The patient is sleeping and has a respiratory rate of 10 breaths per minute.What is the nurse's best first action?

Accepted Answer

Many patients experience some degree of respiratory depression with opioid analgesics.If the patient can be aroused with minimally-intrusive techniques and the respiratory rate increases spontaneously,no further intervention is required.

Question 12

After surgery,a patient expresses to the nurse the fear of becoming addicted to the opioid analgesic that has been prescribed for pain.What is the nurse's best response?

Accepted Answer

Pain after surgery is acute and temporary pain.The use of opioid drugs,when used for relief of acute pain,even in high doses,rarely results in addiction.

Question 13

A patient with arthritis of the left knee reports pain extending from the knee half-way down the lower leg.What type of pain is this patient perceiving?

Accepted Answer

Radiating pain may be felt all around and extending from the damaged area causing the pain.

Question 14

A patient taking warfarin (Coumadin)has mild to moderate pain after exercising.Which over-the-counter pain reliever does the nurse recommend?

Accepted Answer

Only acetaminophen does not interfere with blood clotting.The other drugs do interfere with blood clotting,and so does warfarin.Taking warfarin with any other drug that interferes with blood clotting places the patient at extreme risk for excessive bleeding and brain hemorrhage.

Question 15

What is the best way for the nurse to determine a patient's need for pain medication on the second day after an abdominal laparotomy?

Accepted Answer

Pain experience and pain tolerance are very personal.True assessment of a patient's discomfort cannot be determined by and should not be based on the patient's behaviors or changes in vital signs.Nor can it be based on how recently the patient received a drug for pain.The only way to know is to ask the patient to rate the pain.

Question 16

What is the most important question for the nurse to ask before administering the first dose of celecoxib (Celebrex)to a patient?

Accepted Answer

Celecoxib is similar to the class of antibiotics known as "sulfa drugs." An allergic reaction to celecoxib is more likely if the patient is also allergic to sulfa drugs.

Question 17

An older adult is taking an oral opioid drug at home for pain control.Which precaution to prevent injury is important for the nurse to teach this patient?

Accepted Answer

In addition to the usual side effects and adverse effect of opioids,an older adult is at risk for low vision.The pupil of the older adult does not dilate fully and less light enters the eye,reducing vision.When the older patient takes an opioid drug,the pupil is even smaller than usual,reducing vision even more.This problem increases the older patient's risk for tripping over objects and falling.

Question 18

Which event or condition is most likely to result in chronic pain?

Accepted Answer

The definition of chronic pain involves the length of time that pain is experienced and the progressive nature of the problem causing the pain.Osteoarthritis meets these criteria.A headache caused by fluid loss during a spinal tap is severe but has a duration of only 3 to 5 days.Hip replacement surgery,although resulting in postoperative pain,is time limited and often relieves chronic hip pain.IV needle insertion is considered painful by some patients,but is short procedural pain.

Question 19

Which is the best clinical definition of pain?

Accepted Answer

Pain is a personal experience that includes physical and emotional components.What is painful for one person may not be painful to another.Because everyone experiences pain in a different way,the most useful clinical definition is that pain is whatever the patient says it is and exists whenever he or she says it does.

Question 20

The nurse notes all of the following changes in the last week in a 72-year-old nursing home patient taking nortriptyline (Pamelor)for chronic pain.For which problem does the nurse immediately notify the prescriber?

Accepted Answer

Nortriptyline is an antidepressant.These drugs can make heat failure worse and can cause urinary retention.Fluid retention with weight gain is a symptom of worsening heart failure.A weight gain of 9 pounds in a week is significant and an indicator of rapidly worsening heart failure.

Quiz 7: Drugs for Pain and Sleep Problems