Nokea
A 52-year-old female patient is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the patients pain in her plan of nursing care, the nurse should consider what characteristic of cancer pain?
- A. Cancer pain is often related to the stress of the patient knowing she has cancer and requires relatively low dosages of pain medications along with a high dose of anti-anxiety medications.
- B. Cancer pain is always chronic and challenging to treat, so distraction is often the best intervention.
- C. Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications.
- D. Cancer pain is often misreported by patients because of confusion related to their disease process.
Correct Answer: C
Rationale: Pain associated with cancer may be acute or chronic. Pain resulting from cancer is so ubiquitous that when cancer patients are asked about possible outcomes, pain is reported to be the most feared outcome. Higher doses of pain medication are usually needed with cancer patients, especially with metastasis. Cancer pain is not treated with anti-anxiety medications. Cancer pain can be chronic and difficult to treat so distraction may help, but higher doses of pain medications are usually the best intervention. No research indicates cancer patients misreport pain because of confusion related to their disease process.
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You are caring for a patient admitted to the medical-surgical unit after falling from a horse. The patient states I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse. When planning the patients care, what variables should you consider? Select all that apply.
- A. How the presence of pain affects patients and families
- B. Resources that can assist the patient with pain management
- C. The influence of the patients cognition on her pain
- D. The advantages and disadvantages of available pain-relief strategies
- E. The difference between acute and intermittent pain
Correct Answer: A,B,D
Rationale: Nurses should understand the effects of chronic pain on patients and families and should be knowledgeable about pain-relief strategies and appropriate resources to assist effectively with pain management. There is no evidence of cognitive deficits in this patient and the difference between acute and intermittent pain has no immediate bearing on this patients care.
The nurse is assessing a patients pain while the patient awaits a cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at this time using a 0 -to-10 pain scale. How should the nurse best respond to this assessment finding?
- A. Remind the patient that he is indeed experiencing pain.
- B. Reinforce teaching about the pain scale number system.
- C. Reassess the patients pain in 30 minutes.
- D. Administer an analgesic and then reassess.
Correct Answer: B
Rationale: The patient is physically exhibiting signs and symptoms of pain. Further teaching may need to be done so the patient can correctly rate the pain. The nurse may also verify that the same scale is being used by the patient and caregiver to promote continuity. Although all answers are correct, the most accurate conclusion would be to reinforce teaching about the pain scale.
You are frequently assessing an 84-year-old womans pain after she suffered a humeral fracture in a fall. When applying the nursing process in pain management for a patient of this age, what principle should you best apply?
- A. Monitor for signs of drug toxicity due to a decrease in metabolism.
- B. Monitor for an increase in absorption of the drug due to age-related changes.
- C. Monitor for a paradoxical increase in pain with opioid administration.
- D. Administer analgesics every 4 to 6 hours as ordered to control pain.
Correct Answer: A
Rationale: Older people may respond differently to pain than younger people. Because elderly people have a slower metabolism and a greater ratio of body fat to muscle mass compared with younger people, small doses of analgesic agents may be sufficient to relieve pain, and these doses may be effective longer. This fact also corresponds to an increased risk of adverse effects. Paradoxical effects are not a common phenomenon. Frequency of administration will vary widely according to numerous variables.
The home health nurse is developing a plan of care for a patient who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the patient teaching?
- A. Self-care and safety
- B. Autonomy and need
- C. Health promotion and exercise
- D. Dependence and health
Correct Answer: A
Rationale: The patient will be at home monitoring his own pain management, administering his own medication, and monitoring and reporting side effects. This requires the ability to perform self-care activities in a safe manner. Creating autonomy is important, but need is a poorly defined concept. Health promotion is an important global concept for maintaining health, and exercise is an appropriate activity; however, self-care and safety are the priorities. Dependence is not a concept used to develop a nursing plan of care, and health is too broad a concept to use as a basis for a nursing plan of care.
Two patients on your unit have recently returned to the postsurgical unit after knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0 -to-10 pain scale, whereas the other patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurses most plausible rationale for understanding the patients different perceptions of pain?
- A. Endorphin levels may vary between patients, affecting the perception of pain.
- B. One of the patients is exaggerating his or her sense of pain.
- C. The patients are likely experiencing a variance in vasoconstriction.
- D. One of the patients may be experiencing opioid tolerance.
Correct Answer: A
Rationale: Different people feel different degrees of pain from similar stimuli. Opioid tolerance is associated with chronic pain treatment and would not likely apply to these patients. The nurse should not assume the patient is exaggerating the pain because the patient is the best authority of his or her existence of pain, and definitions for pain state that pain is whatever the person says it is, existing whenever the experiencing person says it does.