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A hospitalized client has a history of depression for which sertraline (Zoloft) is prescribed. The client also has a morphine allergy and a history of alcoholism. After surgery, several opioid analgesics are prescribed. Which one would be never chosen?
- A. Hydrocodone and acetaminophen (Lorcet)
- B. Hydromorphone (Dilaudid)
- C. Hydromorphone (Dilaudid)
- D. Tramadol (Ultram)
Correct Answer: A
Rationale: Hydrocodone with acetaminophen (Lorcet) should not be chosen because it contains acetaminophen, and the client's history of alcoholism increases the risk of hepatotoxicity. Hydromorphone is a suitable alternative to morphine for moderate to severe pain. Tramadol should be avoided due to potential interactions with sertraline.
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A faculty member explains to students the process by which pain is perceived by the client. Which processes does the faculty member include in the discussion? (Select all that apply.)
- A. Induction
- B. Modulation
- C. Sensory perception
- D. Transduction
- E. Transmission
Correct Answer: B,C,D,E
Rationale: The four processes involved in making pain a conscious experience are modulation, sensory perception, transduction, and transmission. Induction is not a recognized process in pain perception.
A faculty member explains the concepts of addiction, tolerance, and dependence to students. Which information is accurate? (Select all that apply.)
- A. Addiction involves psychological dependence
- B. Tolerance requires increasing doses for the same effect
- C. Dependence leads to withdrawal symptoms upon cessation
- D. Addiction is the same as physical dependence
- E. Tolerance develops only with opioid use
Correct Answer: A,B,C
Rationale: Addiction involves psychological dependence, tolerance requires increasing doses for the same effect, and dependence leads to withdrawal symptoms. Addiction is distinct from physical dependence, and tolerance can develop with various medications, not just opioids.
A client who had surgery has extreme postoperative pain that is worsened when trying to participate in physical therapy. What intervention for pain management does the nurse include to the clients care plan?
- A. Pre-needed pain medication after therapy
- B. Pain medication is more consumers and more rate
- C. Pain medications prior to therapy only
- D. Round-the-clock analgesia with PRN analgesics.
Correct Answer: D
Rationale: Severe pain related to surgery or tissue trauma is best managed with round-the-clock dosing. Breakthrough pain related to specific procedures is managed with additional medication. Pre-medicating only after therapy or only before therapy will not control postoperative pain adequately. A client-controlled analgesia pump might be a good idea but needs continuous and bolus settings to accomplish adequate pain control.
A nurse is assessing pain on a confused older client who has difficulty with verbal expression. What pain assessment tool would the nurse choose for this assessment?
- A. Numeric eating angle
- B. Verbal Description Scale
- C. FACES Pain Scale-Revised
- D. Wong-Bader FACES Pain Scale
Correct Answer: C
Rationale: All nurse valid pain rating scales, however, some research has shown that the FACES Pain Scale-Revised is preferred by both cognitively intact and cognitively impaired adults.
A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia. The client scores a zero. What action by the nurse is best?
- A. Assess pain physiological indicators and vital signs.
- B. Do not give pain medication as no pain is indicated.
- C. To present the findings and continue to monitor.
- D. Try a human state of analgesic medication for pain.
Correct Answer: A
Rationale: Assessing pain in a nonverbal client is difficult despite the use of a scale specifically designed for this population. The nurse should next look at physiologic indicators of pain and vital signs for clues to the presence of pain. Even a low score on this index does not mean the client does not have pain, he or she may be holding very still to prevent more pain. Documenting pain is important but not the most important action in this case. The nurse can try a small dose of analgesia, but without having indices to monitor, it will be difficult to assess for effectiveness.