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A medical nurse is appraising the effectiveness of a patients current pain control regimen. The nurse is aware that if an intervention is deemed ineffective, goals need to be reassessed and other measures need to be considered. What is the role of the nurse in obtaining additional pain relief for the patient?
- A. Primary caregiver
- B. Patient advocate
- C. Team leader
- D. Case manager
Correct Answer: B
Rationale: If the intervention was ineffective, the nurse should consider other measures. If these are ineffective, pain-relief goals need to be reassessed in collaboration with the physician. The nurse serves as the patients advocate in obtaining additional pain relief.
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A 60-year-old patient who has diabetes had a below-knee amputation 1 week ago. The patient asks why does it still feel like my leg is attached, and why does it still hurt? The nurse explains neuropathic pain in terms that are accessible to the patient. The nurse should describe what pathophysiologic process?
- A. The proliferation of nociceptors during times of stress
- B. Age-related deterioration of the central nervous system
- C. Psychosocial dependence on pain medications
- D. The abnormal reorganization of the nervous system
Correct Answer: D
Rationale: At any point from the periphery to the CNS, the potential exists for the development of neuropathic pain. Hyperexcitable nerve endings in the periphery can become damaged, leading to abnormal reorganization of the nervous system called neuroplasticity, an underlying mechanism of some neuropathic pain states. Neuropathic pain is not a result of age-related changes, nociceptor proliferation, or dependence on medications.
You are assessing an 86-year-old postoperative patient who has an unexpressive, stoic demeanor. When you enter the room, the patient is curled into the fetal position and your assessment reveals that his vital signs are elevated and he is diaphoretic. You ask the patient what his pain level is on a 0-to-10 scale that you explained to the patient prior to surgery. The patient indicates a pain level of three or so. You review your pain-management orders and find that all medications are ordered PRN. How would you treat this patients pain?
- A. Treat the patient on the basis of objective signs of pain and reassess him frequently.
- B. Call the physician for new orders because it is apparent that the pain medicine is not working.
- C. Believe what the patient says, reinforce education, and reassess often.
- D. Ask the family what they think and treat the patient accordingly.
Correct Answer: C
Rationale: As always, the best guide to pain management and administration of analgesic agents in all patients, regardless of age, is what the individual patient says. However, further education and assessment are appropriate. You cannot usually treat pain the patient denies having if the orders are PRN only. The scenario does not indicate the present pain-management orders are not working for this patient. The familys insights do not override the patients self-report.
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 caring for a 51-year-old female patient whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem?
- A. Anxiety
- B. Skin breakdown
- C. Depression
- D. Hallucinations
Correct Answer: C
Rationale: Depression is associated with chronic pain and can be exacerbated by the effects of chronic fatigue. Anxiety is also plausible, but depression is a paramount risk. Skin breakdown and hallucinations are much less likely.
Your patient is receiving postoperative morphine through a patient-controlled analgesic (PCA) pump and the patients orders specify an initial bolus dose. What is your priority assessment?
- A. Assessment for decreased level of consciousness (LOC)
- B. Assessment for respiratory depression
- C. Assessment for fluid overload
- D. Assessment for paradoxical increase in pain
Correct Answer: B
Rationale: A patient who receives opioids by any route must be assessed frequently for changes in respiratory status. Sedation is an expected effect of a narcotic analgesic, though severely decreased LOC is problematic. Fluid overload and paradoxical increase in pain are unlikely, though opioid-induced hyperalgesia (OIH) occurs in rare instances.