Nokea
A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical patients pain. What principle should guide the nurses use of placebos in pain management?
- A. Placebos require a higher level of informed consent than conventional care.
- B. Placebos are an acceptable, but unconventional, form of nonpharmacological pain management.
- C. Placebos are never recommended in the treatment of pain.
- D. Placebos require the active participation of the patients family.
Correct Answer: C
Rationale: Broad agreement is that there are no individuals for whom and no condition for which placebos are the recommended treatment. This principle supersedes the other listed statements.
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The nurse who is a member of the palliative care team is assessing a patient. The patient indicates that he has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate. What teaching should the nurse do with this patient?
- A. Medication should be taken when pain levels are low so the pain is easier to reduce.
- B. Pain medication can be increased when the pain becomes intense.
- C. It is difficult to control chronic pain, so this is an inevitable part of the disease process.
- D. The patient will likely benefit more from distraction than pharmacologic interventions.
Correct Answer: A
Rationale: Better pain control can be achieved with a preventive approach, reducing the amount of time patients are in pain. Low levels of pain are easier to reduce or control than intense levels of pain. Pain medication is used to prevent pain so pain medication is not increased when pain becomes intense. Chronic pain is treatable. Giving the patient alternative methods to control pain is good, but it will not work if the patient is in so much pain that he cannot institute reliable alternative methods.
The wife of a patient you are caring for asks to speak with you. She tells you that she is concerned because her husband is requiring increasingly high doses of analgesia. She states, He was in pain long before he got cancer because he broke his back about 20 years ago. For that problem, though, his pain medicine wasnt just raised and raised. What would be the nurses best response?
- A. I didnt know that. I will speak to the doctor about your husbands pain control.
- B. Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the patient relief.
- C. Cancer is a chronic kind of pain so the more it hurts the patient, the more medicine we give the patient until it no longer hurts.
- D. Does the increasing medication dosage concern you?
Correct Answer: B
Rationale: Much pain associated with cancer is a direct result of tumor involvement. Conveying patient/family concerns to the physician is something a nurse does, but is not the best response by the nurse. Cancer pain can be either acute or chronic, and you do not tell a family member that you are going to keep increasing the dosage of the medication until it doesnt hurt anymore. The family member is obviously concerned.
You are the home health nurse caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will be taking care of the patient. What would your priority nursing interventions be for this visit?
- A. Teach the family the theory of pain management and the use of alternative therapies.
- B. Provide psychosocial family support during this emotional experience.
- C. Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.
- D. Provide family teaching regarding use of morphine, recognizing morphine overdose, and offering spiritual guidance.
Correct Answer: C
Rationale: If PCA is to be used in the patients home, the patient and family are taught about the operation of the pump as well as the side effects of the medication and strategies to manage them. The family would also need to monitor the IV site and notify the nurse of any changes, such as infiltration, that could endanger the patient. Teaching the family the theory of pain management or the use of alternative therapies and the nurse providing emotional support are important, but the family must be able to operate the pump as well as know the side effects of the medication and strategies to manage them. Offering spiritual guidance would not be a priority at this point and morphine is not the only medication administered by PCA.
The nurse caring for a 79-year-old man who has just returned to the medicalsurgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurses management of the patients pain?
- A. The elderly may require lower doses of medication and are easily confused with new medications.
- B. The elderly may have altered absorption and metabolism, which prohibits the use of opioids.
- C. The elderly may be confused following surgery, which is an age-related phenomenon unrelated to the medication.
- D. The elderly may require a higher initial dose of pain medication followed by a tapered dose.
Correct Answer: A
Rationale: The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and, therefore, the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion. Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors like environment. Opioids are not absolutely contraindicated and confusion following surgery is never normal. Medication should begin at a low dose and slowly increase until the pain is managed.
A nurse on an oncology unit has arranged for an individual to lead meditation exercises for patients who are interested in this nonpharmacological method of pain control. The nurse should recognize the use of what category of nonpharmacological intervention?
- A. A body-based modality
- B. A mind-body method
- C. A biologically based therapy
- D. An energy therapy
Correct Answer: B
Rationale: Meditation is one of the recognized mind-body methods of nonpharmacological pain control. The other answers are incorrect.