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A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing?
- A. Acute pain
- B. Chronic pain
- C. Somatic pain
- D. Neuropathic pain
Correct Answer: B
Rationale: Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient's symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain.
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A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions?
- A. Administering NSAIDs
- B. Administering an immediate-release opioid
- C. Changing the opioid route to the rectal route
- D. Making no changes to the current therapy
Correct Answer: B
Rationale: If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions.
A patient with a history of chronic pain has been using an opioid analgesic for 4 months and reports that a larger dose of the pain medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these?
- A. Opioid addiction
- B. Opioid tolerance
- C. Opioid toxicity
- D. Opioid abstinence syndrome
Correct Answer: B
Rationale: Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal).
A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient's medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain?
- A. Antidepressant
- B. Anticonvulsant
- C. Corticosteroid
- D. Local anesthesia
Correct Answer: C
Rationale: Corticosteroids have an anti-inflammatory effect, which may help to reduce pain. The other medications do not have anti-inflammatory properties.
The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose?
- A. Dilated pupils
- B. Restlessness
- C. Respiration rate of 6 breaths/min
- D. Heart rate of 55 beats/min
Correct Answer: C
Rationale: The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose.
A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 breaths/minute. The nurse prepares for which priority action at this time?
- A. Assessment of the patient's pain level
- B. Immediate intubation and artificial ventilation
- C. Administration of naloxone (Narcan)
- D. Close observation of signs of opioid tolerance
Correct Answer: C
Rationale: Naloxone is an opioid antagonist used to reverse the effects of opioid overdose, such as respiratory depression. The patient's symptoms of lethargy and shallow respirations at 7 breaths/minute indicate a potential opioid overdose, making naloxone administration the priority action. The other options are not appropriate in this urgent situation.