Nokea
A patient who uses a fentanyl patch for persistent cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0-10 scale) and requests 'something for pain that will work quickly.' Which of the following types of pain is the most appropriate for the nurse to document for this patient?
- A. Somatic pain
- B. Referred pain
- C. Neuropathic pain
- D. Breakthrough pain
Correct Answer: D
Rationale: Pain that occurs beyond the persistent pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.
You may also like to solve these questions
The nurse is caring for a patient with cancer pain that the patient describes as at 'level 8 (0-10 scale), deep, and aching.' Which of the following prescribed medications should the nurse administer first?
- A. Fentanyl patch
- B. Ketorolac tablets PO
- C. Hydromorphone IV
- D. Acetaminophen suppository
Correct Answer: C
Rationale: The patient's pain level indicates that a rapidly acting medication such as an IV opioid is needed. The other medications also may be appropriate to use, but will not work as rapidly or as effectively as hydromorphone IV.
A patient with second-degree burns has been receiving morphine through patientcontrolled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. Which of the following actions should the nurse implement?
- A. Administer a dose of morphine every 1-2 hours from the PCA machine while the patient is sleeping.
- B. Consult with the health care provider about using a different treatment protocol to control the patient's pain.
- C. Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
- D. Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.
Correct Answer: B
Rationale: PCAs are best for controlling acute pain, this patient's history indicates persistent pain and a need for a pain management plan that will provide adequate analgesia while the patient is sleeping. Administering a dose of morphine when the patient already has severe pain will not address the problem. Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a patient through PCA.
These medications are ordered for an older-adult patient with arthritis in both hips who is complaining of level 3 (0-10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy?
- A. Acetylsalicylic acid 650 mg orally
- B. Naproxen 200 mg orally
- C. Oxycodone 5 mg orally
- D. Acetaminophen 650 mg orally
Correct Answer: D
Rationale: Acetaminophen is the best first-choice medication. The principle of 'start low, go slow' is used to guide therapy when treating elderly adults because the ability to metabolize medications is decreased and the likelihood of medication interactions is increased. Nonopioid analgesics are used first for mild to moderate pain, although opioids may be used later. Acetylsalicylic acid and the NSAIDs are associated with a high incidence of gastrointestinal bleeding in elderly patients.
The nurse is admitting a patient to hospital with a history of persistent cancer pain. When reviewing the patient's home medications, which of the following medications should be of most concern?
- A. Amitriptyline 50 mg at bedtime
- B. Oxycodone 80 mg twice daily
- C. Ibuprofen 800 mg three times daily
- D. Meperidine 25 mg every 4 hours
Correct Answer: D
Rationale: Meperidine is contraindicated for persistent pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods. The ibuprofen, amitriptyline, and oxycodone are all appropriate medications for long-term pain management.
The nurse is caring for a patient who has persistent musculoskeletal pain and states 'I feel depressed because I ache too much to play golf.' The patient says the pain is usually at a level 7 (0-10 scale). Which of the following patient goals has the highest priority when the nurse is developing the treatment plan?
- A. The patient will exhibit fewer signs of depression.
- B. The patient will say that the aching has decreased.
- C. The patient will state that pain is at a level 2 of 10.
- D. The patient will be able to play 1-2 rounds of golf.
Correct Answer: D
Rationale: For persistent pain, patients are encouraged to set functional goals such as being able to perform daily activities and hobbies. The patient has identified playing golf as the desired activity, so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment. The nurse also should assess for depression, but the patient has identified the depression as being due to the inability to play golf, so the goal of being able to play 1 or 2 rounds of golf is the most appropriate.