Nokea
A patient with persistent abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. Which of the following reasons provide the basis for the nurse's response in relation to the effectiveness of these strategies?
- A. Impact the cognitive and affective components of pain.
- B. Increase the modulating effect of the efferent pathways.
- C. Prevent transmission of nociceptive stimuli to the cortex.
- D. Slow the release of transmitter chemicals in the dorsal horn.
Correct Answer: A
Rationale: Cognitive therapies impact on the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.
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The nurse is caring for a patient with diabetes who has persistent burning leg pain even when taking oxycodone twice daily. Which of the following prescribed medications is the most appropriate choice for the nurse to administer as an adjuvant to decrease the patient's pain?
- A. Acetylsalicylic acid
- B. Dextroamphetamine
- C. Amitriptyline
- D. Acetaminophen
Correct Answer: C
Rationale: The patient's pain symptoms are consistent with neuropathic pain and the tricyclic antidepressants are effective for treating this type of pain. Acetylsalicylic acid and acetaminophen are more effective for nociceptive pain and dextroamphetamine is used in managing opioid-induced sedation.
A patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of morphine sulphate extended-release is due. Which of the following actions is priority for the nurse to implement?
- A. Administer the prescribed PRN immediate-release morphine.
- B. Suggest the use of alternative therapies such as heat or cold.
- C. Utilize distraction by talking about things the patient enjoys.
- D. Consult with the doctor about increasing the morphine sulphate extended-release dose.
Correct Answer: A
Rationale: The patient's pain requires rapid treatment and the nurse should administer the immediate-release morphine. Increasing the morphine sulphate extended-release dose and use of alternative therapies also may be needed, but the initial action should be to use the prescribed analgesic medications.
A patient who is receiving sustained-release morphine sulphate every 12 hours for persistent pain experiences level 9 (0-10 scale) breakthrough pain and anxiety. Which of these prescribed medications should the nurse anticipate administering?
- A. Lorazepam 1 mg orally
- B. Amitriptyline 10 mg orally
- C. Ibuprofen 400-800 mg orally
- D. Immediate-release morphine 30 mg orally
Correct Answer: D
Rationale: The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid such as the immediate-release morphine. The ibuprofen and amitriptyline may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of antianxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.
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.
The nurse is caring for a patient diagnosed with tendinitis in the outpatient clinic and advises that the patient use a topical ointment to assist with pain relief. The patient informs the nurse that they have never used a topical ointment for pain relief before so the nurse provides education related to the correct use of the ointment. Which of the following information should the nurse include in the teaching plan?
- A. Apply the ointment after a 20-minute massage of the area.
- B. Use moist heat for 10 minutes to the area prior to applying the ointment.
- C. Test the ointment on a small area of the skin for adverse effects.
- D. Use EMLA to the area prior to applying the ointment.
Correct Answer: C
Rationale: Skin testing is advisable when the patient has not used the particular medication before because the strengths of the medications vary and different intensities of sensation are produced. On application, these medications usually produce a strong hot or cold sensation and should not be used after massage or a heat treatment when blood vessels are already dilated. An eutectic mixture of local anaesthetics (EMLA) is not appropriate for tendonitis and should not be applied prior to another pain-relieving ointment.