Nokea
An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the patient is exaggerating and does not need pain medication. What is the nurses best response?
- A. Pain often comes and goes with postsurgical patients. Please ask her about pain again in about 30 minutes.
- B. We need to provide pain medications because it is the law, and we must always follow the law.
- C. Unless there is strong evidence to the contrary, we should take the patients report at face value.
- D. Its not unusual for patients to misreport pain to get our attention when we are busy.
Correct Answer: C
Rationale: A broad definition of pain is whatever the person says it is, existing whenever the experiencing person says it does. Action should be taken unless there are demonstrable extenuating circumstances. The other answers are incorrect.
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Your patient has just returned from the postanesthetic care unit (PACU) following left tibia open reduction internal fixation (ORIF). The patient is complaining of pain, and you are preparing to administer the patients first scheduled dose of hydromorphone (Dilaudid). Prior to administering the drug, you would prioritize which of the following assessments?
- A. The patients electrolyte levels
- B. The patients blood pressure
- C. The patients allergy status
- D. The patients hydration status
Correct Answer: C
Rationale: Before administering medications such as narcotics for the first time, the nurse should assess for any previous allergic reactions. Electrolyte values, blood pressure, and hydration status are not what you need to assess prior to giving a first dose of narcotics.
You are the nurse coming on shift in a rehabilitation unit. You receive information in report about a new patient who has fibromyalgia and has difficulty with her ADLs. The off-going nurse also reports that the patient is withdrawn, refusing visitors, and has been vacillating between tears and anger all afternoon. What do you know about chronic pain syndromes that could account for your new patients behavior?
- A. Fibromyalgia is not a chronic pain syndrome, so further assessment is necessary.
- B. The patient is likely frustrated because she has to be in the hospital.
- C. The patient likely has an underlying psychiatric disorder.
- D. Chronic pain can cause intense emotional responses.
Correct Answer: D
Rationale: Regardless of how patients cope with chronic pain, pain that lasts for an extended period can result in depression, anger, or emotional withdrawal. Nowhere in the scenario does it indicate the patient is upset about the hospitalization or that she has a psychiatric disorder. Fibromyalgia is closely associated with chronic pain.
You are the case manager for a 35-year-old man being seen at a primary care clinic for chronic low back pain. When you meet with the patient, he says that he is having problems at work; in the past year he has been absent from work about once every 2 weeks, is short-tempered with other workers, feels tired all the time, and is worried about losing his job. You are developing this patients plan of care. On what should the goals for the plan of care focus?
- A. Increase the patients pain tolerance in order to achieve psychosocial benefits.
- B. Decrease the patients need to work and increase his sleep to 8 hours per night.
- C. Evaluate other work options to decrease the risk of depression and ineffective coping.
- D. Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety.
Correct Answer: D
Rationale: Chronic pain may affect the patients quality of life by interfering with work, interpersonal relationships, or sleep. Thus, the best set of goals would be to decrease time lost from work to increase the quality of interpersonal relationships, and decrease anxiety. Increasing pain tolerance is an unrealistic and inappropriate goal; exercise could help, but would not be the focus of the plan of care. Decreasing the need to work does not address his pain. Evaluating other work options to decrease the risk of depression is a misdirected diagnosis.
The nurse is assessing a patients pain while the patient awaits a cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at this time using a 0 -to-10 pain scale. How should the nurse best respond to this assessment finding?
- A. Remind the patient that he is indeed experiencing pain.
- B. Reinforce teaching about the pain scale number system.
- C. Reassess the patients pain in 30 minutes.
- D. Administer an analgesic and then reassess.
Correct Answer: B
Rationale: The patient is physically exhibiting signs and symptoms of pain. Further teaching may need to be done so the patient can correctly rate the pain. The nurse may also verify that the same scale is being used by the patient and caregiver to promote continuity. Although all answers are correct, the most accurate conclusion would be to reinforce teaching about the pain scale.
You have just received report on a 27-year-old woman who is coming to your unit from the emergency department with a torn meniscus. You review her PRN medications and see that she has an NSAID (ibuprofen) ordered every 6 hours. If you wanted to implement preventive pain measures when the patient arrives to your unit, what would you do?
- A. Use a pain scale to assess the patients pain, and let the patient know ibuprofen is available every 6 hours if she needs it.
- B. Do a complete assessment, and give pain medication based on the patients report of pain.
- C. Check for allergies, use a pain scale to assess the patients pain, and offer the ibuprofen every 6 hours until the patient is discharged.
- D. Provide medication as per patient request and offer relaxation techniques to promote comfort.
Correct Answer: C
Rationale: One way preventive pain measures can be implemented is by using PRN medications on a more regular or scheduled basis to allow for more uniform pain control. Smaller drug doses of medication are needed with the preventive pain method when PRN medications are given around the clock. Offering the medication is more beneficial than letting the patient know ibuprofen is available.