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Based on this information, the provider decides to add pharmacologic strategies to the plan of care. Which interventions are the priority for Carla? Select all that apply.
- A. Provide information about a multimodal pain regimen
- B. Focus on the side effects of high-dose immediate-release opioids
- C. Discuss the significant risk for addiction with Carla and her wife
- D. Teach adjuvant medications such as gabapentin for treatment of neuropathic pain
- E. Integrate elements from the biopsychosocial model when designing interventions
Correct Answer: A,D,E
Rationale: Priority interventions include educating about a multimodal pain regimen (A), teaching about adjuvant medications like gabapentin for neuropathic pain (D), and integrating biopsychosocial elements (E) to address Carla's chronic pain holistically. Focusing on high-dose opioid side effects (B) or addiction risks (C) is less relevant, as Carla prefers avoiding pain medications and no high-dose opioids are indicated.
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A patient reports diffuse abdominal pain that is difficult to localize. The nurse documents this as which type of pain?
- A. Cutaneous
- B. Visceral
- C. Superficial
- D. Somatic
Correct Answer: B
Rationale: Visceral pain is poorly localized and originates in body organs like the abdomen (B). Cutaneous and superficial pain (A, C) involve the skin or subcutaneous tissue, while somatic pain (D) originates in tendons, ligaments, bones, or nerves and is more localized.
A nurse on an adult surgical floor enters a patient room and observes a family member pressing the button to administer a dose of PCA via the infusion pump. What response by the nurse is most appropriate?
- A. That dose will sure be helpful after their type of surgery.
- B. Having only the patient use the pump prevents respiratory complications.
- C. If the patient asked you to press the button, then it's OK.
- D. Since the pump has built in safeguards, you can help with pain management.
Correct Answer: B
Rationale: PCA by proxy (family administering doses) risks overdose, oversedation, and respiratory depression (B). Only the patient should press the PCA button, regardless of safeguards (D) or patient requests (C), and option A ignores the safety issue.
When developing the care plan for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain not related to cancer or palliative/end-of-life care is most effectively relieved through which method?
- A. Providing the highest effective dose of an opioid on a PRN (as needed) basis
- B. Using nonopioid drugs conservatively
- C. Applying multimodal nonpharmacologic and nonopioid pharmacologic therapies
- D. Administering a continuous intravenous infusion on a regular basis
Correct Answer: C
Rationale: Multimodal nonpharmacologic and nonopioid therapies (C) are preferred for chronic pain unrelated to cancer or palliative care. High-dose PRN opioids (A) are not ideal, nonopioids should not be used conservatively (B), and continuous IV infusions (D) are typically for acute or palliative settings.
How will the nurse and Carla know that the treatment plan has been effective?
- A. Carla is completely pain free but is taking large doses of OTC acetaminophen.
- B. Carla reports some pain but states she was able to engage in the full walking tour with occasional rest periods.
- C. Carla admits that she is not taking the medication because she has just learned to live with the pain.
- D. Carla tried a few nonpharmacologic recommendations but has opted to simply double the prescribed dose.
Correct Answer: B
Rationale: The treatment plan is effective if Carla achieves her functional goal of completing a walking tour with minimal pain and occasional rest (B), aligning with her stated goals of 1/10 pain at rest and 3/10 with activity. Complete pain relief with high acetaminophen doses (A) risks toxicity, ignoring medications (C) indicates nonadherence, and doubling doses (D) is unsafe.
What other intervention(s) can be implemented for Carla?
- A. Nothing quite yet-we need to see how the medications work before implementing other interventions.
- B. The nurse could collaborate with Carla's wife to substitute the medications for placebos to see if the idea of medication helps the pain.
- C. Carla could take any number of over-the-counter (OTC) and herbal supplements to augment the medications.
- D. The nurse could ask Carla if she is willing to incorporate imagery, mindfulness, or other nonpharmacologic interventions.
Correct Answer: D
Rationale: Nonpharmacologic interventions like imagery and mindfulness (D) align with Carla's preference to avoid medications and can complement pharmacologic strategies. Waiting to assess medication effects (A) delays holistic care, placebos (B) are unethical, and indiscriminate OTC/herbal use (C) risks interactions and lacks evidence.