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The nurse caring for a 79-year-old man who has just returned to the medicalsurgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurses management of the patients pain?
- A. The elderly may require lower doses of medication and are easily confused with new medications.
- B. The elderly may have altered absorption and metabolism, which prohibits the use of opioids.
- C. The elderly may be confused following surgery, which is an age-related phenomenon unrelated to the medication.
- D. The elderly may require a higher initial dose of pain medication followed by a tapered dose.
Correct Answer: A
Rationale: The elderly often require lower doses of medication and are easily confused with new medications. The elderly have slowed metabolism and excretion, and, therefore, the elderly should receive a lower dose of pain medication given over a longer period time, which may help to limit the potential for confusion. Unfortunately, the elderly are often given the same dose as younger adults, and the resulting confusion is attributed to other factors like environment. Opioids are not absolutely contraindicated and confusion following surgery is never normal. Medication should begin at a low dose and slowly increase until the pain is managed.
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Two patients on your unit have recently returned to the postsurgical unit after knee arthroplasty. One patient is reporting pain of 8 to 9 on a 0 -to-10 pain scale, whereas the other patient is reporting a pain level of 3 to 4 on the same pain scale. What is the nurses most plausible rationale for understanding the patients different perceptions of pain?
- A. Endorphin levels may vary between patients, affecting the perception of pain.
- B. One of the patients is exaggerating his or her sense of pain.
- C. The patients are likely experiencing a variance in vasoconstriction.
- D. One of the patients may be experiencing opioid tolerance.
Correct Answer: A
Rationale: Different people feel different degrees of pain from similar stimuli. Opioid tolerance is associated with chronic pain treatment and would not likely apply to these patients. The nurse should not assume the patient is exaggerating the pain because the patient is the best authority of his or her existence of pain, and definitions for pain state that pain is whatever the person says it is, existing whenever the experiencing person says it does.
The home health nurse is developing a plan of care for a patient who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the patient teaching?
- A. Self-care and safety
- B. Autonomy and need
- C. Health promotion and exercise
- D. Dependence and health
Correct Answer: A
Rationale: The patient will be at home monitoring his own pain management, administering his own medication, and monitoring and reporting side effects. This requires the ability to perform self-care activities in a safe manner. Creating autonomy is important, but need is a poorly defined concept. Health promotion is an important global concept for maintaining health, and exercise is an appropriate activity; however, self-care and safety are the priorities. Dependence is not a concept used to develop a nursing plan of care, and health is too broad a concept to use as a basis for a nursing plan of care.
You are caring for a patient admitted to the medical-surgical unit after falling from a horse. The patient states I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse. When planning the patients care, what variables should you consider? Select all that apply.
- A. How the presence of pain affects patients and families
- B. Resources that can assist the patient with pain management
- C. The influence of the patients cognition on her pain
- D. The advantages and disadvantages of available pain-relief strategies
- E. The difference between acute and intermittent pain
Correct Answer: A,B,D
Rationale: Nurses should understand the effects of chronic pain on patients and families and should be knowledgeable about pain-relief strategies and appropriate resources to assist effectively with pain management. There is no evidence of cognitive deficits in this patient and the difference between acute and intermittent pain has no immediate bearing on this patients care.
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.
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.