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The nurse caring for a 91-year-old patient with osteoarthritis is reviewing the patients chart. This patient is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this patient?
- A. Depression
- B. Chronic illness
- C. Inadequate pain control
- D. Drug interactions
Correct Answer: D
Rationale: Drug interactions are more likely to occur in older adults because of the higher incidence of chronic illness and the increased use of prescription and OTC medications. The other options are all good answers for this patient because of the patients age and disease process. However, they are not what the nurse would be most concerned about in terms of ensuring safety.
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A medical nurse is appraising the effectiveness of a patients current pain control regimen. The nurse is aware that if an intervention is deemed ineffective, goals need to be reassessed and other measures need to be considered. What is the role of the nurse in obtaining additional pain relief for the patient?
- A. Primary caregiver
- B. Patient advocate
- C. Team leader
- D. Case manager
Correct Answer: B
Rationale: If the intervention was ineffective, the nurse should consider other measures. If these are ineffective, pain-relief goals need to be reassessed in collaboration with the physician. The nurse serves as the patients advocate in obtaining additional pain relief.
A patients intractable neuropathic pain is being treated on an inpatient basis using a multimodal approach to analgesia. After administering a recently increased dose of IV morphine to the patient, the nurse has returned to assess the patient and finds the patient unresponsive to verbal and physical stimulation with a respiratory rate of five breaths per minute. The nurse has called a code blue and should anticipate the administration of what drug?
- A. Acetylcysteine
- B. Naloxone
- C. Celecoxib
- D. Acetylsalicylic acid
Correct Answer: B
Rationale: Severe opioid-induced sedation necessitates the administration of naloxone, an opioid antagonist. Celecoxib, acetylcysteine, and acetylsalicylic acid are ineffective.
You are the nurse caring for the 25-year-old victim of a motor vehicle accident with a fractured pelvis and a ruptured bladder. The nurses aide (NA) tells you that she is concerned because the patients resting heart rate is 110 beats per minute, her respirations are 24 breaths per minute, temperature is 99.1 F axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as you assess this patients physiologic status?
- A. The patients understanding of pain physiology
- B. The patients serum glucose level
- C. The patients white blood cell count
- D. The patients rating of her pain
Correct Answer: D
Rationale: The nurses assessment of the patients pain is a priority. There is no suggestion of diabetes and leukocytosis would not occur at this early stage of recovery. The patient does not need to fully understand pain physiology in order to communicate the presence, absence, or severity of pain.
You are frequently assessing an 84-year-old womans pain after she suffered a humeral fracture in a fall. When applying the nursing process in pain management for a patient of this age, what principle should you best apply?
- A. Monitor for signs of drug toxicity due to a decrease in metabolism.
- B. Monitor for an increase in absorption of the drug due to age-related changes.
- C. Monitor for a paradoxical increase in pain with opioid administration.
- D. Administer analgesics every 4 to 6 hours as ordered to control pain.
Correct Answer: A
Rationale: Older people may respond differently to pain than younger people. Because elderly people have a slower metabolism and a greater ratio of body fat to muscle mass compared with younger people, small doses of analgesic agents may be sufficient to relieve pain, and these doses may be effective longer. This fact also corresponds to an increased risk of adverse effects. Paradoxical effects are not a common phenomenon. Frequency of administration will vary widely according to numerous variables.
The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse why he has had to keep getting larger doses of his pain medication, although they do not seem to affect him. What is the nurses best response?
- A. Over time you become more tolerant of the drug.
- B. You may have become immune to the effects of the drug.
- C. You may be developing a mild addiction to the drug.
- D. Your body absorbs less of the drug due to the cancer.
Correct Answer: A
Rationale: Over time, the patient is likely to become more tolerant of the dosage. Little evidence indicates that patients with cancer become addicted to the opioid medications. Patients do not become immune to the effects of the drug, and the body does not absorb less of the drug because of the cancer.