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The nurse is accepting care of an adult patient who has been experiencing severe and intractable pain. When reviewing the patients medication administration record, the nurse notes the presence of gabapentin (Neurontin). The nurse is justified in suspecting what phenomenon in the etiology of the patients pain?
- A. Neuroplasticity
- B. Misperception
- C. Psychosomatic processes
- D. Neuropathy
Correct Answer: D
Rationale: The anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) are first-line analgesic agents for neuropathic pain. Neuroplasticity is the ability of the peripheral and central nervous systems to change both structure and function as a result of noxious stimuli; this does not likely contribute to the patients pain. Similarly, psychosomatic factors and misperception of pain are highly unlikely.
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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.
You are caring for a patient with sickle cell disease in her home. Over the years, there has been joint damage, and the patient is in chronic pain. The patient has developed a tolerance to her usual pain medication. When does the tolerance to pain medication become the most significant problem?
- A. When it results in inadequate relief from pain
- B. When dealing with withdrawal symptoms resulting from the tolerance
- C. When having to report the patients addiction to her physician
- D. When the family becomes concerned about increasing dosage
Correct Answer: A
Rationale: Tolerance to opioids is common and becomes a problem primarily in terms of maintaining adequate pain control. Symptoms of physical dependence may occur when opiates are discontinued, but there is no indication that the patients medication will be discontinued. This patient does not have an addiction and the familys concerns are secondary to those of the patient.
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.
The nurse is caring for a 51-year-old female patient whose medical history includes chronic fatigue and poorly controlled back pain. These medical diagnoses should alert the nurse to the possibility of what consequent health problem?
- A. Anxiety
- B. Skin breakdown
- C. Depression
- D. Hallucinations
Correct Answer: C
Rationale: Depression is associated with chronic pain and can be exacerbated by the effects of chronic fatigue. Anxiety is also plausible, but depression is a paramount risk. Skin breakdown and hallucinations are much less likely.
You are assessing an 86-year-old postoperative patient who has an unexpressive, stoic demeanor. When you enter the room, the patient is curled into the fetal position and your assessment reveals that his vital signs are elevated and he is diaphoretic. You ask the patient what his pain level is on a 0-to-10 scale that you explained to the patient prior to surgery. The patient indicates a pain level of three or so. You review your pain-management orders and find that all medications are ordered PRN. How would you treat this patients pain?
- A. Treat the patient on the basis of objective signs of pain and reassess him frequently.
- B. Call the physician for new orders because it is apparent that the pain medicine is not working.
- C. Believe what the patient says, reinforce education, and reassess often.
- D. Ask the family what they think and treat the patient accordingly.
Correct Answer: C
Rationale: As always, the best guide to pain management and administration of analgesic agents in all patients, regardless of age, is what the individual patient says. However, further education and assessment are appropriate. You cannot usually treat pain the patient denies having if the orders are PRN only. The scenario does not indicate the present pain-management orders are not working for this patient. The familys insights do not override the patients self-report.