Nokea
The nurse is applying knowledge of the pathophysiology of pain when planning this patients nursing care. What is the physiologic process by which noxious stimuli, such as burns, activate nociceptors?
- A. Transduction
- B. Transmission
- C. Perception
- D. Modulation
Correct Answer: A
Rationale: Transduction refers to the processes by which noxious stimuli, such as a surgical incision or burn, activate primary afferent neurons called nociceptors. Transmission, perception, and modulation are subsequent to this process.
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A 52-year-old female patient is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the patients pain in her plan of nursing care, the nurse should consider what characteristic of cancer pain?
- A. Cancer pain is often related to the stress of the patient knowing she has cancer and requires relatively low dosages of pain medications along with a high dose of anti-anxiety medications.
- B. Cancer pain is always chronic and challenging to treat, so distraction is often the best intervention.
- C. Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications.
- D. Cancer pain is often misreported by patients because of confusion related to their disease process.
Correct Answer: C
Rationale: Pain associated with cancer may be acute or chronic. Pain resulting from cancer is so ubiquitous that when cancer patients are asked about possible outcomes, pain is reported to be the most feared outcome. Higher doses of pain medication are usually needed with cancer patients, especially with metastasis. Cancer pain is not treated with anti-anxiety medications. Cancer pain can be chronic and difficult to treat so distraction may help, but higher doses of pain medications are usually the best intervention. No research indicates cancer patients misreport pain because of confusion related to their disease process.
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.
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 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.
The mother of a cancer patient comes to the nurse concerned with her daughters safety. She states that her daughters morphine dose that she needs to control her pain is getting higher and higher. As a result, the mother is afraid that her daughter will overdose. The nurse educates the mother about what aspect of her pain management?
- A. The dose range is higher with cancer patients, and the medical team will be very careful to prevent addiction.
- B. Frequently, female patients and younger patients need higher doses of opioids to be comfortable.
- C. The increased risk of overdose is an inevitable risk of maintaining adequate pain control during cancer treatment.
- D. There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.
Correct Answer: D
Rationale: Patients requiring opioids for chronic pain, especially cancer patients, need increasing doses to relieve pain. The requirement for higher drug doses results in a greater drug tolerance, which is a physical dependency as opposed to addiction, which is a psychological dependency. The dose range is usually higher with cancer patients. Although tolerance to the drug will increase, addiction is not dose related, but is a separate psychological dependency issue. No research indicates that women and/or younger people need higher doses of morphine to be comfortable. Overdose is not an inevitable risk.