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The nurse is assessing a patients pain while the patient awaits a cholecystectomy. The patient is tearful, hesitant to move, and grimacing. When asked, the patient rates his pain as a 2 at this time using a 0 -to-10 pain scale. How should the nurse best respond to this assessment finding?
- A. Remind the patient that he is indeed experiencing pain.
- B. Reinforce teaching about the pain scale number system.
- C. Reassess the patients pain in 30 minutes.
- D. Administer an analgesic and then reassess.
Correct Answer: B
Rationale: The patient is physically exhibiting signs and symptoms of pain. Further teaching may need to be done so the patient can correctly rate the pain. The nurse may also verify that the same scale is being used by the patient and caregiver to promote continuity. Although all answers are correct, the most accurate conclusion would be to reinforce teaching about the pain scale.
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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 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.
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.
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.
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.