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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.
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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.
A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical patients pain. What principle should guide the nurses use of placebos in pain management?
- A. Placebos require a higher level of informed consent than conventional care.
- B. Placebos are an acceptable, but unconventional, form of nonpharmacological pain management.
- C. Placebos are never recommended in the treatment of pain.
- D. Placebos require the active participation of the patients family.
Correct Answer: C
Rationale: Broad agreement is that there are no individuals for whom and no condition for which placebos are the recommended treatment. This principle supersedes the other listed statements.
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.
The nurse who is a member of the palliative care team is assessing a patient. The patient indicates that he has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate. What teaching should the nurse do with this patient?
- A. Medication should be taken when pain levels are low so the pain is easier to reduce.
- B. Pain medication can be increased when the pain becomes intense.
- C. It is difficult to control chronic pain, so this is an inevitable part of the disease process.
- D. The patient will likely benefit more from distraction than pharmacologic interventions.
Correct Answer: A
Rationale: Better pain control can be achieved with a preventive approach, reducing the amount of time patients are in pain. Low levels of pain are easier to reduce or control than intense levels of pain. Pain medication is used to prevent pain so pain medication is not increased when pain becomes intense. Chronic pain is treatable. Giving the patient alternative methods to control pain is good, but it will not work if the patient is in so much pain that he cannot institute reliable alternative methods.
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.