Nokea
The nurse is caring for a patient with persistent back pain who has arrived at the pain clinic for a follow-up appointment. In order to evaluate whether the pain management is effective, which of the following questions is most appropriate for the nurse to ask?
- A. Can you describe the quality of your pain?
- B. Has there been a change in the pain location?
- C. How would you rate your pain on a 0-10 scale?
- D. Does the pain keep you from doing things you enjoy?
Correct Answer: D
Rationale: The goal for the treatment of persistent pain usually is to enhance function and quality of life. The other questions also are appropriate to ask, but information about patient function is more useful in evaluating effectiveness.
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A patient who is receiving sustained-release morphine sulphate every 12 hours for persistent pain experiences level 9 (0-10 scale) breakthrough pain and anxiety. Which of these prescribed medications should the nurse anticipate administering?
- A. Lorazepam 1 mg orally
- B. Amitriptyline 10 mg orally
- C. Ibuprofen 400-800 mg orally
- D. Immediate-release morphine 30 mg orally
Correct Answer: D
Rationale: The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid such as the immediate-release morphine. The ibuprofen and amitriptyline may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of antianxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.
The nurse is caring for a patient diagnosed with tendinitis in the outpatient clinic and advises that the patient use a topical ointment to assist with pain relief. The patient informs the nurse that they have never used a topical ointment for pain relief before so the nurse provides education related to the correct use of the ointment. Which of the following information should the nurse include in the teaching plan?
- A. Apply the ointment after a 20-minute massage of the area.
- B. Use moist heat for 10 minutes to the area prior to applying the ointment.
- C. Test the ointment on a small area of the skin for adverse effects.
- D. Use EMLA to the area prior to applying the ointment.
Correct Answer: C
Rationale: Skin testing is advisable when the patient has not used the particular medication before because the strengths of the medications vary and different intensities of sensation are produced. On application, these medications usually produce a strong hot or cold sensation and should not be used after massage or a heat treatment when blood vessels are already dilated. An eutectic mixture of local anaesthetics (EMLA) is not appropriate for tendonitis and should not be applied prior to another pain-relieving ointment.
The nurse is caring for a patient with diabetes who has persistent burning leg pain even when taking oxycodone twice daily. Which of the following prescribed medications is the most appropriate choice for the nurse to administer as an adjuvant to decrease the patient's pain?
- A. Acetylsalicylic acid
- B. Dextroamphetamine
- C. Amitriptyline
- D. Acetaminophen
Correct Answer: C
Rationale: The patient's pain symptoms are consistent with neuropathic pain and the tricyclic antidepressants are effective for treating this type of pain. Acetylsalicylic acid and acetaminophen are more effective for nociceptive pain and dextroamphetamine is used in managing opioid-induced sedation.
The nurse is admitting a patient to hospital with a history of persistent cancer pain. When reviewing the patient's home medications, which of the following medications should be of most concern?
- A. Amitriptyline 50 mg at bedtime
- B. Oxycodone 80 mg twice daily
- C. Ibuprofen 800 mg three times daily
- D. Meperidine 25 mg every 4 hours
Correct Answer: D
Rationale: Meperidine is contraindicated for persistent pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods. The ibuprofen, amitriptyline, and oxycodone are all appropriate medications for long-term pain management.
When doing a pain assessment for a patient who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the patient's pain?
- A. How long have you had this pain?
- B. How would you describe your pain?
- C. How much medication do you take for the pain?
- D. How many times a day do you medicate for pain?
Correct Answer: B
Rationale: Because pain is a multidimensional experience, asking a question that addresses the patient's experience with the pain is likely to elicit more information than the more specific information asked in the other three responses. All of these questions are appropriate, but the response beginning 'How would you describe your pain' is the best initial question.