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What other intervention(s) can be implemented for Carla?
- A. Nothing quite yet-we need to see how the medications work before implementing other interventions.
- B. The nurse could collaborate with Carla's wife to substitute the medications for placebos to see if the idea of medication helps the pain.
- C. Carla could take any number of over-the-counter (OTC) and herbal supplements to augment the medications.
- D. The nurse could ask Carla if she is willing to incorporate imagery, mindfulness, or other nonpharmacologic interventions.
Correct Answer: D
Rationale: Nonpharmacologic interventions like imagery and mindfulness (D) align with Carla's preference to avoid medications and can complement pharmacologic strategies. Waiting to assess medication effects (A) delays holistic care, placebos (B) are unethical, and indiscriminate OTC/herbal use (C) risks interactions and lacks evidence.
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Based on the objective and subjective assessment of this patient, where should the nurse focus the initial efforts of the interprofessional team?
- A. Collaborating with the endocrinologist to manage the patient's blood glucose and A1c
- B. Consulting psychiatry to set up a medication regimen to treat the patient's anxiety and depression
- C. Working with the provider, the patient, and the patient's wife to address functional pain goals
- D. Providing detailed information on the microvascular and macrovascular complications of type 2 diabetes
Correct Answer: C
Rationale: The priority is addressing Carla's functional pain goals (C) to improve her quality of life, as her pain impacts her daily functioning and stress affects her diabetes management. While glucose control (A) and psychiatric consultation (B) are relevant, pain management is the immediate focus. Education on complications (D) is secondary to addressing current pain.
When developing the care plan for a patient with chronic pain, the nurse plans interventions based on the knowledge that chronic pain not related to cancer or palliative/end-of-life care is most effectively relieved through which method?
- A. Providing the highest effective dose of an opioid on a PRN (as needed) basis
- B. Using nonopioid drugs conservatively
- C. Applying multimodal nonpharmacologic and nonopioid pharmacologic therapies
- D. Administering a continuous intravenous infusion on a regular basis
Correct Answer: C
Rationale: Multimodal nonpharmacologic and nonopioid therapies (C) are preferred for chronic pain unrelated to cancer or palliative care. High-dose PRN opioids (A) are not ideal, nonopioids should not be used conservatively (B), and continuous IV infusions (D) are typically for acute or palliative settings.
Which question by the nurse will be most helpful in determining whether a patient who is experiencing a myocardial infarction has referred pain?
- A. Did your chest pain last 2 minutes or less?
- B. Was the pain on the surface of your chest?
- C. Is this pain in your residual limb shooting or burning?
- D. Are you having any arm or shoulder pain?
Correct Answer: D
Rationale: Referred pain is perceived in an area distant from its origin, such as arm or shoulder pain during a myocardial infarction (D). Questions about duration (A), surface location (B), or phantom limb pain (C) are less relevant to identifying referred pain in this context.
The nurse applies the gate control theory of pain to provide pain relief to a patient with chronic lower back pain. What nursing intervention will help relieve pain by 'closing the gate'?
- A. Encouraging regular use of analgesics
- B. Applying moist heat to the area at intervals
- C. Reviewing the pain experience with the patient
- D. Ambulating the patient after administering medication
Correct Answer: B
Rationale: The gate control theory suggests stimulating large nerve fibers to block pain signals. Applying moist heat (B) stimulates these fibers to 'close the gate,' reducing pain perception. Analgesics (A), reviewing pain (C), or ambulation post-medication (D) do not directly target this mechanism.
Students in a leadership class are discussing how social determinants of health affect pain management. Which statement is correct and should be included in the discussion?
- A. Outcomes of pain management are generally satisfactory regardless of income.
- B. Minority patients often receive excess medication.
- C. Patients from minority groups often wait a long time before seeking treatment for pain.
- D. Social determinants of health are unrelated to pain management.
Correct Answer: C
Rationale: Social determinants impact pain management; minority patients often delay seeking treatment due to access barriers, cultural factors, or mistrust (C). Outcomes vary by income (A), minority patients often receive less medication (B), and social determinants are related to pain management (D).