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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.
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A nurse is caring for patients who are nonverbal. What are examples of behavioral responses to pain? Select all that apply.
- A. Cradling a wrist that was injured in a car accident
- B. Moaning and crying from abdominal pain
- C. Increasing pulse following a myocardial infarction
- D. Striking out at a nurse who attempts to provide a bath
- E. Acting depressed and withdrawn while experiencing chronic cancer pain
- F. Pulling away from a nurse trying to give an injection
Correct Answer: A,B,D,F
Rationale: Behavioral responses include cradling an injured area (A), moaning and crying (B), striking out (D), and pulling away (F). Increased pulse (C) is a physiologic response, and depression/withdrawal (E) is an affective response.
During postconference, nursing students are exploring definitions of pain and its nature. Which statements should be included in this discussion? Select all that apply.
- A. It is whatever the health care provider treating the pain says it is.
- B. Pain exists whenever the person experiencing it says it is present.
- C. It is an emotional and sensory reaction to tissue damage.
- D. Pain is a simple, universal, and easy-to-describe phenomenon.
- E. When a cause cannot be identified, pain is psychological in nature.
- F. It is classified by duration, location, source, transmission, and etiology.
Correct Answer: B,C,F
Rationale: Pain is defined as whatever the patient says it is (B), an emotional and sensory reaction to tissue damage (C), and classified by duration, location, source, transmission, and etiology (F). It is not defined by the provider (A), nor is it simple or universal (D). Pain without an identifiable cause is not necessarily psychological (E).
A patient is receiving a multimodal medication regimen as part of the treatment plan for neuropathic phantom limb pain. When the patient reports a bloody bowel movement, which medication prescription requires notification of the provider?
- A. Acetaminophen
- B. Nonsteroidal antiinflammatory
- C. Opioid medication
- D. Antianxiety medication
Correct Answer: B
Rationale: NSAIDs (B) can interfere with platelet function and increase bleeding risk, necessitating provider notification for a bloody bowel movement. Acetaminophen (A), opioids (C), and antianxiety medications (D) are less likely to cause gastrointestinal bleeding.
How will the nurse and Carla know that the treatment plan has been effective?
- A. Carla is completely pain free but is taking large doses of OTC acetaminophen.
- B. Carla reports some pain but states she was able to engage in the full walking tour with occasional rest periods.
- C. Carla admits that she is not taking the medication because she has just learned to live with the pain.
- D. Carla tried a few nonpharmacologic recommendations but has opted to simply double the prescribed dose.
Correct Answer: B
Rationale: The treatment plan is effective if Carla achieves her functional goal of completing a walking tour with minimal pain and occasional rest (B), aligning with her stated goals of 1/10 pain at rest and 3/10 with activity. Complete pain relief with high acetaminophen doses (A) risks toxicity, ignoring medications (C) indicates nonadherence, and doubling doses (D) is unsafe.
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.