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When the nurse assists a patient recovering from abdominal surgery to walk, the nurse observes that the patient grimaces, moves stiffly, and becomes pale. The nurse received in shift report that the patient has consistently refused pain medication. To help promote comfort, which additional data will the nurse gather? Select all that apply.
- A. Patient's understanding of or fear of taking prescribed analgesics
- B. Assessment of any current pain
- C. Presence of anxiety or additional stressors
- D. Assessment of the surgical incision for infection
- E. What the patient has eaten to this point
- F. Whether the patient is using the incentive spirometer
Correct Answer: A,B,C,D
Rationale: To promote comfort, the nurse should assess fears of analgesics (A), current pain (B), anxiety or stressors (C), and incision for infection (D), as these may explain refusal and pain behaviors. Diet (E) and spirometer use (F) are less directly related to pain management.
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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.
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.
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.
When assessing pain in a child, the nurse needs to be aware of what considerations?
- A. Immature neurologic development results in reduced pain sensation
- B. Inadequate or inconsistent relief of pain is widespread
- C. Reliable assessment tools are currently unavailable
- D. Narcotic analgesic use should be avoided
Correct Answer: B
Rationale: Inadequate or inconsistent pain relief in children is a widespread issue (B). Children feel pain, reliable assessment tools exist, and opioids can be used safely with careful monitoring, making A, C, and D incorrect.
A postoperative patient asks the nurse about pain management following surgery. What teaching will the nurse provide?
- A. Avoid asking for pain medication often, as it can be addictive.
- B. It is better to wait until the pain is severe before asking for pain medication.
- C. It's natural to have pain after surgery; it will lessen in intensity in a few days.
- D. You will be more comfortable if you take the medication at regular intervals.
Correct Answer: D
Rationale: Patients should take pain medication at regular intervals to prevent severe pain (D). Waiting until pain is severe (B) makes it harder to control, and addiction is rare with short-term use (A). Pain should be managed, not accepted as natural (C).