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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.
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Based on this information, the provider decides to add pharmacologic strategies to the plan of care. Which interventions are the priority for Carla? Select all that apply.
- A. Provide information about a multimodal pain regimen
- B. Focus on the side effects of high-dose immediate-release opioids
- C. Discuss the significant risk for addiction with Carla and her wife
- D. Teach adjuvant medications such as gabapentin for treatment of neuropathic pain
- E. Integrate elements from the biopsychosocial model when designing interventions
Correct Answer: A,D,E
Rationale: Priority interventions include educating about a multimodal pain regimen (A), teaching about adjuvant medications like gabapentin for neuropathic pain (D), and integrating biopsychosocial elements (E) to address Carla's chronic pain holistically. Focusing on high-dose opioid side effects (B) or addiction risks (C) is less relevant, as Carla prefers avoiding pain medications and no high-dose opioids are indicated.
A pregnant woman has received an epidural analgesic prior to delivery. Assessment for which outcome to the medication will the nurse prioritize?
- A. Pruritus
- B. Urinary retention
- C. Vomiting
- D. Respiratory depression
Correct Answer: D
Rationale: Respiratory depression (D) is the priority outcome to monitor with epidural opioids, as it is life-threatening. Pruritus, urinary retention, and vomiting (A, B, C) are less critical side effects.
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.
A patient reports diffuse abdominal pain that is difficult to localize. The nurse documents this as which type of pain?
- A. Cutaneous
- B. Visceral
- C. Superficial
- D. Somatic
Correct Answer: B
Rationale: Visceral pain is poorly localized and originates in body organs like the abdomen (B). Cutaneous and superficial pain (A, C) involve the skin or subcutaneous tissue, while somatic pain (D) originates in tendons, ligaments, bones, or nerves and is more localized.
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.