Nokea
You are frequently assessing an 84-year-old womans pain after she suffered a humeral fracture in a fall. When applying the nursing process in pain management for a patient of this age, what principle should you best apply?
- A. Monitor for signs of drug toxicity due to a decrease in metabolism.
- B. Monitor for an increase in absorption of the drug due to age-related changes.
- C. Monitor for a paradoxical increase in pain with opioid administration.
- D. Administer analgesics every 4 to 6 hours as ordered to control pain.
Correct Answer: A
Rationale: Older people may respond differently to pain than younger people. Because elderly people have a slower metabolism and a greater ratio of body fat to muscle mass compared with younger people, small doses of analgesic agents may be sufficient to relieve pain, and these doses may be effective longer. This fact also corresponds to an increased risk of adverse effects. Paradoxical effects are not a common phenomenon. Frequency of administration will vary widely according to numerous variables.
You may also like to solve these questions
The mother of a cancer patient comes to the nurse concerned with her daughters safety. She states that her daughters morphine dose that she needs to control her pain is getting higher and higher. As a result, the mother is afraid that her daughter will overdose. The nurse educates the mother about what aspect of her pain management?
- A. The dose range is higher with cancer patients, and the medical team will be very careful to prevent addiction.
- B. Frequently, female patients and younger patients need higher doses of opioids to be comfortable.
- C. The increased risk of overdose is an inevitable risk of maintaining adequate pain control during cancer treatment.
- D. There is no absolute maximum opioid dose and her daughter is becoming more tolerant to the drug.
Correct Answer: D
Rationale: Patients requiring opioids for chronic pain, especially cancer patients, need increasing doses to relieve pain. The requirement for higher drug doses results in a greater drug tolerance, which is a physical dependency as opposed to addiction, which is a psychological dependency. The dose range is usually higher with cancer patients. Although tolerance to the drug will increase, addiction is not dose related, but is a separate psychological dependency issue. No research indicates that women and/or younger people need higher doses of morphine to be comfortable. Overdose is not an inevitable risk.
You are the case manager for a 35-year-old man being seen at a primary care clinic for chronic low back pain. When you meet with the patient, he says that he is having problems at work; in the past year he has been absent from work about once every 2 weeks, is short-tempered with other workers, feels tired all the time, and is worried about losing his job. You are developing this patients plan of care. On what should the goals for the plan of care focus?
- A. Increase the patients pain tolerance in order to achieve psychosocial benefits.
- B. Decrease the patients need to work and increase his sleep to 8 hours per night.
- C. Evaluate other work options to decrease the risk of depression and ineffective coping.
- D. Decrease the time lost from work to increase the quality of interpersonal relationships and decrease anxiety.
Correct Answer: D
Rationale: Chronic pain may affect the patients quality of life by interfering with work, interpersonal relationships, or sleep. Thus, the best set of goals would be to decrease time lost from work to increase the quality of interpersonal relationships, and decrease anxiety. Increasing pain tolerance is an unrealistic and inappropriate goal; exercise could help, but would not be the focus of the plan of care. Decreasing the need to work does not address his pain. Evaluating other work options to decrease the risk of depression is a misdirected diagnosis.
The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse why he has had to keep getting larger doses of his pain medication, although they do not seem to affect him. What is the nurses best response?
- A. Over time you become more tolerant of the drug.
- B. You may have become immune to the effects of the drug.
- C. You may be developing a mild addiction to the drug.
- D. Your body absorbs less of the drug due to the cancer.
Correct Answer: A
Rationale: Over time, the patient is likely to become more tolerant of the dosage. Little evidence indicates that patients with cancer become addicted to the opioid medications. Patients do not become immune to the effects of the drug, and the body does not absorb less of the drug because of the cancer.
You are the nurse in a pain clinic caring for an 88-year-old man who is suffering from long-term, intractable pain. At this point, the pain team feels that first-line pharmacological and nonpharmacological methods of pain relief have been ineffective. What recommendation should guide this patients subsequent care?
- A. The patient may want to investigate new alternative pain management options that are outside the United States.
- B. The patient may benefit from referral to a neurologist or neurosurgeon to discuss pain-management options.
- C. The patient may want to increase his exercise and activities significantly to create distractions.
- D. The patient may want to relocate to long-term care in order to have his ADL needs met.
Correct Answer: B
Rationale: In some situations, especially with long-term severe intractable pain, usual pharmacologic and nonpharmacologic methods of pain relief are ineffective. In those situations, neurologic and neurosurgical approaches to pain management may be considered. Investigating new alternative painmanagement options that are outside the United States is unrealistic and may even be dangerous advice. Increasing his exercise and activities to create distractions is unrealistic when a patient is in intractable pain and this recommendation conveys the attitude that the pain is not real. Moving into a nursing home so others may care for him is an intervention that does not address the issue of pain.
A 60-year-old patient who has diabetes had a below-knee amputation 1 week ago. The patient asks why does it still feel like my leg is attached, and why does it still hurt? The nurse explains neuropathic pain in terms that are accessible to the patient. The nurse should describe what pathophysiologic process?
- A. The proliferation of nociceptors during times of stress
- B. Age-related deterioration of the central nervous system
- C. Psychosocial dependence on pain medications
- D. The abnormal reorganization of the nervous system
Correct Answer: D
Rationale: At any point from the periphery to the CNS, the potential exists for the development of neuropathic pain. Hyperexcitable nerve endings in the periphery can become damaged, leading to abnormal reorganization of the nervous system called neuroplasticity, an underlying mechanism of some neuropathic pain states. Neuropathic pain is not a result of age-related changes, nociceptor proliferation, or dependence on medications.