Nokea
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.
You may also like to solve these questions
An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the patient is exaggerating and does not need pain medication. What is the nurses best response?
- A. Pain often comes and goes with postsurgical patients. Please ask her about pain again in about 30 minutes.
- B. We need to provide pain medications because it is the law, and we must always follow the law.
- C. Unless there is strong evidence to the contrary, we should take the patients report at face value.
- D. Its not unusual for patients to misreport pain to get our attention when we are busy.
Correct Answer: C
Rationale: A broad definition of pain is whatever the person says it is, existing whenever the experiencing person says it does. Action should be taken unless there are demonstrable extenuating circumstances. The other answers are incorrect.
You are the home health nurse caring for a homebound client who is terminally ill. You are delivering a patient-controlled analgesia (PCA) pump to the patient at your visit today. The family members will be taking care of the patient. What would your priority nursing interventions be for this visit?
- A. Teach the family the theory of pain management and the use of alternative therapies.
- B. Provide psychosocial family support during this emotional experience.
- C. Provide patient and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.
- D. Provide family teaching regarding use of morphine, recognizing morphine overdose, and offering spiritual guidance.
Correct Answer: C
Rationale: If PCA is to be used in the patients home, the patient and family are taught about the operation of the pump as well as the side effects of the medication and strategies to manage them. The family would also need to monitor the IV site and notify the nurse of any changes, such as infiltration, that could endanger the patient. Teaching the family the theory of pain management or the use of alternative therapies and the nurse providing emotional support are important, but the family must be able to operate the pump as well as know the side effects of the medication and strategies to manage them. Offering spiritual guidance would not be a priority at this point and morphine is not the only medication administered by PCA.
You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of patients who live with chronic pain should inform your care planning?
- A. They are typically more comfortable with underlying pain than patients without chronic pain.
- B. They often have a lower pain threshold than patients without chronic pain.
- C. They often have an increased tolerance of pain.
- D. They can experience acute pain in addition to chronic pain.
Correct Answer: D
Rationale: It is tempting to expect that people who have had multiple or prolonged experiences with pain will be less anxious and more tolerant of pain than those who have had little experience with pain. However, this is not true for many people. The more experience a person has had with pain, the more frightened he or she may be about subsequent painful events. Chronic pain and acute pain are not mutually exclusive.
You are caring for a 20-year-old patient with a diagnosis of cerebral palsy who has been admitted for the relief of painful contractures in his lower extremities. When creating a nursing care plan for this patient, what variables should the nurse consider? Select all that apply.
- A. Patients gender
- B. Patients comorbid conditions
- C. Type of procedure be performed
- D. Changes in neurologic function due to the procedure
- E. Prior effectiveness in relieving the pain
Correct Answer: B,C,D,E
Rationale: The nursing care of patients who undergo procedures for the relief of chronic pain depends on the type of procedure performed, its effectiveness in relieving the pain, and the changes in neurologic function that accompany the procedure. The patients comorbid conditions will also affect care, but his gender is not a key consideration.
You have just received report on a 27-year-old woman who is coming to your unit from the emergency department with a torn meniscus. You review her PRN medications and see that she has an NSAID (ibuprofen) ordered every 6 hours. If you wanted to implement preventive pain measures when the patient arrives to your unit, what would you do?
- A. Use a pain scale to assess the patients pain, and let the patient know ibuprofen is available every 6 hours if she needs it.
- B. Do a complete assessment, and give pain medication based on the patients report of pain.
- C. Check for allergies, use a pain scale to assess the patients pain, and offer the ibuprofen every 6 hours until the patient is discharged.
- D. Provide medication as per patient request and offer relaxation techniques to promote comfort.
Correct Answer: C
Rationale: One way preventive pain measures can be implemented is by using PRN medications on a more regular or scheduled basis to allow for more uniform pain control. Smaller drug doses of medication are needed with the preventive pain method when PRN medications are given around the clock. Offering the medication is more beneficial than letting the patient know ibuprofen is available.