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You are the nurse caring for a postsurgical patient who is Asian-American who speaks very little English. How should you most accurately assess this patients pain?
- A. Use a chart with English on one side of the page and the patients native language on the other so he can rate his pain.
- B. Ask the patient to write down a number according to the 0-to-10 point pain scale.
- C. Use the Visual Analog Scale (VAS).
- D. Use the services of a translator each time you assess the patient so you can document the patients pain rating.
Correct Answer: A
Rationale: Of the listed options, a language comparison chart is most plausible. The VAS requires English language skills, even though it is visual. Asking the patient to write similarly requires the use of English. It is impractical to obtain translator services for every pain assessment, since this is among the most frequently performed nursing assessments.
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A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical patients pain. What principle should guide the nurses use of placebos in pain management?
- A. Placebos require a higher level of informed consent than conventional care.
- B. Placebos are an acceptable, but unconventional, form of nonpharmacological pain management.
- C. Placebos are never recommended in the treatment of pain.
- D. Placebos require the active participation of the patients family.
Correct Answer: C
Rationale: Broad agreement is that there are no individuals for whom and no condition for which placebos are the recommended treatment. This principle supersedes the other listed statements.
The nurse caring for a 91-year-old patient with osteoarthritis is reviewing the patients chart. This patient is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this patient?
- A. Depression
- B. Chronic illness
- C. Inadequate pain control
- D. Drug interactions
Correct Answer: D
Rationale: Drug interactions are more likely to occur in older adults because of the higher incidence of chronic illness and the increased use of prescription and OTC medications. The other options are all good answers for this patient because of the patients age and disease process. However, they are not what the nurse would be most concerned about in terms of ensuring safety.
You are part of the health care team caring for an 87-year-old woman who has been admitted to your rehabilitation facility after falling and fracturing her left hip. The patient appears to be failing to regain functional ability and may have to be readmitted to an acute-care facility. When planning this patients care, what do you know about the negative effects of the stress associated with pain?
- A. Stress is less pronounced in older adults because they generally have more sophisticated coping skills than younger adults
- B. It is particularly harmful in the elderly who have been injured or who are ill.
- C. It affects only those patients who are already debilitated prior to experiencing pain.
- D. It has no inherent negative effects; it just alerts the person/health care team of an underlying disease process.
Correct Answer: B
Rationale: The widespread endocrine, immunologic, and inflammatory changes that occur with the stress of pain can have significant negative effects. This is particularly harmful in patients whose health is already compromised by age, illness, or injury. Older adults are not immune to the negative effects of stress. Prior debilitation does not have to be present in order for stress to cause potential harm.
You are caring for a patient admitted to the medical-surgical unit after falling from a horse. The patient states I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse. When planning the patients care, what variables should you consider? Select all that apply.
- A. How the presence of pain affects patients and families
- B. Resources that can assist the patient with pain management
- C. The influence of the patients cognition on her pain
- D. The advantages and disadvantages of available pain-relief strategies
- E. The difference between acute and intermittent pain
Correct Answer: A,B,D
Rationale: Nurses should understand the effects of chronic pain on patients and families and should be knowledgeable about pain-relief strategies and appropriate resources to assist effectively with pain management. There is no evidence of cognitive deficits in this patient and the difference between acute and intermittent pain has no immediate bearing on this patients care.
You are admitting a patient to your rehabilitation unit who has a diagnosis of persistent, severe pain. According to the patients history, the patients pain has not responded to conventional approaches to pain management. What treatment would you expect might be tried with this patient?
- A. Intravenous analgesia
- B. Long-term intrathecal or epidural catheter
- C. Oral analgesia
- D. Intramuscular analgesia
Correct Answer: B
Rationale: For patients who have persistent, severe pain that fails to respond to other treatments or who obtain pain relief only with the risk of serious side effects, medication administered by a long-term intrathecal or epidural catheter may be effective. The other listed means of pain control would already have been tried in a patient with persistent severe pain that has not responded to previous treatment.