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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.
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The home health nurse is developing a plan of care for a patient who will be managing his chronic pain at home. Using the nursing process, on which concepts should the nurse focus the patient teaching?
- A. Self-care and safety
- B. Autonomy and need
- C. Health promotion and exercise
- D. Dependence and health
Correct Answer: A
Rationale: The patient will be at home monitoring his own pain management, administering his own medication, and monitoring and reporting side effects. This requires the ability to perform self-care activities in a safe manner. Creating autonomy is important, but need is a poorly defined concept. Health promotion is an important global concept for maintaining health, and exercise is an appropriate activity; however, self-care and safety are the priorities. Dependence is not a concept used to develop a nursing plan of care, and health is too broad a concept to use as a basis for a nursing plan of care.
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.
You are the emergency department (ED) nurse caring for an adult patient who was in a motor vehicle accident. Radiography reveals an ulnar fracture. What type of pain are you addressing when you provide care for this patient?
- A. Chronic
- B. Acute
- C. Intermittent
- D. Osteopenic
Correct Answer: B
Rationale: Acute pain is usually of recent onset and commonly associated with a specific injury. Acute pain indicates that damage or injury has occurred. Chronic pain is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributed to a specific cause or injury. Phantom pain occurs when the body experiences a loss, such as an amputation, and still feels pain in the missing part. Osteopenic pain is not a recognized category of pain.
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.
You are the nurse caring for the 25-year-old victim of a motor vehicle accident with a fractured pelvis and a ruptured bladder. The nurses aide (NA) tells you that she is concerned because the patients resting heart rate is 110 beats per minute, her respirations are 24 breaths per minute, temperature is 99.1 F axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as you assess this patients physiologic status?
- A. The patients understanding of pain physiology
- B. The patients serum glucose level
- C. The patients white blood cell count
- D. The patients rating of her pain
Correct Answer: D
Rationale: The nurses assessment of the patients pain is a priority. There is no suggestion of diabetes and leukocytosis would not occur at this early stage of recovery. The patient does not need to fully understand pain physiology in order to communicate the presence, absence, or severity of pain.