Nokea
Your patient has just returned from the postanesthetic care unit (PACU) following left tibia open reduction internal fixation (ORIF). The patient is complaining of pain, and you are preparing to administer the patients first scheduled dose of hydromorphone (Dilaudid). Prior to administering the drug, you would prioritize which of the following assessments?
- A. The patients electrolyte levels
- B. The patients blood pressure
- C. The patients allergy status
- D. The patients hydration status
Correct Answer: C
Rationale: Before administering medications such as narcotics for the first time, the nurse should assess for any previous allergic reactions. Electrolyte values, blood pressure, and hydration status are not what you need to assess prior to giving a first dose of narcotics.
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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.
The nurse is accepting care of an adult patient who has been experiencing severe and intractable pain. When reviewing the patients medication administration record, the nurse notes the presence of gabapentin (Neurontin). The nurse is justified in suspecting what phenomenon in the etiology of the patients pain?
- A. Neuroplasticity
- B. Misperception
- C. Psychosomatic processes
- D. Neuropathy
Correct Answer: D
Rationale: The anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) are first-line analgesic agents for neuropathic pain. Neuroplasticity is the ability of the peripheral and central nervous systems to change both structure and function as a result of noxious stimuli; this does not likely contribute to the patients pain. Similarly, psychosomatic factors and misperception of pain are highly unlikely.
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.
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 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.