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Your patient is 12-hours post ORIF right ankle. The patient is asking for a breakthrough dose of analgesia. The pain-medication orders are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner?
- A. To prevent respiratory depression from the opioid
- B. To eliminate the need for additional medication during the night
- C. To achieve better pain control than with one medication alone
- D. To eliminate the potentially adverse effects of the opioid
Correct Answer: C
Rationale: A multimodal regimen combines drugs with different underlying mechanisms, which allows lower doses of each of the drugs in the treatment plan, reducing the potential for each to produce adverse effects. This method also reduces, but does not eliminate, adverse effects of the opioid. This regimen is not motivated by the need to prevent respiratory depression or to eliminate nighttime dosing.
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A patients intractable neuropathic pain is being treated on an inpatient basis using a multimodal approach to analgesia. After administering a recently increased dose of IV morphine to the patient, the nurse has returned to assess the patient and finds the patient unresponsive to verbal and physical stimulation with a respiratory rate of five breaths per minute. The nurse has called a code blue and should anticipate the administration of what drug?
- A. Acetylcysteine
- B. Naloxone
- C. Celecoxib
- D. Acetylsalicylic acid
Correct Answer: B
Rationale: Severe opioid-induced sedation necessitates the administration of naloxone, an opioid antagonist. Celecoxib, acetylcysteine, and acetylsalicylic acid are ineffective.
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.
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 caring for a patient with sickle cell disease in her home. Over the years, there has been joint damage, and the patient is in chronic pain. The patient has developed a tolerance to her usual pain medication. When does the tolerance to pain medication become the most significant problem?
- A. When it results in inadequate relief from pain
- B. When dealing with withdrawal symptoms resulting from the tolerance
- C. When having to report the patients addiction to her physician
- D. When the family becomes concerned about increasing dosage
Correct Answer: A
Rationale: Tolerance to opioids is common and becomes a problem primarily in terms of maintaining adequate pain control. Symptoms of physical dependence may occur when opiates are discontinued, but there is no indication that the patients medication will be discontinued. This patient does not have an addiction and the familys concerns are secondary to those of the patient.
A nurse on an oncology unit has arranged for an individual to lead meditation exercises for patients who are interested in this nonpharmacological method of pain control. The nurse should recognize the use of what category of nonpharmacological intervention?
- A. A body-based modality
- B. A mind-body method
- C. A biologically based therapy
- D. An energy therapy
Correct Answer: B
Rationale: Meditation is one of the recognized mind-body methods of nonpharmacological pain control. The other answers are incorrect.