ch. 10 MJ Flashcards
When doing a pain assessment for a patient who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the patient’s pain?
a. “How long have you had this pain?”
b. “How would you describe your pain?”
c. “How much medication do you take for the pain?”
d. “How many times a day do you medicate for pain?”
b. “How would you describe your pain?”
A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0 to 10 scale) and requests “something for pain that will work quickly.” The nurse will document this as
a. somatic pain.
b. referred pain.
c. neuropathic pain.
d. breakthrough pain.
d. breakthrough pain.
A postoperative patient asks the nurse how the prescribed ibuprofen (Motrin) will control the incisional pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing the
a. modulating effect of descending nerves.
b. sensitivity of the brain to painful stimuli.
c. production of pain-sensitizing chemicals.
d. spinal cord transmission of pain impulses.
c. production of pain-sensitizing chemicals.
A patient with chronic cancer pain is receiving imipramine (Tofranil) in addition to long-acting morphine for pain control. Which information is the best indicator that the imipramine is effective?
a. The patient sleeps 8 hours every night.
b. The patient has no symptoms of anxiety.
c. The patient states, “I feel much less depressed since I’ve been taking the imipramine.”
d. The patient states, “The pain is manageable, and I can accomplish my desired activities.
d. The patient states, “The pain is manageable, and I can accomplish my desired activities.
A patient with chronic abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. The nurse’s reply is based on the information that these strategies
a. impact the cognitive and affective components of pain.
b. increase the modulating effect of the efferent pathways.
c. prevent transmission of nociceptive stimuli to the cortex.
d. slow the release of transmitter chemicals in the dorsal horn.
a. impact the cognitive and affective components of pain.
A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which of these prescribed medications will be best for the nurse to administer?
a. lorazepam (Ativan) 1 mg orally
b. amitriptyline (Elavil) 10 mg orally
c. ibuprofen (Motrin) 400 to 800 mg orally
d. immediate-release morphine 30 mg orally
d. immediate-release morphine 30 mg orally
A patient with chronic back pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask?
a. “Can you describe the quality of your pain?”
b. “Has there been a change in the pain location?”
c. “How would you rate your pain on a 0 to 10 scale?”
d. “Does the pain keep you from doing things you enjoy?”
d. “Does the pain keep you from doing things you enjoy?”
A patient with second-degree burns has been receiving morphine through patient-controlled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. The most appropriate action by the nurse is to
a. administer a dose of morphine every 1 to 2 hours from the PCA machine while the patient is sleeping.
b. consult with the health care provider about using a different treatment protocol to control the patient’s pain.
c. request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
d. teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.
b. consult with the health care provider about using a different treatment protocol to control the patient’s pain.
When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side effect of the medication?
a. The patient has cramping abdominal pain.
b. The patient becomes restless and agitated.
c. The patient has not voided for over 10 hours.
d. The patient complains of a “pounding” headache
c. The patient has not voided for over 10 hours
When the nurse visits a hospice patient, the patient has a respiratory rate of 8 breaths/minute and complains of severe pain. Which action is best for the nurse to take?
a. Inform the patient that increasing the morphine will cause the respiratory drive to fail.
b. Administer a nonopioid analgesic, such as a nonsteroidal anti-inflammatory drug (NSAID), to improve patient pain control.
c. Tell the patient that additional morphine can be administered when the respirations are 12.
d. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.
d. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.
A patient with a history of chronic cancer pain is admitted to the hospital. When reviewing the patient’s home medications, which of these will be of most concern to the admitting nurse?
a. amitriptyline (Elavil) 50 mg at bedtime
b. oxycodone (OxyContin) 80 mg twice daily
c. ibuprofen (Advil) 800 mg 3 times daily
d. meperidine (Demerol) 25 mg every 4 hours
d. meperidine (Demerol) 25 mg every 4 hours
Which of these prescribed therapies should the nurse use first when caring for a patient with cancer pain that the patient describes as at “level 8 (0 to 10 scale), deep, and aching.”
a. fentanyl (Duragesic) patch
b. ketorolac (Toradol) tablets
c. hydromorphone (Dilaudid) IV
d. acetaminophen (Tylenol) suppository
c. hydromorphone (Dilaudid) IV
The nurse is caring for a diabetic patient who has chronic burning leg pain even when taking oxycodone (OxyContin) twice daily. Which of these prescribed medications is the best choice for the nurse to administer as an adjuvant to decrease the patient’s pain?
a. aspirin (Ecotrin)
b. celecoxib (Celebrex)
c. amitriptyline (Elavil)
d. acetaminophen (Tylenol)
c. amitriptyline (Elavil)
A patient who uses extended-release morphine sulfate (MS Contin) for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone (Vicodin) tablets, but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take?
a. Wake the patient and administer the hydrocodone.
b. Wait until the patient wakes up and reassess the pain.
c. Consult with the health care provider about changing the MS Contin dose.
d. Suggest the use of nondrug therapies for pain relief instead of additional opioids.
a. Wake the patient and administer the hydrocodone.
These medications are prescribed by the health care provider for a patient who uses long-acting morphine (MS Contin) for chronic back pain, but still has ongoing pain. Which medication should the nurse question?
a. morphine (Roxanol)
b. pentazocine (Talwin)
c. celecoxib (Celebrex)
d. dexamethasone (Decadron)
b. pentazocine (Talwin)
The nurse assesses a postoperative patient who is receiving morphine through patient-controlled analgesia (PCA). Which information is most important to report to the health care provider?
a. The patient complains of nausea after eating.
b. The patient’s respiratory rate is 10 breaths/minute.
c. The patient has not had a bowel movement for 3 days.
d. The patient has a distended bladder and has not voided.
b. The patient’s respiratory rate is 10 breaths/minute.
A patient who has chronic musculoskeletal pain tells the nurse, “I feel depressed because I ache too much to play golf.” The patient says the pain is usually at a level 7 (0 to 10 scale). Which patient goal has the highest priority when the nurse is developing the treatment plan?
a. The patient will exhibit fewer signs of depression.
b. The patient will say that the aching has decreased.
c. The patient will state that pain is at a level 2 of 10.
d. The patient will be able to play 1 to 2 rounds of golf.
d. The patient will be able to play 1 to 2 rounds of golf.
A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic pain complains of nausea and abdominal fullness. The best initial action by the nurse is to
a. administer the ordered antiemetic medication.
b. tell the patient that the nausea will subside in about a week.
c. order the patient a clear liquid diet until the nausea decreases.
d. consult with the health care provider about using a different opioid.
a. administer the ordered antiemetic medication.
A patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first?
a. Administer the prescribed PRN immediate-acting morphine.
b. Suggest the use of alternative therapies such as heat or cold.
c. Utilize distraction by talking about things the patient enjoys.
d. Consult with the doctor about increasing the MS Contin dose.
a. Administer the prescribed PRN immediate-acting morphine.
Which nursing action should the nurse delegate to nursing assistive personnel (NAP) when caring for a patient who is using a fentanyl (Duragesic) patch and a heating pad for treatment of chronic back pain?
a. Assess the skin under the heating pad.
b. Check the respiratory rate every 2 hours.
c. Monitor sedation using the sedation assessment scale.
d. Ask the patient about whether pain control is effective
b. Check the respiratory rate every 2 hours.
A patient who is using a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first?
a. Remove the fentanyl patch.
b. Notify the health care provider.
c. Continue to monitor the patient’s status.
d. Give the prescribed PRN naloxone (Narcan)
a. Remove the fentanyl patch.
These medications are ordered for an 86-year-old patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy?
a. aspirin (Bayer) 650 mg orally
b. naproxen (Aleve) 200 mg orally
c. oxycodone (Roxicodone) 5 mg orally
d. acetaminophen (Tylenol) 650 mg orally
d. acetaminophen (Tylenol) 650 mg orally
