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Flashcards in Geriatrics 5 Deck (25)
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1
Q

An older patient with a history of severe arthritis has not received pain medication for over 18 hours. The patient is currently complaining of severe pain in both legs. What will the nurse attribute as being the reason for the patient’s increase in pain?

  1. Dependency on narcotics
  2. Over-exaggeration of the amount of pain
  3. Need for alternative measures for pain relief
  4. Untreated pain resulting in lower pain threshold
A

4: With untreated pain, the nociceptors become sensitive and more responsive to stimuli resulting in a lowered pain threshold. This patient experienced a long period of time between administrations of pain medication, and this causes an increase in the pain experienced.

2
Q

The nurse is caring for two patients. An older patient reports abdominal pain as being 5 out of 10 on the pain rating scale, whereas a younger patient reports left lower quadrant abdominal pain as being 10 out 10 on the scale. What would the nurse identify as reason for the discrepancy between the two patients’ measurements of pain?

  1. Younger patients tend to be more dramatic when complaining of pain.
  2. Visceral pain is less severe in older patients and may be reported as mild.
  3. Visceral pain is more severe in older patients, but they are less likely to complain.
  4. Visceral pain is less severe in younger patients but is reported as high in intensity.
A

2: Visceral pain is often less severe in the older patient and reported with vague complaints. This often is an explanation for the higher incidence of silent myocardial infarctions and less dramatic presentations of abdominal problems requiring surgery in older adults.

3
Q

An older patient living at home with cancer reports having to take twice as much pain medication over the last 24 hours. What should the nurse do with this information?

  1. Adjust the medication as needed.
  2. Discuss options to treat breakthrough pain.
  3. Try alternative methods for pain relief instead of pain medication.
  4. Talk with the physician to change the medication because of opioid tolerance.
A

2: If the patient experiences breakthrough pain on a consistent basis, the nurse should notify the patient’s provider so that the dose of the long-acting, sustained-release preparation can be increased to more effectively control the pain.

4
Q

An older patient with headaches, dizziness, and ataxia takes meperidine for arthritic pain. What impact does this medication have on this patient’s health problems?

  1. This medication is not causing the patient’s symptoms.
  2. This medication is not effective in older patients for pain relief.
  3. This medication is more effective to treat pain than aspirin or acetaminophen.
  4. This medication causes toxic side effects similar to what the patient is experiencing.
A

4: Meperidine is not recommended for treatment of persistent pain in older persons because it tends to cause accumulations of toxic metabolites that can cause delirium, ataxia, and dizziness.

5
Q

The nurse is caring for an older patient with chronic pain caused by arthritis and uterine cancer. What is the best approach for the nurse to take when managing this patient’s pain?

  1. Administering the pain medication around the clock
  2. Administering the medication when the patient requests it
  3. Consulting the physician to order intravenous pain medication
  4. Administering the medication sparingly to avoid narcotic addiction
A

1: Pain medication is best when it is administered around the clock.

6
Q

An older patient asks why sustained-release pain medication cannot be chewed. How should the nurse respond to this patient?
Standard Text: Select all that apply.
1. Chewing deactivates the medication.
2. The medication is damaging to the teeth and gums.
3. Chewing destroys their controlled-release properties.
4. The saliva in the mouth breaks the medication down and makes it toxic.
5. Chewing causes a rapid absorption of the entire dose and a possible overdose.

A

3: Chewing sustained-release preparations of analgesics destroys their controlled-release properties.
5: Chewing sustained-release preparations of analgesics causes rapid absorption of the entire dose, resulting in possible overdose.

7
Q

An older patient with a speech deficit from a previous stroke is admitted for a repair of a hip fracture. Which techniques will the nurse use to assess this patient’s pain level?
Standard Text: Select all that apply.
1. Ask to describe the level of pain.
2. Observe for tense body posturing.
3. Listen for sounds such as groaning.
4. Notice changes in appetite or sleep.
5. Observe facial expressions such as grimacing.

A

2: Tense body posturing is a pain behavior that the patient who is unable to speak might demonstrate.
3: Sounds such as groaning are pain behaviors that the patient who is unable to speak might demonstrate.
4: Changes in appetite or sleep are pain behaviors that the patient who is unable to speak might demonstrate.
5: Grimacing is a pain behavior that the patient who is unable to speak might demonstrate.

8
Q

An older patient recovering from surgery is prescribed morphine sulfate 2 to 6 mg every 4 hours prn for pain. What approach will the nurse take to manage this patient’s pain?

  1. Administer the lowest dose of 2 mg.
  2. Administer the highest dose of 6 mg.
  3. Avoid the narcotic for risk of addiction.
  4. Administer the dose only when the patient asks for the medication.
A

1: Older patients usually have more sensitivity to opioid analgesics, and most often these patients are started on smaller doses to avoid toxicity. The dose is then titrated upward until effective pain relief is achieved without adverse effects.

9
Q

An older patient with a history of constipation is prescribed an opioid analgesic for postoperative pain. What should the nurse include in this patient’s plan of care to avoid the pain management complication of constipation?
Standard Text: Select all that apply.
1. Mix psyllium in 4 ounces of water.
2. Provide stool softeners as prescribed.
3. Monitor for adequate daily fluid intake.
4. Increase ingestion of fresh fruit each day.
5. Offer senna tea each evening before sleep.

A

2: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Stool softeners should be provided as prescribed.
3: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. The patient should be encouraged to increase the oral fluid intake.
4: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Fruits may also be helpful to prevent constipation.
5: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Senna tea may also be helpful to prevent constipation.

10
Q

The nurse is planning to implement nonpharmacological approaches with an older patient with chronic osteoarthritis pain. What should the nurse keep in mind when implementing these approaches?

  1. The effectiveness of nonpharmacological approaches is questionable.
  2. Nonpharmacological approaches are less effective in the older patient.
  3. Nonpharmacological approaches are more effective in the older patient.
  4. Nonpharmacological approaches are effective when used with pharmacological therapy.
A

4: Greater reductions in pain are seen when pharmacological and
nonpharmacological techniques are combined.

11
Q

An older patient is prescribed topical capsaicin for joint pain. What should the nurse instruct the patient about the use of this medication?
Standard Text: Select all that apply.
1. Avoid getting the medication in the eyes.
2. This medication will react with other medications.
3. It will cause a burning sensation when first applied.
4. Do not permit the medication to touch an open wound.
5. The burning sensation will decrease with subsequent uses.

A

1: The patient should be instructed to avoid getting capsaicin in the eyes as this will cause burning.
3: The patient should be instructed that this medication will cause a burning sensation when first applied.
4: The patient should be instructed to avoid getting capsaicin in an open wound since it will cause burning.
5: The patient should be instructed that the burning sensation from capsaicin will decrease when applied frequently.

12
Q
The nurse learns that an older patient with chronic pain is not a candidate for the nonpharmacological pain management approach of massage. For which health problems is massage contraindicated?
Standard Text: Select all that apply.
1. Cancer
2. Fractures
3. Bleeding disorders
4. Low platelet counts
5. Deep vein thrombosis
A

2: Massage is contraindicated in patients with fractures.
3: Massage is contraindicated in patients with bleeding disorders.
4: Massage is contraindicated in patients with low platelet counts.
5: Massage is contraindicated in patients with deep vein thrombosis.

13
Q
An older patient, experiencing severe pain from diabetic neuropathy, is having minimal pain relief from opioid analgesics. Which adjuvant medications should the nurse ask the healthcare provider to consider helping this patient's pain?
Standard Text: Select all that apply.
1. Calcitonin
2. Muscle relaxants
3. Topical analgesics
4. Tricyclic antidepressant
5. Antianxiety medications
A

3: Topical analgesics are helpful for the pain of diabetic neuropathy.
4: Tricyclic antidepressants are helpful for the pain of diabetic neuropathy.

14
Q

A terminally ill older patient with ongoing pain is prescribed an increased dose of morphine. What should the nurse consider when providing this dose of pain medication to the patient?

  1. The ultimate goal for the patient is to control pain.
  2. The organization’s attorney should be made aware of the physician’s order.
  3. The nurse may be charged with a crime for administering the medication dose.
  4. It is more important to ensure the patient does not experience respiratory depression.
A

1: Management of pain in terminal conditions may call for higher doses of opioids; however, pain should be treated aggressively to maximize comfort, even if the unintended effect of treatment results in the hastening of death.

15
Q

An older patient with renal disease and advanced cancer pain asks for stronger pain medication. What does the nurse need to take into consideration when determining which prescribed pain medication to provide to this patient?

  1. Methadone is a viable option for this patient.
  2. Meperidine is the most versatile opioid available.
  3. Oral morphine may be a starting point to be considered for this patient.
  4. Fentanyl is often the first opioid tried because of the low incidence of side effects.
A

3: Morphine is a commonly used and versatile opioid for the treatment of moderate to severe pain. Short- and long-acting formulations exist, and the drug can be delivered via many routes including oral form.

16
Q

An older patient receiving a low dose of oral morphine for chronic pain feels sleepy when taking the medication. What should the nurse explain to the patient about this analgesic?

  1. “Lowering the dose may reduce these feelings.”
  2. “Unfortunately you will need to change medications.”
  3. “Feeling sleepy is an unfortunate problem with morphine.”
  4. “Once you develop a tolerance to the medications, this will improve.”
A

4: Opioid analgesic use is associated with mild sedation initially. Once tolerance develops, the drowsiness should be lessened.

17
Q

An older patient with chronic pain is newly prescribed transdermal fentanyl. What will the nurse do when providing this medication?
Standard Text: Select all that apply.
1. Monitor liver function tests.
2. Use the lowest possible dose.
3. Anticipate and treat side effects.
4. Apply the patch to clean, dry, hairless skin.
5. Provide the patient with oral pain medications the first day the patch it used.

A

4: The nurse should apply the transdermal fentanyl patch to
clean, dry, hairless skin.
5: Since the peak effects of the first dose of transdermal fentanyl take 24 hours, the patient should be covered with oral pain medications the first day of application.

18
Q

An older patient receiving intravenous morphine sulfate is experiencing nausea and vomiting. What action should the nurse take at this time?

  1. Provide the patient with meperidine for pain as prescribed.
  2. Suspend the use of morphine and use a different opioid analgesic.
  3. Provide a prescribed antiemetic for a few days and gradually taper it.
  4. Discuss using nonopioid analgesics since the patient cannot tolerate them.
A

3: Opioid analgesics are associated with nausea and vomiting. The use of an antiemetic can be implemented for a short period and then withdrawn. The patient will then be able to tolerate the opioid.

19
Q

The nurse observes myoclonic movements in an older patient receiving morphine sulfate for pain. What should the nurse do with this finding?

  1. Contact the prescribing physician.
  2. Observe the patient for more movements.
  3. Document the finding in the patient’s medical record.
  4. Send a blood sample to the lab to analyze the drug level.
A

1: Myoclonic jerking movements may be associated with high-dose opioid therapy especially morphine. An alternate opioid should be used if this occurs and the physician needs to be contacted to change the medication order.

20
Q

An older patient newly diagnosed with arthritis wants to know what else can be done to help with the pain. What should the nurse instruct this patient?
Standard Text: Select all that apply.
1. Maintain a healthy weight.
2. Avoid positions that increase or cause pain.
3. Avoid eating red meat and processed grains.
4. Alcohol should not be used for pain control.
5. Perform regular gentle exercise like walking every day for 20 minutes.

A

1: Weight control reduces pain, especially in older patients.
2: Recognizing what avoidable positions cause pain will help reduce the amount of pain from the arthritis.
5: Regular exercise strengthens muscles that support painful joints and may help speed recovery, prevent injury, and reduce disability.

21
Q

An older patient recovering from surgery refuses pain medication because of the fear of becoming addicted. What action should the nurse take at this time?

  1. Contact the physician.
  2. Administer the medication when the patient is sleeping.
  3. Withhold the analgesic medication and continue to observe the patient.
  4. Determine what methods of pain management are acceptable to the patient.
A

4: The risk of addiction in the elderly is rare. Additionally, the risk of addiction is limited when managing acute pain. The patient is in pain. Management of the pain is the priority. Determining what the patient will consider using is important. During the review of acceptable pain management interventions, the lines of communication will remain open and the patient may reconsider the decision.

22
Q

An older patient with mild arthritis pain asks the nurse what can be taken to help with the minor discomfort. How should the nurse respond to this patient?

  1. Ibuprofen should be used on an empty stomach.
  2. Aspirin in the best choice because it has fewer side effects.
  3. Acetaminophen (Tylenol) is a good choice for mild pain, but check with your doctor.
  4. Nonsteroidal anti-inflammatory medications are used for patients with a stomach ulcer history.
A

3: Acetaminophen (Tylenol) is a good choice for mild to moderate pain caused by osteoarthritis. The patient should check with the healthcare provider about the dose if he is going to take it for more than a few days.

23
Q

An older patient prescribed an oral time-released pain medication is having difficulty swallowing the dose. What should the nurse do to help this patient?

  1. Teach the patient to chew the medication.
  2. Give the same medication through a parenteral route.
  3. Consult with the physician to have the medication route changed.
  4. Contact the pharmacy to have the oral route changed to transdermal.
A

3: The nurse should discuss the patient’s inability to swallow the medication with the physician so that an alternative route can be determined.

24
Q

The spouse of an older patient asks that the patient be given pills and to tell the patient that they are for pain. How should the nurse respond to the spouse’s request?

  1. “I cannot do that.”
  2. “We can investigate this option.”
  3. “Let’s speak with the physician about this request.”
  4. “Administering a ‘placebo’ or fake medication is not ethical.”
A

4: The use of placebos is not ethical in clinical practice for management of pain. Placebos should be limited to research protocols where patients have given informed consent and are aware that they may receive an inert medication as part of the research protocol.

25
Q

An older patient with chronic low back pain asks the nurse if there is anything else besides taking pain medication that the patient can do to help with the discomfort. What recommendation can the nurse safely make to the patient?

  1. Sign up for a Tai Chi class.
  2. Yoga has been found to be helpful.
  3. Avoid spinal manipulation therapy.
  4. Talk with your doctor about getting a prescription for vitamins.
A

2: Yoga can reduce functional disability, pain, and depression in people with low back pain.