Chp 44 Pain Mngmt Exam 87 Questions with Verified Answers,100% CORRECT

Chp 44 Pain Mngmt Exam 87 Questions with Verified Answers Intro - CORRECT ANSWER Pain is often under-recognized, misunderstood, and inadequately treated. Subjective No two people experience pain in the same way. Nurses are legally and ethically responsible for assessing and managing pain. Pain management should be patient centered, with nurses practicing patient advocacy, empowerment, compassion, and respect Scientific Knowledge Base - CORRECT ANSWER Gate-Control Theory of Pain ØPhysiological responses ØBehavioral responses Acute and chronic pain ØAcute/transient pain ØChronic/persistent noncancer pain ØChronic episodic pain ØCancer pain ØIdiopathic pain Nursing Knowledge Base - CORRECT ANSWER Knowledge, attitudes, and beliefs ØAttitude of health care providers ØMalingerer, complainer, or difficult patient Nurses' assumptions about patients in pain ØLimit ability to offer pain relief ØDo not believe if patient does not appear in pain ØMust accept a patient's report of pain ØView experience through the patient's eyes Factors Influencing Pain - CORRECT ANSWER Physiological ØAge ØFatigue ØGenes ØNeurological function Social ØPrevious experience ØFamily and social network ØSpiritual factors Psychological factors ØAttention ØAnxiety and fear ØCoping style Cultural factors ØMeaning of pain ØEthnicity Critical Thinking - CORRECT ANSWER Knowledge of pain physiology and the many factors that influence pain help you manage a patient's pain. Critical thinking attitudes and intellectual standards ensure the aggressive assessment, creative planning, and thorough evaluation needed to obtain an acceptable level of patient pain relief, while balancing treatment benefits with treatment associated risks. Assessment - CORRECT ANSWER Through the patient's eyes ØAsk the patient's pain level ØUse ABCs of pain management ØPain is not a number Patient's expression of pain Physical examination Characteristics of pain ØTiming (onset, duration, and pattern) Patient's expression of pain ØPain is individualistic Physical examination Characteristics of pain ØTiming ØLocation ØSeverity Pain scales - CORRECT ANSWER ØNumerical rating scale ØVerbal descriptive scale ØVisual analog scale ØWong-Baker Faces Pain Rating Scale Assessment 2 - CORRECT ANSWER Characteristics of pain ØQuality ØAggravating and precipitating factors ØRelief measures Effects of pain on the patient ØBehavioral effects ØInfluence on activities of daily living (ADLs) Concomitant symptoms ØUsually increases pain severity 1. When a smiling and cooperative patient complains of discomfort, nurses caring for this patient often harbor misconceptions about the patient's pain. Which of the following is true? A. Chronic pain is psychological in nature. B. Patients are the best judges of their pain. C. Regular use of narcotic analgesics leads to drug addiction. D. Amount of pain is reflective of actual tissue damage. - CORRECT ANSWER B. Patients are the best judges of their pain. Nursing Diagnosis - CORRECT ANSWER Examples of other diagnoses that may be related to pain: ØDifficulty Coping ØFatigue ØImpaired Mobility ØImpaired Sleep Social Isolation Planning - CORRECT ANSWER Analyze information from multiple sources. Apply critical thinking Adhere to professional standards Use a concept map Goals and outcomes Setting priorities Teamwork and collaboration Implement: Health promotion - CORRECT ANSWER Health promotion ØUse different types of pain-relief measures. ØBe willing to use more than one type of pain relief measure as appropriate. ØUse measures that the patient believes are effective. ØKeep an open mind about ways to relieve pain. ØKeep trying. ØAlthough pain may not be totally eliminated, substantial improvement in function is realistic. Maintaining wellness Nonpharmacological pain-relief interventions - CORRECT ANSWER ØCognitive and behavioral approach ØRelaxation and guided imagery ØDistraction ØMusic ØCutaneous stimulation ØHerbals ØReducing pain perception and reception Acute Care - CORRECT ANSWER Acute care: pharmacological pain therapies ØAnalgesics •Nonopioids •Opioids •Adjuvants/co-analgesics Acute care: pharmacological pain therapies -Patient-controlled analgesia ØTopical and transdermal analgesics ØLocal anesthesia via injection ØPerineural local anesthetic infusion ØEpidural analgesia Cancer - CORRECT ANSWER Cancer pain and chronic noncancer pain management ØBreakthrough cancer pain ØOpioids should be used judiciously ØWHO three-step analgesic ladder 2. A patient has just undergone an appendectomy. When discussing with the patient several pain-relief interventions, the most appropriate recommendation would be: A. adjunctive therapy. B. nonopioids. C. NSAIDs. D. PCA pain management. - CORRECT ANSWER D. PCA pain management 3. A postoperative patient is using PCA. You will evaluate the effectiveness of the medication when: A. you compare assessed pain w/baseline pain. B. body language is incongruent with reports of pain relief. C. family members report that pain has subsided. D. vital signs have returned to baseline. - CORRECT ANSWER A. you compare assessed pain w/baseline pain. Evaluation - CORRECT ANSWER Through the patient's eyes ØPatients help decide the best times to attempt pain treatments ØThey are the best judge of whether a pain-relief intervention works Patient outcomes Evaluate for change in the severity and quality of the pain Safety Guidelines for Nursing Skills - CORRECT ANSWER The patient is the only person who should press the button to administer the pain medication when PCA is used. Monitor the patient for signs and symptoms of oversedation and respiratory depression. Monitor for potential side effects of opioid analgesics. nociception - CORRECT ANSWER In contrast to pain being a first-person, subjective perception, nociception is defined as an observable activity in the nervous system in response to an adequate stimulus (third-person perspective) (Treede, 2018). Normal or nociceptive pain is the protective physiologic series of events that bring awareness of actual or potential tissue damage. There are four physiological processes of nociception: transduction, transmission, perception, and modulation (Das, 2015). A patient in pain cannot discriminate among the processes. Understanding each process helps you recognize factors that cause pain, symptoms that accompany it, and the rationale for selected therapies. Transduction - CORRECT ANSWER Transduction is the process whereby an activated nociceptor converts energy produced by these stimuli (e.g., exposure to pressure or a hot surface) into an action potential. Once transduction is complete, transmission of the nociceptive impulse begins. Inflammation caused by disease processes or cellular damage resulting from thermal, mechanical, or chemical stimuli cause the release of vasoactive and pro-nociceptive mediators such as prostaglandins, bradykinin, substance P, and histamine Neurophysiology of Pain: Neuroregulators - CORRECT ANSWER FIG. 44.1 Chemical synapses involve transmitter chemicals (neurotransmitters) that signal postsynaptic cells. - CORRECT ANSWER Spinothalamic pathway that conducts pain stimuli to the brain. - CORRECT ANSWER Modulation - CORRECT ANSWER Projection neurons activate endogenous descending inhibitory mediators (see Box 44.1), such as endorphins (endogenous opioids), serotonin, norepinephrine, and gamma-aminobutyric acid (GABA), that aid in producing an analgesic effect. These mediators hinder the transmission of nociceptive impulses in the dorsal horn neurons. This inhibition of the pain impulse is the fourth and last phase of the normal pain process known as modulation (Pasero and McCaffery, 2011). Modulation can also occur through peripheral and/or central sensitization, resulting in increased perception of pain (Bourne et al., 2014). Afferent nerve fibers sensitized by vasoactive and pronociceptive mediators lower the threshold of activation and result in continuous nociceptive input to dorsal horn neurons and central sensitization. Clinical manifestations of central sensitization include expansion of the pain beyond the initial location, exaggerated response to noxious stimuli known as hyperalgesia, and pain in response to normally non-noxious stimuli, also called allodynia. Physiological Reactions to Pain - CORRECT ANSWER Acute Pain - CORRECT ANSWER Acute pain is protective, usually has an identifiable cause, is of short duration, and has limited tissue damage and emotional response. It is common after acute injury, disease, or surgery. Acute pain warns people of injury or disease; thus it is protective. It eventually resolves, with or without treatment, after an injured area heals. Patients in acute pain are frightened and anxious and expect relief quickly. It is self-limiting; therefore a patient knows that an end is in sight. Because acute pain has a predictable ending (healing) and an identifiable cause, health team members are usually willing to treat it aggressively. Chronic/Persistent Noncancer Pain - CORRECT ANSWER Chronic pain affects more than 50 million American adults, and among those affected, nearly 20 million live with high-impact chronic pain (Dahlhamer et al., 2018). Unlike acute pain, chronic pain is not protective and thus serves no purpose, but it has a dramatic effect on a person's quality of life. Chronic noncancer pain is ongoing or recurrent pain that lasts beyond the usual course of an acute illness or the healing of an injury (more than 3 to 6 months) and that adversely affects an individual's well-being Classification of Pain By Inferred Pathology - CORRECT ANSWER Idiopathic Pain - CORRECT ANSWER Idiopathic pain is chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition. An example of idiopathic pain is complex regional pain syndrome (CRPS). Research is needed to better identify the causes of idiopathic pain to identify more effective treatments. Common Biases and Misconceptions About Pain - CORRECT ANSWER Focus on Older AdultsFactors Influencing Pain in Older Adults - CORRECT ANSWER pain in infants - CORRECT ANSWER Misconceptions About Pain in Older Adults - CORRECT ANSWER pain threshold - CORRECT ANSWER Research on healthy human subjects suggests that genetic information passed on by parents possibly increases or decreases a person's sensitivity to pain and determines pain threshold or tolerance. Recent advances in the study of genetics and pain have shown that even slight changes in deoxyribonucleic acid (DNA) or expression of genes could partly explain individual differences in pain. Numerous genetic risk factors have been identified for pain in musculoskeletal, neuropathic, and vascular conditions, as well as migraine (Zorina-Lichtenwalter et al., 2016) Genetic influences have been shown to play 1067a role in sensitivity, perception, and expression of pain in a variety of conditions (James, 2013). As a nurse you may encourage patients who have persistent pain syndromes to seek genetic counseling. Cultural Aspects of CareAssessing Pain in Culturally - CORRECT ANSWER Nursing Assessment Questions - CORRECT ANSWER Routine Clinical Approach to Pain Assessment and Management: ABCDE - CORRECT ANSWER A: Ask about pain regularly. Assess pain systematically. B: Believe patient and family in their report of pain and what relieves it. C: Choose pain control options appropriate for the patient, family, and setting. D: Deliver interventions in a timely, logical, and coordinated fashion. E: Empower patients and their families. Enable them to control their course to the greatest extent possible. Possible Sources for Error in Pain Assessment - CORRECT ANSWER Evidence-Based PracticePain Assessment in the Nonverbal Patient - CORRECT ANSWER Classification of Pain By Location - CORRECT ANSWER Behavioral Indicators of Effects of Pain - CORRECT ANSWER Nursing Diagnostic Process Chronic Pain - CORRECT ANSWER Nursing Care Plan: Assessment/Planning - CORRECT ANSWER Nursing Care Plan: intervention - CORRECT ANSWER Nursing Care Plan: Evaluation - CORRECT ANSWER Nonpharmacological Pain-Relief Interventions - CORRECT ANSWER Nonpharmacological interventions can be used alone or in combination with pharmacological measures. However, in the case of moderate to severe acute pain, nonpharmacological therapies should not be used in place of pharmacological therapies. A number of nonpharmacological interventions are available for lessening pain. Evidence-based therapies include acupuncture and massage, osteopathic and chiropractic manipulation, cognitive-behavioral intervention, meditative movement and mind-body interventions, and dietary and self-management approaches to pain management. Researchers suggest that these evidence-based nonpharmacological interventions should be used routinely to provide a comprehensive plan for pain management, although the effectiveness may vary depending on the type of pain that the patient is experiencing and the patient's belief in the therapy. Both active (physical movement) and passive nonpharmacological strategies can target different pathways for pain relief while increasing physical functioning. For example, cognitive-behavioral interventions change patients' perceptions of pain, alter pain behavior, and provide patients with a greater sense of control. Distraction, prayer, mindfulness, relaxation, guided imagery, music, and biofeedback are examples of therapies frequently initiated by nurses Relaxation and Guided Imagery - CORRECT ANSWER Relaxation and guided imagery allow patients to alter affective-motivational and cognitive pain perception. Relaxation is mental and physical freedom from tension or stress that provides individuals a sense of self-control. You use relaxation techniques at any phase of health or illness. Physiological and behavioral changes associated with relaxation include decreased pulse, blood pressure, and respirations; heightened awareness; decreased oxygen consumption; a sense of peace; and decreased muscle tension and metabolic rate (Tick et al., 2018). Relaxation techniques include meditation, yoga, Zen, guided imagery, and progressive relaxation exercises (see Chapter 32). For effective relaxation, teach techniques only when a patient is not distracted by acute discomfort. Sometimes a combination of these techniques is needed to achieve optimal pain relief. With practice the patient performs relaxation exercises independently. Cutaneous Stimulation - CORRECT ANSWER Stimulation of the skin through a massage, warm bath, cold application, or transcutaneous electrical nerve stimulation (TENS) may reduce pain perception. How cutaneous stimulation works is unclear. One suggestion is that it causes release of endorphins, thus blocking the transmission of painful stimuli. The gate-control theory suggests that cutaneous stimulation activates larger, faster-transmitting A-beta sensory nerve fibers. This closes the gate, thus decreasing pain transmission through small-diameter C fibers Procedural Guidelines Massage - CORRECT ANSWER Controlling Painful Stimuli in Patient's Environment - CORRECT ANSWER Analgesics - CORRECT ANSWER Analgesics are the most common and effective method of pain relief. Nurses need to understand the medications available for pain relief, indications for use and pharmacological effects, and risks for addiction. Reassure patients that treatment of pain is necessary to aid recovery and that nonpharmacological strategies can be used to augment the effectiveness of analgesics, healing, and pain relief. There are three types of analgesics: (1) nonopioids, including acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs); (2) opioids (traditionally called narcotics); and (3) adjuvants or co-analgesics, a variety of medications that enhance analgesics or have analgesic properties (US Department of Veterans Affairs, 2017). Nonopioids. Acetaminophen (Tylenol), considered one of the most tolerated and safest analgesics available, is available in a variety of over-the-counter (OTC) oral medications (e.g., cold and flu remedies) or rectal forms and in an intravenous (IV) preparation (Ofirmev). Opioids. Opioid or opioid-like analgesics are prescribed for moderate-to-severe pain. In any acute pain situation, opioids are not always necessary, but with severe trauma and immediately postoperatively, short-term use of opioid medications (3-5 days) is rarely a problem although side effects are most problematic when initiating treatment Common Opioid Side Effects - CORRECT ANSWER Multimodal analgesia - CORRECT ANSWER Careful assessment and critical thinking are required to safely administer analgesics (Box 44.14). The current pharmacological approach to acute and chronic pain management is to provide multimodal analgesia . Multimodal analgesia combines drugs with at least two different mechanisms of action to optimize pain control. Medications are combined to target different sites in the peripheral or central pain pathways (Fig. 44.10). The use of different agents allows for lower-than-usual doses of each medication, which is a benefit of multimodal analgesia. A multimodal regimen lowers the risk of side effects while providing pain relief that is as good as or even better than could be obtained from each of the medications alone. Nursing Principles for Administering Analgesics - CORRECT ANSWER Patient Characteristics Associated with Higher Risk for Opioid-Related Adverse Drug Events - CORRECT ANSWER Key Steps for Safe Opioid Use - CORRECT ANSWER Adjuvants - CORRECT ANSWER Adjuvants. Co-analgesics or adjuvants are drugs originally developed to treat conditions other than pain but that also have analgesic properties. For example, tricyclic antidepressants (e.g., nortriptyline), anticonvulsants (e.g., gabapentin), and infusional lidocaine successfully treat chronic pain, especially neuropathic pain. Corticosteroids relieve the pain from inflammation and bone metastasis. Other examples of co-analgesics are bisphosphonates and calcitonin for bone pain. Adjuvants have analgesic properties, enhance pain control, or relieve other symptoms associated with neuropathic pain. You give adjuvants alone or with analgesics. Sedatives, antianxiety agents, and muscle relaxants have no analgesic effect, although they may be effective for their specific indications. patient-controlled analgesia (PCA) - CORRECT ANSWER A drug delivery system called patient-controlled analgesia (PCA) is a method for pain management that many patients prefer (see Skill 44.1). It is a drug delivery system that allows patients to self-administer opioids (usually morphine, hydromorphone, or fentanyl) with minimal risk of overdose. The goal is to maintain a constant plasma level of analgesic to avoid the problems of prn dosing. Systemic PCA traditionally involves IV or subcutaneous drug administration; however, a controlled analgesia device for oral medications is available. This device allows patients access to their own oral prn mediations, including opioids and other analgesics, antiemetics, and anxiolytics, at the bedside. Patient Teaching Patient-Controlled Analgesia - CORRECT ANSWER Local Anesthesia via Injection - CORRECT ANSWER Local anesthesia is the local infiltration of an anesthetic medication to induce loss of sensation to a body part. Health care providers often use local anesthesia during brief surgical procedures such as removing a skin lesion or suturing a wound by applying local anesthetics topically on skin and mucous membranes or injecting them subcutaneously or intradermally to anesthetize a body part. Regional anesthesia is the injection or infusion of local anesthetics to block a group of sensory nerve fibers. The anesthetics produce temporary loss of sensation by inhibiting nerve conduction. Local anesthetics also block motor and autonomic functions, depending on the amount used and the location and depth of administration. Smaller sensory nerve fibers are more sensitive to local anesthetics than are large motor fibers. As a result, the patient loses sensation before losing motor function; conversely, motor activity returns before sensation. Perineural Local Anesthetic Infusion - CORRECT ANSWER A type of regional anesthesia is the use of perineural injections and infusions of local anesthetic agents to relieve pain. This technique is used for a variety of inpatient and outpatient adult and pediatric surgical procedures. A surgeon places the tip of an unsutured catheter near a nerve or groups of nerves, and the catheter exits from the surgical wound. Infusions of local anesthetics (bupivacaine or ropivacaine) may be run on a pump similar to those used for IV infusions, on ambulatory pumps, or on disposable systems (e.g., On-Q). The pump may be set on demand or continuous mode, and the catheter is usually left in place for 48 hours. Some patients have pump systems that are left in place even after discharge. Patients learn how to discontinue the pump at home and bring the catheter to the next health care provider visit. Some patients still need oral analgesics, but perineural infusions Epidural Analgesia - CORRECT ANSWER Another pain therapy that often involves the administration of anesthetic agents is epidural analgesia, a form of regional anesthesia. Preservative-free opioids are often administered as single agents or in combination with local anesthetics into a patient's epidural space. Epidural analgesia effectively treats acute postoperative pain, rib fracture pain, labor and delivery pain, and chronic cancer pain. Research has shown that adults having surgery under general anesthesia experience fewer postoperative cardiovascular, respiratory, and gastrointestinal complications when receiving epidural analgesia compared with patients receiving systemic analgesia (IV analgesics) Anatomical drawing of epidural space - CORRECT ANSWER Nursing Care for Patients With Epidural Infusions - CORRECT ANSWER breakthrough cancer pain - CORRECT ANSWER Many patients with cancer experience breakthrough cancer pain (BTCP), a transitory increase in pain in someone who has relatively stable and an adequately controlled level of baseline pain (ACPA, 2018). It occurs either spontaneously or in relation to a specific predictable or unpredictable trigger (Scarborough and Smith, 2018). BTCP is a challenging aspect of cancer because, even though it is self-limiting in nature, its presence has a significant, negative impact on the quality of life of patients and family caregivers (Scarborough and Smith, 2018). Individualized assessment is critical for understanding how BTCP affects a patient's life. A holistic approach to care is often needed Types of Breakthrough Pain and Treatment - CORRECT ANSWER FIG. 44.13 Adaptation of the WHO analgesic ladder. NSAID, Nonsteroidal antiinflammatory drug; PCA, patient-controlled analgesia. - CORRECT ANSWER pseudoaddiction - CORRECT ANSWER Many patients, family members, and health care providers have concerns about the risks of addiction associated with opioid use. The estimated prevalence of prescription opioid abuse and opioid use disorders ranges from less than 1% to 40% due to the limited availability of uniform definitions of what constitutes misuse, abuse, and addiction. Patients who consult with numerous health care providers may be labeled as drug seekers when they actually may be seeking adequate pain relief. This situation may be associated with behaviors that are indicative of pseudoaddiction. Nurses need to discourage patients from "doctor shopping" and having multiple health care providers for treating pain and refer them to pain specialists when effective management cannot be obtained through their general health care providers. Barriers to Effective Pain Management - CORRECT ANSWER physical dependence, addiction, and drug tolerance - CORRECT ANSWER Patients and health care providers often do not understand the differences among physical dependence, addiction, and drug tolerance (Box 44.20). Experiencing a physical dependency does not imply addiction, and drug tolerance in and of itself is not the same as addiction. That is not to say that addiction does not occur or that patients who suffer from addiction should not be treated for pain. Patients with addiction and pain should be treated with the same amount of dignity and respect as all other patients, although safety and monitoring are priority concerns. An interprofessional team approach ensures a more effective pain-management plan for a patient with acute pain who also suffers from addiction. Nurses and health care providers need to avoid labeling patients as drug seeking because this term is poorly defined and can cause bias and prejudice. If there are concerns that a patient is abusing opioids, they should be voiced to the patient, and the patient's health care provider should be advised of the concerns. Many patients on long-term opioid medications enter into "pain contracts" that state the expected responsibilities of both the patient and health care provider. If the agreement is violated or other assessments dictate, additional resources may be identified to aid the patient in addressing the addictive illness. Definitions Related to the Use of Opioids in Pain Treatment - CORRECT ANSWER Physical Dependence A state of adaptation that is manifested by a drug class-specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Common symptoms of opioid withdrawal include shaking, chills, abdominal cramps, excessive yawning, and joint pain. Addiction A primary chronic neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addictive behaviors include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Drug Tolerance A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more effects of the drug over time. placebos - CORRECT ANSWER There are many different definitions and interpretations of the terms placebo and placebo effect. It is generally accepted that placebos are pharmacologically inactive preparations or procedures that produce no beneficial or therapeutic effect. Many professional organizations discourage the use of placebos to treat pain. The ethics of therapeutic placebo use is highly controversial; however, evidence suggests that health care providers frequently use placebo treatments, and patients may be open to these interventions under certain situations (Kisaalita et al., 2016). A study involving a patient-centered approach surveyed patients with chronic musculoskeletal pain about their knowledge and acceptability of placebo analgesic use across different clinical contexts. Patient-Controlled Analgesia: assessment - CORRECT ANSWER Patient-Controlled Analgesia: PLanning/Implementation - CORRECT ANSWER Patient-Controlled Analgesia: evaluation - CORRECT ANSWER Key Points - CORRECT ANSWER • There are four physiological processes of nociceptive pain: transduction, transmission, perception, and modulation. • Pain is characterized by its duration, location, cause, intensity, and impact on the individual. • Individual, physiological, psychological, social, cultural, and environment factors influence pain. • Cultural beliefs affect how individuals cope with pain as they learn what is expected and accepted by their culture, including how to react to pain. • The assessment of pain incorporates a patient's physiological, affective, cognitive, behavioral, spiritual, and social dimensions. • Acute pain is protective, usually has an identifiable cause, is of short duration, and has limited tissue damage and emotional response. In contrast, chronic pain is not protective and thus serves no purpose, but it has a dramatic effect on a person's quality of life. • Active and passive nonpharmacological measures can be used along with analgesics (nonopioid or opioid) and adjuvant medications for the treatment of pain. • When administering analgesics, consider that opioids given with nonopioids provide a multimodal analgesia approach, but always avoid using multiple opioids with the same duration and mechanism of action. • Lack of knowledge and misconceptions about pain and appropriate pain management are significant barriers to pain management. • Evaluation of the response to pain should include pain intensity, as well as side effects, behavior, and functional outcomes. 1. Which of the following signs or symptoms in a patient who is opioid-naïve is of greatest concern to the nurse when assessing the patient 1 hour after administering an opioid? 1. Oxygen saturation of 95% 2. Difficulty arousing the patient 3. Respiratory rate of 12 breaths/min 4. Pain intensity rating of 5 on a scale of 0 to 10 - CORRECT ANSWER 2. Difficulty arousing the patient 2. A health care provider writes the following order for a patient who is opioid-naïve who returned from the operating room following a total hip replacement: "Fentanyl patch 100 mcg, change every 3 days." On the basis of this order, the nurse takes the following action: 1. Calls the health care provider and questions the order 2. Applies the patch the third postoperative day 3. Applies the patch as soon as the patient reports pain 4. Places the patch as close to the hip dressing as possible - CORRECT ANSWER 1. Calls the health care provider and questions the order 3. A patient is being discharged home on an around-the-clock (ATC) opioid for postoperative pain. Because of this order, the nurse anticipates an additional order for which class of medication? 1. Opioid antagonists 2. Antiemetics 3. Stool softeners 4. Muscle relaxants - CORRECT ANSWER 3. Stool softeners 4. A new medical resident writes an order for oxycodone CR 10 mg PO q2h prn. Which part of the order does the nurse question? 1. The drug 2. The time interval 3. The dose 4. The route - CORRECT ANSWER 2. The time interval 5. The nurse reviews a patient's medical administration record (MAR) and finds that the patient has received oxycodone/acetaminophen (5/325), two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most? 1. The patient's level of pain 2. The potential for addiction 3. The amount of daily acetaminophen 4. The risk for gastrointestinal bleeding - CORRECT ANSWER 3. The amount of daily acetaminophen 6. When using ice massage for pain relief, which of the following is correct? (Select all that apply.) 1. Apply ice using firm pressure over the skin. 2. Apply ice for 5 minutes or until numbness occurs. 3. Apply ice no more than 3 times a day. 4. Limit application of ice to no longer than 10 minutes. 5. Use a slow, circular steady massage. - CORRECT ANSWER 1. Apply ice using firm pressure over the skin. 2. Apply ice for 5 minutes or until numbness occurs. 5. Use a slow, circular steady massage. 7. A patient with a 3-day history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The patient had been taking hydrocodone/APAP 5/325 up to four tablets/day before her stroke for the past year to manage her arthritic pain. The health care provider's order reads as follows: "Hydrocodone/APAP 5/325 1 tab, per gastrostomy tube, q4h, prn." Which action by the nurse is most appropriate? 1. No action is required by the nurse because the order is appropriate. 2. Request to have the order changed to around the clock (ATC) for the first 48 hours. 3. Ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3h, prn. 4. Begin the hydrocodone/APAP when the patient shows nonverbal symptoms of pain. - CORRECT ANSWER 2. Request to have the order changed to around the clock (ATC) for the first 48 hours. 8. Place the following steps in the correct order for administration of patient-controlled analgesia: 1. Insert drug cartridge into infusion device and prime tubing. 2. Wipe injection port of maintenance IV line vigorously with antiseptic swab for 15 seconds and allow to dry. 3. Demonstrate to patient how to push medication demand button. 4. Secure connection and anchor PCA tubing with tape. 5. Instruct patient to notify a nurse for possible side effects or changes in the severity or location of pain. 6. Insert needleless adapter into injection port nearest patient. 7. Apply clean gloves. Check infuser and patient-control module for accurate labeling or evidence of leaking. 8. Program computerized PCA pump as ordered to deliver prescribed medication dose and lockout interval. 9. Attach needleless adapter to tubing adapter of patient-controlled module. - CORRECT ANSWER 3. Demonstrate to patient how to push medication demand button. 5. Instruct patient to notify a nurse for possible side effects or changes in the severity or location of pain. 7. Apply clean gloves. Check infuser and patient-control module for accurate labeling or evidence of leaking. 1. Insert drug cartridge into infusion device and prime tubing. 9. . Attach needleless adapter to tubing adapter of patient-controlled module 2. Wipe injection port of maintenance IV line vigorously with antiseptic swab for 15 seconds and allow to dry. 6. Insert needleless adapter into injection port nearest patient. 4. Secure connection and anchor PCA tubing with tape. 8. Program computerized PCA pump as ordered to deliver prescribed medication dose and lockout interval. 9. When teaching a patient about transcutaneous electrical nerve stimulation (TENS), which of the following represent an accurate description of the nonpharmacological therapy? (Select all that apply.) 1. Turn TENS on before patient feels discomfort. 2. TENS works peripherally and centrally on nerve receptors. 3. TENS does not require a health care provider order. 4. Remove any skin preparations before attaching TENS electrodes. 5. Placing electrodes directly over or near the pain site works best. - CORRECT ANSWER 2. TENS works peripherally and centrally on nerve receptors. 4. Remove any skin preparations before attaching TENS electrodes. 5. Placing electrodes directly over or near the pain site works best 10. Match the characteristics w/ acute or chronic A. Has a protective effect B. Lasts more than 3 to 6 months C. Usually has identifiable cause D. Dramatically affects quality of life E. Viewed as a disease F. Eventually resolves with or without treatment - CORRECT ANSWER A. Acute B. Chronic C. Acute D. Chronic E. Chronic F. Acute