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  1. A patient is walking up and down the hall and visiting with other patients. He is laughing and joking. He approaches the nurse's station, asks for his pain shot, and reports that his pain is 6 on a scale of 0 to 10. Based on McCaffrey's definition of pain, which assumptions by the nurse is most likely correct?
    The patient is having pain at a level of 6 on a scale of 0 to 10.

    Rationale:  Pain is whatever the patient says it is, whenever the patient says it is.
  2. A patient with terminal cancer has been requiring 5 mg of IV morphine every 1 to 2 hours to control pain, yet is engrossed in a movie on television and appears to be in no pain. Which of the following explanations of this behavior is most likely correct?
    Distraction can be an effective treatment for pain when used with appropriate drug treatments.
  3. Which patient is showing tolerance to opioid analgesics?
    The patient who needs increasing doses of opioids to achieve the same level of pain relief.

    Rationale:  Tolerance is the need for more medication to achieve the same effect
  4. A patient has incisional pain following total hip replacement surgery. Which types of pain the patient experiencing?

    Rationale:  Nociceptive pain occurs with tissue injury
  5. With which type of pain is the patient LEAST likely to present with outward signs, such as moaning or changes in vital signs?
    Chronic nonmalignant pain

    Rationale:  Chronic pain is least likely to be associated with changes in vital signs because the patient has adapted to the pain.
  6. Which method is the most reliable way to assess the severity of a patient's pain?
    Ask the patient to rate his or her pain using a valid assessment scale
  7. According to the World Health Organization's analgesic ladder, at what point in a patient's pain experience is it appropriate to use adjuvant treatments?
    • In addition to analgesics for early, mild pain.
    • In addition to analgesics for pain that is persistent despite treatment.
    • In addition to analgesics for pain that is growing increasingly more severe.
  8. A patient is hospitalized following a motor vehicle accident. He has multiple orthopedic injuries and is in acute pain. He has an order for morphnine 6m IV every 4 hours as needed. He can also have a nonopioid oral analgesic every 4 hours as needed. To reduce the risk of adverse effects and maintain an acceptable level of sedation and pain control, which analgesic schedule will be most effective?
    Give both the IV opioid and the PO nonopioid every 4 hours around the clock.
  9. Mr. Lawrence is an 88 y/o man admitted with a broken hip after a fall. He has an order for meperidine 50 to 75 mg IM every 4hr PRN for pain. As his nurse, which of the following actions should you take?
    Talk to the RN or physician about getting an order for a different analgesic

    Rationale:  Meperidine should be avoided in elderly patients
  10. A patient is started on gabapentin (Neurontin) 300mg by mouth three times daily for chronic nerve pain related to diabetic neuropathy. Which instructions should the nurse provide?
    Take one capsule every eight hours continuously to keep the pain under control.

    Rationale:  Gabapentin must be taken continuously to be effective. Chronic neuropathy is not likely to go away, so treatment will be ongoing
  11. A nurse receives an order to administer 1 mL of sterile normal saline solution IM to a patient suspected of opioid abuse. Which response by the nurse is appropriate first?
    Share concerns about the order with the supervisor and explain why the nurse cannot in good conscience administer the saline.

    Rationale:  A placebo should not be administered except in research studies. The supervisor should be involved in educating the physician
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