Adams4e Tif Ch18

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E Chapter 18
Question 1 Type: MCMA The nurse teaches patients about nonpharmacological techniques for pain management. The nurse determines learning has occurred when the patients make which statement(s)? Note Credit will be gi!en onl" if all correct choices and no incorrect choices are selected. Standard Text: #elect all that appl". 1. $Nonpharmacological techniques are a good ad%unct to pharmacotherap".$ 2. $Nonpharmacological techniques ha!e not reached mainstream "et.$ 3. $Nonpharmacological techniques ma" be used in place of drugs.$ 4. $Nonpharmacological techniques include an aerobic e&ercise.$ . $Nonpharmacological techniques are not usuall" !alued b" nurses.$ Corre!t Ans"er: '() #ationa$e 1 Nonpharmacological techniques ma" be used in place of drugs( or as an ad%unct to pharmacotherap". An aerobic e&ercise is not considered a nonpharmacological technique for relief of pain. Nonpharmacological techniques ha!e reached mainstream and are commonl" used. Nonpharmacological techniques are !alued and used b" most nurses. #ationa$e 2 Nonpharmacological techniques ma" be used in place of drugs( or as an ad%unct to pharmacotherap". An aerobic e&ercise is not considered a nonpharmacological technique for relief of pain. Nonpharmacological techniques ha!e reached mainstream and are commonl" used. Nonpharmacological techniques are !alued and used b" most nurses. #ationa$e 3 Nonpharmacological techniques ma" be used in place of drugs( or as an ad%unct to pharmacotherap". An aerobic e&ercise is not considered a nonpharmacological technique for relief of pain. Nonpharmacological techniques ha!e reached mainstream and are commonl" used. Nonpharmacological techniques are !alued and used b" most nurses. #ationa$e 4 Nonpharmacological techniques ma" be used in place of drugs( or as an ad%unct to pharmacotherap". An aerobic e&ercise is not considered a nonpharmacological technique for relief of pain. Nonpharmacological techniques ha!e reached mainstream and are commonl" used. Nonpharmacological techniques are !alued and used b" most nurses. #ationa$e Nonpharmacological techniques ma" be used in place of drugs( or as an ad%unct to pharmacotherap". An aerobic e&ercise is not considered a nonpharmacological technique for relief of pain. Nonpharmacological
Adams, Pharmacology for Nurse: A Pathophysiologic Approach, *+, Cop"right -.'* b" /earson ,ducation( 0nc.
techniques ha!e reached mainstream and are commonl" used. Nonpharmacological techniques are !alued and used b" most nurses. %$o&a$ #ationa$e: Co'niti(e )e(e$: Appl"ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess ,!aluation )earnin' ,ut!ome: '12* Question 2 Type: MC#A The nursing instructor teaches the nursing students about neural mechanisms of pain. 3hat does the nursing instructor teach about substance /? 1. #ubstance / modifies sensor" information in the spinal cord. 2. #ubstance / is also known as an endogenous opioid. 3. #ubstance / stimulates pain receptors in the spinal cord. 4. #ubstance / controls which pain signals reach the brain. Corre!t Ans"er: * #ationa$e 1 #pinal substance / is critical because it controls whether pain signals will continue to the brain. ,ndogenous opioids( not substance /( modif" sensor" information at the le!el of the spinal cord. #ubstance / does not stimulate pain receptors in the spinal cord. #ubstance / is not an endogenous opioid. #ationa$e 2 #pinal substance / is critical because it controls whether pain signals will continue to the brain. ,ndogenous opioids( not substance /( modif" sensor" information at the le!el of the spinal cord. #ubstance / does not stimulate pain receptors in the spinal cord. #ubstance / is not an endogenous opioid. #ationa$e 3 #pinal substance / is critical because it controls whether pain signals will continue to the brain. ,ndogenous opioids( not substance /( modif" sensor" information at the le!el of the spinal cord. #ubstance / does not stimulate pain receptors in the spinal cord. #ubstance / is not an endogenous opioid. #ationa$e 4 #pinal substance / is critical because it controls whether pain signals will continue to the brain. ,ndogenous opioids( not substance /( modif" sensor" information at the le!el of the spinal cord. #ubstance / does not stimulate pain receptors in the spinal cord. #ubstance / is not an endogenous opioid. %$o&a$ #ationa$e: Co'niti(e )e(e$: Appl"ing C$ient *eed: /h"siological 0ntegrit"
C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess 0mplementation )earnin' ,ut!ome: '12Question 3 Type: MC#A The patient( addicted to heroin( is being treated for opioid dependence. 4e has been prescribed methadone (5olophine). The patient asks how this will help because methadone (5olophine) is another opioid. 3hat is the best response b" the nurse? 1. $Methadone (5olophine) will make "ou reall" sick if "ou use heroin.$ 2. $Methadone (5olophine) does not cause euphoria like heroin does.$ 3. $Methadone (5olophine) cures "our addiction to heroin.$ 4. $Methadone (5olophine) causes "ou to ha!e an allerg" to heroin.$ Corre!t Ans"er: #ationa$e 1 Methadone (5olophine) does not cause the euphoria of heroin( or cure the dependence. 0t is a substitute drug that allows the patient to be producti!e. Methadone (5olophine) does not cure heroin addiction. Methadone (5olophine) does not cause an allerg" to heroin. Methadone (5olophine) will not cause a person to become sick if the" use heroin. #ationa$e 2 Methadone (5olophine) does not cause the euphoria of heroin( or cure the dependence. 0t is a substitute drug that allows the patient to be producti!e. Methadone (5olophine) does not cure heroin addiction. Methadone (5olophine) does not cause an allerg" to heroin. Methadone (5olophine) will not cause a person to become sick if the" use heroin. #ationa$e 3 Methadone (5olophine) does not cause the euphoria of heroin( or cure the dependence. 0t is a substitute drug that allows the patient to be producti!e. Methadone (5olophine) does not cure heroin addiction. Methadone (5olophine) does not cause an allerg" to heroin. Methadone (5olophine) will not cause a person to become sick if the" use heroin. #ationa$e 4 Methadone (5olophine) does not cause the euphoria of heroin( or cure the dependence. 0t is a substitute drug that allows the patient to be producti!e. Methadone (5olophine) does not cure heroin addiction. Methadone (5olophine) does not cause an allerg" to heroin. Methadone (5olophine) will not cause a person to become sick if the" use heroin. %$o&a$ #ationa$e: Co'niti(e )e(e$: Appl"ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess 0mplementation
)earnin' ,ut!ome: '126 Question 4 Type: MC#A The patient has intractable pain( and the ph"sician has proposed a ner!e block. The nurse plans to teach the patient about ner!e blocks. 3hich statement would be included in the best plan of the nurse? 1. A ner!e block depresses the acti!it" of the s"mpathetic ner!ous s"stem. 2. A ner!e block enhances the effect of most of the endogenous opioids. 3. A ner!e block modifies sensor" information being sent to the spinal cord. 4. A ner!e block stops pain transmission along the ner!e to stop the pain. Corre!t Ans"er: * #ationa$e 1 Ner!e blocks are accomplished b" in%ection of alcohol or another neuroto&ic substance into neurons. This blocks ner!e transmission and has the potential to pro!ide total pain relief. A ner!e block does not enhance the effect of endogenous opioids. A ner!e block does not modif" sensor" information sent to the spinal cord. A ner!e block does not depress the acti!it" of the s"mpathetic ner!ous s"stem. #ationa$e 2 Ner!e blocks are accomplished b" in%ection of alcohol or another neuroto&ic substance into neurons. This blocks ner!e transmission and has the potential to pro!ide total pain relief. A ner!e block does not enhance the effect of endogenous opioids. A ner!e block does not modif" sensor" information sent to the spinal cord. A ner!e block does not depress the acti!it" of the s"mpathetic ner!ous s"stem. #ationa$e 3 Ner!e blocks are accomplished b" in%ection of alcohol or another neuroto&ic substance into neurons. This blocks ner!e transmission and has the potential to pro!ide total pain relief. A ner!e block does not enhance the effect of endogenous opioids. A ner!e block does not modif" sensor" information sent to the spinal cord. A ner!e block does not depress the acti!it" of the s"mpathetic ner!ous s"stem. #ationa$e 4 Ner!e blocks are accomplished b" in%ection of alcohol or another neuroto&ic substance into neurons. This blocks ner!e transmission and has the potential to pro!ide total pain relief. A ner!e block does not enhance the effect of endogenous opioids. A ner!e block does not modif" sensor" information sent to the spinal cord. A ner!e block does not depress the acti!it" of the s"mpathetic ner!ous s"stem. %$o&a$ #ationa$e: Co'niti(e )e(e$: Appl"ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess /lanning )earnin' ,ut!ome: '12) Question
Type: MC#A The patient recei!es morphine for pain. 4e asks the nurse how it works to relie!e pain. 3hat is the best response b" the nurse? 1. $0t inhibits the primar" pain neurotransmitters in "our brain.$ 2. $0t stimulates the receptors that secrete endorphins in "our brain.$ 3. $0t stimulates a receptor in "our brain that induces pleasure.$ 4. $0t promotes the primar" pleasure neurotransmitters in "our brain.$ Corre!t Ans"er: ) #ationa$e 1 7pioids e&ert their actions b" interacting with the mu and kappa receptors in the brain. 5rugs that stimulate these receptors are opioid agonists. 7pioids do not promote release of the pleasurable neurotransmitters. 7pioids do not promote secretion of endorphins. 7pioids do not inhibit neurotransmitters responsible for pain. #ationa$e 2 7pioids e&ert their actions b" interacting with the mu and kappa receptors in the brain. 5rugs that stimulate these receptors are opioid agonists. 7pioids do not promote release of the pleasurable neurotransmitters. 7pioids do not promote secretion of endorphins. 7pioids do not inhibit neurotransmitters responsible for pain. #ationa$e 3 7pioids e&ert their actions b" interacting with the mu and kappa receptors in the brain. 5rugs that stimulate these receptors are opioid agonists. 7pioids do not promote release of the pleasurable neurotransmitters. 7pioids do not promote secretion of endorphins. 7pioids do not inhibit neurotransmitters responsible for pain. #ationa$e 4 7pioids e&ert their actions b" interacting with the mu and kappa receptors in the brain. 5rugs that stimulate these receptors are opioid agonists. 7pioids do not promote release of the pleasurable neurotransmitters. 7pioids do not promote secretion of endorphins. 7pioids do not inhibit neurotransmitters responsible for pain. %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess 0mplementation )earnin' ,ut!ome: '129 Question Type: MC#A The patient has a patient2controlled analgesia (/CA) pump following surger". The nurse keeps nalo&one (Narcan) in the patient:s room as per protocol. 3hat does the nurse recogni8e as the rationale for this protocol? 1. Nalo&one (Narcan) enhances the effect of the opioid in the patient2controlled analgesia (/CA) pump and increases analgesia.
2. Nalo&one (Narcan) is the antidote if an anaph"lactic reaction to the opioid in the patient2controlled analgesia (/CA) pump occurs. 3. Nalo&one (Narcan) is a!ailable to treat an" s"stemic side effects( like constipation( of the opioid in the patient2 controlled analgesia (/CA) pump. 4. Nalo&one (Narcan) will re!erse the effects of the narcotic in the patient2controlled analgesia (/CA) pump if an o!erdose occurs. Corre!t Ans"er: * #ationa$e 1 Nalo&one (Narcan) is an opioid antagonist( and will re!erse the effects of the narcotic in the pump if an o!erdose occurs. Nalo&one (Narcan) does not enhance the effects of opioids. Nalo&one (Narcan) is not used to treat anaph"lactic reactions. Nalo&one (Narcan) is not used to treat opioid2related constipation. #ationa$e 2 Nalo&one (Narcan) is an opioid antagonist( and will re!erse the effects of the narcotic in the pump if an o!erdose occurs. Nalo&one (Narcan) does not enhance the effects of opioids. Nalo&one (Narcan) is not used to treat anaph"lactic reactions. Nalo&one (Narcan) is not used to treat opioid2related constipation. #ationa$e 3 Nalo&one (Narcan) is an opioid antagonist( and will re!erse the effects of the narcotic in the pump if an o!erdose occurs. Nalo&one (Narcan) does not enhance the effects of opioids. Nalo&one (Narcan) is not used to treat anaph"lactic reactions. Nalo&one (Narcan) is not used to treat opioid2related constipation. #ationa$e 4 Nalo&one (Narcan) is an opioid antagonist( and will re!erse the effects of the narcotic in the pump if an o!erdose occurs. Nalo&one (Narcan) does not enhance the effects of opioids. Nalo&one (Narcan) is not used to treat anaph"lactic reactions. Nalo&one (Narcan) is not used to treat opioid2related constipation. %$o&a$ #ationa$e: Co'niti(e )e(e$: Appl"ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess ,!aluation )earnin' ,ut!ome: '12; Question . Type: MC#A 3hat is a priorit" assessment question to ask a postsurgical patient prior to administration of an opioid analgesic? 1. $4a!e "ou e!er been addicted to prescription pain medications?$ 2. $3h" do "ou want to recei!e this pain medication?$ 3. $3ould "ou like me to help "ou change "our position for comfort?$ 4. $3ould "ou please rate "our pain on a scale of '2to2'.?$
Corre!t Ans"er: * #ationa$e 1 The nurse should alwa"s assess the patient:s le!el of pain prior to the administration of an analgesic. Asking a postsurgical patient wh" a pain medication is requested does not make a lot of sense. Administration of pain medication postsurger" is a priorit"< this is not the time to assess if the patient has an addiction. 7ffering to help a postsurgical patient change positions is appropriate( but should be done after the patient recei!es the pain medication. #ationa$e 2 The nurse should alwa"s assess the patient:s le!el of pain prior to the administration of an analgesic. Asking a postsurgical patient wh" a pain medication is requested does not make a lot of sense. Administration of pain medication postsurger" is a priorit"< this is not the time to assess if the patient has an addiction. 7ffering to help a postsurgical patient change positions is appropriate( but should be done after the patient recei!es the pain medication. #ationa$e 3 The nurse should alwa"s assess the patient:s le!el of pain prior to the administration of an analgesic. Asking a postsurgical patient wh" a pain medication is requested does not make a lot of sense. Administration of pain medication postsurger" is a priorit"< this is not the time to assess if the patient has an addiction. 7ffering to help a postsurgical patient change positions is appropriate( but should be done after the patient recei!es the pain medication. #ationa$e 4 The nurse should alwa"s assess the patient:s le!el of pain prior to the administration of an analgesic. Asking a postsurgical patient wh" a pain medication is requested does not make a lot of sense. Administration of pain medication postsurger" is a priorit"< this is not the time to assess if the patient has an addiction. 7ffering to help a postsurgical patient change positions is appropriate( but should be done after the patient recei!es the pain medication. %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12' Question 8 Type: MC#A The postsurgical patient has an order for morphine - mg 0= push e!er" - hours and propo&"phene '.. (5ar!on '..) e!er" ) hours. 4e recei!ed the morphine - hours ago( and is complaining of pain again. 3hat will the best plan of the nurse include? 1. /lan to administer the morphine again. 2. /lan to administer the propo&"phene '.. (5ar!on '..). 3. /lan to ha!e the patient do some distraction techniques.
4. /lan to assess the patient:s le!el of pain. Corre!t Ans"er: * #ationa$e 1 The patient:s le!el of pain should be assessed prior to the administration of an" analgesic. The patient:s le!el of pain should be assessed prior to administration of propo&"phene (5ar!on) '... The patient:s le!el of pain should be assessed prior to administration of additional morphine. 5istraction techniques are appropriate( but should not take the place of a pain assessment and administration of an analgesic. #ationa$e 2 The patient:s le!el of pain should be assessed prior to the administration of an" analgesic. The patient:s le!el of pain should be assessed prior to administration of propo&"phene (5ar!on) '... The patient:s le!el of pain should be assessed prior to administration of additional morphine. 5istraction techniques are appropriate( but should not take the place of a pain assessment and administration of an analgesic. #ationa$e 3 The patient:s le!el of pain should be assessed prior to the administration of an" analgesic. The patient:s le!el of pain should be assessed prior to administration of propo&"phene (5ar!on) '... The patient:s le!el of pain should be assessed prior to administration of additional morphine. 5istraction techniques are appropriate( but should not take the place of a pain assessment and administration of an analgesic. #ationa$e 4 The patient:s le!el of pain should be assessed prior to the administration of an" analgesic. The patient:s le!el of pain should be assessed prior to administration of propo&"phene (5ar!on) '... The patient:s le!el of pain should be assessed prior to administration of additional morphine. 5istraction techniques are appropriate( but should not take the place of a pain assessment and administration of an analgesic. %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess /lanning )earnin' ,ut!ome: '12' Question / Type: MC#A The patient comes to the emergenc" department with a head in%ur"( broken ribs( and internal bleeding. 7pioid analgesics are contraindicated. 3hat does the nurse recogni8e as the primar" rationale for this? 1. The use of opioid analgesics will depress the patient:s blood pressure. 2. The patient ma" not be able to communicate his le!el of pain. 3. 7pioids will not effecti!el" relie!e pain in the patient:s peripher". 4. 7pioids can mask changes in the patient:s le!el of consciousness. Corre!t Ans"er: *
#ationa$e 1 7pioids are central ner!ous s"stem (CN#) depressants and can mask the patient:s le!el of consciousness< this is dangerous when the patient has a head in%ur". 5epression of blood pressure could occur( but this is not as critical as le!el of consciousness. The patient ma" not be able to determine his le!el of pain( but this is not as critical as le!el of consciousness. 7pioids do not effecti!el" relie!e pain in the patient:s peripher"( but this is not as critical as le!el of consciousness. #ationa$e 2 7pioids are central ner!ous s"stem (CN#) depressants and can mask the patient:s le!el of consciousness< this is dangerous when the patient has a head in%ur". 5epression of blood pressure could occur( but this is not as critical as le!el of consciousness. The patient ma" not be able to determine his le!el of pain( but this is not as critical as le!el of consciousness. 7pioids do not effecti!el" relie!e pain in the patient:s peripher"( but this is not as critical as le!el of consciousness. #ationa$e 3 7pioids are central ner!ous s"stem (CN#) depressants and can mask the patient:s le!el of consciousness< this is dangerous when the patient has a head in%ur". 5epression of blood pressure could occur( but this is not as critical as le!el of consciousness. The patient ma" not be able to determine his le!el of pain( but this is not as critical as le!el of consciousness. 7pioids do not effecti!el" relie!e pain in the patient:s peripher"( but this is not as critical as le!el of consciousness. #ationa$e 4 7pioids are central ner!ous s"stem (CN#) depressants and can mask the patient:s le!el of consciousness< this is dangerous when the patient has a head in%ur". 5epression of blood pressure could occur( but this is not as critical as le!el of consciousness. The patient ma" not be able to determine his le!el of pain( but this is not as critical as le!el of consciousness. 7pioids do not effecti!el" relie!e pain in the patient:s peripher"( but this is not as critical as le!el of consciousness. %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess ,!aluation )earnin' ,ut!ome: '12'' Question 10 Type: MC#A The patient recei!es morphine for pain. 3hich comment b" the patient does the nurse assess to be a side effect of morphine? 1. $M" ears are constantl" ringing.$ 2. $M" heart feels like it is skipping beats.$ 3. $0 feel like 0 am going to throw up.$ 4. $0 feel cold shi!ers all o!er.$ Corre!t Ans"er: )
#ationa$e 1 Nausea is a common side effect of morphine. >eeling cold shi!ers is not associated with morphine. ?inging ears are not associated with morphine. 4eart palpitations are not associated with morphine. #ationa$e 2 Nausea is a common side effect of morphine. >eeling cold shi!ers is not associated with morphine. ?inging ears are not associated with morphine. 4eart palpitations are not associated with morphine. #ationa$e 3 Nausea is a common side effect of morphine. >eeling cold shi!ers is not associated with morphine. ?inging ears are not associated with morphine. 4eart palpitations are not associated with morphine. #ationa$e 4 Nausea is a common side effect of morphine. >eeling cold shi!ers is not associated with morphine. ?inging ears are not associated with morphine. 4eart palpitations are not associated with morphine. %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12'. Question 11 Type: MC#A The patient recei!es aspirin. The nurse assesses an ad!erse effect to this drug when the patient makes which response? 1. $M" stools ha!e been gra" in color.$ 2. $There is a constant ringing in m" ears.$ 3. $@right lights gi!e me a headache.$ 4. $0 ha!e to get up a lot at night to urinate.$ Corre!t Ans"er: #ationa$e 1 Aspirin is ototo&ic( and ma" cause ringing in the ears. Aspirin does not cause photophobia. A decrease in bilirubin (gra" stools) is not caused b" aspirin. There isn:t an" relationship between aspirin and nocturnal renal output. #ationa$e 2 Aspirin is ototo&ic( and ma" cause ringing in the ears. Aspirin does not cause photophobia. A decrease in bilirubin (gra" stools) is not caused b" aspirin. There isn:t an" relationship between aspirin and nocturnal renal output. #ationa$e 3 Aspirin is ototo&ic( and ma" cause ringing in the ears. Aspirin does not cause photophobia. A decrease in bilirubin (gra" stools) is not caused b" aspirin. There isn:t an" relationship between aspirin and nocturnal renal output.
#ationa$e 4 Aspirin is ototo&ic( and ma" cause ringing in the ears. Aspirin does not cause photophobia. A decrease in bilirubin (gra" stools) is not caused b" aspirin. There isn:t an" relationship between aspirin and nocturnal renal output. %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12'. Question 12 Type: MC#A The nurse pro!ides care for se!eral patients. >or which patient would the nurse assess acetaminophen (T"lenol) to be contraindicated? 1. A -2"ear2old with a high fe!er due to the flu 2. A ;92"ear2old with osteoarthritis 3. A 'A2"ear2old with a bladder infection 4. A 992"ear old who sociall" drinks alcohol Corre!t Ans"er: * #ationa$e 1 Acetaminophen (T"lenol) is hepatoto&ic( and ma" cause problems in patients who consume alcohol. Acetaminophen (T"lenol) would be the drug of choice for a child with the flu. Acetaminophen (T"lenol) would not be contraindicated with osteoarthritis( but aspirin would be more effecti!e. There isn:t an" association between the use of acetaminophen (T"lenol) and a bladder infection. #ationa$e 2 Acetaminophen (T"lenol) is hepatoto&ic( and ma" cause problems in patients who consume alcohol. Acetaminophen (T"lenol) would be the drug of choice for a child with the flu. Acetaminophen (T"lenol) would not be contraindicated with osteoarthritis( but aspirin would be more effecti!e. There isn:t an" association between the use of acetaminophen (T"lenol) and a bladder infection. #ationa$e 3 Acetaminophen (T"lenol) is hepatoto&ic( and ma" cause problems in patients who consume alcohol. Acetaminophen (T"lenol) would be the drug of choice for a child with the flu. Acetaminophen (T"lenol) would not be contraindicated with osteoarthritis( but aspirin would be more effecti!e. There isn:t an" association between the use of acetaminophen (T"lenol) and a bladder infection. #ationa$e 4 Acetaminophen (T"lenol) is hepatoto&ic( and ma" cause problems in patients who consume alcohol. Acetaminophen (T"lenol) would be the drug of choice for a child with the flu. Acetaminophen (T"lenol) would not be contraindicated with osteoarthritis( but aspirin would be more effecti!e. There isn:t an" association between the use of acetaminophen (T"lenol) and a bladder infection.
%$o&a$ #ationa$e: Co'niti(e )e(e$: Appl"ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12'. Question 13 Type: MC#A 3hat is an important instruction for the nurse to gi!e to the patient who is taking acetaminophen (T"lenol)? 1. $Check "our gums for bleeding when taking acetaminophen (T"lenol).$ 2. $5o not take an" narcotics with acetaminophen (T"lenol).$ 3. $5o not drink alcohol with acetaminophen (T"lenol).$ 4. $5o not take acetaminophen (T"lenol) on an empt" stomach.$ Corre!t Ans"er: ) #ationa$e 1 Acetaminophen (T"lenol) is to&ic to the li!er( and should not be taken b" patients who will be consuming alcohol. Acetaminophen (T"lenol) can be taken with or without food. There is no contraindication between acetaminophen (T"lenol) and narcotics< the" are often combined for more effecti!e pain relief. @leeding in the gums is an effect of aspirin( not acetaminophen (T"lenol). #ationa$e 2 Acetaminophen (T"lenol) is to&ic to the li!er( and should not be taken b" patients who will be consuming alcohol. Acetaminophen (T"lenol) can be taken with or without food. There is no contraindication between acetaminophen (T"lenol) and narcotics< the" are often combined for more effecti!e pain relief. @leeding in the gums is an effect of aspirin( not acetaminophen (T"lenol). #ationa$e 3 Acetaminophen (T"lenol) is to&ic to the li!er( and should not be taken b" patients who will be consuming alcohol. Acetaminophen (T"lenol) can be taken with or without food. There is no contraindication between acetaminophen (T"lenol) and narcotics< the" are often combined for more effecti!e pain relief. @leeding in the gums is an effect of aspirin( not acetaminophen (T"lenol). #ationa$e 4 Acetaminophen (T"lenol) is to&ic to the li!er( and should not be taken b" patients who will be consuming alcohol. Acetaminophen (T"lenol) can be taken with or without food. There is no contraindication between acetaminophen (T"lenol) and narcotics< the" are often combined for more effecti!e pain relief. @leeding in the gums is an effect of aspirin( not acetaminophen (T"lenol). %$o&a$ #ationa$e: Co'niti(e )e(e$: Appl"ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&:
*ursin'/+nte'rated Con!epts: Nursing /rocess 0mplementation )earnin' ,ut!ome: '12'Question 14 Type: MCMA The patient is to start on sumatriptan (0mitre&) for migraine headaches. 3hat will the best plan of the nurse include as it relates to this medication? Note Credit will be gi!en onl" if all correct choices and no incorrect choices are selected. Standard Text: #elect all that appl". 1. /lan to teach the patient not to dri!e until the effects of the medication are known. 2. /lan to teach the patient to a!oid pseudoephedrine (#udafed) with this medication. 3. /lan to teach the patient the importance of taking the medication with protein. 4. /lan to instruct the patient to take the medication with food to a!oid ulcers. . /lan to teach the patient to increase fluid intake with this medication. Corre!t Ans"er: '(#ationa$e 1 5rowsiness and di88iness can occur with sumatriptan (0mitre&). /seudoephedrine (#udafed) is a !asoconstrictor as is sumatriptan (0mitre&). The combination could dramaticall" increase the patient:s blood pressure. There isn:t an" relationship between sumatriptan (0mitre&) and ulcers. #umatriptan (0mitre&) does not need to be taken with protein. There is no need to increase fluid intake with sumatriptan (0mitre&). #ationa$e 2 5rowsiness and di88iness can occur with sumatriptan (0mitre&). /seudoephedrine (#udafed) is a !asoconstrictor as is sumatriptan (0mitre&). The combination could dramaticall" increase the patient:s blood pressure. There isn:t an" relationship between sumatriptan (0mitre&) and ulcers. #umatriptan (0mitre&) does not need to be taken with protein. There is no need to increase fluid intake with sumatriptan (0mitre&). #ationa$e 3 5rowsiness and di88iness can occur with sumatriptan (0mitre&). /seudoephedrine (#udafed) is a !asoconstrictor as is sumatriptan (0mitre&). The combination could dramaticall" increase the patient:s blood pressure. There isn:t an" relationship between sumatriptan (0mitre&) and ulcers. #umatriptan (0mitre&) does not need to be taken with protein. There is no need to increase fluid intake with sumatriptan (0mitre&). #ationa$e 4 5rowsiness and di88iness can occur with sumatriptan (0mitre&). /seudoephedrine (#udafed) is a !asoconstrictor as is sumatriptan (0mitre&). The combination could dramaticall" increase the patient:s blood pressure. There isn:t an" relationship between sumatriptan (0mitre&) and ulcers. #umatriptan (0mitre&) does not need to be taken with protein. There is no need to increase fluid intake with sumatriptan (0mitre&). #ationa$e 5rowsiness and di88iness can occur with sumatriptan (0mitre&). /seudoephedrine (#udafed) is a !asoconstrictor as is sumatriptan (0mitre&). The combination could dramaticall" increase the patient:s blood
pressure. There isn:t an" relationship between sumatriptan (0mitre&) and ulcers. #umatriptan (0mitre&) does not need to be taken with protein. There is no need to increase fluid intake with sumatriptan (0mitre&). %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess /lanning )earnin' ,ut!ome: '121 Question 1 Type: MC#A A dull( aching pain is defined as 1. ner!e pain. 2. somatic. 3. neuropathic. 4. !isceral. Corre!t Ans"er: * #ationa$e 1 =isceral pain is defined as a dull( throbbing( or aching pain. #ationa$e 2 =isceral pain is defined as a dull( throbbing( or aching pain. #ationa$e 3 =isceral pain is defined as a dull( throbbing( or aching pain. #ationa$e 4 =isceral pain is defined as a dull( throbbing( or aching pain. %$o&a$ #ationa$e: Co'niti(e )e(e$: ?emembering C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12'. Question 1Type: MC#A 0dentif" the correct statement regarding the neural mechanism of pain
1. 7nce the pain impulse reaches the spinal cord( neurotransmitters inhibit the signal. 2. Alpha fibers are wrapped in m"elin< C fibers are not. 3. 3hen tissues are damaged( pain impulses go directl" to the brain !ia alpha and beta fibers. 4. M"elin is a substance that slows ner!e transmission. Corre!t Ans"er: #ationa$e 1 A pain impulse tra!els to the spinal cord !ia alpha and C fibers. The alpha fibers are wrapped in m"elin (a lipid substance that speeds ner!e transmission)< the C fibers are not. 7nce the impulse reaches the spinal cord( neurotransmitters pass the message along to the ne&t neuron. #ationa$e 2 A pain impulse tra!els to the spinal cord !ia alpha and C fibers. The alpha fibers are wrapped in m"elin (a lipid substance that speeds ner!e transmission)< the C fibers are not. 7nce the impulse reaches the spinal cord( neurotransmitters pass the message along to the ne&t neuron. #ationa$e 3 A pain impulse tra!els to the spinal cord !ia alpha and C fibers. The alpha fibers are wrapped in m"elin (a lipid substance that speeds ner!e transmission)< the C fibers are not. 7nce the impulse reaches the spinal cord( neurotransmitters pass the message along to the ne&t neuron. #ationa$e 4 A pain impulse tra!els to the spinal cord !ia alpha and C fibers. The alpha fibers are wrapped in m"elin (a lipid substance that speeds ner!e transmission)< the C fibers are not. 7nce the impulse reaches the spinal cord( neurotransmitters pass the message along to the ne&t neuron. %$o&a$ #ationa$e: Co'niti(e )e(e$: ?emembering C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess ,!aluation )earnin' ,ut!ome: '12- and '12) Question 1. Type: MC#A 3hich of the following treatments has the highest potential to pro!ide total pain relief? 1. Chiropractic manipulation 2. Neuronal in%ection of alcohol 3. Acupuncture 4. Transcutaneous electrical ner!e stimulation (T,N#) Corre!t Ans"er: Adams, Pharmacology for Nurse: A Pathophysiologic Approach, *+, Cop"right -.'* b" /earson ,ducation( 0nc.
#ationa$e 1 T,N#( chiropractic manipulation( and acupuncture are less likel" to pro!ide total pain relief. Ner!e blocks irre!ersibl" stop impulse transmission along the treated ner!es. #ationa$e 2 T,N#( chiropractic manipulation( and acupuncture are less likel" to pro!ide total pain relief. Ner!e blocks irre!ersibl" stop impulse transmission along the treated ner!es. #ationa$e 3 T,N#( chiropractic manipulation( and acupuncture are less likel" to pro!ide total pain relief. Ner!e blocks irre!ersibl" stop impulse transmission along the treated ner!es. #ationa$e 4 T,N#( chiropractic manipulation( and acupuncture are less likel" to pro!ide total pain relief. Ner!e blocks irre!ersibl" stop impulse transmission along the treated ner!es. %$o&a$ #ationa$e: Co'niti(e )e(e$: ?emembering C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess /lanning )earnin' ,ut!ome: '12* Question 18 Type: MC#A 0dentif" the correct statement regarding opioid receptors. 1. The sigma and kappa receptors are of greatest concern from a pharmacologic standpoint. 2. 5rugs that block opioid receptors inhibit the pain impulse. 3. 7pioid agonists will acti!ate mu and kappa receptors( producing analgesia. 4. 7pioids e&ert their actions b" interacting with a total of four receptors. Corre!t Ans"er: ) #ationa$e 1 7pioid agonists stimulate mu and kappa receptors( resulting in a !ariet" of effects( including analgesia. There are at least si& t"pes of receptors. The mu and kappa receptors are of greatest concern from a pharmacologic standpoint. 5rugs that block opioid receptors are called opioid antagonists( and do not inhibit the pain impulse. #ationa$e 2 7pioid agonists stimulate mu and kappa receptors( resulting in a !ariet" of effects( including analgesia. There are at least si& t"pes of receptors. The mu and kappa receptors are of greatest concern from a pharmacologic standpoint. 5rugs that block opioid receptors are called opioid antagonists( and do not inhibit the pain impulse. #ationa$e 3 7pioid agonists stimulate mu and kappa receptors( resulting in a !ariet" of effects( including analgesia. There are at least si& t"pes of receptors. The mu and kappa receptors are of greatest concern from a
pharmacologic standpoint. 5rugs that block opioid receptors are called opioid antagonists( and do not inhibit the pain impulse. #ationa$e 4 7pioid agonists stimulate mu and kappa receptors( resulting in a !ariet" of effects( including analgesia. There are at least si& t"pes of receptors. The mu and kappa receptors are of greatest concern from a pharmacologic standpoint. 5rugs that block opioid receptors are called opioid antagonists( and do not inhibit the pain impulse. %$o&a$ #ationa$e: Co'niti(e )e(e$: ?emembering C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess ,!aluation )earnin' ,ut!ome: '129 Question 1/ Type: MC#A A patient on a morphine patient2controlled analgesic (/CA) 0= pump has a respirator" rate of 1( and is difficult to arouse. 3hich of the following would be the priorit" inter!ention? 1. Administering acti!ated charcoal 2. Bowering the dose of morphine 3. Administering a medication that blocks mu and kappa receptors 4. 0ntubation and mechanical !entilation Corre!t Ans"er: ) #ationa$e 1 Administering the opioid antagonist nalo&one (Narcan) is indicated in the gi!en situation. Bowering the dose is not aggressi!e enough( and intubation is too aggressi!e. Acti!ated charcoal is not indicated for an o!erdose that has occurred !ia the 0= route. #ationa$e 2 Administering the opioid antagonist nalo&one (Narcan) is indicated in the gi!en situation. Bowering the dose is not aggressi!e enough( and intubation is too aggressi!e. Acti!ated charcoal is not indicated for an o!erdose that has occurred !ia the 0= route. #ationa$e 3 Administering the opioid antagonist nalo&one (Narcan) is indicated in the gi!en situation. Bowering the dose is not aggressi!e enough( and intubation is too aggressi!e. Acti!ated charcoal is not indicated for an o!erdose that has occurred !ia the 0= route. #ationa$e 4 Administering the opioid antagonist nalo&one (Narcan) is indicated in the gi!en situation. Bowering the dose is not aggressi!e enough( and intubation is too aggressi!e. Acti!ated charcoal is not indicated for an o!erdose that has occurred !ia the 0= route.
%$o&a$ #ationa$e: Co'niti(e )e(e$: Appl"ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess 0mplementation )earnin' ,ut!ome: '12; Question 20 Type: MC#A 3hich of the following is an ad!erse effect associated with morphine( and would be the priorit" if present? 1. ?estlessness 2. Constipation 3. ?espirator" depression 4. /s"chological dependence Corre!t Ans"er: ) #ationa$e 1 All are ad!erse effects( but respirator" depression is the top priorit". #ationa$e 2 All are ad!erse effects( but respirator" depression is the top priorit". #ationa$e 3 All are ad!erse effects( but respirator" depression is the top priorit". #ationa$e 4 All are ad!erse effects( but respirator" depression is the top priorit". %$o&a$ #ationa$e: Co'niti(e )e(e$: Cnderstanding C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12'. Question 21 Type: MC#A 3hich patient would be at greatest risk for de!eloping opioid dependence? 1. -*2"ear2old with sickle2cell anemia 2. ))2"ear2old with diabetes
3. '62"ear2old with a broken arm 4. 692"ear2old with congesti!e heart failure Corre!t Ans"er: ' #ationa$e 1 #ickle2cell anemia is a chronic and painful disorder( and is often treated with opioids. 5iabetes and congesti!e heart failure are chronic disorders( but are not t"picall" managed with opioids. @roken bones are painful( and opioids ma" be used. 4owe!er( broken bones and the associated pain are acute e!ents. #ationa$e 2 #ickle2cell anemia is a chronic and painful disorder( and is often treated with opioids. 5iabetes and congesti!e heart failure are chronic disorders( but are not t"picall" managed with opioids. @roken bones are painful( and opioids ma" be used. 4owe!er( broken bones and the associated pain are acute e!ents. #ationa$e 3 #ickle2cell anemia is a chronic and painful disorder( and is often treated with opioids. 5iabetes and congesti!e heart failure are chronic disorders( but are not t"picall" managed with opioids. @roken bones are painful( and opioids ma" be used. 4owe!er( broken bones and the associated pain are acute e!ents. #ationa$e 4 #ickle2cell anemia is a chronic and painful disorder( and is often treated with opioids. 5iabetes and congesti!e heart failure are chronic disorders( but are not t"picall" managed with opioids. @roken bones are painful( and opioids ma" be used. 4owe!er( broken bones and the associated pain are acute e!ents. %$o&a$ #ationa$e: Co'niti(e )e(e$: Cnderstanding C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '126 Question 22 Type: MC#A 3hich statement is accurate concerning the management of migraine headaches? 1. Acute treatment and pre!ention are achie!ed !ia the same medications. 2. There are no pharmacologic agents a!ailable to pre!ent migraine headaches. 3. Chronic headache pain is managed !ia dail" N#A05 use. 4. =asoconstriction of cranial arteries helps reduce acute headache pain. Corre!t Ans"er: * #ationa$e 1 Migraine headaches are thought to occur from an initial !asoconstricti!e episode that is followed b" !asodilation and acute pain. Acute episodes are treated with cranial arter" !asoconstrictors and pre!ention !ia !asodilators.
#ationa$e 2 Migraine headaches are thought to occur from an initial !asoconstricti!e episode that is followed b" !asodilation and acute pain. Acute episodes are treated with cranial arter" !asoconstrictors and pre!ention !ia !asodilators. #ationa$e 3 Migraine headaches are thought to occur from an initial !asoconstricti!e episode that is followed b" !asodilation and acute pain. Acute episodes are treated with cranial arter" !asoconstrictors and pre!ention !ia !asodilators. #ationa$e 4 Migraine headaches are thought to occur from an initial !asoconstricti!e episode that is followed b" !asodilation and acute pain. Acute episodes are treated with cranial arter" !asoconstrictors and pre!ention !ia !asodilators. %$o&a$ #ationa$e: Co'niti(e )e(e$: Cnderstanding C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess ,!aluation )earnin' ,ut!ome: '121 Question 23 Type: MC#A >or which of the following patients suffering a migraine headache would sumatriptan (0mitre&) be indicated? 1. 6)2"ear2old with angina pectoris 2. );2"ear2old female with preeclampsia 3. *92"ear2old diabetic male 4. -62"ear2old asthmatic male Corre!t Ans"er: * #ationa$e 1 #umatriptan is contraindicated in patients with h"pertension( angina( and diabetes. 0t also is a /regnanc" Categor" C drug. #ationa$e 2 #umatriptan is contraindicated in patients with h"pertension( angina( and diabetes. 0t also is a /regnanc" Categor" C drug. #ationa$e 3 #umatriptan is contraindicated in patients with h"pertension( angina( and diabetes. 0t also is a /regnanc" Categor" C drug. #ationa$e 4 #umatriptan is contraindicated in patients with h"pertension( angina( and diabetes. 0t also is a /regnanc" Categor" C drug. %$o&a$ #ationa$e:
Co'niti(e )e(e$: ?emembering C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess /lanning )earnin' ,ut!ome: '12'. Question 24 Type: MC#A 3hich statement is accurate concerning the use of aspirin (A#A) to treat pain? 1. 4igh doses are necessar" (' gram) to achie!e anticoagulant effects. 2. ,nteric2coated capsules are a!ailable to reduce D0 side effects. 3. 0ncrease consumption of herbs such as garlic and ginger to potentiate the anti2inflammator" effects. 4. 0n low doses ()-9 mg)( it significantl" reduces inflammation. Corre!t Ans"er: #ationa$e 1 Aspirin can cause bleeding in low doses. ,nteric2coated capsules can help pre!ent bleeding( and a!oiding certain herbs such as ginger and garlic should be ad!ised. The anti2inflammator" effects of aspirin occur in high doses. #ationa$e 2 Aspirin can cause bleeding in low doses. ,nteric2coated capsules can help pre!ent bleeding( and a!oiding certain herbs such as ginger and garlic should be ad!ised. The anti2inflammator" effects of aspirin occur in high doses. #ationa$e 3 Aspirin can cause bleeding in low doses. ,nteric2coated capsules can help pre!ent bleeding( and a!oiding certain herbs such as ginger and garlic should be ad!ised. The anti2inflammator" effects of aspirin occur in high doses. #ationa$e 4 Aspirin can cause bleeding in low doses. ,nteric2coated capsules can help pre!ent bleeding( and a!oiding certain herbs such as ginger and garlic should be ad!ised. The anti2inflammator" effects of aspirin occur in high doses. %$o&a$ #ationa$e: Co'niti(e )e(e$: Cnderstanding C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12'. Question 2
Type: MCMA The nurse has %ust taken a %ob in a hospital that cares for an ethnicall" di!erse population and is concerned about being culturall" sensiti!e. 4ow should the nurse plan to manage caring for patients in pain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that appl". 1. Treat all patients alike. 2. Bisten carefull" as the patient:s comments about pain are translated. 3. #how respect for the patient:s preferences e!en if the" are !er" different from the nurse:s. 4. Ask questions about the patient:s beliefs and customs regarding pain management. . 3atch how other nurses pro!ide care to their patients. Corre!t Ans"er: -()(* #ationa$e 1 Not all patients respond identicall" to inter!entions. #ationa$e 2 ,!en if the nurse has to use the ser!ices of a translator( careful listening is an important step in pro!iding culturall" sensiti!e care. #ationa$e 3 #howing respect is important in pro!iding culturall" sensiti!e care in all areas( including pain management. #ationa$e 4 The nurse cannot practice what the nurse does not know. Asking questions is the method used to gain information to facilitate sensiti!e care. #ationa$e 7ther nurses ma" not be pro!iding the care needed for this nurse:s patients.
%$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: @asic Care and Comfort *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12' Question 2Type: MCMA The patient has ad!anced cancer and is e&periencing malignant pain. 4ow should the nurse plan to manage this pain?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that appl". 1. Cse the intra!enous route for pain medication administration. 2. #et up a dosing schedule that pro!ides for around2the2clock doses. 3. ,ncourage the patient to wait '. minutes after pain medication is required to ask for a dose. 4. Augment the patient:s regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain. . Counsel the patient that it is not possible to eliminate all the pain of cancer and that some must be tolerated. Corre!t Ans"er: -(* #ationa$e 1 Appro&imatel" A.E of cancer pain can be controlled b" use of oral medications if the" are dosed appropriatel". #ationa$e 2 7ften the problem in controlling pain of an" t"pe is that the patient $gets behind$ the pain rather than medicating for it before it gets se!ere. Around2the2clock dosing helps to pre!ent $pla"ing catch2up$ to the pain. #ationa$e 3 This plan would allow the pain to worsen before medication is gi!en and would result in the patient getting $behind$ the pain. #ationa$e 4 @reakthrough pain is e&pected and ma" require additional pharmaceutical or nonpharmaceutical measures. #ationa$e 3hile it is true that some cancer patients de!elop intractable pain( man" are able to control pain to a le!el that is !er" tolerable. %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: /harmacological and /arenteral Therapies *ursin'/+nte'rated Con!epts: Nursing /rocess /lanning )earnin' ,ut!ome: '12Question 2. Type: MCMA The patient rings the nurse call button and requests pain medication. Cpon assessment( the nurse finds the patient sitting up in a chair( watching tele!ision with a friend. =ital signs are normal and the patient:s skin is warm and dr". 3hich nursing actions are appropriate?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that appl". 1. Ask the patient to rate his pain on the pain scale. 2. Tell the patient that he does not look as if he is in pain. 3. 4a!e the patient go back to bed and ask the !isitor to lea!e. 4. Check to see when the patient last recei!ed pain medication. . 4a!e another nurse assess the patient. Corre!t Ans"er: '(* #ationa$e 1 3hen the patient complains of pain( the nurse should alwa"s ask for a pain rating. #ationa$e 2 /atients respond to pain differentl". >or e&ample( this patient ma" be tr"ing to hide the intensit" of his pain from his friend. #ationa$e 3 4a!ing the patient go back to bed and asking the !isitor to lea!e is puniti!e and could be interpreted as the nurse not belie!ing the patient. @eing acti!e and ha!ing di!ersions can help with pain management. #ationa$e 4 The nurse should check to see when the patient last had pain medication( what drug was gi!en( what dose was gi!en( and b" what route it was administered. #ationa$e There is no reason to ha!e another nurse assess the patient. This action ma" impl" that the nurse does not trust the patient. %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: /harmacological and /arenteral Therapies *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12) Question 28 Type: MCMA The home hospice nurse is completing the initial assessment of a patient who is has terminal congesti!e heart failure. The patient frequentl" has pain with breathing. 3hat questions should the nurse ask? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that appl".
1. $4ow much pain are "ou willing to tolerate?$ 2. $3hat do "ou like to do throughout the da"?$ 3. $4a!e "ou e!er been addicted to a pain medication?$ 4. $Are there an" pain medications "ou would like to a!oid?$ . $3hat things besides drugs help with "our pain?$ Corre!t Ans"er: '(-(*(9 #ationa$e 1 0t is sometimes impossible to eliminate all pain and all ad!erse medication effects. The nurse needs to know how much pain and how man" of the effects the patient is willing to tolerate. #ationa$e 2 Fnowing what the patient likes to do and when it is important for the patient to be most awake and alert helps the nurse create a pain management plan. #ationa$e 3 Addiction is not a concern at the end of life. Man" patients are alread" concerned about becoming addicted and the nurse should not reinforce this m"th. #ationa$e 4 #ome patients cannot tolerate the side effects of some medications. 0t is important for the nurse to assess for these preferences. #ationa$e Nonpharmacologic pain relief strategies should also be in!estigated.
%$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: /harmacological and /arenteral Therapies *ursin'/+nte'rated Con!epts: Nursing /rocess Assessment )earnin' ,ut!ome: '12'* Question 2/ Type: MCMA The patient has been started on morphine sulfate (M# Contin) for chronic back pain resulting from inoperable disk degeneration. 3hat nursing actions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that appl". 1. Cse the prn order of docusate (5ulcola&) routinel" e!er" night. 2. Ask the dietar" department to add bran cereal to the patient:s breakfast tra"s.
3. Ask the health care pro!ider to write an order for an indwelling urinar" catheter. 4. ?e!iew the trending of the patient:s hemoglobin and hematocrit le!els. . Check the medical record for a prn order for an antiemetic. Corre!t Ans"er: '(-(*(9 #ationa$e 1 7ne of the ad!erse effects of morphine therap" is constipation. The nurse should be proacti!e b" gi!ing the docusate e!er" night. #ationa$e 2 0ntake of additional fiber( as long as sufficient fluid is taken( is useful in pre!enting the constipation that is common with the use of morphine. #ationa$e 3 3hile morphine ma" promote urinar" retention( other methods of controlling this ad!erse effect should be used initiall". #ationa$e 4 Morphine should not be administered to those who are h"po!olemic due to the risk of h"potension. #ationa$e Nausea and !omiting are ad!erse effects of the use of morphine. Cntil the patient becomes tolerant of this effect( an antiemetic ma" be necessar". %$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: /harmacological and /arenteral Therapies *ursin'/+nte'rated Con!epts: Nursing /rocess 0mplementation )earnin' ,ut!ome: '12'* Question 30 Type: MCMA The patient has been keeping a $headache diar"$ of her migraines. Cpon re!iew of this diar"( the nurse notes that the headaches are described as mild and ha!e happened four times in the last ) months. The patient reports that she $generall" %ust lies down until the" pass$ but that her new %ob will not allow that time. #he is requesting information about pain medication. 3hat medications would the nurse e&pect to be prescribed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: #elect all that appl". 1. 0buprofen 2. Acetaminophen and caffeine 3. #umatriptan (0mitre&)
4. ,rgotamine (,rgostat) . Amitript"line (,la!il) Corre!t Ans"er: '(#ationa$e 1 N#A05s are often effecti!e for the mild migraines this patient e&periences. #ationa$e 2 Acetaminophen and caffeine together are used for treatment of mild migraines. #ationa$e 3 #umatriptan is a serotonin receptor agonist and is usuall" used onl" for moderate to se!ere migraines. #ationa$e 4 ,rgotamine is an ergot alkaloid that is a serotonin receptor agonist. This drug is used onl" with moderate to se!ere migraines. #ationa$e Amitript"line is used to pre!ent migraines( not to reduce pain once the" occur.
%$o&a$ #ationa$e: Co'niti(e )e(e$: Anal"8ing C$ient *eed: /h"siological 0ntegrit" C$ient *eed Su&: /harmacological and /arenteral Therapies *ursin'/+nte'rated Con!epts: Nursing /rocess /lanning )earnin' ,ut!ome: '12')

Adams4e Tif Ch18

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Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E Chapter 18

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