Deck 9: Pain Management

Question 1

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

Answer 1

1, 3, 4, 5

Question 2

The nurse is caring for an older client with chronic pain caused by arthritis and uterine cancer. What is the best approach for the nurse to take when managing this client's pain?
1) Administering the pain medication around the clock
2) Administering the medication when the client requests it
3) Consulting the physician to order intravenous pain medication
4) Administering the medication sparingly to avoid narcotic addiction

Answer 2

1

Question 3

An older adult client has a history of osteoarthritis. The nurse cares for the client in the postoperative period after a below-the-knee amputation for complications of peripheral vascular disease. Which finding most concerns the nurse?
1) The client has a history of depression and anxiety, treated with a selective serotonin reuptake inhibitor.
2) The client takes acetaminophen (Tylenol) instead of prescribed pain medication as needed for osteoarthritis.
3) The client's spouse visits the hospital occasionally, usually to assist with the morning meal and bathing.
4) The client is irritable, reports moderate generalized pain, and states that he cannot "put a number on it."

Answer 3

2

Question 4

An older client receiving intravenous morphine sulfate is experiencing nausea and vomiting. What action should the nurse take at this time?
1) Provide the client with meperidine for pain as prescribed.
2) Suspend the use of morphine and use a different opioid analgesic.
3) Provide a prescribed antiemetic for a few days and gradually taper it.
4) Discuss using nonopioid analgesics since the client cannot tolerate them.

Question 5

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

Question 6

An older client receiving a low dose of oral morphine for chronic pain feels sleepy when taking the medication. What should the nurse explain to the client about this analgesic?
1) "Lowering the dose may reduce these feelings."
2) "Unfortunately you will need to change medications."
3) "Feeling sleepy is an unfortunate problem with morphine."
4) "Once you develop a tolerance to the medications, this will improve."

Question 7

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

Question 8

The nurse explores nonpharmacological approaches with an older client with chronic osteoarthritis pain. What is the best action for the nurse to teach to the client?
1) Weight control should eliminate osteoarthritis-related knee pain.
2) Avoid activities that increase osteoarthritis-related discomfort.
3) When pain medications are taken regularly, other pain interventions are not needed.
4) Daily swimming is a useful adjunct to prescribed pain medication.

Question 9

A terminally ill older client with ongoing pain is prescribed an increased dose of morphine. What is the best way for the nurse to manage this new dose?
1) Ensure the client is medicated on schedule and when needed.
2) Continue the previous dose until the client exhibits increased pain.
3) Slowly increase the current dose until the new dose is achieved.
4) Hold the next dose if the client's respiratory rate decreases.

Question 10

An older client recovering from surgery is prescribed IV morphine sulfate 2 to 6 mg every four hours prn for pain. What approach will the nurse take to manage this client's pain?
1) Begin by administering 2 mg IV every four hours as needed.
2) Administer 4 mg of morphine every time the client requests pain relief.
3) If the 2 mg dose is not effective within 15 minutes, administer another 2 mg.
4) Offer a 6 mg dose of morphine for reports of moderate to severe pain.

Question 11

An older client newly diagnosed with arthritis wants to know what else can be done to help with the pain. What should the nurse instruct this client? Select all that apply.
1) Maintain a healthy weight.
2) Avoid positions that increase or cause pain.
3) Reduce intake of red meat and processed grains.
4) Alcohol should not be used for any reason.
5) Perform daily gentle exercise like walking.

Question 12

An older client living at home with cancer reports having to take twice as much pain medication over the last 24 hours. What should the nurse do with this information?
1) Double the current dose of narcotic pain medication.
2) Discuss options to prevent and treat breakthrough pain.
3) Use non-pharmacological methods for pain relief instead of pain medication.
4) Advocate for a medication change because the client has opioid tolerance.

Question 13

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

Question 14

The nurse observes myoclonic movements in an older client receiving IV morphine sulfate for pain. What should the nurse do with this finding?
1) Contact the prescribing health care provider.
2) Continue to monitor the client for side effects.
3) Obtain a prescription for a decreased dose.
4) Request to change from IV dosing to oral dosing.

Question 15

An older client with a history of severe arthritis has not received pain medication for over 18 hours. The client is currently complaining of severe pain in both legs. What will the nurse attribute as being the reason for the client's increase in pain?
1) Dependency on narcotics
2) Over-exaggeration of the amount of pain
3) Need for alternative measures for pain relief
4) Untreated pain resulting in lower pain threshold

Question 16

An older client undergoing chemotherapy for cancer asks the nurse about using massage for pain relief. How does the nurse best respond? Select all that apply.
1) "We will have to discuss this with your oncologist."
2) "Wait until the chemotherapy is completed."
3) "Massage has many benefits, including relief of pain."
4) "The tumor was removed, so a massage is safe."
5) "Reiki is a good alternative to massage therapy."

Question 17

An older client takes meperidine daily for arthritic pain. Which finding is most concerning?
1) The client has a low glomerular filtration rate.
2) The client is arousable only to touch and voice.
3) The client has a history of a seizure disorder.
4) The client reports headaches, dizziness, and ataxia.

Question 18

An older client with chronic pain is newly prescribed transdermal fentanyl. What will the nurse do when providing this medication? Select all that apply.
1) Teach the client to avoid other narcotics after 72 hours with the patch.
2) Start with the lowest possible dose of the medication patch.
3) Anticipate and treat side effects such as nausea or constipation.
4) Apply the patch to clean, dry, hairless skin in a fatty area.
5) Administer other pain medications the first day the patch is used.

Question 19

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

Question 20

An older client with muscle wasting, renal disease, and advanced cancer pain asks for stronger pain medication than immediate-release oral morphine. What is the most important consideration when recommending a pain medication change to the health care provider for this client?
1) If the narcotic dose is increased, constipation is more likely.
2) Sleeping through meals is more likely when narcotic doses are increased.
3) Extended-release oral morphine should be considered for this client.
4) A Fentanyl transdermal patch provides excellent relief for cancer-related pain.

Question 21

An older client recovering from surgery refuses pain medication because of the fear of becoming addicted. What action should the nurse take at this time?
1) Contact the physician.
2) Administer the medication when the client is sleeping.
3) Withhold the analgesic medication and continue to observe the client.
4) Determine what methods of pain management are acceptable to the client.

Question 22

An older client with chronic low back pain asks the nurse if there is anything else besides taking pain medication that the client can do to help with the discomfort. What recommendation can the nurse safely make to the client?
1) Purchase a Tai Chi home exercise program.
2) A yoga class might be helpful to relieve pain.
3) Acupuncture will correct any source of back pain.
4) Take over-the-counter chondroitin or glucosamine.

Question 23

An older client with arthritis pain asks the nurse what can be taken to help with the mild discomfort. How should the nurse respond to this client?
1) "How would you rate this pain on a scale of 0-10?"
2) "Non pharmacological methods are best for mild pain."
3) "Acetaminophen or ibuprofen are good choices for mild pain."
4) "If you have a history of stomach ulcers, you can't take anything."

Question 24

An older client prescribed an oral time-release pain medication is having difficulty swallowing the dose. What should the nurse do to help this client?
1) Teach the client to crush the medication and put it in applesauce.
2) Offer alternatives to pharmacological therapy, including massage.
3) Consult with the health care provider to have the medication route changed.
4) Assess the client for continued need of pain medication doses.

Question 25

The spouse of an older client asks that the client be given pills and to tell the client that they are for pain. How should the nurse respond to the spouse's request?
1) "I have to tell the client what each pill is for."
2) "I will explain to the client that pain is normal with aging."
3) "Let's speak with the health care provider about this request."
4) "Administering a placebo pill is not ethical."