Deck 4: Symptom Management: Pain at the End of Life

Question 1

A patient newly diagnosed with cancer is complaining of mild pain. Following the analgesic ladder, the nurse realizes that which of the following types of medications would be indicated to treat this patient's pain?

A) Methadone
B) Codeine
C) Morphine
D) NSAIDs

Answer 1

NSAIDs

Question 2

A terminally ill patient tells the nurse that she does not have any pain, yet the nurse is planning to provide the prescribed pain medication. Which of the following did the nurse most likely assess in this patient?

A) Blood pressure of 138/74 mm Hg
B) Nonverbal indication of pain
C) Heart rate of 90 beats per minute
D) Respiratory rate of 20 per minute

Answer 2

Nonverbal indication of pain

Question 3

A patient receiving an opioid analgesic for pain has a respiratory rate of 6 per minute and is unable to be aroused. Which of the following would be indicated for this patient?

A) Warming blanket
B) Opioid reversal with naloxone
C) Elevate the head of the bed to 30 degrees
D) Increase intravenous fluids

Answer 3

Opioid reversal with naloxone

Question 4

A terminally ill patient tells the nurse that his pain is better controlled in the hospital than at home because the pain medication cost is high and he does not get the prescriptions filled as he should. Which of the following should the nurse do to help this patient?

A) Suggest the patient take over the counter medication to help with the pain
B) Call the hospital pharmacy and have several months of medications prepared for the patient to take home
C) Ask the patient if there are any other expenses that can be eliminated so that he can get his prescriptions filled
D) Discuss this issue with the physician to see if medications can be prescribed as generics

Question 5

A terminally ill patient tells the nurse to "not even try" to find medication for his pain since he is used to "suffering" and often thinks that the best solution is just to "end it all." The nurse realizes this patient is demonstrating:

A) Side effect of pain medication
B) Depression
C) Adequate pain control
D) Cognitive effects of the terminal disease

Question 6

In assessing the amount of pain that a terminally ill patient is currently experiencing, the nurse asks him if the pain is worse while breathing, moving, or swallowing. The nurse is assessing which aspect of the OLD-CART pain assessment scale?

A) Aggravating factors
B) Onset
C) Location
D) Duration

Question 7

The nurse is assessing a terminally ill patient's current level of pain. The patient is able to talk and understands the nurse's assessment. Which of the following pain scales would be most appropriate for the nurse to use at this time?

A) Wong-Baker scale
B) Pain scale from 0 to 10
C) Pritchett and Hull scale
D) Percentage scale

Question 8

A patient tells the nurse that he visualizes a calm warm beach, sunny sky, and pleasant music while waiting for the pain medication to take effect. The nurse realizes this patient is utilizing which of the following?

A) Meditation
B) Hallucination
C) Guided imagery
D) Distraction

Question 9

A terminally ill patient tells the nurse that he expects to "suffer" during his last days on earth since that explains his humanity and that he is still "alive." The nurse realizes that the patient is experiencing which of the following?

A) Lack of oxygen to the cerebral tissues
B) Confusion
C) Irrational behavior
D) Questioning his life in efforts to explain the purpose of the pain

Question 10

A terminally ill patient tells the nurse that while pain medication does take the physical pain away, he feels mentally tormented. Which of the following can the nurse do to help this patient?

A) Ask the patient if there is any clergy to contact
B) Suggest a psychiatric consult
C) Stay with the patient, listen, and offer words of support
D) Ask the physician to increase the frequency of pain medication

Question 11

A terminally ill non-English speaking patient continues to cry out "hot" when being turned and repositioned in the bed. It is documented that the patient uses ice to reduce pain in the lower back. Which of the following should the nurse do to assist this patient?

A) Limit the times the patient is to be turned and repositioned
B) Provide pain medication with a cool or cold ice pack
C) Keep the room dimly lit
D) Remove the top sheet and blanket from the patient

Question 12

The nurse is concerned that a terminally ill patient with aphasia is having pain but is unable to verbally express the degree. Which of the following can the nurse do to help this patient?

A) Assess the patient's facial expressions
B) Provide pain medication around the clock
C) Provide pain medication when the patient is awake
D) Provide pain medication when the patient's blood pressure and heart rate increase

Question 13

A patient tells the nurse that when he takes codeine, he gets nauseated and itchy. The nurse realizes that the patient is describing which of the following?

A) Exacerbation of the illness
B) True allergic reaction
C) Reaction to the additives in codeine
D) Inadequate clearance of the medication from the system

Question 14

A patient nearing the end of his life tells his family that he is in constant pain but has not received any medication for hours. When the family asks the nurse about pain medication, the nurse responds that there is not enough pain medication in the world to alleviate the patient's pain. This nurse's response is evidence of which of the following?

A) The patient does not have a current order for pain medication
B) The nurse is waiting for narcotics to be delivered from the pharmacy
C) Assumption that pain at the end of life cannot be relieved
D) Pain medication would hasten the patient's death

Question 15

The daughter of a terminally ill patient is overheard telling the patient that she should not constantly ask for pain medication since the nursing staff will get "upset" and not give "good care." Which of the following should the nurse do to help this patient and her family?

A) Explain to the patient and her daughter that asking for pain medication will not upset the staff and will not change the level of care the patient needs
B) Tell the daughter that if the nursing staff cannot help the patient at the time of the medication request, the patient will just have to wait
C) Say nothing and document that the patient is very needy
D) Document that the daughter should not be permitted to visit with the patient since it upsets the patient and the nursing staff

Question 16

The nurse is assessing the amount of pain that a terminally ill patient is experiencing. This is the first time the patient is being admitted to the hospital for care. Which of the following scales would provide the nurse with the most information?

A) Pritchett and Hull scale
B) Pain scale from 0 to 10
C) Wong-Baker scale
D) McGill-Melzack Pain Questionnaire

Question 17

A terminally ill patient receiving opioid analgesics is demonstrating evidence of uncontrolled pain and sadness. Which of the following types of medications might be indicated for this patient?

A) Antidepressant
B) Anticonvulsant
C) Anti-anxiety
D) Corticosteroid

Question 18

A terminally ill patient, prescribed a time-released pain medication, is requesting additional pain medication every 2 hours. Which of the following does this suggest to the nurse?

A) The time-released pain medication needs to be adjusted
B) The rescue dose needs to be increased
C) The patient is developing a psychological dependency
D) The patient is developing a physical dependency

Question 19

A terminally ill elderly patient begins to call out for help and is seen lying stiffly in bed, rubbing her left thigh. The nurse believes that which of the following is occurring with this patient?

A) Loneliness
B) Confusion
C) Experiencing pain
D) Sadness