Test Bank for Ebersole and Hess Toward Healthy Aging Human Needs and Nursing Response 8th Edition by Touhy and Jett

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1 Test Bank for Ebersole and Hess Toward Healthy Aging Human Needs and Nursing Response 8th Edition by Touhy and Jett MULTIPLE CHOICE Chapter 17: Pain and Comfort 1. When performing a pain assessment on a client who is aphasic, the nurse should consider: A. reports from the family or staff at the nursing home about changes in functional status. B. that the patient is lying quietly in bed so not likely experiencing pain. C. that the patient s previous stroke interrupted pain pathways so she does not feelpain. D. that older adults do not tolerate opioid analgesics well and so exhibit sideeffects. ANS: A When an individual is not able to verbally communicate complaints of pain, reports from family or caregivers are important. In addition, in older adults, pain is often manifested as changes in functional status. To assume that the patient is not in pain because she is lying quietly in bed is incorrect. One should not assume that she feels no pain due to her stroke. Older adults tolerate opioid analgesics. DIF: Cognitive level: Application TOP: Nursing Process: Assessment MSC: 2. An older adult is admitted to the hospital after a serious fall. When noting that the client has been prescribed meperidine (Demerol) for muscle pain, the nurse: a. Administers the medication so as to prevent the client from developing the fear of pain b. Questions the client and family concerning any allergies to analgesic medications c. Calls the physician to question the appropriateness of this medication order d. Conducts a pain assessment and determines the client s need for an analgesicmedication Some medications used in younger adults, for example, meperidine (Demerol), are always contraindicated in the older adult. The metabolites of Demerol can cause confusion, psychotic behavior, and seizure activity. The remaining options would not be

2 inappropriate, except for the fact that they relate to the administration of an inappropriate medication. DIF: Cognitive level: Application TOP: Nursing Process: Planning Copyright 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Test Bank 17-2 MSC: 3. ANS: D Persistent pain can manifest itself as depression, eating and sleeping disturbances, and impaired function, all of which can lead to lifestyle changes. Persistent pain usually does not lead to markedly altered vital signs. Acute or persistent pain can manifest itself as a burning pain. Persistent pain has no time frame; it is continually persistent at varying levels of intensity. 4. The initial step to effect the safe management of mild to moderate acute pain that has not been controlled with over the counter medications is to: a. Begin acetaminophen (Tylenol) every 4 hours for 24 hours b. Supplement with non-pharmacological interventions c. Administer a single low dose of short acting opioid and monitor for relief d. Titrate dosage of a short acting opioid upward over 24 hours to achieve relief If pain continues, consider a single low-dose, short-acting opioid and observe effect. Acetaminophen is an over the counter analgesic and so its effect is already determined to

3 be ineffective. Non-pharmacological interventions are only appropriate once pain management has been successfully implemented. Titrating dose upward is appropriate only after effects of initial dose have been determined. 5. An older adult is admitted to the hospital with complications resulting from lung cancer with metastases to bone. A long-acting opioid administered around-theclock is prescribed. When explaining this intervention to the family, the nurse bases the explanation on the principle that this technique: a. Prevents the development of an addiction to opioids. b. Provides more stable therapeutic plasma levels of the drug. c. Prevents many side effects of traditionally administered opioids. d. Provides relief with lesser amounts of opioids. ANS: B Copyright 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Test Bank 17-3 Administering pain medications on an around-the-clock dosing schedule provides more stable therapeutic plasma level of drugs and eliminates the extremes of overmedication or under-medication. Around-the-clock dosing does not address the fear of addiction issue. The fear of addiction is unfounded; the issue is adequate pain relief for an individual with malignant pain. The nurse needs to assess for the side effects of opioids with any dosing schedule. Around-the-clock dosing does not necessarily decrease the amount of opioids used; however, it does allow for better pain management. 6. An older adult is being treated for severe pain resulting from a history of osteoarthritis. In her discharge teaching, which information is most important to the successful management of the pain? a. check for incompatibilities before taking any new medications b. arrange to take a dose of analgesic prior to physical activity c. to take the analgesic around the clock as prescribed d. be alert for the signs of overdose toxicity For someone with severe persistent pain it is important to achieve the highest level of

4 pain control it is helpful to ease the memory of pain, especially for those whose persistent pain is intense, like that of many chronic illnesses. This means to prevent the pain, not simply relieve it. The most effective way to do this is to provide around-theclock (ATC) dosing, at the appropriate dosage. The other options are appropriate medication related instructions but are not as directed towards successful management of chronic pain as is the correct option. 7. An older client with a history of hypertension and osteoarthritis who has recently fallen and fractured two ribs is prescribed extra strength Tylenol for the pain. What statement by the client requires further evaluation by the nurse? A. I find that when I drink herbal tea and then take my Tylenol at bedtime, I sleep through the whole night. B. I heard that meditation may help me deal with the pain without taking all that a. Tylenol. C. Two extra strength Tylenol tablets (500 mg/tablet) every 4 hours around-theclock and my pain is gone. D. I make sure that I take my Tylenol with breakfast when I first get up. Copyright 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Test Bank 17-4 The maximum dose for Tylenol is 4 g per 24-hour period; two extra strength Tylenol tablets every 4 hours would mean that the client is taking 6 g and would need further evaluation. Herbal tea may have a relaxing effect and help her sleep. Meditation is one of the alternative modalities that help some patients deal with pain. The practice of taking Tylenol with breakfast upon waking is acceptable. DIF: Cognitive level: Application TOP: Nursing Process: Evaluation MSC: 8. An older adult with gastric cancer with bone metastases is being discharged from the hospital after beginning a regimen of opioid analgesics to control the metastatic pain. What should be included in the discharge teaching plan? a. The development of a plan to prevent constipation b. Benefits of grief counseling c. Increasing calories in the diet d. Preventing pressure ulcers

5 ANS: A Side effects of opioids are significant to older adults and include constipation. Because constipation is almost universal when opioids are used, the nurse should ensure that an appropriate bowel regimen is taken at the same time as the opioids.. The remaining options are not specifically related to the management of the client s pain or the effects of opioid treatment. 9. An older adult is currently prescribed both aspirin (81 mg) and ibuprofen daily. What instructions are most important for the nurse to provide to assure the expected outcomes for this client? a. The medications should be taken together to ensure the effectiveness of both medications b. Take ibuprofen 30 minutes after the aspirin so as to not interfere with its effectiveness c. The aspirin will negatively affect the analgesic affect of the ibuprofen d. The medications should be taken at least 4 hours apart to minimize risk ofgastric irritation ANS: B In 2006 the Food and Drug Administration in the United States issued a warning regarding the concomitant use of aspirin (81 mg) and ibuprofen. When taken together the aspirin is less cardio-protective; that is, there is less anti-platelet effect increasing the person s risk for a cardiac event. Persons who take immediate release aspirin and take a single dose of ibuprofen 400mg: It should be at least 30 minutes after or 8 hours before the aspirin. Copyright 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Test Bank When educating a client on the use of an adjuvant medication, which statement best demonstrates the nurse s understanding of this therapy? A. These medications are used instead of opioids to decrease the likelihood of addiction. B. Adjuvant medications are prescribed because they seldom cause any significant side effects.

6 C. These types of medications are used to eliminate the side effects of opioid medications. D. These drugs are used in combination with analgesics to increase the effect of the analgesics. ANS: D Adjuvant medications are not analgesics but are thought to alter the perception of pain and are used with analgesics to potentiate the effect of the analgesics. Adjuvant medications are used with opioids and may have long half-lives in older adults. The nurse must monitor the patient for adverse effects. Adjuvant medications do not eliminate the side effects of opioids. 11. An older patient who was recently admitted to the subacute setting after having a knee replacement, is very anxious and refuses to get out of bed, stating that it is too painful. Which intervention will the nurse implement? A. Share with the patient that it s important to get out of bed and that there is pain medication available if it does hurt B. Use the Hoyer lift to get her out of bed so that the knee will not experience much movement and so there will be little pain. C. Offer pain medication, administer the medication, and wait 20 minutes before getting her out of bed. D. Allow the patient to remain in bed but share that getting up will be required at least twice a day starting the next morning. Administration of an as-needed analgesic 20 to 30 minutes before activity may eliminate discomfort and fear of discomfort, and may enhance the individual s capacity for the activity. It is not true that performing an activity quickly will lessen the pain or that the patient will get used to the pain. A Hoyer lift is only indicated when an individual is completely immobile. Activity is an important part of rehabilitation. Copyright 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Test Bank 17-6

7 MULTIPLE RESPONSE 1. An older aphasic patient has severe osteoarthritis, bilateral contractures of the lower extremities, and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around-the-clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective? Select all that apply. a. Patient slept throughout the night. b. Patient winces only when turned and repositioned. c. Patient slept during dressing change. d. Patient compliant with attempts to provide AM care. e. Patient ate 80% of breakfast, 70% of lunch and 100% of dinner ANS: A, C, D, E Pain cues presented by this client is the wincing when being turned, indicating that this intervention is pain producing. The remaining observations are concurrent with effective pain management. DIF: Cognitive level: Application TOP: Nursing Process: Evaluation MSC: 2. An older adult is seen in the emergency department after falling and sustaining substantial soft tissue bruising. The assessment interview notes a history of arthritic pain in several joints. The client is prescribed acetaminophen 650 mg four times per day and Motrin 800 mg four times per day for control of the persistent arthritic pain. When providing discharge teaching, the nurse includes information regarding the signs and symptoms of: Select all that apply. a. gastrointestinal bleeding b. renal impairment c. medication interactions d. confusion e. increased anxiety ANS: A, B, C There is no indication that the patient is at risk for mental status changes such as confusion or increased anxiety. The remaining options are directly related to the possible outcomes of long-term pain management with these medications.

8 3. When individualizing pain management for a client hospitalized after major surgery, the nurse will: Select all that apply. a.titrate the prescribed analgesic medication to provide effective pain management b.assess the client for cultural beliefs that affect individual expression of pain c. Reassure the client that pain medication is available whenever they express a need for it d.anticipate the client s need for pain medications e.implement non-pharmacological pain management interventions wheneverpossible ANS: A, B, D, E The client will require knowledge about the frequency of the administration of the medication; if the requests are consistently made before the medication can be re-administered, the treatment plan should be re-evaluated and altered. The other options reflect appropriate interventions for effective pain management.

A PATIENT GUIDE FOR MANAGING PAIN

A PATIENT GUIDE FOR MANAGING PAIN PAIN MANAGEMENT Knowing the Facts Pain can be controlled. Pain is common after surgery and with many types of illnesses. Most patients with acute and chronic pain can