Chapter 10: Pain Lewis et al.: Medical-Surgical Nursing in Canada, 3rd Edition Exam Questions With Complete Solutions.

1. A 45-year-old woman has breast cancer that has spread to her liver and spine. She has been taking oxycodone (Percodan) and amitriptyline (Elavil) for pain control at home, but she now has constant severe pain and is hospitalized for pain control and development of a pain management program. During assessment of the patient, what information related to her pain is most important for the nurse to obtain initially? a. The pattern, area, intensity, and nature of her pain b. Identification of trigger points of pain by palpation of painful areas c. The schedule and total dosages of the drugs she is currently taking and when breakthrough pain occurs d. The presence of a sympathetic response, such as tachycardia, diaphoresis, and a rise in blood pressure - ANS: A Pain is a complex experience involving physiological, sensory (i.e., the perception of pain by the individual that addresses the pain location, intensity, pattern, and quality), affective, behavioural, and cognitive dimensions; therefore, the nurse needs to assess the pattern, area, nature, and intensity of the pain immediately. PTS: 1 DIF: Cognitive Level: Application REF: page 158 OBJ: 5 TOP: Nursing Process: Assessment MSC: CRNE: CH-1 2. The physician plans to titrate narcotic analgesic to provide pain relief for a patient with surgical pain. What does the nurse's role in include? a. Monitoring the effects of continuous intravenous (IV) infusion of narcotic analgesics b. Teaching the patient to try to increase the time between doses of pain medication c. Assisting the patient to plan the use of a specific total dose of analgesic over a 24-hour period d. Determining with the patient the optimal analgesic dosage required for pain relief with attention to the side effects produced - ANS: D The goal of titration is to use the smallest dosage of analgesic that provides effective pain control with the fewest side effects.PTS: 1 DIF: Cognitive Level: Application REF: page 166 OBJ: 6 TOP: Nursing Process: Implementation MSC: CRNE: CH-52 3. It is determined that a step 3 drug as proposed by the World Health Organization (WHO) is necessary for a patient whose cancer pain is unrelieved by step 2 drugs. Which is an appropriate drug and route for this patient? a. Oral codeine b. Oral morphine c. Intramuscular meperidine (Demerol) d. Intravenous oxymorphone (Numorphan) - ANS: B