NUR 308 EAQ Pain Management. (PRE-TEST)

NUR 308 EAQ Pain Management. (PRE-TEST) Pre-Test 1. The nurse is caring for a hospitalized patient whose home medications include daily acetaminophen for headaches. Which associated assessment finding should the nurse report to the healthcare provider immediately? A. Pain level of 4/10 B. Urinary output 75 mL/hr C. Dyspepsia D. Dark urine 2. Which of these outcomes would be most appropriate to establish for a patient who is being treated for post-operative pain following an open abdominal procedure? Select all that apply. A. Patient reports pain level of 2/10 on 0–10 scale. B. Patient’s blood pressure is 162/81 mm Hg. C. Patient monitor displays sinus tachycardia. D. Patient will be free from pain during hospitalization. E. Oxygen saturation remains above 94% on room air. 3. The nurse should include which questions when assessing a patient’s pain following a fractured ankle injury? Select all that apply. A. Intensity B. Onset C. How much weight he is able to bear D. Location E. What makes it better or worse 4. A patient has undergone knee replacement surgery. The nurse should perform which priority assessment after the patient has received an intravenous dose of hydromorphone for pain? A. Assess respiratory rate B. Auscultate lung sounds C. Re-assess pain D. Check surgical wound 5. An older adult has suffered a stroke and exhibits expressive aphasia. When assessing for pain, which tool is best for the nurse to utilize with this patient? A. Numerical scale B. FACES scale C. Wong-Baker Faces D. Verbal scale Activity You are responsible for providing care to Mr. Jones, a 58-year-old salesman who was admitted to the surgical unit for a left total knee replacement surgery. Mr. Jones is 12 hours post-op. During shift report, the assigned nurse shares the following information with you: • Pain rating of an 8 of 10 during initial assessment • Prescribed pain medication (morphine) administered per order • Post-medication administration assessment revealed pain rated at 5 of 10. 1. Patient was restless most of the overnight. You enter Mr. Jones’ room to complete a shift assessment. Which is your priority action? A. Palpating a radial pulse B. Monitoring blood pressure C. Conducting a pain assessment D. Inspecting the surgical incision ANS: Pain assessment and management is your priority based on the information shared during the shift assessment, which portrays the concern that the patient’s pain has not been controlled with morphine alone. The American Pain Society champions this relatively straightforward way to improve pain management, since inclusion of a pain assessment when assessing vital signs (blood pressure, pulse, and respirations) gives the pain assessment clinical priority. 2. Which tool should you use to assess Mr. Jones’ current level of pain? A. FACES pain scale B. FLACC pain scale C. Numerical pain scale D. Neonatal infant pain scale ANS: A numerical pain scale allows the patient to rate current level of pain on a scale of 1 to 10. This unidimensional measurement is designed to assess treatment response to both pharmacologic and non-pharmacologic interventions for many forms of acute pain, including burns, postoperative pain, and chronic non-cancer pain. Evidence suggests that this unidimensional scale may be less effective as a measure of chronic pain or of mixed acute and chronic pain. The FACES scale is more appropriate for a pediatric patient. The FLACC pain scale is more appropriate when assessing pain for an infant patient. The neonatal infant pain scale, referred to as NIPS, is designed for a neonate. 3. Which questions should you ask Mr. Jones in order to conduct a focused pain assessment? Select all that apply. A. “When did your pain begin?” B. “Can you describe your pain for me?” C. “Are there any activities that make your pain worse?” D. “When was the last time you received pain medication?” E. "Can you trace your pain for me?" ANS: OPQRST-AAA is a useful mnemonic the nurse can use to evaluate pain symptoms, with each letter representing an important line of questioning: • O – Onset of pain • P – Provocation • Q – Quality of pain • R – Region or radiation • S – Severity • T – Time and duration • AAA – Aggravating/alleviating factors and associated symptoms. It is not necessary to ask the patient when he last received pain medication. This information is provided during shift report and can be verified with the medication administration record (MAR). A brief interview using the OPQRST-AAA mnemonic can be conducted in less than 5 minutes and can occur simultaneously with other assessment activities. The information gained through this structured questioning approach clarifies the nature of pain experienced by the patient and informs the clinician’s review and selection of effective therapeutic interventions. 4. The nurse assesses Mr. Jones’ current level of pain and finds that it is back to an 8 on a 1 to 10 scale. He describes the pain in his left knee as “stabbing and angry.” Which prescribed pain medication should you administer to Mr. Jones? A. aspirin B. morphine C. ibuprofen D. hydromorphone ANS: Mr. Jones’ is experiencing acute, severe pain; therefore, it is appropriate to administer an intravenous opioid to address his pain. While morphine and hydromorphone are both intravenous analgesics, the patient’s pain has not been addressed by morphine thus far; therefore, hydromorphone is the most appropriate pain medication to administer at this time. Hydromorphone is eight times more potent than morphine. Aspirin is often contraindicated after a surgical procedure due to the risk for bleeding. Ibuprofen, a non-steroid anti-inflammatory drug (NSAID), is appropriate to treat chronic pain due to inflammation. 5. You administer the prescribed IV hydromorphone to Mr. Jones. Which is your priority assessment based on the current data? A. Pain B. Heart rate C. Respiration D. Blood pressure ANS: While it is important to reassess Mr. Jones’ level of pain, the priority assessment after administering an IV opioid drug such as hydromorphone is to monitor the patient for the adverse reaction of respiratory depression. Heart rate and blood pressure are not priority assessments for this patient based on the current data. 6. The hydromorphone administered at the beginning of the shift worked well to address Mr. Jones’ pain. Thirty minutes post administration, he rated his current level of pain at a 3 on a 1 to 10 scale. It is now early afternoon and Mr. Jones is preparing for physical therapy. Which nursing action is most appropriate at this time? A. Assessing the patient’s current level of pain B. Monitoring the patient for respiratory depression C. Asking the therapist to initiate therapy on the next shift D. Administering a prn dose of prescribed oral pain medication ANS: Physical therapy often causes an exacerbation in the level of pain experienced by the patient. It is important for you to assess Mr. Jones’ current level of pain and implement an intervention to manage his pain in preparation for physical therapy. There is no indication that you have administered an opioid pain medication necessitating an assessment for respiratory depression. While administering a pain medication prior to physical therapy may be appropriate, you cannot make this determination prior to conducting a pain assessment. 7. Mr. Jones received a dose of acetaminophen with codeine prior to the physical therapy session. After the session Mr. Jones states, “I am very uncomfortable now that therapy is over. I don’t want a strong pain medication because it made me really drowsy. What else can I have to treat my pain?” You review Mr. Jones’ medication prescriptions and find that he