Chapter 24 limb pain: Upper extremity
1.A 91-year-old nursing home resident has been receiving meperidine (Demerol) injections for right
shoulder pain. During the morning assessment, the nurse finds the resident irritable and jumpy. Which
nursing actions and rationales is appropriate?
a. Administer a dose of Demerol because the patient is exhibiting signs of withdrawal.
b. Administer a dose of Demerol because these are symptoms of pain in an older adult patient. c. Notify the
registered nurse (RN) or physician that the resident may be experiencing toxic effects of Demerol.
d. Assess the patients pain level before determining the appropriate dose of Demerol to administer.
ANS: C
The RN or physician should be notified and a different analgesic ordered. Meperidine (Demerol),
when broken down in the body, produces a toxic metabolite called normeperidine. Normeperidine is a
cerebral irritant that can cause adverse effects ranging from dysphoria and irritable mood to seizures in the
older adult. A. B. C. Administering a dose of Demerol will worsen the symptoms.
2.A 60-year-old woman has developed reflexive sympathetic dystrophy after arthroscopic repair
of her shoulder. A key feature of this condition is that the:
a. Affected extremity will eventually regain its function.
b. Pain is felt at one site but originates from another location.
c. Patients pain will be associated with nausea, pallor, and diaphoresis.
d. Slightest touch, such as a sleeve brushing against her arm, causes severe and intense pain. ANS: D
A key feature of reflexive sympathetic dystrophy is that a typically innocuous stimulus can
create a severe, intensely painful response. The affected extremity becomes less functional over
time.
3. The nurse is assessing a patients pain. The nurse knows that the most reliable indicator of pain
would be the:
a. Patients vital signs.
b. Physical examination.
c. Results of a computerized axial tomographic scan. d. Subjective report.
ANS: D
The subjective report is the most reliable indicator of pain. Physical examination findings can lend support,
but the clinician cannot exclusively base the diagnosis of pain on physical assessment findings.
4.A patient admitted with liver disease complains of pain in his right shoulder. What should the nurse use as
explanation for this patients site of pain?
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1.A 91-year-old nursing home resident has been receiving meperidine (Demerol) injections for right
shoulder pain. During the morning assessment, the nurse finds the resident irritable and jumpy. Which
nursing actions and rationales is appropriate?
a. Administer a dose of Demerol because the patient is exhibiting signs of withdrawal.
b. Administer a dose of Demerol because these are symptoms of pain in an older adult patient. c. Notify the
registered nurse (RN) or physician that the resident may be experiencing toxic effects of Demerol.
d. Assess the patients pain level before determining the appropriate dose of Demerol to administer.
ANS: C
The RN or physician should be notified and a different analgesic ordered. Meperidine (Demerol),
when broken down in the body, produces a toxic metabolite called normeperidine. Normeperidine is a
cerebral irritant that can cause adverse effects ranging from dysphoria and irritable mood to seizures in the
older adult. A. B. C. Administering a dose of Demerol will worsen the symptoms.
2.A 60-year-old woman has developed reflexive sympathetic dystrophy after arthroscopic repair
of her shoulder. A key feature of this condition is that the:
a. Affected extremity will eventually regain its function.
b. Pain is felt at one site but originates from another location.
c. Patients pain will be associated with nausea, pallor, and diaphoresis.
d. Slightest touch, such as a sleeve brushing against her arm, causes severe and intense pain. ANS: D
A key feature of reflexive sympathetic dystrophy is that a typically innocuous stimulus can
create a severe, intensely painful response. The affected extremity becomes less functional over
time.
3. The nurse is assessing a patients pain. The nurse knows that the most reliable indicator of pain
would be the:
a. Patients vital signs.
b. Physical examination.
c. Results of a computerized axial tomographic scan. d. Subjective report.
ANS: D
The subjective report is the most reliable indicator of pain. Physical examination findings can lend support,
but the clinician cannot exclusively base the diagnosis of pain on physical assessment findings.
4.A patient admitted with liver disease complains of pain in his right shoulder. What should the nurse use as
explanation for this patients site of pain?
Downloaded by Ce Co ()
