Adams4e Tif Ch18

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 18Question 1Type: MCMA

The nurse teaches patients about nonpharmacological techniques for pain management. The nurse determines learning has occurred when the patients make which statement(s)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. "Nonpharmacological techniques are a good adjunct to pharmacotherapy."

2. "Nonpharmacological techniques have not reached mainstream yet."

3. "Nonpharmacological techniques may be used in place of drugs."

4. "Nonpharmacological techniques include an aerobic exercise."

5. "Nonpharmacological techniques are not usually valued by nurses."

Correct Answer: 1,3

Rationale 1: Nonpharmacological techniques may be used in place of drugs, or as an adjunct to pharmacotherapy. An aerobic exercise is not considered a nonpharmacological technique for relief of pain. Nonpharmacological techniques have reached mainstream and are commonly used. Nonpharmacological techniques are valued and used by most nurses.




Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.


Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 18-4

Question 2Type: MCSA

The nursing instructor teaches the nursing students about neural mechanisms of pain. What does the nursing instructor teach about substance P?

1. Substance P modifies sensory information in the spinal cord.

2. Substance P is also known as an endogenous opioid.

3. Substance P stimulates pain receptors in the spinal cord.

4. Substance P controls which pain signals reach the brain.

Correct Answer: 4

Rationale 1: Spinal substance P is critical because it controls whether pain signals will continue to the brain. Endogenous opioids, not substance P, modify sensory information at the level of the spinal cord. Substance P does not stimulate pain receptors in the spinal cord. Substance P is not an endogenous opioid.




Global Rationale:


Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 18-2


The patient, addicted to heroin, is being treated for opioid dependence. He has been prescribed methadone (Dolophine). The patient asks how this will help because methadone (Dolophine) is another opioid. What is the best response by the nurse?

1. "Methadone (Dolophine) will make you really sick if you use heroin."

2. "Methadone (Dolophine) does not cause euphoria like heroin does."

3. "Methadone (Dolophine) cures your addiction to heroin."

4. "Methadone (Dolophine) causes you to have an allergy to heroin."

Correct Answer: 2

Rationale 1: Methadone (Dolophine) does not cause the euphoria of heroin, or cure the dependence. It is a substitute drug that allows the patient to be productive. Methadone (Dolophine) does not cure heroin addiction. Methadone (Dolophine) does not cause an allergy to heroin. Methadone (Dolophine) will not cause a person to become sick if they use heroin.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 18-7


The patient has intractable pain, and the physician has proposed a nerve block. The nurse plans to teach the patient about nerve blocks. Which statement would be included in the best plan of the nurse?

1. A nerve block depresses the activity of the sympathetic nervous system.

2. A nerve block enhances the effect of most of the endogenous opioids.

3. A nerve block modifies sensory information being sent to the spinal cord.

4. A nerve block stops pain transmission along the nerve to stop the pain.

Correct Answer: 4

Rationale 1: Nerve blocks are accomplished by injection of alcohol or another neurotoxic substance into neurons. This blocks nerve transmission and has the potential to provide total pain relief. A nerve block does not enhance the effect of endogenous opioids. A nerve block does not modify sensory information sent to the spinal cord. A nerve block does not depress the activity of the sympathetic nervous system.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 18-3Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.


The patient receives morphine for pain. He asks the nurse how it works to relieve pain. What is the best response by the nurse?

1. "It inhibits the primary pain neurotransmitters in your brain."

2. "It stimulates the receptors that secrete endorphins in your brain."

3. "It stimulates a receptor in your brain that induces pleasure."

4. "It promotes the primary pleasure neurotransmitters in your brain."

Correct Answer: 3

Rationale 1: Opioids exert their actions by interacting with the mu and kappa receptors in the brain. Drugs that stimulate these receptors are opioid agonists. Opioids do not promote release of the pleasurable neurotransmitters. Opioids do not promote secretion of endorphins. Opioids do not inhibit neurotransmitters responsible for pain.




Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 18-5


The patient has a patient-controlled analgesia (PCA) pump following surgery. The nurse keeps naloxone (Narcan) in the patient's room as per protocol. What does the nurse recognize as the rationale for this protocol?


1. Naloxone (Narcan) enhances the effect of the opioid in the patient-controlled analgesia (PCA) pump and increases analgesia.

2. Naloxone (Narcan) is the antidote if an anaphylactic reaction to the opioid in the patient-controlled analgesia (PCA) pump occurs.

3. Naloxone (Narcan) is available to treat any systemic side effects, like constipation, of the opioid in the patient-controlled analgesia (PCA) pump.

4. Naloxone (Narcan) will reverse the effects of the narcotic in the patient-controlled analgesia (PCA) pump if an overdose occurs.

Correct Answer: 4

Rationale 1: Naloxone (Narcan) is an opioid antagonist, and will reverse the effects of the narcotic in the pump if an overdose occurs. Naloxone (Narcan) does not enhance the effects of opioids. Naloxone (Narcan) is not used to treat anaphylactic reactions. Naloxone (Narcan) is not used to treat opioid-related constipation.




Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 18-6


What is a priority assessment question to ask a postsurgical patient prior to administration of an opioid analgesic?

1. "Have you ever been addicted to prescription pain medications?"

2. "Why do you want to receive this pain medication?"


3. "Would you like me to help you change your position for comfort?"

4. "Would you please rate your pain on a scale of 1-to-10?"

Correct Answer: 4

Rationale 1: The nurse should always assess the patient's level of pain prior to the administration of an analgesic. Asking a postsurgical patient why a pain medication is requested does not make a lot of sense. Administration of pain medication postsurgery is a priority; this is not the time to assess if the patient has an addiction. Offering to help a postsurgical patient change positions is appropriate, but should be done after the patient receives the pain medication.




Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 18-1


The postsurgical patient has an order for morphine 2 mg IV push every 2 hours and propoxyphene 100 (Darvon 100) every 3 hours. He received the morphine 2 hours ago, and is complaining of pain again. What will the best plan of the nurse include?

1. Plan to administer the morphine again.


2. Plan to administer the propoxyphene 100 (Darvon 100).

3. Plan to have the patient do some distraction techniques.

4. Plan to assess the patient's level of pain.

Correct Answer: 4

Rationale 1: The patient's level of pain should be assessed prior to the administration of any analgesic. The patient's level of pain should be assessed prior to administration of propoxyphene (Darvon) 100. The patient's level of pain should be assessed prior to administration of additional morphine. Distraction techniques are appropriate, but should not take the place of a pain assessment and administration of an analgesic.




Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 18-1


The patient comes to the emergency department with a head injury, broken ribs, and internal bleeding. Opioid analgesics are contraindicated. What does the nurse recognize as the primary rationale for this?

1. The use of opioid analgesics will depress the patient's blood pressure.

2. The patient may not be able to communicate his level of pain.

3. Opioids will not effectively relieve pain in the patient's periphery.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

4. Opioids can mask changes in the patient's level of consciousness.

Correct Answer: 4

Rationale 1: Opioids are central nervous system (CNS) depressants and can mask the patient's level of consciousness; this is dangerous when the patient has a head injury. Depression of blood pressure could occur, but this is not as critical as level of consciousness. The patient may not be able to determine his level of pain, but this is not as critical as level of consciousness. Opioids do not effectively relieve pain in the patient's periphery, but this is not as critical as level of consciousness.




Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 18-11


The patient receives morphine for pain. Which comment by the patient does the nurse assess to be a side effect of morphine?

1. "My ears are constantly ringing."

2. "My heart feels like it is skipping beats."

3. "I feel like I am going to throw up."Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

4. "I feel cold shivers all over."

Correct Answer: 3

Rationale 1: Nausea is a common side effect of morphine. Feeling cold shivers is not associated with morphine. Ringing ears are not associated with morphine. Heart palpitations are not associated with morphine.




Global Rationale:



The patient receives aspirin. The nurse assesses an adverse effect to this drug when the patient makes which response?

1. "My stools have been gray in color."

2. "There is a constant ringing in my ears."

3. "Bright lights give me a headache."

4. "I have to get up a lot at night to urinate."

Correct Answer: 2

Rationale 1: Aspirin is ototoxic, and may cause ringing in the ears. Aspirin does not cause photophobia. A decrease in bilirubin (gray stools) is not caused by aspirin. There isn't any relationship between aspirin and nocturnal renal output.

Rationale 2: Aspirin is ototoxic, and may cause ringing in the ears. Aspirin does not cause photophobia. A decrease in bilirubin (gray stools) is not caused by aspirin. There isn't any relationship between aspirin and nocturnal renal output.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.



Global Rationale:



The nurse provides care for several patients. For which patient would the nurse assess acetaminophen (Tylenol) to be contraindicated?

1. A 2-year-old with a high fever due to the flu

2. A 65-year-old with osteoarthritis

3. A 19-year-old with a bladder infection

4. A 55-year old who socially drinks alcohol

Correct Answer: 4

Rationale 1: Acetaminophen (Tylenol) is hepatotoxic, and may cause problems in patients who consume alcohol. Acetaminophen (Tylenol) would be the drug of choice for a child with the flu. Acetaminophen (Tylenol) would not be contraindicated with osteoarthritis, but aspirin would be more effective. There isn't any association between the use of acetaminophen (Tylenol) and a bladder infection.





Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 18-10


What is an important instruction for the nurse to give to the patient who is taking acetaminophen (Tylenol)?

1. "Check your gums for bleeding when taking acetaminophen (Tylenol)."

2. "Do not take any narcotics with acetaminophen (Tylenol)."

3. "Do not drink alcohol with acetaminophen (Tylenol)."

4. "Do not take acetaminophen (Tylenol) on an empty stomach."

Correct Answer: 3

Rationale 1: Acetaminophen (Tylenol) is toxic to the liver, and should not be taken by patients who will be consuming alcohol. Acetaminophen (Tylenol) can be taken with or without food. There is no contraindication between acetaminophen (Tylenol) and narcotics; they are often combined for more effective pain relief. Bleeding in the gums is an effect of aspirin, not acetaminophen (Tylenol).



Rationale 4: Acetaminophen (Tylenol) is toxic to the liver, and should not be taken by patients who will be consuming alcohol. Acetaminophen (Tylenol) can be taken with or without food. There is no contraindication between acetaminophen (Tylenol) and narcotics; they are often combined for more effective pain relief. Bleeding in the gums is an effect of aspirin, not acetaminophen (Tylenol).Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Global Rationale:


Question 14Type: MCMA

The patient is to start on sumatriptan (Imitrex) for migraine headaches. What will the best plan of the nurse include as it relates to this medication?



1. Plan to teach the patient not to drive until the effects of the medication are known.

2. Plan to teach the patient to avoid pseudoephedrine (Sudafed) with this medication.

3. Plan to teach the patient the importance of taking the medication with protein.

4. Plan to instruct the patient to take the medication with food to avoid ulcers.

5. Plan to teach the patient to increase fluid intake with this medication.

Correct Answer: 1,2

Rationale 1: Drowsiness and dizziness can occur with sumatriptan (Imitrex). Pseudoephedrine (Sudafed) is a vasoconstrictor as is sumatriptan (Imitrex). The combination could dramatically increase the patient's blood pressure. There isn't any relationship between sumatriptan (Imitrex) and ulcers. Sumatriptan (Imitrex) does not need to be taken with protein. There is no need to increase fluid intake with sumatriptan (Imitrex).



Rationale 4: Drowsiness and dizziness can occur with sumatriptan (Imitrex). Pseudoephedrine (Sudafed) is a vasoconstrictor as is sumatriptan (Imitrex). The combination could dramatically increase the patient's blood Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

pressure. There isn't any relationship between sumatriptan (Imitrex) and ulcers. Sumatriptan (Imitrex) does not need to be taken with protein. There is no need to increase fluid intake with sumatriptan (Imitrex).


Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 18-8


A dull, aching pain is defined as

1. nerve pain.

2. somatic.

3. neuropathic.

4. visceral.

Correct Answer: 4

Rationale 1: Visceral pain is defined as a dull, throbbing, or aching pain.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 18-10



Identify the correct statement regarding the neural mechanism of pain

1. Once the pain impulse reaches the spinal cord, neurotransmitters inhibit the signal.

2. Alpha fibers are wrapped in myelin; C fibers are not.

3. When tissues are damaged, pain impulses go directly to the brain via alpha and beta fibers.

4. Myelin is a substance that slows nerve transmission.

Correct Answer: 2

Rationale 1: A pain impulse travels to the spinal cord via alpha and C fibers. The alpha fibers are wrapped in myelin (a lipid substance that speeds nerve transmission); the C fibers are not. Once the impulse reaches the spinal cord, neurotransmitters pass the message along to the next neuron.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 18-2 and 18-3


Which of the following treatments has the highest potential to provide total pain relief?

1. Chiropractic manipulation

2. Neuronal injection of alcoholAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

3. Acupuncture

4. Transcutaneous electrical nerve stimulation (TENS)

Correct Answer: 2

Rationale 1: TENS, chiropractic manipulation, and acupuncture are less likely to provide total pain relief. Nerve blocks irreversibly stop impulse transmission along the treated nerves.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 18-4


Identify the correct statement regarding opioid receptors.

1. The sigma and kappa receptors are of greatest concern from a pharmacologic standpoint.

2. Drugs that block opioid receptors inhibit the pain impulse.

3. Opioid agonists will activate mu and kappa receptors, producing analgesia.

4. Opioids exert their actions by interacting with a total of four receptors.

Correct Answer: 3

Rationale 1: Opioid agonists stimulate mu and kappa receptors, resulting in a variety of effects, including analgesia. There are at least six types of receptors. The mu and kappa receptors are of greatest concern from a pharmacologic standpoint. Drugs that block opioid receptors are called opioid antagonists, and do not inhibit the pain impulse.





Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 18-5


A patient on a morphine patient-controlled analgesic (PCA) IV pump has a respiratory rate of 8, and is difficult to arouse. Which of the following would be the priority intervention?

1. Administering activated charcoal

2. Lowering the dose of morphine

3. Administering a medication that blocks mu and kappa receptors

4. Intubation and mechanical ventilation

Correct Answer: 3

Rationale 1: Administering the opioid antagonist naloxone (Narcan) is indicated in the given situation. Lowering the dose is not aggressive enough, and intubation is too aggressive. Activated charcoal is not indicated for an overdose that has occurred via the IV route.





Global Rationale:



Which of the following is an adverse effect associated with morphine, and would be the priority if present?

1. Restlessness

2. Constipation

3. Respiratory depression

4. Psychological dependence

Correct Answer: 3

Rationale 1: All are adverse effects, but respiratory depression is the top priority.




Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 18-10



Which patient would be at greatest risk for developing opioid dependence?

1. 24-year-old with sickle-cell anemia

2. 33-year-old with diabetes

3. 17-year-old with a broken arm

4. 75-year-old with congestive heart failure

Correct Answer: 1

Rationale 1: Sickle-cell anemia is a chronic and painful disorder, and is often treated with opioids. Diabetes and congestive heart failure are chronic disorders, but are not typically managed with opioids. Broken bones are painful, and opioids may be used. However, broken bones and the associated pain are acute events.




Global Rationale:



Which statement is accurate concerning the management of migraine headaches?

1. Acute treatment and prevention are achieved via the same medications.

2. There are no pharmacologic agents available to prevent migraine headaches.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

3. Chronic headache pain is managed via daily NSAID use.

4. Vasoconstriction of cranial arteries helps reduce acute headache pain.

Correct Answer: 4

Rationale 1: Migraine headaches are thought to occur from an initial vasoconstrictive episode that is followed by vasodilation and acute pain. Acute episodes are treated with cranial artery vasoconstrictors and prevention via vasodilators.




Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 18-8


For which of the following patients suffering a migraine headache would sumatriptan (Imitrex) be indicated?

1. 73-year-old with angina pectoris

2. 36-year-old female with preeclampsia

3. 45-year-old diabetic male

4. 27-year-old asthmatic male

Correct Answer: 4

Rationale 1: Sumatriptan is contraindicated in patients with hypertension, angina, and diabetes. It also is a Pregnancy Category C drug. Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 2: Sumatriptan is contraindicated in patients with hypertension, angina, and diabetes. It also is a Pregnancy Category C drug.



Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 18-10


Which statement is accurate concerning the use of aspirin (ASA) to treat pain?

1. High doses are necessary (1 gram) to achieve anticoagulant effects.

2. Enteric-coated capsules are available to reduce GI side effects.

3. Increase consumption of herbs such as garlic and ginger to potentiate the anti-inflammatory effects.

4. In low doses (325 mg), it significantly reduces inflammation.

Correct Answer: 2

Rationale 1: Aspirin can cause bleeding in low doses. Enteric-coated capsules can help prevent bleeding, and avoiding certain herbs such as ginger and garlic should be advised. The anti-inflammatory effects of aspirin occur in high doses.



Rationale 4: Aspirin can cause bleeding in low doses. Enteric-coated capsules can help prevent bleeding, and avoiding certain herbs such as ginger and garlic should be advised. The anti-inflammatory effects of aspirin occur in high doses.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Global Rationale:



The nurse has just taken a job in a hospital that cares for an ethnically diverse population and is concerned about being culturally sensitive. How should the nurse plan to manage caring for patients in pain?



1. Treat all patients alike.

2. Listen carefully as the patient's comments about pain are translated.

3. Show respect for the patient's preferences even if they are very different from the nurse's.

4. Ask questions about the patient's beliefs and customs regarding pain management.

5. Watch how other nurses provide care to their patients.

Correct Answer: 2,3,4

Rationale 1: Not all patients respond identically to interventions.

Rationale 2: Even if the nurse has to use the services of a translator, careful listening is an important step in providing culturally sensitive care.

Rationale 3: Showing respect is important in providing culturally sensitive care in all areas, including pain management.

Rationale 4: The nurse cannot practice what the nurse does not know. Asking questions is the method used to gain information to facilitate sensitive care.

Rationale 5: Other nurses may not be providing the care needed for this nurse's patients.

Global Rationale:

Cognitive Level: Analyzing


Client Need: Physiological IntegrityClient Need Sub: Basic Care and ComfortNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 18-1


The patient has advanced cancer and is experiencing malignant pain. How should the nurse plan to manage this pain?



1. Use the intravenous route for pain medication administration.

2. Set up a dosing schedule that provides for around-the-clock doses.

3. Encourage the patient to wait 10 minutes after pain medication is required to ask for a dose.

4. Augment the patient's regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain.

5. Counsel the patient that it is not possible to eliminate all the pain of cancer and that some must be tolerated.

Correct Answer: 2,4

Rationale 1: Approximately 90% of cancer pain can be controlled by use of oral medications if they are dosed appropriately.

Rationale 2: Often the problem in controlling pain of any type is that the patient "gets behind" the pain rather than medicating for it before it gets severe. Around-the-clock dosing helps to prevent "playing catch-up" to the pain.

Rationale 3: This plan would allow the pain to worsen before medication is given and would result in the patient getting "behind" the pain.

Rationale 4: Breakthrough pain is expected and may require additional pharmaceutical or nonpharmaceutical measures.

Rationale 5: While it is true that some cancer patients develop intractable pain, many are able to control pain to a level that is very tolerable.

Global Rationale:

Cognitive Level: AnalyzingAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 18-2


The patient rings the nurse call button and requests pain medication. Upon assessment, the nurse finds the patient sitting up in a chair, watching television with a friend. Vital signs are normal and the patient's skin is warm and dry. Which nursing actions are appropriate?



1. Ask the patient to rate his pain on the pain scale.

2. Tell the patient that he does not look as if he is in pain.

3. Have the patient go back to bed and ask the visitor to leave.

4. Check to see when the patient last received pain medication.

5. Have another nurse assess the patient.

Correct Answer: 1,4

Rationale 1: When the patient complains of pain, the nurse should always ask for a pain rating.

Rationale 2: Patients respond to pain differently. For example, this patient may be trying to hide the intensity of his pain from his friend.

Rationale 3: Having the patient go back to bed and asking the visitor to leave is punitive and could be interpreted as the nurse not believing the patient. Being active and having diversions can help with pain management.

Rationale 4: The nurse should check to see when the patient last had pain medication, what drug was given, what dose was given, and by what route it was administered.

Rationale 5: There is no reason to have another nurse assess the patient. This action may imply that the nurse does not trust the patient.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological Integrity


Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 18-3


The home hospice nurse is completing the initial assessment of a patient who is has terminal congestive heart failure. The patient frequently has pain with breathing. What questions should the nurse ask?



1. "How much pain are you willing to tolerate?"

2. "What do you like to do throughout the day?"

3. "Have you ever been addicted to a pain medication?"

4. "Are there any pain medications you would like to avoid?"

5. "What things besides drugs help with your pain?"

Correct Answer: 1,2,4,5

Rationale 1: It is sometimes impossible to eliminate all pain and all adverse medication effects. The nurse needs to know how much pain and how many of the effects the patient is willing to tolerate.

Rationale 2: Knowing what the patient likes to do and when it is important for the patient to be most awake and alert helps the nurse create a pain management plan.

Rationale 3: Addiction is not a concern at the end of life. Many patients are already concerned about becoming addicted and the nurse should not reinforce this myth.

Rationale 4: Some patients cannot tolerate the side effects of some medications. It is important for the nurse to assess for these preferences.

Rationale 5: Nonpharmacologic pain relief strategies should also be investigated.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: Assessment


Learning Outcome: 18-14


The patient has been started on morphine sulfate (MS Contin) for chronic back pain resulting from inoperable disk degeneration. What nursing actions are indicated?



1. Use the prn order of docusate (Dulcolax) routinely every night.

2. Ask the dietary department to add bran cereal to the patient's breakfast trays.

3. Ask the health care provider to write an order for an indwelling urinary catheter.

4. Review the trending of the patient's hemoglobin and hematocrit levels.

5. Check the medical record for a prn order for an antiemetic.

Correct Answer: 1,2,4,5

Rationale 1: One of the adverse effects of morphine therapy is constipation. The nurse should be proactive by giving the docusate every night.

Rationale 2: Intake of additional fiber, as long as sufficient fluid is taken, is useful in preventing the constipation that is common with the use of morphine.

Rationale 3: While morphine may promote urinary retention, other methods of controlling this adverse effect should be used initially.

Rationale 4: Morphine should not be administered to those who are hypovolemic due to the risk of hypotension.

Rationale 5: Nausea and vomiting are adverse effects of the use of morphine. Until the patient becomes tolerant of this effect, an antiemetic may be necessary.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 18-14



The patient has been keeping a "headache diary" of her migraines. Upon review of this diary, the nurse notes that the headaches are described as mild and have happened four times in the last 3 months. The patient reports that she "generally just lies down until they pass" but that her new job will not allow that time. She is requesting information about pain medication. What medications would the nurse expect to be prescribed?



1. Ibuprofen

2. Acetaminophen and caffeine

3. Sumatriptan (Imitrex)

4. Ergotamine (Ergostat)

5. Amitriptyline (Elavil)

Correct Answer: 1,2

Rationale 1: NSAIDs are often effective for the mild migraines this patient experiences.

Rationale 2: Acetaminophen and caffeine together are used for treatment of mild migraines.

Rationale 3: Sumatriptan is a serotonin receptor agonist and is usually used only for moderate to severe migraines.

Rationale 4: Ergotamine is an ergot alkaloid that is a serotonin receptor agonist. This drug is used only with moderate to severe migraines.

Rationale 5: Amitriptyline is used to prevent migraines, not to reduce pain once they occur.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 18-13


Adams4e Tif Ch18

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