Sherpath: Management of Pain: Chapter 7, Care of Patients with Pain

Question 1 of 9

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Which medication blocks pain at the peripheral nervous system level?

• • HydromorphoneHydromorphone is an opioid that blocks pain at the central nervous system level.
• • CarbamazepineCarbamazepine is an anticonvulsant that slows electrical impulses in the brain to prevent seizures.
• • BaclofenBaclofen is a muscle relaxant and GABA agonist that works primarily in the spinal cord.
• Correct
  • NaproxenNaproxen is a nonsteroidal antiinflammatory drug that blocks pain at the peripheral nervous system level by decreasing inflammation.

Question 2 of 9

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What route of administration would be contraindicated in the patient receiving ongoing treatment for pain with meperidine?

• • SubcutaneousSubcutaneous administration would be a safe option for ongoing treatment with an analgesic drug.
• • Intravenous (IV)IV administration would be a safe option for ongoing treatment with an analgesic drug.
• Correct
  • Intramuscular (IM)IM injections are not the mode of choice when there is an ongoing need for analgesics. This mode is generally used when one or two doses are needed, and other routes are not indicated.
• • OralOral administration is a common route of administration and would be an appropriate option for ongoing treatment with an analgesic drug, as long as the patient is able to safely swallow oral medications.

Question 3 of 9

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Which statement made by the patient’s support person demonstrates that education on patient-controlled analgesia (PCA) has been successful?

• Correct
  • “The patient is not able to exceed the maximum dose of pain medication.”The PCA pump is programmed so that the patient can decide when a dose is given but cannot exceed the maximum dose or minimum time interval.
• • “The PCA pump alerts nursing staff a prescribed dose of analgesia is needed.”The PCA pump is an infusion decide controlled by the patient that injects the prescribed dose of analgesia.
• • “I can push the button if the patient is unable to.”If a patient is not capable of knowing when and how to push the button, the patient is not a candidate for PCA. Allowing PCA by proxy leads to a higher risk of respiratory depression.
• • “We can only use intravenous (IV) infusions once we go home.”PCA is usually given IV, but it may also be administered subcutaneously, and this occurs most often in the home setting.

Question 4 of 9

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Which type of pharmacologic intervention would be most appropriate for a patient with extensive burns on all four extremities?

• • Patient-controlled analgesia (PCA)A PCA would not be the intervention of choice because of the increased risk of infection. Also, with burns on the extremities, the patient may have trouble pushing the button.
• Correct
  • Peripheral nerve catheterA peripheral nerve catheter is used to deliver local anesthetic and is most effective for patients with burns on their extremities.
• • Epidural analgesiaAn epidural analgesic would not be the intervention of choice because of the increased risk for infection as a result of the indwelling vascular access, which is of great concern with burn patients.
• • Topical analgesiaA topical analgesic would not be indicated for a patient suffering from extensive burns because it could alter the drug’s absorption.

Question 5 of 9

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Which nonanalgesic medication can be used for pain control? Select all that apply. One, some, or all responses may be correct.

• • AmlodipineAmlodipine is a calcium channel blocker used for hypertension and would not be indicated as a nonanalgesic treatment option.
• Correct
  • MethotrexateMethotrexate is an immunosuppressant indicated for intractable pain or to prevent further inflammation and joint damage in rheumatoid conditions.
• Correct
  • GabapentinGabapentin is an anticonvulsant routinely used for neuropathic pain.
• Correct
  • AmitriptylineAmitriptyline is an antidepressant that can also be effective in managing nerve root pain.
• • LithiumLithium is an antimanic agent used to treat bipolar disorder and would not be indicated as a nonanalgesic treatment option.
• Correct
  • BaclofenBaclofen is a muscle relaxant that can ease spasms in patients with back pain, multiple sclerosis, and other neurologic and muscular disorders.

Question 6 of 9

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Which is considered out of the nurse’s scope of practice when administering analgesics?

• • Monitoring for the effectiveness of pain reliefMonitoring pain relief effectiveness is an appropriate nursing responsibility. Pain relief should be monitored after 15 to 30 minutes and at 1– to 2–hour intervals.
• • Notifying the provider of an altered level of consciousnessA decreased level of consciousness could be a side effect of the analgesic and the provider must be notified immediately.
• • Documenting the degree and duration of painDocumenting the degree and duration of pain relief is an important nursing responsibility.
• Correct
  • Administering a new analgesic if pain management is ineffectiveAdministering a new analgesic is not an intervention that the nurse could independently perform and is considered outside the nurse’s scope of practice. Although this may be an appropriate intervention, the nurse would need an order from the health care provider to make any changes to the treatment regime.

Question 7 of 9

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The nurse is teaching a patient about interventions to help with constipation. Which statement made by the patient indicates education has been successful?

• Correct
  • “My pain medications will slow my digestive tract down.”Pain medications slow peristalsis.
• • “I will decrease the amount of fiber in my diet.”Patient should increase the amount of dietary fiber to help soften the stool and make it easier to pass.
• • “I will decrease the amount of water I am drinking.”Fluids will help to soften stools and make them easier to pass.
• • “I will discontinue to take my Miralax as prescribed by the doctor.”Miralax has been proven to be effect for opioid-induced constipation, and it works to soften the stool and make it easier to pass.

Question 8 of 9

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Which patient would be the most appropriate candidate for heat therapy?

• • 32-year-old unconscious male recovering from emergency surgeryAnyone with an altered level of consciousness or loss of normal sensation may not realize something is too hot. As such, this patient would not be a good candidate for heat therapy.
• • 60-year-old female with diabetic neuropathy and foot painA patient with diabetic neuropathy might not be able to feel the heat and could burn herself.
• • 94-year-old male with osteoporosis and pain in his backThe older adult population is sensitive to heat and should be monitored very carefully if heat therapy is indicated.
• Correct
  • 56-year-old female oriented to time and place with cervical spine painThis patient would be an excellent candidate for heat therapy for her neck pain because she is mentally alert and shows no signs of a condition that may alter her response to heat.

Question 9 of 9

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Which statement regarding the use of menthol for pain relief is accurate?

• • “Menthol can be used to cool the skin.”Menthol is used as a warming agent to provide analgesia.
• • “Menthol can be given orally.”Menthol is given as a topical analgesic that is massaged into the skin.
• • “Menthol can be used with a heating pad.”Menthol cannot be used with an external heating source because it could overheat the skin surface.
• Correct
  • “Menthol should be washed off the hands after use.”Menthol can irritate the eyes and mucous membranes, so patient should wash their hands well after applying it.