Chapter 21 Pain The Fifth Vital Sign

Chapter 21 Pain The Fifth Vital Sign

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.1)A client has been given 15 mg of morphine sulfate subcutaneously 1 hour ago. When the nursechecks the client to determine the effect of the pain medication, the client is arousable, denies pain,and drifts off to sleep during the conversation with the nurse. Based on this information, the mostappropriate evaluation of the medication’s effect is:1)A)The medication is effective because the client can easily fall asleep.B)The medication is ineffective because the client is arousable.C)The dosage of the medication may be more than the client needs for pain management.D)The medication is effective because the client denies pain.Answer:CExplanation:A)The client has been given an opioid subcutaneously. Peak action of morphinesulfate is expected within 50 to 90 minutes after administration. The client has a 4rating on the Sedation Rating Scale, which is indicated by the inability to stayawake for the conversation with the nurse. This may indicate the need to obtain anorder for a decreased dosage of the pain medication. Although arousability anddenial of pain are desirable effects of the medication, they are not the most relevantdeterminants of the effect based on the information in the case scenario.EvaluationPhysiological Integrity-Pharmacological and Parenteral TherapiesAnalysisB)The client has been given an opioid subcutaneously. Peak action of morphinesulfate is expected within 50 to 90 minutes after administration. The client has a 4rating on the Sedation Rating Scale, which is indicated by the inability to stayawake for the conversation with the nurse. This may indicate the need to obtain anorder for a decreased dosage of the pain medication. Although arousability anddenial of pain are desirable effects of the medication, they are not the most relevantdeterminants of the effect based on the information in the case scenario.EvaluationPhysiological Integrity-Pharmacological and Parenteral TherapiesAnalysisC)The client has been given an opioid subcutaneously. Peak action of morphinesulfate is expected within 50 to 90 minutes after administration. The client has a 4rating on the Sedation Rating Scale, which is indicated by the inability to stayawake for the conversation with the nurse. This may indicate the need to obtain anorder for a decreased dosage of the pain medication. Although arousability anddenial of pain are desirable effects of the medication, they are not the most relevantdeterminants of the effect based on the information in the case scenario.EvaluationPhysiological Integrity-Pharmacological and Parenteral TherapiesAnalysis1
D)The client has been given an opioid subcutaneously. Peak action of morphinesulfate is expected within 50 to 90 minutes after administration. The client has a 4rating on the Sedation Rating Scale, which is indicated by the inability to stayawake for the conversation with the nurse. This may indicate the need to obtain anorder for a decreased dosage of the pain medication. Although arousability anddenial of pain are desirable effects of the medication, they are not the most relevantdeterminants of the effect based on the information in the case scenario.EvaluationPhysiological Integrity-Pharmacological and Parenteral TherapiesAnalysis2)A hospice unit uses a three-step ladder approach to pain management in cancer. Basic to theimplementation of this approach in nursing care, it is essential that the nurse:2)A)Encourage the use of adjuvant analgesics to reduce the amount of medication that is needed.B)Understand that the client is less likely to become physiologically or psychologicallydependent upon opioid analgesics with this approach.C)Document interventions for pain and the results of the interventions every 4 hours.D)Recognize that the pain experience is highly individualized.Answer:DExplanation:A)The question asks for a principle that is basic to providing nursing care in painmanagement. Recognizing that pain is highly individualized is the only choice thataddresses this. The statements that the client is less likely to become dependent onopioid analgesics and that encouraging the use of adjuvant analgesics will reducethe amount of medication needed are incorrect. Documenting pain interventionsand their results addresses an action that follows a nursing intervention and alsocontains an inappropriate timeframe.PlanningPhysiological Integrity-Basic Care and ComfortApplicationB)The question asks for a principle that is basic to providing nursing care in painmanagement. Recognizing that pain is highly individualized is the only choice thataddresses this. The statements that the client is less likely to become dependent onopioid analgesics and that encouraging the use of adjuvant analgesics will reducethe amount of medication needed are incorrect. Documenting pain interventionsand their results addresses an action that follows a nursing intervention and alsocontains an inappropriate timeframe.PlanningPhysiological Integrity-Basic Care and ComfortApplicationC)The question asks for a principle that is basic to providing nursing care in painmanagement. Recognizing that pain is highly individualized is the only choice thataddresses this. The statements that the client is less likely to become dependent onopioid analgesics and that encouraging the use of adjuvant analgesics will reducethe amount of medication needed are incorrect. Documenting pain interventionsand their results addresses an action that follows a nursing intervention and alsocontains an inappropriate timeframe.PlanningPhysiological Integrity-Basic Care and ComfortApplication2
D)The question asks for a principle that is basic to providing nursing care in painmanagement. Recognizing that pain is highly individualized is the only choice thataddresses this. The statements that the client is less likely to become dependent onopioid analgesics and that encouraging the use of adjuvant analgesics will reducethe amount of medication needed are incorrect. Documenting pain interventionsand their results addresses an action that follows a nursing intervention and alsocontains an inappropriate timeframe.PlanningPhysiological Integrity-Basic Care and ComfortApplication3)Unit staff nurses are updating client care plans regarding pain assessment and management. Forwhich of the following clients is it appropriate to plan to assess pain in relation to peripheralneuropathy? (Select all that apply.)3)A)The client with bilateral below-the-knee amputationsB)The client receiving vincristine sulfate (Oncovin)C)The client with HIV diseaseD)The client with a history of type 1 diabetes mellitusE)The client receiving didanosine (ddI, Videx)F)The client with angina pectorisAnswer:B, C, D, EExplanation:A)Peripheral neuropathy is associated with peripheral vascular disorders and withside effects of several medications. Insulin-dependent diabetes mellitus and HIVdisease are two conditions in which peripheral neuropathy is common.Didanosine is used in the treatment of HIV disease and side effects includeparesthesias and neuropathies. Vincristine sulfate is used in the treatment oflymphomas and other malignant disorders and adverse effects include irreversibleneuropathies. Phantom pain is associated with amputations. The pain of anginapectoris is not peripheral pain, nor is it neuropathic pain.PlanningPhysiological Integrity-Physiological AdaptationApplicationB)Peripheral neuropathy is associated with peripheral vascular disorders and withside effects of several medications. Insulin-dependent diabetes mellitus and HIVdisease are two conditions in which peripheral neuropathy is common.Didanosine is used in the treatment of HIV disease and side effects includeparesthesias and neuropathies. Vincristine sulfate is used in the treatment oflymphomas and other malignant disorders and adverse effects include irreversibleneuropathies. Phantom pain is associated with amputations. The pain of anginapectoris is not peripheral pain, nor is it neuropathic pain.PlanningPhysiological Integrity-Physiological AdaptationApplication3
C)Peripheral neuropathy is associated with peripheral vascular disorders and withside effects of several medications. Insulin-dependent diabetes mellitus and HIVdisease are two conditions in which peripheral neuropathy is common.Didanosine is used in the treatment of HIV disease and side effects includeparesthesias and neuropathies. Vincristine sulfate is used in the treatment oflymphomas and other malignant disorders and adverse effects include irreversibleneuropathies. Phantom pain is associated with amputations. The pain of anginapectoris is not peripheral pain, nor is it neuropathic pain.PlanningPhysiological Integrity-Physiological AdaptationApplicationD)Peripheral neuropathy is associated with peripheral vascular disorders and withside effects of several medications. Insulin-dependent diabetes mellitus and HIVdisease are two conditions in which peripheral neuropathy is common.Didanosine is used in the treatment of HIV disease and side effects includeparesthesias and neuropathies. Vincristine sulfate is used in the treatment oflymphomas and other malignant disorders and adverse effects include irreversibleneuropathies. Phantom pain is associated with amputations. The pain of anginapectoris is not peripheral pain, nor is it neuropathic pain.PlanningPhysiological Integrity-Physiological AdaptationApplicationE)Peripheral neuropathy is associated with peripheral vascular disorders and withside effects of several medications. Insulin-dependent diabetes mellitus and HIVdisease are two conditions in which peripheral neuropathy is common.Didanosine is used in the treatment of HIV disease and side effects includeparesthesias and neuropathies. Vincristine sulfate is used in the treatment oflymphomas and other malignant disorders and adverse effects include irreversibleneuropathies. Phantom pain is associated with amputations. The pain of anginapectoris is not peripheral pain, nor is it neuropathic pain.PlanningPhysiological Integrity-Physiological AdaptationApplicationF)Peripheral neuropathy is associated with peripheral vascular disorders and withside effects of several medications. Insulin-dependent diabetes mellitus and HIVdisease are two conditions in which peripheral neuropathy is common.Didanosine is used in the treatment of HIV disease and side effects includeparesthesias and neuropathies. Vincristine sulfate is used in the treatment oflymphomas and other malignant disorders and adverse effects include irreversibleneuropathies. Phantom pain is associated with amputations. The pain of anginapectoris is not peripheral pain, nor is it neuropathic pain.PlanningPhysiological Integrity-Physiological AdaptationApplication