Chapter 09 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 09

Question 1

Type: MCSA

An older patient with a history of severe arthritis has not received pain medication for over 18 hours. The patient is currently complaining of severe pain in both legs. What will the nurse attribute as being the reason for the patients increase in pain?

1. Dependency on narcotics

2. Over-exaggeration of the amount of pain

3. Need for alternative measures for pain relief

4. Untreated pain resulting in lower pain threshold

Correct Answer: 4

Rationale 1: Narcotic dependency in the older adult is unlikely.
Reference: Page 212

Rationale 2: Pain is whatever the patient says it is. The nurse cannot assume that the patient is over-exaggerating the amount of pain being experienced.
Reference: Page 212

Rationale 3: Alternative measures may be helpful, but something else is needed to help the patient with severe pain.
Reference: Page 212

Rationale 4: With untreated pain, the nociceptors become sensitive and more responsive to stimuli resulting in a lowered pain threshold. This patient experienced a long period of time between administrations of pain medication, and this causes an increase in the pain experienced.
Reference: Page 212

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Define pain and the consequences of pain in the older adult.

Question 2

Type: MCSA

The nurse is caring for two patients. An older patient reports abdominal pain as being 5 out of 10 on the pain rating scale, whereas a younger patient reports left lower quadrant abdominal pain as being 10 out 10 on the scale. What would the nurse identify as reason for the discrepancy between the two patients measurements of pain?

1. Younger patients tend to be more dramatic when complaining of pain.

2. Visceral pain is less severe in older patients and may be reported as mild.

3. Visceral pain is more severe in older patients, but they are less likely to complain.

4. Visceral pain is less severe in younger patients but is reported as high in intensity.

Correct Answer: 2

Rationale 1: There is no evidence to support that younger patients are more dramatic when complaining of pain.
Reference: Page 213

Rationale 2: Visceral pain is often less severe in the older patient and reported with vague complaints. This often is an explanation for the higher incidence of silent myocardial infarctions and less dramatic presentations of abdominal problems requiring surgery in older adults.
Reference: Page 213

Rationale 3: Although older patients often do not complain of pain, their visceral pain is not more severe.
Reference: Page 213

Rationale 4: Evidence indicates that younger patients experience more severe visceral pain.
Reference: Page 213

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 1. Define pain and the consequences of pain in the older adult.

Question 3

Type: MCSA

An older patient living at home with cancer reports having to take twice as much pain medication over the last 24 hours. What should the nurse do with this information?

1. Adjust the medication as needed.

2. Discuss options to treat breakthrough pain.

3. Try alternative methods for pain relief instead of pain medication.

4. Talk with the physician to change the medication because of opioid tolerance.

Correct Answer: 2

Rationale 1: The patient may be experiencing breakthrough pain and a different pain management approach may be needed. Adjusting the medication as needed could lead to problems with pain management.
Reference: Page 222

Rationale 2: If the patient experiences breakthrough pain on a consistent basis, the nurse should notify the patients provider so that the dose of the long-acting, sustained-release preparation can be increased to more effectively control the pain.
Reference: Page 222

Rationale 3: Alternative methods of pain relief may or may not be effective with breakthrough pain.
Reference: Page 222

Rationale 4: There is no evidence to suggest that the patient has opioid tolerance.
Reference: Page 222

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 4

Type: MCSA

An older patient with headaches, dizziness, and ataxia takes meperidine for arthritic pain. What impact does this medication have on this patients health problems?

1. This medication is not causing the patients symptoms.

2. This medication is not effective in older patients for pain relief.

3. This medication is more effective to treat pain than aspirin or acetaminophen.

4. This medication causes toxic side effects similar to what the patient is experiencing.

Correct Answer: 4

Rationale 1: This medication can be the reason for the patients symptoms since it causes toxic metabolites to build up in the blood leading to headaches, dizziness, and ataxia.
Reference: Page 219

Rationale 2: This medication can be effective in treating an older patients pain.
Reference: Page 219

Rationale 3: This medication is no more effective than aspirin or acetaminophen.
Reference: Page 219

Rationale 4: Meperidine is not recommended for treatment of persistent pain in older persons because it tends to cause accumulations of toxic metabolites that can cause delirium, ataxia, and dizziness.
Reference: Page 219

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 5

Type: MCSA

The nurse is caring for an older patient with chronic pain caused by arthritis and uterine cancer. What is the best approach for the nurse to take when managing this patients pain?

1. Administering the pain medication around the clock

2. Administering the medication when the patient requests it

3. Consulting the physician to order intravenous pain medication

4. Administering the medication sparingly to avoid narcotic addiction

Correct Answer: 1

Rationale 1: Pain medication is best when it is administered around the clock.
Reference: Page 222

Rationale 2: Needless suffering occurs when waiting for the patient to request something for pain.
Reference: Page 222

Rationale 3: Oral medications are the least invasive and may provide sufficient relief; therefore, they should be tried first.
Reference: Page 222

Rationale 4: Needless suffering occurs when the medication is used sparingly. Older people are less likely to become addicted to narcotics.
Reference: Page 222

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4. Recognize the nurses role in treating pain in the older adult.

Question 6

Type: MCMA

An older patient asks why sustained-release pain medication cannot be chewed. How should the nurse respond to this patient?

Standard Text: Select all that apply.

1. Chewing deactivates the medication.

2. The medication is damaging to the teeth and gums.

3. Chewing destroys their controlled-release properties.

4. The saliva in the mouth breaks the medication down and makes it toxic.

5. Chewing causes a rapid absorption of the entire dose and a possible overdose.

Correct Answer: 3,5

Rationale 1: Chewing sustained-release preparations of analgesics destroys their controlled-release properties and causes rapid absorption of the entire dose, resulting in possible overdose. Chewing does not deactivate the medication.
Reference: Page 223

Rationale 2: Chewing sustained-release preparations of analgesics destroys their controlled-release properties and causes rapid absorption of the entire dose, resulting in possible overdose. The medication is not damaging to the teeth and gums.
Reference: Page 223

Rationale 3: Chewing sustained-release preparations of analgesics destroys their controlled-release properties.
Reference: Page 223

Rationale 4: Chewing sustained-release preparations of analgesics destroys their controlled-release properties and causes rapid absorption of the entire dose, resulting in possible overdose. The saliva in the mouth does not make the medication toxic.
Reference: Page 223

Rationale 5: Chewing sustained-release preparations of analgesics causes rapid absorption of the entire dose, resulting in possible overdose.
Reference: Page 223

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 7

Type: MCMA

An older patient with a speech deficit from a previous stroke is admitted for a repair of a hip fracture. Which techniques will the nurse use to assess this patients pain level?

Standard Text: Select all that apply.

1. Ask to describe the level of pain.

2. Observe for tense body posturing.

3. Listen for sounds such as groaning.

4. Notice changes in appetite or sleep.

5. Observe facial expressions such as grimacing.

Correct Answer: 2,3,4,5

Rationale 1: The patient is unable to speak, so verbally asking the patient to describe the level of pain will not provide the nurse with any information about the patients current level of pain.
Reference: Page 217

Rationale 2: Tense body posturing is a pain behavior that the patient who is unable to speak might demonstrate.
Reference: Page 217

Rationale 3: Sounds such as groaning are pain behaviors that the patient who is unable to speak might demonstrate.
Reference: Page 217

Rationale 4: Changes in appetite or sleep are pain behaviors that the patient who is unable to speak might demonstrate.
Reference: Page 217

Rationale 5: Grimacing is a pain behavior that the patient who is unable to speak might demonstrate.
Reference: Page 217

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Identify appropriate pain assessment techniques, including those to use with dementia.

Question 8

Type: MCSA

An older patient recovering from surgery is prescribed morphine sulfate 2 to 6 mg every 4 hours prn for pain. What approach will the nurse take to manage this patients pain?

1. Administer the lowest dose of 2 mg.

2. Administer the highest dose of 6 mg.

3. Avoid the narcotic for risk of addiction.

4. Administer the dose only when the patient asks for the medication.

Correct Answer: 1

Rationale 1: Older patients usually have more sensitivity to opioid analgesics, and most often these patients are started on smaller doses to avoid toxicity. The dose is then titrated upward until effective pain relief is achieved without adverse effects.
Reference: Page 218

Rationale 2: The highest dose is not appropriate since older patients usually have more sensitivity to opioid analgesics.
Reference: Page 218

Rationale 3: Narcotic addiction is not likely in the older patient.
Reference: Page 218

Rationale 4: Waiting for the patient to ask for the medication may cause undue suffering.
Reference: Page 218

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 9

Type: MCMA

An older patient with a history of constipation is prescribed an opioid analgesic for postoperative pain. What should the nurse include in this patients plan of care to avoid the pain management complication of constipation?

Standard Text: Select all that apply.

1. Mix psyllium in 4 ounces of water.

2. Provide stool softeners as prescribed.

3. Monitor for adequate daily fluid intake.

4. Increase ingestion of fresh fruit each day.

5. Offer senna tea each evening before sleep.

Correct Answer: 2,3,4,5

Rationale 1: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Bulking agents such as psyllium should be avoided to prevent fecal impaction.
Reference: Page 220

Rationale 2: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Stool softeners should be provided as prescribed.
Reference: Page 220

Rationale 3: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. The patient should be encouraged to increase the oral fluid intake.
Reference: Page 220

Rationale 4: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Fruits may also be helpful to prevent constipation.
Reference: Page 220

Rationale 5: A prophylactic bowel regimen must be initiated when opioid analgesics are utilized. Senna tea may also be helpful to prevent constipation.
Reference: Page 220

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 10

Type: MCSA

The nurse is planning to implement nonpharmacological approaches with an older patient with chronic osteoarthritis pain. What should the nurse keep in mind when implementing these approaches?

1. The effectiveness of nonpharmacological approaches is questionable.

2. Nonpharmacological approaches are less effective in the older patient.

3. Nonpharmacological approaches are more effective in the older patient.

4. Nonpharmacological approaches are effective when used with pharmacological therapy.

Correct Answer: 4

Rationale 1: Nonpharmacological approaches are more effective when used with pharmacological therapy. Their effectiveness is not questionable by the choice to use them depends upon the patients beliefs and willingness to use them.
Reference: Page 218

Rationale 2: The effectiveness of nonpharmacological approaches is not related to age.
Reference: Page 218

Rationale 3: The effectiveness of nonpharmacological approaches is not related to age.
Reference: Page 218

Rationale 4: Greater reductions in pain are seen when pharmacological and
nonpharmacological techniques are combined.
Reference: Page 218

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 11

Type: MCMA

An older patient is prescribed topical capsaicin for joint pain. What should the nurse instruct the patient about the use of this medication?

Standard Text: Select all that apply.

1. Avoid getting the medication in the eyes.

2. This medication will react with other medications.

3. It will cause a burning sensation when first applied.

4. Do not permit the medication to touch an open wound.

5. The burning sensation will decrease with subsequent uses.

Correct Answer: 1,3,4,5

Rationale 1: The patient should be instructed to avoid getting capsaicin in the eyes as this will cause burning.
Reference: Page 224

Rationale 2: This medication does not react with other medications.
Reference: Page 224

Rationale 3: The patient should be instructed that this medication will cause a burning sensation when first applied.
Reference: Page 224

Rationale 4: The patient should be instructed to avoid getting capsaicin in an open wound since it will cause burning.
Reference: Page 224

Rationale 5: The patient should be instructed that the burning sensation from capsaicin will decrease when applied frequently.
Reference: Page 224

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 12

Type: MCMA

The nurse learns that an older patient with chronic pain is not a candidate for the nonpharmacological pain management approach of massage. For which health problems is massage contraindicated?

Standard Text: Select all that apply.

1. Cancer

2. Fractures

3. Bleeding disorders

4. Low platelet counts

5. Deep vein thrombosis

Correct Answer: 2,3,4,5

Rationale 1: Massage is generally safe in people with cancer, but the oncologist should be consulted.
Reference: Page 224

Rationale 2: Massage is contraindicated in patients with fractures.
Reference: Page 224

Rationale 3: Massage is contraindicated in patients with bleeding disorders.
Reference: Page 224

Rationale 4: Massage is contraindicated in patients with low platelet counts.
Reference: Page 224

Rationale 5: Massage is contraindicated in patients with deep vein thrombosis.
Reference: Page 224

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 13

Type: MCMA

An older patient, experiencing severe pain from diabetic neuropathy, is having minimal pain relief from opioid analgesics. Which adjuvant medications should the nurse ask the healthcare provider to consider helping this patients pain?

Standard Text: Select all that apply.

1. Calcitonin

2. Muscle relaxants

3. Topical analgesics

4. Tricyclic antidepressant

5. Antianxiety medications

Correct Answer: 3,4

Rationale 1: Calcitonin is helpful to assist with bone pain. It is not indicated to help with the pain of diabetic neuropathy.
Reference: Page 221

Rationale 2: Muscle relaxants help when there is a muscle component to the pain. This does not occur with diabetic neuropathy.
Reference: Page 221

Rationale 3: Topical analgesics are helpful for the pain of diabetic neuropathy.
Reference: Page 221

Rationale 4: Tricyclic antidepressants are helpful for the pain of diabetic neuropathy.
Reference: Page 221

Rationale 5: Antianxiety medications are helpful when the patient is anxious or has muscle spasms. They are not indicated for diabetic neuropathy.
Reference: Page 221

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 14

Type: MCSA

A terminally ill older patient with ongoing pain is prescribed an increased dose of morphine. What should the nurse consider when providing this dose of pain medication to the patient?

1. The ultimate goal for the patient is to control pain.

2. The organizations attorney should be made aware of the physicians order.

3. The nurse may be charged with a crime for administering the medication dose.

4. It is more important to ensure the patient does not experience respiratory depression.

Correct Answer: 1

Rationale 1: Management of pain in terminal conditions may call for higher doses of opioids; however, pain should be treated aggressively to maximize comfort, even if the unintended effect of treatment results in the hastening of death.
Reference: Page 218

Rationale 2: Contacting the organizations attorney does not follow the chain of command. If the nurse has concerns, the nurse manager should be contacted.
Reference: Page 218

Rationale 3: The nurse is not seeking to end the patients life and cannot be charged with a crime.
Reference: Page 218

Rationale 4: Management of pain in terminal conditions is the priority even if an unintended effect of respiratory depression occurs.
Reference: Page 218

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 15

Type: MCSA

An older patient with renal disease and advanced cancer pain asks for stronger pain medication. What does the nurse need to take into consideration when determining which prescribed pain medication to provide to this patient?

1. Methadone is a viable option for this patient.

2. Meperidine is the most versatile opioid available.

3. Oral morphine may be a starting point to be considered for this patient.

4. Fentanyl is often the first opioid tried because of the low incidence of side effects.

Correct Answer: 3

Rationale 1: Methadone has a long half-life, which may result in toxic accumulation of the drug in the person with hepatic or renal impairment. Methadone should be initiated and titrated cautiously to manage persistent pain in the older patient, and only prescribed by clinicians experienced in its use.

Rationale 2: Meperidine has the potential to cause confusion or seizures due to buildup of a toxic metabolite.

Rationale 3: Morphine is a commonly used and versatile opioid for the treatment of moderate to severe pain. Short- and long-acting formulations exist, and the drug can be delivered via many routes including oral form.

Rationale 4: Fentanyl is not a medication that should be considered for persons who have never been exposed to opioids.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 16

Type: MCSA

An older patient receiving a low dose of oral morphine for chronic pain feels sleepy when taking the medication. What should the nurse explain to the patient about this analgesic?

1. Lowering the dose may reduce these feelings.

2. Unfortunately you will need to change medications.

3. Feeling sleepy is an unfortunate problem with morphine.

4. Once you develop a tolerance to the medications, this will improve.

Correct Answer: 4

Rationale 1: Lowering the dosage will not meet the ultimate goal, which is pain control.
Reference: Page 220

Rationale 2: Suggesting a medication change is not within the scope of the nurses responsibility.
Reference: Page 220

Rationale 3: Telling the patient this is an unfortunate result of the medication does little to meet the patients needs for information and is not the best action by the nurse.
Reference: Page 220

Rationale 4: Opioid analgesic use is associated with mild sedation initially. Once tolerance develops, the drowsiness should be lessened.
Reference: Page 220

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 17

Type: MCMA

An older patient with chronic pain is newly prescribed transdermal fentanyl. What will the nurse do when providing this medication?

Standard Text: Select all that apply.

1. Monitor liver function tests.

2. Use the lowest possible dose.

3. Anticipate and treat side effects.

4. Apply the patch to clean, dry, hairless skin.

5. Provide the patient with oral pain medications the first day the patch it used.

Correct Answer: 4,5

Rationale 1: Liver function tests should be monitored for carbamazepine and not transdermal fentanyl.
Reference: Page 220

Rationale 2: The lowest possible dose should be used for corticosteroids and not transdermal fentanyl.
Reference: Page 220

Rationale 3: Side effects should be anticipated and treated for morphine sulfate, oxycodone hydrocodone, and hydromorphone, not transdermal fentanyl.
Reference: Page 220

Rationale 4: The nurse should apply the transdermal fentanyl patch to clean, dry, hairless skin.
Reference: Page 220

Rationale 5: Since the peak effects of the first dose of transdermal fentanyl take 24 hours, the patient should be covered with oral pain medications the first day of application.
Reference: Page 220

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 18

Type: MCSA

An older patient receiving intravenous morphine sulfate is experiencing nausea and vomiting. What action should the nurse take at this time?

1. Provide the patient with meperidine for pain as prescribed.

2. Suspend the use of morphine and use a different opioid analgesic.

3. Provide a prescribed antiemetic for a few days and gradually taper it.

4. Discuss using nonopioid analgesics since the patient cannot tolerate them.

Correct Answer: 3

Rationale 1: Meperidine is not a recommended medication for pain control in the older patient because of harmful metabolites.
Reference: Page 221

Rationale 2: The patient needs to develop tolerance to the morphine. Another opioid analgesic may produce the same side effects of nausea and vomiting.
Reference: Page 221

Rationale 3: Opioid analgesics are associated with nausea and vomiting. The use of an antiemetic can be implemented for a short period and then withdrawn. The patient will then be able to tolerate the opioid.
Reference: Page 221

Rationale 4: The patients level of pain is severe in that intravenous morphine is being used. Nonopioid analgesics may not help control this patients pain.
Reference: Page 221

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe pharmacological and nonpharmacological approaches useful in treating pain in the older adult.

Question 19

Type: MCSA

The nurse observes myoclonic movements in an older patient receiving morphine sulfate for pain. What should the nurse do with this finding?

1. Contact the prescribing physician.

2. Observe the patient for more movements.

3. Document the finding in the patients medical record.

4. Send a blood sample to the lab to analyze the drug level.

Correct Answer: 1

Rationale 1: Myoclonic jerking movements may be associated with high-dose opioid therapy especially morphine. An alternate opioid should be used if this occurs and the physician needs to be contacted to change the medication order.
Reference: Page 221

Rationale 2: The nurse needs to do more than observe the patient for more movements. This medication needs to be discontinued.
Reference: Page 221

Rationale 3: The nurse needs to do more than document the finding in the patients medical record. This medication needs to be discontinued.
Reference: Page 221

Rationale 4: The nurse needs an order to draw blood for a drug level.
Reference: Page 221

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize the nurses role in treating pain in the older adult.

Question 20

Type: MCMA

An older patient newly diagnosed with arthritis wants to know what else can be done to help with the pain. What should the nurse instruct this patient?

Standard Text: Select all that apply.

1. Maintain a healthy weight.

2. Avoid positions that increase or cause pain.

3. Avoid eating red meat and processed grains.

4. Alcohol should not be used for pain control.

5. Perform regular gentle exercise like walking every day for 20 minutes.

Correct Answer: 1,2,5

Rationale 1: Weight control reduces pain, especially in older patients.
Reference: Page 223

Rationale 2: Recognizing what avoidable positions cause pain will help reduce the amount of pain from the arthritis.
Reference: Page 223

Rationale 3: There is no evidence to suggest that red meat and processed grains contribute to the pain of arthritis.
Reference: Page 223

Rationale 4: There is no evidence to suggest that alcohol should be avoided in the patient with arthritis.
Reference: Page 223

Rationale 5: Regular exercise strengthens muscles that support painful joints and may help speed recovery, prevent injury, and reduce disability.
Reference: Page 223

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize the nurses role in treating pain in the older adult.

Question 21

Type: MCSA

An older patient recovering from surgery refuses pain medication because of the fear of becoming addicted. What action should the nurse take at this time?

1. Contact the physician.

2. Administer the medication when the patient is sleeping.

3. Withhold the analgesic medication and continue to observe the patient.

4. Determine what methods of pain management are acceptable to the patient.

Correct Answer: 4

Rationale 1: Contacting the physician is premature and the patient is not in danger.
Reference: Page 222

Rationale 2: Administration of the medication that that been refused would be a violation of the patients rights.
Reference: Page 222

Rationale 3: The nurse needs to do more than observe the patient.
Reference: Page 222

Rationale 4: The risk of addiction in the elderly is rare. Additionally, the risk of addiction is limited when managing acute pain. The patient is in pain. Management of the pain is the priority. Determining what the patient will consider using is important. During the review of acceptable pain management interventions, the lines of communication will remain open and the patient may reconsider the decision.
Reference: Page 222

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize the nurses role in treating pain in the older adult.

Question 22

Type: MCSA

An older patient with mild arthritis pain asks the nurse what can be taken to help with the minor discomfort. How should the nurse respond to this patient?

1. Ibuprofen should be used on an empty stomach.

2. Aspirin in the best choice because it has fewer side effects.

3. Acetaminophen (Tylenol) is a good choice for mild pain, but check with your doctor.

4. Nonsteroidal anti-inflammatory medications are used for patients with a stomach ulcer history.

Correct Answer: 3

Rationale 1: Ibuprofen should be taken with food since it can cause stomach irritation.
Reference: Page 227

Rationale 2: Aspirin has the side effects of stomach upset and ulcer formation.
Reference: Page 227

Rationale 3: Acetaminophen (Tylenol) is a good choice for mild to moderate pain caused by osteoarthritis. The patient should check with the healthcare provider about the dose if he is going to take it for more than a few days.
Reference: Page 227

Rationale 4: NSAIDs should be avoided altogether if the patient has a stomach ulcer history.
Reference: Page 227

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Explain patient-family teaching guidelines for pain management.

Question 23

Type: MCSA

An older patient prescribed an oral time-released pain medication is having difficulty swallowing the dose. What should the nurse do to help this patient?

1. Teach the patient to chew the medication.

2. Give the same medication through a parenteral route.

3. Consult with the physician to have the medication route changed.

4. Contact the pharmacy to have the oral route changed to transdermal.

Correct Answer: 3

Rationale 1: A time-released medication cannot be chewed because it destroys the controlled-release properties and causes rapid absorption of the entire dose, resulting in a possible overdose.
Reference: Page 222

Rationale 2: The nurse cannot change the route of prescribed medication.
Reference: Page 222

Rationale 3: The nurse should discuss the patients inability to swallow the medication with the physician so that an alternative route can be determined.
Reference: Page 222

Rationale 4: The nurse cannot change the route of prescribed medication.
Reference: Page 222

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize the nurses role in treating pain in the older adult.

Question 24

Type: MCSA

The spouse of an older patient asks that the patient be given pills and to tell the patient that they are for pain. How should the nurse respond to the spouses request?

1. I cannot do that.

2. We can investigate this option.

3. Lets speak with the physician about this request.

4. Administering a placebo or fake medication is not ethical.

Correct Answer: 4

Rationale 1: The nurse needs to explain to the spouse why this cannot be done.
Reference: Page 223

Rationale 2: Placebo use is limited to research. The investigation of their usage is inappropriate.
Reference: Page 223

Rationale 3: Placebo use is limited to research. The consideration of their usage is inappropriate.
Reference: Page 223

Rationale 4: The use of placebos is not ethical in clinical practice for management of pain. Placebos should be limited to research protocols where patients have given informed consent and are aware that they may receive an inert medication as part of the research protocol.
Reference: Page 223

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize the nurses role in treating pain in the older adult.

Question 25

Type: MCSA

An older patient with chronic low back pain asks the nurse if there is anything else besides taking pain medication that the patient can do to help with the discomfort. What recommendation can the nurse safely make to the patient?

1. Sign up for a Tai Chi class.

2. Yoga has been found to be helpful.

3. Avoid spinal manipulation therapy.

4. Talk with your doctor about getting a prescription for vitamins.

Correct Answer: 2

Rationale 1: Tai Chi improves musculoskeletal pain; however, a risk of doing this is back pain.
Reference: Page 224

Rationale 2: Yoga can reduce functional disability, pain, and depression in people with low back pain.
Reference: Page 224

Rationale 3: Spinal manipulation is commonly used in older adults to treat low back pain.
Reference: Page 224

Rationale 4: The purchase of vitamins does not require a physicians prescription.
Reference: Page 224

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize the nurses role in treating pain in the older adult.

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