Exam (elaborations)
Gerontological Nursing, 4e (Tabloski) Chapter 9 Pain Management
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Gerontological Nursing, 4e (Tabloski) Chapter 9 Pain Management
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Gerontological Nursing, 4e (Tabloski)Chapter 9 Pain Management
Anrolderrclientrwithrarhistoryrofrsevererarthritisrhasrnotrreceivedrpainrmedicationrforroverr18rhours.rTh
erclientrisrcurrentlyrcomplainingrofrsevererpainrinrbothrlegs.rWhatrwillrthernurserattributerasrbeingrtherr
easonrforrtherclient'srincreaserinrpain?
1. Dependencyronrnarcotics
2. Over-exaggerationrofrtheramountrofrpain
3. Needrforralternativermeasuresrforrpainrrelief
4. Untreatedrpainrresultingrinrlowerrpainrthresholdr
Answer:r 4
Explanation:r 1.rNarcoticrdependencyrinrtherolderradultrisrunlikely.
2. Painrisrwhateverrtherclientrsaysritris.rThernursercannotrassumerthatrtherclientrisrover-
rexaggeratingrtheramountrofrpainrbeingrexperienced.
3. Alternativermeasuresrmayrberhelpful,rbutrsomethingrelserisrneededrtorhelprtherclientrwithrsev
ererpain.
4. Withruntreatedrpain,rthernociceptorsrbecomersensitiverandrmorerresponsivertorstimulirresultingrinra
rloweredrpainrthreshold.rThisrclientrexperiencedrarlongrperiodrofrtimerbetweenradministrationsrofrpai
nrmedication,randrthisrcausesranrincreaserinrtherpainrexperienced.
PagerRef:r212
CognitiverLevel:r Analyzing
ClientrNeed:r PhysiologicalrIntegrity
ClientrNeedrSub:r PharmacologicalrandrParenteralrTherapiesrNurs/Integr
Conc.:r NursingrProcess:rAssessment
LearningrOutcome:r 1.rDefinerpainrandrtherconsequencesrofrpainrinrtherolderradult.
1
Copyrightr©r2019rPearsonrEducation,rInc.
,1) Anrolderradultrclientrhasrarhistoryrofrosteoarthritis.rThernursercaresrforrtherclientrinrtherpostoperat
iverperiodrafterrarbelow-the-
kneeramputationrforrcomplicationsrofrperipheralrvascularrdisease.rWhichrfindingrmostrconcernsrthe
rnurse?
1. Therclientrhasrarhistoryrofrdepressionrandranxiety,rtreatedrwithrarselectiverserotoninrreuptakerinhi
bitor.
2. Therclientrtakesracetaminophenr(Tylenol)rinsteadrofrprescribedrpainrmedicationrasrneededrforrost
eoarthritis.
3. Therclient'srspouservisitsrtherhospitalroccasionally,rusuallyrtorassistrwithrthermorningrmealrandrbat
hing.
4. Therclientrisrirritable,rreportsrmoderatergeneralizedrpain,randrstatesrthatrhercannotr"putrarnu
mberronrit."
Answer:r 2
Explanation:r 1.rDepressionrandranxietyrcanrworsenrwithrundertreated,rpersistentrpain.rTherfactrther
clientrisralreadyrbeingrtreatedrforrthisrisrarpositiverfinding.
2. Arhistoryrofrundertreated,rchronicrpainrisroftenrrelatedrtormusculoskeletalrdisorders.rTherclientrhasr
notrbeenrtakingrmedicationsrthatrmightrhaverhelpedrtherpain.rThisrcanrresultrinrhyperalgesia,ranrincre
asedrsensitivityrtorpainrthatrleadsrtoranrexaggeratedrpainrresponse.
3. Ideally,rtherclientrwouldrhavermorercontinuousrin-
hospitalrsupport,rbutrtherclientrdoesrhaverarsupportrperson.rTherspousermayrberbusyrwithrwork,rfam
ily,rorrotherrresponsibilities.
4. Olderrclientsrsometimesrarervaguerwithrpainrreports,rparticularlyrwhenrthererarermultiplerpainrsou
rces,rsuchrasrchronicrmusculoskeletalrpainrandracutersurgicalrpain.rItrisrnotruncommonrforrsomeoner
inrmoderatertorsevererpainrtordemonstraterfrustrationrwith,rorrrefusalrtoruse,rtherpainrscale.
PagerRef:r203-
205rCognitiverLevel:r Analyz
ing
ClientrNeed:r PhysiologicalrIntegrity
ClientrNeedrSub:r PhysiologicalrAdaptationrNurs
/IntegrConc.:r NursingrProcess:rDiagnosis
LearningrOutcome:r 1.rDefinerpainrandrtherconsequencesrofrpainrinrtherolderradult.
2
Copyrightr©r2019rPearsonrEducation,rInc.
, 2) Anrolderrclientrlivingratrhomerwithrcancerrreportsrhavingrtortakertwicerasrmuchrpainrmed
icationroverrtherlastr24rhours.rWhatrshouldrthernurserdorwithrthisrinformation?
1. Doublerthercurrentrdoserofrnarcoticrpainrmedication.
2. Discussroptionsrtorpreventrandrtreatrbreakthroughrpain.
3. Usernon-pharmacologicalrmethodsrforrpainrreliefrinsteadrofrpainrmedication.
4. Advocaterforrarmedicationrchangerbecausertherclientrhasropioidrtolerance.rA
nswer:r 2
Explanation:r 1.rTherclientrmayrberexperiencingrbreakthroughrpainrandrardifferentrpainrmanagementra
pproachrmayrberneeded.rTitratingrthermedicationrdoserupwardrisrarreasonableroption,rbutrdoublingrther
doserisrtoordrasticrandrcanrleadrtoradversereffects.
2. Ifrtherclientrexperiencesrbreakthroughrpainronrarconsistentrbasis,rthernursershouldrnotifyrtherclie
nt'srproviderrsorthatrtherdoserofrtherlong-acting,rsustained-
releaserpreparationrcanrberincreasedrtormorereffectivelyrcontrolrtherpain.rImmediate-
releaserdosesrareralsorusedrtorbetterrmanagerbreakthroughrpain.
3. Alternativermethodsrofrpainrreliefrmayrorrmayrnotrbereffectiverwithrbreakthroughrpain.rThernurser
couldrimplementrtheserinrconjunctionrwith,rbutrnotrinsteadrof,rbetterrpharmacologicalrpainrmanage
ment.
4. Thererisrnorevidencertorsuggestrthatrtherclientrhasropioidrtolerance.rOpioidrtolerancerdoesrnotrocc
urroverrtherperiodrofronerday,rbutrratherrtakesrardays,rweeks,rorrmonthsrtorcreaterarproblem.rPagerRe
f:r215
CognitiverLevel:r Applying
ClientrNeed:r PhysiologicalrIntegrity
ClientrNeedrSub:r PharmacologicalrandrParenteralrTherapiesrNurs/Integr
Conc.:r NursingrProcess:rImplementation
LearningrOutcome:r 3.rDescriberpharmacologicalrandrnonpharmacologicalrapproachesrusefulrinrtreati
ngrpainrinrtherolderradult.
3
Copyrightr©r2019rPearsonrEducation,rInc.
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