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Exam 11: Pain and Comfort

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Question 1

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An 88-year-old man is admitted to the emergency department for pneumonia.When reviewing his drug regimen,the nurse notes that he is on Darvon (propoxyphene) for arthritic pain.The nurse knows that:

A) Darvon is not recommended for treatment of arthritic pain in older adults,but is recommended for other chronic pain conditions.
B) Darvon is not recommended for use in older adults due to toxicity of metabolites.
C) Opioid analgesics are not recommended for treatment of arthritic pain in older adults.
D) Demerol would be a more appropriate analgesic to use for treatment of arthritic pain in older adults.

E) A) and C)
F) B) and D)

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Question 2

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A 99-year-old male patient has severe osteoarthritis,bilateral contractures of the lower extremities,and a stage IV pressure ulcer.He frequently moans and sleeps restlessly,and lashes out at staff during routine care.The nurse practitioner prescribes analgesic medications to be administered around-the-clock,with as-needed doses to be administered 20 minutes before care routines or dressing changes.What observation by the nurse would indicate that the pain regimen is effective?

A) "Patient slept throughout the night."
B) "Patient sleeping,but winces when turned from side to side."
C) "Patient slapped nurse during dressing change."
D) "Patient resisting care and refusing to eat."

E) A) and B)
F) B) and C)

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Question 3

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An older adult is seen in the emergency department after falling on an icy surface.She is complaining of a painful right hip.She also has a history of osteoarthritis and states that she takes acetaminophen 650 mg four times per day and Motrin 800 mg four times per day for control of persistent arthritic pain.She is discharged from the emergency department after x-rays reveal that she only has soft tissue bruising.In her discharge teaching,the nurse should include all except:

The safest narcotic choice for your elderly client experiencing severe acute pain is:

Adjuvant medications:

A 77-year-old female patient is admitted to the hospital for pneumonia.She has a history of lung cancer with metastases to bone.She is ordered a long-acting opioid administered around-the-clock.Her daughter asks you why the pain medication is ordered in that manner.You base your answer knowing that:

A 72-year-old patient is started on an analgesic regimen with opioids to treat persistent pain.What assessment is most important for the nurse to perform for all older patients on opioid analgesic regimens?

An 89-year-old patient was transferred from the nursing home for repair of a right hip fracture.She had a stroke that has left her aphasic.She is lying in bed quietly.When performing a pain assessment,the nurse should consider:

Compared with acute pain,persistent pain:

An 81-year-old female patient was recently admitted to the subacute setting after having a knee replacement.She is very anxious and refuses to get out of bed,stating that it is too painful.What is the best action for the nurse?

An 88-year-old male patient with gastric cancer with bone metastases is being discharged from the hospital where he was started on a regimen of opioid analgesics to control the metastatic pain.What should be included in the discharge teaching plan?

A 78-year-old client is being seen in the geriatrician's office for a blood pressure check.She has a history of hypertension and osteoarthritis,and has recently fallen and fractured two ribs.She has been prescribed extra strength Tylenol for the pain.What statement by the client requires further evaluation by the nurse?