Staff at the care facility note that a woman has started ...

[MGLQZ]

Staff at the care facility note that a woman has started complaining of back pain in recent weeks and occasionally groans in pain.
 
  She has many comorbids that require several prescription medications. The nurse knows that which of the following factors is likely to complicate the clinician's assessment and treatment of the client's pain?
  A)
  Neural pain pathways in the elderly differ from those in younger adults and are less responsive to treatment.
  B)
  Assessment and treatment are possibly complicated by the large number of drugs that the client receives.
  C)
  Accurate pain assessment is not possible in clients with significant cognitive deficits.
  D)
  Frequent complaints of pain in older adults with dementia normally indicate hyperalgesia rather than an underlying physical problem.

Question 2

As you are walking in the park, a huge black Labrador (dog) runs up to you and places his paws on your shoulders. Immediately your heart starts racing, you feel palpations and anxiety, and your hands become a little shaky.
 
  The nurse knows that this response is primarily caused by
  A)
  fear of dogs that make you feel like your chest is being tightened and that you have lost control of the situation.
  B)
  increased levels of glucocorticoids by the adrenal glands that result in an increase in epinephrine level.
  C)
  response of the cholinergic muscarinic receptors on innervational targets of postganglionic fibers.
  D)
  stimulation of the release of 2-adrenergic receptors, which will open the airway and increase oxygenation.

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Answer to Question 1

Ans:
B

Feedback:

Polypharmacy complicates both assessment and treatment of pain in the older adult. While minor changes in pain pathways do occur as an age-related change, these do not mean that treatment is unsuccessful. Pain assessment is more difficult in clients with cognitive deficits, but it is not impossible. Reports of pain in the elderly, as with any client, may signal an underlying health problem.

Answer to Question 2

Ans:
B

Feedback:

Any situation sufficiently stressful to evoke increased levels of glucocorticoids also increases epinephrine levels. Increased epinephrine levels results in tachycardia, palpitations, anxiety, and tremors. Cholinergic muscarinic receptors and  blockers do not help in times of immediate stress.