A nurse is caring for a patient with chronic pain. Which ...

[abern]

A nurse is caring for a patient with chronic pain. Which statement by the nurse indicates an understanding of pain management?
 
  a. This patient says the pain is a 5 but is not acting like it. I am not going to give any pain medication.
  b. I need to reassess the patient's pain 1 hour after administering oral pain medication.
  c. It wasn't time for the patient's medication, so when it was requested, I gave a placebo.
  d. The patient is sleeping, so I pushed the PCA button.

Question 2

A nurse receives an order from a health care provider to administer hydrocodone and acetaminophen (Vicodin ES 7.5/750), to a patient who is experiencing 8/10 postsurgical pain.
 
  The order is to give 2 tablets every 6 hours by mouth as needed for pain. What is the nurse's next best action?
  a. Give the Vicodin ES to the patient immediately because the patient is experiencing severe pain.
  b. Ask the health care provider for a nonsteroidal antiinflammatory drug (NSAID) order.
  c. Ask the health care provider to verify the dosage and frequency of the medication.
  d. Give the Vicodin ES in addition to playing soothing music for the patient.

[vish98]

Answer to Question 1

ANS: B
Be sure to evaluate after an appropriate period of time. For instance, oral medications usually peak in about 1 hour, whereas IVP medications peak in 15 to 30 minutes. Ask a patient if a medication alleviates the pain when it is peaking. Because oral medications usually peak in about an hour, you need to reassess the patient's pain within an hour of administration. Nurses must believe any patient report of pain, even if nonverbal communication is not consistent with pain ratings. The patient is the only person who should push the PCA button. Pushing the PCA when a patient is sleeping is dangerous and may lead to narcotic overdose or respiratory depression. Giving the patient a placebo and telling the patient it is medication is unethical.

Answer to Question 2

ANS: C
The maximum 24-hour dosage for acetaminophen is 4 grams. If the patient took 2 tablets of Vicodin ES every 6 hours, the patient would take in 6 grams of acetaminophen in 24 hours (2 tablets = 750 + 750 = 1500 4 could have 4 doses in 24 hours every 6 hours = 6000 mg = 6 g). This exceeds the safe dosage of acetaminophen, so the best action is to question this order. Giving the medication as ordered would possibly result in the patient's taking more acetaminophen than is considered a safe dose. Acetaminophen overdose can result in liver failure. NSAIDs are used to treat mild to moderate pain. At this moment, the patient is experiencing severe pain. Implementing music therapy is a nursing intervention and is an independent nursing action that can be instituted with pain medication, but the possible acetaminophen dose is the priority.

[abern]

Excellent

[Joy Chen]

TYSM