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Pain Assessment and Management Strategies for Elderly Patients

doi: 10.1097/NHH.0000000000000098
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Pain Assessment and Management Strategies for Elderly Patients


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GENERAL PURPOSE: To present strategies to assist hospice and home healthcare clinicians in assessing and managing elderly patients' pain.

LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to:

  1. Identify common drugs used to treat pain and associated adverse effects in the elderly.
  2. Select strategies to assess and manage pain in the elderly.
  1. About how many Americans currently serve as caregivers to homebound elderly adults?
    1. Just under 5 million
    2. Nearly 20 million
    3. About 35 million
    4. More than 50 million
  2. One of the most common opioids prescribed to treat pain in elderly patients is
    1. oxycodone.
    2. tramadol.
    3. codeine.
    4. hydrocodone.
  3. Opioids are especially dangerous for elderly patients because diminishing function in which of these organs or systems increases the risk for adverse effects?
    1. Intestinal and musculoskeletal
    2. Pulmonary and hematologic
    3. Pancreatic and gastric
    4. Renal and hepatic
  4. One of the most significant adverse effects of the use of intravenous formulations of opioids in elderly patients is
    1. respiratory depression.
    2. muscle spasms.
    3. dehydration.
    4. fever.
  5. Occurring particularly with oral formulations, one of the major adverse effects of opioids in elderly patients is
    1. hearing loss.
    2. hematuria.
    3. cognitive changes.
    4. tachycardia.
  6. An important concern with opioid treatment in elderly patients who have dementia or cerebrovascular injury is
    1. delirium.
    2. depression.
    3. coughing.
    4. mydriasis.
  7. Because elderly patients who have cognitive deficits may be unable to say that they have pain, clinicians should assess them for which of these indicators of pain?
    1. Flat affect
    2. Somnolence
    3. Hypotension
    4. Increased agitation
  8. Which of the following clinical manifestations is almost always associated with opioid use?
    1. Confusion
    2. Constipation
    3. Seizures
    4. Diarrhea
  9. Findings from a literature review of pain management in elderly patients strongly support the use of nonpharmacologic treatment approaches such as physical therapies, which include
    1. herbal supplements.
    2. guided imagery.
    3. exercise.
    4. massage.
  10. Which type of pain is considered “lancinating,” that is, the worst of the worst?
    1. Nociceptive
    2. Psychogenic
    3. Neuropathic
    4. Myofascial
  11. Nonsteroidal anti-inflammatory drugs must be used with caution by elderly patients because of the risk of
    1. diuresis.
    2. bleeding.
    3. insomnia.
    4. dependence.
  12. After a patient receives epidural steroid injections, the clinician should inform the patient about the most common adverse effects, which include
    1. oliguria.
    2. muscle weakness.
    3. anorexia.
    4. blurry vision.
  13. Patients with moderate-to-severe cognitive impairments may benefit most from which type of pain scale?
    1. Visual analog
    2. Observational
    3. Numeric rating
    4. Descriptive verbal
  14. Of the four categories of behaviors Zwakhalen and colleagues asked nurses to assess in elderly patients with dementia who might have pain, the “other” category included
    1. mood.
    2. activity.
    3. changes in sleep.
    4. facial grimacing.
  15. The P in the acronym PQRST stands for
    1. place.
    2. pallor.
    3. position.
    4. paresthesia.
  16. Which of the following members of the interdisciplinary team is responsible for monitoring comorbidity and changes in the patient's status?
    1. Pharmacist
    2. Social worker
    3. Physical therapist
    4. Occupational therapist


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