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A patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of morphine sulphate extended-release is due. Which of the following actions is priority for the nurse to implement?
- A. Administer the prescribed PRN immediate-release morphine.
- B. Suggest the use of alternative therapies such as heat or cold.
- C. Utilize distraction by talking about things the patient enjoys.
- D. Consult with the doctor about increasing the morphine sulphate extended-release dose.
Correct Answer: A
Rationale: The patient's pain requires rapid treatment and the nurse should administer the immediate-release morphine. Increasing the morphine sulphate extended-release dose and use of alternative therapies also may be needed, but the initial action should be to use the prescribed analgesic medications.
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The nurse is admitting a patient to hospital with a history of persistent cancer pain. When reviewing the patient's home medications, which of the following medications should be of most concern?
- A. Amitriptyline 50 mg at bedtime
- B. Oxycodone 80 mg twice daily
- C. Ibuprofen 800 mg three times daily
- D. Meperidine 25 mg every 4 hours
Correct Answer: D
Rationale: Meperidine is contraindicated for persistent pain because it forms a metabolite that is neurotoxic and can cause seizures when used for prolonged periods. The ibuprofen, amitriptyline, and oxycodone are all appropriate medications for long-term pain management.
The nurse assesses a postoperative patient who is receiving morphine through patientcontrolled analgesia (PCA). Which information is most important to report to the health care provider?
- A. The patient complains of nausea after eating.
- B. The patient's respiratory rate is 10 breaths/minute.
- C. The patient has not had a bowel movement for 3 days.
- D. The patient has a distended bladder and has not voided.
Correct Answer: B
Rationale: The patient's respiratory rate indicates a need to decrease the PCA dose or change the medication in order to avoid further respiratory depression. The other information also may require intervention, but is not as urgent to report as the respiratory rate.
The nurse is caring for a patient who is taking an opioid for postoperative pain. Which of the following interventions should the nurse include in the patients plan of care to manage possible adverse effects of opioids?
- A. Ensure the medication is given PRN only.
- B. Administer the prescribed stool softener OD
- C. Ensure the administration route maximizes drug concentration at the site of the adverse effect.
- D. Request a prescription for a different classification of medication.
Correct Answer: B
Rationale: Examples of ways to manage anticipated adverse effects of opioids are to administer stool softeners to prevent constipation and an antiemetic to prevent nausea. The medication should have a scheduling dosage regimen to maintain blood levels rather than only PRN. Changing to a different medication in the same classification may be appropriate rather than changing the drug classification. Another way to manage an adverse effect is to use an administration route that minimizes rather than maximizes drug concentrations at the site of the adverse effect.
The nurse is caring for a patient with cancer pain that the patient describes as at 'level 8 (0-10 scale), deep, and aching.' Which of the following prescribed medications should the nurse administer first?
- A. Fentanyl patch
- B. Ketorolac tablets PO
- C. Hydromorphone IV
- D. Acetaminophen suppository
Correct Answer: C
Rationale: The patient's pain level indicates that a rapidly acting medication such as an IV opioid is needed. The other medications also may be appropriate to use, but will not work as rapidly or as effectively as hydromorphone IV.
The nurse is caring for a patient who has persistent musculoskeletal pain and states 'I feel depressed because I ache too much to play golf.' The patient says the pain is usually at a level 7 (0-10 scale). Which of the following patient goals has the highest priority when the nurse is developing the treatment plan?
- A. The patient will exhibit fewer signs of depression.
- B. The patient will say that the aching has decreased.
- C. The patient will state that pain is at a level 2 of 10.
- D. The patient will be able to play 1-2 rounds of golf.
Correct Answer: D
Rationale: For persistent pain, patients are encouraged to set functional goals such as being able to perform daily activities and hobbies. The patient has identified playing golf as the desired activity, so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment. The nurse also should assess for depression, but the patient has identified the depression as being due to the inability to play golf, so the goal of being able to play 1 or 2 rounds of golf is the most appropriate.