Nokea
A patient with second-degree burns has been receiving morphine through patientcontrolled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. Which of the following actions should the nurse implement?
- A. Administer a dose of morphine every 1-2 hours from the PCA machine while the patient is sleeping.
- B. Consult with the health care provider about using a different treatment protocol to control the patient's pain.
- C. Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
- D. Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.
Correct Answer: B
Rationale: PCAs are best for controlling acute pain, this patient's history indicates persistent pain and a need for a pain management plan that will provide adequate analgesia while the patient is sleeping. Administering a dose of morphine when the patient already has severe pain will not address the problem. Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a patient through PCA.
You may also like to solve these questions
The health care provider plans to titrate a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time?
- A. Assessing for signs that the patient is becoming addicted to the opioid
- B. Monitoring for therapeutic and adverse effects of opioid administration
- C. Emphasizing that the risk of some opioid adverse effects increases over time
- D. Educating the patient about how analgesics improve postoperative activity level
- E. Teaching about the need to decrease opioid doses by the second postoperative day
Correct Answer: B,D
Rationale: Monitoring for pain relief and teaching the patient about how opioid use will improve postoperative outcomes are appropriate actions when administering opioids for acute pain. Although postoperative patients usually need decreasing amount of opioids by the second postoperative day, each patient's response is individual. Tolerance may occur, but addiction to opioids will not develop in the acute postoperative period. The patient should use the opioids to achieve adequate pain control, and so the nurse should not emphasize the adverse effects.
These medications are ordered for an older-adult patient with arthritis in both hips who is complaining of level 3 (0-10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy?
- A. Acetylsalicylic acid 650 mg orally
- B. Naproxen 200 mg orally
- C. Oxycodone 5 mg orally
- D. Acetaminophen 650 mg orally
Correct Answer: D
Rationale: Acetaminophen is the best first-choice medication. The principle of 'start low, go slow' is used to guide therapy when treating elderly adults because the ability to metabolize medications is decreased and the likelihood of medication interactions is increased. Nonopioid analgesics are used first for mild to moderate pain, although opioids may be used later. Acetylsalicylic acid and the NSAIDs are associated with a high incidence of gastrointestinal bleeding in elderly patients.
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.
These medications are prescribed by the health care provider for a patient who uses long-acting morphine for persistent back pain, but still has ongoing pain. Which of the following medications should the nurse question?
- A. Morphine
- B. Pentazocine
- C. Celecoxib
- D. Dexamethasone
Correct Answer: B
Rationale: Opioid agonist-antagonists can precipitate withdrawal if used in a patient who is physically dependent on agonist drugs such as morphine. The other medications are appropriate for the patient.
A patient with persistent abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. Which of the following reasons provide the basis for the nurse's response in relation to the effectiveness of these strategies?
- A. Impact the cognitive and affective components of pain.
- B. Increase the modulating effect of the efferent pathways.
- C. Prevent transmission of nociceptive stimuli to the cortex.
- D. Slow the release of transmitter chemicals in the dorsal horn.
Correct Answer: A
Rationale: Cognitive therapies impact on the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.