Nokea
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.
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The nurse is caring for a patient who is receiving epidural morphine. Which of the following information obtained by the nurse indicates that the patient may be experiencing an adverse effect of the medication?
- A. The patient has cramping abdominal pain.
- B. The patient becomes restless and agitated.
- C. The patient has not voided for over 10 hours.
- D. The patient complains of a 'pounding' headache.
Correct Answer: C
Rationale: Urinary retention is a common adverse effect of epidural opioids. Headache is not an anticipated adverse effect of morphine, although if there is a cerebrospinal fluid leak, the patient may develop a 'spinal' headache. Sedation (rather than restlessness or agitation) would be a possible adverse effect. Hypotonic bowel sounds and constipation (rather than abdominal cramping) are concerns.
A postoperative patient asks the nurse how the prescribed ibuprofen will control the incisional pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing which of the following physiological responses?
- A. Modulating effect of descending nerves
- B. Sensitivity of the brain to painful stimuli
- C. Production of pain-sensitizing chemicals
- D. Spinal cord transmission of pain impulses
Correct Answer: C
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by the NSAIDs.
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.
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.
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.