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The nurse is caring for a patient diagnosed with tendinitis in the outpatient clinic and advises that the patient use a topical ointment to assist with pain relief. The patient informs the nurse that they have never used a topical ointment for pain relief before so the nurse provides education related to the correct use of the ointment. Which of the following information should the nurse include in the teaching plan?
- A. Apply the ointment after a 20-minute massage of the area.
- B. Use moist heat for 10 minutes to the area prior to applying the ointment.
- C. Test the ointment on a small area of the skin for adverse effects.
- D. Use EMLA to the area prior to applying the ointment.
Correct Answer: C
Rationale: Skin testing is advisable when the patient has not used the particular medication before because the strengths of the medications vary and different intensities of sensation are produced. On application, these medications usually produce a strong hot or cold sensation and should not be used after massage or a heat treatment when blood vessels are already dilated. An eutectic mixture of local anaesthetics (EMLA) is not appropriate for tendonitis and should not be applied prior to another pain-relieving ointment.
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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 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.
The nurse is caring for a patient who has just started taking sustained-release morphine sulphate for persistent pain and is nausea with abdominal fullness. Which of the following interventions is the most appropriate for the nurse to implement?
- A. Administer the ordered antiemetic medication.
- B. Tell the patient that the nausea will subside in about a week.
- C. Order the patient a clear liquid diet until the nausea decreases.
- D. Consult with the health care provider about using a different opioid.
Correct Answer: A
Rationale: Nausea is frequently experienced with the initiation of opioid therapy, and antiemetics usually are prescribed to treat this expected adverse effect. There is no indication that a different opioid is needed, although if the nausea persists, the health care provider may order a change of opioid. Although tolerance develops and the nausea will subside in about a week, it is not appropriate to allow the patient to continue to be nauseated. A clear liquid diet may decrease the nausea, but the best choice would be to administer the antiemetic medication and allow the patient to eat.
The nurse is caring for a patient who is using fentanyl patch and immediate-release morphine for persistent cancer pain who develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which of the following actions is the priority for the nurse to implement?
- A. Remove the fentanyl patch.
- B. Notify the health care provider.
- C. Continue to monitor the patient's status.
- D. Give the prescribed PRN naloxone.
Correct Answer: A
Rationale: The assessment data indicate possible overdose of opioid. The first action should be to remove the patch. Naloxone administration in a patient who has been persistently using opioids can precipitate withdrawal and would not be the first action. Notification of the health care provider and continued monitoring also are needed, but the patient's data indicate that more rapid action is needed.
The nurse is caring for a patient with persistent back pain who has arrived at the pain clinic for a follow-up appointment. In order to evaluate whether the pain management is effective, which of the following questions is most appropriate for the nurse to ask?
- A. Can you describe the quality of your pain?
- B. Has there been a change in the pain location?
- C. How would you rate your pain on a 0-10 scale?
- D. Does the pain keep you from doing things you enjoy?
Correct Answer: D
Rationale: The goal for the treatment of persistent pain usually is to enhance function and quality of life. The other questions also are appropriate to ask, but information about patient function is more useful in evaluating effectiveness.