Nokea
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.
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The nurse is caring for a patient with diabetes who has persistent burning leg pain even when taking oxycodone twice daily. Which of the following prescribed medications is the most appropriate choice for the nurse to administer as an adjuvant to decrease the patient's pain?
- A. Acetylsalicylic acid
- B. Dextroamphetamine
- C. Amitriptyline
- D. Acetaminophen
Correct Answer: C
Rationale: The patient's pain symptoms are consistent with neuropathic pain and the tricyclic antidepressants are effective for treating this type of pain. Acetylsalicylic acid and acetaminophen are more effective for nociceptive pain and dextroamphetamine is used in managing opioid-induced sedation.
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 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.
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 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.