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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.
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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.
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.
When doing a pain assessment for a patient who has been admitted with metastatic breast cancer, which question asked by the nurse will give the most information about the patient's pain?
- A. How long have you had this pain?
- B. How would you describe your pain?
- C. How much medication do you take for the pain?
- D. How many times a day do you medicate for pain?
Correct Answer: B
Rationale: Because pain is a multidimensional experience, asking a question that addresses the patient's experience with the pain is likely to elicit more information than the more specific information asked in the other three responses. All of these questions are appropriate, but the response beginning 'How would you describe your pain' is the best initial question.
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.
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.