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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.
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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 has persistent musculoskeletal pain and states 'I feel depressed because I ache too much to play golf.' The patient says the pain is usually at a level 7 (0-10 scale). Which of the following patient goals has the highest priority when the nurse is developing the treatment plan?
- A. The patient will exhibit fewer signs of depression.
- B. The patient will say that the aching has decreased.
- C. The patient will state that pain is at a level 2 of 10.
- D. The patient will be able to play 1-2 rounds of golf.
Correct Answer: D
Rationale: For persistent pain, patients are encouraged to set functional goals such as being able to perform daily activities and hobbies. The patient has identified playing golf as the desired activity, so a pain level of 2 of 10 or a decrease in aching would be less useful in evaluating successful treatment. The nurse also should assess for depression, but the patient has identified the depression as being due to the inability to play golf, so the goal of being able to play 1 or 2 rounds of golf is the most appropriate.
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 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.
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.