Nokea
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.
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The nurse is preparing a patient for discharge who has been receiving morphine 10 mg IV for pain and will continue to take morphine PO at home. Which of the following dosages is an equianalgesic oral dose for this patient?
- A. 10 mg
- B. 20 mg
- C. 30 mg
- D. 40 mg
Correct Answer: C
Rationale: The approximate equianalgesic oral dose for morphine 10 mg parenterally is 30 mg PO.
The nurse visits a hospice patient and assesses a respiratory rate of 8 breaths/minute and the patient states 'I am having severe pain.' Which of the following interventions should the nurse implement at this time?
- A. Inform the patient that increasing the morphine will cause the respiratory drive to fail.
- B. Administer a nonopioid analgesic, such as a nonsteroidal anti-inflammatory drug (NSAID), to improve patient pain control.
- C. Tell the patient that additional morphine can be administered when the respirations are 12.
- D. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.
Correct Answer: D
Rationale: The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's respiratory rate. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly.
These medications are prescribed by the health care provider for a patient who uses long-acting morphine for persistent back pain, but still has ongoing pain. Which of the following medications should the nurse question?
- A. Morphine
- B. Pentazocine
- C. Celecoxib
- D. Dexamethasone
Correct Answer: B
Rationale: Opioid agonist-antagonists can precipitate withdrawal if used in a patient who is physically dependent on agonist drugs such as morphine. The other medications are appropriate for the patient.
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 patient who uses a fentanyl patch for persistent cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0-10 scale) and requests 'something for pain that will work quickly.' Which of the following types of pain is the most appropriate for the nurse to document for this patient?
- A. Somatic pain
- B. Referred pain
- C. Neuropathic pain
- D. Breakthrough pain
Correct Answer: D
Rationale: Pain that occurs beyond the persistent pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.