Nokea
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.
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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.
A postoperative patient asks the nurse how the prescribed ibuprofen will control the incisional pain. The nurse will teach the patient that ibuprofen interferes with the pain process by decreasing which of the following physiological responses?
- A. Modulating effect of descending nerves
- B. Sensitivity of the brain to painful stimuli
- C. Production of pain-sensitizing chemicals
- D. Spinal cord transmission of pain impulses
Correct Answer: C
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) provide analgesic effects by decreasing the production of pain-sensitizing chemicals such as prostaglandins at the site of injury. Transmission of impulses through the spinal cord, brain sensitivity to pain, and the descending nerve pathways are not affected by the NSAIDs.
A patient who is receiving sustained-release morphine sulphate every 12 hours for persistent pain experiences level 9 (0-10 scale) breakthrough pain and anxiety. Which of these prescribed medications should the nurse anticipate administering?
- A. Lorazepam 1 mg orally
- B. Amitriptyline 10 mg orally
- C. Ibuprofen 400-800 mg orally
- D. Immediate-release morphine 30 mg orally
Correct Answer: D
Rationale: The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid such as the immediate-release morphine. The ibuprofen and amitriptyline may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of antianxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.
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.
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.