Nokea
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.
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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.
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.
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 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.
A patient with second-degree burns has been receiving morphine through patientcontrolled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. Which of the following actions should the nurse implement?
- A. Administer a dose of morphine every 1-2 hours from the PCA machine while the patient is sleeping.
- B. Consult with the health care provider about using a different treatment protocol to control the patient's pain.
- C. Request that the health care provider order a bolus dose of morphine to be given when the patient awakens with pain.
- D. Teach the patient to push the button every 10 minutes for an hour before going to sleep, even if the pain is minimal.
Correct Answer: B
Rationale: PCAs are best for controlling acute pain, this patient's history indicates persistent pain and a need for a pain management plan that will provide adequate analgesia while the patient is sleeping. Administering a dose of morphine when the patient already has severe pain will not address the problem. Teaching the patient to administer unneeded medication before going to sleep can result in oversedation and respiratory depression. It is illegal for the nurse to administer the morphine for a patient through PCA.