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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.
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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.
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 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.
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 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.