Morphine

The HCP prescribes morphine 2-4 mg push every 2 hours for PRN pain for a client who has postoperative pain following abdominal surgery. Prior to performing an abdominal dressing change with packing at 1000, the nursing assesses the client's pain as a 1 on a scale of 0=no pain to 10=worst pain. THe client is awake and oriented, and vital signs are WNL. The nurse reviews the pain medication record and sees that at 0700, the client reported a pain level of 8, when 4 mg of morphine was administered via IV. at 0900, the clients pain level was a 4, and 2 mg of IV morphine was administered. What should the nurse do? 1. perform the dressing change 2. administer morphine 2 mg IV before the dressing change 3. Administer morphine 4 mg IV after the dressing change4. Call the HCP for a new medication prescription

2. administer morphine 2 mg IV before the dressing change

a client with pancreatic cancer has been recieving morphine cia a subcutaneous pump for 2 weeks. the client is requiring an increased dose of the morphine to manage the pain. the nurse should document that the client is: 1. tolerating the medication well' 2. developing an addiction to morphine 3. developing a tolerance for the medication 4. experiencing physical dependance

3. developing a tolerance for the medication

A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths/min. Which medication would the nurse anticipate administering? A) Naloxone (Narcan) B) Acetylcysteine (Mucomyst) C) Methylprednisolone (Solu-Medrol) D) Protamine sulfate

A) Naloxone (Narcan)Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

Which side effect of morphine does not subside over time? A. Constipation B. Sedation C. Respiratory depression D. Nausea and vomiting

A. Constipation

Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? A. Morphine B. Pentazocine C. Hydrocodone D. Nalmefene

A. Morphine

A postoperative patient has an epidural infusion of morphine sulfate [Astramorph]. The patient's respiratory rate declines to 8 breaths per minute. Which medication would the nurse anticipate administering? A. Naloxone B. Meperedine C. Nalbuphine D. Prednisone

A. Naloxone

The nurse is planning care for a patient receiving morphine by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A Administering a cough suppressant B Inserting a Foley catheter C Administering an antidiarrheal D Monitoring liver function tests

B Inserting a Foley catheter

A patient with chronic pain was admitted to the hospital. The physician orders morphine PO 5 mg every 4 hours. The patient states that he usually takes his home morphine prescription 10 mg every 4 hours and has been for several months. This patient is at risk for which of the following? A. Physical dependence B. Abstinence syndrome C. Addiction D. Tolerance

C. Addiction

A patient with second-degree burns has been receiving morphine through patient-controlled analgesia (PCA) for a week. The patient wakes up frequently during the night complaining of pain. The most appropriate action by the nurse is to a. administer a dose of morphine every 1 to 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.

b. consult with the health care provider about using a different treatment protocol to control the patient's pain.PCAs are best for controlling acute pain; this patient's history indicates chronic 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.

A nurse is caring for a cancer patient receiving subcutaneous morphine sulfate for pain. Which of the following nursing actions is most important in the care of this patient? A. Monitor urine output. B. Monitor respiratory rate. C. Monitor heart rate. D. Monitor temperature.

Answer: B. Monitor respiratory rate. Morphine sulfate can suppress respiration and respiratory reflexes, such as cough. Patients should be monitored regularly for these effects to avoid respiratory compromise. Morphine sulfate does not significantly affect urine output, heart rate, or body temperature.

The nurse is planning care for a patient receiving morphine sulfate (Duramorph) by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A) Administer cough suppressant. B) Insert Foley catheter. C) Administer antidiarrheal. D) Monitor liver function tests.

B) Insert Foley catheter. Morphine can cause urinary hesitancy and urinary retention. If bladder distention or the inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those drugs would need to be administered to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

Which agent below is most likely to cause serious respiratory depression as a potential adverse reaction? A) Morphine (Duramorph) B) Pentazocine (Talwin) C) Hydrocodone (Lortab) D) Nalmefene (Revex)

a) Morphine (Duramorph)Morphine is a strong opioid agonist and as such has the highest likelihood of respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression but not as often and serious as morphine. Nalmefene is an opioid antagonist and would be used to reverse respiratory depression with opioids.

A patient with cancer-related pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first? a. Administer the prescribed PRN immediate-acting 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 MS Contin dose.

a. Administer the prescribed PRN immediate-acting morphine.The patient's pain requires rapid treatment and the nurse should administer the immediate-acting morphine. Increasing the MS Contin dose and use of alternative therapies also may be needed, but the initial action should be to use the prescribed analgesic medications.

A patient who is using a fentanyl (Duragesic) patch and immediate-release morphine for chronic cancer pain develops new-onset confusion, dizziness, and a decrease in respiratory rate. Which action should the nurse take first? 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 (Narcan).

a. Remove the fentanyl patch.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 chronically 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 who uses extended-release morphine sulfate (MS Contin) for chronic abdominal pain caused by ovarian cancer asks the nurse to administer the prescribed hydrocodone (Vicodin) tablets, but the patient is asleep when the nurse returns with the medication. Which action is best for the nurse to take? a. Wake the patient and administer the hydrocodone. b. Wait until the patient wakes up and reassess the pain. c. Consult with the health care provider about changing the MS Contin dose. d. Suggest the use of nondrug therapies for pain relief instead of additional opioids.

a. Wake the patient and administer the hydrocodone.Since patients with chronic pain frequently use withdrawal and decreased activity as coping mechanisms for pain, the patient's sleep is not an indicator that she is pain free. The nurse should wake the patient and administer the hydrocodone.

A patient who has just started taking sustained-release morphine sulfate (MS Contin) for chronic pain complains of nausea and abdominal fullness. The best initial action by the nurse is to 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

a. administer the ordered antiemetic medication.Nausea is frequently experienced with the initiation of opioid therapy, and antiemetics usually are prescribed to treat this expected side 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 (MS Contin) for chronic back pain, but still has ongoing pain. Which medication should the nurse question? a. morphine (Roxanol) b. pentazocine (Talwin) c. celecoxib (Celebrex) d. dexamethasone (Decadron)

b. pentazocine (Talwin)Opioid agonist-antagonists can precipitate withdrawal if used in a patient who is physically dependent on mu agonist drugs such as morphine. The other medications are appropriate for the patient.

The nurse assesses a postoperative patient who is receiving morphine through patient-controlled analgesia (PCA). Which information is most important to report to the health care provider? a. The patient complains of nausea after eating. b. The patient's respiratory rate is 10 breaths/minute. c. The patient has not had a bowel movement for 3 days. d. The patient has a distended bladder and has not voided.

bThe patient's respiratory rate is 10 breaths/minute.The patient's respiratory rate indicates a need to decrease the PCA dose or change the medication in order to avoid further respiratory depression. The other information also may require intervention, but is not as urgent to report as the respiratory rate.

When caring for a patient who is receiving epidural morphine, which information obtained by the nurse indicates that the patient may be experiencing a side 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.

c. The patient has not voided for over 10 hours.Urinary retention is a common side effect of epidural opioids. Headache is not an anticipated side 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 side effect. Hypotonic bowel sounds and constipation (rather than abdominal cramping) are concerns.

The safest narcotic choice for an elderly client with acute pain is: a. Meperidine (Demerol) b. Oxycodone c. Fentanyl transdermal patch d. Morphine sulfate

d. Morphine sulfate.Rationale: Morphine is the "gold standard" of narcotics for acute pain. The other choices are incorrect.

A patient with chronic cancer pain is receiving imipramine (Tofranil) in addition to long-acting morphine for pain control. Which information is the best indicator that the imipramine is effective? a. The patient sleeps 8 hours every night. b. The patient has no symptoms of anxiety. c. The patient states, "I feel much less depressed since I've been taking the imipramine." d. The patient states, "The pain is manageable, and I can accomplish my desired activities.

d. The patient states, "The pain is manageable, and I can accomplish my desired activities.Imipramine is being used in this patient to manage chronic pain and improve functional ability. Although the medication also is prescribed for patients with depression, insomnia, and anxiety, the evaluation for this patient is based on improved pain control and activity level.

When the nurse visits a hospice patient, the patient has a respiratory rate of 8 breaths/minute and complains of severe pain. Which action is best for the nurse to take? 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.

d. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly. 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 patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which of these prescribed medications will be best for the nurse to administer? a. lorazepam (Ativan) 1 mg orally b. amitriptyline (Elavil) 10 mg orally c. ibuprofen (Motrin) 400 to 800 mg orally d. immediate-release morphine 30 mg orally

d. immediate-release morphine 30 mg orallyThe severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid, such as the immediate-release morphine. The Motrin and Elavil may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of anti-anxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.

The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which of the following assessments requires immediate nursing interventions? a.) Blood pressure 110/70 b.) The client is drowsy. c.) Pain is unrelieved in 15 minutes. d.) Respiratory rate 10/minute

d.) Respiratory rate 10/minute Opioids activate mu and kappa receptors that can cause profound respiratory depression. Respiratory rate should remain above 12. The BP is not significantly low. Drowsiness is an expected effect of morphine. Unrelieved pain warrants further assessment, but not as immediately as do decreased respirations.