MS: Ch8 Pain (Evolve)

A patient asks the nurse why a dose of hydromorphone (Dilaudid) by IV push is given before starting the medication via PCA. Which response is most appropriate? "PCA will never be effective unless a loading dose is given first." "The IV push dose will enhance the effects of the PCA for the next 8 hours." "The IV push dose will provide for immediate pain relief, which can be maintained by using the PCA." "PCA takes at least 2 hours to begin working, so the IV push dose will provide pain relief in the interim."

"The IV push dose will provide for immediate pain relief, which can be maintained by using the PCA." An IV push loading dose of an opioid analgesic provides an effective opioid level in the body, which results in immediate pain control. The PCA medication doses may be smaller and can be used more frequently to maintain pain control when the loading dose begins to wear off.

A postoperative patient has an order to receive morphine sulfate 4 mg IM every 3 to 4 hours prn for pain. On hand are prefilled syringes labeled morphine sulfate 10 mg/mL. How many milliliters should the nurse administer? 0.4 mL 0.55 mL 0.6 mL 0.75 mL

0.4 mL

When assessing a patient receiving morphine sulfate 2 mg every 10 minutes via PCA pump, the nurse should take action as soon as the patient's respiratory rate drops down to or below which parameter? 16 breaths/min 14 breaths/min 12 breaths/min 10 breaths/min

12 breaths/min To protect the patient from adverse effects of respiratory depression from this medication, the nurse should alert the health care provider as soon as the respiratory rate drops down to or below 12 breaths/min.

The nurse is preparing to administer celecoxib 200 mg PO for pain relief. Available are capsules containing 100 mg. How many capsules should the nurse administer? _____capsules

2

A patient with osteoarthritis has been taking ibuprofen 400 mg every 8 hours. The patient states that the drug does not seem to work as well as it used to in controlling the pain. The most appropriate response to the patient is based on what knowledge? Another NSAID may be indicated because of individual variations in response to drug therapy. It may take several months for NSAIDs to reach therapeutic levels in the blood and thus be effective. If NSAIDs are not effective in controlling symptoms, systemic corticosteroids are the next line of therapy. The patient is probably not compliant with the drug therapy, and therefore the nurse must initially assess the patient's knowledge base and initiate appropriate teaching.

Another NSAID may be indicated because of individual variations in response to drug therapy. Patients vary in their response to medications, so when one NSAID does not provide relief, another should be tried. There is no evidence to ascertain any noncompliance to drug therapy. It does not take several months for the medication to reach therapeutic levels, and it should begin working after the first dose.

The patient's neuropathic pain is not well controlled with the opioid analgesic prescribed. What medications may be added for a multimodal approach to treat the patient's pain (select all that apply.)? Select all that apply. Fentanyl Antiseizure drugs β-Adrenergic agonists Tricyclic antidepressants Nonsteroidal antiinflammatory drugs

Antiseizure drugs -Antiseizure drugs, tricyclic antidepressants, selective norepinephrine reuptake inhibitors, transdermal lidocaine, and α2-adrenergic agonists are used for multimodal treatment when opioid analgesics alone do not control neuropathic pain. Tricyclic antidepressants -Antiseizure drugs, tricyclic antidepressants, selective norepinephrine reuptake inhibitors, transdermal lidocaine, and α2-adrenergic agonists are used for multimodal treatment when opioid analgesics alone do not control neuropathic pain.

The nurse is preparing to administer celecoxib to a patient. What medication taken by the patient should the nurse monitor for increasing the risk of adverse effects? Aspirin Scopolamine Theophylline Acetaminophen

Aspirin Celecoxib is a nonsteroidal antiinflammatory drug (NSAID) of the cyclooxygenase-2 (COX-2) inhibitor type. Although celecoxib does not inhibit COX-1 and thus has a decreased risk of bleeding, bleeding is still of concern as an adverse effect. For this reason, the drug should not be taken with other drugs that increase risk of bleeding, such as aspirin.

The nurse should teach a patient to avoid which medication while taking ibuprofen? Aspirin Furosemide Nitroglycerin Morphine sulfate

Aspirin The patient should not take aspirin while taking ibuprofen because the combination could increase the risk of gastrointestinal bleeding.

A patient has been prescribed a nonsteroidal antiinflammatory medication (NSAID). Which effect should the nurse instruct the patient to immediately report? Blurred vision Nasal stuffiness Urinary retention Black or tarry stools

Black or tarry stools Black, tarry stools could indicate gastrointestinal bleeding, which is a risk associated with NSAIDs. For this reason, the patient should be taught to report this sign and other signs of bleeding immediately. Blurred vision, nasal stuffiness, and urinary retention are not common side effects of NSAIDS.

A patient admitted with metastatic lung cancer is ordered to receive morphine sulfate for pain. Which side effect of this medication should the nurse try to prevent with oral intake and medication? Diarrhea Agitation Constipation Urinary incontinence

Constipation Morphine sulfate is an opioid analgesic that can lead to constipation as a side effect, and tolerance to opioid-induced constipation does not develop. It is very important to use measures, such as increased fiber and fluids in the diet, and exercise when possible, to prevent this side effect. A gentle stimulant laxative plus a stool softener are also frequently needed to prevent constipation in a patient who is likely to develop this side effect.

Which nursing intervention is most appropriate when preparing to administer an opioid analgesic agent to a patient in pain? Give the medication on an empty stomach. Count the number of doses on hand before administration. Give the medication with a glass of juice or other cold beverage. Assess the patient for allergies to aspirin before administration.

Count the number of doses on hand before administration. Because opioid analgesics are controlled substances, the nurse needs to count the number of doses and check that it matches the number recorded before removing and administering the medication. The medication is better tolerated with a small meal or snack before taking it to decrease the effect of gastrointestinal upset. The medication can be taken with any type of beverage, and it does not have to be juice or a cold beverage. Opioid analgesics do not usually have any type of aspirin products, so it is unnecessary to inquire about allergy to aspirin.

The patient is receiving fentanyl patch for control of chronic cancer pain. What should the nurse observe for in the patient as a potential life-threatening adverse effect of this medication? Hypertension Pupillary dilation Urinary incontinence Decreased respiratory rate

Decreased respiratory rate Respiratory depression is a potentially life-threatening adverse effect of fentanyl (Duragesic), which is an opioid analgesic, via any route.

After administering acetaminophen with oxycodone (Percocet) for pain, which intervention would be of highest priority for the nurse to complete before leaving the patient's room? Ensure that the side rails are raised. Leave the overbed light on at low setting. Offer to turn on the television to provide distraction. Ensure that documentation of intake and output is accurate.

Ensure that the side rails are raised. Percocet has acetaminophen and oxycodone as ingredients. Because the medication contains an opioid analgesic with sedative properties, the nurse must ensure patient safety before leaving the room, such as leaving the bedrails raised. This will help prevent the patient from falling from bed. Leaving the light or television on will not provide a positive environment for healing sleep.

The postoperative patient is receiving epidural fentanyl for pain relief. For which common side effects should the nurse monitor the patient (select all that apply.)? Select all that apply. Ataxia Itching Nausea Urinary retention Gastrointestinal bleeding

Itching -Common side effects of intraspinal opioids include nausea, itching, and urinary retention. Ataxia is a common side effect of intraspinal clonidine. Nausea -Common side effects of intraspinal opioids include nausea, itching, and urinary retention. Ataxia is a common side effect of intraspinal clonidine. Urinary retention -Common side effects of intraspinal opioids include nausea, itching, and urinary retention. Ataxia is a common side effect of intraspinal clonidine.

The nurse is caring for a patient receiving morphine sulfate 10 mg IV push when necessary for pain. Upon assessment, the nurse finds the patient obtunded with a respiratory rate of 8/minute. Which medication would the nurse prepare to administer to treat these symptoms? Atropine Naloxone Protamine sulfate Neostigmine bromide (Prostigmin)

Naloxone Naloxone is the antidote or reversal agent for opioid analgesics, such as morphine. Excessive sedation and respiratory depression are symptoms of overdose or severe adverse effects that must be reversed for patient safety.

Which clinical manifestation should the nurse attribute to adverse effects of morphine sulfate administered via PCA? Diarrhea Urinary incontinence Nausea and vomiting Increased blood pressure

Nausea and vomiting Morphine sulfate promotes nausea and vomiting by directly stimulating the chemoreceptor trigger zone in the medulla. Other common side effects include constipation, sedation, respiratory depression, decreased blood pressure, and pruritus.

The nurse is caring for a patient receiving morphine sulfate via PCA. Which patient assessment data demonstrate the most therapeutic effect of this medication? Pain rating 3/10, awake and alert, respirations 24 Pain rating 2/10, awake and alert, respirations 18 Pain rating 2/10, drowsy but arousable, respirations 18 Pain rating 1/10, drowsy but arousable, respirations 16

Pain rating 2/10, awake and alert, respirations 18 Effective pain management is achieved when there is adequate pain control (rating of 3 or less on a scale of 0 to 10) with normal respirations and an absence of sedation. These data exhibit the best effectiveness of the pain medication in all of these areas.

A nurse is reviewing the assessment data from the admission assessment of a patient admitted from the emergency department. What specific element of a pain assessment is missing from the documentation?Tab 1Tab 2Tab 3General SurveySubjective informationAbdominal assessment TremblingDoubled overRight upper quadrant "belly pain." Pain radiates to back.More comfortable bent forward than in bed.Similar pain in the past but only for 2 hours."This is the worst pain ever!"Pain started after eating fish and chips at a fast food restaurant 4 hours ago.Abdomen bloated and tender on examinationSkin warm and moist Pattern Quality Intensity Location

Quality The quality or characteristics of the pain is missing (e.g., cramping, stabbing, throbbing). The pattern includes the onset and duration (after eating fish and chips 4 hours ago). The intensity is "the worst pain ever!" The location is the right upper quadrant of the abdomen with radiation to the back.

Which assessment is of highest priority for the nurse to complete before administration of morphine? Pain rating Blood pressure Respiratory rate Level of consciousness

Respiratory rate A decreased respiratory rate below 12 breaths/min is a sign of opioid toxicity. Using the ABC approach in prioritization of care, a patent airway is always the first priority and is important to assess as a baseline before and during the administration of morphine. Although pain rating, blood pressure, and level of consciousness are important parts of the assessment of a patient receiving an opioid analgesic, the medication should not be administered if the respiratory rate is depressed.

The nurse should question an order written for acetaminophen with oxycodone for a patient exhibiting which clinical manifestation? Severe jaundice Oral candidiasis Increased urine output Elevated blood glucose

Severe jaundice Acetaminophen and oxycodone are the ingredients in Percocet. Because acetaminophen is metabolized in the liver, the patient could develop acetaminophen toxicity in the presence of severe liver disease (evidenced by jaundice). The prudent nurse would question the order before administration.

A patient is receiving morphine sulfate via patient-controlled analgesia (PCA). What nursing action is most effective to reduce the risk of adverse effects? Instruct the patient not to push the button too frequently. Teach the caregiver not to push the button for the patient. Ask the patient to do deep breathing exercises every hour. Administer medications to prevent the occurrence of diarrhea.

Teach the caregiver not to push the button for the patient. It is important to teach the caregiver not to push the button for the patient because it is only the patient who can determine the need for the medication. If the caregiver pushes the button, the patient could receive more of a dose than is actually needed, and this increases the risk of adverse effects. The patient will be unable to successfully push the button too frequently because the medication will be locked out from administration with the pump programmed. The patient may have difficulty following the direction of deep breathing exercises every hour because he or she will be sedated from the morphine. Constipation, not diarrhea, is a side effect of morphine.

The patient is a documented abuser of opioids and just had surgery. The nurse is concerned about the high dose of opioid analgesic prescribed for this patient. What is the best action for the nurse to take? Remember that pain can be observed in patients. Relieve this patient's pain to avoid adverse consequences. Be sure the patient is really in pain before giving the analgesic. This patient has the right to appropriate assessment and management of pain.

This patient has the right to appropriate assessment and management of pain. Patients with addictive disease and pain have the right to be treated with dignity, respect, and the same quality of pain assessment and management as all other patients. For an addict, severe pain should be treated with a single opioid at much higher doses than those used with drug-naïve patients. Observation of pain is not always evident. The stress of unrelieved pain may contribute to increased drug use in the patient actively abusing drugs.