A nurse is caring for a patient who has been receiving morphine via PCA pump following abdominal surgery two days ago and is scheduled to be switched to oral analgesics today.

The patient’s current settings are a demand dose of 1 mg, a lockout interval of 10 minutes, a four-hour limit of 30 mg, and a basal rate of 2 mg/hr.

The patient reports satisfactory pain relief with these settings and has received an average of 20 mg of morphine per four-hour period in addition to the basal rate over the past day.

The provider orders oxycodone/acetaminophen (Percocet) 5/325 mg PO every six hours PRN for pain, starting today at noon, and discontinues the PCA pump at that time.

What action should the nurse take?

Request a prescription for a higher dose of Percocet from the provider.

Administer Percocet every six hours around-the-clock for two days.

Stop administering morphine one hour before giving Percocet.

Give Percocet only if patient reports breakthrough pain.

Answer and Explanation

The Correct Answer is B

The correct answer is choice B. Administer Percocet every six hours around the clock for two days.

This is because the patient has been receiving a continuous infusion of morphine via a PCA pump, which means that they have a steady level of opioids in their system.

If the PCA pump is discontinued abruptly and the patient is switched to oral analgesics PRN, they may experience withdrawal symptoms and inadequate pain relief.

Therefore, the patient needs to receive a scheduled dose of oral opioids for at least two days to prevent a sudden drop in opioid blood concentration and to maintain adequate analgesia.

After two days, the patient’s pain level and opioid requirement may be reassessed and the oral analgesics may be tapered or given PRN as needed.

Choice A is wrong because a higher dose of Percocet is not necessary if the patient reports satisfactory pain relief with the current PCA settings. The equivalent oral dose of morphine for the patient’s average PCA consumption is about 120 mg per day (20 mg x 6 doses), which is equivalent to about 80 mg of oxycodone per day (1.5 x 120 mg).

The prescribed dose of Percocet is 20 mg of oxycodone per day (5 mg x 4 doses), which is about 25% of the patient’s previous opioid requirement. This reduction is appropriate to account for incomplete cross-tolerance between different opioids.

Choice C is wrong because stopping morphine one hour before giving Percocet will not prevent a gap in analgesia. The half-life of morphine is about 2 to 4 hours, which means that it takes about 10 to 20 hours for morphine to be eliminated from the body.

Therefore, stopping morphine one hour before giving Percocet will not significantly reduce the morphine blood concentration and will not avoid the risk of additive effects or overdose.

Choice D is wrong because giving Percocet only if the patient reports breakthrough pain will not provide adequate pain relief for the patient who has been receiving a continuous infusion of morphine via a PCA pump.

The patient may experience withdrawal symptoms and increased pain sensitivity if the opioid blood concentration drops suddenly.

Therefore, the patient needs to receive a scheduled dose of oral opioids for at least two days to prevent a gap in analgesia and to allow a smooth transition from IV to oral opioids.

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is ["A","B","D","E"]

Explanation

The correct answer is choice A, B, D, and E.Hydroxyzine is an antihistamine that hasantiemeticandsedativeeffects that are thought to be mediated by its actions in the brain.It can alsodecrease anxietyrelated to pain by inhibiting the hypothalamic H-1 histamine receptors.Hydroxyzine may also have apotentiatingeffect on other analgesics, although the evidence for this is not conclusive.

Choice C is wrong because hydroxyzine does not have any anti-inflammatory properties.It is a competitive antagonist of histamine H1-receptors, not a cyclooxygenase inhibitor.

A. Elevated aspartate aminotransferase (AST) B. Elevated alanine aminotransferase (ALT) C. Elevated alkaline phosphatase (ALP) D. Elevated blood urea nitrogen (BUN) E. Elevated creatinine.

Correct Answer is ["A","B","C"]

Explanation

The correct answer is choice A, B, and C. These are all liver enzymes that can indicate hepatotoxicity (liver damage) from acetaminophen overdose.

The normal ranges for these enzymes are:

• AST: 10 to 40 U/L

• ALT: 7 to 56 U/L

• ALP: 45 to 115 U/L

Choice D and E are wrong because they are indicators of renal function, not liver function.

The normal ranges for these values are:

• BUN: 7 to 20 mg/dL

• Creatinine: 0.6 to 1.2 mg/dL

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

(Select all that apply) A patient with postoperative pain is prescribed hydroxyzine as an adjuvant analgesic. The nurse should teach the patient about which of the following benefits of this medication.

Correct Answer is ["A","B","D","E"]

Explanation

A nurse is reviewing laboratory results for a client who takes acetaminophen for osteoarthritis pain management.Which of the following findings should alert the nurse to possible hepatotoxicity? (Select all that apply.).

Correct Answer is ["A","B","C"]

Explanation

A nurse is teaching a client who has cancer pain about the use of oral oxycodone with acetaminophen (Percocet). Which statement by the client indicates a need for further teaching?

A nurse is teaching a client who has chronic pain about nonpharmacological pain management techniques. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.).

A nurse is caring for an older adult client who has difficulty communicating verbally due to aphasia following a stroke. Which of the following strategies should the nurse use to assess this client’s pain? (Select all that apply.)

A patient with chronic back pain is prescribed gabapentin as an adjuvant analgesic. The nurse should instruct the patient to report which of the following adverse effects?

A nurse is administering naloxone to a patient who has overdosed on heroin. What is the expected outcome of this intervention?

A patient who has chronic low back pain is prescribed oxycodone (OxyContin) for long-term use. Which of the following interventions should the nurse implement to prevent complications from this medication? (Select all that apply.)

The nurse is preparing to administer morphine sulfate, an opioid analgesic, to a client who reports pain at level 8 on a scale of 0 to 10. Which action should the nurse take first?