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

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

The correct answer is choice A. Avoid driving while taking this medication.The nurse should instruct the client to avoid driving or operating heavy machinery while taking acetaminophen and hydrocodone (Vicodin) because these medications can cause drowsiness, dizziness, and impaired mental function.The nurse should also warn the client about the risk of addiction, overdose, and death from misuse of this medication.

Choice B is wrong because taking this medication on an empty stomach can increase the risk of nausea and vomiting.The nurse should advise the client to take this medication with food or milk to prevent stomach upset.

Choice C is wrong because increasing the intake of foods rich in vitamin K is not relevant to taking acetaminophen and hydrocodone (Vicodin).Vitamin K is involved in blood clotting and may interact with some anticoagulant medications, but not with this medication.

Choice D is wrong because limiting fluid intake to prevent fluid retention is not necessary for a client taking acetaminophen and hydrocodone (Vicodin).This medication does not cause fluid retention or edema.The nurse should encourage the client to drink plenty of fluids to prevent constipation, which is a common side effect of opioid medications.

A. Assess the client’s respiratory rate. B. Check the client’s allergy history. C. Review the client’s medication record. D. Verify the dosage with another nurse.

Correct Answer is B

Explanation

The correct answer is choice B. Check the client’s allergy history.

This is because morphine sulfate is a medication that can cause severe allergic reactions in some people, such as anaphylaxis, which can be life-threatening.

Therefore, the nurse should always check the client’s allergy history before administering any medication, especially opioids.

Choice A is wrong because assessing the client’s respiratory rate is not the first action the nurse should take.

Although morphine sulfate can cause respiratory depression, which is a serious side effect that needs to be monitored, the nurse should first ensure that the client is not allergic to the medication.

Choice C is wrong because reviewing the client’s medication record is not the first action the nurse should take.

Although morphine sulfate can interact with other medications, such as sedatives, antidepressants, or alcohol, which can increase the risk of respiratory depression or overdose, the nurse should first ensure that the client is not allergic to the medication.

Choice D is wrong because verifying the dosage with another nurse is not the first action the nurse should take.

Although morphine sulfate is a high-alert medication that requires double-checking to prevent medication errors, the nurse should first ensure that the client is not allergic to the medication.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing discharge teaching to a client who has a prescription for acetaminophen and hydrocodone (Vicodin).Which of the following instructions should the nurse include in the teaching?

Correct Answer is A

Explanation

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?

Correct Answer is B

Explanation

A patient with cancer-related bone pain is receiving etidronate as an adjuvant analgesic. The nurse should monitor the patient for which of the following laboratory values?

Which component of pain assessment is addressed by asking a client to rate his or her current level of discomfort on a scale of 0-10?

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 educating a patient who has been prescribed aspirin for the prevention of cardiovascular events. Which of the following instructions should the nurse include? (Select all that apply.)

(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.

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.)

A nurse is caring for a client who has a sickle cell crisis and is receiving morphine via patient-controlled analgesia (PCA) pump. Which assessment finding indicates that the PCA pump is effective?