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.
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
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is choice A. Hepatic necrosis.Acetaminophen (APAP) is a common cause of drug-induced liver injury and can lead to hepatic necrosis, especially in patients who have chronic hepatitis C.APAP is metabolized by the liver and produces a toxic intermediate called N-acetyl-p-benzoquinone imine (NAPQI), which can deplete glutathione and damage hepatocytes.Patients who have chronic hepatitis C may have reduced glutathione levels and increased oxidative stress, making them more susceptible to APAP toxicity.
Choice B. Pulmonary fibrosis is wrong because APAP does not cause pulmonary fibrosis.
Pulmonary fibrosis is a chronic lung disease that involves scarring of the lung tissue and impaired gas exchange.Some drugs that can cause pulmonary fibrosis are amiodarone, bleomycin, methotrexate and nitrofurantoin.
Choice C. Pancreatitis is wrong because APAP does not cause pancreatitis.
Pancreatitis is an inflammation of the pancreas that can result from gallstones, alcohol abuse, hypertriglyceridemia, hypercalcemia, infections, trauma or certain medications.
Some drugs that can cause pancreatitis are azathioprine, valproic acid, didanosine and pentamidine.
Choice D. Cardiac dysrhythmias is wrong because APAP does not cause cardiac dysrhythmias.
Cardiac dysrhythmias are abnormal heart rhythms that can result from electrolyte imbalances, ischemia, myocardial infarction, heart failure, congenital defects or certain medications.
Some drugs that can cause cardiac dysrhythmias are digoxin, quinidine, sotalol and erythromycin.
Correct Answer is ["A","B","C","D"]
Explanation
The correct answer is choice A, B, C, and D.Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that has anti-inflammatory, analgesic, and antipyretic effects.It works by inhibiting the synthesis of prostaglandins, which are involved in inflammation, pain, and fever.However, ibuprofen can also cause adverse effects such as gastric irritation, bleeding complications, renal impairment, and hypersensitivity reactions.
Therefore, the nurse should instruct the client to:
• Take ibuprofen with food or milk to prevent gastric irritation.This will reduce the direct contact of the drug with the stomach lining and decrease the risk of ulcers and bleeding.
• Drink at least 2 liters of fluid per day to prevent renal impairment.This will help maintain adequate hydration and renal perfusion and prevent the accumulation of ibuprofen in the kidneys.
• Avoid alcohol and other NSAIDs to prevent bleeding complications.Alcohol and other NSAIDs can increase the risk of gastric bleeding by interfering with the protective effects of prostaglandins on the stomach mucosa.
• Report any signs of hypersensitivity such as rash, itching, or wheezing.These may indicate an allergic reaction to ibuprofen that can be serious or life-threatening.
Choice E is wrong because ibuprofen does not affect blood pressure significantly.However, some other NSAIDs such as celecoxib may increase the risk of cardiovascular events such as thrombosis, myocardial infarction, and stroke.Therefore, clients with hypertension or cardiovascular disease should use NSAIDs with caution and monitor their blood pressure regularly.
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