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.

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Free Nursing Study Resources

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

Explanation

The correct answer is choice A, C and E. These statements indicate that the client understands the teaching about nonpharmacological pain management techniques.

• Choice A is correct becausemeditationcan help the client relax and cope with pain by reducing stress and anxiety.

• Choice C is correct becausedistractioncan help the client divert attention from pain by engaging in enjoyable or stimulating activities.

• Choice E is correct becauseheatcan help the client soothe the painful area by increasing blood flow and relaxing muscles.

• Choice B is wrong becausecold packsshould not be applied to the painful area for more than15 minutesat a time, as they can cause tissue damage or frostbite.

• Choice D is wrong becausemassageshould not be done with firm pressure, as it can aggravate the pain or cause injury.Gentle massage may be beneficial for some clients.

A. Intensity B. Quality C. Onset D. Duration (Source: https://quizlet.com/303867498/pain-management-nclex-practice-quiz-25-questions-flash-cards/).

Correct Answer is A

Explanation

The correct answer is choice A. Intensity.Intensity is one of the key components of pain assessmentand it is measured by asking a client to rate his or her current level of discomfort on a scale of 0-10.

This helps to quantify the severity of pain and monitor its changes over time.

Choice B. Quality is wrong because quality refers to the nature or characteristics of pain, such as burning, stabbing, throbbing, etc.It is usually assessed by asking the client to describe the pain in his or her own words.

Choice C.Onset is wrong because onset refers to the time when the pain started or what triggered it.It is usually assessed by asking the client about the mechanism of injury or etiology of pain, if identifiable.

Choice D.Duration is wrong because duration refers to how long the pain lasts or how often it occurs.It is usually assessed by asking the client about the course or temporal pattern of pain, such as constant, intermittent, or episodic.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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.).

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

Explanation

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?

Correct Answer is A

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 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.)

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?

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?

A client with osteoarthritis has been prescribed celecoxib (Celebrex). The nurse should instruct the client to report which of the following adverse effects immediately?

A nurse is caring for a client who has rheumatoid arthritis and has been prescribed ibuprofen (Advil). Which of the following instructions should the nurse include in the teaching? Select all that apply.

The primary health care provider instructs the nurse to obtain the patient’s pain level every four hours. Which actions by the nurse help facilitate the pain assessment? Select all that apply.

A nurse is caring for a patient who is receiving epidural analgesia with buprenorphine (Buprenex). Which assessment finding would indicate that an adverse effect may be occurring?