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?

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.

The correct answer is choice A, B, C and E.Aspirin is a medication that can prevent cardiovascular events by inhibiting platelet aggregation and reducing inflammation.

However, aspirin also has some side effects that the patient should be aware of and report to the doctor if they occur.

Choice A is correct because taking aspirin with food or milk can reduce the risk of stomach irritation and ulcers that aspirin can cause.

Choice B is correct because aspirin can increase the risk of bleeding and bruising due to its antiplatelet effect.The patient should monitor for signs of bleeding such as black, tarry stools, bloody or cloudy urine, vomiting of blood or material that looks like coffee grounds, and unusual bleeding or bruising.

Choice C is correct because taking other NSAIDs (nonsteroidal anti-inflammatory drugs) concurrently with aspirin can increase the risk of stomach ulcers and bleeding.

NSAIDs include ibuprofen, naproxen, diclofenac, and others.

Choice D is wrong because tinnitus (ringing in the ears) is a sign of aspirin toxicity and should not be ignored.The patient should stop taking aspirin and seek medical attention if they experience tinnitus, confusion, hallucinations, rapid breathing, or seizures.

Choice E is correct because enteric-coated tablets can reduce the gastric irritation caused by aspirin by delaying its release until it reaches the small intestine.However, enteric-coated tablets may not be as effective as regular tablets in preventing cardiovascular events.