A nurse is caring for a patient who reports pain in his left leg that he rates as an 8 on a scale from 0 to 10 and states that he feels tingling and numbness in his toes.

The patient has an order for morphine sulfate 2 mg IV bolus PRN every two hours for pain greater than 7, last administered three hours ago, and ibuprofen 400 mg PO PRN every four hours for pain less than or equal to 7, last administered six hours ago.

What action should the nurse take first?

Administer morphine sulfate 2 mg IV bolus.

Administer ibuprofen 400 mg PO.

Assess the patient’s leg for circulation, sensation, and movement.

Reassess the patient’s pain in 15 minutes.

Answer and Explanation

The Correct Answer is C

The correct answer is choice C. Assess the patient’s leg for circulation, sensation, and movement.

This is because the patient’s symptoms of pain, tingling, and numbness in his left leg could indicate a potential complication of impaired blood flow or nerve damage after surgery. The nurse should prioritize assessing the patient’s leg for any signs of compromised circulation, sensation, or movement before administering any pain medication.

Choice A is wrong because administering morphine sulfate 2 mg IV bolus without assessing the patient’s leg could mask the symptoms of a serious problem and delay appropriate interventions. Morphine sulfate is a potent opioid analgesic that can cause respiratory depression, sedation, and constipation.

Choice B is wrong because administering ibuprofen 400 mg PO without assessing the patient’s leg could also mask the symptoms of a serious problem and delay appropriate interventions. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal bleeding, renal impairment, and increased risk of cardiovascular events.

Choice D is wrong because reassessing the patient’s pain in 15 minutes without assessing the patient’s leg could result in the worsening of the patient’s condition and increased risk of complications. The nurse should not delay assessing the patient’s leg for any signs of impaired circulation, sensation, or movement.

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Correct Answer is B

Explanation

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.

A. Avoid driving while taking this medication B. Take this medication on an empty stomach C. Increase intake of foods rich in vitamin K D. Limit fluid intake to prevent fluid retention.

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.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

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

A nurse is educating a client about ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), that has been prescribed for moderate pain and inflammation. Which of the following instructions should the nurse include? (Select all that apply.).

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

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?

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 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.)

Which statement made by a client taking aspirin indicates an understanding of its use?

A patient who is addicted to heroin is admitted to the hospital for treatment of an infection. The patient is prescribed methadone (Dolophine) as part of a detoxification program. What is the rationale for using methadone in this patient?

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.).