A patient with terminal cancerrelated pain and a history of ...

[humphriesbr@me.com]

A patient with terminal cancerrelated pain and a history of opioid abuse complains of breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first?
 
  a. Use distraction by talking about things the patient enjoys.
  b. Administer the prescribed PRN immediate-acting morphine.
  c. Suggest the use of alternative therapies such as heat or cold.
  d. Consult with the doctor about increasing the MS Contin dose.

Question 2

The nurse reviews the medication orders for an older patient with arthritis in both hips who is complaining of level 3 (0 to 10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy?
 
  a. Naproxen (Aleve) 200 mg orally
  b. Oxycodone (Roxicodone) 5 mg orally
  c. Acetaminophen (Tylenol) 650 mg orally
  d. Aspirin (acetylsalicylic acid, ASA) 650 mg orally

[InfiniteSteez]

Answer to Question 1

ANS: B
The patient's pain requires rapid treatment and the nurse should administer the immediate-acting morphine. Increasing the MS Contin dose and use of alternative therapies may also be needed, but the initial action should be to use the prescribed analgesic medications.

Answer to Question 2

ANS: C
Acetaminophen is the best first-choice medication. The principle of start low, go slow is used to guide therapy when treating older adults because the ability to metabolize medications is decreased and the likelihood of medication interactions is increased. Nonopioid analgesics are used first for mild to moderate pain, although opioids may be used later. Aspirin and the NSAIDs are associated with a high incidence of gastrointestinal bleeding in older patients.