When visiting a hospice patient, the nurse assesses that the ...

[charchew]

When visiting a hospice patient, the nurse assesses that the patient has a respiratory rate of 11 breaths/minute and complains of severe pain. Which action is best for the nurse to take?
 
  a. Inform the patient that increasing the morphine will cause the respiratory drive to fail.
  b. Tell the patient that additional morphine can be administered when the respirations are 12.
  c. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.
  d. Administer a nonopioid analgesic, such as a nonsteroidal antiinflammatory drug (NSAID), to improve patient pain control.

Question 2

The nurse reviews the medication administration record in order to choose the most appropriate pain medication for a patient with cancer who describes the pain as deep, aching and at a level 8 on a 0 to 10 scale.
 
  Which medication should the nurse administer?
  a. Fentanyl (Duragesic) patch
  b. Ketorolac (Toradol) tablets
  c. Hydromorphone (Dilaudid) IV
  d. Acetaminophen (Tylenol) suppository

[SeanoH09]

Answer to Question 1

ANS: C
The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's respiratory rate.

Answer to Question 2

ANS: C
The patient's pain level indicates that a rapidly acting medication such as an IV opioid is needed. The other medications also may be appropriate to use, but will not work as rapidly or as effectively as the IV hydromorphone.

[charchew]

Excellent

[ryhom]

TYSM