The patient has been started on morphine sulfate (MS Contin) for ...

[clippers!]

The patient has been started on morphine sulfate (MS Contin) for chronic back pain resulting from inoperable disk degeneration. What nursing actions are indicated?
 
  1. Use the prn order of docusate (Dulcolax) routinely every night.
  2. Ask the dietary department to add bran cereal to the patient's breakfast trays.
  3. Ask the health care provider to write an order for an indwelling urinary catheter.
  4. Review the trending of the patient's hemoglobin and hematocrit levels.
  5. Check the medical record for a prn order for an antiemetic.

Question 2

The patient rings the nurse call button and requests pain medication. Upon assessment, the nurse finds the patient sitting up in a chair, watching television with a friend. Vital signs are normal and the patient's skin is warm and dry.
 
  Which nursing actions are appropriate?
  1. Ask the patient to rate his pain on the pain scale.
  2. Tell the patient that he does not look as if he is in pain.
  3. Have the patient go back to bed and ask the visitor to leave.
  4. Check to see when the patient last received pain medication.
  5. Have another nurse assess the patient.

[mcarey591]

Answer to Question 1

Correct Answer: 1,2,4,5
Rationale 1: One of the adverse effects of morphine therapy is constipation. The nurse should be proactive by giving the docusate every night.
Rationale 2: Intake of additional fiber, as long as sufficient fluid is taken, is useful in preventing the constipation that is common with the use of morphine.
Rationale 3: While morphine may promote urinary retention, other methods of controlling this adverse effect should be used initially.
Rationale 4: Morphine should not be administered to those who are hypovolemic due to the risk of hypotension.
Rationale 5: Nausea and vomiting are adverse effects of the use of morphine. Until the patient becomes tolerant of this effect, an antiemetic may be necessary.

Answer to Question 2

Correct Answer: 1,4
Rationale 1: When the patient complains of pain, the nurse should always ask for a pain rating.
Rationale 2: Patients respond to pain differently. For example, this patient may be trying to hide the intensity of his pain from his friend.
Rationale 3: Having the patient go back to bed and asking the visitor to leave is punitive and could be interpreted as the nurse not believing the patient. Being active and having diversions can help with pain management.
Rationale 4: The nurse should check to see when the patient last had pain medication, what drug was given, what dose was given, and by what route it was administered.
Rationale 5: There is no reason to have another nurse assess the patient. This action may imply that the nurse does not trust the patient.

[clippers!]

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[mcarey591]

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