A client with chronic pain reports that oral morphine is no longer effective for pain control. Which medication would the nurse expect the provider to prescribe to achieve improved pain relief?

Duragesic

Oramorph SR

Hydrocodone

Intranasal butorphanol (Stadol)

Answer and Explanation

The Correct Answer is A

Duragesic is the brand name for fentanyl transdermal patches, which deliver potent, long-acting opioid analgesia through the skin. Fentanyl is significantly stronger than morphine, making it an appropriate alternative for clients with chronic pain who have developed tolerance to oral morphine. The patch provides continuous pain relief over 72 hours, making it ideal for clients who require stable, round-the-clock opioid therapy.

Rationale for Correct Answer:

A. Duragesic: Fentanyl patches are used for clients who are opioid-tolerant and need long-term, continuous pain control. It bypasses the GI tract and provides consistent systemic analgesia, which is beneficial when oral opioids become ineffective.

Rationale for Incorrect Answers:

B. Oramorph SR: This is a sustained-release formulation of morphine, similar to what the client is already using. If morphine is no longer effective, increasing the dose or continuing the same drug in a different form is unlikely to help.

C. Hydrocodone: Hydrocodone is less potent than morphine. Switching from morphine to hydrocodone would likely reduce pain control rather than improve it.

D. Intranasal butorphanol (Stadol): Butorphanol is a mixed agonist-antagonist opioid. It can precipitate withdrawal and reduce pain relief in clients already taking full opioid agonists like morphine, making it inappropriate for this scenario.

Key Takeaways:

Fentanyl (Duragesic) is appropriate for clients with chronic pain and opioid tolerance.
Changing to a stronger opioid is often necessary when current opioids become ineffective.
Mixed agonist-antagonists like butorphanol should be avoided in clients taking full opioid agonists due to the risk of withdrawal and decreased analgesia.

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Free Nursing Study Resources

Correct Answer is ["C","D","E"]

Explanation

Opioid analgesics are effective for moderate to severe pain but are associated with a variety of adverse effects, particularly involving the central nervous system and gastrointestinal system. Nurses must monitor for these expected reactions to ensure prompt recognition and intervention.

Rationale for Correct Answers:

C. Bradypnea: Opioids depress the respiratory center in the brainstem, which can lead to respiratory depression, especially at higher doses or in opioid-naïve clients.

D. Orthostatic hypotension: Opioids can cause vasodilation and reduced sympathetic tone, leading to a drop in blood pressure when changing positions.

E. Nausea: A common early side effect, nausea occurs due to opioid stimulation of the chemoreceptor trigger zone in the brain.

Rationale for Incorrect Answers:

A. Urinary incontinence: Opioids more commonly cause urinary retention, not incontinence, due to increased sphincter tone and decreased bladder contractility.

B. Diarrhea: Opioids cause constipation, not diarrhea, by slowing gastrointestinal motility through action on opioid receptors in the gut.

Key Takeaways:

Common adverse effects of opioids include bradypnea, orthostatic hypotension, nausea, constipation, and urinary retention.
Respiratory depression is the most serious side effect and requires immediate attention.
Nurses must monitor vital signs, GI status, and bladder function closely during opioid therapy.

A. Referral for surgical treatment of the pain. B. Regularly scheduled short-acting opioids plus acetaminophen. C. A combination of long-acting and short-acting opioids. D. Assessment for exaggeration or drug-seeking behavior.

Correct Answer is C

Explanation

Clients with cancer pain often experience baseline persistent pain with breakthrough pain episodes. The most effective strategy involves long-acting opioids to manage continuous pain and short-acting opioids to control sudden, transient increases in pain, such as those during dressing changes. This approach provides consistent pain control while allowing flexibility to address unpredictable spikes in pain.

Rationale for Correct Answer:

C. A combination of long-acting and short-acting opioids: This is the standard of care for managing both persistent and breakthrough cancer pain. Long-acting opioids maintain a steady analgesic level, while short-acting opioids are used for intermittent severe pain episodes.

Rationale for Incorrect Answers:

A. Referral for surgical treatment of the pain: Surgical intervention is not a first-line approach for managing cancer-related pain unless the pain is caused by a reversible structural issue (e.g., tumor pressing on nerves). Pain control is typically achieved pharmacologically.

B. Regularly scheduled short-acting opioids plus acetaminophen: Short-acting opioids alone are not sufficient for sustained pain control. They may lead to peaks and troughs in pain relief, and the addition of acetaminophen does not address breakthrough pain effectively.

D. Assessment for exaggeration or drug-seeking behavior: This undermines trust and is inappropriate, especially in clients with cancer-related pain, who often require escalating analgesia due to disease progression. Pain reports should be accepted as valid and managed accordingly.

Key Takeaways:

Cancer pain is best managed with a combination of long-acting opioids for baseline pain and short-acting opioids for breakthrough pain.
Breakthrough pain is common during procedures like dressing changes and requires preemptive short-acting analgesia.
Nurses should trust clients’ pain reports and avoid stigmatizing assumptions such as drug-seeking behavior.

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A client with chronic pain reports that oral morphine is no longer effective for pain control. Which medication would the nurse expect the provider to prescribe to achieve improved pain relief?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is monitoring a client who is receiving opioid analgesia. Which of the following adverse effects should the nurse anticipate? Select all that apply

Correct Answer is ["C","D","E"]

Explanation

A nurse is caring for a client with cancer who reports ongoing moderate pain with brief episodes of severe pain during dressing changes. The nurse anticipates that effective management includes:

Correct Answer is C

Explanation

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