A patient with terminal cancer-related pain and a history of opioid abuse reports breakthrough pain 2 hours before the next dose of sustained-release morphine sulfate (MS Contin) is due. Which action should the nurse take first?
Use distraction by talking about things the patient enjoys.
Consult with the doctor about increasing the MS Contin dose.
Suggest the use of alternative therapies such as heat or cold.
Administer the prescribed PRN immediate-acting morphine.
The Correct Answer is D
Rationale:
A. Distraction may be helpful as an adjunct, but it does not adequately manage breakthrough cancer pain.
B. Dose adjustments may be needed for long-term management, but the immediate priority is relieving the patient’s current breakthrough pain.
C. Nonpharmacologic measures may provide some comfort but are not sufficient for breakthrough cancer pain.
D. Breakthrough pain should be treated promptly with prescribed short-acting opioid analgesics, even in patients with a history of opioid abuse. Effective pain relief is the priority in terminal cancer care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. The client should report inadequate pain relief to the nurse, as PCA therapy may need adjustment. This shows appropriate understanding of PCA use.
B. PCA should be used as prescribed to maintain consistent pain control, not delayed until pain is severe.
C. PCA pumps have lockout intervals to prevent overdosing. Clients do not need to fear self-administering doses when in pain.
D. Only the client should push the PCA button. Allowing others to administer doses increases the risk of oversedation and respiratory depression.
Correct Answer is A
Explanation
Rationale:
A. Breakthrough pain is a sudden, intense flare of pain that occurs even though the patient is receiving around-the-clock analgesia (such as a fentanyl patch). It requires fast-acting supplemental medication.
B. Referred pain is felt in a location different from its source (e.g., shoulder pain from gallbladder disease).
C. Neuropathic pain results from nerve damage and is typically described as burning, tingling, or shooting, not sudden breakthrough pain.
D. Somatic pain originates in bones, joints, muscles, or skin. While the patient may have somatic pain, the description of sudden severe pain despite ongoing analgesia defines breakthrough pain.
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