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Chapter 34. Pain Management

Which of the following would NOT be an appropriate choice for postoperative pain management in a patient dependent on opioids?

A. Epidural analgesia with morphine and bupivacaine

B. Patient-controlled analgesia with hydromorphone

C. Oral oxycodone 5 mg po every 4 to 6 hours as needed for pain

D. Morphine 10 mg IV every 4 to 6 hours as needed for pain

Mrs. B is an 85-year-old patient with a diagnosis of severe Alzheimer disease and metastatic breast cancer. Upon admission to the long-term care facility, pain management is listed in her care plan. Which of the following pain assessment tools may be helpful in monitoring the effectiveness of her pain medication?

I. Visual analog scale

II. PAINAD

III. Physiological indicators

A. I only

B. III only

C. I and II

D. II and III

E. I, II, and III

If tolerance occurs in a patient who is receiving long-term opioid therapy, this means that:

A. The patient has become addicted and should be referred to a drug treatment program

B. The patient has lost control over his or her use of the medication, and treatment should be discontinued

C. The patient is having a normal physiological response to the medication and will experience a withdrawal syndrome if the medication is stopped or quickly decreased

D. The patient has become tolerant to the drug, and another therapeutic category must be selected

E. The dose can be increased as needed to achieve pain relief

BA is a 58-year-old man with lung cancer and bone metastases who is currently receiving morphine oral solution 10 mg every 4 hours around the clock. In the last 24 hours, BA has used an additional 20 mg of morphine as rescue doses. He desires to switch to a sustained-release form of morphine, MS Contin. Suggest the most appropriate dose of MS Contin for this patient.

A. MS Contin 60 mg every day

B. MS Contin 90 mg every day

C. MS Contin 30 mg two times daily

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