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Chapter 34. Pain Management

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

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A. Epidural analgesia with morphine and bupivacaine

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B. Patient-controlled analgesia with hydromorphone

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

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

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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?

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I. Visual analog scale

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II. PAINAD

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III. Physiological indicators

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A. I only

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B. III only

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C. I and II

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D. II and III

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E. I, II, and III

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

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

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

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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

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

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

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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.

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A. MS Contin 60 mg every day

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B. MS Contin 90 mg every day

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C. MS Contin 30 mg two times daily

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