1. The average dose of morphine is 10mg IV. Based on the guidelines for elderly patients, what

NUR 108 Acute Pain

• The average dose of morphine is 10mg IV. Based on the guidelines for elderly patients, what

dose should be used initially?

• 4mg
• 6mg
• 8mg
• 10mg

Answer

• 6mg - fits in the range of 25-50% reduction for elderly

• Unrelieved pain and narcotics can cause all of the following except

• Mental Confusion
• Urinary Retention
• Hypotension
• Decreased GI motility

Answer

• Hypotension - would become hypertensive with unrelieved pain

• A patient who had a total knee replacement 5 days ago rates his pain at 5/10. Which drug is

appropriate?

• morphine IV
• ibuprofen (Advil) PO
• oxycodone/acetaminophen (Percocet) oral
• ketorolac (Toradol) IV

Answer

• Percocet - moderate pain level on the WHO ladder calls for that combination of drugs for a

5/10 pain

• A patient who had abdominal surgery earlier in the day and complains of pain 4/10.The

patient sleeps when undisturbed and has difficulty staying away during your physical assessment.The patient is still NPO.

• morphine IV
• oxy/acetamin (Percocet) oral 1 / 2

• hydrocodone/aceta (Vicodin) oral
• ketorolac (Toradol) IV

Answer

• ketorolac (Toradol) IV - patient is NPO, Toradol has less side effects than morphine,

particularly CNS depression and they already have a hard time staying awake

• A patient who had a minor outpatient surgical procedure and complains of pain 2/10.
• morphine IV
• oxygen/acetamin (Percocet) oral
• hydrocodone/aceta (Vicodin) oral
• ibuprofen (advil) oral

Answer

• ibuprofen (Advil) oral - fits WHO ladder, minor pain level, teach them to know what to look

for if pain isn't controlled with that

• A patient who had major abdominal surgery and is complaining of pain 8/10. He was last

medicated four hours ago with 10mg morphine. morphine 10-15mg IV q 4hrs PRN is ordered.

• morphine 10mg IV

• morphine 15mg IV

Answer

• morphine 15mg IV - had 10mg 4 hours ago and it didn't last, so you would want to up the

dose since there is a scale and PRN with pain 8/10

• Physiologic Effects of Unrelieved Pain - Endocrine

Answer Increased - ACTH, Cortisol, ADH, epinephrine, norepinephrine, catecholamines, renin, angiotensin II, aldosterone, glucagon, interleukin, growth hormone Decreased - insulin & testosterone

• Physiologic Effects of Unrelieved Pain - Metabolic

Answer gluconeogenesis, hepatic glycogenolysis, hyperglycemia, glucose intolerance, insulin resistance, muscle protein catabolism, increased lipolysis

• Physiologic Effects of Unrelieved Pain - Cardiovascular
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