Nursing interventions for a patient with multiple myeloma undergoing chemotherapy and experiencing chronic pain are essential. This NCLEX question delves into prioritizing care, including medication administration, pain assessment, and monitoring for side effects like hyperglycemia. Test your understanding of oncology nursing with this scenario-based question.
The nurse in the oncology unit is caring for a patient undergoing chemotherapy for treatment of multiple myeloma with the priority hypothesis of chronic pain.
Medication Administration Record (MAR) |
Prednisolone 20 mg PO daily |
Duloxetine 60 mg PO daily |
Morphine SR 20 mg PO every 12 hours |
Bisacodyl 5 mg once PR daily, as needed |
Based on the clinical information, which nursing intervention(s) is/are appropriate?
Select all that apply.
A. Routinely monitor the patient’s blood glucose levels
B. Encourage the patient to schedule acupuncture once discharged
C. Advise the patient to limit alcohol consumption to 2 glasses of wine per day
D. Assess for breakthrough pain every shift E. Encourage the patient to consume a low residue diet
Scroll down for the correct answers!
The correct answers to today’s NCLEX-RN® Question are…
A. Routinely monitor the patient’s blood glucose levels
Rationale: Corticosteroids such as prednisolone can be prescribed in conjunction with analgesics to alleviate pain and discomfort caused by cancer. They are antiinflammatory medications that reduce swelling and inflammation caused by cancer. One side effect of corticosteroids is hyperglycemia, therefore, the nurse should monitor the patient’s blood glucose levels.
D. Assess for breakthrough pain every shift
Rationale: Patients taking pain medications around the clock, such as morphine every twelve hours, may experience sudden pain spikes, known as breakthrough pain. The nurse should assess for breakthrough pain in patients with cancer since it may be necessary to administer additional prescribed analgesics.
Major Takeaway
Patients with cancer are at risk for acute and chronic pain, which can decrease quality of life. The nurse should perform pharmacologic and nonpharmacologic interventions to manage pain, including administering corticosteroids and opioids as prescribed as well as encouraging nonpharmacologic interventions such as guided imagery and assessing for breakthrough pain. The nurse should not encourage acupuncture since it can increase risk for infection, nor should they advise the patient to consume two glasses of wine per day. Further, due to the side effects of corticosteroids, such as the patient’s prescribed prednisolone, the nurse should monitor blood glucose and encourage the patient to consume a fibrous diet to combat opioid-induced constipation since the patient is taking morphine.
Incorrect answer explanations
B. Encourage the patient to schedule acupuncture once discharged
Rationale:Nonpharmacologic interventions can be used to treat cancer pain, such as guided imagery, massage, and distraction. Since acupuncture can put the patient at risk for infection, it should not be encouraged. Patients undergoing chemotherapy are at risk for infection due to treatment-induced neutropenia.
C. Advise the patient to limit alcohol consumption to 2 glasses of wine per day
Rationale: Patients taking opioids, such as morphine, for pain control should be advised not to consume alcohol because the combination can cause drowsiness which may lead to safety issues, such as falls or impaired driving.
E. Encourage the patient to consume a low residue diet
Rationale: The most common and persistent side effect from opioids, such as morphine, is constipation. Therefore, the patient should be advised to consume foods with fiber, such as bran, rather than follow a low residue, or low fiber diet.
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