A patient who is receiving sustained-release morphine sulfate (MS Contin) every 12 hours for chronic pain experiences level 9 (0 to 10 scale) breakthrough pain and anxiety. Which action by the nurse is best?
a. Provide amitriptyline (Elavil) 10 mg orally.
b. Administer lorazepam (Ativan) 1 mg orally.
c. Offer ibuprofen (Motrin) 400 to 800 mg orally.
d. Give immediate-release morphine 30 mg orally.
ANS: D
The severe breakthrough pain indicates that the initial therapy should be a rapidly acting opioid, such as the immediate-release morphine. Lorazepam and amitriptyline may be appropriate to use as adjuvant therapy, but they are not likely to block severe breakthrough pain. Use of antianxiety agents for pain control is inappropriate because this patient's anxiety is caused by the pain.
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