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9141Mr. H, 83 years old, has been admitted to the acute care facility for 1-day chemotherapy treatment for metastatic disease to the bone caused by prostate cancer. He is in extreme pain. When the nurse evaluates Mr. H, he states, “This is the worst pain I have ever had in my life. My back hurts so bad.” He says that the pain is a 10 on a scale of 1 to 10. Mr. H tells the nurse that the pain just came on suddenly. He had been taking 400 mg of ibuprofen (Motrin) at home every 6 hours, but the pain still was so severe that he had to see his primary care provider this morning. An MRI showed a tumor in the L8-L9 area. The nurse is most concerned about relieving Mr. H’s pain. The nurse looks at his admission orders and notes the following: “morphine sulfate 3 mg IV every 4 hours PRN, and oxycodone PO 5/325 mg (Percocet) 1 or 2 tabs every 4-6 hours PRN.” Mr. H is concerned about becoming dependent on painkillers.
The nurse, who has had experience working with patients with bone pain, thinks the dosage of medication ordered by the provider is low. Is the nurse correct? Based on the nurse’s understanding of pharmacodynamics, what is the most appropriate action to take at this time?
The nurse administers 4 mg of morphine intravenously. About 45 minutes later, the nurse evaluates Mr. H’s response to the pain medication. He states that his pain is a 9 on a scale of 1 to 10, and he asks whether something more can be done for him. What is the most appropriate action for the nurse to take at this time?
How should the nurse address Mr. H’s concern about becoming addicted to the morphine?

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