# A 65-year-old client with chronic cancer pain has been started on long-acting morphine ER 30 mg PO every 12 hours with immediate-release morphine 10 mg every 4 hours as needed for breakthrough pain. Which scheduled intervention does the nurse anticipate to prevent the most common adverse effect? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=375145&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question A 65-year-old client with chronic cancer pain has been started on long-acting morphine ER 30 mg PO every 12 hours with immediate-release morphine 10 mg every 4 hours as needed for breakthrough pain. Which scheduled intervention does the nurse anticipate to prevent the most common adverse effect? ## Option 1. A prophylactic antiemetic such as ondansetron 4 mg PO every 8 hours scheduled around the clock, along with avoidance of spicy foods and small frequent meals to reduce the risk of nausea and vomiting from opioid therapy. 2. Administration of naloxone 0.4 mg IV push every 4 hours as a scheduled dose to counteract respiratory depression, combined with continuous pulse oximetry and hourly respiratory rate monitoring to detect early hypoventilation from opioid use. 3. A bowel regimen with a stimulant laxative such as senna 17.2 mg PO at bedtime, plus a stool softener such as docusate 100 mg PO twice daily, plus encouragement of fluids, fiber and activity from the start of opioid therapy. **✔ Correct answer** 4. A strict nothing-by-mouth status with maintenance intravenous fluids at 75 mL/hour to allow bowel rest, along with daily abdominal x-rays to monitor for ileus, since opioids slow gastrointestinal motility and can cause obstruction. **Correct answer: 3** ## Explanation Opioid-induced constipation (OIC) is the most common side effect of opioid therapy, occurs in nearly all patients, does not improve with tolerance, and is the leading reason patients abandon opioid analgesia. Mechanism: mu-receptor activation in the gut decreases peristalsis, increases sphincter tone, and decreases secretions. Standard prophylaxis from day one of opioid initiation: (1) stimulant laxative — senna 17.2 mg or bisacodyl 10 mg PO at bedtime — addresses decreased peristalsis, (2) stool softener — docusate 100 mg PO twice daily — alone is insufficient but added to a stimulant; some institutions omit docusate as evidence is mixed, (3) increase oral fluids to at least 2 L/day if not contraindicated, (4) increase dietary fiber gradually unless impaction risk, (5) activity, ambulation, abdominal massage. Escalate: osmotic laxative (polyethylene glycol, lactulose), enemas for impaction, peripheral mu-antagonist (methylnaltrexone, naloxegol, naldemedine) for refractory OIC. Diphenhydramine alone, fluid restriction, and bedrest are wrong. Bulk-forming laxatives (psyllium) are typically avoided in OIC because they require fluid and motility. ## In-depth explanation OIC prevention starts on day 1 with stimulant laxative plus optional softener plus fluids/fiber/activity. Tolerance never develops to constipation — it is a permanent side effect that must be actively prevented. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en) - [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=375145&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375145&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375145&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375145&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375145&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._