# A nurse is caring for a client with pancreatic cancer who is experiencing severe abdominal pain rated 9/10. The client has been prescribed morphine sulfate 4 mg IV every 4 hours PRN for pain. What is the priority nursing intervention?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=540725  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a client with pancreatic cancer who is experiencing severe abdominal pain rated 9/10. The client has been prescribed morphine sulfate 4 mg IV every 4 hours PRN for pain. What is the priority nursing intervention?

## 보기

1. Administer the prescribed morphine sulfate and assess pain relief within 30 minutes **✔ 정답**
2. Apply a heating pad to the abdomen to provide comfort
3. Encourage the client to ambulate to distract from the pain
4. Offer oral acetaminophen as a first-line pain management approach

**정답: 1**

## 해설

Pain management is the priority for severe cancer pain. Administering prescribed morphine with follow-up assessment ensures effective control, while other options are less immediate or appropriate.

## 심화 해설

Clinical Context and Priority Setting

The client is experiencing severe, acute pain (rated 9/10) secondary to pancreatic cancer. In the hierarchy of nursing priorities, addressing acute, severe pain is paramount. Unrelieved pain is not merely a comfort issue; it triggers a pathophysiological stress response that can lead to tachycardia, increased myocardial oxygen demand, hyperglycemia, and impaired immune function. The prescribed medication, morphine sulfate, is a pure mu-opioid agonist and remains a cornerstone for managing moderate to severe cancer-related pain, as highlighted by current frameworks emphasizing its essential role in this context [2]. The route, intravenous (IV), is the most appropriate for rapid onset when a patient is suffering from severe pain, bypassing the absorption delays of the oral route and the variable absorption of the intramuscular route.

Analysis of the Correct Intervention

Administering the prescribed morphine sulfate and then evaluating its effect is the correct sequence of actions. The medication order is valid, the indication is clear, and the patient's reported pain score demands immediate pharmacological intervention. The 30-minute reassessment window aligns with the pharmacokinetic profile of IV morphine, where peak analgesic effect typically occurs within 15 to 20 minutes. This reassessment is a critical safety step to evaluate both the therapeutic effect and to monitor for potential adverse effects. While opioids are essential, their use requires careful consideration of risks, including respiratory depression and other complications such as opioid-induced nausea and vomiting (OINV), which can negatively affect a patient's quality of life and adherence to therapy [2,4]. A prompt reassessment allows the nurse to identify and manage these issues early.

Why Other Options are Incorrect

- **Option 2: Apply a heating pad to the abdomen to provide comfort.** While non-pharmacological interventions are valuable components of a multimodal pain management strategy, they are adjuncts, not replacements, for opioid therapy in cases of severe, acute pain . Applying heat to the abdomen of a client with pancreatic cancer is also potentially hazardous; the tumor's location and potential for local inflammation or metastasis make deep heat application a risk for complications without a specific medical order.

- **Option 3: Encourage the client to ambulate to distract from the pain.** Distraction is a cognitive-behavioral technique that can be effective for mild to moderate pain. For a patient rating their pain as 9/10, this approach is physiologically and psychologically inappropriate. Severe pain of this intensity demands pharmacological relief first; expecting a patient to ambulate in this state is unrealistic and neglects the severity of their suffering.

- **Option 4: Offer oral acetaminophen as a first-line pain management approach.** This action directly contradicts the established analgesic ladder for cancer pain. For severe pain, the standard of care is a strong opioid, not a non-opioid analgesic like acetaminophen. Acetaminophen is appropriate for mild pain or as an adjuvant to an opioid for moderate pain, but it is insufficient as a sole agent for a pain score of 9/10. Opting for a less effective medication when a more appropriate one is prescribed would constitute an unethical delay in providing adequate pain relief.

Pathophysiology and Pharmacological Rationale

Pancreatic cancer often causes severe pain due to tumor invasion of the celiac plexus, retroperitoneal nerve structures, and surrounding organs. This nociceptive and often neuropathic pain generates intense signals that ascend the spinothalamic tract. Morphine works by binding to mu-opioid receptors in the central nervous system, primarily in the periaqueductal gray matter and the dorsal horn of the spinal cord, inhibiting the release of excitatory neurotransmitters like substance P and thereby closing the "gate" on pain signal transmission. The IV route ensures the drug reaches these receptor sites rapidly, providing the fastest possible relief for this level of suffering. The evolving paradigm in cancer pain management supports this mechanism-based approach, where a strong opioid is the central component for severe pain, integrated within a broader, patient-centered plan .References (research sources)

- [2]The Improving Opioid Use for Cancer Pain Framework: Addressing the needs of patients with cancer and pain in a new era of opioid prescribing.Research articleDy SM, Sharma R, Waldfogel JM, Jones KF, Rieder TN. (2026) · DOI: 10.1002/cncr.70487

## 임상 시나리오

Managing Severe Cancer Pain with IV OpioidsPrioritizing rapid analgesia and safety reassessment
For a client with severe pain (9/10), the priority is administering the prescribed IV morphine. The IV route is critical for its rapid onset, bypassing absorption delays.

Reassess pain and monitor for adverse effects within 30 minutes, aligning with the drug's peak analgesic effect at 15-20 minutes. This evaluates both therapeutic response and safety.

CautionUnrelieved severe pain triggers a harmful stress response (tachycardia, increased myocardial demand). Do not delay opioid administration for non-pharmacological measures or weak oral analgesics in this acute scenario.

## 핵심 개념

- **Morphine Sulfate** — A pure mu-opioid agonist and first-line opioid for moderate to severe cancer-related pain, providing effective analgesia.
- **Intravenous (IV) Route** — Administration method that bypasses absorption delays, providing the fastest onset of action for immediate pain relief in severe cases.
- **Peak Analgesic Effect** — The time at which a drug reaches its maximum pain-relieving effect; for IV morphine, this typically occurs within 15 to 20 minutes.
- **PRN Order** — A medication order given 'pro re nata' (as needed), which requires the nurse to use clinical judgment to determine when administration is indicated.
- **Pain Reassessment** — A critical safety step performed after intervention to evaluate therapeutic effect and monitor for adverse effects, timed according to drug pharmacokinetics.

## 같은 주제 문제

- [The nurse is conducting a comprehensive assessment on a patient presenting with vague abdo…](https://mymerci.kr/pages/nclex_q.php?qn_id=540610)
- [A 58-year-old male patient presents to the oncology unit with a 3-month history of progres…](https://mymerci.kr/pages/nclex_q.php?qn_id=540611)
- [A nurse is assessing a 58-year-old patient with suspected pancreatic cancer. Which assessm…](https://mymerci.kr/pages/nclex_q.php?qn_id=540612)
- [A nurse is caring for a client with advanced lung cancer who is receiving palliative chemo…](https://mymerci.kr/pages/nclex_q.php?qn_id=540616)
- [A nurse is assessing a 65-year-old client with suspected pancreatic cancer. Which assessme…](https://mymerci.kr/pages/nclex_q.php?qn_id=540720)
- [A nurse is caring for a 72-year-old client with suspected pancreatic cancer. Which assessm…](https://mymerci.kr/pages/nclex_q.php?qn_id=540721)
- [A nurse is assessing a 68-year-old client who was recently diagnosed with pancreatic cance…](https://mymerci.kr/pages/nclex_q.php?qn_id=540722)
- [A nurse is caring for a 55-year-old client with pancreatic cancer who is experiencing seve…](https://mymerci.kr/pages/nclex_q.php?qn_id=540723)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._