Ch 15 Opioid Analgesics

A nurse is to administer a prescribed opioid to a client. Which of the following conditions should the nurse confirm in the client to ensure that opioid therapy is not contraindicated in this client? A) Client does not have acute bronchial asthma. B) Client does not have acute diabetic retinopathy. C) Client does not have acute pre-existing liver disease. D) Client does not have decreased intracranial pressure.

A Feedback: Opioid therapy is contraindicated in clients with acute bronchial asthma; therefore, the nurse should confirm that the client does not have this condition before administering opioid therapy. Opioid therapy is not known to be contraindicated in clients with diabetic retinopathy and pre-existing liver disease. Opioid therapy is contraindicated in clients with increased, not decreased, intracranial pressure.

Prior to the administration of an opioid analgesic, the nurse should obtain which information from the client? Select all that apply. A) Pain assessment B) Allergy history C) Health history D) Past medication history E) Current medication therapy

A, B, C, D, E Feedback: Prior to the administration of an opioid analgesic, the nurse should obtain information about the following: pain assessment, allergy history, health history, and past and current medication therapy.

A nurse is caring for a client who is addicted to opioids. The physician has prescribed maintenance therapy using methadone for detoxification. Which of the following should the nurse keep in mind when caring for the client undergoing this therapy? A) Dosages vary according to length of the client's addiction. B) Methadone is discontinued on an outpatient basis. C) Dosages vary according to the client's weight. D) Male clients are prescribed higher doses than female clients.

A Feedback: The nurse must keep in mind that dosages vary with clients, the length of addiction, and the average amount of drug used each day. Dosages do not vary according to clients' weights. Methadone is not discontinued on an outpatient basis. Clients enrolled in an outpatient methadone program for detoxification or maintenance therapy on methadone must continue to receive methadone when hospitalized. Male clients are not prescribed higher doses than females.

A nurse is assigned to care for a client who has been prescribed an opioid analgesic. Which of the following activities should the nurse perform as part of the preadministration assessment? A) Document description of pain and an estimate of when the pain began. B) Obtain client's blood pressure and pulse within 5 to 10 minutes. C) Monitor the client for symptoms of respiratory depression. D) Record each bowel movement and its appearance, color, and consistency.

A Feedback: The nurse should document the description of pain and an estimate of when the pain began as part of the preadministration assessment. Obtaining blood pressure and pulse within 5 to 10 minutes, monitoring the client for symptoms of respiratory depression, and recording bowel movements are part of the ongoing assessments conducted by the nurse when caring for the client. The nurse obtains the blood pressure, pulse and respiratory rate, and pain rating in 5 to 10 minutes if the drug is given intravenously (IV). Respiratory depression occurs in clients who do not use opioids routinely and are being given an opioid drug for acute pain relief or surgical procedures. When an opiate is used as an antidiarrheal drug, the nurse records each bowel movement, as well as its appearance, color, and consistency.

A nurse has administered an opioid to a client. Which of the following would the nurse do if the client shows a decrease in respirations? A) Monitor and encourage the client to cough and breathe deeply every 2 hours. B) Instruct the client to restrict his consumption of liquids. C) Instruct the client to take complete bed rest. D) Instruct the client to avoid any kind of exercise.

A Feedback: The nurse should encourage the client to cough and breathe deeply every 2 hours if the client shows a decrease in respirations after the administration of opioid analgesics. The nurse need not instruct the client to restrict his consumption of liquids to help him cope with the effects of an ineffective breathing pattern. The nurse should perform tasks such as getting the client out of bed and encouraging therapeutic activities such as leg exercises (when ordered); therefore, the nurse should not instruct the client to avoid any kind of exercise or to take complete bed rest.

A nurse is assessing a client who is to receive an opioid analgesic. The nurse would contact the primary health care provider immediately if which of the following occur? Select all that apply. A) Respiratory rate of less than 10 breaths/min B) Decrease in pulse C) Increase in pulse D) Increase in blood pressure E) Blood pressure of 90/65 mm Hg

A, B, C, E Feedback: The nurse should contact the primary health care provider immediately if any of the following occur while a client is receiving an opioid analgesic: significant decrease in respiratory rate or a respiratory rate less than 10 breaths/min; significant increase or decrease in the pulse rate or a change in the pulse quality; or significant decrease in blood pressure or a systolic blood pressure below 100 mm Hg.

A postoperative client has a nursing diagnosis of Ineffective Breathing Pattern and is fearful that movement may result in more pain. Which of the following would be most appropriate for the nurse to do? Select all that apply. A) Get the client out of bed. B) Have the client do deep breathing. C) Encourage the client to lie still in bed. D) Get the client to cough every 2 hours. E) Administer more pain medication.

A, B, D Feedback: The client taking an opioid may be fearful that exercise will cause more pain. To help overcome this fear, the nurse should get the client out of bed and encourage therapeutic activities, such as deep breathing, coughing, and leg exercises (when ordered). Having the client lie still in bed and giving more pain medication would be inappropriate.

When describing opioid analgesics to a group of nursing students, the instructor would expect to include which classifications? Select all that apply. A) An agonist B) A partial agonist C) A partial antagonist D) An antagonist E) An agonist-antagonist

A, B, E Feedback: An opioid analgesic may be classified as an agonist, partial agonist, and agonist-antagonist.

A nurse should be aware of contraindications to the use of opioids to help decrease the likelihood of adverse reactions. The nurse understands that opioids would be contraindicated in which client? Select all that apply. A) A client with acute bronchial asthma B) A client with an acute myocardial infarction C) A client with a head injury D) A client with grand mal seizures E) A client with mild renal impairment

A, C, D Feedback: The use of opioids is contraindicated in clients with acute bronchial asthma, emphysema, upper airway obstruction, head injury, increased intracranial pressure, convulsive disorders, severe renal or hepatic dysfunction, and acute ulcerative colitis.

A client is receiving an opioid analgesic following abdominal surgery. The client has been out of bed to the chair and is encouraged to ambulate with assistance. The nurse is also encouraging the client to increase his fluids. He reports that his appetite is good and he has been finishing most of his meals. His bowel sounds are active but he is having difficulty passing stools. A laxative is ordered. Which nursing diagnosis would be most appropriate? A) Imbalanced Nutrition: Less Than Body Requirements B) Constipation C) Risk for Injury D) Deficient Knowledge

B Feedback: The client is most likely experiencing constipation from the opioid therapy as well as from the lack of ambulation and activity. The client is eating, so imbalanced nutrition is not necessarily a problem. He is at risk for injury if he is experiencing adverse reactions related to the opioid therapy, but this is not apparent. Although he may have deficient knowledge about the drug, this, too, is not seen in this case.

A nurse is caring for a client with chronic pain who has been prescribed epidural analgesia. The nurse monitors the client for which of the following after insertion of the epidural catheter and throughout the therapy? A) Abdominal pain B) Respiratory depression C) Fever D) Nervousness

B Feedback: The most serious adverse reaction associated with the epidurally administered opioids is respiratory depression. The nurse should closely monitor the client for respiratory depression after insertion of the epidural catheter and throughout the therapy. Clients using epidural analgesics for chronic pain are monitored for respiratory problems with an apnea monitor. The client may also experience sedation, confusion, nausea, pruritus, or urinary retention. The nurse need not monitor the client for abdominal pain, fever, and nervousness because they do not occur as a result of the administration of epidural analgesia.

A client is prescribed an opioid analgesic. The initial interview reveals that the client chronically drinks alcohol. The nurse would assess the client for which of the following as a possible interaction between the opioid analgesic and alcohol? A) Respiratory depression B) Central nervous system depression C) Hypotension D) Sedation

B Feedback: The nurse should monitor the client for central nervous system depression. The nurse need not monitor the client for respiratory depression, hypotension, or sedation because these are the effects of the interaction of opioid analgesics with barbiturates, not alcohol.

A group of nursing students are reviewing information about epidural pain management with opioid analgesics. The students demonstrate understanding of the information when they identify which of the following as an advantage over other routes of administration? Select all that apply. A) Longer time to tolerance development B) Lower total dose of opioid C) Fewer adverse reactions D) Greater client comfort E) Decreased demand on nursing staff

B, C, D Feedback: Epidural administration offers several advantages over other routes of administration for opioid analgesics, including lower total dosages of the drug used, fewer adverse reactions, and greater client comfort.

To decrease the risk of injury to a client taking an opioid, which action would be most appropriate? Select all that apply. A) Keep the lights in the client's room turned down. B) Assist the client from the bed to the toilet. C) Assist the client with rising from a lying position. D) Assist the client with hall-walking activities. E) Advise the client to stay in bed all night.

B, C, D Feedback: To decrease the risk of injury to a client taking an opioid, the nurse should assist the client with ambulatory activities and with rising from a sitting or lying position. The nurse should also keep the client's room well lit during daytime hours, keep the client's room free of clutter, and advise the client to seek assistance when getting out of bed at night.

A nurse is assessing a client receiving an opioid as treatment for diarrhea. The nurse would notify the primary health care provider immediately if which of the following occur? Select all that apply. A) Constipation B) Blood noted in the stool C) Worsening of diarrhea D) Report of severe abdominal pain E) Diarrhea unrelieved

B, C, D, E Feedback: A nurse monitoring a client taking an opioid for diarrhea should notify the physician immediately if diarrhea is not relieved or becomes worse, if the client has severe abdominal pain, or if blood in the stool is noted.

A client is receiving an opioid analgesic. Assessment reveals that his respiratory rate has dropped. Which of the following would the nurse expect to implement? Select all that apply. A) Oxygen administration B) Coaching of the client to breathe C) Discontinuation of the opioid analgesic D) Naloxone administration E) Albuterol administration

B, D Feedback: Coaching the client to breathe and administering naloxone (in severe cases) are appropriate measures used to treat a drop in respiratory rate in a client receiving an opioid analgesic. Oxygen would have little effect if the client's rate has dropped. The opioid would not be discontinued. Albuterol would be used if the client was experiencing bronchospasms.

A nurse is working at a substance abuse clinic. The nurse would expect which of the following to be used in the treatment and management of opioid dependence? Select all that apply. A) Fentanyl (Duragesic) B) Methadone (Dolophine) C) Propoxyphene (Darvon) D) Levomethadyl (Orlaam) E) Oxycodone (OxyContin)

B, D Feedback: Levomethadyl and methadone are the two opiates used in the treatment and management of opiate dependence.

A nurse is caring for a newborn. The newborn's mother is suspected to be opioid dependent. When assessing the newborn, which of the following would alert the nurse to the possibility of withdrawal? Select all that apply. A) Jaundice B) Increased respiratory rate C) Decreased respiratory rate D) Sneezing E) Fever

B, D, E Feedback: Opiate withdrawal symptoms in a newborn usually appear during the first few days of life and include irritability, excessive crying, yawning, sneezing, increased respiratory rate, tremors, fever, vomiting, and diarrhea.

A nurse is reviewing the differences between opioid agonists and opioid agonist-antagonists. The nurse correctly identifies which of the following as an opioid agonist-antagonist? Select all that apply. A) Alfentanil (Alfenta) B) Buprenorphine (Buprenex) C) Meperidine (Demerol) D) Nalbuphine (Nubain) E) Pentazocine (Talwin)

B, D, E Feedback: Opioid agonist-antagonists include buprenorphine, butorphanol, nalbuphine, and pentazocine.

A nurse is caring for a client who has been prescribed an opioid. Which of the following would the nurse include in the ongoing assessment? A) Review the client's health history. B) Review the client's allergy history. C) Inquire about the pain experienced by the client. D) Review the client's past and current drug therapies.

C Feedback: As part of the ongoing assessment, the nurse should inquire about the pain experienced by the client and believe the client and family in their reports of pain. The nurse must exercise good judgment because not all changes in pain type, location, or intensity require notifying the primary health care provider. The nurse has to review the client's health and allergy history and the client's past and current drug therapies as part of the preadministration assessment, which is conducted before the administration of the drug, not after.

A client is prescribed a transdermal opioid. After teaching the client and family how to administer this drug, the nurse determines that the teaching was successful when they state which of the following? A) "The drug should be reapplied every 24 hours." B) "We should try to apply the patch to about the same site each time." C) "The site should only be cleaned with water before each application." D) "A hairy area, like the forearm, is an appropriate place to apply the patch."

C Feedback: Only water is used to clean the site because soap and other substances may irritate the skin. The patch is applied for 72 hours and sites should be rotated. Any site that is used should be free of hair.

A client is receiving drugs through a PCA infusion pump. When teaching the client about this therapy, which of the following would the nurse include? A) Pain relief should occur 1 hour after pushing the control button. B) The control button and the button to call the nurse are the same. C) The control button activates administration of the drug. D) The machine delivers the drug every time the control button is used.

C Feedback: The nurse should inform the client that the control button activates administration of the drug. Pain relief occurs shortly after, and not an hour after, pushing the button. The nurse should educate the client on the difference between the control button and the button to call the nurse, especially when they are similar in appearance and feel. The machine does not deliver the drug every time the control button is used; the machine regulates the dose of the drug as well as the time interval between doses. If the control button is used too soon after the last dose, the machine will not deliver the drug until the correct time.

A nurse is caring for a client who is prescribed an opioid analgesic by her primary health care provider. Which assessment finding would lead the nurse to suspect that the client is experiencing an adverse reaction? A) Decreased intracranial pressure B) Increased breathing rate C) Tachycardia D) Urinary frequency

C Feedback: The nurse should monitor the client for tachycardia, increased intracranial pressure, depressed breathing rate, and urinary retention as possible adverse reactions.

A nurse is administering an opioid analgesic to a client with severe chronic pain. The nurse understands that the rate of tolerance to an opioid analgesic's effects varies from client to client. The nurse identifies which of the following as affecting the rate at which tolerance develops? Select all that apply. A) Body weight B) Gender C) Dosage D) Route of administration E) Age

C, D Feedback: The rate at which tolerance to an opioid analgesic develops varies according to dosage, the route of administration, and the individual.

A nurse is caring for a client with pain caused by terminal illness. The primary care provider has prescribed an opioid for the client. The nurse would be alert for the development of which of the following? A) Emphysema B) Alopecia C) Dehydration D) Severe anorexia

D Feedback: The nurse should monitor the client for severe anorexia, which is one of the adverse reactions of opioid analgesics on the GI system. Other adverse effects on the GI system include constipation, nausea, and acute abdominal pain. The nurse need not monitor the client for emphysema, alopecia, or severe headache. Opioid analgesics do not cause emphysema, but their administration is contraindicated in clients who have this condition. Administration of opioid analgesics is not known to cause alopecia or dehydration in clients.

A client is prescribed oxymorphone. The client is also receiving promethazine. The nurse would carefully monitor which of the following? Select all that apply. A) Temperature B) Blood pressure C) Pulse D) Respiratory rate E) Blood glucose

B, C, D Feedback: The nurse should take care to closely monitor a client's blood pressure, pulse, and respiratory rate when oxymorphone is administered with promethazine.

Which of the following would alert the nurse to suspect that a client is experiencing intermediate manifestations of abstinence syndrome? Select all that apply. A) Rhinorrhea B) Increased blood pressure C) Tachycardia D) Mydriasis E) Miosis

C, D Feedback: Intermediate symptoms of abstinence syndrome include mydriasis, tachycardia, twitching, tremor, restlessness, irritability, anxiety, and anorexia.

After teaching a group of nursing students about opioids, the instructor determines that additional teaching is needed when the students identify which of the following as a natural opioid? A) Meperidine B) Morphine C) Codeine D) Opium

A Feedback: Meperidine is a synthetic opioid. Natural opioids include morphine sulfate, codeine, opium alkaloids, and tincture of opium.

A nurse would expect that epidural administration of opioid analgesics is reserved for which of the following? Select all that apply. A) Labor pain B) Support of anesthesia C) Postoperative pain D) Moderate acute pain E) Intractable chronic pain

A, C, E Feedback: Epidural administration of opioid analgesics is reserved for postoperative pain, labor pain, and intractable chronic pain.

A nurse would expect to administer opioid analgesics primarily for the client with which of the following? Select all that apply. A) Severe acute pain B) Mild acute pain C) Moderate chronic pain D) Mild chronic pain E) Opioid dependence

A, C, E Feedback: Opioid analgesics are used primarily for the treatment of moderate to severe acute pain and chronic pain and in the treatment and management of opiate dependence.

A nurse assesses a client for common adverse reactions of opioids. Which of the following would the nurse identify? Select all that apply. A) Respiratory depression B) Diarrhea C) Mydriasis D) Constipation E) Miosis

A, D, E Feedback: Respiratory depression, miosis, and constipation are examples of common adverse reactions seen with the use of opioids.