Chapter 18: Drugs for the control of pain
A patient who is breastfeeding is prescribed morphine for pain and asks if the medication will affect the baby. Which response should the nurse provide? a) "I will talk with the healthcare provider about a different type of medication." b) "You will need to wean your baby before taking this medication." c) "We don't know how morphine will affect your baby, but you need the medicine." d) "Morphine will have no effect on your baby if you are breastfeeding."
a) "I will talk with the healthcare provider about a different type of medication." Morphine is a Pregnancy category B or category D in long-term use or with high doses. The best response is to discuss the prescription with the healthcare provider because the medication has a duration of 7 hours. The baby does not need to be weaned. Morphine can effect the baby if breastfeeding. Morphine can cause adverse effects in an infant who is being breastfed.
A patient receives a subcutaneous dose of naloxone (Narcan) for a respiratory rate of 6 breaths/min caused by an opioid analgesic. At which time should the nurse assess the effectiveness of this medication? a) 5-15 min b) 30 to 60 min c) 15 to 30 minutes d) 1 to 2 minutes
a) 5-15min Naloxone (Narcan) has an onset of action of 2-5 minutes if given subcutaneously and peaks within 5 to 15 minutes. The effectiveness will not be observed at 1 to 2 minutes. The effectiveness of the medication may begin to wear off after 15 minutes. The effectiveness should be assessed before 30 minutes or 1 hour.
A patient is prescribed an opioid analgesic for pain. Which instruction should the nurse provide to prevent orthostatic hypotension? a) Change positions slowly, especially when moving to an upright position. b) Avoid taking calcium or iron supplements. c) Remain in a reclining position and avoid being upright. d) Avoid cutting, chewing, or breaking tablets open.
a) Change positions slowly, especially when moving to an upright position.
The nurse is teaching a patient about a medication prescribed for migraine headaches. Which statement should indicate that the teaching was effective? a) "I will take the medication as soon as I notice a migraine headache starting." b) "I will take the medication once the migraine headache becomes too painful to handle." c) "I will take the medication every 30 minutes until the pain starts to go away." d) "I will use one spray of the intranasal spray in both nostrils."
a) "I will take the medication as soon as I notice a migraine headache starting." The patient should be instructed to take the medication as soon as the first symptoms begin to minimize the risk for severe pain. Waiting until the pain becomes severe makes it more likely that the medication will not work as well. The medication should not be taken every 30 minutes until pain relief is achieved; this can cause a rebound headache or an overdose of the medication. The appropriate dose is one intranasal spray in one nostril, not in both nostrils.
A patient experiences moderate migraines once or twice a month with occasional nausea and vomiting. Which medication should the nurse anticipate being prescribed? a) Sumatriptan (Imitrex) b) Caffeine c) Ibuprofen (Motrin) d) Dihydroergotamine (DHE 45)
a) Sumatriptan (Imitrex) Pharmacotherapy of a mild migraine begins with acetaminophen or NSAIDs. If an over-the-counter medication or an NSAID such as ibuprofen is unable to stop the migraine, the preferred drug is a triptan. Although oral forms of the triptans are most convenient, patients who experience nausea and vomiting during the migraine may require an alternative dosage form. Caffeine is not strong enough for this level of migraine. Dihydroergotamine has nausea and vomiting as an adverse effect.
A patient reports severe itching after receiving several doses of morphine (Astramorph). Which action should the nurse take? a) Document the finding b) Administer prescribed antihistamine c) Discontinue the use of the medication completely. d) Withhold the next dose of pain medication until the itching has passed.
b) Administer prescribed antihistamine. Itching is a common adverse effect of opioid analgesics. An antihistamine should be provided to relieve the itching. Documenting the adverse effect should be done but it is not a priority. It is not necessary to discontinue or withhold the medication.
A patient who is laughing with visitors requests pain medication for severe postsurgical pain. Which action should the nurse take? a) Refuse to administer the pain medication. b) Administer the pain medication as prescribed. c) Administer 325 mg of acetaminophen. d) Give the patient a back massage.
b) Administer the pain medication as prescribed. The psychologic reaction to pain is subjective. During physical assessment, the same degree and type of pain that would be described as excruciating or unbearable by one patient may not even be mentioned by another patient. The prescribed pain medication should be given. Administering a low dose of acetaminophen or giving a back massage are not appropriate measures for a patient experiencing postsurgical pain.
A patient with pain lasting 8 months informs the nurse that narcotic analgesics are no longer helping. Which classification of pain should the nurse document for this patient? a) Severe b) Chronic c) Acute d) Moderate
b) Chronic
A patient experiencing pain is prescribed a nonsteroidal anti-inflammatory drug (NSAID). In which way should the nurse expect this patient's pain to be managed? a) Central nervous system b) Nociceptor level c) Inhibition of endorphins d) Release of substance P
b) Nociceptor level NSAIDs act at the nociceptor level. Opioids act within the CNS. The neurotransmitter substance P is thought to be responsible for continuing the pain message to the brain. The activity of substance P may be affected by other neurotransmitters including endorphins.
A patient receiving around-the-clock opioids for pain relief has a respiratory rate of 7 breaths/min. Which action should the nurse take? a) Administer the next dose of pain medication as prescribed. b) Prepare to administer naloxone (Narcan). c) Document the finding in the patient's chart. d) Repeat the vital sign measurement in 15 minutes.
b) Prepare to administer naloxone (Narcan) A respiratory rate of 7 breaths/min is dangerously low and indicates respiratory depression, a serious adverse effect of opioids. An opioid antagonist is indicated. The next pain medication dose should not be provided because it could cause further respiratory depression. Waiting to reassess the vital signs could cause the patient's condition to deteriorate. The nurse needs to do more than document the vital signs.
A patient with a migraine headache is prescribed sumatriptan (Imitrex). For which reason should the nurse question this medication? a) Family history of mental illness b) Recent myocardial infarction c) Family history of lung cancer d Treatment for osteoarthritis
b) Recent myocardial infarction Because of its vasoconstricting action, sumatriptan should be used cautiously, if at all, in patients with recent myocardial infarction. It is not contraindicated in those with osteoarthritis or a family history of lung cancer or mental illness.
A patient is prescribed morphine sulfate (Astramorph PF) for postoperative pain. For which situation should the nurse consider withholding the medication? a) The patient's vital signs are pulse 92, respirations 26, and blood pressure 146/90 mm Hg. b) The patient's level of consciousness changes from alert to disoriented. c) The patient is restless and anxious and has cool, clammy skin. d) The patient reports acute pain from a fractured right tibia prior to surgery
b) The patient's level of consciousness changes from alert to disoriented. Morphine sulfate (Astramorph PF) depresses the central nervous system. The patient should be assessed for changes in level of consciousness, disorientation, and confusion before giving the medication. Morphine is used for moderate to severe pain. Because restlessness, anxiety, cool and clammy skin, and slightly elevated vital signs may be due to severe pain, the medication should be administered.
The nurse is reviewing information received during hand-off communication. For which patient should the nurse anticipate a prescription for an opioid analgesic? a) A patient with chronic back pain b) A patient one-week post-operative abdominal surgery c) A patient with advanced cancer who needs around-the-clock pain relief d) A patient with a history of substance use
c) A patient with advanced cancer who needs around-the-clock pain relief Opioids are the first-line drugs for severe to extreme pain that cannot be controlled with other classes of analgesics. The patient with advanced cancer requiring around-the-clock pain relief is the most appropriate for an opioid analgesic. Chronic back pain and one week post-operative surgical pain can be treated with a less potent analgesic. The patient with a history of substance use should not be given an opioid analgesic.
A patient experiences burning and shooting pain in the feet. Which type of pain should the nurse document for this patient? a) Visceral b) Somatic c) Neuropathic d) Nociceptor
c) Neuropathic -Neuropathic pain is caused by an injury or irritation to the nerve tissue and is often described as a burning or shooting pain. -Nociceptor refers to activation of receptor nerve endings that receive and transmit pain signals to the central nervous system (CNS). -Somatic pain produces sharp, localized sensations in the body. -Visceral pain produces generalized dull and internal throbbing or aching pain.
Several patients are receiving an opioid for pain management. Which patient should the nurse closely monitor during ambulation? a) A 26-year-old patient scheduled for surgery in the morning b) A 10-year-old patient with a broken arm c) An 87-year-old patient recovering from surgery d) A 42-year-old patient who had surgery 6 days ago
c) An 87-year-old patient recovering from surgery Older adults are at significantly higher risk for falls or injury when taking opioids due to the risk of dizziness and hypotension. The 87-year-old patient is most at risk for injury.
A patient who is postmenopausal received a dose of sumatriptan (Imitrex) Which assessment should the nurse complete first? a) Musculoskeletal pain b) Liver function c) Cardiovascular status d) Kidney function
c) Cardiovascular status Patients who are postmenopausal, men over age 40, smokers, and people with known coronary artery disease risk factors are at a greater risk for cardiovascular adverse effects from triptans and ergot alkaloids. Sumatriptan is contraindicated in patients with acute kidney injury (AKI) or hepatic impairment. Musculoskeletal pain and liver damage are not associated with this drug.
The nurse is reviewing documentation for a patient with severe low back pain. Which statement should the nurse question? a)"Reports acute pain that is improving after routine use of over-the-counter analgesics." b)"Experiencing chronic pain that is interfering with the ability to perform activities of daily living." c)"Experiencing chronic pain for the last few days." d)"Has had acute low back pain for the last 2 weeks."
c) Experiencing chronic pain for the last few days. Chronic pain is longer lasting pain that may persist for weeks, months, or years. Pain lasting longer than six months can interfere with activities of daily living and can contribute to feelings of helplessness or hopelessness. Acute pain is an intense pain occurring over a brief time, usually from time of injury until tissue repair.
A patient experiences respiratory depression after opioid administration. Which type of receptor should the nurse recognize is responsible for this effect? a) Beta b) Delta c) Mu d) Alpha
c) Mu Medications that cause respiratory depression activate the mu receptor. The beta, delta, and alpha receptors are not responsible for respiratory depression in patients taking an opioid
A patient requests medication for pain. Which action should the nurse take before administering this medication? a) Implement non-pharmacologic pain relief measures. b) Ask visitors to leave so the patient can rest. c) Check the medical record for a history of addiction. d) Assess for intensity, character, and location of the pain
d) Assess for intensity, character, and location of the pain
A patient experiencing pain is prescribed a nonsteroidal anti-inflammatory drug (NSAID). In which way should the nurse expect this patient's pain to be managed? a) Release of substance P b) Inhibition of endorphins c) Nocioceptor level d) Central nervous system
c) Nociceptor level (sensory receptor for painful stimuli) NSAIDs act at the nociceptor level. Opioids act within the CNS. The neurotransmitter substance P is thought to be responsible for continuing the pain message to the brain. The activity of substance P may be affected by other neurotransmitters including endorphins.
A patient with severe pain is prescribed morphine. Which supplement should the nurse instruct the patient to avoid taking with this medication? a) Vitamin D b) Melatonin c) Valerian d) Garlic
c) Valerian Valerian may potentiate the effect of morphine and should not be taken. Melatonin, vitamin D, and garlic are not identified as altering the effects of morphine.
A patient recovering from surgery reports an allergy to acetaminophen. Which pain medication combination should the nurse expect to administer? a) Percodan b) Endocet c) Percocet d) Vicodin
c) percodan Percodan is a combination drug containing oxycodone and aspirin. Endocet, Percocet, and Vicodin all contain acetaminophen and should not be administered to a patient with an allergy to acetaminophen.
A patient is prescribed aspirin for arthritic pain. Which should the nurse instruct the patient when taking this medication? a) "It can be safely taken with garlic." b) "Bruising is expected when taking this medication." c) "There are no major adverse effects of this medication." d) "Do not take with alcohol."
d) "Do not take with alcohol." Taking aspirin with alcohol increases the risk of gastric ulcer formation. Garlic may increase the risk of bleeding when taking aspirin. Aspirin can cause bleeding and gastrointestinal ulceration. Bruising is an indication of bleeding that should be reported to the healthcare provider.
The nurse is asked to explain the cause of pain. Which response should the nurse make? a) "Pain is an overused term that may be used to describe any feeling that is not normal." b) "There is no real explanation for the development of pain." c) "Pain is caused by some imbalance in the body." d) "Pain occurs when free nerve endings are stimulated."
d) "Pain occurs when free nerve endings are stimulated." The process of pain transmission begins when nociceptors are stimulated. Nociceptors are free nerve endings located throughout the entire body. The nerve impulse signaling the pain is sent to the spinal cord along sensory neurons. Pain is not caused by a body imbalance. There are well-studied theories to explain the development of pain. Pain is not an overused term.
A patient is given oral sumatriptan (Imitrex). After which amount of time should the nurse assess the effectiveness of this medication? a) 15 min b) 45 min c) 30 min d) 120 min
d) 120 min An oral dose of sumatriptan peaks in 2 hours or 120 minutes. Effectiveness should be assessed at this time. Assessing any sooner will not help determine effectiveness.
The nurse notes tight neck muscles in a patient with a moderate headache. Which health problem should the nurse suspect? a) Slipped cervical disk b) Migraine headache c) Anxiety d) Tension headache
d) Tension headache