Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents

False Explanation: Past experience with pain has a large impact on how pain is perceived.

A client's past experience with pain has little impact on the patient's perception of pain.

Raise blood pressure

Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential?

Duration of action will be prolonged

How will a client's impaired renal function affect the pharmacokinetics of morphine?

take the medication as soon as the earliest symptoms of migraine are sensed

In order to maximize therapeutic benefit while reducing the risk of adverse effects of sumatriptan, the nurse should encourage the client to implement which intervention?

Severe unilateral pulsating pain

Which assessment finding would support a client's report of migraine headaches?

ineffective role performance related to migraine headaches

A 60-year-old client tearfully explains to the nurse how her husband downplays her frequent migraines and tells her that she needs to "just push through a headache." She describes how her migraines have limited her ability to provide childcare for her young grandchildren and explains that she is unable to keep up her garden. The nurse should identify what nursing diagnosis when planning this client's care?

"Acetaminophen is appropriate."

A caregiver asks the nurse what the caregiver can give a 9-year-old child for a headache. What is the nurse's best response?

The number of ergotamine tablets the client took at home

A client admitted for a severe migraine reports taking ergotamine tartrate at home. What is most essential information for the nurse to obtain?

Receive order for diphenhydramine and administer.

A client admitted to the emergency department with a migraine headache unrelieved with current prescribed medications. The nurse administers prescribed ketorolac tromethamine 30 mg IV and metoclopramide 10 mg IV, and the client suddenly develops involuntary movement of upper limbs, facial grimacing, sticking out the tongue rhythmically, contractures of the neck and head to one side in a twisting motion, and rapid involuntary spasms of eyelids. Which action would the nurse implement first?

level of consciousness (LOC)

A client has been administered an opioid. What effect should the client be regularly assessed for?

"It produces vascular constriction of cranial blood vessels."

A client is prescribed sumatriptan. Which statement should be included in the teaching plan regarding how the medication works?

oral

A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route?

codeine Explanation: Typically, codeine or hydrocodone are used to relieve coughing

A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain:

Methadone

A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment?

"Wait at least half-an-hour before you take another pill."

A client prescribed sumatriptan as abortive therapy for migraines reports, "I took that pill about an hour-and-a-half ago, and I still don't feel any better. Can I take another?" How should the nurse respond?

The client cannot safely take ergotamine until she has weaned her infant.

A client who is 14 weeks pregnant requests a prescription for ergotamine to help manage migraine headaches that have become increasing more severe and frequent in recent months. How will this client's current health status affect the nurse's response to this request?

Abrupt reversal of opioid-induced respiratory depression may cause vomiting Explanation: It is important to keep suction equipment readily available because abrupt reversal of opioid-induced respiratory depression may cause vomiting. None of the other rationales provided is a valid reason for adding suction equipment to the room of a client who requires a dose of naloxone

A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone (Narcan). Which explanation by the nurse is correct?

"Let's discuss adding an herbal to your prescribed medication."

A client, prescribed several medications for migraines, asks the nurse if there is any herbal supplement the client can take as well. What is the nurse's best response?

Vasoconstriction of blood vessels

A female client tells the nurse that the first thing she does when she gets a headache is drink a caffeinated beverage. The nurse is aware that caffeine is known to decrease the pain of migraine headaches by what mechanism?

Using a pain rating scale Explanation: A pain rating scale is the most reliable method because it provides measurable evidence of pain severity. A client's description of pain is useful, but does not provide objective or quantifiable data over time. Although percussing or palpating provides information, it would increase the client's pain and be inappropriate. Vital sign changes occur for numerous reasons and are not the best indicator of pain in clients who can speak

A group of students is reviewing various methods for assessing pain. The students demonstrate understanding of the material when they identify what as the most reliable method?

Vomiting

A health care provider suggests opioid treatment for a client with respiratory depression. The nurse should be aware of which condition that can occur during an abrupt reversal of opioid respiratory treatment?

0.5 mL Explanation: 5 mg/X=10 mg/mL. The calculation results in .5 mL. The administration of 0.25, 1, or 2 mL is incorrect.

A hospice patient has been ordered morphine (Roxanol) 5 mg every 2 hours. Roxanol contains 10 mg/mL. How many mL will be administered?

Migraines The severity of her headaches coupled with the fact that she experiences a prodrome suggests that she experiences migraines. This clinical presentation is not typical of cluster headaches or tension headaches. Ischemic headache is not a recognized subtype.

A middle-aged client describes her headaches as "utterly debilitating" and tells the nurse, "It's hard to explain, but I just know when one is coming, and I'm never wrong." This client's statement suggests what diagnosis?

The client's stool tests positive for occult blood

A nurse has administered a scheduled dose of naproxen to a hospital client who has been taking the drug for several weeks. What assessment finding should cause the nurse to suspect that the client on long-term naproxen therapy is experiencing adverse effects of this treatment?

"Where exactly are you hurting?"

A nurse has entered a client's room at the beginning of a shift to quickly assess the clent's airway, breathing, circulation, and consciousness. The nurse observes that the client is wincing, stating, " Oh, I am in so much pain right now." What initial question should the nurse ask this client?

make sure the side rails are up.

A nurse has just administered an IM injection of meperidine (Demerol) to an elderly client. The priority nursing action for the nurse would be which?

Pain scale

A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication?

Administer subcutaneous sumatriptan succinate (Imitrex).

A nurse is caring for a client diagnosed with migraine headaches. Which nursing intervention should be implemented during an acute headache?

The client is not hypersensitive to the opioid antagonist.

A nurse is caring for a client who required an opioid antagonist. Which should the nurse confirm to ensure that administration of the opioid antagonist is not contraindicated in the client?

respiratory depression Explanation: The nurse should closely monitor the patient for respiratory depression after insertion of the epidural catheter and throughout the therapy. Patients using epidural analgesics for chronic pain are monitored for respiratory problems with an apnea monitor. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. The nurse need not monitor the patient for abdominal pain, fever, and nervousness because they do not occur as a result of the administration of epidural analgesia

A nurse is caring for a patient with chronic pain who has been prescribed epidural analgesia. The nurse should monitor the patient for which condition after insertion of the epidural catheter and throughout the therapy?

hypersensitivity to naloxone

A nurse should not administer an opioid antagonist to a client with which finding?

Postoperative acute respiratory depression Suspected acute opioid overdosage Reversal of opioid induced hypotension

A nurse should recognize which situations necessitate the need for an opioid antagonist. Which situations necessitate the need for an opioid antagonist? (Select all that apply.)

Central nervous system depression

A patient is prescribed opioid analgesic. During the initial interview with the patient, the nurse understands that the patient chronically drinks alcohol. Which effect of the interaction between opioid analgesic and alcohol should the nurse monitor for in the patient?

Binding to serotonin to produce vasoconstriction Explanation: Sumatriptan (Imitrex) binds to the serotonin receptors in the intracranial blood vessels, resulting in vasoconstriction. Sumatriptan does not bind to phospholipids to diminish anxiety. Sumatriptan does not interrupt the calcium intake in the neuron. Sumatriptan does not reduce inflammation in the temporal arteries

A patient is suffering from a migraine headache. What is the action of sumatriptan (Imitrex)?

bowel patterns Morphine, like most opioid analgesics, creates a risk for constipation. The drug is unlikely to influence the client's temperature, skin integrity, or urine specific gravity.

A trauma client has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the client's what?

the route of administration Explanation: Patient response to morphine depends on the route of administration and the dosage

Morphine, an opioid agonist, is administered for both acute and chronic pain. Along with the administered dosage, what determines the patient's response to morphine?

fentanyl Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic)

Naloxone (Narcan) will reverse the effects of which drug?

True Explanation: Opioid receptors are highly concentrated in some regions of the central nervous system, including the ascending and descending pain pathways and portions of the brain essential to the endogenous analgesia system.

Opioid receptors are highly concentrated in some regions of the central nervous system, including the ascending and descending pain pathways and portions of the brain essential to the endogenous analgesia system.

crushing the medication may precipitate an overdose

The client has difficulty swallowing and requests the nurse to crush all the medications. The nurse notes a client prescribed an extended-release opioid requests that all medications be crushed to facilitate the administration. What information about this form of opioid presents a problem respecting the client's request?

Respiratory rate

The client has had a myocardial infarction. The nurse is administering morphine sulfate for the pain. What vital sign would the nurse monitor that directly relates to the use of this narcotic?

Ask for pain medication before the pain gets severe

The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery?

Call the provider as another dose of opioid antagonist may be necessary.

The nurse has administered a dose of naloxone (Narcan) and the client's respiratory depression improved within five minutes. When the nurse reassessed the client two hours later, the client demonstrates symptoms of respiratory depression. Which action should the nurse perform next?

Within one to five minutes, an effect may be seen Explanation: Onset of action is generally rapid and may be seen within one to five minutes. Additional doses may be required to achieve optimal effects. The other answers are incorrect because they are referring to a time later than onset of action, or refer to a conditional onset of action that is untrue.

The nurse has just administered an opioid antagonist to a client who had been experiencing respiratory depression. How soon can the nurse expect to see improvement in the client's respiratory function?

Assess the client's other vital signs

The nurse is caring for a postoperative client taking an opioid medication for pain. The nurse assesses the client to have bradypnoea and an oxygen saturation value of 90%. Which actions should the nurse perform before administering the ordered opioid antagonist?

The client may begin to demonstrate symptoms of withdrawal Explanation: The client may begin to demonstrate symptoms of withdrawal when he or she has a history of opioid abuse and is administered an opioid antagonist. The other answers are incorrect. In fact, clients will likely have increased pain due to antagonistic effects of the drug. The standard dosage and a single dose will be administered even with a history of opioid abuse

The nurse is caring for a postoperative client with a history of opioid abuse who has been ordered to receive a dose of an opioid antagonist medication. Which issues should the nurse be prepared to address?

"I will alternate the nostril used, and administer 2 sprays in the nostril, and repeat in 2 hours if needed."

The nurse is educating a young adult client diagnosed with migraine headaches about the prescribed intranasal sumatriptan for abortive therapy. Which statement made by the client establishes the need for further clarification?

At the onset of migraine symptoms Explanation: Sumatriptan should be taken at the onset of migraine symptoms.

The nurse is giving instructions to a client who has just been prescribed sumatriptan for the treatment of migraine headaches. The client will be instructed to take this medication at what time?

a woman 85 years of age Explanation: The transdermal route of medication administration is dependent upon the amount of subcutaneous tissue present for medication distribution. Subcutaneous tissue is reduced as a result of the aging process. Therefore, the client 85 years of age would be least likely to be prescribed a transdermal medication. The clients 25, 35 and 50 years of age would have adequate subcutaneous tissue for medication distribution

The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl?

Assessing the client for migraine pain Explanation: Sumatriptan is indicated for the treatment of acute migraine and cluster headaches. As such, the nurse should assess the client for indications of this health problem, more so than respiratory status or blood pressure. Narcotic withdrawal syndrome is unrelated

The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize?

an 88-year-old female with failure to thrive

The nurse should question the health care provider's IV morphine prescription for which client?

10 to 20 minutes

The nurse should share with the client receiving intravenous (IV) morphine that maximum relief of pain will occur in what time frame?

Constipation

The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect?

Assist client from their bed to the toilet. Assist client with rising from a lying position. Assist client with hall-walking activities.

To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.)

propanolol

What beta-adrenergic antagonist is used for migraine prophylaxis?

Vital signs

What is a priority nursing assessment of a client prescribed oral sumatriptan?

a return to normal respiratory rate, rhythm, and depth Explanation: The primary reason for administering an opioid antagonist is because the client is experiencing respiratory depression. Therefore, the goal is to improve the client's respiratory rate, rhythm, and depth. None of the other options is part of the drug therapy.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide:

1 to 2 minutes

When describing the onset of action of naloxone, the nurse would explain that the drug achieves its effect in which amount of time?

acute somatic pain

When diagnostic testing reveals a bone fracture, what type of pain is the client experiencing?

c. An adequate breathing pattern is maintained d. Therapeutic response is achieved and discomfort is reduced e. Client maintains adequate nutritional status. Explanation: The plan of care is considered effective when therapeutic response is achieved and discomfort is reduced; an adequate breathing pattern is maintained; the number of bowel movements is maintained; and adequate nutritional status is maintained. Urinary output should mirror increased fluid intake (increased fluid in, increased fluid out).

When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs? (Select all that apply.)

sweating, tachycardia, and increased blood pressure Explanation: Side effects of opioid antagonists include nausea and vomiting, sweating, increased blood pressure, and tremors. All other side effects listed are not side effects of opioid antagonists.

Which adverse reactions may occur as a result of administering an opioid antagonist?

It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops

Which statement best describes a drug's characteristic of having no ceiling effect?

there is risk of an extremely high dose available all at once if the tablet is crushed.

An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the client that:

Monoamine oxidase (MAO) inhibitor

Prior to administering morphine, the nurse checks the client's medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication?

For clients with a history of angina pectoris, myocardial infarction, or uncontrolled hypertension

The client is taking sumatriptan (Imitrex) for migraine headaches. For which client is this medication contraindicated?

Narcan

The client returns from the post-anesthesia recovery unit. The nurse notes a respiratory rate of 6. Which drug would the nurse anticipate being given immediately?

1030 With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours

The nurse administers morphine 15 mg oral solution to a client with cancer pain at 0930. When should the nurse reassess the client for peak effect?