Chapter 26

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? After surgery, a client may feel nauseated as a side effect of the anesthesia. Abrupt reversal of opioid-induced respiratory depression may cause vomiting. This is a precaution in case the client begins to choke when resuming a general diet. Suction equipment should be placed in all client rooms as a standard of care postoperatively.

Abrupt reversal of opioid-induced respiratory depression may cause vomiting.

A client is prescribed sumatriptan. Which statement should be included in the teaching plan regarding how the medication works? "It produces vascular constriction of cranial blood vessels." "The medication causes bronchiole constriction." "The medication impairs the reuptake of norepinephrine." "It relaxes smooth muscles of the cardiovascular system."

"It produces vascular constriction of cranial blood vessels."

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? "I have heard that B complex vitamins help." "I think you should try them before filling your prescriptions." "Let's discuss adding a herbal to your prescribed medication." "We should call the prescriber and ask for guidance."

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

A 50-year-old woman has been prescribed sumatriptan for the treatment of migraines. What instructions should then the nurse provide to the patient about the safe and effective use of this drug? "Take a dose of sumatriptan each morning when you suspect there's a chance of having a migraine." "Take this drug as soon as you feel the first signs of a migraine." "Lie down when you feel a migraine coming on and take some sumatriptan around 30 minutes later." "Take a dose of sumatriptan after you feel that you're unable to endure the pain of your migraine."

"Take this drug as soon as you feel the first signs of a migraine."

When describing the onset of action of naloxone, the nurse would explain that the drug achieves its effect in which amount of time? 1 to 2 minutes 10 to 15 minutes 15 to 30 minutes 30 to 60 minutes

1-2 minutes

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? 1030 1200 1230 1300

1030

A nurse should recognize the situations when naloxone (Narcan) should be used cautiously. What represents one of those situations? (Select all that apply.)

A client who is pregnant A client with cardiovascular disease A client with an opioid dependency

The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery? Take as little pain medication as possible to prevent addiction. Ask for pain medication before the pain gets severe. Request your pain medication whenever it is available to you. Wait as long as possible for pain medication; it will work more effectively.

Ask for pain medication before the pain gets severe.

To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.) Keep the lights in the client's room turned down. Assist client from their bed to the toilet. Assist client with rising from a lying position. Assist client with hall-walking activities. Advise the client to stay in bed all night.

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

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? Every day at the same time At the onset of migraine symptoms Every 5 minutes until the pain goes away After other migraine medications have been ineffective

At the onset of migraine symptoms

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? Administer a second dose and then notify the provider to obtain an order. No further action is required because the naloxone has already been administered. Call the provider as another dose of opioid antagonist may be necessary. Continue to monitor the client's vital signs and oxygen saturation levels.

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

An elderly client experiencing recurrent tension headaches reports taking an over-the-counter (OTC) combination of acetaminophen, aspirin, and caffeine several times a week. The nurse should recognize that this combination medication may be contraindicated if the client has a history of what medical condition? gastrointestinal (GI) bleeding peripheral vascular disease coronary artery disease contact dermatitis

GI bleeding

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? Heart rate Respiratory rate Temperature Pulse

Respiratory rate

A patient with chronic back pain is admitted to a local health care facility for respiratory depression and is prescribed an opioid antagonist. What assessment should a nurse perform before administering an opioid antagonist to the patient? Monitor patient's blood pressure every five minutes until the patient responds. Review patient's allergy history and treatment modalities. Monitor vital signs every 5 to 15 minutes if the patient is responsive. Monitor respiratory rate and rhythm of the patient.

Review patient's allergy history and treatment modalities.

Which assessment finding would support a client's report of migraine headaches? Severe unilateral pulsating pain Sharp steady eye pain Dull band of pain around the head Onset occurring during sleep

Severe unilateral pulsating pain

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? Take the medication before breakfast each day. Take the medication on days when migraines may be anticipated. Take the medication as soon as the earliest symptoms of migraine are sensed. Take the medication when the pain of a migraine becomes too much to bear.

Take the medication as soon as the earliest symptoms of migraine are sensed.

While assessing clients receiving opioid analgesics for pain management, what finding would alert the nurse and require healthcare provider notification? The client with a pulse of 65, a respiratory rate of 14, and a BP of 104/72 The client with a pulse of 118, a respiratory rate of 8, and a BP of 80/60 The client with a pulse of 70, a respiratory rate of 12, and a BP of 110/68 The client with a pulse of 100, a respiratory rate of 18, and a BP of 120/80

The client with a pulse of 118, a respiratory rate of 8, and a BP of 80/60

A-delta fibers are small myelinated fibers that respond quickly to acute pain. True False

True

Morphine, when administered orally, has a duration of action of 5 to 7 hours. True False

True

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

codeine

A nurse is teaching a client about her prescription for acetaminophen that she will take at home. This medication consists of acetaminophen and what other likely drug that enhances the analgesic effect of acetaminophen? codeine acetylsalicylic acid methadone tramadol

codeine

The nurse explains that there are adverse reactions that may be associated with the use of sumatriptan (Imitrex). The nurse would indicate which reactions? Select all that apply. Dizziness Fatigue Flushing Dry mouth Diarrhea

dizziness, fatigue, flushing, dry mouth

A nurse should not administer an opioid antagonist to a client with which finding? hypersensitivity to naloxone uncontrolled type 2 diabetes history of opioid abuse history of alcohol abuse

hypersensitivity to naloxone

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

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

A hospital client has been prescribed morphine for the treatment of post-surgical pain. The client tells the nurse, "I'm determined to push through my pain if I can, because there's no way I want to end up addicted to narcotics." What should the nurse teach the client?

It is extremely unlikely that the client would become addicted to narcotics used for this purpose

Which medications are opioids for which naloxone (Narcan) may be given to counter the effects? Meperidine (Demerol) Acetaminophen (Tylenol) Ibuprofen (Motrin) Naproxen (Aleve)

meperidine

A 40-year-old male client with arthritis of the knee joint has been prescribed an analgesic to relieve the pain. Which medication is a narcotic analgesic? Aspirin Ibuprofen Celecoxib Morphine

morphine

A terminally ill client has developed increased respiratory secretions and labored breathing. Which medication is prescribed to decrease these symptoms? meclizine ampicillin naloxone morphine sulfate

morphine sulfate

Which client would the nurse identify as being opioid naive? one who does not routinely take opioids person who routinely takes opioids individual who is physically dependent on opioids one who is psychologically dependent on opioids

one who does not routinely take opioids

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

oral

Pain may be classified according to: region, intensity, and duration. age, gender, or cause. location, intensity, and medical history. origin, duration, or cause.

origin, duration, or cause.

A nurse is caring for a 49-year-old client in the intensive care unit. The client was in a motor vehicle accident and is in severe pain. The client has been given morphine. After 2 days in the unit, the nurse can detect nasal congestion when the client speaks to her. The nurse will monitor for which? renal impairment. myocardial infarction. hypersensitivity to the drug. pneumonia.

pneumonia

Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential? Lower blood pressure Manage hypertension Raise blood pressure Manage hypotension

raise BP

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? Abdominal pain Respiratory depression Fever Nervousness

respiratory depression

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: the tablet would have no effect if crushed and ingested. there is risk of an extremely high dose available all at once if the tablet is crushed. crushing the tablet increases the drug's efficacy. crushing the tablet is a safe option.

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

What is a priority nursing assessment of a client prescribed oral sumatriptan? Vital signs Urinary output Head to toe assessment Glasgow coma scale

vital signs

Which conditions would occur due to the administration of an opioid antagonist in a client who is physically dependent on opioids? drowsiness hypotension withdrawal symptoms insomnia

withdrawal symtoms

Which should be included when assessing pain? (Select all that apply.) Location of the pain Intensity of pain What factors cause the pain to improve or worsen What medications client usually takes to relieve the pain

Location of the pain Intensity of pain What factors cause the pain to improve or worsen What medications client usually takes to relieve the pain

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? Antibiotic Antihypertensive Monoamine oxidase (MAO) inhibitor NSAID

MAO inhibitor Patient should not receive morphine within 14 days of taking an 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? Antibiotic Antihypertensive Monoamine oxidase (MAO) inhibitor NSAID

MAOI

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? "When did this pain begin?" "Would you like me to get you something?" "In the past, what has helped your pain?" "Where exactly are you hurting?"

"Where exactly are you hurting?"

The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize? Assessing the client for migraine pain Assessing the client for narcotic withdrawal syndrome Assessing the client for respiratory depression Assessing the client's lying, sitting and standing blood pressure

Assessing the client for migraine pain

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? The medication can be very irritating to mucous membranes. The crushed medication can permanently stain teeth. Crushing the medication may precipitate an overdose. Crushing the medication interferes with its absorption.

Crushing the medication may precipitate an overdose.

A client has been administered an opioid. What effect should the client be regularly assessed for? oliguria level of consciousness (LOC) edema tachycardia

LOC

A male client is given regular doses of morphine for a period of 6 months. His dosage now needs to be reduced gradually. The health care provider advises the nurse to pay attention to the clinical management of the client's pain to allow proper agonist coverage during the change in drug dosage. Why is the client likely to suffer unnecessary pain and discomfort if proper management is not ensured? Tolerance to the drug Physical dependence on the drug Addiction to the drug Adverse effects of the drug

Physical dependence on the drug

Which information presented in the client's history should prompt the nurse to discourage a client from self-medicating with an over-the-counter (OTC) acetaminophen, aspirin, and caffeine combination drug? The client has not adhered to previous treatment regimens. The client has a chronic venous ulcer on the lower leg. The client has a diagnosis of liver cirrhosis. The client is a smoker.

The client has a diagnosis of liver cirrhosis

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? The client is not lactating. The client does not have high blood pressure The client is not hypersensitive to the opioid antagonist. The client does not have a cardiovascular disease.

The client is not hypersensitive to the opioid antagonist.

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? Vasodilation of blood vessels Vasoconstriction of blood vessels Inhibits the synthesis of prostaglandins Satisfies the thirst center in the brain, which aborts the headache

Vasoconstriction of blood vessels

When diagnostic testing reveals a bone fracture, what type of pain is the client experiencing? acute somatic pain chronic visceral pain visceral pain neuropathic pain

acute somatic pain

When diagnostic testing reveals a bone fracture, what type of pain is the client experiencing? acute somatic pain chronic visceral pain visceral pain neuropathic pain

acute somatic pain

What reaction should the nurse assess for when a client is prescribed a nonopioid analgesic in addition to a narcotic analgesic?

additive effect