Chapter 26: Narcotics, Narcotic Antagonists, and Antimigraine Agents

The nurse has entered the room of a pt who is being treated w/ regular doses of morphine. The pt is unresponsive to voice but responsive to touch, with a respiratory rate of 6 breaths per minute. In addition to informing the care team, what is a priority action? A) Administration of acetylcysteine as prescribed B) Administration of naloxone as prescribed C) Auscultating the pt lungs D) Cardiac monitoring

B; Reverses the effects of opioids

The pt is newly prescribed ergotamine as treatment for migraine headaches. What finding in the pt medical history would cause the nurse to hold the drug and question it's administration? A) The pt takes diuretic to control BP B) The pt take beta blockers for HTN C) The pt take an OTC analgesic for pain control D) The pt takes and oral med to control blood sugar

B; Risk for peripheral ischemia and gangrene is increased w/ this combo

A patient is suffering from a migraine headache. What is the action of sumatriptan? Binding to phospholipids to diminish anxiety Binding to serotonin to produce vasoconstriction Reducing inflammation in the temporal arteries Interrupting the calcium intake in the neuron

Binding to serotonin to produce vasoconstriction

A pt with chronic pain and a history of poor adherence to medication schedules requires a narcotic analgesic that can provide a steady delivery of pain relief. What medication is most likely to meet this pt's needs? A) Hydromorphone B) Tramadol C) Fentanyl D) Naloxone

C

Injecting a narcotic into an area of the body that is chilled can be dangerous because: A) An abscess will form B) The injection will be very painful C) An excessive amount may be absorbed all at once D) Narcotics are inactivated in cold temps

C

Most narcotics are controlled substances because they: A) Are very expensive B) Can cause respiratory depression C) Can be addictive D) Can be used only in a hospital setting

C

Opioid receptors are found throughout the body: A) Only in people who have become addicted to opiates B) In increasing numbers w/ chronic pain conditions C) To incorporate pain perception and blocking D) To initiate the release of endorphins

C

The nurse is providing health education to a pt who is prescribed sumatriptan for the treatment of migraines. The nurse should caution the pt about what potential adverse effects? A) Urinary hesitation and diarrhea B) Dry mouth and urinary frequency C) Numbness and chest tightness D) Halitosis (bad breath) and dry cough

C

The nurse would hold pentazocine, if ordered, and consult the provider if the pt is allergic to what? A) Aspirin B) Penicillin C) Sulfites D) Eggs

C

The only triptan that has been approved for use in treating cluster headaches as well as migraine is: A) Naratriptan B) Rizatriptan C) Sumatriptan D) Zolmitriptan

C

What does a nurse keep readily available should a pt who is receiving morphine experience significant respiratory depression? A) Nalbuphine B) Buprenorphine C) Naloxone D) Ergotamine

C

What action by the nurse best addresses a common adverse effect related to narcotic administration? A) Encourage the pt to eat several meals daily B) Teach the pt to perform deep breathing and coughing exercises C) Encourage the pt fluid intake D) Teach the pt to take antiemetics as prescribed

C; constipation is usual

Although naloxone is given to counter opioid medication side effects such as respiratory depression, what additional issues (if any) may result from administration of an opioid antagonist? Decrease in the client's pain rating Increase in the client's pain rating No change in the client's pain rating None of these options

Increase in the client's pain rating

A pt is undergoing inpatient addiction rehab following many years of addiction to heroin. What med would be the most useful adjunct to treatment? A) Methadone B) Oxycodone C) Oxymorphone D) Tramadol

A

A pt who lives with chronic pain has just learned that she is pregnant. What narcotic analgesic is most appropriate for this pt? A) Oxycodone B) Meperidine C) Fentanyl D) Sufentanil

A

SATA. The nurse would expect to administer a narcotic as the analgesic of choice for which pts? A) A pt with severe postoperative pain B) A pt with severe chronic obstructive pulmonary disease and difficulty breathing C) A pt with severe, chronic pain D) A pt with ulcerative colitis E) A pt with recent biliary surgery F) A cancer pt with severe bone pain

A C F

A pt care provider has prescribed morphine for the pt chronic pain. What health education should the nurse provide to this pt? A) "Avoid drinking alcohol while taking this med." B) "Eat small, frequent meals to reduce GI upset" C) "Have blood levels drawn in one week" D) "Avoid sun exposure, or apply high SPF sunscreen"

A; Alcohol can exacerbate CNS depression

A client's post-surgical pain is severe and persistent. The client states that recent doses of morphine IV have "helped only a little bit." The client has a PRN dose of morphine available, and wants to receive the medication. The client's respiratory rate is 14 breaths per minute. What is the nurse's best action? Inform the client that morphine would cause excessive respiratory depression and offer non-pharmacologic interventions Offer an ice pack and reassess the client's respiratory status in 30 minutes Contact the care provider to seek direction Administer the morphine as prescribed and monitor the client's respiratory status closely

Administer the morphine as prescribed and monitor the client's respiratory status closely

Select all that apply: 1. Narcotics are drugs that react with opioid receptors throughout the body. Which conditions would the nurse expect to find when assessing a patient who was taking a narcotic? a. Hypnosis b. Sedation c. Analgesia d. Euphoria e. Orthostatic hypotension f. Increased salivation

b,c,d,e

1. According to the gate control theory, pain a. is caused by gates in the CNS. b. can be blocked or intensified by gates in the CNS. c. is caused by gates in peripheral nerve sensors. d. cannot be affected by learned experiences.

b. can be blocked or intensified by gates in the CNS.

7. The triptans are a class of drugs that bind to selective serotonin receptor sites and cause a. cranial vascular dilation. b. cranial vascular constriction. c. clinical depression. d. nausea and vomiting.

b. cranial vascular constriction.

5. Proper administration of an ordered narcotic a. can lead to addiction. b. should be done promptly to prevent increased pain and the need for larger doses. c. would include holding the drug as long as possible until the patient really needs it. d. should rely on the patient's request for medication.

b. should be done promptly to prevent increased pain and the need for larger doses.

4. Injecting a narcotic into an area of the body that is chilled can be dangerous because a. an abscess will form. b. the injection will be very painful. c. an excessive amount may be absorbed all at once. d. narcotics are inactivated in cold temperatures.

c. an excessive amount may be absorbed all at once.

3. Most narcotics are controlled substances because they a. are very expensive. b. can cause respiratory depression. c. can be addictive. d. can be used only in a hospital setting.

c. can be addictive.

8. The only triptan that has been approved for use in treating cluster headaches as well as migraines is a. naratriptan. b. rizatriptan. c. sumatriptan. d. zolmitriptan

c. sumatriptan.

2. Opioid receptors are found throughout the body a. only in people who have become addicted to opiates. b. in increasing numbers with chronic pain conditions. c. to incorporate pain perception and blocking. d. to initiate the release of endorphins.

c. to incorporate pain perception and blocking.

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? tramadol codeine acetylsalicylic acid methadone

codeine Codeine is often given with acetaminophen for additive analgesic effects. None of the other medications are used in combination with acetaminophen.

6. Migraine headaches a. occur during sleep and involve sweating and eye pain. b. occur with stress and feel like a dull band around the entire head. c. often occur when drinking coffee. d. are throbbing headaches on one side of the head.

d. are throbbing headaches on one side of the head.

Which medications are opioids for which naloxone may be given to counter the effects? Meperidine Naproxen Acetaminophen Ibuprofen

Meperidine

Naproxen has been prescribed to a client whose increasingly severe migraines are interfering with work performance and family life. When providing health education to this client, the nurse should instruct the client to consider what intervention? Take the pills with meals to minimize stomach upset. Arrange for monthly blood work. Report any new onset of constipation promptly. Crush the pills and mix with applesauce to reduce gastritis.

Take the pills with meals to minimize stomach upset. Naproxen should be taken on a full stomach. The pills should not be crushed. Constipation is not a noted adverse effect, and regular blood work is not warranted.

A client who is receiving morphine reports nausea after every dose of medication. What is the nurse's best response to this client? "I'm sorry. That means you won't be able to have any more pain medication." "This is a common side effect of the medication. I will try to make sure you have something to eat when you take the morphine." "I will mark your chart that you are allergic to morphine." "I will ask the health care provider if I can give you acetaminophen for the pain instead of the morphine."

"This is a common side effect of the medication. I will try to make sure you have something to eat when you take the morphine."

A pt has received a narcotic agonist for pain relief. The nurse should monitor the pt for what? A) HTN B) Pupil constriction C) Tachypnea D) Diarrhea

B

A pt w/ a history of migraines has been prescribed sumatriptan. What education should the nurse provide about the safe and effective use of this drug? A) "You'll likely be prescribed doses three times a day, so take it with meals to remind yourself." B) "Take your med as soon as you first sense a migraine coming" C) "Take you med at bedtime to minimize the effects of sedation" D) "Make sure that you don't drink any grapefruit juice while your'e taking this med"

B

According to the gate control theory, pain: A) Is caused by gates in the CNS B) Can be blocked or intensified by gates in the CNS C) Is caused by gates in peripheral nerve sensors D) Cannot be affected by learned experiences

B

Proper administration of an ordered narcotic: A) Can lead to addiction B) Should be done promptly to prevent increased pain and the need for larger doses C) Would include holding the drug as long as possible until the pt really needs it D) Should rely on the pt request for the med

B

The nurse administers Butorphanol 1 mg via nasal spay as prescribed, but the pt reports to significant pain relief. What is the nurse's best action? A) Administer an intramuscular dose of Butorphanol B) Administer another dose in 60 to 90 minutes C) Administer up to 3 repeat doses, 5 minutes apart D) Administer up to 3 repeat doses, 15 minutes apart

B

The nurse observes that a new pt med regimen includes sumatriptan. What assessment should the nurse prioritize? A) Assessing the pt for narcotic withdrawal syndrome B) Assessing the pt for migraine pain C) Assessing the pt lying, sitting and standing BP D) Assessing the pt for respiratory depression

B

The pt tell 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 pt? A) Narcotics used in health care settings are non addictive and are unrelated to drugs used recreationally B) It is extremely unlikely that the pt would become addicted to narcotics used for this purpose C) Any addiction that the pt develops can be treated prior to discharge from the hospital D) The pt need for pain control should be a higher priority than the fear of addiction

B

The triptans are a class of drugs that bind to selective serotonin receptor sites and cause: A) Cranial vascular dilation B) Cranial vascular constriction C) Clinical depression D) Nausea and vomiting

B

Select all that apply: Narcotics are drugs that react w/ opioid receptors throughout the body. Which of the following would the nurse expect to find when assessing a pt who was taking a narcotic? A) Hypnosis B) Sedation C) Analgesia D) Euphoria E) Orthostatic hypotension F) Increased salivation

B C D E

Select all that apply. When assessing a pt reporting of a classic migraine headache, what should the nurse expect to assess? A) Tearing B) Aura C) Nausea D) One-sided pulsating pain E) Sharp, steady eye pain F) Sensitivity to light

B C D F

Select all that apply. The nurse administered a scheduled dose of morphine to a pt and is now reforming a follow-up assessment. The nurse should anticipate a changes in what assessment parameters compared to preadministration? A) Orientation to person, place, and time B) Pain rating C) Temp D) Respiratory rate E) Oxygen saturation

B D

A pt is prescribed ergotamine and requires rapid relief for a migraine w/ a sudden onset. What route should the nurse best administer this med in? A) PO B) Sublingual C) IM D) IV

B; Not available IM or IV

At 10:30 hours, the nurse administers morphine 5 mg IV as prescribed for a pt in pain. The nurse should expect to assess for the drug's maximum effect at what time? A) 10:40 B) 11:10 C) 11:30 D) 10:50

D; peak at 20 min

A group of students are reviewing various methods for assessing pain. The students demonstrate understanding of the material when they identify what as the most relatable method? A) Asking a pt to describe his or her pain B) Percussing or palpating the area where pain is identified C) Assessing the pt vital signs D) Using a pain rating scale

D

A pt has been prescribed morphine for the treatment of pain. The pt states, "Sometimes one dose doesn't work for me, so I have to take another an hour or two later." What is the nurse's best response? A) "Do you not know what would happen if you accidentally overdosed?" B) "That's dangerous, and you should never take your med more often than it's prescribed" C) "Make sure to let your care provider know about that at your next scheduled appointment" D) "Make sure to tell your provider about your need for more meds, because it's unsafe to take it that often"

D

A pt is prescribed Zolmitriptan for migraine headaches. The nurse should instruct the pt to administer this drug by which route? A) Intranasal B) Subcutaneous C) Sublingual D) Oral

D

Migraine headaches: A) Occur during sleep and involve sweating and eye pain B) Occur w/ stress and feel like a dull band around the entire head C) Often occur when drinking coffee D) Are throbbing headaches on one side of the head/Severe unilateral pulsating pain

D

Which pt may benefit from the addition of Codeine to his or her pain control regimen? A) A pt with decreased renal function B) A pt who is experiencing pruritus (itching) C) A pt whose pain is causing insomnia D) A pt who has a dry, persistent cough

D

The nurse is developing a care plan for a pt taking morphine to control pain. What nursing diagnosis would be appropriate if the pt displayed the most common GI adverse effect? A) Imbalanced nutrition: Less than body requirements related to anorexia B) Acute pain related to gastritis C) Fluid volume deficit related to increase bowel motility D) Constipation related to GI effects of med

D; most common adverse effect of narcotics is constipation

True or False: A pt past experience w/ pain has little impact on his or her perception of pain.

False

True or False: Larger doses of narcotic antagonists are needed to reverse the effects of morphine than for pentazocine.

False; larger doses of narcotic antagonists are needed to reverse the effects of pentazocine than morphien

True or False: Beta receptors react w/ endorphins in the periphery to modulate pain transmission.

False; they react w/ enkephalins in the periphery to modulate pain transmission

A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent? Morphine Fentanyl Codeine Hydromorphone

Fentanyl

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

True or False: Morphine, when administered PO, has duration of action of 5-7 hours.

True

False; Mu receptors are primarily pain-blocking receptors

True or False: The sigma receptors are primarily pain-blocking receptors.

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?a) Within one to five minutes, an effect may be seen. b) Slow improvement can be noted throughout the shift. c) Response is highly individualized based upon client weight. d) Improvement will occur within 30 minutes from the time of administration.

a) Within one to five minutes, an effect may be seen

Select all that apply: 2. The nurse would expect to administer a narcotic as the analgesic of choice for which patients? a. A patient with severe postoperative pain b. A patient with severe chronic obstructive pulmonary disease and difficulty in breathing c. A patient with severe, chronic pain d. A patient with ulcerative colitis e. A patient with recent biliary surgery f. A cancer patient with severe bone pain

a,c,f

A 30-year-old client experiences migraines that appear closely linked to her menstrual cycle. What pharmacologic treatment is most specific to this client's particular experience of migraines? estradiol almotriptan ergotamine chlorpromazine

estradiol