Chapter 26: Narcotics, Narcotic Antagonists and Antimigraine Agents, Prep U Pathopharmacology

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

Assess the client's other vital signs.

When describing the action of ergot derivatives, the nurse would incorporate understanding of:

Blockage of alpha-adrenergic receptors

The nurse is caring for four clients. For which client would the nurse question the health care provider's order of IV morphine?

A 78-year-old with osteoarthritis

The nurse is caring for a client who has been prescribed a nonopioid analgesic in addition to a narcotic analgesic. What effect will the nurse expect?

Additive effect

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

codeine.

The anatomy and physiology instructor is talking about pain sensations. What responds to stimulation by generating nerve impulses that produce pain sensations?

A-delta sensory nerves

A client's healthcare provider has prescribed meperidine 75 mg PO q4h PRN for the client's chronic pain. What education should the nurse provide to this client regarding this medication?

"Avoid drinking alcohol while taking meperidine."

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

"I can take my over-the-counter cold remedies in addition to this drug for cold symptoms."

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

A client with a history of migraines has been prescribed sumatriptan. What education should the nurse provide about the safe and effective use of this drug?

"Take your medication as soon as you first sense a migraine coming."

A client has sought care for the treatment of migraines that have become increasingly severe. The care provider has prescribed abortive therapy. What should the nurse teach the client about this drug regimen?

"Take your medication at the first sign of a migraine."

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

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

The nurse administers butorphanol 1 mg via nasal spray as prescribed but the client reports no significant pain relief. What is the nurse's best action?

Administer another dose in 60 to 90 minutes

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

Administer subcutaneous sumatriptan succinate (Imitrex).

A client who is receiving morphine reports nausea after every dose of medication. What is the nurse's best response to this client?

"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 nurse has entered a client's room at the beginning of a shift to quickly assess the client'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?

"Where exactly are you hurting?"

After administered a dose of ergotamine to a client, what assessments should the nurse prioritize to assure safe care? Select all that apply.

-heart rate -blood pressure

The health care provider has ordered 0.2 mg naloxone to be administered intramuscularly stat. The pharmacy has available naloxone 0.4 mg/mL. How much naloxone will the nurse administer to the client?

0.5 mL

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

At 1030, the nurse administers morphine 5 mg IV as prescribed for a client in pain. The nurse should expect to assess for the drug's maximum effect at what time?

1050

Naloxone 2 mg IM has been ordered for a post surgical client. The pharmacy has sent to the floor naloxone 1 mg/mL. How much naloxone will the client receive?

2 mL

The nurse administers an oral dose of morphine to a client at 3:00 PM. The nurse would expect the drug to peak at which time?

4:00 PM

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

An 88-year-old client with failure to thrive

The nurse has administered a dose of naloxone 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?

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

The nurse educates the client who has just been given a prescription for ergotamine to call the health care provider if the client develops which symptoms? (Select all that apply.)

Chest pain Weakness Palpitations

A nurse is caring for a client with renal impairment. The client has been prescribed an opioid analgesic. Which nursing intervention would be most appropriate?

Consult with the prescriber about lowering the dosage of the drug.

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

Fentanyl (Duragesic)

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

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

The client returns to the unit following surgery. The client reports being in pain. After checking the medication administration record in the client's chart, the nurse sees that the client has not received the morphine the health care provider has ordered for over an hour. As the order reads q 1-2 hours, the nurse administers the low dose of the morphine. The PACU nurse calls to tell the floor nurse that the nurse forgot to chart the last dose of morphine the client had received just before the client was transferred to the floor. What drug would the floor nurse be sure to have on the unit that is used to reverse the effects of opioids?

Naloxone hydrochloride (Narcan) tartrate

The pathophysiology of pain begins with a signal from what source?

Nociceptors

The nurse is providing health education to a client prescribed almotriptan for the treatment of migraines. The nurse should caution the client about what potential adverse effects?

Numbness and chest tightness

A client is to receive naltrexone. The nurse would expect to administer this drug by which route?

Oral

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

Sweating, tachycardia, and increased blood pressure

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?

The client's stool tests positive for occult blood.

A woman has presented to the emergency department after cutting her hand badly on the blade of a food processor. The pain that this woman is currently experiencing is the result of

activation of the woman's delta and C nociceptors.

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?

bowel patterns

A nurse is caring for a client with renal impairment. The client has been prescribed an opioid analgesic. Which nursing intervention would be most appropriate?

consult with the prescriber about lowering the dosage of the drug

The nurse is administering morphine to a trauma client for acute pain. What is a common side effect of morphine?

drowsiness

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

duration of action will be prolonged

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

Naloxone will reverse the effects of which drugs? Select all that apply.

fentanyl codeine

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

What action should the nurse take when administering meperidine 75 mg IM every 4 hours to a young adult?

give the medication as prescribed

A nurse is assessing a client's pain level. Which would be the most appropriate method?

have the client rate it on a scale of 1 to 10

A client has been prescribed naproxen for the treatment of migraines. The nurse who will administer the medication is aware that the black box warning that accompanies this drug will consequently prioritize what assessment?

heart rate and rhythm

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

hypersensitivity to naloxone

The nurse is caring for a client taking pentazocine/naloxone. What would be an appropriate nursing diagnosis for this client's care plan?

Impaired gas exchange related to respiratory depression

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?

Increase in the client's pain rating

"I can take my over-the-counter cold remedies in addition to this drug for cold symptoms."

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

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?

ineffective role performance related to migraine headaches

How do opioid analgesics relieve moderate-to-severe pain?

inhibiting the transmission of pain signals from peripheral tissues to the brain

A client has been administered an opioid. For what effect should the nurse regularly assess?

level of consciousness (LOC)

The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse?

level of consciousness and respiratory rate

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?

make sure the side rails are up.

Which medications are opioids for which naloxone may be given to counter the effects?

meperidine

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

methadone

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?

monoamine oxidase (MAO) inhibitor

Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which substance?

opioids

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

oral

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?

pain scale

The nurse should teach the client prescribed chlorpromazine hydrochloride that this medication is likely to cause what reaction?

reduction of light-sensitivity experienced during migraines

An adult client with a history of migraines has been prescribed propranolol. The nurse should identify what goal of therapy when planning care for a client prescribed propranolol?

the client will experience significantly fewer migraines

When teaching the client how to safely administer prochlorperazine, the nurse should emphasize what teaching point?

the importance of taking the pill whole and not crushing or splitting it

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:

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

Opioids have adverse effects on what body systems that are potentially life threatening? Select all that apply.

-central nervous (CNS) -respiratory

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

a return to normal respiratory rate, rhythm, and depth

The nurse should recognize that naproxen achieves a therapeutic effect through which means?

inhibiting the synthesis of COX-1 and COX-2

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?

using a pain rating scale

The nursing instructor is talking with the junior nursing class about migraine headaches. What would the instructor tell the students is the method of action of Sumatriptan?

vasoconstrictive on cranial blood vessels

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

vital signs

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?

within one to five minutes, an effect may be seen

A nurse suspects that a client who has been receiving morphine is exhibiting early symptoms of abstinence syndrome. Which finding would the nurse most likely be assessing?

yawning rhinorrhea sweating

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?

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

To decrease the risk of injury to a client taking an opioid, what should the nurse do?

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 to administer an opioid antagonist. The nurse knows that the valid reasons for administering this type of medication include what reasons?

Postoperative acute respiratory depression Suspected or known acute opioid overdosage Adverse effects related to opioid administration

The nursing instructor is talking with the junior nursing class about migraine headaches. What would the instructor tell the students is the method of action of Sumatriptan?

Vasoconstrictive on cranial blood vessels

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?

Vomiting

A group of nursing students are reviewing information about how pain is classified. The group demonstrates understanding when they identify which type based on duration? Select all that apply.

acute chronic

The nurse enters the client's room to see how the client's pain level is because PRN Demerol can be given. The client is sitting up in bed laughing and visiting with family. The client states that the pain is a "10" on a pain scale of 0 to 10. What is the best response by the nurse?

administer the pain medication as ordered

A class of new nursing students is learning how to administer medications to clients. What should the instructor teach the students about giving opiates?

assess the respiratory rate before giving a dose of opiates

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

assessing the client for migraine pain

A client suffering from migraine headaches is prescribed sumatriptan. What is the action of the drug?

binding to serotonin to produce vasoconstriction

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?

respiratory rate

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?

route of administration

Morphine, the prototype drug for opioid analgesics, is given for both acute and chronic pain. The patient's response to the drug depends on the:

route of administration.

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