Chapter 26 PrepU

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 Blood pressure, pulse, and respirations are important assessments to make prior to administering an opioid antagonist. It is unnecessary to call for a respiratory therapy consult because the cause of the respiratory depression is known. While assessing and managing pain are important postoperative interventions, the respiratory depression-management interventions are the most important ones to be addressed.

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

Binding to serotonin to produce vasoconstriction Sumatriptan 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.

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

Blood pressure After administration of sumatriptan, the nurse should assess for adverse effects. These include increased blood pressure as well as chest pain, shock, dizziness and vertigo. Urine output and head to toe assessment are not warranted. The Glasgow comas scale is used to determine best neurological function and not migraine pain.

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 effects of some opioids may last longer than the effects of naloxone. A repeat dose of naloxone may be ordered if results obtained from the initial dose are unsatisfactory. Therefore, calling for an order would be an appropriate response. Taking no action in light of respiratory depression, or merely continuing to monitor the client, could lead to deterioration in the client's condition. No medication should be administered without a provider order.

A nurse is assessing a client's pain level. Which would be the most appropriate method? Palpate the area where the client says the client has pain. Ask the client to describe their pain in their own words. Review the client's vital signs for changes. Have the client rate it on a scale of 0 to 10.

Have the client rate it on a scale of 0 to 10. The most appropriate method for assessing pain is to have the client rate his pain by using some type of scale. This provides objective evidence of the severity of the pain and provides a basis for comparison later on.

A client who has been prescribed sumatriptan as abortive therapy for migraines reports, "I took that pill about an hour-and-a-half ago, but I feel like a headache is returning. Can I take another pill?" How should the nurse respond? "Wait at least half-an-hour before you take another pill." "You can take another pill now and one more in 1 hour, but then no more." "Yes, it's likely safe to take one more dose of your sumatriptan." "You should probably go to the emergency department."

"Wait at least half-an-hour before you take another pill." Administration of a second dose of the oral preparation of sumatriptan when symptoms return is acceptable but not earlier than 2 hours after the first tablet.

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

"Where exactly are you hurting?" To begin the pain assessment, first determine the location of the pain. Location gives possible clues to the source of the pain and can help identify whether the pain is acute or of a more chronic nature. Questions about preferred treatments and the timing of the pain are appropriate and important, but it is normally necessary to first ascertain the location of the client's pain.

The client is to take almotriptan 6.25 mg orally for a migraine. Almotriptan is sent to the unit from the pharmacy in 12.5-mg tablets. The nurse will administer how many tablet(s)?

0.5 tablet 6.25/12.5 = 0.5 or 1/2 tablet

A client has been prescribed morphine 4 - 6 mg IV q4h PRN. The client reports pain rated at 8/10 and the nurse verifies on the MAR that the client has most often required 6-mg doses. The nurse chooses to administer 6 mg. The drug is available in ampules containing 10mg/mL. How many mL should the nurse withdraw and administer?

0.6 6 mg ÷ 10 mg/mL = 0.6 mL

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

1-2 minutes Naloxone is capable of restoring respiratory function within 1 to 2 minutes of administration. The shorter the time to restoring respiration, the less time the client has to depend on manual or mechanical ventilation, and the better the outcome for the client.

The nurse administers morphine 15 mg oral solution to a client with cancer pain at 09:30. What time should the nurse reassess the client for peak analgesic effect?

10:30 With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours.

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? Suction equipment should be placed in all client rooms as a standard of care postoperatively. 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.

Abrupt reversal of opioid-induced respiratory depression may cause vomiting. 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 nurse is caring for a client diagnosed with migraine headaches. Which nursing intervention should be implemented during an acute headache? Administer diclofenac. Administer naproxen. Administer ergotamine subcutaneously. Administer subcutaneous sumatriptan succinate (Imitrex).

Administer subcutaneous sumatriptan succinate (Imitrex) Sumatriptan succinate (Imitrex) should be administered. Ergotamine is administered sublingually. Diclofenac and naproxen are NSAIDs.

What action should the nurse take when a young adult is prescribed hydromorphone 2 mg orally every 6 hours? Administer the medication as prescribed. Question the health care provider about the frequency. Call the health care provider for a smaller dose. Question the health care provider about the route.

Administer the medication as prescribed. The client should be administered the full dose of medication, which is within dosing recommendations. For this reason, there is no need to question the health care provider.

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? Ibuprofen Aspirin Morphine Celecoxib

morphine Morphine is a narcotic analgesic. Aspirin, ibuprofen, and celecoxib are nonnarcotic analgesics. Aspirin is classified as a salicylate and ibuprofen as a nonsteroidal anti-inflammatory drug (NSAID). Celecoxib is a newer NSAID that acts by inhibiting the cyclo-oxygenase-2 (COX-2) enzyme.

Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which substance? opioids benzodiazepines NSAIDs alcohol

opioids Opioid antagonists may produce withdrawal symptoms in clients physically dependent on opioids. Naloxone has no effect on benzodiazepines, alcohol, or NSAIDs.

A nurse is conducting a presentation for a community group about herbal remedies used for pain relief. Which remedy would the nurse include in the presentation? ginger garlic passionflower ginseng

passionflower Passionflower has been used in medicine to treat pain, anxiety, and insomnia. Ginger, garlic, and ginseng are not used for pain relief.

The nurse is caring for a client who is receiving morphine via patient-controlled analgesia (PCA). In addition to pain assessment, what assessments should the nurse prioritize? respiratory rate and fluid balance level of consciousness and respiratory rate apical heart rate and temperature urine output and inspection of the IV site

Level of consciousness and respiratory rate The nurse should assess respiratory rate and level of consciousness because respiratory depression and sedation are adverse effects of opioid analgesics. None of the other assessment parameters is as likely to be volatile as LOC and respiratory rate.

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

Meperidine Meperidine is an opioid medication for which naloxone is an opioid antagonist, and for which naloxone counters the effects. Acetaminophen is not an opioid medication and naloxone would have no effect on a client receiving this medication. Ibuprofen and naproxen are nonsteroidal anti-inflammatory drugs, and naloxone would have no effect on a client receiving these medications.

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

Methadone Methadone is used for detoxification and temporary maintenance treatment of narcotic addition. Oxycodone is used for the relief of moderate-to-severe pain in adults. Oxymorphone is used for the relief of moderate-to-severe pain in adults, preoperative medication, and obstetrical analgesia. Tramadol is used for the relief of moderate-tomoderately severe pain, and its use should be limited in clients with a history of addiction.

A nurse working in a alcohol detoxification clinic may use what to treat clients with alcohol dependence? Nifedipine (Procardia) Nalmefene (Revex) Naloxone (Narcan) Naltrexone (Depade)

Naltrexone (Depade) Naltrexone is used primarily to treat alcohol dependence.

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

Oral Zolmitriptan is administered orally only.

A client who lives with chronic pain has just learned that she is pregnant. What narcotic analgesic is most appropriate for this client? Oxycodone Fentanyl Propoxyphene Sufentanil

Oxycodone Oxycodone is classified as a pregnancy category B drug. Fentanyl, meperidine, and sufentanil are classified as pregnancy category C drugs.

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? myocardial infarction. pneumonia. renal impairment. hypersensitivity to the drug.

pneumonia Respiratory depression is a common adverse effect of morphine. If the client gets a cold, as the nasal congestion can be a sign, this respiratory depression could cause retained secretions and put the client at greater risk for developing pneumonia. The drug does not cause myocardial infarction or renal impairment. A common cold is not known to cause hypersensitivity to the morphine

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? hypersensitivity to the drug. myocardial infarction. pneumonia. renal impairment.

pneumonia Respiratory depression is a common adverse effect of morphine. If the client gets a cold, as the nasal congestion can be a sign, this respiratory depression could cause retained secretions and put the client at greater risk for developing pneumonia. The drug does not cause myocardial infarction or renal impairment. A common cold is not known to cause hypersensitivity to the morphine.

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?

The route of administration Patient response to morphine depends on the route of administration and the dosage.

An 80-year-old client has been prescribed oxycodone every 12 hours for severe, noncancerous, chronic pain. The client tells the nurse of difficulty swallowing and asks if the medication tablet can be crushed before swallowing. What will the nurse need to advise the client? Crushing the tablet increases the drug's efficacy and so dosage would need to be decreased. The effect of the medication should not be affected if crushed and ingested. The tablet is an extended release produce and should not be crushed, chewed, or broken. It would be better to split the medication in half before swallowing.

The tablet is an extended-release produce and should not be crushed, chewed, or broken. The nurse should explain that oxycodone is intended to provide around-the-clock pain relief by releasing the drug slowly over time and should not be crushed, chewed, or broken. Neither crushing or splitting the tablet would increases the drug's efficacy but neither are safe options.

A family member of a client in the emergency department reports that the client has been illegally using fentanyl. The nurse should prioritize assessment of what vital sign to assess for overdose? temperature blood pressure heart rate respiratory rate

respiratory rate All the client's vital signs are important areas of assessment. However, opioids have a profound effect on respiratory rate, and this is a priority assessment.

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

"It produces vascular constriction of cranial blood vessels." Sumatriptan binds to the serotonin receptors 5-HT1D, producing vascular constriction of the cranial blood vessels and relieving the pain of a migraine headache. It also relieves the nausea, vomiting, photophobia, and phonophobia that accompany the migraine headache. Sumatriptan does not cause bronchiole constriction or impair the reuptake of norepinephrine. It does not relax smooth muscles of the cardiovascular system.

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 ask the health care provider if I can give you acetaminophen for the pain instead of the morphine." "I will mark your chart that you are allergic to 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." Nausea is a common side effect of morphine. Giving it with food helps to reduce the occurrence of the problem.

The nurse is caring for a patient who is suffering from postoperative pain. The physician orders 2.5 mg of morphine IV q2h. Morphine is supplied in 10 mg/mL vials. How many mL will the nurse administer in each dose? 2.5 mL 1 mL 0.5 mL 0.25 mL

0.25 mL Since 1 mL contains 10 mg of morphine, the nurse will administer 0.25 mL to deliver 2.5 mg of morphine (2.5 mg ÷ 10 mg/mL = 0.25 mL)

A hospital client is reporting pain, and the provider has prescribed 3 mg hydromorphone SC. The medication is available in single-use vials of 10 mg/1 mL. How many milliliter of hydromorphone should the nurse draw up? Record your answer to the nearest tenth.

0.3 Rationale: The nurse should divide 3 mg by 10 mg/mL, resulting in 0.3 mL.

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 half of the prescribed pain medication. Administer the pain medication as ordered. Reassess pain level in one hour. Tell the client he does not look like he needs any pain medication.

Administer the pain medication as ordered. Pain is what the client says it is. If the client states pain is a "10" and is requesting medication, the nurse should medicate as per orders. The client laughing and visiting may be a method of coping with the pain. The nurse should demonstrate a nonjudgmental attitude to build a trusting relationship. The nurse cannot alter the dosage of medication without consulting the health care provider.

A postsurgical client has been receiving morphine by patient-controlled analgesic for 2 days. What action by the nurse best addresses potential adverse effects? encouraging active range of motion exercises administering a stool softener as prescribed auscultating the client's lung for adventitious sounds applying calf compressors as prescribed

Administering a stool softener as prescribed Narcotics create a significant risk for constipation, and relevant nursing interventions are required. Respiratory rate must be closely monitored, but there is not a high likelihood of adventitious lung sounds. There is no obvious risk for venous stasis that would require calf compressors. Exercises have general benefits but do not address the particular adverse effects of morphine.

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? Administer the drug through the IV route. Consult with the prescriber about lowering the dosage of the drug. Administer an antacid with the drug. Provide aggressive bowel program.

Consult with the prescriber about lowering the dosage of the drug. The nurse should lower the dosage of the drug when caring for a client with renal impairment who has been prescribed an opioid analgesic, but only after consulting with the prescriber and obtaining a prescription to do so. The nurse has to provide an aggressive bowel program to clients who experience an adverse reaction on their GI system due to the action of the opioid analgesics. Use of an antacid is recommended only if prescribed by the primary health care provider under specific circumstances. The nurse need not administer the drug through the IV route for a client with renal impairment who has been prescribed opioid analgesics.

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? Vital signs Pain scale Glasgow coma scale Subjective assessment

Pain scale The method the nurse should prioritize in this situation is using the pain scale. Following the administration of the acetaminophen-aspirin-caffeine combination, the client should exhibit diminished pain. The nurse assesses for pain using the pain scale. A subjective assessment would involve more than just the pain scale. Assesing vital signs would be an objective assessment and not necessarily confirm therapeutic effects The Glasgow coma scale would not be indicated for migraine headache.

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? Adverse effects of the drug Tolerance to the drug Physical dependence on the drug Addiction to the drug

Physical dependence on the drug If morphine use lasts longer than 3 months, then physical dependence will occur. Dependence is characterized by a withdrawal or abstinence syndrome when morphine is discontinued; it represents an exaggerated rebound from its acute effects. Physical dependence is not the same as tolerance or addiction. Tolerance means that the body has become accustomed to the effects of a substance and that the client must use more of it to achieve the desired effect, while addiction involves compulsive use of the drug for a secondary gain, not for pain control.

Prior to the administration of an opioid antagonist, what must the nurse obtain? (Select all that apply.) Pain assessment Respiratory rate Blood pressure Blood glucose Pulse

Respiratory rate Blood pressure Pulse Prior to the administration of an opioid antagonist, the nurse must obtain the client's blood pressure, pulse, and respiratory rate.

A client with a history of migraines has been prescribed sumatriptan and is experiencing relief. What physiologic response is the client most likely experiencing?

Vasoconstriction of cranial blood vessels Sumatriptan binds to serotonin receptors to cause vasoconstrictive effects on cranial blood vessels. It does not directly influence endorphin levels. Stimulation of A-delta and C fibers causes increased, not decreased, pain levels.

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. a reduction in the client's rating of their pain. management of alcohol withdrawal symptoms. alertness and improve memory function.

a return to normal respiratory rate, rhythm, and depth. 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.

The nurse explains to a client being treated for migraines that there are adverse reactions associated with the use of sumatriptan. The nurse would identify which reaction(s)? Select all that apply. diarrhea burning sensation numbness dizziness chest tightness

dizziness chest tightness burning sensation numbness Sumatriptan is in a class of medications called selective serotonin receptor agonists. It works by narrowing blood vessels in the head, stopping pain signals from being sent to the brain, and blocking the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Central nervous system effects may include numbness, tingling, burning sensation, feelings of coldness or strangeness, dizziness, weakness, myalgia, and vertigo. Gastrointestinal effects such as dysphagia and abdominal discomfort may occur. Cardiovascular effects can be severe and include blood pressure alterations and tightness or pressure in the chest. Diarrhea is not an adverse reaction.

The nurse is preparing to administer morphine IV to a client with multiple trauma. Before administering the morphine, what common adverse effect should the nurse inform the client about? occipital headache photophobia drowsiness paresthesia in lower extremities

drowsiness Common adverse effects include dizziness, drowsiness, and visual changes. Morphine does not commonly cause paresthesia in the lower extremities, an occipital headache, or photophobia.

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? situational low self-esteem related to migraine headaches ineffective role performance related to migraine headaches spiritual distress related to migraine headaches ineffective health maintenance related to migraine headaches

ineffective role performance related to migraine headaches Many nursing diagnoses likely apply to this client's situation, but there is evidence that she grieves her inability to perform a caregiving role for her grandchildren. There is no evidence that the client's health maintenance is inadequate or that she has low self-esteem. Spiritual distress is also not in evidence.

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 The priority nursing action will be to make sure that the side rails are up. Meperidine can cause dizziness and sedation, which increase the risk of the client falling. The side rails should be up to remind the client that she should not get out of bed without help. Closing the draperies, checking the temperature of the room, and making sure the client is comfortable creates an environment that will enhance the efficacy of the medication therapy but are not the priority actions.