Chapter 49 Pharmacology

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."

A postsurgical client has been provided with a morphine patient-controlled analgesic (PCA) but has expressed reluctance to use it for fear of becoming addicted. How can the nurse bestrespond to this client's concerns?

"It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction."

The nurse is caring for a client who is experiencing postoperative pain. The client is prescribed 2.5 mg of morphine IV every 2 hours. Morphine is supplied in 10 mg/mL vials. How many mL should the nurse administer?

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

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

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

A nurse is teaching a client about the use of a PCA infusion pump. The nurse determines the teaching is successful when the client correctly indicates which factor about the system?

The control button activates administration of the drug.

A nurse is caring for a client who is receiving naloxone intravenously. The client develops acute pain while the drug is being administered. Which factor should the nurse investigate first?

The drug was administered as too rapid a dose.

A female client is 12 hours post-appendectomy. Her son asks the nurse to reduce the amount of pain medication that his mother is taking. He states, "When I had my appendix out, I needed half the pain medication that she does." What is the nurse's best response?

"Pain is a subjective experience; we all feel pain differently."

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."

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

Naloxone 2 mg IM has been ordered for a post surgical client. The pharmacy has sent to the floor naloxone 1 mg/mL. How many milliliters of naloxone will the client receive? Record the answer as a whole number.

2

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

Which of the following clients is more likely to have respiratory depression when receiving an opioid medication, requiring administration of an opioid antagonist?

A surgical client who is not used to taking opioid analgesics

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

Ask for pain medication before the pain gets severe.

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.

The nurse is caring for a client who is receiving an opioid. Which actions by the nurse will help decrease the risk of injury to this client? Select all that Client's age Movement of aapply.

Facial expressions Movement of arms and hands Guarding of the leg

The nurse is caring for a client who is receiving an opioid. Which actions by the nurse will help decrease the risk of injury to this client? Select all that apply.

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

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.

A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be important for the nurse to do?

Coach the client to breathe.

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.

A patient is receiving drugs through a PCA infusion pump. Which of the following information should a nurse offer to the patient for proper administration of the drug through the infusion pump?

Control button activates administration of the drug.

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 0 to 10.

A nurse has administered an opioid to a client. Which activities should the nurse encourage the client to do?

Cough and breathe deeply every 2 hours.

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?

Crushing the medication may precipitate an overdose.

A 57-year-old client is given morphine for myocardial ischemic pain. The nurse needs to monitor the client frequently for which adverse effect?

Decreased respiratory rate

The nurse receives a phone call from a male client who has become constipated while taking the opioid analgesic prescribed for his pain. The nurse instructs the client to do what to help relieve this problem? (Select all that apply.)

Drink 2 to 3 quarts of water per day Take a daily stool softener Try to establish a regular bowel routine

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

Drowsiness

A client diagnosed with impaired renal function has been prescribed morphine. How will the client's underlying condition affect the pharmacokinetics of the drug?

Duration of action will be prolonged.

The nurse is caring for a client who has been admitted to the emergency department after a fall. An x-ray indicates that the client has fractured his ankle. Because of a previous stroke, the client does not speak. What other method will the nurse use to assess this client's pain? (Select all that apply.)

Facial expressions Movement of arms and hands Guarding of the leg

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

Fentanyl

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

Fentanyl (Duragesic)

A nursing instructor is preparing a teaching plan for a nursing class on opioid analgesics. Which body system would the nursing instructor describe as not adapting to and compensating for the secondary effects of this class of drugs?

GI system

The nurse is explaining to a client about the analgesic and its possible adverse effects. The client is receiving an opioid analgesic. What would be important to teach this client is a possible adverse effect of this drug?

Hypotension

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

A nurse is caring for the newborn of a suspected opioid-dependent mother. Which assessment findings would the nurse prioritize in the newborn? Select all that apply.

Increased respiratory rate Sneezing Fever

The client tells the nurse that the health care provider described a drug as having "no ceiling effect." How should the nurse respond when the client asks what that means?

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

When teaching a client about patient-controlled analgesia (PCA), which would the nurse integrate into the teaching plan?

Many postoperative clients require less opioid when PCA is used.

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

The client in labor receives morphine every 2 hours to manage labor pain. After 22 hours of labor, the client delivers a healthy neonate. What is the nurse's priority action related to the newborn?

Monitor for opioid effects.

A client with respiratory depression is administered an opioid antagonist by the nurse. What ongoing assessment should the nurse perform when prioritize?

Monitor vital signs every 5 to 15 minutes.

The nurse notes a respiratory rate of 6 breaths/min in a client in the postanesthesia recovery unit. Which drug would the nurse anticipate being given immediately?

Naloxone

A client is experiencing significant respiratory depression and sedation related to morphine administration. The nurse would anticipate administering:

Naloxone.

A client who was recently diagnosed with cancer is now receiving morphine for pain. Since this client has been receiving morphine for only a short time, he is best described by which term?

Opiate naive

Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management?

Opioids

A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments?

Pain intensity, respiratory rate, and level of consciousness

A geriatric client received a narcotic analgesic before leaving the postanesthesia care unit to return to the regular unit. What is the priority nursing intervention for the nurse receiving the client on the regular unit?

Put side rails up and place bed in low position.

An opioid naive patient experiences acute pain after surgery and is put on opioid therapy. Which severe adverse reactions of opioid treatment should the nurse monitor for in the patient?

Respiratory depression

The nurse is caring for a client who is receiving a prescribed opioid analgesic. What reactions that could be related to the drug therapy should prompt the nurse to contact the health care provider immediately? Select all that apply:

Respiratory rate of less than 10 breaths/min Decrease in pulse Blood pressure of 95/65 mmHg

The nurse reviews a client's medication administration record before giving a new medication. For which medication would the nurse question giving the client a dose of tapentadol?

St. John's wort

Keith, 12 years old, is seen in the emergency department for a severe sunburn. He reports pain, which he rates 7/10. What type of pain is he suffering from?

Superficial somatic pain

What client characteristic may contraindicate the use of tramadol for the treatment of a client's pain following traumatic injuries?

The client has a history of crack cocaine addiction.

Of the following clients, which one will be most likely to develop physical dependence upon the opioid analgesic they are receiving for pain management?

The client living with a chronic noncancer-related illness

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?

The client may begin to demonstrate symptoms of withdrawal.

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?

The tablet is an extended release produce and should not be crushed, chewed, or broken.

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.)

Therapeutic response is achieved and discomfort is reduced. An adequate breathing pattern is maintained. Client maintains adequate nutritional status.

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 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.

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 postsurgical client has been prescribed morphine to address the pain that is anticipated over the next 24 to 48 hours. What is the most effective strategy to manage a client's postsurgical pain for the initial 24 to 48 hours?

administering morphine on a scheduled basis and supplementing it with additional morphine when the pain worsens

A client diagnosed with a viral respiratory infection has an intense headache and cough. What drug will best address both of this client's symptoms?

codeine

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

codeine.

While studying pharmacology, the nursing student learns that a naturally occurring narcotic drug with analgesic and antitussive effects is:

codeine.

Which client would the nurse identify as being opioid naive?

one who does not routinely take opioids

A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan

has a shorter half-life than morphine.

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

hypersensitivity to naloxone

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

opioids

Which condition should the nurse monitor for in the client receiving an opioid antagonist?

sweating

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.