Pharm 2 Chapter 15 Prep U
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 best respond 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."
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.
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?"
The nurse is caring for client who has undergone multiple surgeries after a motor vehicle crash. Intravenous morphine effectively controlled pain for the first several days, but the client states that pain is still a 10 on a 0-10 scale with the maximum dosage of medication. What is the best response by the nurse?
"You have developed a tolerance to the morphine sulfate.
What order for naloxone would be appropriate for the nurse to administer for reversal of opioid effects?
0.1 mg IV repeat every 2 to 3 minutes
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
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 many mL will the nurse administer to the client?
0.5 mL
The nurse should monitor the client more frequently and notify the primary health care provider immediately if a client's respiratory rate falls below how many breaths per minute when an opioid analgesic is administered?
10 breaths/min
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?
1100
A 62-year-old patient has been prescribed a fentanyl transdermal patch for chronic cancer pain. The client asks the nurse how long it will take for her to experience pain relief. The nurse will instruct the client that she should feel pain relief in approximately what timeframe?
12 to 24 hours
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.) - Client reports decreased bowel movements. - An adequate breathing pattern is maintained. - Therapeutic response is achieved and discomfort is reduced. - Client maintains adequate nutritional status. - Client reports decreased urinary output.
An adequate breathing pattern is maintained, Therapeutic response is achieved and discomfort is reduced, Client maintains adequate nutritional status.
A hospital client's pain is rated at 9/10, and the nurse is preparing to administer 4 mg hydromorphone PO as prescribed. What are the appropriate interventions by the nurse prior to administering the medication?
Assess the client's baseline respiratory rate.
The nurse is caring for a postoperative client receiving an opioid medication for pain management. The nurse finds the client lethargic with a respiratory rate of 6 breaths per minute. Which of the following actions should be performed first?
Attempt to arouse the client and coach his or her breathing pattern.
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 teaching a client about the prescription for acetaminophen to be taken at home. This medication consists of acetaminophen and what other likely drug that enhances the analgesic effect of acetaminophen?
Codeine
Tylenol #3 consists of acetaminophen (Tylenol) and another medication. What is the other medication?
Codeine
A full-term infant was born 1 minute ago and has a heart rate of 110 bpm, blue hands and feet, poor tone, and a feeble cry. What should the nurse do first?
Dry and stimulate the newborn.
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.
When providing care to a client receiving an opioid analgesic, which would be most important for the nurse to do if the client's respiratory rate drops?
Encourage the client to take deep breaths.
Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse is teaching the client upon discharge to avoid alcohol while taking this medication because it can cause which?
Respiratory depression
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
The client has been diagnosed with a mild sprain in his left ankle. He has been taking acetaminophen and is currently rating his pain as 2-3 on a 0-10 scale ("0" indicating no pain). According to the World Health Organization's (WHO) analgesic protocol, what level (step) of pain control is the client demonstrating?
Step 1
Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness?
They should be given on a regular schedule, around the clock.
The nurse has just administered an opioid antagonist medication. Which side effect might the nurse anticipate that the client will experience? (Select all that apply.) - Decreased blood pressure - Tremors - Nausea and vomiting - Bradycardia - Sweating
Tremors, nausea ad vomiting, sweating
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.
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
A group of nursing students are reviewing information about opioid analgesics. The students demonstrate understanding of the information when they identify which as the gold standard in pain management?
morphine sulfate
A terminally ill client has developed increased respiratory secretions and labored breathing. Which medication is prescribed to decrease these symptoms?
morphine sulfate
A new graduate nurse lists which of the following as uses for opioid antagonists? (Check all that apply.) - postoperative acute respiratory - depression - postoperative nausea - pain control - suspected acute opioid overdosage - opioid adverse effects (reversal)
postoperative acute respiratory depression, suspected acute opioid overdosage, opioid adverse effects (reversal)
After obtaining the history of a client who is prescribed opioid therapy, the nurse determines that the client is opioid naive. The nurse would be especially alert for which effect after the client receives the prescribed opioid?
respiratory depression
The nurse administering an opioid antagonist to a client who is physically dependent on the opioid should expect to see which?
withdrawal symptoms
Which medications are opioids for which naloxone may be given to counter the effects?
Meperidine
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 is in the end of life and has developed increased respiratory secretions and labored breathing. The health care provider will order which medication to decrease these symptoms?
Morphine sulfate
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
What is the mechanism of action of naloxone (Narcan), an opioid antagonist?
Displaces opioids by more effectively binding to opioid receptor sites
A nurse administrates an opioid medication to a client. For what side effect should the nurse assess?
Drowsiness
A client has been administered an opioid. For what effect should the nurse regularly assess?
Level of consciousness (LOC)
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.
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 hypersensitive to the opioid antagonist.
The nurse is providing client teaching about a prescribed opioid analgesic. When monitoring the client for potential adverse effects, what assessment should the nurse prioritize?
blood pressure
The client is 65-years-old and has a diagnosis of cancer. Morphine has been ordered for pain management. Before the administration of morphine, the initial action of the nurse would be to check which?
respiratory rate, depth, and rhythm.
