Pharm II Prep-U Ch.26 Opioid Agonists, Opioid Antagonists, and Antimigraine Agents

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 Rationale: If there is 0.4 mg in 1 mL and the nurse wishes to give 0.2 mg, then the nurse should withdraw 1/2 of 1 mL or 0.5 mL.

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 mL Rationale: 6 mg ÷ 10 mg/mL = 0.6 mL

A client is to receive naltrexone. The nurse would expect to administer this drug by which route? A. Oral B. Intramuscular C. Intravenous D. Subcutaneous

A. Oral Rationale: Naltrexone is administered orally.

The nurse administers an oral opioid analgesic to a client at 6 PM for pain documented as 6 on a scale of 0 to 10. At 6:30 PM, the client states that the pain level is 3 on a scale of 0 to 10, and that level is acceptable to him. The client asks the nurse why another assessment was necessary after the administration of the pain medication. What is the nurse's best response to this client about proper pain management? A. "We assess every client in relation to pain, initially to determine appropriate interventions and later to determine whether the interventions were effective in preventing or relieving pain." B. "We assess every client in relation to pain according to hospital policy." C."We assess every client in relation to pain, initially to determine if the medication is the correct dose." D."We assess every client in relation to pain and their activity level."

A. "We assess every client in relation to pain, initially to determine appropriate interventions and later to determine whether the interventions were effective in preventing or relieving pain." Rationale: The nurse must assess every client in relation to pain, initially to determine appropriate interventions and later to determine whether the interventions were effective in preventing or relieving pain.

A client receiving an opioid for pain management develops respiratory depression. Which action will the nurse take when administering intravenous naloxone as prescribed? A. Assess if an additional dose is required. B. Evaluate the effectiveness after 30 minutes. C. Prepare to administer an additional dose through inhalation. D. Provide a non-narcotic pain medication before the naloxone.

A. Assess if an additional dose is required. Rationale: Naloxone is an opioid antagonist that reverses the analgesia and the central nervous system effects of opioids. Because naloxone has a shorter duration of action than opioids, repeated doses are usually required. After initial administration, the nurse will assess the client to determine whether an additional dose is required. The effects of the medication occur about 2 minutes after an intravenous dose, so waiting 30 minutes to evaluate effectiveness is inappropriate. The American Heart Association does not recommend the inhaled route to treat life-threatening opioid-related respiratory depression. It is not recommended to provide a non-narcotic pain medication before giving the naloxone.

To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.) A. Assist client with hall-walking activities. B. Keep the lights in the client's room turned down. C. Assist client from their bed to the toilet. D. Assist client with rising from a lying position. E. Advise the client to stay in bed all night.

A. Assist client with hall-walking activities. C. Assist client from their bed to the toilet. D. Assist client with rising from a lying position. Rationale: To decrease the risk of injury to a client taking an opioid, the nurse should assist the client with ambulatory activities and with rising from a sitting or lying position. The nurse should also keep the client's room well-lit during daytime hours, keep the client's room free of clutter, and advise the client to seek assistance when getting out of bed at night.

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

A. Fentanyl Rationale: Fentanyl is available as a transdermal patch.

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? A. Respiratory rate B. Pulse C. Temperature D. Heart rate

A. Respiratory rate Rationale: The first sign of narcotic overdose is often respiratory depression. Therefore, monitoring the client's vital signs, particularly respirations, is extremely important when administering narcotics.

The nurse is to administer an opioid antagonist. The nurse knows that the valid reasons for administering this type of medication include what reasons? (Select all that apply.) A. Suspected or known acute opioid overdosage B. Reduction of acute postoperative surgical site pain C. Postoperative acute respiratory depression D. Adverse effects related to opioid administration E. Enhancement of an opioid analgesic physiologic effect

A. Suspected or known acute opioid overdosage C. Postoperative acute respiratory depression D. Adverse effects related to opioid administration Rationale: Opioid antagonists are used for the treatment of acute respiratory depression, overdosage, and adverse effects of opioid administration. Administration often counters the pain-relieving effects of an opioid medication and does not enhance opioid effects. These are not actions of an opioid antagonist.

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? A. The client may begin to demonstrate symptoms of withdrawal. B. During pain assessment, the client may report less pain. C. Multiple doses may be needed to be therapeutic. D. Double the standard dosage of the medication may be needed.

A. The client may begin to demonstrate symptoms of withdrawal. Rationale: The client may begin to demonstrate symptoms of withdrawal when he or she has a history of opioid abuse and is administered an opioid antagonist. The other answers are incorrect. In fact, clients will likely have increased pain due to antagonistic effects of the drug. The standard dosage and a single dose will be administered even with a history of opioid abuse.

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? A. The route of administration B. The patient's disease process C. The patient's insistence on receiving the drug D. The patient's gender

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

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.) A. Therapeutic response is achieved and discomfort is reduced. B. Client maintains adequate nutritional status. C. Client reports decreased urinary output. D. Client reports decreased bowel movements. E. An adequate breathing pattern is maintained.

A. Therapeutic response is achieved and discomfort is reduced. B. Client maintains adequate nutritional status. E. An adequate breathing pattern is maintained. Rationale: The plan of care is considered effective when therapeutic response is achieved and discomfort is reduced; an adequate breathing pattern is maintained; the number of bowel movements is maintained; and adequate nutritional status is maintained. Urinary output should mirror increased fluid intake (increased fluid in, increased fluid out).

The nurse administers hydromorphone IV to the postoperative client as prescribed. What is the best method for the nurse to evaluate the client's response to the medication? A. Use a pain assessment tool before and 30 minutes after administration. B. Ask the client if the medication has been effective. C. Assess the client's vital signs before and after drug administration. D. Observe the client's behavior without the client's awareness, 30 minutes after administration.

A. Use a pain assessment tool before and 30 minutes after administration. Rationale: A standard pain assessment tool should be used both pre- and postanalgesia. This type of data is more accurate than asking the client a yes/no question about the effectiveness of the medication. The nurse should observe the client's response, but this does not provide the most accurate assessment data. Similarly, vital signs should be monitored, but trends do not necessarily demonstrate effectiveness.

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? A. Using a pain rating scale B. Asking a client to describe his or her pain C. Assessing the client's vital signs D. Percussing or palpating the area where pain is identified

A. Using a pain rating scale Rationale: A pain rating scale is the most reliable method because it provides measurable evidence of pain severity. A client's description of pain is useful, but does not provide objective or quantifiable data over time. Although percussing or palpating provides information, it would increase the client's pain and be inappropriate. Vital sign changes occur for numerous reasons and are not the best indicator of pain in clients who can speak.

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

A. administering a stool softener as prescribed Rationale: 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.

Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which substance? A. opioids B. alcohol C. NSAIDs D. benzodiazepines

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

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

B. Have the client rate it on a scale of 0 to 10. Rationale: 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 is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment? A. Oxymorphone B. Methadone C. Oxycodone D. Tramadol

B. Methadone Rationale: Methadone is used for detoxification and temporary maintenance treatment of narcotic addiction. 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 to moderately severe pain, and its use should be limited in clients with a history of addiction.

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.) A. Hirsutism B. Palpitations C. Weakness D. Jaundice E. Chest pain

B. Palpitations C. Weakness E. Chest pain Rationale: Ergotamine may cause both cardiovascular and musculoskeletal adverse effects. The cardiovascular adverse effects of ergotamine include absence of pulse, bradycardia, cardiac valvular fibrosis, cyanosis, edema, heart rhythm changes, gangrene, hypertension, ischemia, precordial distress, chest pain, tachycardia, and vasospasm. Musculoskeletal adverse effects include muscle pain, numbness, paresthesia, and weakness.

What factors affect how the patient will experience and respond to pain? Select all that apply. A. It is a conscious response that the patient has a choice about. B. Past experience with pain C. Learned behavior from childhood D. Cultural expectation about how one should respond to pain

B. Past experience with pain C. Learned behavior from childhood D. Cultural expectation about how one should respond to pain Rationale: The experience of pain is personal and subjective; however, how people respond to painful stimuli reflects what they have learned about pain from their families, society, and cultures of origin. Learned messages about pain are indirect, and people react to them subconsciously. These messages include reasons that people experience pain and what are considered appropriate responses to it.

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? A. The client does not have high blood pressure. B. The client is not hypersensitive to the opioid antagonist. C. The client is not lactating. D. The client does not have a cardiovascular disease.

B. The client is not hypersensitive to the opioid antagonist. Rationale: The nurse should confirm that the client is not hypersensitive to the opioid antagonist to ensure that its administration is not contraindicated in the client. Elevated blood pressure is an adverse reaction of opioid antagonists, but administration of these drugs is not known to be contraindicated in clients with high blood pressure. Opioid antagonists are used cautiously in clients who are lactating and in clients who have cardiovascular disease, but presence of these conditions does not contraindicate the use of opioid antagonists.

When describing the actions of various drugs, a nursing instructor defines the drug as a substance that counteracts the action of something else. The instructor is describing which action? A. analgesic B. antagonist C. agonist D. anti-inflammatory

B. antagonist Rationale: An antagonist is defined as a substance that counteracts the action of something else. An agonist is a chemical that binds to a receptor and activates the receptor to produce a biologic response. An analgesic is given to relieve or reduce pain, and an anti-inflammatory is given to reduce the inflammation that can cause pain.

The nurse is caring for a client whose pain is being treated with pentazocine. What would be an appropriate nursing diagnosis for this client's care plan? A. risk for autonomic dysreflexia related to central nervous system depression B. impaired gas exchange related to respiratory depression C. risk for infection related to immune system depression D. diarrhea related to adverse gastrointestinal effects

B. impaired gas exchange related to respiratory depression Rationale: Nursing diagnoses may include impaired gas exchange related to respiratory depression. The drug is more likely to cause constipation due to slowing of the GI tract instead of diarrhea. The drug has no effect on immune function. Autonomic dysreflexia is not caused by CNS depression and is limited to clients with spinal cord injuries.

A nurse is providing health education to a client who has been recently diagnosed with migraines. What should the nurse include in the teaching? A. the need to maximize light exposure to prevent migraines B. the importance of avoiding foods that may precipitate migraines C. the role of herbal supplements in preventing migraines D. the importance of limiting all forms of psychosocial stress

B. the importance of avoiding foods that may precipitate migraines Rationale: The nurse should advise the client to avoid foods that precipitate migraine effects, including aged cheeses, fermented foods, aspartame, monosodium glutamate, and chocolate. Stress is not a known causative factor. Herbal supplements and increased light exposure are unlikely to be of benefit.

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? A."Take a dose of sumatriptan after you feel that you're unable to endure the pain of your migraine." B."Lie down when you feel a migraine coming on and take some sumatriptan around 30 minutes later." C. "Take this drug as soon as you feel the first signs of a migraine." D."Take a dose of sumatriptan each morning when you suspect there's a chance of having a migraine."

C. "Take this drug as soon as you feel the first signs of a migraine." Rationale: Administer sumatriptan as soon as the headache begins. Sumatriptan is more efficacious when given before the headache escalates. However, it is not normally taken on a prophylactic basis.

The nurse is teaching a client about the safe and effective use of ergotamine in the home setting. What instruction should the nurse provide? A. "This drug may give your urine an orange tint, but this is normal." B. "It's best to take this medication with meals so your stomach doesn't get upset." C. "When you take the pill, place it under your tongue and then let it dissolve completely." D. "Take this medication at the same time every day to maximize its effectiveness."

C. "When you take the pill, place it under your tongue and then let it dissolve completely." Rationale: Ergotamine is administered sublingually. It is an abortive treatment that is not taken at the same time each day. It is not noted to discolor the urine or cause stomach upset.

A hospice patient has been ordered morphine 5 mg PO every 2 hours. As provided, the medication contains 10 mg/mL. How many mL will be administered? A. 2 mL B. 1 mL C. 0.5 mL D. 0.25 mL

C. 0.5 mL Rationale: 5 mg/X=10 mg/mL. The calculation results in .5 mL. The administration of 0.25, 1, or 2 mL is incorrect.

A nurse is caring for a client diagnosed with migraine headaches. Which nursing intervention should be implemented during an acute headache? A. Administer diclofenac. B. Administer naproxen. C. Administer subcutaneous sumatriptan succinate (Imitrex). D. Administer ergotamine subcutaneously.

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

The nurse is giving instructions to a client who has just been prescribed sumatriptan for the treatment of migraine headaches. The client will be instructed to take this medication at what time? A. Every 5 minutes until the pain goes away B. Every day at the same time C. At the onset of migraine symptoms D. After other migraine medications have been ineffective

C. At the onset of migraine symptoms Rationale: Sumatriptan should be taken at the onset of migraine symptoms.

When describing the action of ergot derivatives, the nurse would incorporate understanding of: A. Inhibition of opioid receptors B. Interference with dopamine C. Blockage of alpha-adrenergic receptors D. Interference with cerebral enzyme systems

C. Blockage of alpha-adrenergic receptors Rationale: Ergot derivatives block alpha-adrenergic and serotonin receptor sites in the brain to cause constriction of cranial vessels, a decrease in cranial artery pulsation, and a decrease in the hyperperfusion of the basilar artery bed.

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

C. Blood pressure Rationale: 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.

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

C. Consult with the prescriber about lowering the dosage of the drug. Rationale: 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.

Which would a nurse have readily available should a client who is receiving morphine experience significant respiratory depression? A. Ergotamine B. Nalbuphine C. Naloxone D. Buprenorphine

C. Naloxone Rationale: Naloxone is a narcotic antagonist that is used to reverse the effects of narcotics such as morphine. Buprenorphine are narcotic agonists-antagonists that are used for moderate to severe pain relief. Ergotamine would be used to prevent and treatment migraine attacks. Nalbuphine is used to provide pain relief during labor and delivery and as an adjunct to general anesthesia as well as to treat moderate to severe pain in adults.

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? A. Addiction to the drug B. Adverse effects of the drug C. Physical dependence on the drug D. Tolerance to the drug

C. Physical dependence on the drug Rationale: 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.

Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential? A. Manage hypotension B. Manage hypertension C. Raise blood pressure D. Lower blood pressure

C. Raise blood pressure Rationale: Both categories of migraine abortive drugs (e.g., ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and have the potential to raise blood pressure.

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? A. Severe headache B. Pruritus C. Respiratory depression D. Urticaria

C. Respiratory depression Rationale: The nurse should monitor for symptoms of respiratory depression developing in the client as one of the severe adverse reactions of opioid treatment. Pruritus, urticaria, and headache are caused by opioids, but these conditions are not the most severe and common adverse reactions observed in opioid naive patients. Therefore, the nurse need not monitor for pruritus, severe headache, or severe angina in an opioid naive patient undergoing opioid therapy.

Which assessment finding would support a client's report of migraine headaches? A. Sharp steady eye pain B. Onset occurring during sleep C. Severe unilateral pulsating pain D. Dull band of pain around the head

C. Severe unilateral pulsating pain Rationale: Migraine headaches are associated with severe unilateral pulsating pain on one side of the head. Sharp steady eye pain with an onset usually during sleep is associated with cluster headaches. A dull band of pain around the head suggests a tension headache.

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? A. metformin B. vitamin D3 C. St. John's wort D. vitamin B complex

C. St. John's wort Rationale: Tapentadol is an opioid agonist used to relieve moderate to severe neuropathic pain. There is a risk of serotonin syndrome if it is combined with St. John's wort. Tapentadol can be safely taken with metformin and other vitamin supplements such as vitamin D3 and vitamin B complex.

A nurse should not administer an opioid antagonist to a client with which finding? A.uncontrolled type 2 diabetes B. history of opioid abuse C. hypersensitivity to naloxone D. history of alcohol abuse

C. hypersensitivity to naloxone Rationale: The use of opioid antagonists is contraindicated in those with a hypersensitivity to the opioid antagonists; therefore, a client with a hypersensitivity to naloxone should not be given the drug. Naloxone can be given to uncontrolled type 2 diabetics. Having a history of opioid or alcohol abuse does not have any effect on the use of naloxone.

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? A. make sure the client is positioned comfortably. B. close the draperies. C. make sure the side rails are up. D. check the temperature of the room.

C. make sure the side rails are up. Rationale: 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.

What beta-adrenergic antagonist is used for migraine prophylaxis? A. verapamil B. topiramate C. propranolol D. valproic acid

C. propranolol Rationale: The most commonly administered beta-adrenergic blocking agent for migraine headaches is propranolol. Verapamil is a calcium channel blocker. Valproic acid is a carboxylic acid derivative administered to control seizures and prevention of migraine headaches. Topiramate is a sulfamate-substituted monosaccharide agent used as an antiepileptic agent and to limit migraine frequency.

A client with a history of migraines has been prescribed sumatriptan and is experiencing relief. What physiologic response is the client most likely experiencing? A. increased synthesis and release of endorphins B. stimulation of A-delta C. vasoconstriction of cranial blood vessels D. stimulation of C fibers

C. vasoconstriction of cranial blood vessels Rationale: 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.

Which conditions would occur due to the administration of an opioid antagonist in a client who is physically dependent on opioids? A. hypotension B. drowsiness C. withdrawal symptoms D. insomnia

C. withdrawal symptoms Rationale: Opioid antagonists produce withdrawal symptoms in clients who are physically dependent on opioids. Drowsiness, hypotension, and insomnia do not occur in opioid-dependent clients who are administered opioid antagonists.

A female client tells the nurse that the first thing she does when she gets a headache is drink a caffeinated beverage. The nurse is aware that caffeine is known to decrease the pain of migraine headaches by what mechanism? A. Satisfies the thirst center in the brain, which aborts the headache B. Inhibits the synthesis of prostaglandins C.Vasoconstriction of blood vessels D. Vasodilation of blood vessels

C.Vasoconstriction of blood vessels Rationale: Caffeine causes vasoconstriction of blood vessels. This helps treat migraine headaches because migraine headaches are caused by vasodilation of cerebral vessels.

A client uses sumatriptan for treating her migraine headaches. Which statement by the client indicates to the nurse that she understands how to take this drug? A. "I can take another dose in about 4 hours, if needed." B. "I should repeat the dose in 30 minutes for a total of three doses." C. "I can repeat a dose in 15 minutes for a total of four doses." D. "I can take another dose 2 hours after the first one."

D. "I can take another dose 2 hours after the first one." Rationale: With sumatriptan, the client should take the first dose at the first sign of a headache and then repeat the dose, if needed, in approximately 2 hours.

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? A. "You should probably go to the emergency department." B. "Yes, it's likely safe to take one more dose of your sumatriptan." C. "You can take another pill now and one more in 1 hour, but then no more." D. "Wait at least half-an-hour before you take another pill."

D. "Wait at least half-an-hour before you take another pill." Rationale: Clients can take a second dose of oral sumatriptan when symptoms return but no sooner than 2 hours after the first tablet. There's no evidence that the client needs to go to the emergency department.

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

D. 1 to 2 minutes Rationale: 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? A. 10:00 B. 11:00 C. 9:45 D. 10:30

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

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? A. Reassess the client's level of pain. B. Call for a respiratory therapy consult. C. Reposition the client for comfort. D. Assess the client's other vital signs.

D. Assess the client's other vital signs. Rationale: 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? A. Interrupting the calcium intake in the neuron B. Binding to phospholipids to diminish anxiety C. Reducing inflammation in the temporal arteries D. Binding to serotonin to produce vasoconstriction

D. Binding to serotonin to produce vasoconstriction Rationale: 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.

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? A. The client will be able to perform activities of daily living during migraines. B. The client's migraines will be lower in intensity than prior to treatment. C. The client's migraines will be shorter in duration than prior to treatment. D. The client will experience significantly fewer migraines.

D. The client will experience significantly fewer migraines. Rationale: Propranolol is used for the prevention of migraines. As such, the primary goals are not reduced duration or intensity of migraines. In addition, the nurse would not identify the goal of continuing normal routines during a migraine.

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? A. Causes vasodilation of cranial blood vessels B. Dulls the perception of pain in the brain C. Helps prevent onset of migraine headache D. Vasoconstrictive on cranial blood vessels

D. Vasoconstrictive on cranial blood vessels Rationale: Sumatriptan binds to serotonin receptors to cause vasoconstrictive effects on cranial blood vessels, which is the cause of migraine headaches. The goal is to do more than just dull the pain. Sumatriptan cannot be given to help prevent migraine headaches. .

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

D. Within one to five minutes, an effect may be seen. Rationale: Onset of action is generally rapid and may be seen within one to five minutes. Additional doses may be required to achieve optimal effects. The other answers are incorrect because they are referring to a time later than onset of action, or refer to a conditional onset of action that is untrue.

The nurse receives a prescription for morphine sulfate 8 mg IV every hour as needed for pain. For what client should the nurse question this order? A. a 28-year-old client with a fractured tibia B. a 17-year-old client, 1-day postoperative appendectomy C. a 45-year-old client, 1-day postoperative mastectomy D. a 78-year-old client with osteoarthritis

D. a 78-year-old client with osteoarthritis Rationale: Older clients are more likely to experience the adverse effects associated with narcotics, including central nervous system, gastrointestinal, and cardiovascular effects. Furthermore, a strong narcotic analgesic would not be indicated for chronic osteoarthritis pain. For both of these reasons, the nurse would question the large dosage of a narcotic. The other clients could appropriately receive morphine 8 mg unless they were smaller than average adults.

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

D. administering a stool softener as prescribed Rationale: 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.

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? A. paresthesia in lower extremities B. photophobia C. occipital headache D. drowsiness

D. drowsiness Rationale: 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 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? A. characteristics of deep tendon reflexes B. character and quantity of urine output C. signs and symptoms of liver failure D. heart rate and rhythm

D. heart rate and rhythm Rationale: The FDA has issued a black box warning stating that naproxen sodium may put clients at increased risk for cardiovascular events and GI bleeding. Renal failure, liver failure, and reduced deep tendon reflexes are not the focus of this black box warning.

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: A. the tablet would have no effect if crushed and ingested. B. crushing the tablet increases the drug's efficacy. C. crushing the tablet is a safe option. D. there is risk of an extremely high dose available all at once if the tablet is crushed.

D. there is risk of an extremely high dose available all at once if the tablet is crushed. Rationale: The nurse should caution the client against crushing the tablet before ingesting it. Crushing allows an extremely high dose of the drug to be available all at once, instead of being released slowly over time. Severe adverse effects are possible when it is used in this manner.

A client is prescribed amitriptyline for migraine prophylaxis. What statement should be included in the care plan regarding the medication administration? A. "Food is helpful to decrease gastrointestinal irritation." B."It should be taken when a migraine aura is felt." C."Take the medication with a full glass of water." D."The medication should be taken at bedtime."

D."The medication should be taken at bedtime." Rationale: Amitriptyline is a tricyclic antidepressant, and the client should be instructed to take the medication at bedtime. Tricyclic antidepressants have a sedative effect. The medication can be taken with or without food. Amitriptyline is used for prevention of migraines regardless of the presence of an aura.

Beta receptors react with endorphins in the periphery to modulate pain transmission. False True

False Rationale: Beta receptors react with enkephalins in the periphery to modulate pain transmission.