Pharm: Pain Meds

The nurse has given instructions for taking codeine sulfate to a client with a severe headache. Which statement by the client indicates the teaching has been effective? 1. "I should increase fluid intake." 2. "I should maintain a low-fiber diet." 3. "I should avoid all exercise to prevent lightheadedness." 4. "I should avoid the use of stool softeners to prevent diarrhea."

1. "I should increase fluid intake." Rationale: Codeine sulfate can cause constipation, so the client is instructed to increase fluid intake to prevent this occurrence. A high-fiber diet and stool softeners may be prescribed to prevent constipation. All exercise is not avoided.

The nurse is caring for a client who underwent an open reduction internal fixation to the right hip. When administering opioid analgesics for pain, the nurse should instruct the client that which are side and adverse effects of opioid analgesics? Select all that apply. 1. Sedation 2. Diarrhea 3. Constipation 4. Increased pain level 5. Respiratory depression

1. Sedation 3. Constipation 5. Respiratory depression Rationale: Side and adverse effects of opioids include constipation, sedation, and respiratory depression. Diarrhea is not a side effect. The pain level should decrease, not increase.

A client with suspected opioid overdose has received a dose of naloxone hydrochloride. The client subsequently becomes restless, starts to vomit, and complains of abdominal cramping. The blood pressure increases from 110/72 mm Hg to 160/86 mm Hg. The nurse provides emotional support and reassurance while administering care to the client, knowing which piece of information? 1. The client may next become suicidal. 2. These are signs of opioid withdrawal. 3. These effects will last only a few moments. 4. The client may otherwise sign out against medical advice.

2. These are signs of opioid withdrawal. Rationale: Signs of opioid withdrawal include increased temperature and blood pressure, abdominal cramping, vomiting, and restlessness. Time of onset may be anywhere from a few minutes to a few hours after administration of naloxone hydrochloride, depending on the opioid involved, the degree of dependence, and the dose of naloxone. The remaining options are incorrect interpretations.

A home health nurse visits a client who suffered a back injury. On reviewing the health care provider's prescriptions, the nurse notes that codeine sulfate has been prescribed for the client, and the nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates an understanding of health measures related to the medication? 1. "The medication is not addicting." 2. "I should watch out for diarrhea as a side effect." 3. "I should increase my fluid intake while taking this medication." 4. "I need to be sure to eat foods that are low in fiber to prevent diarrhea."

3. "I should increase my fluid intake while taking this medication." Rationale: Codeine sulfate is an opioid analgesic used to treat pain and can cause constipation. Because it is an opioid analgesic, codeine sulfate can be addicting. The client is instructed to increase fluid intake to prevent constipation. The client also should consume foods high in fiber and should take a stool softener.

The nurse is preparing to give a postcraniotomy client medication for incisional pain. The family asks the nurse why the client is receiving codeine sulfate and not "something stronger." In formulating a response, the nurse incorporates which information about codeine sulfate? 1. It is one of the strongest opioid analgesics available. 2. It cannot lead to physical or psychological dependence. 3. It does not alter respirations or mask neurological signs as do other opioids. 4. It does not cause gastrointestinal (GI) upset or constipation as do other opioids.

3. It does not alter respirations or mask neurological signs as do other opioids. Rationale: Codeine sulfate is an opioid analgesic used for clients after craniotomy. It often is combined with a nonopioid analgesic such as acetaminophen for added effect. It does not alter the respiratory rate or mask neurological signs as do other opioids. Side effects of codeine sulfate include GI upset and constipation. Chronic use of the medication can lead to physical and psychological dependence.

A client reports frequent use of acetaminophen for relief of headaches and other discomforts. The nurse should evaluate which diagnostic data to determine if the client is at risk for toxicity? 1. Chest x-ray 2. Electrocardiogram 3. Liver function studies 4. Upper gastrointestinal x-ray results

3. Liver function studies Rationale: In adults, overdose of acetaminophen causes liver damage. In addition, clients with liver disorders are at a higher risk of experiencing hepatotoxicity with chronic acetaminophen use. Options 1, 2, and 4 are not associated with acetaminophen overdose.

The nurse is caring for a client receiving codeine sulfate for pain. The nurse determines that the client is experiencing a side or adverse effect of the medication based on which finding? 1. Distended jugular veins 2. Bounding peripheral pulses 3. No bowel movement in 3 days 4. Change in blood pressure from 120/60 mm Hg to 140/80 mm Hg

3. No bowel movement in 3 days Rationale: The client taking codeine sulfate is at risk for constipation. Thus, the nurse monitors the frequency of bowel movements. The nurse also would monitor the client for hypotension, decreased respirations, and urinary retention. The nurse would plan measures to counteract these expected effects, such as encouraging fluids, coughing and deep breathing, and increasing mobility to the extent tolerated by the client.

The nurse is caring for a client who has been taking hydrocodone for the last 3 months. For which side and adverse effects of this medication should the nurse assess the client? 1. Tachycardia and hypertension 2. Diarrhea and abdominal cramping 3. Psychological and physical dependence 4. Increased respiratory rate and bronchospasm

3. Psychological and physical dependence Rationale: Hydrocodone is an opioid analgesic that also has antitussive properties. Side and adverse effects of this medication include physical and psychological dependence, bradycardia and hypotension, respiratory depression, nausea, vomiting, constipation, sedation, and confusion.

The nurse is caring for a client receiving morphine sulfate for pain. Because this medication has been prescribed for this client, which nursing action should be included in the plan of care? 1. Encourage fluids. 2. Monitor the client's temperature. 3. Maintain the client in a supine position. 4. Encourage the client to cough and deep breathe.

4. Encourage the client to cough and deep breathe Rationale: Morphine sulfate suppresses the cough reflex. Clients need to be encouraged to cough and deep breathe to prevent pneumonia. The remaining options are not associated specifically with the use of this medication.

A client with cancer is receiving a continuous intravenous infusion of morphine sulfate. The nurse monitoring the client for adverse effects would become most concerned about which vital sign? 1. Temperature of 99.1°F (37.3°C) 2. Blood pressure of 110/70 mm Hg 3. Apical heart rate of 90 beats/minute 4. Respirations of 10 breaths/minute

4. Respirations of 10 breaths/minute Rationale: Before an opioid is administered, respiratory rate, blood pressure, and pulse rate should be assessed. Morphine sulfate should be withheld and the health care provider notified if the respiratory rate is at or below 12 breaths per minute, if the blood pressure is significantly below the pretreatment value, or if the pulse rate is significantly above or below pretreatment value. A temperature of 99.1°F (37.3°C) is not associated with the use of morphine sulfate.

Meperidine hydrochloride is prescribed for a client with pain. What should the nurse monitor for as a side or adverse effect of this medication? 1. Diarrhea 2. Bradycardia 3. Hypertension 4. Urinary retention

4. Urinary retention Rationale: Side and adverse effects of meperidine include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention; therefore, the remaining options are incorrect.