Pharmacology

What instructions should the nurse provide to the client to ensure compliance with taking sedatives or hypnotics for insomnia? Select all that apply.

"Consult your primary care provider if unable to sleep." "A time-released form of the medication may be an option for you."

The nurse is educating a client on the appropriate use of a transdermal patch. Which statements indicate the client is in need of additional education? Select all that apply.

"I can apply a new patch before I remove the old one." "I should wash the site where I am applying the patch with soap and hot water." "When I'm wearing the patch, it's okay if I take a hot bath or sit in a sauna." "I should apply the patch to the same spot every time I change it."

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 nurse enters the client's room to administer bedtime medications. The client informs the nurse that he is not ready to go to sleep and to leave the sleeping pill with him and he will take it when he is ready. What would be the nurse's best response?

"Just push the call light when you are ready and I will bring it to you then."

The nurse is teaching a client about medications that cause numbness and/or a stupor-like state, are addictive and/or abused, and/or are obtained illegally. Which statements indicates the client understands what the nurse has instructed?

"When I take pain medication prescribed for someone else, I am taking a narcotic."

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?

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

The client has Dalmane 15 mg PO at bedtime ordered. The drug comes in 30-mg tablets. How much should the nurse administer to this client?

1/2 tablet

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 09:30. What time should the nurse reassess the client for peak analgesic effect?

10:30

When should the nurse obtain the client's blood pressure, pulse, respiratory rate and pain rating after IM administration of an opioid analgesic?

20 to 30 minutes

When should the nurse obtain the client's blood pressure, pulse, respiratory rate and pain rating after oral administration of an opioid analgesic?

30 minutes

Zolpidem is prescribed for a hospitalized 58-year-old client having difficulty falling asleep at night. What is the best time for the nurse to administer this medication?

9 PM

The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl?

A woman 85 years of age

A client's post-surgical pain is severe and persistent. The client states that recent doses of morphine IV have "helped only a little bit." The client has a PRN dose of morphine available, and wants to receive the medication. The client's respiratory rate is 14 breaths per minute. What is the nurse's best action?

Administer the morphine as prescribed and monitor the client's respiratory status closely

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 the pain medication as ordered.

A nursing assistant is seen carrying a bedtime snack of crackers and coffee into a client's room. The nurse is preparing to administer an oral dose of zaleplon (Sonata) to the client. What is the nurse's best action?

Advise the client that a snack may interfere with absorption of this medication.

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 assessing the respiratory status of a post surgical client. The nurse counts a respiratory rate of 8 breaths/minute for the client who received a sedative one hour ago. What is the nurse's priority action?

Assess level of consciousness.

The nursing instructor is teaching about sedatives and hypnotics. The student correctly identifies the two classes of sedatives as being which? Select all that apply.

Barbiturates Nonbarbiturates

When reviewing information about medications that are compounded by the pharmacist, the nurse knows which statements are true? Select all that apply.

Brompton's mixture is the most commonly used solution. A clinical pharmacist will prepare the medication in a form (e.g., solution, salve, or suppository) best suited for the individual client. It is necessary to monitor for adverse reactions of each drug contained in the preparation.

A nursing student is researching information about secobarbital (Seconal). The student would most likely find that this drug is classified in which pregnancy category?

Category D

Secobarbital (Seconal) is classified in which pregnancy category? (Choose one)

Category D

Before administering a barbiturate to a client, what is the nurse's priority action?

Check level of consciousness.

A nurse obtains a health history from a client who has been prescribed temazepam. Which finding would require immediate follow-up by the nurse?

Client is diagnosed with hepatitis C.

Tylenol #3 consists of acetaminophen (Tylenol) and another medication. What is the other medication?

Codeine

A 15-year-old boy with a history of asthma is admitted to the hospital for repair of a compound fracture of the left wrist. The physician prescribes codeine to manage his pain. The client's respiratory status must be monitored closely while taking codeine because of which?

Codeine will decrease the clients cough reflex.

The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect?

Constipation

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.

The client has difficulty swallowing and requests the nurse to crush all the medications. 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.

The nurse works on a busy floor giving multiple sedatives and hypnotics. What priority concern should the nurse carefully assess for when administering a sedative or hypnotic?

Depressed respiratory function

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

Drowsiness

How will a client's impaired renal function affect the pharmacokinetics of morphine?

Duration of action will be prolonged.

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

The nurse is caring for a client taking Talwin. What would be an appropriate nursing diagnosis for this client's care plan?

Impaired gas exchange related to respiratory depression

A client who is 84 years old is experiencing chronic lower back pain that has not responded to NSAIDs. The provider has prescribed a transdermal fentanyl patch. What should the nurse do to ensure safe and effective care? Select all that apply.

Monitor the client's respiratory status closely. Keep the client's bed in the lowest position. Ensure the client has access to the call light.

In the healthcare setting, the nurse knows that which opoid analgesic drugs are used? Select all that apply.

Morphine Meperidine Methadone Codeine

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

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

Oxycodone

A client has been ordered a fentanyl patch for chronic pain. What client teaching should be provided to the client and family upon discharge?

Remove the patch every 3 days.

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 nurse is caring for a newborn client. The mother was taking opioid analgesics for chronic pain management throughout her pregnancy. Which finding indicates that the infant may be experiencing withdrawal?

Sneezing

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

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

If a pregnant client has taken a benzodiazepine during pregnancy, what would be the biggest concern?

The infant may experience withdrawal symptoms during the postnatal period.

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.

What reaction should the nurse assess for when a client is prescribed a nonopioid analgesic in addition to a narcotic analgesic?

additive effect

The nurse should question the health care provider's IV morphine prescription for which client?

an 88-year-old female with failure to thrive

What classification of over-the-counter (OTC) medications is often used by clients as treatment for insomnia?

antihistamines

A client is prescribed midazolam in combination with an opioid in the preoperative phase of a laparoscopic cholecystectomy. What does the administration of midazolam assist in minimizing?

anxiety

Nurses use complementary techniques to promote the effects of a sedative or hypnotic. What are some things nurses can do to promote an optimal response to therapy? (Select all that apply.)

back rubs quiet atmosphere night lights or darkened room

Which medications are capable of central nervous system depression, hypnosis, deep coma, respiratory depression, and prescribed infrequently?

barbiturates

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

Pain may be classified according to what factors? Select all that apply

cause origin duration

What aspect of a client's health is most likely to cause insomnia?

chronic pain

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

codeine

A nurse is teaching a client about her prescription for acetaminophen that she will take at home. This medication consists of acetaminophen and what other likely drug that enhances the analgesic effect of acetaminophen?

codeine

The nurse is preparing a client for epidural administration of an opioid analgesic. The nurse describes which reaction as a benefit of this type of administration?

development of fewer adverse reactions

A nurse has noted that a newly admitted client has been taking ramelteon for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug?

difficulty falling asleep at night

The client who reports a headache the morning after taking a hypnotic is experiencing which complications?

drug hangover

A 45-year-old male client tells the nurse that he has not slept well for the past 2 weeks. Which drug might the physician prescribe for this client?

eszopiclone

A group of nursing students are reviewing information about the different classifications of opioids. The students demonstrate understanding of the information when they identify which as an opioid agonist? Select all that apply.

hydromorphone fentanyl oxycodone

Following the subcutaneous (subcut) administration of pain medication, the nurse would know to check the client's vital signs in what amount of time?

in 20 to 30 minutes

How do opioid analgesics relieve moderate-to-severe pain?

inhibiting the transmission of pain signals from peripheral tissues to the brain

A client has been administered an opioid. What effect should the client be regularly assessed for?

level of consciousness (LOC)

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.

A terminally ill client has developed increased respiratory secretions and labored breathing. Which medication is prescribed to decrease these symptoms?

morphine sulfate

A nurse has been taught to observe for adverse reactions whenever administering a medication. One non-nervous system reaction after giving a sedative is:

nausea

A nurse knows that when elderly clients take a sedative or hypnotic, they are at increased risk for oversedation. When they become very confused and demonstrate marked excitement, this is known as which type of reaction?

paradoxical reaction

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?

pneumonia

A nursing student correctly identifies the benzodiazepines as being which of the following class of drugs?

pregnancy category X

A client has received a narcotic agonist for pain relief. The nurse should monitor the client for what?

pupil constriction.

What information should the nurse provide to a client prescribed eszopiclone?

the importance of taking the drug immediately before going to bed

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.

After administration of a hypnotic, a client complains of being unable to sleep. What is the nurse's best action?

Notify the health care provider.

A nurse has entered a client's room at the beginning of a shift to quickly assess the clent'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 should not administer sedatives or hypnotic drugs to which client?

Comatose client

An older adult client is prescribed a sedative for the treatment of insomnia. The nurse would suspect that the client is experiencing an adverse reaction to the drug based on assessment of which of the following?

Confusion

The nurse is admitting a client to the postsurgical unit from the postanesthetic care unit. The client is in pain so the nurse administers 4 mg morphine IV as prescribed. After administering the drug, the PACU nurse calls to say a dose of morphine was given and not documented. What actions should the nurse perform? Select all that apply.

Ensure naloxone is readily available. Inform the client's health care provider. Document the event. Monitor the client's respiratory rate closely.

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

A 30-year-old male client has been ordered Demerol 100 mg IM every 4 hours for 2 days after a fractured femur. What action should the nurse take?

Give the medication as ordered.

What action should the nurse take when administering meperidine 75 mg IM every 4 hours to a young adult?

Give the medication as prescribed.

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?

Morphine

The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetadine and a sedative to calm the client. What should the nurse be concerned about?

Increased sedative effect

Nate is a 24-year-old man, status post--motor vehicle accident, with multiple broken bones including two rib fractures. The physician prescribes a morphine PCA pump for the client's pain. When the nurse assesses Nate, the nurse finds clear breath sounds bilaterally, a respiratory rate of 18, and a weak cough. What would be the priority nursing diagnosis based on this assessment?

Ineffective airway clearance secondary to cough suppression by the drug

When describing the uses for sedatives and hypnotics, which would the nursing instructor identify as the primary use?

Insomnia

Which should be included when assessing pain? (Select all that apply.)

Location of the pain Intensity of pain What factors cause the pain to improve or worsen What medications client usually takes to relieve the pain

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.

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

Monitor for opioid effects.

The client returns from the post-anesthesia recovery unit. The nurse notes a respiratory rate of 6. Which drug would the nurse anticipate being given immediately?

Narcan

A nursing student studying sedatives and hypnotics in pharmacology class correctly states that they are best given for which of the following periods?

No more than 2 weeks

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

Opioids

A client appears very drowsy at bedtime and is difficult to arouse. The client is receiving halcion 0.25 mg PO at bedtime. Based on these findings, what would be the best nursing diagnosis for this client?

Risk for injury

The physician prescribing a drug for sleep will usually select a nonbarbiturate instead of a barbiturate. This is mainly due to which of the following reasons?

They have a lesser effect than barbiturates do on the respiratory rate.

The nurse administers promethazine to the client before sending the client to the preoperative holding area. What outcome demonstrates therapeutic effects?

The client is conscious but drowsy.

Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness?

They should be given on a regular schedule, around the clock.

After teaching a group of nursing students about herbal products used for sleep and relaxation, the instructor determines that the teaching was successful when the students identify which as being used to improve overall sleep quality, shortening the length of time it takes to fall asleep and decreasing the number of nighttime awakenings?

Valerian

An 86-year-old client was administered a sedative at bedtime, which resulted in hyper-alertness and confusion. The client's son present at the bedside, states he does not understand the term "paradoxical reaction." What is the nurse's best explanation for this term?

When a drug has the opposite effect of the usual intent

The nurse would instruct a client prescribed which medication to not take the drug with food?

Zolpidem

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 receiving opioid therapy. The nurse should be alert to the possibility that which could occur if the client receives an opioid agonist-antagonist?

opioid withdrawal symptoms

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.

The nursing student has learned about several groups of drugs and some are unrelated drugs that includes Lunesta and Ambien. These two medications belong in which group?

Nonbenzodiazepines

The client has been ordered a sedative. The nurse assesses a respiratory rate of 10 breaths/minute. What is the nurse's best action before adminsitering the sedative?

Notify the healthcare provider.

The nurse is conducting an educational presentation on the use of drugs and herbal supplements. Which herbal supplements is used mainly for its sedative-hypnotic properties?

Valerian

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