prep u ch 26
The client is to take almotriptan 6.25 mg orally for a migraine. Almotriptan is sent to the unit from the pharmacy in 12.5-mg tablets. The nurse will administer how many tablet(s)?
0.5
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?
0.5 mL
What client may benefit from the addition of codeine to their pain control regimen?
A client who has a dry, persistent cough
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 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 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 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.
A client has been administered an opioid. For what effect should the nurse regularly assess?
Level of consciousness (LOC)
The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse?
Level of consciousness and respiratory rate
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?
Physical dependence on the drug
The nurse is caring for a patient who is suffering from postoperative pain. The physician orders 2.5 mg of morphine IV q2h. Morphine is supplied in 10 mg/mL vials. How many mL will the nurse administer in each dose?
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
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
What beta-adrenergic antagonist is used for migraine prophylaxis?
propranolol
Acetaminophen-aspirin-caffeine act on a migraine headache by:
reducing pain associated with a migraine.
While caring for a client who is prescribed an opioid antagonist for treatment of respiratory depression caused by opioid therapy, the nurse would assess the client for which adverse reaction? Select all that apply.
tremors nausea tachycardia
A client newly prescribed ergotamine calls the clinic to report nausea and vomiting after taking the medication. Which assessment question would the nurse ask to help determine if the symptoms are related to the ergot alkaloid?
"Are you experiencing any muscle pain?"
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."
The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize?
Assessing the client for migraine pain
In the healthcare setting, the nurse knows that which opioid analgesic drugs are used? Select all that apply.
Morphine Meperidine Methadone Codeine
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
The nurse is caring for a client who has been prescribed narcotic therapy for analgesia following abdominal surgery. What is the best way to determine the client's pain level and to monitor the therapeutic effect of the medication?
Use a pain assessment tool before and after medication administration.
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.
Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which substance?
opioids
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?
"Wait at least half-an-hour before you take another pill."
A client suffering from migraine headaches is prescribed sumatriptan. What is the action of the drug?
Binding to serotonin to produce vasoconstriction
What is a priority nursing assessment of a client prescribed oral sumatriptan?
Blood pressure
Prior to the administration of an opioid antagonist, what must the nurse obtain? (Select all that apply.)
Blood pressure Pulse Respiratory rate
A nurse is caring for a client diagnosed with migraine headaches. Which nursing intervention should be implemented during an acute headache?
Administer subcutaneous sumatriptan succinate (Imitrex).
What action should the nurse take when a young adult is prescribed hydromorphone 2 mg orally every 6 hours?
Administer the medication as prescribed.
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.
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
A nurse monitoring a client receiving naloxone (Narcan) should be cognizant for the development of which adverse reactions? (Select all that apply.)
Tachycardia Nausea Tremors
A client diagnosed with migraines expresses interest in taking an over-the-counter acetaminophen, aspirin, and caffeine combination drug. Which information presented in the client's history should prompt the nurse to discourage the client from taking the drug?
The client has a diagnosis of liver cirrhosis.
While assessing clients receiving opioid analgesics for pain management, what finding would alert the nurse and require healthcare provider notification?
The client with a pulse of 118, a respiratory rate of 8, and a BP of 80/60
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?
The route of administration
What selective serotonin receptor agonist is prescribed to treat migraine headaches?
sumatriptan
A caregiver asks the nurse what the caregiver can give a 9-year-old child for a headache. What is the nurse's best response?
"Acetaminophen is appropriate."
A client is prescribed sumatriptan. Which statement should be included in the teaching plan regarding how the medication works?
"It produces vascular constriction of cranial blood vessels."
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."
The male client states that he does not have a back injury and that it is his leg that hurts. He feels every one is not listening to him. What is the best response by the nurse?
"Sometimes when there is nerve damage, it shows up as pain in a different part of the body."
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?
"Take this drug as soon as you feel the first signs of a migraine."
A client with a history of migraines has been prescribed sumatriptan. What education should the nurse provide about the safe and effective use of this drug?
"Take your medication as soon as you first sense a migraine coming."
A client with a history of migraine headaches self-medicates with an over-the-counter (OTC) medication that contains a common combination of drugs. The nurse recognizes the client is medicating with a combination of which drugs? Select all that apply.
Acetaminophen Aspirin Caffeine
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
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."
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?"
A hospice client has been prescribed morphine 5 mg sub-Q every 2 hours. The medication vial reads "10 mg/mL." How many milliliters will be administered?
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
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
The nurse is preparing to administer morphine sulfate IV to a client in severe postoperative pain. The client asks the nurse how long it will take to start working. What is the best response by the nurse?
10-20 minutes
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.
The nurse should question the health care provider's IV morphine prescription for which client?
An 88-year-old client with failure to thrive
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.
To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.)
Assist client from their bed to the toilet. Assist client with rising from a lying position. Assist client with hall-walking activities.
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?
At the onset of migraine symptoms
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.
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 maintains adequate nutritional status. Therapeutic response is achieved and discomfort is reduced. An adequate breathing pattern is maintained.
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
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.
Naloxone (Narcan) will reverse the effects of which drug?
Fentanyl (Duragesic)
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.)
Nausea and vomiting Tremors Sweating
The pathophysiology of pain begins with a signal from what source?
Nociceptors
A surgical client, with highly elevated AST and ALT levels, is to receive morphine sulfate 10 mg postoperatively. What action should the nurse take prior to administering the medication?
Notify the health care provider for a reduced dosage.
The nurse is providing health education to a client prescribed almotriptan for the treatment of migraines. The nurse should caution the client about what potential adverse effects?
Numbness and chest tightness
A client is prescribed zolmitriptan for migraine headaches. The nurse should instruct the client to administer this drug by which route?
Oral
A client is to receive naltrexone. The nurse would expect to administer this drug by which route?
Oral
What would the nurse expect to assess in a client receiving a narcotic for pain relief?
Orthostatic hypotension
A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication?
Pain scale
The nurse is caring for a client who has been prescribed a potent opioid. What potentially life-threatening adverse effect should the nurse monitor for?
Respiratory depression
The nurse is to administer a dose of naloxone. Which would be the highest priority problem to be addressed when caring for a client who is to receive a dose of naloxone?
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 nurse is administering opioid analgesics to a client for postoperative pain. What is the nurse's most important assessment prior to administering the medication?
Respiratory rate
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
Which adverse reactions may occur as a result of administering an opioid antagonist?
Sweating, tachycardia, and increased blood pressure
The nurse is providing education to a client who has been prescribed sumatriptan. In order to maximize therapeutic benefit while reducing the risk of adverse effects, the nurse should encourage the client to implement which intervention?
Take the medication as soon as the earliest symptoms of migraine are sensed.
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.
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
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 30-year-old client experiences migraines that appear closely linked to her menstrual cycle. What pharmacologic treatment is most specific to this client's particular experience of migraines?
estradiol
A 60-year-old client tearfully explains to the nurse how her husband downplays her frequent migraines and tells her that she needs to "just push through a headache." She describes how her migraines have limited her ability to provide childcare for her young grandchildren and explains that she is unable to keep up her garden. The nurse should identify what nursing diagnosis when planning this client's care?
ineffective role performance related to migraine headaches
A hospital client has been prescribed morphine for the treatment of post-surgical pain. The client tells the nurse, "I'm determined to push through my pain if I can, because there's no way I want to end up addicted to narcotics." What should the nurse teach the client?
It is extremely unlikely that the client would become addicted to narcotics used for this purpose
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 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
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
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.
Which medications are opioids for which naloxone may be given to counter the effects?
Meperidine
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
Prior to administering morphine, the nurse checks the client's medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication?
Monoamine oxidase (MAO) inhibitor
Which would a nurse have readily available should a client who is receiving morphine experience significant respiratory depression?
Naloxone
A nurse administrates an opioid medication to a client. For what side effect should the nurse assess?
Drowsiness
A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent?
Fentanyl
Which conditions would occur due to the administration of an opioid antagonist in a client who is physically dependent on opioids?
withdrawal symptoms
A class of new nursing students is learning how to administer medications to clients. What should the instructor teach the students about giving opiates?
Assess the respiratory rate before giving a dose of opiates.
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
Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential?
Raise blood pressure
