Prep U's - Chapter 49 - Drug Therapy with Opioids

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?

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

A toddler weighing 16 kg is prescribed morphine oral elixir 0.2 mg/kg every 6 hours as needed for postoperative pain. The medication available is 5 mg/20 ml. How many milliliters (ml) of the elixir will the nurse provide to the client for each dose? Record your answer to the nearest tenths place.

Answer: 12.8 mL Rationale: The client is prescribed 0.2 mg per kilogram (kg). Multiply the client's weight of 16 kg x 0.2 mg = 3.2 mg. The medication available is 5 mg/20 ml. The equation 3.2 mg/x = 5 mg/20 ml is used. With cross multiplying, the equation is 64/5 = x; solving for x, the client is to receive 12.8 ml of the elixir.

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 milliliters of hydromorphone should the nurse draw up? Record your answer to the nearest tenth. A. 5.5 B. 5.4 C. 4.5 D. 3.60

Answer: 3.60 Rationale: The nurse should divide 3 mg by 10 mg/mL, resulting in 0.3 mL.

The nurse is caring for a client who is experiencing postoperative pain. The client is prescribed 2.5 mg of morphine IV every 2 hours. Morphine is supplied in 10 mg/mL vials. How many mL should the nurse administer? A. 0.25 mL B. 0.5 mL C. 1 mL D. 2.5 mL

Answer: A Rationale: 10 mg = 1 mL and a dose of 2.5 mg is ordered. 10 mg/1 mL: 2.5 mg/X. Cross-multiply to yield 2.5 mg = 10X. Divide each side by 10 to learn the nurse should administer 0.25 mL.

Which of the following clients is more likely to have respiratory depression when receiving an opioid medication, requiring administration of an opioid antagonist? A. A surgical client who is not used to taking opioid analgesics. B. A client with a history of opioid analgesic abuse. C. A client with chronic pain who is on long-term opioid therapy. D. A client with progressive pain from a cancer diagnosis.

Answer: A Rationale: A surgical client who is not used to taking opioid analgesics on an continual basis is opioid naive and is most likely to have respiratory depression. Those who use opioid analgesics more often tend to have fewer side effects, such as respiratory depression.

A client diagnosed with impaired renal function has been prescribed morphine. How will the client's underlying condition affect the pharmacokinetics of the drug? A. Duration of action will be prolonged. B. Onset of desired effect will be shortened. C. Desired effect will be lessened. D. The peak drug effect will occur earlier.

Answer: A Rationale: Clients with renal impairment should take minimal doses of morphine for the shortest effective time because usual doses may produce profound sedation and a prolonged duration of action. Desired effect, onset, and peak are not concerns.

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? A. Naloxone B. Butorphanol C. Epinephrine D. Acetaminophen and diphenhydramine

Answer: A Rationale: Naloxone has long been the drug of choice to treat respiratory depression caused by an opioid. Therapeutic effects occur within minutes after IV, IM, or sub-Q injection and last 1 to 2 hours. Butorphanol would worsen respiratory depression. Acetaminophen and diphenhydramine are used to treat headache. Epinephrine may be prescribed for an allergic reaction but not for respiratory depression.

Keith, 12 years old, is seen in the emergency department for a severe sunburn. He reports pain, which he rates 7/10. What type of pain is he suffering from? A. Superficial somatic pain. B. Deep somatic pain. C. Neuropathic pain. D. Visceral pain.

Answer: A Rationale: Sunburn is an example of superficial somatic pain. Somatic pain is characterized as well localized and intermittent, or as constant, aching, gnawing, throbbing, burning, or cramping. Neuropathic pain can be described as shooting, burning, or stabbing and generally follows a radicular or radiating pattern. The bone and joint pain of arthritis and muscle strains after intense physical exertion are examples of deep somatic pain. Visceral pain results from stimulation within the deep tissues or organs and surrounding structural tissues.

Of the following clients, which one will be most likely to develop physical dependence upon the opioid analgesic they are receiving for pain management? A. The client living with a chronic noncancer-related illness. B. The client recovering from an ankle fracture. C. The client recovering from cholecystectomy. D. The client recovering from a below-knee amputation.

Answer: A Rationale: The client living with a chronic, noncancer-related illness will be the one receiving the highest dose in the most frequent time interval; this client is considered chronically ill. The clients recovering from surgical procedures (cholecystectomy and below-knee amputation) as well as an ankle fracture are receiving opioid analgesics for acute pain, and will be healed before physical dependence develops.

A nurse will be prepared to administer naloxone (Narcan) to a patient who has had an overdose of morphine. Repeated doses of Narcan will be necessary because Narcan: A. has a shorter half-life than morphine. B. causes the respiratory rate to decrease. C. combined with morphine, increases the physiologic action of the morphine. D. has less strength in each dose than do individual doses of morphine.

Answer: A Rationale: The duration of the morphine may be longer than the duration of naloxone. Therefore, naloxone has a shorter half-life than morphine. Repeated doses may be necessary to maintain reversal of the opiate's effects. Naloxone does not increase the action of morphine, and it causes the respiratory rate to increase, not decrease. Dosage strength is not associated with drug duration.

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

Answer: A 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 patient is receiving drugs through a PCA infusion pump. Which of the following information should a nurse offer to the patient for proper administration of the drug through the infusion pump? A. Control button activates administration of the drug. B. Pain relief should occur one hour after pushing the control button. C. Control button and the button to call the nurse are the same. D. Machine delivers drug every time the control button is used.

Answer: A Rationale: The nurse should inform the patient that the control button activates administration of the drug. Pain relief occurs shortly after, and not an hour after, pushing the button. The nurse should educate the patient on the difference between the control button and the button to call the nurse, especially when they are similar in appearance and feel. The machine does not deliver the drug every time the control button is used; the machine regulates the dose of the drug as well as the time interval between doses. If the control button is used too soon after the last dose, the machine will not deliver the drug until the correct time.

The nurse is caring for a client who has been admitted to the emergency department after a fall. An x-ray indicates that the client has fractured his ankle. Because of a previous stroke, the client does not speak. What other method will the nurse use to assess this client's pain? (Select all that apply.) A. Guarding of the leg. B. Movement of arms and hands. C. Client's gender. D. Client's age. E. Facial expressions.

Answer: A, B, E Rationale: For clients who can't verbalize pain, the nurse assesses the client's facial expression, limb movements, guarding, and grimacing.

Naloxone is administered via which of the following? Select all that apply: A. IV piggyback B. IM injection C. Subcutaneous injection D. Intrathecal injection E. IV push

Answer: A, B, E Rationale: Naloxone can be administered by IV infusion (push or piggyback), IM injection, or subcutaneous injection. It is not given via an intrathecal injection.

The nurse is caring for a client who is receiving an opioid. Which actions by the nurse will help decrease the risk of injury to this client? Select all that apply. A. Assist the client with rising from a lying position. B. Keep the lights in the client's room turned down. C. Advise the client to stay in bed all night. D. Assist the client from the bed to the toilet. E. Assist the client with hall-walking activities.

Answer: A, D, E 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.

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

Answer: B 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.

Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management? A. Anesthetics B. Opioids C. Narcotics D. Antibiotics

Answer: B Rationale: Health care professionals use the term "opioid" to describe drugs used in pain management. The term "narcotic" describes drugs that are addictive, abused, and/or obtained illegally, and that produce numbness and/or a stupor-like state. The term "anesthetic" describes drugs that cause a reversible loss of sensation. The term "antibiotic" describes drugs that are used to treat bacterial infection.

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? A. This is a precaution in case the client begins to choke when resuming a general diet. B. Abrupt reversal of opioid-induced respiratory depression may cause vomiting. C. After surgery, a client may feel nauseated as a side effect of the anesthesia. D. Suction equipment should be placed in all client rooms as a standard of care postoperatively.

Answer: B Rationale: It is important to keep suction equipment readily available because abrupt reversal of opioid-induced respiratory depression may cause vomiting. None of the other rationales provided is a valid reason for adding suction equipment to the room of a client who requires a dose of naloxone.

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? A. skin integrity B. bowel patterns C. core body temperature D. urine specific gracity

Answer: B Rationale: Morphine, like most opioid analgesics, creates a risk for constipation. The drug is unlikely to influence the client's temperature, skin integrity, or urine specific gravity.

Naloxone (Narcan) will reverse the effects of which drug? A. Valproic Acid (Depakote) B. Fentanyl (Duragesic) C. Lorazepam (Ativan) D. Warfarin (Coumadin)

Answer: B Rationale: Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic).

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. 1 to 2 minutes C. 15 to 30 minutes D. 30 to 60 minutes

Answer: B 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 is caring for four clients. For which client would the nurse question the health care provider's order of IV morphine? A. A 45-year-old, 1-day postoperative mastectomy. B. A 78-year-old with osteoarthritis. C. A 17-year-old, 1-day postoperative appendectomy. D. An 8-year-old with a fractured femur.

Answer: B Rationale: Older clients are more likely to experience the adverse effects associated with these drugs, including central nervous system, gastrointestinal, and cardiovascular effects.

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

Answer: B 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.

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

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

Which client would the nurse identify as being opioid naive? A. person who routinely takes opioids. B. one who does not routinely take opioids. C. individual who is physically dependent on opioids. D. one who is psychologically dependent on opioids.

Answer: B Rationale: Opioid-naive clients are defined as those who do not use opioids or infrequently use them. Those who routinely take and are physically or psychologically dependent on opioids are not considered opioid naive.

A nurse has administered an opioid to a client. Which activities should the nurse encourage the client to do? A. Get up and walk once every hour. B. Cough and breathe deeply every 2 hours. C. Restrict his consumption of liquids. D. Maintain complete bed rest.

Answer: B Rationale: The nurse should encourage the client to cough and breathe deeply every 2 hours if the client shows a decrease in respirations after the administration of opioid analgesics. The nurse does not need to instruct the client to restrict consumption of liquids to help cope with the effects of an ineffective breathing pattern. The nurse should perform tasks such as getting the client out of bed and encouraging therapeutic activities such as leg exercises (when ordered); therefore, the nurse should not instruct the client to avoid any kind of exercise or to take complete bed rest.

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? A. It would be better to split the medication in half before swallowing. B. The tablet is an extended-release produce and should not be crushed, chewed, or broken. C. The effect of the medication should not be affected if crushed and ingested. D. Crushing the tablet increases the drug's efficacy and so dosage would need to be decreased.

Answer: B Rationale: The nurse should explain that oxycodone is intended to provide around-the-clock pain relief by releasing the drug slowly over time and should not be crushed, chewed, or broken. Neither crushing or splitting the tablet would increases the drug's efficacy but neither are safe options.

A client with a terminal illness is prescribed an opioid for pain management. The nurse should carefully monitor the client for development of which adverse reaction? A. Dehydration B. Severe anorexia C. Emphysema D. Alopecia

Answer: B Rationale: The nurse should monitor the client for severe anorexia, which is one of the adverse reactions of opioid analgesics on the GI system. Other adverse effects on the GI system include constipation, nausea, and acute abdominal pain. The nurse does not need to monitor the client for emphysema, alopecia, or severe headache. Opioid analgesics do not cause emphysema, but their administration is contraindicated in clients who have this condition. Administration of opioid analgesics is not known to cause alopecia or dehydration in clients.

Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness? A. They should be given as soon as the client feels uncomfortable. B. They should be given on a regular schedule, around the clock. C. They should be given topically only as a last resort. D. They should be given IM as the preferred route of administration.

Answer: B Rationale: When opioids are required by clients with chronic pain, the main consideration is client comfort, not preventing drug addiction. Effective treatment requires that pain be relieved and prevented from recurring; titration of opioid dosage is usually the best approach. Analgesics should be given on a regular schedule, around the clock. Oral, rectal, and transdermal routes of administration are generally preferred over injections.

Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management? A. Anesthetics B. Opioids C. Narcotics D. Antibiotics

Answer: B Rationale: Health care professionals use the term "opioid" to describe drugs used in pain management. The term "narcotic" describes drugs that are addictive, abused, and/or obtained illegally, and that produce numbness and/or a stupor-like state. The term "anesthetic" describes drugs that cause a reversible loss of sensation. The term "antibiotic" describes drugs that are used to treat bacterial infection.

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

Answer: B, C, D 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).

Naloxone is administered via which of the following? Select all that apply: A. Intrathecal injection. B. IM injection C. IV piggyback D. Subcutaneous injection E. IV push

Answer: B, C, D, E Rationale: Naloxone can be administered by IV infusion (push or piggyback), IM injection, or subcutaneous injection. It is not given via an intrathecal injection.

It is important for the nurse to recognize the symptoms of the abstinence syndrome in clients taking opioids. Which of the following are intermediate symptoms of the abstinence syndrome? Select all that apply: A. Increased blood pressure B. Mydriasis C. Miosis D. Tachycardia E. Rhinorrhea

Answer: B, D Rationale: Intermediate symptoms of the abstinence syndrome include mydriasis, tachycardia, twitching, tremor, restlessness, irritability, anxiety, and anorexia.

A woman who has given birth to a baby girl by cesarean delivery is experiencing abdominal pain. The client receives a bolus dose of morphine intravenously. The nurse would recommend that the mother refrain from breast-feeding the baby for how long? A. 6 to 8 hours B. 1 to 2 hours C. 4 to 6 hours D. 2 to 4 hours

Answer: C Rationale: Many sources recommend waiting 4 to 6 hours to breast-feed a baby after receiving a narcotic.

A geriatric client received a narcotic analgesic before leaving the post anesthesia care unit to return to the regular unit. What is the priority nursing intervention for the nurse receiving the client on the regular unit? A. Maintain the head of the client's bed at ≥ 45°. B. Create a restful, dark, quiet environment. C. Put side rails up and place bed in low position. D. Encourage fluid intake.

Answer: C Rationale: Older clients are more susceptible to the central nervous system effects of narcotics; it is important to ensure their safety by using side rails and placing the bed in the low position in case the client tries to get up unaided. Postoperative clients are allowed nothing by mouth until bowel function returns, so an oral medication or encouraging fluids would not be appropriate. This client will require careful observation for respiratory depression, so a dark room would be unsafe. There is no need to keep the head of the client's bed raised.

The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse? A. Respiratory rate and electrolytes. B. Urine output and pain intensity. C. Level of consciousness and respiratory rate. D. Pain intensity and blood glucose level.

Answer: C Rationale: The nurse should assess respiratory rate and level of consciousness because respiratory depression and sedation are adverse effects of opioid analgesics. Blood glucose levels, electrolytes, and urine output are not priority assessments with opioid ingestion.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide: A. a reduction in the client's rating of their pain. B. alertness and improve memory function. C. a return to normal respiratory rate, rhythm, and depth. D. management of alcohol withdrawal symptoms.

Answer: C Rationale: The primary reason for administering an opioid antagonist is because the client is experiencing respiratory depression. Therefore, the goal is to improve the client's respiratory rate, rhythm, and depth. None of the other options is part of the drug therapy.

The client tells the nurse that the health care provider described a drug as having "no ceiling effect." How should the nurse respond when the client asks what that means? A. It is a drug that reduces the likelihood of drug abuse and dependence. B. It is a drug that has a special caution because use of this drug is more likely to have adverse effects. C. It is a drug that no longer has a patent and can be sold by its generic name. D. It is a valuable drug to use because dosage can be increased to relieve pain when pain increases, or tolerance develops.

Answer: D Rationale: A drug with no ceiling effect is one in which there is no upper limit to the dosage that can be given to clients who have developed tolerance to previous dosages. This characteristic is especially valuable in clients with severe cancer-related pain because drug dosage can be increased and titrated to relieve pain when pain increases or tolerance develops. None of the other statements explain the terminology.

A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments? A. Respiratory rate, pain intensity, and urinalysis. B. Liver function studies, pain intensity, and blood glucose level. C. Respiratory rate, seizure activity, and electrolytes. D. Pain intensity, respiratory rate, and level of consciousness.

Answer: D Rationale: The nurse must assess the patient's pain intensity before and after administering an opioid analgesic. The respiratory rate and level of consciousness need to be assessed because respiratory depression and sedation are two adverse effects of opioid analgesics. Seizure activity, electrolytes, liver function, blood glucose level, and urinalysis may need to be assessed during opioid analgesic therapy related to adverse effects, but they would not be the priority assessments.