PrepU - Ch. 49: Drug Therapy With Opioids for Pharmacology
17. A client taking an opioid for chronic pain management says, "I cannot have a bowel movement." Which suggestion will the nurse make to this client? "Lie down for 30 minutes after a meal." "Skip a few doses of the medication." "Reduce the amount of water you drink." "Eat more fruits and vegetables."
"Eat more fruits and vegetables." Constipation is a common adverse effect when taking an opioid. One suggestion for this problem is to eat more fruits and vegetables, as these foods are high in fiber and add bulk to aid with the constipation. The client should be encouraged to take the medication as prescribed, not to skip doses. The client should be encouraged to increase activity as tolerated. Lying down after eating will not help reduce constipation. Adequate amounts of fluids are necessary to reduce constipation; reducing the amount of water will exacerbate the constipation.
18. A client taking an opioid for chronic pain management says, "I cannot have a bowel movement." Which suggestion will the nurse make to this client? "Eat more fruits and vegetables." "Skip a few doses of the medication." "Lie down for 30 minutes after a meal." "Reduce the amount of water you drink."
"Eat more fruits and vegetables." Constipation is a common adverse effect when taking an opioid. One suggestion for this problem is to eat more fruits and vegetables, as these foods are high in fiber and add bulk to aid with the constipation. The client should be encouraged to take the medication as prescribed, not to skip doses. The client should be encouraged to increase activity as tolerated. Lying down after eating will not help reduce constipation. Adequate amounts of fluids are necessary to reduce constipation; reducing the amount of water will exacerbate the constipation.
4. 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 0.66 mg ÷ 10 mg/mL = 0.6 mL
1. 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? "If you do become addicted, we'll make sure to provide you with the support and resources necessary to help you with your recovery." "It's important that you accept that your current need to control your pain is more important than fears of becoming addicted." "You don't need to worry. It's actually not true that you can get addicted to the medications we use in a hospital setting." "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."
"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." Addiction to opioids is a rare occurrence among hospital clients who do not have a history of drug abuse. It would be inappropriate to downplay the client's concerns, however. A more appropriate response would be to explain the phenomenon of dependence and to differentiate it from addiction
2. A client who is receiving morphine reports nausea after every dose of medication. What is the nurse's best response to this client? "I will ask the health care provider if I can give you acetaminophen for the pain instead of the morphine." "I'm sorry. That means you won't be able to have any more pain medication." "I will mark your chart that you are allergic to morphine." "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."
"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." Nausea is a common side effect of morphine. Giving it with food helps to reduce the occurrence of the problem.
8. 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? 11:00 10:30 10:00 9:45
10:30 With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours.
18. The nurse is caring for four clients. For which client would the nurse question the health care provider's order of IV morphine? A 45-year-old, 1-day postoperative mastectomy A 78-year-old with osteoarthritis An 8-year-old with a fractured femur A 17-year-old, 1-day postoperative appendectomy
A 78-year-old with osteoarthritis Older clients are more likely to experience the adverse effects associated with these drugs, including central nervous system, gastrointestinal, and cardiovascular effects.
19. Which of the following clients is more likely to have respiratory depression when receiving an opioid medication, requiring administration of an opioid antagonist? A client with progressive pain from a cancer diagnosis A client with chronic pain who is on long-term opioid therapy A surgical client who is not used to taking opioid analgesics A client with a history of opioid analgesic abuse
A surgical client who is not used to taking opioid analgesics 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.
16. 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? After surgery, a client may feel nauseated as a side effect of the anesthesia. This is a precaution in case the client begins to choke when resuming a general diet. Abrupt reversal of opioid-induced respiratory depression may cause vomiting. Suction equipment should be placed in all client rooms as a standard of care postoperatively.
Abrupt reversal of opioid-induced respiratory depression may cause vomiting. 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.
11. 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. Wait as long as possible for pain medication; it will work more effectively. Take as little pain medication as possible to prevent addiction. Request your pain medication whenever it is available to you.
Ask for pain medication before the pain gets severe. The nurse should emphasize the importance of pain control, stressing to the client that pain relief is greater if the medication is taken when pain is not very severe. If the client waits too long for pain medication, it will be much harder to control the pain. Also, the client should not take pain medication whenever it is available, but only when it is needed. It is rare for a client to become addicted to pain medication when it is taken for the relief of pain. The need for the pain medication goes away when the pain subsides.
5. A client has been taking morphine PO for several months following a back injury. The care team is working with the client to wean the client off morphine. The client reports he is getting minimal relief from the pain with the new nonopioid medication he is receiving. What action should the nurse prioritize for this client? Administer a higher dose of morphine Assess for signs of withdrawal syndrome Monitor the client for hypersensitivity Assess for signs of addiction
Assess for signs of withdrawal syndrome Caution should be used in cases of physical dependence on a narcotic because a withdrawal syndrome may be precipitated, the narcotic antagonistic properties can block the analgesic effect, and so intensify the pain. It is important to differentiate between addiction and dependence because addiction generally does not occur in clients receiving narcotics for medical reasons. There is no indication of a hypersensitivity reaction. Giving a higher dose of the opioid would eliminate the progress made to date on weaning the client from the narcotic, so attempts should be made to avoid this intervention.
20. To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.) Advise the client to stay in bed all night. Keep the lights in the client's room turned down. Assist client with hall-walking activities. Assist client from their bed to the toilet. Assist client with rising from a lying position.
Assist client with hall-walking activities. Assist client from their bed to the toilet. Assist client with rising from a lying position. 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.
14. 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. No further action is required because the naloxone has already been administered. Continue to monitor the client's vital signs and oxygen saturation levels. Administer a second dose and then notify the provider to obtain an order.
Call the provider as another dose of opioid antagonist may be necessary. The effects of some opioids may last longer than the effects of naloxone. A repeat dose of naloxone may be ordered if results obtained from the initial dose are unsatisfactory. Therefore, calling for an order would be an appropriate response. Taking no action in light of respiratory depression, or merely continuing to monitor the client, could lead to deterioration in the client's condition. No medication should be administered without a provider order.
1. A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be important for the nurse to do? Increase the drug dosage level to be administered. Continue administering the prescribed drug. Monitor blood pH level. Coach the client to breathe.
Coach the client to breathe. Sometimes the somnolence and pain relief produced by the opioid drug will slow the client's breathing pattern. The nurse should make efforts to arouse the client and coach them to breathe. The nurse need not monitor the blood pH level of the client, continue administering the prescribed drug, or increase the drug dosage level to be administered when caring for a client with a lowered breathing pattern because these interventions will not help increase the client's breathing rate.
9. 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? Machine delivers drug every time the control button is used. Pain relief should occur one hour after pushing the control button. Control button activates administration of the drug. Control button and the button to call the nurse are the same.
Control button activates administration of the drug. 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.
17. 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 crushed medication can permanently stain teeth. Crushing the medication interferes with its absorption. The medication can be very irritating to mucous membranes.
Crushing the medication may precipitate an overdose. Health care providers and clients must be cautioned to avoid crushing or chewing the tablets or opening capsules because immediate release of the drug constitutes an overdose. None of the other answers apply.
9. 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? The medication can be very irritating to mucous membranes. Crushing the medication interferes with its absorption. The crushed medication can permanently stain teeth. Crushing the medication may precipitate an overdose.
Crushing the medication may precipitate an overdose. Health care providers and clients must be cautioned to avoid crushing or chewing the tablets or opening capsules because immediate release of the drug constitutes an overdose. None of the other answers apply.
15. A client diagnosed with impaired renal function has been prescribed morphine. How will the client's underlying condition affect the pharmacokinetics of the drug? The peak drug effect will occur earlier. Duration of action will be prolonged. Desired effect will be lessened. Onset of desired effect will be shortened.
Duration of action will be prolonged. 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.
13. 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.) Client's gender Movement of arms and hands Facial expressions Client's age Guarding of the leg
Facial expressions Movement of arms and hands Guarding of the leg For clients who can't verbalize pain, the nurse assesses the client's facial expression, limb movements, guarding, and grimacing.
3. A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent? Codeine Hydromorphone Morphine Fentanyl
Fentanyl Fentanyl is available as a transdermal patch.
15. Naloxone (Narcan) will reverse the effects of which drug? Lorazepam (Ativan) Warfarin (Coumadin) Fentanyl (Duragesic) Valproic Acid (Depakote)
Fentanyl (Duragesic) Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic).
13. A nurse is assessing a client's pain level. Which would be the most appropriate method? Palpate the area where the client says the client has pain. Ask the client to describe their pain in their own words. Have the client rate it on a scale of 0 to 10. Review the client's vital signs for changes. Have the client rate it on a scale of 0 to 10.
Have the client rate it on a scale of 0 to 10. 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.
6. 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 arrhythmias Ataxia Blurred vision
Hypotension Orthostatic hypotension is commonly seen with some narcotics. Ataxia, blurred vision, and arrhythmias are not generally adverse effects of an opioid analgesic.
3. Although naloxone is given to counter opioid medication side effects such as respiratory depression, what additional issues (if any) may result from administration of an opioid antagonist? Increase in the client's pain rating None of these options Decrease in the client's pain rating No change in the client's pain rating
Increase in the client's pain rating An opioid antagonist will counter not only the negative effects of an opioid medication but the beneficial effects of the opioid (such as pain relief) as well, resulting in an increase in the client's pain rating. It would not result in a decrease or lack of change in the pain rating.
11. Which of the following can occur if the nurse administers naloxone (Narcan) as a rapid IV bolus? Select all that apply: Hypotension Respiratory depression Intense pain Withdrawal Vomiting
Intense pain Withdrawal Vomiting Withdrawal, return of intense pain, and vomiting may occur if the nurse administers naloxone (Narcan) as a rapid IV bolus.
13. 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? It is a drug that no longer has a patent and can be sold by its generic name. It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops. It is a drug that reduces the likelihood of drug abuse and dependence. It is a drug that has a special caution because use of this drug is more likely to have adverse effects.
It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops. 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.
10. A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment? Oxycodone Tramadol Oxymorphone Methadone
Methadone 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.
12. A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment? Oxymorphone Tramadol Oxycodone Methadone
Methadone 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.
13. 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. Assess for congenital anomaly. Monitor for withdrawal syndrome. Administer naloxone.
Monitor for opioid effects. Morphine, meperidine, and oxymorphone are often used for analgesia during labor. The mother should be monitored closely for adverse reactions, and, if the drug is used during a prolonged labor, the newborn infant should be monitored for opioid effects. Naloxone would only be given if the newborn displays opioid effects. Withdrawal syndrome would not be seen with less than 24 hours of use. Every newborn is assessed for congenital anomalies, but this would not be related to administration of morphine to the mother and so would not be the highest priority.
12. 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.) Monitor the client's respiratory rate closely. Inform the client's health care provider. Administer buprenorphine as prescribed. Ensure naloxone is readily available. Arrange for cardiac monitoring. Document the event.
Monitor the client's respiratory rate closely. Inform the client's health care provider. Ensure naloxone is readily available. Document the event. The nurse should inform the care team and document this event. Close respiratory monitoring would be necessary, but cardiac monitoring would not likely be required. Naloxone is the drug of choice for treatment of opioid overdose and should be readily available. Buprenorphine hydrochloride is a narcotic-agonist-antagonist and would suppress respirations further.
5. 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? Acetaminophen and diphenhydramine Naloxone Epinephrine Butorphanol
Naloxone 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.
TEST 1 1. Which client would the nurse identify as being opioid naive? individual who is physically dependent on opioids one who does not routinely take opioids one who is psychologically dependent on opioids person who routinely takes opioids
One who does not routinely take opioids 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.
17. A client who was recently diagnosed with cancer is now receiving morphine for pain. Since this client has been receiving morphine for only a short time, he is best described by which term? Opiate tolerant Opiate intolerant Opiate agonistic Opiate naive
Opiate naive An opiate tolerant client is one who, because of previous opioid use, has developed a drug tolerance. An opioid tolerant client typically requires a larger-than-usual dose for pain relief. Conversely, an opiate naive client has not received sufficient opioids for development of tolerance. The client described in the scenario is opiate naive.
6. Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management? Narcotics Antibiotics Anesthetics Opioids
Opioids 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.
6. 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? Pain intensity, respiratory rate, and level of consciousness Respiratory rate, seizure activity, and electrolytes Liver function studies, pain intensity, and blood glucose level Respiratory rate, pain intensity, and urinalysis
Pain intensity, respiratory rate, and level of consciousness 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.
10. 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.) Enhancement of an opioid analgesic physiologic effect Reduction of acute postoperative surgical site pain Postoperative acute respiratory depression Suspected or known acute opioid overdosage Adverse effects related to opioid administration
Postoperative acute respiratory depression Suspected or known acute opioid overdosage Adverse effects related to opioid administration 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.
8. A geriatric client received a narcotic analgesic before leaving the postanesthesia care unit to return to the regular unit. What is the priority nursing intervention for the nurse receiving the client on the regular unit? Maintain the head of the client's bed at ≥ 45°. Create a restful, dark, quiet environment. Encourage fluid intake. Put side rails up and place bed in low position.
Put side rails up and place bed in low position. 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.
15. 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 Surgical incision Bowel elimination Infection prevention
Respiratory depression Naloxone is given to counter the effects of opioid or anesthesia side effects, such as respiratory depression. Therefore, if naloxone is being administered the client is experiencing respiratory depression. All of the other items to be addressed, while important, are not as high a priority as respiratory depression.
20. The nurse is caring for a client who is receiving a prescribed opioid analgesic. What reactions that could be related to the drug therapy should prompt the nurse to contact the health care provider immediately? Select all that apply: Respiratory rate of less than 10 breaths/min Decrease in pulse Blood pressure of 95/65 mmHg Diarrhea Increase in blood pressure
Respiratory rate of less than 10 breaths/min Decrease in pulse Blood pressure of 95/65 mmHg The nurse should contact the provider immediately if any of the following occurs while a client is receiving an opioid analgesic: significant decrease in respiratory rate or a respiratory rate less than 10 breaths/min; significant increase or decrease in the pulse rate or a change in the pulse quality; or significant decrease in blood pressure or a systolic pressure below 100 mmHg. Constipation is more likely than diarrhea with opioid use, and an increase in blood pressure is not a noted adverse reaction.
19. 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? Visceral pain Deep somatic pain Neuropathic pain Superficial somatic pain
Superficial somatic pain 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.
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6. The nurse receives a phone call from a male client who has become constipated while taking the opioid analgesic prescribed for his pain. The nurse instructs the client to do what to help relieve this problem? (Select all that apply.) Take a laxative twice a day Eat a diet low in fiber Take a daily stool softener Try to establish a regular bowel routine Drink 2 to 3 quarts of water per day
Take a daily stool softener Try to establish a regular bowel routine Drink 2 to 3 quarts of water per day Constipation is a common problem that occurs with the use of opioids. The client should be encouraged to eat a high-fiber diet, drink 2 to 3 quarts of water, take daily stool softener and laxative (if OK'd by a health care provider), and establish a bowel routine
1. What client characteristic may contraindicate the use of tramadol for the treatment of a client's pain following traumatic injuries? The client is 48 hours postorthopedic surgery. The client has a history of crack cocaine addiction. The client required a transfusion of packed red blood cells on admission. The client has developed a wound infection and is at risk of sepsis.
The client has a history of crack cocaine addiction. The use of tramadol is generally limited in clients who have a history of addiction. Infection, surgery, and transfusions would not necessarily preclude the use of this narcotic.
9. 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 recovering from cholecystectomy The client recovering from a below-knee amputation The client living with a chronic noncancer-related illness The client recovering from an ankle fracture
The client living with a chronic noncancer-related illness 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.
11. 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? During pain assessment, the client may report less pain. Double the standard dosage of the medication may be needed. The client may begin to demonstrate symptoms of withdrawal. Multiple doses may be needed to be therapeutic.
The client may begin to demonstrate symptoms of withdrawal. 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.
16. 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 reports decreased bowel movements. Therapeutic response is achieved and discomfort is reduced. Client maintains adequate nutritional status. An adequate breathing pattern is maintained. Client reports decreased urinary output.
Therapeutic response is achieved and discomfort is reduced. Client maintains adequate nutritional status. An adequate breathing pattern is maintained. 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).
12. Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness? They should be given IM as the preferred route of administration. They should be given on a regular schedule, around the clock. They should be given as soon as the client feels uncomfortable. They should be given topically only as a last resort.
They should be given on a regular schedule, around the clock. 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.
4. Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness? They should be given topically only as a last resort. They should be given on a regular schedule, around the clock. They should be given as soon as the client feels uncomfortable. They should be given IM as the preferred route of administration
They should be given on a regular schedule, around the clock. 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.
20. 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? Percussing or palpating the area where pain is identified Assessing the client's vital signs Using a pain rating scale Asking a client to describe his or her pain
Using a pain rating scale 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.
9. 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? Slow improvement can be noted throughout the shift. Response is highly individualized based upon client weight. Within one to five minutes, an effect may be seen. Improvement will occur within 30 minutes from the time of administration
Within one to five minutes, an effect may be seen. 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.
14. 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. a reduction in the client's rating of their pain. alertness and improve memory function. management of alcohol withdrawal symptoms.
a return to normal respiratory rate, rhythm, and depth. 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.
19. A client with a viral respiratory infection has an intense headache and cough. What drug will best address both of this client's symptoms? ibuprofen codeine acetaminophen hydromorphone
codeine Codeine is a narcotic drug used for its analgesic and antitussive effects. Hydromorphone, ibuprofen, and acetaminophen do not have antitussive effects.
4. While studying pharmacology, the nursing student learns that a naturally occurring narcotic drug with analgesic and antitussive effects is: ibuprofen. codeine. acetaminophen. aspirin.
codeine. Codeine is a narcotic drug used for its analgesic and antitussive effects. Aspirin, ibuprofen, and acetaminophen do not have antitussive effects.
18. 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 causes the respiratory rate to decrease. has less strength in each dose than do individual doses of morphine. has a shorter half-life than morphine. combined with morphine, increases the physiologic action of the morphine.
has a shorter half-life than morphine. 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.
19. 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 has a shorter half-life than morphine. causes the respiratory rate to decrease. combined with morphine, increases the physiologic action of the morphine. has less strength in each dose than do individual doses of morphine.
has a shorter half-life than morphine. 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.
2. A nurse should not administer an opioid antagonist to a client with which finding? history of opioid abuse uncontrolled type 2 diabetes history of alcohol abuse hypersensitivity to naloxone
hypersensitivity to naloxone 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.
15. Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which substance? opioids alcohol NSAIDs benzodiazepines
opioids Opioid antagonists may produce withdrawal symptoms in clients physically dependent on opioids. Naloxone has no effect on benzodiazepines, alcohol, or NSAIDs.
7. The nurse is caring for an older client receiving morphine for chronic pain caused by terminal cancer. Which priority action will the nurse take when the client develops a respiratory rate of 6 breaths per minute? apply oxygen via face mask as prescribed prepare for intubation and mechanical ventilation provide rescue breathing elevate the head of the bed
prepare for intubation and mechanical ventilation The older client is at risk for respiratory depression from morphine. A respiratory rate of 6 breaths per minute indicates respiratory depression that is managed by insertion of an endotracheal tube prior to implementing mechanical ventilation. Rescue breathing is not identified as an appropriate intervention for the client experiencing respiratory depression from opioid use. Elevating the head of the bed will not improve the client's respiratory rate. Applying oxygen will not be sufficient if the respiratory rate is only 6 breaths per minute.
16. A client has received a narcotic agonist for pain relief. The nurse should monitor the client for what? hypertension. tachypnea. pupil constriction. diarrhea.
pupil constriction. Narcotics are associated with pupil constriction, constipation, orthostatic hypotension, and respiratory depression with apnea.
14. After obtaining the history of a client who is prescribed opioid therapy, the nurse determines that the client is opioid naive. The nurse would be especially alert for which effect after the client receives the prescribed opioid? respiratory depression hypertension diarrhea physical dependence
respiratory depression Opioid-naive clients are mostly at risk for respiratory depression after opioid administration. First-time opioid users do not experience diarrhea, hypertension, or physical dependence.
7. 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: crushing the tablet increases the drug's efficacy. there is risk of an extremely high dose available all at once if the tablet is crushed. the tablet would have no effect if crushed and ingested. crushing the tablet is a safe option.
there is risk of an extremely high dose available all at once if the tablet is crushed. 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.