Analgesics Pharm exam 1

625) After surgery, an adolescent has a patient-controlled analgesia (PCA) pump that is set to allow morphine delivery every 6 minutes. Which statement indicates to the nurse that the family understand instructions about the PCA pump? 'I'll make sure that she pushes the PCA button every 6 minutes.' 'She needs to push the PCA button whenever she needs pain medication.' 'I'll have to wake her up on a regular basis so she can push the PCA button.' 'I'll press the PCA button every 6 minutes so she gets enough pain medication while she's sleeping.'

'She needs to push the PCA button whenever she needs pain medication.'

413) Which client statement indicates that teaching about acetaminophen is effective? "I can drink beer with this but not wine." "I need to limit my intake of acetaminophen to 650 mg a day." "I should take an emetic if I accidentally overdose on acetaminophen." "I have to be careful about which over-the-counter cold preparations I take."

"I have to be careful about which over-the-counter cold preparations I take."

867) A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. Which medication is indicated to prevent progression to a myocardial infarction? Aspirin Atropine Gabapentin Epinephrine

Aspirin Rationale: Early administration of aspirin in the setting of acute myocardial infarction (MI) has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, significantly reduces damage and can be lifesaving, the earlier the better; hence the reason why it is part of emergency management treatment. Gabapentin is an anticonvulsant and does not have a role in reducing development of an MI. Atropine and epinephrine are emergency medications that increase cardiac activity and thus oxygen demand; this can increase the risk for MI.

302) Which response would the nurse give to a client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted? "Yes, both are antipyretics and have the same effect." "Acetaminophen irritates the stomach more than ibuprofen does." "Acetaminophen is the preferred treatment for rheumatoid arthritis." "Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

"Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

628) The mother of a toddler with hemophilia A asks the nurse, 'Can I give my child ibuprofen for fever or pain?' How will the nurse respond? 'Ibuprofen is a good choice for fever or pain.' 'Give your child acetaminophen. Ibuprofen may cause bleeding.' 'No. I'll explain why your child isn't allowed pain medications.' 'You seem concerned about giving medications to your child.'

'Give your child acetaminophen. Ibuprofen may cause bleeding.'

4 The nurse educating a client who is postpartum about the use of ibuprofen for uterine cramping. Which statement should the nurse include in the teaching? AThis medication could cause gastrointestinal discomfort BYou may experience decreased vaginal discharge with this medication CTaking this medication could decrease your breast milk production DYou could experience dizziness while taking this medication

AThis medication could cause gastrointestinal discomfort

712) Which medication would the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis? Aspirin Hydromorphone Meperidine Alprazolam

Aspirin Rationale: Because of its anti-inflammatory effect, acetylsalicylic acid is useful in treating arthritis symptoms. Opioids such as hydromorphone and meperidine should be avoided because they promote medication dependency and do not affect the inflammatory process. Alprazolam is an antianxiety, not an anti-inflammatory, agent.

237) Which medication increases the risk for upper gastrointestinal (GI) bleeding? Select all that apply. One,some, or all responses may be Aspirin Ibuprofen Ciprofloxacin Acetaminophen Methylprednisolone

Aspirin Ibuprofen Methylprednisolone Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid and ibuprofen, and corticosteroids such as methylprednisolone are known causes of medication-induced gastrointestinal (GI) bleeding by causing irritation and erosion of the gastric mucosal barrier. Ciprofloxacin, an antibiotic, has not been associated with GI bleeding. Acetaminophen is a safe alternative to NSAIDs to reduce the risk of GI bleeding.

6 The nurse is caring for a client that is taking prednisone and aspirin for rheumatoid arthritis. Which action by the nurse is appropriate for this client? AAssess the client's pain level once a shift BMonitor the client's temperature every two hours CTest the client's stool for occult blood DApply a hot pack to a warm, acutely inflamed joint

CTest the client's stool for occult blood

762) A terminally ill client is receiving a morphine drip that exceeds the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. Which action will the nurse take? Add a placebo to the morphine to appease the spouse. Discuss with the spouse the risk for morphine addiction. Assess the client's pain before increasing the dose of morphine. Check the client's heart rate before increasing the morphine to the next level.

Assess the client's pain before increasing the dose of morphine.

595) A child with juvenile idiopathic arthritis is prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy at home. Which important toxic effect of NSAIDs would the nurse include in discharge instructions to the child and family?Diarrhea Hypothermia Blood in the urine Increased irritability

Blood in the urine

24. The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A. The frequency of the dosing is necessary to increase the effectiveness. B. Therapeutic blood levels of this drug are reached in 4 to 6 weeks. C. Another type of nonsteroidal antiinflammatory drug may be indicated. D. Systemic corticosteroids are the next drugs of choice for pain relief.

C. Another type of nonsteroidal antiinflammatory drug may be indicated. Individual responses to nonsteroidal antiinflammatory drugs are vary from person to person, so another nonsteroidal antiinflammatory drug (NSAID) may be indicated for this particular client.

49.The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports hearing non-stop ringing in the ears. Which action should the nurse implement? A. Refer the client to an audiologist for evaluation of her hearing. B. Advise the client that this is a common side effect. C. Notify the healthcare provider of the finding immediately. D. Face the client directly and speak in a low, monotone voice.

C. Notify the healthcare provider of the finding immediately. ASA tox

18 A nurse is evaluating a client who takes naproxen for pain associated with osteoarthritis. Which documented statement indicates the expected outcome was met? ADecreased erythema noted to joints BMuscle strength 3/5 to lower extremities CClient observed with steady gait upon ambulation DDeep tendon reflexes +3

CClient observed with steady gait upon ambulation

194) Which mechanism of action explains why naloxone is administered for a heroin overdose? Competition with opioids for occupancy of opioid receptors Blunts severity of withdrawal symptoms as heroin wears off Accelerated metabolism of heroin and stimulation of respiratory centers Stimulation of cortical sites that control consciousness and cardiovascular function

Competition with opioids for occupancy of opioid receptors

17 A nurse is performing pain assessments on several clients. Which client would benefit the most from the administration of intravenous PRN pain medication? AA client eating breakfast verbalizing a headache BA client with a fractured arm pending discharge CA client post-abdominal surgery sitting in a chair DA client pending bedside debridement of a wound

DA client pending bedside debridement of a wound

708) A client with arthritis takes large doses of aspirin. Which symptom would the nurse include when teaching the client about the clinical manifestations of aspirin toxicity? Feelings of drowsiness Disturbances in hearing Intermittent constipation Metallic taste in the mouth

Disturbances in hearing Rationale: Ringing in the ears occurs because of aspirin's effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity. Feelings of drowsiness are not side effects of aspirin; aspirin promotes comfort, which may permit rest. Aspirin may cause diarrhea, nausea, and vomiting, not intermittent constipation. A metallic taste in the mouth is not a side effect of salicylates such as aspirin.

16 A client is diagnosed with rheumatoid arthritis (RA). Which types of drugs might the nurse expect to be ordered as a combination drug therapy regimen? Select all that apply. Glucocorticoids Biological-response modifiers Antimicrobial agents Anti inflammatory meds Diuretics

Glucocorticoids Anti inflammatory meds Biological-response modifiers

142) Which characteristic identifies the reason that methadone is useful in the treatment of opioid addiction? Is a nonaddictive medication Has an effect of longer duration Does not produce a cumulative effect Carries little risk of psychological dependence

Has an effect of longer duration Rationale: Methadone's duration of effect is 12 to 24 hours, compared with other opioids, which have a 3- to 6-hour duration of effect. It is just as addictive but controls the addiction and keeps the client out of the illicit drug market. Methadone does produce a cumulative effect. Physical and psychological dependence is possible, just as with other opioids.

810) A client is receiving patient-controlled analgesia (PCA) after surgery. Which benefit would this type of therapy provide? Select all that apply. One, some, or all responses may be . Client is able to self-administer pain-relieving medications as necessary Amount of medication received is determined entirely by the client Decreases client dependency Relieves the nurse of monitoring the client Increases client sense of autonomy

Increases client sense of autonomy Client is able to self-administer pain-relieving medications as necessary Decreases client dependency

746) Which medication would the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema? Morphine Phenobarbital Hydroxyzine Chloral hydrate

Morphine Rationale: Morphine binds with the same receptors as natural opioids. However, it has a rapid onset, lowers the blood pressure, decreases pulmonary reflexes, and produces sedation. Phenobarbital has a slower onset than morphine and does not affect respirations and blood pressure to the same extent as morphine. Hydroxyzine generally is used to control anxiety associated with less acute situations. Chloral hydrate is a hypnotic that is not appropriate for the acute situation described.

800) A client has increased intracranial pressure and is unconscious with a heart rate of 60 beats/min, respirations 16 breaths/min, and blood pressure 142/64 mm Hg. The nurse reviews the treatment plan and questions which prescription?Mannitol Dexamethasone Chlorpromazine Morphine

Morphine Rationale: Morphine injection is contraindicated for an unconscious, neurologically impaired client because it depresses respirations. Mannitol, an osmotic diuretic, is used to reduce increased intracranial pressure. Dexamethasone, a corticosteroid anti-inflammatory agent, is used to help reduce increased intracranial pressure. Chlorpromazine, an antipsychotic/neuroleptic/antiemetic, can be given safely to a neurologically impaired client for restlessness.

955) The nurse is caring for a client hospitalized with a myocardial infarction. Which analgesic is the medication of choice for this client? Ketorolac Meperidine Flurazepam Morphine sulfate

Morphine sulfate Rationale: For myocardial infarction, morphine sulfate is the medication of choice because it relieves pain quickly and reduces anxiety while decreasing cardiac workload. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the pain of a myocardial infarction. Although ketorolac and meperidine relieve pain, they do not offer all the additional benefits of morphine. In addition, meperidine has additional adverse effects. Flurazepam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the pain of a myocardial infarction.

825) A client, admitted to the cardiac care unit with a myocardial infarction, complains of chest pain. Which intervention will be most effective in relieving the client's pain? Nitroglycerin sublingually Oxygen per nasal cannula Lidocaine hydrochloride 50-mg intravenous (IV) bolus Morphine sulfate 2 mg IV

Morphine sulfate 2 mg IV MONA Rationale: Morphine is an opioid analgesic that acts on the central nervous system by a sympathetic mechanism. Morphine decreases systemic vascular resistance, which decreases left ventricular afterload, thus decreasing myocardial oxygen consumption. Nitroglycerin sublingually relieves anginal pain, not myocardial infarction pain. Oxygen administration elevates arterial oxygen tension, potentially improving tissue oxygenation; however, oxygen administration will not relieve the pain. Lidocaine is an antidysrhythmic, not an analgesic.

132) Which medication is indicated for management of clinical manifestations associated with an opioid overdose? Naloxone Methadone Epinephrine Amphetamine

Naloxone

1036) A health care provider prescribes aspirin therapy for a client with arthritis. The nurse will advise the client to report which adverse effects? Select all that apply. One, some, or all responses may be . Ongoing nausea Constipation Easy bruising Decreased pulse Ringing in the ears

Ongoing nausea Easy bruising Ringing in the ears

1029) Which therapeutic outcomes are expected after administering ibuprofen? Select all that apply. One, some, or all responses may be . Diuresis Pain relief Temperature reduction Bronchodilation Anticoagulation Reduced inflammation

Pain relief Temperature reduction Reduced inflammation

1090) A client in the coronary care unit develops 'viselike' chest pain radiating to the neck. Assessment reveals a blood pressure of 124/64 mm Hg, an irregular apical pulse of 64 beats per minute, and diaphoresis. Cardiac monitoring is instituted, and morphine sulfate 4 mg intravenous (IV) push stat is prescribed. Which intervention is the priority nursing care for this client? Relief of pain Client teaching Cardiac monitoring Maintenance of bed rest

Relief of pain

1516) An adolescent client has orders for morphine sulfate for severe pain and acetaminophen-codeine compound for moderate pain after a spinal fusion. The pain assessment reveals the client is rigid and crying in pain. Which information would influence the nurse's choice of analgesic? One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive. Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest.

Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic.

240) Naloxone effectively reverses a client's respiratory depression from an overdose of heroin. Which rationale explains why the nurse will continue to closely monitor this client's status?Naloxone and heroin can cause cardiac depression when combined. The medication may cause peripheral neuropathy. Symptoms of the heroin overdose may return after the naloxone is metabolized. Hyperexcitability and amnesia may cause the client to thrash about and become injured.

Symptoms of the heroin overdose may return after the naloxone is metabolized.

781) A health care provider prescribes aspirin for a client with severe arthritis. Which advice will the nurse provide to the client? Take the medicine with meals. See a dentist if bleeding gums develop. Switch to acetaminophen if tinnitus occurs. Avoid spicy foods while taking the medication.

Take the medicine with meals. Rationale: Acetylsalicylic acid is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Bleeding gums should be reported to the health care provider, not the dentist. Acetaminophen does not contain the anti-inflammatory properties present in aspirin; tinnitus should be reported to the health care provider. Avoiding spicy foods is unnecessary as long as aspirin is taken with food.

20 The nurse is assessing a client with suspected aspirin overdose. Which assessment findings would support this diagnosis? Select all that apply. Respiratory rate of 28 Tinnitus Hypoglycemia Jaundice Serum pH 7.31 Headache

Tinnitus Headache Serum pH 7.31 Respiratory rate of 28

1028) A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical findings warrant immediate follow up by the nurse? Select all that apply. One, some, or all responses may. Polyuria Unconsciousness Bradycardia Dilated pupils Bradypnea

Unconsciousness Bradycardia Bradypnea

233) How would the nurse instruct a client with arthritis to take aspirin when the client states that the aspirin causes stomach irritation? An hour before a meal With food and a full glass of water With sodium bicarbonate At the same time as the other medications

With food and a full glass of water Rationale: A full glass of water helps decrease gastric irritation by diluting the acidic substances in the stomach. If aspirin is taken on an empty stomach, gastric irritation is increased. Although taking the medicine with sodium bicarbonate will limit gastric irritation, it will also decrease the effect of aspirin by increasing its renal excretion. Aspirin has a gastric-irritating and ulcerogenic effect, which may be potentiated by other medications.

1043) After surgery the client has a prescription for morphine sulfate via intravenous (IV) route every 3 hours as needed for pain. The client's preoperative blood pressure was 128/76 mm Hg. Postoperative assessments reveal that the client's blood pressure ranges between 90/60 mm Hg and 100/70 mm Hg. Which action will the nurse take if the client requests medication for pain? Administer morphine as prescribed. Obtain a prescription for a vasoconstrictor. Give half the prescribed amount of morphine. Withhold morphine until the blood pressure stabilizes.

Withhold morphine until the blood pressure stabilizes. Rationale: Morphine is an opioid analgesic that may decrease the blood pressure further. It should be withheld and not administered at this time. It is not unusual for blood pressure to be lowered after surgery, plus a vasoconstrictor may not be the best option to increase blood pressure; if obtaining a prescription, a better option would be to have an alternative for pain. Administration of a medication dosage other than that prescribed is not an independent nursing function.