Chapter 10: Analgesic Drugs

A patient is prescribed oxycodone extended release (ER) for pain management. What information is essential to include in the teaching plan? Select all that apply. 1. "Do not crush the medication." 2. "Swallow the medication whole." 3. "Take the medication frequently." 4. "Do not dissolve the medication in water." 5. "Increase the dose if you experience no pain relief."

1. "Do not crush the medication." 2. "Swallow the medication whole". 4. "Do not dissolve the medication in water." Rationale: Oxycodone ER is an extended- release dosage form. the nurse should instruct the patient not to chew or crush the medicine to prevent excessive sedation, urinary retention, and respiratory depression. The medication should be swallowed whole. Chewing or crushing or dissolving the medication in water would result in increased serum concentration of the drug, which may cause adverse effects. rapid absorption of the drug results in severe opioid toxicity. The medication is not taken frequently, because it is an extended-release form. This means it works for longer periods of time. the patient should not increase the dose if there is no pain relief, but rather should call the primary health care provider.

a patient has taken an excessive dose of acetaminophen for pain management. Which adverse effects associated with acetaminophen are likely to be found in the patient? Select all that apply. 1. Nausea 2. Vomiting. 3. Blurred vision 4. Decreased hearing 5. Elevated liver enzymes

1. Nausea 2. Vomiting 3. Elevated liver enzymes Rationale: Acetaminophen is a non-steroidal anti-inflammatory drug. Nausea, vomiting, and elevated liver enzymes are the effects of an excess dose of acetaminophen. Acetaminophen does not affect vision or hearing function.

A patient is being discharged after undergoing surgery with a prescription for fentanyl and a phenothiazine. What information is essential to include in the discharge teaching plan? 1. "The phenothiazine will treat constipation." 2. "The phenothiazine is taken to decrease nausea." 3. "The phenothiazine will increase the effects of fentanyl." 4. "The phenothiazine decreases the risk of respiratory depression from fentanyl."

2. "The phenothiazine is taken to decrease nausea." Rationale: The patina is prescribed fentanyl for surgical pain management. Fentanyl is an opioid analgesic. Opioids decrease gastrointestinal tract peristalsis and also stimulates the vomiting center in the central nervous system, resulting in nausea. A phenothiazine helps to manage nausea. Phenothiazine do not affect the respiratory system or the digestive system . Therefore, it is not helpful for the management of respiratory depression or constipation. phenothiazines have no synergistic effect with fentanyl. Therefore, phenothiazines do not improve efficacy of fentanyl.

Which condition listed in the patients medical history could be a contraindication to administration of morphine sulfate? 1. Cancer 2. Asthma 3. Diarrhea 4. Anorexia

2. Asthma Rationale: Morphine sulfate should be used with caution with patients with asthma, because naturally occurring opioids cause the release of histamine; a release of histamine in a patient with asthma can trigger bronchoconstriction. Because both conditions can result in hypoteinemia and a lack of protein-binding sites for morphine, which can alter the pharmacokinetics of the medication. The administration of morphine sulfate can help diminish diarrhea.

Which factor should the nurse consider while planning pharmacologic therapy for a patient with pain? 1. narcotic analgesics should not be used for more than 24 hours. 2. Pain relief is best obtained by administering analgesics around the clock . 3. Analgesics should be administered as needed to minimize adverse effects. 4. Patients should request analgesics when the pain level reaches 3 on a scale of 1 to 10.

2. Pain relief is best obtained by administering analgesics around the clock. Rationale: Studies have demonstrated that analgesics administered around the clock rather than on an as-needed basis provide the optimal pain relief. Narcotic analgesics have potential for addition, but pain is more important, so they may be used for more than 24 hours. A rating of 3 on the pain scale may indicate effective pain relief.

Which assessment finding indicates that the patient may have received an overdose of morphine sulfate? 1. Blood in urine 2. Pinpoint pupils 3. Heart rate 110 beats/min 4. Respiratory rate 28 breaths/min

2. Pinpoint pupils Rationale: Morphine sulfate is an opioid drug used for pain management. After administration of morphine sulfate, the nurse should assess the patients pupillary reaction to light. Pinpoint pupils indicate an overdose of morphine sulfate. Overdose of morphine sulfate does not cause blood in urine, increased heart rate or increased respiratory rate.

A patient who regularly tales acetaminophen returned to the clinic for a follow-up visit. Which assessment indicates the need for a change in the patients therapy? 1. Hemoglobin 11.2 g/dL 2. Serum bilirubin 3.2 mg/dL 3. Serum creatinine 0.8 mg/dL 4. Random blood glucose 160 mg/dL

2. Serum bilirubin 3.2 mg/dL Rationale: Acetaminophen used for pain relief can be hepatotoxic if taken in large doses. Elevated serum bilirubin indicates chemical damage to the liver. A serum bilirubin level of 3.2 mg/dL is much higher than normal; it indicates hepatotoxicity and the need for a change in therapy. A hemoglobin level of 11.3 g/dL, serum creatinine level of 0.8 mg/dL, and random blood glucose level of 160 mg/dL are under the normal range.

Which finding alerts the nurse to the possibility that the patient is experiencing adverse effects of morphine sulfate? 1. Diarrhea 2. Insomnia 3. Drowsiness 4. Hyperactive bowel sounds

3. Drowsiness Rationale: Morphine sulfate depresses the central nervous system, resulting in drowsiness. It also causes a decrease in gastrointestinal motility, leading to constipation. This effect is helpful in treating diarrhea. Morphine sulfate does not cause insomnia . Morphine does not cause hyperactive bowel sounds.

A patient needs to switch analgesics drugs after an adverse reaction to the present regimen. the patient is concerned about not receiving an effective dose of the new drug to control pain. The nurse resounds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses of these drugs with what prototype? 1. Codeine 2. Fentanyl 3. Morphine 4. Meperidine

3. Morphine Rationale: Equinanalgesia refers to the ability to provide equivalent pain relief by calculating dosages of different drugs and/ or routes of administration that provide comparable analgesia. If the opioid used is not morphine, the nurse will convert its dose to the equianalgesic dose of morphine.

What is the primary indication for the administration of morphine? 1. To treat ischemic pain 2. To diminish feelings of anxiety 3. To relieve acute and chronic pain 4. To induce a state of unconsciousness

3. To relieve acute and chronic pain Rationale: The principal indication for morphine is the relief of moderate to severe acute and chronic pain, including postoperative pain and cancer pain. In addition, morphine is used during acute myocardial infarction to relieve pain, anxiety, and dyspnea and tp promote relaxation of vascular smooth muscles. Morphine may also be administered before surgery for sedation. Nitroglycerin is used to treat ischemic pain.

Which condition would contraindicate the administration of naltrexone hydrochloride? 1. Anemia 2. Asthma 3. Diabetes 4. Hepatitis

4. Hepatitis Rationale: Administration of naltrexone hydrochloride is contraindicated in a patient who has hepatitis or liver dysfunction. Administering naltrexone hydrochloride to these patients may produce severe complications, because the drug metabolized in the liver. naltrexone hydrochloride does not alter hemoglobin levels, respiratory function, or blood sugar levels. Thus, the administration of naltrexone hydrochloride is safe in a patient who has anemia, asthma, or diabetes.

In monitoring a patient for adverse affects to morphine sulfate (MS Contin), the nurse assesses for stimulation of which area in the central nervous system (CNS). 1. Stimulation of circulation 2. Stimulation of respiratory rate 3. Stimulation of the cough reflex 4. Stimulation of the chemoreceptor trigger zone

4. Stimulation of the chemoreceptor trigger zone Rationale: Morphine sulfate can irritate the gastrointestinal tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting. Opioids cause a decease in respiratory rate, not stimulation.

The nurse is caring for a patient who has oral ulcers. What type of pain, originating from the skin and mucous membranes, does the patient have? 1. Deep pain 2. Visceral pain 3. Somatic pain 4. Superficial pain

4. Superficial pain Rationale: Pain is an unpleasant sensory and emotional experience that is associated with either actual or potential tissue damage. Superficial pain originates from the skin and mucous membranes. Deep pain originates below the skin level. Visceral pain originates from organs and smooth muscles. Somatic pain originates from skeletal muscles, ligaments, and joints.

A resident of the nursing home has quite severe arthritis. When administering an analgesic to this elderly resident, the nurse should: A. Give the medication before the activity session in the day room. B. Give the medication when the resident states the pain is at 6 or higher on a 1-10 pain scale. C. Give the pain medication at mealtime. D. Make sure that the medication is not a narcotic.

A. Give the medication before the activity session in the day room.

A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. the patient asks the nurse what benefits these patches have. The nurse's best response includes which of these feature? A. More constant drug levels for analgesia B. Less constipation and animal dry mouth C. Less drowsiness than with oral opioids D. lower dependency potential and no major adverse effects.

A. More constant drug levels for analgesia

Which agent below is most likely to cause serious respiratory depression as a potential adverse reaction? A. Morphine (Duramorph) B. Pentazocine (Talwin) C. Hydrocodone (Lortab) D. Nalmefene (Revex)

A. Morpphine (Duramorph) Rationale: Morphine is a strong opioid agonist and as such the high-test likelihood of respiratory depression. Pentavozine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression but not as often and serious as morphine. Nalmefene is an opioid antagonist and would be used to reverse reparatory depression with opioids.

A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths/min. Which medication would the nurse anticipate administering? A. Naloxone (Narcan) B. Acetylcysteine (Mucomyst) C. Methylprednisolone (Solu-Medrol) D. Protamine Sulfate

A. Naloxone (Narcon) Rationale: Naloxone is narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

Naloxene (Narcan) is administered to a client with severe respiratory depression and suspected drug overdose. After 20 minutes, the client remains unresponsive. The most likely explanation for this is: A. The client did not use an opioid drug. B. The dose of naloxone was inadequate. C. The client is resistant to this drug. D. The drug overdose is irreversible.

A. the client did not use an opioid drug. Rationale: If opioid antagonist (Naloxone) fails to reverse symptoms of respiratory depression quickly, the overdose was likely due to a non-opioid substance.

A patient admitted to the hospital with a diagnosis of pneumonia asked the nurse, " Why am I receiving codeine? I don't have ant pain." The nurse's response is based on the knowledge that codeine also has which effect? A. Immunostimulant B. Antitussive C. Expectorant D. Immunosuppressant

B. Antitussive Rationale: Codeine provides both analgesics and antitussive therapeutic effects ( as Cough suppressant).

Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Lightheadedness d. Nervousness e. Urinary retention f. Itching

B. Constipation C. Lightheadedness E. Urinary retention F. Itching

Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) A. Diarrhea B. Constipation C. Pruritus D. Urinary frequency E. Nausea

B. Constipation C. Pruritus E. Nausea

Nursing intervention for a client receiving opioid analgesics over an extended period of time should include: A. Referring the client to a drug treatment center. B. Encourage increasing fluid and fiber in diet. C. Monitoring for G.I. bleeding. D. Teaching the client to take her own blood pressure.

B. Encourage increasing fluid and fiber in diet. Rationale: Opioids suppress intestinal contractility, increase anal sphincter tone, and inhibit fluids into the intestines, which can lead to constipation. There is nothing to indicate the drug is related to addiction problems. Opioids do not cause GI bleeding.

In developing a plan of care for a patient receiving morphine sulfate (MS Contin), which nursing diagnosis has the highest priority? A. Acute pain related to metastatic tumor cancer B. Impaired gas exchange related ti respiratory depression C. Constipation related to decreased GI motility D. Risk for injury related to CNS adverse effects

B. Impaired gas exchange related to respiratory depression

The nurse is planning care for a patient receiving morphine sulfate (Duramorph) by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A. Administer cough suppressant. B. Insert Foley catheter. C. Administer antidiarrheal. D. Monitor liver function tests.

B. Insert Foley catheter Rationale: Morphine can cause urinary hesitancy and urinary retention. If bladder distention or the inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those drugs would need to be administered to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

A nurse is caring for a cancer patient receiving subcutaneous morphine sulfate for pain. Which of the following nursing actions is most important in the care of this patient? A. Monitor urine output B. Monitor respiratory rate. C. Monitor heart rate D. Monitor temperature

B. Monitor respiratory rate Rationale: Morphine sulfate can suppress respiration and respiratory reflexes, such as cough. Patients should be monitored regularly for these effects to avoid respiratory compromise. Morphine sulfate does not significantly affect urine output, heart rate, or body temperature.

Two days after surgery, an elderly client refuses a PRN dose of analgesic dose for fear of becoming "hooked." The nurse should respond by stating that: A. It is impossible to become hooked on PRN narcotics. B. Short term use of narcotics is not likely to cause a person to become dependent on them. C. Side effects that occur in the elderly mean that medications will be discontinued as soon as possible. D. The elderly is least likely to become dependent on narcotics.

B. Short term use of narcotics is not likely to cause a person to become dependent on them.

The nurse is working on a postoperative unit where pain management is part of routine care. Which statement below is most helpful in guiding clinical practice in this setting? A. At least 30% of the U.S population is prone to addiction and abuse. B. The development of opioid dependence is rare when opioids are used for acute pain C. Morphine is a common drug of abuse in the general population. D. The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.

B. The development of opioid dependence is rare when opioids are used for acute pain.

A patient with renal cancer prescribed for a patient. The nurse checks the patient's medical history knowing this medication is contraindicated in which disorder? A. Renal insufficiency B. Severe asthma C. Sleep apnea D. Severe head injury E. Liver disease

B. severe asthma C. Sleep apnea D. Severe head injury

A patient prescribed massage therapy for musculoskeletal pain asks the nurse. "How is rubbing my muscles going to make the pain go away?" What is the nurse's best response? A. "Massaging muscles helps relax the contracted fibers and decrease painful stimuli." B. "Massaging muscles decreases the inflammatory response that initiates the painful stimuli." C. "Massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus block painful stimuli from reaching the brain." D. "Massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain."

C. "Massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus block painful stimuli from reaching the brain."

The healthcare provider prescriber 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 anti-inflammatory drug may be indicated. D. Systemic corticosteroids are the next drug of choice for pain relief.

C. Another type of nonsteroidal anti-inflammatory drug may be indicated.

The nurse is creating a pain management plan for a client with a previous history of substance abuse. Which of the following should be included in this plan? A. Ak the physician to prescribe short-acting analgesics. B. Ask the physician to prescribe a medication similar to the one the client abused. C. Ask the physician to prescribe analgesics for the oral route. D. Keep a dose of Narcan at the bedside.

C. Ask the physician to prescribe analgesics for the oral route. Rationale: Extended-release and long-acting analgesics are recommended for clients with a history of abuse. Specific interventions should: Avoid analgesics similar to the abused drugs; Utilize long-acting analgesics; Avoid Narcan; Administer medication through the oral route.

When assessing a patient for adverse effects related to morhpine sulfate (MS Contin), which clinical findings are the nurse most likely to find? A. Diarrhea B. Weight gain C. Constipation D. Inability to void E. Excessive bruising

C. Constipation D. Inability to void

A patient is suffering from tendonitis of the knee. the nurse is reviewing the patient's medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain? A. Antidepressant B. Anticonvulsant C. Corticosteroid D. Local anesthesia

C. Corticosteroid

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval? A. Once a week B. Every 24 hours C. Every 72 hours D. When pain recurs

C. Every 72 hours

A nurse administers naloxene (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate giving this medication? A. Drowsiness B. Tics and tremors C. Increased pain D. nausea and vomiting

C. Increased pain Rationale: Naloxene is a medication that reverses the effects of narcotics. Although the patient's respiratory status will improve after the administration of naloxone, pain will be more acute.

The safest narcotic choice for an elderly client with acute pain is: A. Meperidine (Demeroll) B. Oxycodone C. Fentanyl transdermal patch D. Morphine sulfate

D. Morphine sulfate Rationale: Morphine is the "gold standard" of narcotics for acute pain. The other choices are incorrect.

An elderly client had abdominal surgery six hours earlier. When the nurse asks the client about pain, the patient responds that there is none. The best intervention on the part of the nurse is: A. Administer a PRN dose of IV pain medication as ordered. B. Assist the client into a sitting position in preparation for ambulation. C. Question the client further about discomfort to assess the meaning of pain. D. Assess the abdominal dressing and consult the surgeon about the findings.

C. Question the client further about discomfort to assess the meaning of pain.

The client admitted with hepatitis B is prescribed Vicodin 2 tabs for treatment of pain. The appropriate nursing action is to: A. Administer the drug as ordered. B. Administer one tablet only. C. Question the physician about the order. D. Hold the drug until the physician arrives.

C. Question the physician about the order. Rationale: Vicodin is a combination drug of hydrocodone and acetaminophen. Acetaminophen can be hepatotoxic, and a contraindicated in liver disease.

A client who incurred an arm injury describes his plan as "sharp and localized to the lower arm." The nurse recognizes that this type of pain would be relieved best by administration of which type of medication? (Select all that apply) A. Muscle relaxant B. Acetaminophen C. Narcotic analgesic D. NSAIDs E. Antidepressant

C. narcotic analgesic D. NSAIDs Rationale: Injury to tissue procedure nociceptor pain, which usually responds to conventional analgesic pain medications such as opiates or NSAIDs.

The client informs the nurse that he has experienced pain in the lower extremities for the past eight months. The nurse recognizes that this pain is classified as: A. Moderate B. Severe C. Acute D. Chronic

D. Chronic Rationale: Chronic pain persists longer than six months.

A patient arrives at the emergency department complaining of back pain. He reports taking at least 3 acetaminophen tablets every three hours for the past week without relief. Which of the following symptoms suggest acetaminophen toxicity. A. Tinnitus B. Diarrhea C. Hypertension D. Hepatic damage

D. Hepatic damage Rationale: Acetaminophen in even modestly large doses can cause serious liver damage that may result in death. Immediate evaluation of liver function is indicated with consideration of N-acetylcysteine administration as an antidote. Tinnitus is associated with Aspirin overdose, not acetaminophen. Diarrhea and hypertension are not associated with acetaminophen

A patient take oxycodone (OxyContin), 40 mg PO twice daily, for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A. Take an antacid with each dose. B. Eat foods high in lactobacilli. C. Take the medication on an empty stomach. D. Increase fluid and fiber in the diet.

D. Increase fluid and fiber in the diet. Rationale: Narcotic analgesics reduce intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can manage this adverse effect.

The nurse us caring for a patient with opioid addiction. The nurse anticipates that the patina will be prescribed which medication? A. Naloxone (Narcan) B. Meperidine (Demerol) C. Morphine (MS Contin) D. Methadone (Dolophine)

D. Methadone (Dolophine)

A client in the ICU who sustained a traumatic abdominal injury 1 week ago continues to complain of severe pain. The nurse notes his vital signs are normal. Which of the following would be appropriate for the nurse to do? A. Encourage early return to ambulation. B. Offer nonnarcotic analgesics for pain C. Utilize distraction. D. Provide the client with pain medication.

D. Provide the client with pain medication.

The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which of the following assessments require immediate nursing intervention? A. Blood pressure 110/70 B. The client is drowsy. C. Pain is unrelieved in 15 minutes. D. Respiratory rate 10/minute.

D. Respiratory rate 10/minute. Rationale: Opioids activate mu and kappa receptors that can cause profound respiratory depression. Respiratory rate should remain above 12. The BP is not significantly low. Drowsiness is an expected effect of morphine. Unrelieved pain warrants further assessment, but not as immediately as do decreased respirations.

The nurse is assessing patients who are in severe pain. Which patient can safely receive morphine for pain relief? Patient A has spinal cancer Patient B has renal impairment Patient C has bradypnea Patient D is under the influence of alcohol.

Patient A has spinal cancer Rationale: Patient A has spinal cancer with metastasis and is in severe pain. Morphine is used to treat moderate to severe pain. The patient has stable vital signs and can receive morphine for pain relief. Patient B has renal impairment, as evidenced by a high serum creatinine value (normal. is 0.7. -1.4), which might lead to the accumulation of the drug metabolite. the metabolite of morphine is toxic; if it is nit excreted and instead accumulates, it might lead to toxicity or other complications. Patient C has bradypnea. Morphine, when given in high doses, causes respiratory depression, so patient C should not receive morphine. Patient D is under the influence of alcohol, and coadministration of morphine with alcohol can result in respiratory depression.