Chapter 15: opioid analgesics

A nurse has just administered an IM injection of meperidine (Demerol) to an elderly client. The priority nursing action for the nurse would be which? close the draperies. make sure the side rails are up. check the temperature of the room. make sure the client is positioned comfortably.

make sure the side rails are up.

A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment? Methadone Oxycodone Oxymorphone Tramadol

methadone

The client has been diagnosed with a mild sprain in his left ankle. He has been taking acetaminophen and is currently rating his pain as 2-3 on a 0-10 scale ("0" indicating no pain). According to the World Health Organization's (WHO) analgesic protocol, what level (step) of pain control is the client demonstrating? Step 1 Step 2 Step 3 Step 4

step 1

The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl? A man 25 years of age A man 50 years of age A woman 85 years of age A woman 35 years of age

A woman 85 years of age

A client's post-surgical pain is severe and persistent. The client states that recent doses of morphine IV have "helped only a little bit." The client has a PRN dose of morphine available, and wants to receive the medication. The client's respiratory rate is 14 breaths per minute. What is the nurse's best action? Offer an ice pack and reassess the client's respiratory status in 30 minutes Inform the client that morphine would cause excessive respiratory depression and offer non-pharmacologic interventions Administer the morphine as prescribed and monitor the client's respiratory status closely Contact the care provider to seek direction

Administer the morphine as prescribed and monitor the client's respiratory status closely

The client is having surgery this week. What information should the nurse give the client concerning the use of pain medication after surgery? Take as little pain medication as possible to prevent addiction. Ask for pain medication before the pain gets severe. Request your pain medication whenever it is available to you. Wait as long as possible for pain medication; it will work more effectively.

Ask for pain medication before the pain gets severe.

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 addiction Assess for signs of withdrawal syndrome Monitor the client for hypersensitivity

Assess for signs of withdrawal syndrome

A hospital client's pain is rated at 9/10, and the nurse is preparing to administer 4 mg hydromorphone PO as prescribed. What are the appropriate interventions by the nurse prior to administering the medication? Ensure the client is aware of NSAID alternatives to this narcotic. Assess the client's apical heart rate for 1 minute. Assess the client's baseline respiratory rate. Ensure that there is naloxone available at the bedside.

Assess the client's baseline respiratory rate.

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? urine specific gravity. skin integrity. bowel patterns. core body temperature.

Bowel patterns

While studying pharmacology, the nursing student learns that a naturally occurring narcotic drug with analgesic and antitussive effects is: codeine. aspirin. ibuprofen. acetaminophen.

Codeine

The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect? Diarrhea Bleeding Sleep deprivation Constipation

Constipation

A 30-year-old client has been ordered meperidine 100 mg IM every 4 hours for 2 days after a fractured femur. What action should the nurse take? Administer half the dose. Call the health care provider for a smaller dose. Give the dose by mouth. Give the medication as ordered.

Give the medication as ordered.

A client has been administered an opioid. For what effect should the nurse regularly assess? Oliguria Level of consciousness (LOC) Edema Tachycardia

LOC

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. Administer naloxone. Monitor for withdrawal syndrome. Assess for congenital anomaly.

Monitor for opioid effects.

A client who is 84 years old is experiencing chronic lower back pain that has not responded to NSAIDs. The provider has prescribed a transdermal fentanyl patch. What should the nurse do to ensure safe and effective care? Select all that apply. Monitor the client's respiratory status closely. Keep the client's bed in the lowest position. Ensure the client has access to the call light. Monitor the client's temperature before and after administration. Avoid administering any other medications while the transdermal patch is in place.

Monitor the client's respiratory status closely. Keep the client's bed in the lowest position. Ensure the client has access to the call light.

x A 40-year-old male client with arthritis of the knee joint has been prescribed an analgesic to relieve the pain. Which medication is a narcotic analgesic? Aspirin Ibuprofen Celecoxib Morphine

Morphine

A client is in the end of life and has developed increased respiratory secretions and labored breathing. The health care provider will order which medication to decrease these symptoms? Meclizine Ampicillin Azithromycin Morphine sulfate

Morphine sulfate

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

Opioids

While taking vital signs on a newborn client to be discharged home, the nurse notes respirations of 40, a pulse of 130, tremors, yawning, and sneezing. What is the next most appropriate action by the nurse? Select all that apply. Do nothing, because the findings are within normal limits. Recognize that this baby could be entering withdrawal. Note the findings on the flowsheet and prepare the baby for discharge. Rush the baby to the nursery and inform one of the nurses there of the findings. Notify the healthcare provider of the findings.

Recognize that this baby could be entering withdrawal. Notify the healthcare provider of the findings.

A client has been prescribed a fentanyl patch for chronic pain. What client teaching should the nurse provide to the client and family upon discharge? Remove the patch every 3 days. Apply it to the chest only. Apply it for breakthrough pain. Remove it daily and clean skin.

Remove the patch every 3 days.

Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse is teaching the client upon discharge to avoid alcohol while taking this medication because it can cause which? respiratory depression over stimulation of the back muscles kidney pain urinary retention

Respiratory depression

The client has had a myocardial infarction. The nurse is administering morphine sulfate for the pain. What vital sign would the nurse monitor that directly relates to the use of this narcotic? Heart rate Respiratory rate Temperature Pulse

Respiratory rate

What client characteristic may contraindicate the use of tramadol for the treatment of a client's pain following traumatic injuries? The client has developed a wound infection and is at risk of sepsis. 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 a history of crack cocaine addiction.

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 an ankle fracture The client living with a chronic noncancer-related illness The client recovering from a below-knee amputation

The client living with a chronic noncancer-related illness

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.) Therapeutic response is achieved and discomfort is reduced. An adequate breathing pattern is maintained. Client reports decreased bowel movements. Client maintains adequate nutritional status. Client reports decreased urinary output.

Therapeutic response is achieved and discomfort is reduced. An adequate breathing pattern is maintained. Client maintains adequate nutritional status.

The nurse is preparing a client for epidural administration of an opioid analgesic. The nurse describes which reaction as a benefit of this type of administration? decrease in respiratory difficulty reduction in symptoms of infection development of fewer adverse reactions decrease in intensity of abdominal pain

development of fewer adverse reactions

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? "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." "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." "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."

The nurse is teaching a client about medications that cause numbness and/or a stupor-like state, are addictive and/or abused, and/or are obtained illegally. Which statements indicates the client understands what the nurse has instructed? "The doctor has given me a prescription for a narcotic." "When I take pain medication prescribed for someone else, I am taking an anesthetic." "When I take pain medication prescribed for someone else, I am taking a narcotic." "When I am given an opioid analgesic for pain, I am actually taking an anesthetic."

"When I take pain medication prescribed for someone else, I am taking a narcotic."

A nurse has entered a client's room at the beginning of a shift to quickly assess the client's airway, breathing, circulation, and consciousness. The nurse observes that the client is wincing, stating, " Oh, I am in so much pain right now." What initial question should the nurse ask this client? "When did this pain begin?" "Would you like me to get you something?" "In the past, what has helped your pain?" "Where exactly are you hurting?"

"Where exactly are you hurting?"

The nurse should monitor the client more frequently and notify the primary health care provider immediately if a client's respiratory rate falls below how many breaths per minute when an opioid analgesic is administered? 10 breaths/min 15 breaths/min 20 breaths/min 25 breaths/min

10 breaths/min

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? 10:30 9:45 10:00 11:00

10:30

When should the nurse obtain the client's blood pressure, pulse, respiratory rate and pain rating after oral administration of an opioid analgesic? 30 minutes 10 minutes 15 minutes 20 minutes

30 mins

A nurse is caring for a client with renal impairment. The client has been prescribed an opioid analgesic. Which nursing intervention would be most appropriate? Provide aggressive bowel program. Administer the drug through the IV route. Consult with the prescriber about lowering the dosage of the drug. Administer an antacid with the drug.

Consult with the prescriber about lowering the dosage of the drug.

The client is postsurgical and is receiving opioid analgesics for pain management. The nurse should encourage the client to do which? Select all that apply. Cough/deep breathing every two hours Remaining supine in semi-Fowler's position Keeping the lights dim to prevent eye strain Get out of bed (e.g., ambulation) Limiting fluid intake

Cough/deep breathing every two hours Get out of bed (e.g., ambulation)

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. The crushed medication can permanently stain teeth. Crushing the medication may precipitate an overdose. Crushing the medication interferes with its absorption.

Crushing the medication may precipitate an overdose.

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

Duration of action will be prolonged.

When providing care to a client receiving an opioid analgesic, which would be most important for the nurse to do if the client's respiratory rate drops? Instantly administer methadone. Position the client in Fowler position. Encourage the client to take deep breaths. Monitor the client for signs of nausea and vomiting.

Encourage the client to take deep breaths

A client has been admitted to the emergency department after overdosing on oxycodone. What nursing diagnosis should the nurse prioritize? impaired swallowing impaired gas exchange ineffective airway clearance ineffective role performance

Impaired gas exchange

The nurse is caring for a client taking pentazocine/naloxone. What would be an appropriate nursing diagnosis for this client's care plan? Diarrhea related to GI effects Disturbed kinesthetic perception related to CVS effects Powerlessness due to low dosage Impaired gas exchange related to respiratory depression

Impaired gas exchange related to respiratory depression

Nate is a 24-year-old man, status post--motor vehicle accident, with multiple broken bones including two rib fractures. The physician prescribes a morphine PCA pump for the client's pain. When the nurse assesses Nate, the nurse finds clear breath sounds bilaterally, a respiratory rate of 18, and a weak cough. What would be the priority nursing diagnosis based on this assessment? Alteration in comfort: Pain Ineffective breathing pattern, hyperventilation Ineffective airway clearance secondary to cough suppression by the drug Alteration in mobility due to trauma

Ineffective airway clearance secondary to cough suppression by the drug

When teaching a client about patient-controlled analgesia (PCA), which would the nurse integrate into the teaching plan? Many postoperative clients require less opioid when PCA is used. Use of PCA requires a greater amount of opioid. Clients experience more adverse effects when PCA is used. Clients can override the lockout interval if needed when a PCA is used.

Many postoperative clients require less opioid when PCA is used.

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 Epinephrine Butorphanol Naloxone

Naloxone

The client's care plan specifies the use of preemptive analgesia. This approach to pain control will involve what nursing intervention? Frequent administration of high-dose opioids Simultaneous use of analgesics from different drug classes Alternating administration of opioid antagonists with opioid agonists Client-controlled analgesia (PCA) use

Simultaneous use of analgesics from different drug classes

The nurse explains to the client that pain medications work by what action in the neurological system? They alter the brain's perception of the pain. They block the pain pathway signal from getting to the brain. They increasingly irritate pain pathways to decrease pain. They block pain receptors in the brain.

They alter the brain's perception of the pain.

A client with a viral respiratory infection has an intense headache and cough. What drug will best address both of this client's symptoms? codeine hydromorphone ibuprofen acetaminophen

codeine

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? Ataxia Blurred vision Hypotension arrhythmias

hypotension

How do opioid analgesics relieve moderate-to-severe pain? inhibiting the transmission of pain signals from the hypothalamus to the spinal cord preventing the opioid from binding with a receptor site inhibiting the transmission of pain signals from peripheral tissues to the brain increasing the production of endorphins in the brain

inhibiting the transmission of pain signals from peripheral tissues to the brain

x A group of nursing students are reviewing information about opioid analgesics. The students demonstrate understanding of the information when they identify which as the gold standard in pain management? codeine oxymorphone morphine sulfate hydromorphone

morphine sulfate

A nurse is caring for a 49-year-old client in the intensive care unit. The client was in a motor vehicle accident and is in severe pain. The client has been given morphine. After 2 days in the unit, the nurse can detect nasal congestion when the client speaks to her. The nurse will monitor for which? renal impairment. myocardial infarction. hypersensitivity to the drug. pneumonia.

pneumonia

What is the nursing goal for a client with chronic cancer pain prescribed opioid therapy? Select all that apply. promoting rest and relaxation providing physical comfort reducing medication dosages preventing opioid addiction supporting independence

promoting rest and relaxation providing physical comfort supporting independence

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

there is risk of an extremely high dose available all at once if the tablet is crushed.