Chapter 26 Pharmacology Note
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?
Abrupt reversal of opioid-induced respiratory depression may cause vomiting.
A nurse is caring for a client diagnosed with a migraine. The client received acetaminophen-aspirin-caffeine by mouth. Which method should be used to assess for the therapeutic effects of the medication?
Pain scale
A caregiver asks the nurse what the caregiver can give a 9-year-old child for a headache. What is the nurse's best response?
"Acetaminophen is appropriate."
A client is prescribed sumatriptan. Which statement should be included in the teaching plan regarding how the medication works?
"It produces vascular constriction of cranial blood vessels."
A nurse has entered a client's room at the beginning of a shift to quickly assess the clent'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?
"Where exactly are you hurting?"
The health care provider has ordered 0.2 mg naloxone to be administered intramuscularly stat. The pharmacy has available naloxone 0.4 mg/mL. How much naloxone will the nurse administer to the client?
0.5
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
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?
0.66 mg ÷ 10 mg/mL = 0.6 mL
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?
Administer the morphine as prescribed and monitor the client's respiratory status closely
The nurse enters the client's room to see how the client's pain level is because PRN demerol can be given. The client is sitting up in bed laughing and visiting with family. The client states that the pain is a "10" on a pain scale of 0 to 10. What is the best response by the nurse?
Administer the pain medication as ordered.
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.
A class of new nursing students is learning how to administer medications to clients. What should the instructor teach the students about giving opiates?
Assess the respiratory rate before giving a dose of opiates.
The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize
Assessing the client for migraine pain
The nurse observes that a new client's medication regimen includes sumatriptan. What assessment should the nurse prioritize?
Assessing the client for migraine pain
To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.)
Assist client from their bed to the toilet.Assist client with rising from a lying position.Assist client with hall-walking activities.
The nurse is giving instructions to a client who has just been prescribed sumatriptan for the treatment of migraine headaches. The client will be instructed to take this medication at what time?
At the onset of migraine symptoms
A female client tells the nurse that the first thing she does when she gets a headache is drink a caffeinated beverage. The nurse is aware that caffeine is known to decrease the pain of migraine headaches by what mechanism?
Vasoconstriction of blood vessels
The client has difficulty swallowing and requests the nurse to crush all the medications. 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.
How will a client's impaired renal function affect the pharmacokinetics of morphine?
Duration of action will be prolonged.
A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent?
Fentanyl
Naloxone (Narcan) will reverse the effects of which drug?
Fentanyl (Duragesic)
Which statement best describes a drug's characteristic of having no ceiling effect?
It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops.
The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse?
Level of consciousness and respiratory rate
Which medications are opioids for which naloxone may be given to counter the effects?
Meperidine
Prior to administering morphine, the nurse checks the client's medication history. The nurse will contact the health care provider and hold the morphine if the nurse notes the client is currently taking which medication?
Monoamine oxidase (MAO) inhibitor
A client is to receive naltrexone. The nurse would expect to administer this drug by which route?
Oral
Both categories of migraine abortive drugs (ergot alkaloids and serotonin agonists) exert powerful vasoconstrictive effects and also have what potential?
Raise blood pressure
A client admitted to the emergency department with a migraine headache unrelieved with current prescribed medications. The nurse administers prescribed ketorolac tromethamine 30 mg IV and metoclopramide 10 mg IV, and the client suddenly develops involuntary movement of upper limbs, facial grimacing, sticking out the tongue rhythmically, contractures of the neck and head to one side in a twisting motion, and rapid involuntary spasms of eyelids. Which action would the nurse implement first?
Receive order for diphenhydramine and administer.
A nurse is caring for a patient with chronic pain who has been prescribed epidural analgesia. The nurse should monitor the patient for which condition after insertion of the epidural catheter and throughout the therapy?
Respiratory depression
Naproxen has been prescribed to a client whose increasingly severe migraines are interfering with work performance and family life. When providing health education to this client, the nurse should instruct the client to consider what intervention?
Take the pills with meals to minimize stomach upset
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?
The client may begin to demonstrate symptoms of withdrawal.
While assessing clients receiving opioid analgesics for pain management, what finding would allert the nurse and require healthcare provider notification?
The client with a pulse of 118, a respiratory rate of 8, and a BP of 80/60
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 maintains adequate nutritional status.
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?
Using a pain rating scale
What is a priority nursing assessment of a client prescribed oral sumatriptan?
Vital signs
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?
Within one to five minutes, an effect may be seen.
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.
When diagnostic testing reveals a bone fracture, what type of pain is the client experiencing?
acute somatic pain
A postsurgical client has been prescribed morphine to address the pain that is anticipated over the next 24 to 48 hours. What is the most effective strategy to manage a client's postsurgical pain for the initial 24 to 48 hours?
administering morphine on a scheduled basis and supplementing it with additional morphine when the pain worsens
A 60-year-old client tearfully explains to the nurse how her husband downplays her frequent migraines and tells her that she needs to "just push through a headache." She describes how her migraines have limited her ability to provide childcare for her young grandchildren and explains that she is unable to keep up her garden. The nurse should identify what nursing diagnosis when planning this client's care
ineffective role performance related to migraine headaches
A client has been administered an opioid. What effect should the client be regularly assessed for?
level of consciousness (LOC)
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?
make sure the side rails are up.
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
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:
there is risk of an extremely high dose available all at once if the tablet is crushed
