CHAPTER 49: DRUG THERAPY WITH OPIOIDS

A female client is crying and states that everyone thinks she is a "drug addict," and that no one will listen to her. She states she has abdominal pain and must have something for the pain. What is the best response of the nurse? "Tell me more about your pain." "Why didn't you speak up earlier?" "You don't look like you're in pain." "Does it hurt badly?"

"Tell me more about your pain." Explanation: Nurses must lessen the barriers to good pain management by showing sensitivity to the client and conducting a through assessment. The nurse needs to encourage the client to share information regarding pain so that an appropriate treatment plan can be designed. To do this open ended statements need to be made. Questions with yes/no responses are not as therapeutic. Nurses must demonstrate nonjudgmental attitudes with clients.

A 72-year-old female client is admitted to the hospital for surgery. After the woman returns to the floor, her daughter tells the nurse she is concerned that her mother will overdose on morphine because she keeps pressing the button on her PCA pump. What would be the nurse's best response?

"The device is preset, so your mother cannot get more than a specific amount." Explanation: A patient controlled analgesia (PCA) system using morphine provides a baseline, constant infusion of morphine and gives the client control of the system to add bolus doses of morphine if the client feels that pain is not being controlled. The system prevents overdose by locking out extra doses until a specific period of time has elapsed. It is correct for the client to control their analgesia, not for a family member to control it. Negating the daughter's question is also incorrect.

The nurse should share with the client receiving intravenous (IV) morphine that maximum relief of pain will occur in what time frame? 10 to 20 minutes 3 to 5 minutes 30 to 45 minutes 5 to 10 minutes

10 to 20 minutes After IV injection of morphine, maximal analgesia and respiratory depression usually occur within 10 to 20 minutes.

The nurse administers morphine 15 mg oral solution to a client with cancer pain at 0930. When should the nurse reassess the client for peak effect?

1030 Explanation: With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours.

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 A respiratory rate of 14 breaths per minute is lower than expected, but is not low enough to warrant withholding a client's medication. The nurse should give the medication and monitor the client closely. There is no clear need to contact the provider.

A patient has been given MS Contin. You enter the room and the patient is unresponsive. His respirations are 6 breaths per minute. What medication will be ordered for the patient? A) Naloxone (Narcan) B) Capsaicin (Zostrix) C) Butorphanol (Stadol) D) Nalbuphine (Nubain)

Ans: A Feedback: Naloxone (Narcan) has long been the drug of choice to treat respiratory depression caused by an opioid. Capsaicin is made from cayenne pepper and applied topically for Page 2 for pain relief. Butorphanol (Stadol) is a synthetic, Schedule IV agonist similar to morphine in analgesic effects and ability to cause respiratory depression. Nalbuphine (Nubain) is a synthetic analgesic used for moderate to severe pain.

A patient has been ordered a fentanyl patch known as Duragesic for chronic pain. What patient teaching should be provided to the patient and family? A) Remove the patch every 3 days. B) Apply it to the chest only. C) Apply it for breakthrough pain. D) Remove it daily and clean skin.

Ans: A Feedback: Duragesic has a slow onset of action, but lasts about 72 hours. Duragesic can be applied to other areas of the skin, not solely on the chest. Duragesic is not applied for breakthrough pain. Duragesic is not removed daily.

A patient has been administered an opioid. For which of the following effects should the patient be assessed? A) Oliguria B) Decreased level of consciousness C) Edema D) Tachycardia

Ans: B Feedback: Opioids will produce decreased LOC. Oliguria is not a result of the administration of an opioid. Edema is not a result of the administration of an opioid. Tachycardia is not a result of the administration of an opioid.

An outpatient has been prescribed hydrocodone for back pain related to a compression fracture. Which of the following interventions should the patient be taught regarding the medication administration? A) Consume a diet high in fiber. B) Decrease activity due to pain. C) Elevate the lower extremities. D) Take aspirin with the medication.

Ans: A Feedback: Hydrocodone is an opioid, which, in the gastrointestinal tract, slows motility. To prevent constipation, the patient should consume a diet high in fiber. A decrease in activity due to pain will increase constipation. Elevating the lower extremities will not increase or decrease pain. Hydrocodone should not be routinely combined with aspirin unless prescribed by the physician.

In which of the following patients should the nurse question the physician's order for IV morphine? A) An 88-year-old female with failure to thrive B) A 45-year-old female, 1-day postoperative mastectomy C) An 8-year-old male with a fractured femur D) A 17-year-old female, 1-day postoperative appendectomy

Ans: A Feedback: Opioid analgesics should be used cautiously in older adults, especially if they are debilitated. Treatment with morphine 1 day after mastectomy is appropriate for pain management. The treatment of pain with morphine is appropriate for a patient with a fractured femur. The treatment of pain with morphine is appropriate for a patient who is 1-day postoperative for an appendectomy.

A 16-year-old has been brought to the emergency department by his football coach after twisting his ankle during a practice drill. Diagnostic testing reveals a fracture. This patient is experiencing what type of pain? A) Acute somatic pain B) Acute cutaneous pain C) Visceral pain D) Neuropathic pain

Ans: A Feedback: Sprains and other traumatic injuries are examples of acute somatic pain. Somatic pain results from stimulation of nociceptors in skin, bone, muscle, and soft tissue. Visceral pain, which is diffuse and not well localized, results when nociceptors are stimulated in abdominal or thoracic organs and their surrounding tissues. Neuropathic pain is caused by lesions or physiologic changes that injure peripheral pain receptors, nerves, or the central nervous system. Cutaneous pain is not a recognized category.

Following the administration of pentazocine (Talwin) to a patient with moderate pain, the nurse should assess for what change in the patient's vital signs? A) Increased blood pressure B) Decreased oxygen saturation C) Increased temperature D) Increased respiratory rate

Ans: A Feedback: Talwin may cause increased blood pressure. It does not typically cause deoxygenation, fever, or tachypnea.

A 30-year-old male patient has been ordered Demerol 75 mg IM every 4 hours after a fractured femur. What action should the nurse take? A) Give the medication as ordered. B) Administer half the dose. C) Call the physician for a smaller dose. D) Give the dose by mouth.

Ans: A Feedback: The patient should be administered the full dose of medication, which is within dosing recommendations. A male patient with a fractured femur who has adequate hepatic and renal function should not receive a lower dose of Demerol and should not receive the medication by mouth.

A nurse is teaching a patient about her prescription for Tylenol #3 that she will take at home. This medication consists of acetaminophen and what other drug? A) Codeine B) Acetylsalicylic acid (aspirin) C) Methadone (Dolophine) D) Tramadol (Ultram)

Ans: A Feedback: Tylenol #3 is acetaminophen (Tylenol) and codeine. Acetylsalicylic acid (aspirin) is not combined with acetaminophen (Tylenol). Methadone (Dolophine) is not combined with Tylenol. Tramadol (Ultram) is not combined with Tylenol.

A surgical patient has highly elevated AST and ALT levels. Standard orders specify that she is to receive morphine sulfate 10 mg postoperatively. What action should the nurse take prior to administering the medication? A) Draw up half of the medication for administration. B) Notify the physician for a reduced dosage. C) Assess the patient's respiratory status. D) Assess the patient's pain tolerance.

Ans: B Feedback: Morphine and meperidine form pharmacologically active metabolites. Thus, liver impairment can interfere with metabolism, and kidney impairment can interfere with excretion. Drug accumulation and increased adverse effects may occur if dosage is not reduced. The nurse cannot administer half of the medication without a physician's order. It is important to assess the patient's respiratory status before administration, but this action is not the primary intervention in this case. Narcotics prior to surgery are administered to increase pain tolerance during the surgical procedure, not during the preoperative phase.

Nonopioid analgesics may sometimes be added to a narcotic analgesic. What action will result? A) Antagonism B) Additive effect C) Interference D) Increased excretion

Ans: B Feedback: Aspirin and Tylenol are added to narcotic analgesics for additive effects of pain relief without the addition of narcotic adverse effects. Aspirin and Tylenol do not provide an antagonistic effect. Aspirin and Tylenol do not cause an interference of action. Aspirin and Tylenol will not increase excretion.

A patient with traumatic injuries describes his current pain as being "unbearable." The pathophysiology of pain begins with a signal from A) myelin sheaths. B) nociceptors. C) baroceptors. D) synapses.

Ans: B Feedback: For a person to feel pain, the signal from nociceptors in peripheral tissues must be transmitted to the spinal cord, then to the hypothalamus and cerebral cortex in the brain. Myelin sheaths, synapses, and baroceptors are not directly involved in pain transmission.

A 54-year-old woman is being admitted to the postsurgical unit following a transverse rectus abdominis myocutaneous (TRAM) flap. The patient's care plan specifies the use of preemptive analgesia. This approach to pain control will involve A) frequent administration of high-dose opioids. B) simultaneous use of analgesics from different drug classes. C) alternating administration of opioid antagonists with opioid agonists. D) patient-controlled analgesia.

Ans: B Feedback: Preemptive analgesia is used to reduce postsurgical pain by simultaneously administering medications from different drug classes to suppress pain by blocking multiple pain pathways. It is not synonymous with PCA and does not require alternation between opioid agonists and antagonists.

A patient who suffers from cancer pain is receiving morphine every 2 hours. For iwhich of the following should the family be taught to assess while the patient is on morphine? A) Diarrhea B) Respiratory depression C) Lung sounds D) Urinary incontinence

Ans: B Feedback: The administration of morphine can result in respiratory depression. The family should be taught to assess the patient for respiratory depression. Morphine sulfate can be administered to treat severe diarrhea. The patient's lung sounds are important to assess, but only after the nurse assesses for respiratory depression. Morphine does not cause urinary incontinence.

A patient is admitted to the surgical division after a mastectomy. The patient has a PCA pump and states to you that she is fearful she will overdose on morphine. Which of the following interventions is most appropriate to teach the patient? A) "The pump will administer all of the doses, so you don't have to worry." B) "If you follow the instructions, that won't happen to you." C) "The device is preset, so you cannot receive more than you need." D) "The device will give you a placebo when you press it often."

Ans: C Feedback: PCA pumps deliver a basic amount of analgesic by continuous infusion, with the patient injecting additional doses when needed. The amount of the drug is preset and limited. The pump will administer a basal rate, but the patient can administer the medication at preset intervals. Telling the patient not to worry is not effective teaching or use of therapeutic communication. Telling the patient to follow the instructions is not effective teaching or use of therapeutic communication. Instructing the patient on a placebo is not effective teaching or use of therapeutic communication.

What is the most effective way to evaluate the patient's pain response after administering an opioid analgesic? A) Observe the patient when he/she is not aware you are assessing him/her. B) Ask another nurse to assess the patient's response to the medication. C) Using a pain scale, ask the patient to describe the pain. D) Ask the family to determine the patient's response to the pain.

Ans: C Feedback: Asking the patient to describe the pain using a pain scale is the most effective assessment of pain response. Observing the patient when he/she is unaware is an objective assessment and does not represent a true pain experience. Asking another nurse to assess the patient's response will not provide accurate data. Asking the family to determine the patient's response will not provide accurate data.

A patient is near the end of life and has developed increased respiratory secretions and labored breathing. The physician is likely to order which of the following medications to decrease these symptoms? A) Meclizine (Antivert) B) Ampicillin C) Naloxone (Narcan) D) Morphine sulfate

Ans: D Feedback: Morphine is used for the treatment of acute pulmonary edema. Meclizine (Antivert) is given for dizziness. Ampicillin is used to treat infection. Naloxone (Narcan) is the opioid antidote.

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 client's vital signs hourly. Delay the ordered dose if respirations are below 15 bpm. Assess the respiratory rate before giving a dose of opiates. Give a dosage only if you think it is necessary.

Assess the respiratory rate before giving a dose of opiates. Check the rate, depth, and rhythm of respirations before each dose. If the rate is fewer than 12 per minute, delay or omit the dose and report to the health care provider. Vital signs do not need to be assessed hourly. Give the medication as scheduled.

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

Codeine Explanation: Codeine is a narcotic drug used for its analgesic and antitussive effects. Hydromorphone, ibuprofen, and acetaminophen do not have antitussive effects.

A patient has been receiving morphine sulfate 5 mg IV every 4 hours for the past several days. She states that the pain is not being relieved as well as it was in the past. What is the reason for this development? A) She has developed a dependency on the morphine. B) She has metastatic cancer and is dying. C) She has greater pain with inactivity. D) She has developed tolerance to morphine.

D) She has developed tolerance to morphine. Ans: D Feedback: Larger-than-usual doses of morphine are required to treat pain in opiate-tolerant people. The patient has not developed a dependence on morphine. A patient with metastatic cancer will require increasing pain management, but this feature is not the rationale for the patient's statement. The increased pain is not related to inactivity.

A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent? Oxycodone Fentanyl Percoset Morphine

Fentanyl

A 12-year-old cancer client is receiving morphine 5-10 mg PO q6 hours. The 12-year-old reports being in pain. The nurse checks the medication record and finds that it has been 5 1/2 hours since the client last received pain medicine. What would the nurse do?

Give the client 5 mg of morphine PO. Explanation: With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours. PO dosage with immediate-release morphine, 5-30 mg q4h PRN.

Although naloxone (Narcan) 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? a decrease in the pain rating an increase in the client's pain rating no change in the pain rating

Increase in the client's pain rating Explanation: 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.

An 80-year-old male client presents to the emergency department with a fractured ankle and multiple abrasions and contusions. He is admitted to the hospital with an order for oxycodone for pain. Oxycodone may be prescribed for a geriatric client because the drug has which characteristic?

It has a short half-life and is less likely to accumulate, causing toxicity or overdosage.

A nurse has administered an opioid to a patient. What nursing interventions should the nurse perform if the patient shows a decrease in respirations? Instruct the patient to restrict his consumption of liquids. Instruct the patient to avoid any kind of exercise. Monitor and encourage patient to cough and breathe deeply every two hours. Instruct the patient to take complete bed rest.

Monitor and encourage patient to cough and breathe deeply every two hours. The nurse should encourage the patient to cough and breathe deeply every two hours if the patient shows a decrease in respirations after the administration of opioid analgesics. The nurse need not instruct the patient to restrict his consumption of liquids to help him cope with the effects of an ineffective breathing pattern. The nurse should perform tasks such as getting the patient out of bed and encouraging therapeutic activities such as leg exercises (when ordered); therefore, the nurse should not instruct the patient to avoid any kind of exercise or to take complete bed rest.

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? Administer naloxone. Monitor for withdrawal syndrome. Assess for congenital anomaly. Monitor for opioid effects.

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.

A patient with respiratory depression is administered an opioid antagonist by the nurse. What ongoing assessment should the nurse perform when administering the opioid antagonist to the patient? Monitor vital signs every 5 to 15 minutes. Teach different breathing patterns to the patient. Monitor the blood pH level of the patient. Review allergy history and other treatment modalities.

Monitor vital signs every 5 to 15 minutes. The ongoing assessment performed by the nurse when administering an opioid antagonist to the patient involves monitoring the vital signs of the patient every 5 to 15 minutes. Monitoring the blood pH level of the patient is not a part of the ongoing assessment. Reviewing the allergy history and other treatment modalities and coaching different breathing patterns to the patient are pre-administration assessments that are performed before the administration of the drug; they are not ongoing assessments.

A client is experiencing significant respiratory depression and sedation related to morphine administration. The nurse would anticipate administering: Ergotamine Naloxone buprenorphine Butorphanol

Naloxone Explanation: Naloxone is a narcotic antagonist that is used to reverse the effects of narcotics such as morphine. Butorphanol and buprenorphine are narcotic agonists-antagonists that are used for moderate to severe pain relief. Ergotamine would be used to prevent and treat migraine attacks.

The client returns from the post-anesthesia recovery unit. The nurse notes a respiratory rate of 6. Which drug would the nurse anticipate being given immediately?

Narcan Explanation: Narcan 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.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide: Relieve opioid withdrawal symptoms Return to normal respiratory rate, rhythm, and depth Reverse opioid dependence

Return to normal respiratory rate, rhythm, and depth. Explanation: 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.

T/F A-delta fibers are small myelinated fibers that respond quickly to acute pain.

True Explanation:Two small-diameter sensory nerves, called the A-delta and C fibers, respectively, respond to stimulation by generating nerve impulses that produce pain sensations. The A-delta fibers are small, myelinated fibers that respond quickly to acute pain. The C fibers are unmyelinated and are slow conducting.

When describing the onset of action of naloxone, the nurse would explain that the drug achieves its effect in which amount of time? a. 1 to 2 minutes b. 10 to 15 minutes c. 15 to 30 minutes d. 30 to 60 minutes

a. 1 to 2 minutes Naloxone is capable of restoring respiratory function within 1 to 2 minutes of administration. The shorter the time to restoring respiration the less time the client has to depend on manual or mechanical ventilation and the better the outcome for the client.

The nurse is caring for four clients. For which client would the nurse question the health care provider's order of IV morphine? a. A 78-year-old with osteoarthritis b. A 45-year-old, 1-day postoperative mastectomy c. An 8-year-old with a fractured femur d. A 17-year-old, 1-day postoperative appendectomy

a. 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.

The nurse suspects opioid overdose in a client after surgery. What interventions must the nurse initiate for this client? (Select all that apply.) a. Administer naloxone b. Decrease the client's IV fluids c. Notify the health care provider d. Prepare for endotracheal intubation e. Insert a Foley catheter

a. Administer naloxone c. Notify the health care provider d. Prepare for endotracheal intubation The nurse will notify the provider, administer naloxone, and prepare for endotracheal intubation. If the client has an IV, the nurse would increase the rate. It is possible the nurse would insert a Foley catheter, but it is not a priority nursing intervention at this time. The priority interventions revolve around the client's respiratory status.

Opioid analgesics can be classified as which of the following? Select all that apply: a. An agonist b. A partial agonist c. A partial antagonist d. An antagonist e. A mixed agonist-antagonis

a. An agonist c. A partial antagonist e. A mixed agonist-antagonist An opioid analgesic may be classified as an agonist, partial agonist, and mixed agonist-antagonist.

The nurse is caring for a postoperative client taking an opioid medication for pain. The nurse assesses the client to have bradypnea and an oxygen saturation value of 90%. Which actions should the nurse perform before administering the ordered opioid antagonist? a. Assess the client's other vital signs. b. Call for a respiratory therapy consult. c. Reassess the client's level of pain. d. Reposition the client for comfort.

a. Assess the client's other vital signs. Blood pressure, pulse, and respirations are important assessments to make prior to administering an opioid antagonist. It is unnecessary to call for a respiratory therapy consult because the cause of the respiratory depression is known. While assessing and managing pain are important postoperative interventions, the respiratory depression-management interventions are the most important ones to be addressed.

Naloxone (Narcan) will reverse the effects of which drug? a. Fentanyl (Duragesic) b. Lorazepam (Ativan) c. Valproic Acid (Depakote) d. Warfarin (Coumadin)

a. Fentanyl (Duragesic) Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic).

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? a. Increase in the client's pain rating b. Decrease in the client's pain rating c. No change in the client's pain rating d. None of these options

a. 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.

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? a. It is a valuable drug to use because dosage can be increased to relieve pain when pain increases or tolerance develops. b. It is a drug that has a special caution because use of this drug is more likely to have adverse effects. c. It is a drug that no longer has a patent and can be sold by its generic name. d. It is a drug that reduces the likelihood of drug abuse and dependence.

a. 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.

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

a. Many postoperative clients require less opioid when PCA is used. Many postoperative clients require less opioid when PCA is used, which leads to fewer adverse effects. The nurse can also set the lockout interval, which the client cannot override when PCA is used.

Which would a nurse have readily available should a client who is receiving morphine experience significant respiratory depression? a. Naloxone b. Buprenorphine c. Ergotamine d. Nalbuphine

a. Naloxone Naloxone is a narcotic antagonist that is used to reverse the effects of narcotics such as morphine. Buprenorphine are narcotic agonists-antagonists that are used for moderate to severe pain relief. Ergotamine would be used to prevent and treatment migraine attacks. Nalbuphine is used to provide pain relief during labor and delivery and as an adjunct to general anesthesia as well as to treat moderate to severe pain in adults.

What factors affect how the patient will experience and respond to pain? Select all that apply. a. Past experience with pain b. Cultural expectation about how one should respond to pain c. Learned behavior from childhood d. It is a conscious response that the patient has a choice about.

a. Past experience with pain b. Cultural expectation about how one should respond to pain c. Learned behavior from childhood The experience of pain is personal and subjective; however, how people respond to painful stimuli reflects what they have learned about pain from their families, society, and cultures of origin. Learned messages about pain are indirect, and people react to them subconsciously. These messages include reasons that people experience pain and what are considered appropriate responses to it.

An opioid antagonist will reverse which opioid effects? (Select all that apply.) a. Respiratory depression b. Constipation c. Analgesia d. Hypotension e. Bradycardia

a. Respiratory depression b. Constipation c. Analgesia d. Hypotension e. Bradycardia Opioid antagonists are not selective for reversal of specific adverse reactions occurring with the use of an opioid, but will reverse all adverse reactions caused by opioids.

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: a. Respiratory rate of less than 10 breaths/min b. Decrease in pulse c. Diarrhea d. Increase in blood pressure e. Blood pressure of 95/65 mmHg

a. Respiratory rate of less than 10 breaths/min b. Decrease in pulse e. 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.

Of the following clients, which one will be most likely to develop physical dependence upon the opioid analgesic they are receiving for pain management? a. The client living with a chronic noncancer-related illness b. The client recovering from cholecystectomy c. The client recovering from an ankle fracture d. The client recovering from a below-knee amputation

a. 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.

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

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

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? a. Using a pain rating scale b. Asking a client to describe his or her pain c. Percussing or palpating the area where pain is identified d. Assessing the client's vital signs

a. 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.

A nurse is caring for a patient who is on morphine therapy. An expected outcome of the morphine therapy would be that the patient has a. adequate pain control with minimal adverse effects. b. complete pain relief with minimal adverse effects. c. complete pain relief with adverse effects that can be treated. d. adequate pain relief with no addiction to the drug.

a. adequate pain control with minimal adverse effects. The most realistic indication of the effectiveness of morphine therapy is when the patient has adequate pain control with minimal adverse effects. Complete pain relief is not a realistic goal. While it is important to ensure that the patient does not become addicted to the drug as a result of the therapy, this is rare occurrence and ensuring minimal adverse effects is the priority.

A nurse should not administer an opioid antagonist to a client with which finding? a. hypersensitivity to naloxone b. uncontrolled type 2 diabetes c. history of opioid abuse d. history of alcohol abuse

a. 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.

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

a. promoting rest and relaxation b. providing physical comfort e. supporting independence When opioids are required by clients with chronic pain, the main consideration is client comfort, not preventing drug addiction. The goals of therapy are to relieve pain and discomfort, promote rest and relaxation, allow performance of usual activities of daily living as health status permits, and minimize the anxiety, depression, and other emotional upsets that develop when pain is not managed effectively.

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? a. respiratory depression b. hypertension c. diarrhea d. physical dependence

a. 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.

The client is brought to the emergency department in respiratory arrest after overdosing on heroin. The person accompanying the client says he has been using heroin for years. After being administered one dose of naloxone, the client begins to breathe spontaneously but remains nonresponsive to stimuli so another dose is prescribed. The nurse should monitor for what signs and symptoms of acute narcotic abstinence syndrome? Select all that apply. a. tachycardia b. hypertension c. vomiting d. bradypnea e. sedation

a. tachycardia b. hypertension c. vomiting The most common adverse effect is an acute narcotic abstinence syndrome that is characterized by nausea, vomiting, sweating, tachycardia, hypertension, tremulousness, and feelings of anxiety. Bradypnea and sedation are not associated with acute narcotic abstinence syndrome.

A hospital client's pain is rated at 9/10 and the nurse is preparing to administer 4 mg hydromorphone PO as prescribed. Before administering the medication, the nurse should: ensure the client is aware of NSAID alternatives to this narcotic. ensure that there is naloxone available at the bedside. assess the client's apical heart rate for one minute. assess the client's baseline respiratory rate.

assess the client's baseline respiratory rate The nurse should check the client's rate, depth, and rhythm of respirations before each dose. Bradycardia would contraindicate safe use, but this does not necessarily require one-minute auscultation of a client's heart rate. Naloxone should be available, but does not need to be at the client's bedside. Teaching about alternatives would depend on the client's status, the current prescriptions and the client's pain level.

A client who is receiving morphine reports nausea after every dose of medication. What is the nurse's best response to this client? a. "I'm sorry. That means you won't be able to have any more pain medication." b. "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." c. "I will mark your chart that you are allergic to morphine." d. "I will ask the health care provider if I can give you acetaminophen for the pain instead of the morphine."

b. "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.

The anatomy and physiology instructor is talking about pain sensations. What responds to stimulation by generating nerve impulses that produce pain sensations? a. A fiber sensory nerves b. A-delta sensory nerves c. Mu receptors d. Sigma-receptors

b. A-delta sensory nerves Two small-diameter sensory nerves, A-delta and C fibers, respond to stimulation by generating nerve impulses that produce pain sensations. Large-diameter sensory nerves, A fibers, transmit sensations associated with touch and temperature. Mu-receptors are primarily pain-blocking receptors and sigma-receptors cause papillary dilation and may be responsible for the hallucinations, dysphoria, and psychoses that can occur with narcotic use.

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? a. After surgery, a client may feel nauseated as a side effect of the anesthesia. b. Abrupt reversal of opioid-induced respiratory depression may cause vomiting. c. This is a precaution in case the client begins to choke when resuming a general diet. d. Suction equipment should be placed in all client rooms as a standard of care postoperatively.

b. 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.

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

b. 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.

To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.) a. Keep the lights in the client's room turned down. b. Assist client from their bed to the toilet. c. Assist client with rising from a lying position. d. Assist client with hall-walking activities. e. Advise the client to stay in bed all night.

b. Assist client from their bed to the toilet. c. Assist client with rising from a lying position. d. Assist client with hall-walking activities. 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.

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? a. No further action is required because the naloxone has already been administered. b. Call the provider as another dose of opioid antagonist may be necessary. c. Administer a second dose and then notify the provider to obtain an order. d. Continue to monitor the client's vital signs and oxygen saturation levels.

b. 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.

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.) a. Eat a diet low in fiber b. Drink 2 to 3 quarts of water per day c. Take a daily stool softener d. Take a laxative twice a day e. Try to establish a regular bowel routine

b. Drink 2 to 3 quarts of water per day c. Take a daily stool softener e. Try to establish a regular bowel routine 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

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.) a. Client's gender b. Facial expressions c. Client's age d. Movement of arms and hands e. Guarding of the leg

b. Facial expressions d. Movement of arms and hands e. Guarding of the leg For clients who can't verbalize pain, the nurse assesses the client's facial expression, limb movements, guarding, and grimacing.

A nurse is assessing a client's pain level. Which would be the most appropriate method? a. Ask the client if the client is experiencing any pain. b. Have the client rate it on a scale of 1 to 10. c. Palpate the area where the client says the client has pain. d. Review the client's vital signs for changes.

b. Have the client rate it on a scale of 1 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.

The nurse is caring for a patient who is receiving an opioid analgesic. What would be a priority assessment by the nurse? a. Pain intensity and blood glucose level b. Level of consciousness and respiratory rate c. Respiratory rate and electrolytes d. Urine output and pain intensity

b. Level of consciousness and respiratory rate The nurse should assess respiratory rate and level of consciousness because respiratory depression and sedation are adverse effects of opioid analgesics. Blood glucose levels, electrolytes, and urine output are not priority assessments with opioid ingestion.

A patient is prescribed naloxone for the treatment of postoperative acute respiratory depression after a kidney transplant operation. Which of the following should the nurse identify as the action of naloxone? a. Naloxone stops internal bleeding. b. Naloxone restores respiratory function. c. Naloxone restores reflexes of limbs. d. Naloxone helps the patient overcome pain.

b. Naloxone restores respiratory function. The nurse should know that naloxone restores respiratory function within one to two minutes after administration in patients. Naloxone neither stops internal bleeding nor does it restore limb reflexes. Naloxone also does not overcome pain.

The nurse has just administered an opioid antagonist medication. Which side effect might the nurse anticipate that the client will experience? (Select all that apply.) a. Decreased blood pressure b. Nausea and vomiting c. Bradycardia d. Tremors e. Sweating

b. Nausea and vomiting d. Tremors e. Sweating Listed side effects of opioid antagonists include nausea, vomiting, tremors, and sweating. Other side effects include increased blood pressure and tachycardia. The other answers are opposite effects of known side effects, such as increased blood pressure and tachycardia, and are therefore incorrect.

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

b. 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.

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? a. Respiratory rate, seizure activity, and electrolytes b. Pain intensity, respiratory rate, and level of consciousness c. Liver function studies, pain intensity, and blood glucose level d. Respiratory rate, pain intensity, and mental status

b. 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 mental status may need to be assessed during opioid analgesic therapy related to adverse effects, but they would not be the priority assessments.

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? a. During pain assessment, the client may report less pain. b. The client may begin to demonstrate symptoms of withdrawal. c. Double the standard dosage of the medication may be needed. d. Multiple doses may be needed to be therapeutic.

b. 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.

Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness? a. They should be given as soon as the client feels uncomfortable. b. They should be given on a regular schedule, around the clock. c. They should be given IM as the preferred route of administration. d. They should be given topically only as a last resort.

b. 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.

A woman has presented to the emergency department after cutting her hand badly on the blade of a food processor. The pain that this woman is currently experiencing is the result of a. the release of intracellular potassium into the woman's hand. b. activation of the woman's delta and C nociceptors. c. the release of gamma-aminobutyric acid (GABA) into the woman's synapses. d. injury to woman's afferent fibers.

b. activation of the woman's delta and C nociceptors. Nociceptic pain is caused by the activation of the delta and C nociceptors in response to painful stimuli, such as injury. The sensation of pain is not the result of potassium release, though this does occur in cases of tissue trauma. The release of GABA inhibits pain. Pain is not the result of injury to the afferent fibers themselves, though these fibers transmit pain signals.

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 a. has less strength in each dose than do individual doses of morphine. b. has a shorter half-life than morphine. c. combined with morphine, increases the physiologic action of the morphine. d. causes the respiratory rate to decrease.

b. 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.

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

b. 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.

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? a. Pain relief should occur one hour after pushing the control button. b. Control button and the button to call the nurse are the same. c. Control button activates administration of the drug. d. Machine delivers drug every time the control button is used.

c. 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.

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? a. The medication can be very irritating to mucous membranes. b. The crushed medication can permanently stain teeth. c. Crushing the medication may precipitate an overdose. d. Crushing the medication interferes with its absorption.

c. 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.

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? a. Ataxia b. Blurred vision c. Hypotension d. arrhythmias

c. Hypotension Orthostatic hypotension is commonly seen with some narcotics. Ataxia, blurred vision, and arrhythmias are not generally adverse effects of an opioid analgesic.

A health care provider suggests opioid treatment for a client with respiratory depression. The nurse should be aware of which condition that can occur during an abrupt reversal of opioid respiratory treatment? a. Dizziness b. Headache c. Vomiting d. Light-headedness

c. Vomiting The nurse should know that an abrupt reversal of opioid respiratory treatment results in vomiting. The nurse must maintain a patent airway and should turn and suction the client as needed in such cases. Headache, dizziness, and light-headedness are not known to occur during an abrupt reversal of opioid respiratory treatment.

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? a. Improvement will occur within 30 minutes from the time of administration. b. Slow improvement can be noted throughout the shift. c. Within one to five minutes, an effect may be seen. d. Response is highly individualized based upon client weight.

c. 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.

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? a. urine specific gravity. b. skin integrity. c. bowel patterns. d. core body temperature.

c. bowel patterns. Morphine, like most opioid analgesics, creates a risk for constipation. The drug is unlikely to influence the client's temperature, skin integrity, or urine specific gravity.

Opioids have adverse effects on what body systems that are potentially life threatening? Select all that apply. central nervous (CNS) respiratory cardiac immune

central nervous (CNS) respiratory Explanation: Sedation from CNS depression and respiratory depression are major adverse effects and are potentially life threatening. Opioids are not generally responsible for life-threatening effects on the other body systems.

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 most important for the nurse to do? Monitor the blood pH level of the client Continue administering the prescribed drug Increase the drug dosage level Coach the client to breath

coach the client to breath Explanation: 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 him or her 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.

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

codeine Explanation: Codeine is a narcotic drug used for its analgesic and antitussive effects. Aspirin, ibuprofen, and acetaminophen do not have antitussive effects.

A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain:

codeine Explanation: Typically, codeine or hydrocodone are used to relieve coughing.

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? a. "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." b. "If you do become addicted, we'll make sure to provide you with the support and resources necessary to help you with your recovery." c. "It's important that you accept that your current need to control your pain is more important than fears of becoming addicted." d. "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."

d. "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.

Which of the following clients is more likely to have respiratory depression when receiving an opioid medication, requiring administration of an opioid antagonist? a. A client with chronic pain who is on long-term opioid therapy b. A client with a history of opioid analgesic abuse c. A client with progressive pain from a cancer diagnosis d. A surgical client who is not used to taking opioid analgesics

d. 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.

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? a. Maintain the head of the client's bed at ≥ 45°. b. Encourage fluid intake. c. Create a restful, dark, quiet environment. d. Put side rails up and place bed in low position.

d. 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.

Which adverse reactions may occur as a result of administering an opioid antagonist? a. Diarrhea, cramping, and increased pain rating b. Decreased blood pressure and decreased pulse c. Increased temperature and decreased oxygen saturation d. Sweating, tachycardia, and increased blood pressure

d. Sweating, tachycardia, and increased blood pressure Side effects of opioid antagonists include nausea and vomiting, sweating, increased blood pressure, and tremors. All other side effects listed are not side effects of opioid antagonists.

When teaching a client about the action of an opioid antagonist, what should the nurse include in the education? a. A medication called an opioid antagonist is given to enhance the effect of the opioid. b. An antagonist increases the rate of respirations to counter the effects of the opioid medication. c. An opioid antagonist acts on the central nervous system to elevate the level of consciousness. d. This medication competes with the opioid pain medication, binding to the cell receptors instead.

d. This medication competes with the opioid pain medication, binding to the cell receptors instead. This medication competes with the opioid pain medication by binding to the cell receptors where the opioid would attach. One of the options describes the effect of an adjuvant medication, not an antagonist. The other answers are incorrect because what is listed is not the action of an opioid antagonist.

The client is 65-years-old and has a diagnosis of cancer. Morphine has been ordered for pain management. Before the administration of morphine, the initial action of the nurse would be to check which? a. apical pulse and compare it with the radial pulse. b. blood pressure. c. temperature. d. respiratory rate, depth, and rhythm.

d. respiratory rate, depth, and rhythm. The most hazardous adverse effects of morphine relate to excessive CNS depression and include respiratory depression, hypoventilation, apnea, respiratory arrest, circulatory depression, cardiac arrest, shock, and coma. The most frequent adverse effect of morphine is respiratory depression. The nurse's initial action should be to check the client's respiratory rate, depth, and rhythm. Morphine should not be administered to any client with respiratory depression because it may precipitate respiratory arrest. Heart rate, blood pressure, and temperature are important and should be assessed, but doing so would not be the initial action of the nurse.

The nurse is administering morphine to a trauma client for acute pain. What is a common side effect of morphine? drowsiness occipital headache increased intracranial pressure paresthesia of lower extremities

drowsiness Explanation: Dizziness, drowsiness, and visual changes are common side effects. If any of these occur, avoid driving, operating complex machinery, or performing delicate tasks. If these effects occur in the hospital, the side rails on the bed may be raised for your own protection. Morphine does not generally cause paresthesia in the lower extremities, an occipital headache, or increased intracranial pressure.

Which client would the nurse identify as being opioid naive? one who does not routinely take opioids one who routinely takes opioids one who is physically or psychologically dependent on opioids

one who does not routinely take opioids Explanation: 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.

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 naive Explanation: 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.

Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which substance?

opioids

While caring for a client who is prescribed an opioid antagonist for treatment of respiratory depression caused by opioid therapy, the nurse would assess the client for which adverse reaction? Select all that apply. tremors fever nausea tachycardia diarrhea

tremors nausea tachycardia The nurse should monitor for tachycardia, tremors, and nausea in the client because these are the adverse reactions associated with the use of opioid antagonists. The other adverse reactions include sweating, vomiting, and increased blood pressure. The nurse need not monitor for fever or diarrhea because these are not adverse reactions caused by opioid antagonists.