PHARM 401 CH 15 & CH 16
Acetylsalicylic acid (aspirin) may be added to a narcotic analgesic. What action will result?
Additive effect
Which intervention should the client be taught regarding the self-administration of hydrocodone?
Consume a diet high in fiber.
Which intervention should the client be taught regarding the self-administration of hydrocodone? Page 164
Consume a diet high in fiber.
All of the following are adverse effects from taking an opioid antagonist EXCEPT
Bradycardia Explanation: Tachycardia is an adverse effect of taking an opioid antagonist, not bradycardia.
When reviewing information about medications that are compounded by the pharmacist, the nurse knows which statements are true? Select all that apply. Page 167
Brompton's mixture is the most commonly used solution. A clinical pharmacist will prepare the medication in a form (e.g., solution, salve, or suppository) best suited for the individual client. It is necessary to monitor for adverse reactions of each drug contained in the preparation.
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? Page 175
Coach the client to breathe.
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
Tylenol #3 consists of acetaminophen (Tylenol) and another medication. What is the other medication? Page 167
Codeine
Tylenol #3 consists of acetaminophen (Tylenol) and another medication. What is the other medication? Page 167
Codeine
The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect? Page 164
Constipation
The nurse works in a long-term care facility. When administering narcotics to clients, the nurse must monitor for which side effect? Page 164
Constipation
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? Page 167
Crushing the medication may precipitate an overdose.
The nurse has learned that when giving Narcan IV to reverse respiratory depression, the drug is given by slow IV push. This is done for which reason?
Giving it fast will cause withdrawal and return of the pain. Page 176
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?
Hypotension
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? Page 164
Hypotension
The nurse is caring for a client taking Talwin. What would be an appropriate nursing diagnosis for this client's care plan?
Impaired gas exchange related to respiratory depression
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?
Increase in the client's pain rating
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.
When teaching a client about patient-controlled analgesia (PCA), which would the nurse integrate into the teaching plan? Page 166
Many postoperative clients require less opioid when PCA is used.
Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management?
Opioids
A 62-year-old client admitted to the hospital is reporting pain. The provider has prescribed 3 mg hydromorphone SC. The medication is available in single-use vials of 10 mg/1mL. How many mL of hydromorphone should the nurse draw up to administer?
0.3 The nurse should divide 3 mg by 10 mg/mL, resulting in 0.3 mL
When diagnostic testing reveals a bone fracture, what type of pain is the client experiencing?
acute somatic pain
A hospice client has been prescribed morphine 5 mg sub-Q every 2 hours. The medication vial reads "10 mg/mL." How many milliliters will be administered?
0.5 mL
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 nurse is caring for a 6-year-old client after surgery. The child has an order for meperidine (Demerol) 1.8 mg/kg IM every 3 to 4 hour as needed for pain. The child weighs 30 kg and the meperidine is available as 50 mg/mL. How many mL, to one decimal place, should the nurse administer per dose?
1.1
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
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
When should the nurse obtain the client's blood pressure, pulse, respiratory rate and pain rating after oral administration of an opioid analgesic? Page 165
30 minutes
agonist
A drug that binds with a receptor and stimulates the receptor to produce a therapeutic response
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? Page 163
morphine sulfate
tolerance
the body's physical adaptation to a drug
The nurse knows that, of the following clients, who is least likely to be prescribed transdermal fentanyl?
A woman 85 years of age
A class of new nursing students is learning how to administer medications to clients. What should the instructor teach the students about giving opiates? Page 165
Assess the respiratory rate before giving a dose of opiates.
The nurse is educating a client on the appropriate use of a transdermal patch. Which statements indicate the client is in need of additional education? Select all that apply. Page 168
"I can apply a new patch before I remove the old one." "I should wash the site where I am applying the patch with soap and hot water." "When I'm wearing the patch, it's okay if I take a hot bath or sit in a sauna." "I should apply the patch to the same spot every time I change it."
A client, admitted to the surgical division after a mastectomy, has a PCA pump and states being fearful about being overdosed on morphine. Which response is most appropriate when addressing the client's concern of being overmedicated? Page 166
"The device is preset, so you cannot receive more than you need."
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? Page 165
"Where exactly are you hurting?"
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? Page 165
"Where exactly are you hurting?"
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? Page 163
Morphine sulfate
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? Page 167
Narcan
Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management? Page 163
Opioids
A client who lives with chronic pain has just learned that she is pregnant. What narcotic analgesic is most appropriate for this client? - Page 165
Oxycodone
Opioids exert widespread pharmacologic effects, especially in the CNS and the gastrointestinal (GI) system. What are two major adverse effects of opioids that are potentially life threatening? Page 164
Sedation and respiratory depression
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
What client characteristic may contraindicate the use of tramadol (Ultram) for the treatment of a client's pain following traumatic injuries?
The client has a history of crack cocaine addiction
The nurse is caring for client who has undergone multiple surgeries after an MVA to set broken bones and repair internal injuries. Although intravenous morphine effectively controlled pain for the first several days, now even the highest prescribed dosage provides inadequate relief. Which has likely caused the diminished effect of the medication on pain? Page 167
The client has become opiate tolerant.
An elderly woman is slated for a hemiarthroplasty (hip replacement surgery) after falling and breaking her hip on the stairs outside her home. The woman's pain in the time since her injury has been severe, and her care team has been treating it with morphine. Which administratio schedules is most likely to control the client's pain?
Twice-daily doses of long-acting morphine, with short-acting morphine available for breakthrough pain p. 167
What is the most effective way for the nurse to evaluate the client's pain response after administering an opioid analgesic?
Using a pain scale, ask the client to describe the pain.
Opioid antagonists such as naloxone (Narcan) should be used cautiously in clients with which conditions? Select all that apply. Page 175
Women who are pregnant Infants of opioid-dependent mothers Women who are breastfeeding an infant
What reaction should the nurse assess for when a client is prescribed a nonopioid analgesic in addition to a narcotic analgesic?
additive effect
partial agonist
agent that binds to a receptor but produces a limited response
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:
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? Page 164
bowel patterns.
While studying pharmacology, the nursing student learns that a naturally occurring narcotic drug with analgesic and antitussive effects is: Page 163
codeine.
miosis
constriction of the pupil of the eye
opiod naive
no previous use or infrequent use of opiod medications
The pathophysiology of pain begins with a signal from what source?
nociceptors
The client who does not use opioids regularly and suffers respiratory depression after given an opioid during a surgical procedure is described as which? Page 175
opioid naive
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? Page 168
pneumonia.
A client asks the nurse if taking passionflower would be okay to help with pain relief. The nurse would respond by telling the client no if the client was also taking which medication? Page 165
warfarin
A nurse administrating an opioid medication should assess for what related side effect? Page 164
drowsiness
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? Page 169
"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 male client states that he does not have a back injury and that it is his leg that hurts. He feels every one is not listening to him. What is the best response by the nurse? Page 142
"Sometimes when there is nerve damage, it shows up as pain in a different part of the body."
A client with a history of migraines has been prescribed sumatriptan. What education should the nurse provide about the safe and effective use of this drug?
"Take your medication as soon as you first sense a migraine coming."
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? Page 151
Administer the pain medication as ordered.
"Sometimes when there is nerve damage, it shows up as pain in a different part of the body." Page 181
Ask for pain medication before the pain gets severe.
A client with moderate to severe pain has morphine sulfate (extended release) 20 mg orally PO q4h PRN ordered for pain. This client states that she cannot swallow pills. Which action is appropriate by the nurse? Page 161
Ask the physician to change the medication.
The nurse is administering morphine to a trauma client for acute pain. What is a common side effect of morphine? Page 169
Drowsiness
How will a client's impaired renal function affect the pharmacokinetics of morphine?
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? - Page 167
Encourage the client to take deep breaths.
Naloxone (Narcan) will reverse the effects of which drug?Page 176
Fentanyl (Duragesic)
A 30-year-old male client has been ordered Demerol 100 mg IM every 4 hours for 2 days after a fractured femur. What action should the nurse take? Page 171
Give the medication as ordered.
What action should the nurse take when administering meperidine 75 mg IM every 4 hours to a young adult?
Give the medication as prescribed.
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.
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? Page 163
Morphine
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? Page 163
Morphine
A client has been ordered a fentanyl patch for chronic pain. What client teaching should be provided to the client and family upon discharge?
Remove the patch every 3 days.
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? Page 167
Respiratory rate
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 living with a chronic noncancer-related illness
Of the following clients, which one will be most likely to develop physical dependence upon the opioid analgesic they are receiving for pain management? Page 167-169
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 maintains adequate nutritional status.
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.) Page 170
Therapeutic response is achieved and discomfort is reduced. An adequate breathing pattern is maintained. Client maintains adequate nutritional status.
Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness?
They should be given on a regular schedule, around the clock.
Clients diagnosed with chronic pain should be given what information regarding opioids' effectiveness? Page 166
They should be given on a regular schedule, around the clock.
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? Page 168
development of fewer adverse reactions
opiod
drug having opiate properties but not necessarily derived from opium; used to relieve moderate to severe pain
patient-controlled analgesia
drug pump and delivery system that allows patients to administer their own analgesic medication intravenously within a preset protocol
agonist-antagonist
drug with both agonist and antagonist properties
A client has been admitted to the emergency department after overdosing on oxycodone. What nursing diagnosis should the nurse prioritize?
impaired gas exchange
Following the administration of naloxone to a client with moderate pain, the nurse should assess for what change in the client's vital signs?
increased blood pressure
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? Page 164
make sure the side rails are up.
cachectic
malnourished, in poor health, physically wasted
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 Page 165
A client with severe diarrhea is receiving opioid therapy. The nurse would be alert for the development of which adverse effect? Select all that apply.Page 164
tachycardia bradycardia palpitations
adjuvant
therapy used in addition to the primary treatment
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: Page 167
there is risk of an extremely high dose available all at once if the tablet is crushed.
A client asks the nurse if taking passionflower would be okay to help with pain relief. The nurse would respond by telling the client no if the client was also taking which medication?
warfarin
