PHARM ANALGESIC HW

4) A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance? A. Alcohol B. Caffeine C. Diphenhydramine D. Ibuprofen

*A. Alcohol

2) The client is using nonsteroidal anti-inflammatory drugs (NSAIDs) to manage arthritis pain. The nurse should caution the client about which potential side effect? A. Urinary incontinence B. Nystagmus C. Constipation D. Occult bleeding

*D. Occult bleeding

A nurse is reviewing analgesic prescriptions for a client with a history of liver cirrhosis. The prescriptions state to administer PRN for pain. Which medication is the nurse most likely to administer to this client? A. Fentanyl B. Acetaminophen C. Ibuprofen D. Ketorolac

* A. Fentanyl

7) The nurse administers acetaminophen to a child who complains of pain after abdominal surgery. The mother asks the nurse why her child isn't being given ibuprofen. Which response by the nurse is most appropriate? A. 'It could prolong bleeding time.' B. 'It's contraindicated for young children.' C. 'It can suppress the healing of the incision.' D. 'It becomes ineffective when given for long periods.'

*A. 'It could prolong bleeding time.'

A client is receiving patient-controlled analgesia (PCA) after surgery. Which benefit would this type of therapy provide? Select all that apply. One, some, or all responses may be correct. A. Client is able to self-administer pain-relieving medications as necessary B. Amount of medication received is determined entirely by the client C. Decreases client dependency D. Relieves the nurse of monitoring the client E.Increases client sense of autonomy

*A. Client is able to self-administer pain-relieving medications as necessary *C. Decreases client dependency *E.Increases client sense of autonomy

8) A health care provider prescribes aspirin therapy for a client with arthritis. The nurse will advise the client to report which adverse effects? Select all that apply. One, some, or all responses may be correct. A. Ongoing nausea B. Constipation C. Easy bruising D. Decreased pulse E. Ringing in the ears

*A. Ongoing nausea *C. Easy bruising *E. Ringing in the ears

A client in the coronary care unit develops 'viselike' chest pain radiating to the neck. Assessment reveals a blood pressure of 124/64 mm Hg, an irregular apical pulse of 64 beats per minute, and diaphoresis. Cardiac monitoring is instituted, and morphine sulfate 4 mg intravenous (IV) push stat is prescribed. Which intervention is the priority nursing care for this client? A. Relief of pain B. Client teaching C. Cardiac monitoring D. Maintenance of bed rest

*A. Relief of pain

A health care provider prescribes morphine for a client being treated for myocardial infarction. Which physiological response will occur if the client experiences the intended therapeutic effect of morphine? A. Increased respiratory rate B. Decreased workload of the heart C. Dilation of coronary arteries D. Diminished metabolites within the ischemic heart muscle

*B. Decreased workload of the heart

A client is prescribed controlled-release oxycodone. Which dosing schedule is best for the nurse to teach the client? A. As needed. B. Every 12 hours. C. Every 24 hours. D. Every 4 to 6 hours.

*B. Every 12 hours.

The nurse is providing care for a client after surgery. The client has an order for acetaminophen with codeine. The client asks the nurse what to expect after taking this medication. Which is the best response by the nurse? A. "This combination medication will better help to manage your pain." B. "The combination medication will reduce the chance of addiction." C. "This medication will minimize any side effects from the codeine." D. "This medication combination will allow healing to occur faster."

*A. "This combination medication will better help to manage your pain."

4) Which medication would the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis? A. Aspirin B. Hydromorphone C. Meperidine D. Alprazolam

*A. Aspirin

The nurse understands which anesthetic medication is commonly used for short procedures on pediatric clients? A. Fentanyl B. Morphine C. Meperidine D. Hydromorphone

*A. Fentanyl

3) A health care provider prescribes aspirin for a client with severe arthritis. Which advice will the nurse provide to the client? A. Take the medicine with meals. B. See a dentist if bleeding gums develop. C. Switch to acetaminophen if tinnitus occurs. D. Avoid spicy foods while taking the medication.

*A. Take the medicine with meals.

6) A nurse has administered acetaminophen for pain relief to an infant. Based on the client's development stage, which action is most important to include in the medication administration record? A. The dose administered based on the client weight B. The client pain level after administration of the medication C. The time the dose was administered to the client D. The client vital signs before the medication was administered

*A. The dose administered based on the client weight

1) The nurse educating a client who is postpartum about the use of ibuprofen for uterine cramping. Which statement should the nurse include in the teaching? A. This medication could cause gastrointestinal discomfort B. You may experience decreased vaginal discharge with this medication C. Taking this medication could decrease your breast milk production D. You could experience dizziness while taking this medication

*A. This medication could cause gastrointestinal discomfort

16) The nurse is preparing to administer aspirin 81 mg to a client who had a stroke. The client states, "I do not want to take that." Which statements should the nurse make to the client? Select all that apply. A. "If you don't take aspirin every day, you might die." B. "Can you tell me what concerns you have about the aspirin?" C. "Do you experience any nausea when you take the aspirin?" D. "Do you take your other medications as prescribed by your provider?" E. "Would you like to take the aspirin at another time of day?"

*B. "Can you tell me what concerns you have about the aspirin?" *C. "Do you experience any nausea when you take the aspirin?" *D. "Do you take your other medications as prescribed by your provider?" *E. "Would you like to take the aspirin at another time of day?"

Which member of the health care team would the nurse ask to serve as a witness when wasting unused morphine? A. Nursing supervisor B. Licensed practical nurse (LPN) C. Client's health care provider D. Designated nursing assistant

*B. Licensed practical nurse (LPN)

19) How would the nurse instruct a client with arthritis to take aspirin when the client states that the aspirin causes stomach irritation? A. An hour before a meal B. With food and a full glass of water C. With sodium bicarbonate D. At the same time as the other medications

*B. With food and a full glass of water

9) Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity will the nurse teach the client to report? Select all that apply. One, some, or all responses may be correct. Bradycardia Joint pain Blood in the stool Ringing in the ears Increased urine output

*Blood in the stool *Ringing in the ears

The nurse is caring for a client with deep partial-thickness burns who is receiving an opioid for pain management. Which mode of medication administration is preferred for this client? A. Oral B. Rectal C. Intravenous D. Intramuscular

*C. Intravenous

Which information would the nurse include in the teaching plan for the client who is prescribed sumatriptan for migraine headache? A. It should be administered when headache is at its peak. B. It should be administered by deep intramuscular injection. C. Is contraindicated in people with coronary artery disease. D. Injectable sumatriptan may be administered every 6 hours as needed.

*C. Is contraindicated in people with coronary artery disease.

Which medication will the nurse question when it is prescribed for a client with acute pancreatitis? A. Ranitidine B. Cimetidine C. Meperidine D.Promethazine

*C. Meperidine

A nurse is providing care to a client post-cholecystectomy. Which observation indicates the client may require PRN pain medication? A. Slow gait when ambulating to the restroom B. Guarding when the abdomen is palpated C. Muscle tension when repositioning in bed D. Refusal to eat the provided meals

*C. Muscle tension when repositioning in bed

A client who receives morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/minute. Which intervention is needed? A. Nasotracheal suction B. Mechanical ventilation C. Naloxone administration D. Cardiopulmonary resuscitation

*C. Naloxone administration

The nurse is caring for a client who is actively dying and has been receiving high doses of opioid analgesics. The client has become unresponsive to verbal stimuli. What action should the nurse take? A. Stop giving the analgesic B. Give an extra dose of the analgesic C. Decrease the analgesic dosage by half D. Continue the analgesic at the current dose

*D. Continue the analgesic at the current dose

15) A toddler ingested half a bottle of aspirin tablets. Which finding should the nurse expect to see in this child? A. Dyspnea B. Hypothermia C. Edema D. Epistaxis

*D. Epistaxis

5) A client has been given a prescription for acetylsalicylic acid. The nurse recalls that this medication has which property? Sedative Hypnotic Analgesic Antibiotic

*Analgesic

4) Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the medication is being used primarily for which property? Analgesic Antipyretic Anti-inflammatory Antiplatelet

*Anti-inflammatory

An adult client has prescriptions for morphine sulfate 2.5 mg IV every 6 hours and ketorolac (Toradol) 30 mg IV every 6 hours. Which action should the nurse implement? A. Administer both medications according to the prescription. B. Hold the ketorolac to prevent an antagonistic effect. C. Hold the morphine to prevent an additive drug interaction. D. Contact the healthcare provider to clarify the prescription.

A. Administer both medications according to the prescription.

A client who is receiving medication for an eye disorder reports bleeding in the eye. Which medication will the nurse expect to find in the client's recent medication history? *A. Ketorolac B. Trifluridine C. Natamycin D. Ciprofloxacin

A. Ketorolac

The nurse is providing postoperative care for a client who has received a prescription for nalbuphine for pain. Which side effects would the nurse anticipate after administering this medication? Select all that apply. One, some, or all responses may be correct. A. Nausea B. Oliguria C. Sedation D. Dry mouth E. Flushed skin F.Orthostatic hypotension

A. Nausea C. Sedation D. Dry mouth F.Orthostatic hypotension

A client is prescribed morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per patient-controlled analgesia (PCA) pump for a total of 5 mg IV maximally per hour. Which nursing action has the highest priority before initiating the PCA pump? A. Assessment of the expiration date on the morphine syringe in the pump. B. Assessment of the rate and depth of the client's respirations. C. Assessment of the type of anesthesia used during the surgical procedure. D. Assessment of the client's subjective and objective signs of pain.

B. Assessment of the rate and depth of the client's respirations.

A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose? A. Review the client's hemoglobin results. B. Notify the healthcare provider. C. Inquire about the reaction to sulfa. D. Record the client's vital signs.

B. Notify the healthcare provider.

Which rationale would the nurse give to explain the purpose of administering an opioid analgesic via epidural catheter when providing postoperative teaching? A. Facilitates oxygen use B. Relieves abdominal pain C. Decreases anxiety and restlessness D. Dilates coronary and peripheral blood vessels

B. Relieves abdominal pain

A postoperative client receiving a continuous IV infusion of meperidine 35 mg/hr for the past four days has become increasingly restless and irritable, and begins to hallucinate. Which action should the nurse take first? A. Administer a PRN dose of the PO lithium. B. Administer naloxone IV push. C. Decrease the IV infusion rate of the meperidine. D. Increase the IV infusion rate of the meperidine.

C. Decrease the IV infusion rate of the meperidine.

The nurse is educating a client about the use of fentanyl citrate via a patient-controlled analgesia pump. Which of the following statements should be included in the teaching? A. You cannot breastfeed your baby while using a patient controlled analgesia pump B. You may get drowsy if you press the administration button too many times C. The administration button should not be pressed by anyone other than you D. A patient controlled analgesia pump reduces the risk of post-partum hemorrhage

C. The administration button should not be pressed by anyone other than you

The nurse is caring for a client hospitalized with a myocardial infarction. Which analgesic is the medication of choice for this client? A. Ketorolac B. Meperidine C. Flurazepam D. Morphine sulfate

D. Morphine sulfate

The nurse on a surgery unit is evaluating which client would be appropriate for patient-controlled analgesia (PCA). Which client would not be appropriate for PCA? A. A 25-year-old client with a history of Down syndrome. B. A 16-year-old client who reads at a fourth-grade level. C. A 71-year-old client with numerous arthritic nodules on their hands. D. A 4-year-old client with intermittent episodes of alertness.

D. A 4-year-old client with intermittent episodes of alertness

The nurse is providing care for a client diagnosed with sickle cell crisis. Which prescribed medication should the nurse clarify with the health care provider? A. Morphine B. Hydromorphone C. Codeine D. Meperidine

D. Meperidine

A client with a myocardial infarction is admitted to the cardiac intensive care unit. Which pain relief medication would the nurse expect to find on the plan of care for this client? A. Morphine B. Diazepam C. Midazolam D. Oxycodone

*A. Morphine

Which medication would the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema? A. Morphine B. Phenobarbital C. Hydroxyzine D. Chloral hydrate

*A. Morphine

Which medication is indicated for management of clinical manifestations associated with an opioid overdose? A. Naloxone B. Methadone C. Epinephrine D. Amphetamine

*A. Naloxone

A nurse has removed a 2 ml vial of fentanyl from the medication dispensing system. After dosage calculations, the nurse determines only 1 ml will be administered to the client. Which action will the nurse perform with the remainder of the medication? A. Request another nurse to witness wasting of the unused medication B. Dispose of the unused medication in the sink C. Store the unused of the medication in the medication cart D. Return the unused medication to the dispensing system

*A. Request another nurse to witness wasting of the unused medication

14) The nurse is assessing a client with suspected aspirin overdose. Which assessment findings would support this diagnosis? Select all that apply. A. Respiratory rate of 28 B. Tinnitus C. Hypoglycemia D. Jaundice E. Serum pH 7.31 F. Headache

*A. Respiratory rate of 28 *B. Tinnitus *E. Serum pH 7.31 *F. Headache

2) A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication would the nurse conclude that the client probably is experiencing? A. Salicylate toxicity B. Allergic reaction C. Withdrawal symptoms D. Aspirin tolerance

*A. Salicylate toxicity

A client with a known history of opioid addiction has a surgical repair of multiple stab wounds to the abdomen. After surgery, the client's pain is not relieved by the prescribed morphine injections. Which phenomenon is the client experiencing when they fail to achieve pain relief? A. Tolerance B. Habituation C. Physical addiction D. Psychological dependence

*A. Tolerance

The nurse is teaching the client about the patient-controlled analgesia (PCA) planned for postoperative care. Which statement by the client indicates further teaching is needed? A. "I will receive a continuous dose of medication." B. "I should call the nurse before I take additional doses." C. "The machine will prevent an overdose of the medication." D. "I will call for assistance if my pain is not relieved."

*B. "I should call the nurse before I take additional doses."

The nurse is teaching a client with migraine headaches about almotriptan. Which statement by the client indicates that the teaching was effective? A. "I will wait to take the medication until the pain has become unbearable." B. "I will take the medication as soon as I notice migraine symptoms." C. "If the first dose does not help, I can take two more doses 15 minutes apart." D. "I will take a dose every morning to make sure to prevent an acute attack."

*B. "I will take the medication as soon as I notice migraine symptoms."

3) The mother of a toddler with hemophilia A asks the nurse, 'Can I give my child ibuprofen for fever or pain?' How will the nurse respond? A. 'Ibuprofen is a good choice for fever or pain.' B. 'Give your child acetaminophen. Ibuprofen may cause bleeding.' C. 'No. I'll explain why your child isn't allowed pain medications.' D. 'You seem concerned about giving medications to your child.'

*B. 'Give your child acetaminophen. Ibuprofen may cause bleeding.'

At which time would the nurse plan to administer morphine 2 mg by mouth every 2 hours as needed to a client who has burns on 55% of the body surface and requires dressing changes? A. 15 minutes before the dressing change B. 60 minutes before the dressing change C. Along with a stool softener each time it is administered D.Only if the client rates pain between 8 and 10 on the pain scale

*B. 60 minutes before the dressing change

5) When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? A. Flank. B. Abdomen. C. Chest. D. Head.

*B. Abdomen.

A nurse is evaluating a client who was prescribed 30 mg of codeine after oral surgery. Which assessment finding indicates the expected outcome of the medication? A. Normoactive bowel sounds B. Absence of pain C. Decreased cough reflex D. Normal respiratory rate

*B. Absence of pain

A client who is addicted to opioids undergoes emergency surgery. During the postoperative period, the health care provider decreases the previously prescribed methadone dosage. Which clinical manifestations will the nurse monitor for when assessing this client? A. Constipation and lack of interest in surroundings B. Agitation and attempts to escape from the hospital C. Skin dryness and scratching under the incision dressing D.Lethargy and refusal to participate in therapeutic exercises

*B. Agitation and attempts to escape from the hospital

2) A client develops tinnitus. Which of the client's medications would the nurse suspect is the cause of this new development? A. Digoxin 0.25 mg, one tablet daily B. Aspirin 325 mg, two tablets every 4 hours C. Captopril 25 mg, one tablet three times daily D. Diphenhydramine 25 mg, one tablet every 4 to 8 hours prn

*B. Aspirin 325 mg, two tablets every 4 hours

Which medications should the nurse caution the client about taking while receiving an opioid analgesic? A. Antacids. B. Benzodiazepines. C. Antihypertensives. D.Oral antidiabetics

*B. Benzodiazepines.

The nurse is preparing an education session for a client prescribed opioids for intractable cancer pain. The nurse should include strategies to help prevent which common side effect associated with long-term use of opioids? A. Sedation. B. Constipation. C. Urinary retention. D.Respiratory depression

*B. Constipation.

The nurse assesses the client's use of a patient-controlled analgesia pump and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment reveals that the client is still experiencing pain. Which action would the nurse take next? A. Monitor the client's pain level for another hour. B. Determine the integrity of the intravenous delivery system. C. Reprogram the pump to deliver a bolus dose every 8 minutes. D.Arrange for the client to be evaluated by the health care provider

*B. Determine the integrity of the intravenous delivery system.

3) A client with arthritis takes large doses of aspirin. Which symptom would the nurse include when teaching the client about the clinical manifestations of aspirin toxicity? A. Feelings of drowsiness B. Disturbances in hearing C. Intermittent constipation D. Metallic taste in the mouth

*B. Disturbances in hearing

4) Which life-threatening complication may occur in clients taking high-dose or long-term ibuprofen? A. Anaphylaxis B. Gastrointestinal (GI) bleeding C. Cardiac dysrhythmia D. Disulfiram reaction

*B. Gastrointestinal (GI) bleeding

Which characteristic identifies the reason that methadone is useful in the treatment of opioid addiction? A. Is a nonaddictive medication B. Has an effect of longer duration C. Does not produce a cumulative effect D. Carries little risk of psychological dependence

*B. Has an effect of longer duration

2) A nurse is assessing a client who takes prescribed oral indomethacin. Which client statement indicates an intended response to the medication? A. My appetite is greater in the mornings B. I am able to rotate my wrists without pain C. I no longer have to urinate in the middle of the night D. My endurance while exercising has improved

*B. I am able to rotate my wrists without pain

Which adverse effect of morphine indicates the need for naloxone administration? A. Blurred vision B. Urinary retention C. Mental confusion D. Respiratory depression

*D. Respiratory depression

A nurse is preparing to administer morphine to a client with chronic pain. Which assessment finding would prompt the nurse to withhold the medication? A. Heart rate of 117 beats/min B. Urine output of 35 ml/hr C. Oxygen saturation of 92% D. Respiratory rate of 11 breaths/min

*D. Respiratory rate of 11 breaths/min

2) Etanercept is prescribed for an adolescent with juvenile idiopathic arthritis. Which route would the nurse expect to administer the medication? A. Sublingual B. Intravenous C. Intramuscular D. Subcutaneous

*D. Subcutaneous

A nurse is preparing to discontinue a client's fentanyl patient-controlled analgesia infusion. Which priority action will the nurse take before discontinuing the infusion? A. Assess the client pain level B. Document the frequency of doses on the medication administration record C. Take the client vital signs D. Verify the infusion record with another registered nurse

*D. Verify the infusion record with another registered nurse

A client receives intrathecal morphine to control severe postoperative pain. Which action will the nurse include as part of the client's initial 24-hour postoperative care plan? A. Monitoring of respiratory rate hourly B. Assessing the client for tachycardia C. Administering naloxone every 3 to 4 hours D. Observing the client for signs of central nervous system (CNS) excitement

*A. Monitoring of respiratory rate hourly

5) A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client makes which statements? Select all that apply. One, some, or all responses may be correct. A. 'I need to report any dark tarry stools.' B. 'I will need to stop taking this medication before any scheduled surgery.' C. 'I should change positions slowly.' D. 'I will take the medication on an empty stomach.' E. 'I need to stop taking low-dose aspirin while I take this medication.'

*A. 'I need to report any dark tarry stools.' *B. 'I will need to stop taking this medication before any scheduled surgery.'

10) Which would the nurse include in the client's medication teaching on the administration of aspirin 650 mg every 6 hours as needed for arthritic pain? Select all that apply. One, some, or all responses may be correct. A. 'Report persistent abdominal pain.' B. 'Do not chew enteric-coated tablets.' C. 'Take the aspirin with meals or a snack.' D. 'See a dentist if bleeding gums develop.' E. 'Switch to acetaminophen if tinnitus occurs.'

*A. 'Report persistent abdominal pain.' *B. 'Do not chew enteric-coated tablets.' *C. 'Take the aspirin with meals or a snack.'

6) A client is admitted to the emergency department with crushing chest pain. A diagnosis of acute coronary syndrome is suspected. Which medication is indicated to prevent progression to a myocardial infarction? A. Aspirin B. Atropine C. Gabapentin D. Epinephrine

*A. Aspirin

20) Which medication increases the risk for upper gastrointestinal (GI) bleeding? Select all that apply. One, some, or all responses may be correct. A. Aspirin B. Ibuprofen C. Ciprofloxacin D. Acetaminophen E. Methylprednisolone

*A. Aspirin *B. Ibuprofen *E. Methylprednisolone

2) A nurse is reviewing prescriptions for a client with a history of rheumatoid arthritis and peptic ulcer disease. The client has prescriptions for ibuprofen and ranitidine. Which action will the nurse perform? A. Clarify the prescription for ibuprofen B. Administer the ibuprofen 30 minutes before the ranitidine C. Hold the ranitidine for 1 hour after meals D. Question the prescription for ranitidine

*A. Clarify the prescription for ibuprofen

Which mechanism of action explains why naloxone is administered for a heroin overdose? A. Competition with opioids for occupancy of opioid receptors B. Blunts severity of withdrawal symptoms as heroin wears off C. Accelerated metabolism of heroin and stimulation of respiratory centers D. Stimulation of cortical sites that control consciousness and cardiovascular function

*A. Competition with opioids for occupancy of opioid receptors

A client recovering from hip replacement surgery is taking acetaminophen with codeine every three hours for pain. For which side effect should the nurse monitor the client? A. Constipation B. Wheezing C. Diffuse rash D. Hyperglycemia

*A. Constipation

Which action is the nurse's responsibility when administering prescribed opioid analgesics? Select all that apply. One, some, or all responses may be correct. A. Count the client's respirations. B. Document the intensity of the client's pain. C. Withhold the medication if the client reports pruritus. D. Verify the number of doses in the locked cabinet before administering the prescribed dose. E. Discard the medication in the client's toilet before leaving the room if the medication is refused.

*A. Count the client's respirations. *B. Document the intensity of the client's pain. *D. Verify the number of doses in the locked cabinet before

A client takes oxycodone every 3 hours for pain after surgery. Which actions would the nurse take before administering each dose of oxycodone? Select all that apply. One, some, or all responses may be correct. A. Count the client's respiratory rate. B. Examine the client for petechiae. C. Observe the client for movement disorders. D. Ask the client to rate the level of pain. E. Assess the client's level of consciousness.

*A. Count the client's respiratory rate. *D. Ask the client to rate the level of pain. *E. Assess the client's level of consciousness.

A nurse is preparing to administer a hydromorphone injection to a client. As the nurse begins to connect the syringe to the intravenous port, the client refuses the medication. Which action does the nurse perform next? A. Discard the medication in the presence of another nurse B. Dispose of the syringe in the sharps container C. Flush the unused medication in the sink D.Document the client refusal of the medication in the electronic record

*A. Discard the medication in the presence of another nurse

A postoperative client has a prescription for acetaminophen with codeine for pain relief. The nurse understands which action to be the primary purpose of this drug combination? A. Enhanced pain relief B. Faster onset of action C. Prevents tolerance D. Minimized side effects

*A. Enhanced pain relief

7) The client with chronic arterial insufficiency of the legs refuses the prescribed dose of aspirin (ASA). The client states, 'My legs are not painful.' Which action will the nurse take? A. Explain the reason for the medication and encourage the client to take it. B. Withhold the medication at this time and return to check with the client again in 30 minutes. C. Withhold the medication and tell the client to ask for it if the legs become uncomfortable. D. Request that the client take the medication and explain that it prevents the client from being uncomfortable in the next few hours.

*A. Explain the reason for the medication and encourage the client to take it.

A client is diagnosed with rheumatoid arthritis (RA). Which types of drugs might the nurse expect to be ordered as a combination drug therapy regimen? Select all that apply. A. Glucocorticoids Correct Answer (Blank) B. Biological-response modifiers Correct Answer (Blank) C. Antimicrobial agents D. Diuretics E.Anti-inflammatory drugs Correct Answer (Blank

*A. Glucocorticoids Correct Answer (Blank) *B. Biological-response modifiers *E.Anti-inflammatory drugs Correct Answer (Blank

18) A client with a history of heart disease has been prescribed prophylactic aspirin daily. Which action should the nurse implement to help prevent aspirin toxicity? A. Monitor serum albumin B. Measure daily protein intake C. Assess serum potassium level D. Teach the client that tinnitus is an expected side effect

*A. Monitor serum albumin

An adolescent is admitted with partial- and full-thickness burns of the arms and upper torso. Which are the primary purposes of administering pain medication via the intravenous route, rather than the intramuscular route? Select all that apply. One, some, or all responses may be correct. A. Adolescents are afraid of injections. B. It decreases the risk of tissue irritation. C. Severe pain is reduced more effectively. D. Impaired peripheral circulation is bypassed. E. It provides for more prolonged relief of pain.

*B. It decreases the risk of tissue irritation. *C. Severe pain is reduced more effectively. *D. Impaired peripheral circulation is bypassed.

A health care provider prescribes transdermal fentanyl 25 mcg/h every 72 hours. During the first 24 hours after starting the fentanyl, the nurse recognizes the need to take which action? A. Titrate the dose until pain is tolerable. B. Manage pain with an analgesic by a different route. C. Assess the client for anticholinergic side effects. D.Instruct the client to take the medication with food.

*B. Manage pain with an analgesic by a different route.

The nurse is assessing a client who is taking prescribed opioids for pain. Which finding should indicate to the nurse that the client is having a side effect of the medication? A. Decreased skin turgor B. No bowel movement for four days C. Hypertension D. Increased respiratory effort

*B. No bowel movement for four days

6) Which therapeutic outcomes are expected after administering ibuprofen? Select all that apply. One, some, or all responses may be correct. A. Diuresis B. Pain relief C. Temperature reduction D. Bronchodilation E. Anticoagulation F. Reduced inflammation

*B. Pain relief *C. Temperature reduction *F. Reduced inflammation

A client received hydromorphone orally one hour ago. When the nurse enters the client's room, the client is unresponsive to verbal stimuli and has a respiratory rate of six breaths per minute. Which action should the nurse take next? A. Begin cardiopulmonary resuscitation. B. Prepare to administer naloxone. C. Administer supplemental oxygen. D.Prepare for endotracheal intubation

*B. Prepare to administer naloxone.

The nurse is caring for a client with acute pain and realizes a medication error has occurred. The client received twice the ordered dose of morphine an hour ago. Which nursing problem is the priority at this time? A. Chronic pain B. Respiratory depression C. Constipation D. Tolerance

*B. Respiratory depression

A client who is addicted to heroin has major surgery. Afterward, the client receives methadone. Which purpose does the methadone serve? A. Allows symptom-free termination of opioid addiction B. Switches the user from illicit opioid use to use of a legal drug C. Provides postoperative pain control without causing opioid dependence D. Counteracts the depressive effects of long-term opioid use on thoracic muscles

*B. Switches the user from illicit opioid use to use of a legal drug

A pain scale of 1 to 10 is used by the nurse to assess a client's degree of pain. The client rates the pain as an 8 before receiving an analgesic and a 7 after being medicated. Which conclusion would the nurse make regarding the client's response to pain medication? A. The client has a low pain tolerance. B. The medication is not adequately effective. C. The medication has sufficiently decreased the pain level. D.The client needs more education about the use of the pain scale

*B. The medication is not adequately effective.

A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical findings warrant immediate follow up by the nurse? Select all that apply. One, some, or all responses may be correct. A. Polyuria B. Unconsciousness C. Bradycardia D. Dilated pupils E. Bradypnea

*B. Unconsciousness *C. Bradycardia *E. Bradypnea

The nurse is caring for a 1-year-old child after heart surgery. The child weighs 22 pounds (10 kg). The health care provider has given an order for morphine sulfate 4 mg IV every 3 to 4 hours as needed for pain. What should the nurse do next? A. Administer the prescribed dose as ordered. B. Verify that the dose is appropriate for this child. C. Give half of the dose first, wait 30 minutes, then give the other half. D. Check with the pharmacist to clarify the dose.

*B. Verify that the dose is appropriate for this child.

1) A nurse is preparing to administer indomethacin to a client with acute pain. Which medication on the client's medical record will prompt the nurse to monitor the client more frequently? A. Pantoprazole B. Warfarin C. Simvastatin D. Alprazolam

*B. Warfarin

The health care provider writes a new order for a fentanyl patch to manage chronic pain experienced by a client in hospice care. The nurse is teaching the client and family members about the fentanyl patch and knows that teaching was effective when the client makes which of the following statements? Select all that apply. A. "I can soak in a hot tub to help decrease my pain." B. "I should cut up the patch before I throw it away so no one else can use it." C. "It may take up to a half day or longer for the patch to start working, the first time I use it." D. "If my pain is too great while I am on the patch, I can take a supplemental pain medication." E. "I will take the old patch off before I apply the new patch on."

*C. "It may take up to a half day or longer for the patch to start working, the first time I use it." *D. "If my pain is too great while I am on the patch, I can take a supplemental pain medication." *E. "I will take the old patch off before I apply the new patch on."

13) A client who recently had a heart attack has been prescribed low-dose (81 mg) aspirin at bedtime. The client states "Why am I supposed to take a 'baby aspirin' instead of a regular 325 mg tablet?" Which statement represents the nurse's best response? A. "Taking a higher dose will affect your hearing." B. "The higher dose will cause you to have heartburn." C. "Taking 325 mg of aspirin daily will increase your risk of bleeding." D. "The higher doses may interfere with your normal sleep patterns."

*C. "Taking 325 mg of aspirin daily will increase your risk of bleeding."

A school-age child with end-stage cancer has a continuous infusion of morphine to manage their pain. Breakthrough pain occurs and a fentanyl 'lollipop' is prescribed. Which instruction would the nurse give the child regarding the use of the lollipop when pain occurs? A. 'Chew it and then swallow every 4 hours.' B. 'Suck on it for half an hour every 6 hours.' C. 'Hold it in your cheek only until the pain is relieved.' D.'Place it in your mouth and suck on it until it dissolves

*C. 'Hold it in your cheek only until the pain is relieved.'

A client is taking hydromorphone (Dilaudid) PO every 4 hours at home. Following surgery, Dilaudid IV every 4 hours PRN and butorphanol tartrate (Stadol) IV every 4 hours PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. Which intervention should the nurse implement? A. Alternate the two medications every 4 hours PRN for pain. B. Alternate the two medications every 2 hours PRN for pain. C. Administer only the Dilaudid every 4 hours PRN for pain. D. Administer only the Stadol every 4 hours PRN for pain.

*C. Administer only the Dilaudid every 4 hours PRN for pain

2) The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A. The frequency of the dosing is necessary to increase the effectiveness. B. Therapeutic blood levels of this drug are reached in 4 to 6 weeks. C. Another type of nonsteroidal antiinflammatory drug may be indicated. D. Systemic corticosteroids are the next drugs of choice for pain relief.

*C. Another type of nonsteroidal antiinflammatory drug may be indicated.

A terminally ill client is receiving a morphine drip that exceeds the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. Which action will the nurse take? A. Add a placebo to the morphine to appease the spouse. B. Discuss with the spouse the risk for morphine addiction. C. Assess the client's pain before increasing the dose of morphine. D. Check the client's heart rate before increasing the morphine to the next level.

*C. Assess the client's pain before increasing the dose of morphine.

1) A child with juvenile idiopathic arthritis is prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy at home. Which important toxic effect of NSAIDs would the nurse include in discharge instructions to the child and family? A. Diarrhea B. Hypothermia C. Blood in the urine D. Increased irritability

*C. Blood in the urine

11) The nurse is planning care for a toddler who has ingested aspirin. Which assessment warrants close monitoring because an increase would result in further complications? A. Blood pressure B. Abdominal girth C. Body temperature D. Serum glucose level

*C. Body temperature

1) A nurse is evaluating a client who takes naproxen for pain associated with osteoarthritis. Which documented statement indicates the expected outcome was met? A. Decreased erythema noted to joints B. Muscle strength 3/5 to lower extremities C. Client observed with steady gait upon ambulation D. Deep tendon reflexes +3

*C. Client observed with steady gait upon ambulation

Morphine has been prescribed for a client in a hospice home care program. Which information will the nurse provide regarding this pain management regimen? A. Medication addiction is a concern with this medication. B. Request the medication before the pain becomes severe. C. Dosages of the medication will be given automatically at regular intervals around the clock. D. Intermittent administration of the medication is possible after an intermittent lock is inserted.

*C. Dosages of the medication will be given automatically at regular intervals around the clock.

A client with a history of osteoporosis and vertebral compression has been coming to the clinic more frequently for prescription refills of hydrocodone/acetaminophen. Which inference will the nurse make? A. The half-life of the medication has decreased. B. An idiosyncratic reaction has occurred. C. Higher doses are needed to achieve pain relief. D.An emotional dependence on the medication has developed

*C. Higher doses are needed to achieve pain relief.

12) The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports hearing non-stop ringing in the ears. Which action should the nurse implement? A. Refer the client to an audiologist for evaluation of her hearing. B. Advise the client that this is a common side effect. C. Notify the healthcare provider of the finding immediately. D. Face the client directly and speak in a low, monotone voice.

*C. Notify the healthcare provider of the finding immediately.

A client who had a myocardial infarction receives 15 mg of morphine sulfate for chest pain. Fifteen minutes after receiving the medication, the client complains of feeling dizzy. Which action will the nurse take? A. Determine if this is an allergic reaction. B. Elevate the client's head and keep the extremities warm. C. Place the client in the supine position and take the vital signs. D. Tell the client that this is not a typical sensation after receiving morphine sulfate.

*C. Place the client in the supine position and take the vital signs.

1) The nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator would be related to this therapy? A. Urinary calculi B. Atrophy of the liver C. Prolonged bleeding time D. Premature erythrocyte destruction

*C. Prolonged bleeding time

A client takes morphine sulfate for severe metastatic bone pain. The nurse will assess the client for which adverse effect? A. Diarrhea B. Addiction C. Respiratory depression D. Diuresis

*C. Respiratory depression

Which action would the nurse take when a client refuses to take deep breaths and cough, saying, "It's too painful." after an abdominal cholecystectomy? A. Give pain medication regularly as soon as possible. B. Obtain a prescription to increase the client's pain medication. C. Schedule coughing and deep-breathing exercises after analgesic has taken effect. D. Substitute incentive spirometry for coughing and deep breathing.

*C. Schedule coughing and deep-breathing exercises after analgesic has taken effect.

A staff nurse is assisting a charge nurse with checking controlled substances at the change of shift. The charge nurse is urgently called to a client's room and has to leave the medication room. Which action will the staff nurse take? A. Continue performing the check while the charge nurse assists the client B. Leave the medication room to find another nurse to assist with the check C. Stop the check and sign out of the medication dispensing system D. Pause the check until the charge nurse returns to the medication room

*C. Stop the check and sign out of the medication dispensing system

In which time frame would the nurse advise a client with a long leg cast for a fractured bone to take the prescribed as-needed oxycodone? A. Just as a last resort B. Before going to sleep C. As the pain becomes intense D. When the discomfort begins

*D. When the discomfort begins

Naloxone effectively reverses a client's respiratory depression from an overdose of heroin. Which rationale explains why the nurse will continue to closely monitor this client's status? A. Naloxone and herioin can cause cardiac depression when combined. B. The medication may cause peripheral neuropathy. C. Symptoms of the heroin overdose may return after the naloxone is metabolized. D. Hyperexcitability and amnesia may cause the client to thrash about and become injured.

*C. Symptoms of the heroin overdose may return after the naloxone is metabolized.

3) The nurse is teaching a group of clients diagnosed with arthritis about the use of non-steroidal anti-inflammatory agents (NSAIDs). In order to minimize side effects of these drugs, which action should the nurse emphasize? A. Eat a diet high in fiber B. Limit foods high in Vitamin K C. Take the medication with food D. Take the drug with an antacid

*C. Take the medication with food

17) The nurse is caring for a client that is taking prednisone and aspirin for rheumatoid arthritis. Which action by the nurse is appropriate for this client? A. Assess the client's pain level once a shift B. Monitor the client's temperature every two hours C. Test the client's stool for occult blood D. Apply a hot pack to a warm, acutely inflamed joint

*C. Test the client's stool for occult blood

Which client statement indicates that teaching about acetaminophen is effective? A. "I can drink beer with this but not wine." B. "I need to limit my intake of acetaminophen to 650 mg a day." C. "I should take an emetic if I accidentally overdose on acetaminophen." D. "I have to be careful about which over-the-counter cold preparations I take."

*D. "I have to be careful about which over-the-counter cold preparations I take."

1) The nurse is teaching a client with rheumatoid arthritis about etanercept. Which statement by the client indicates that the client understood the teaching? A. "I will take the medication daily, first thing in the morning on an empty stomach." B. "The medication needs to be mixed well. I will shake the bottle to mix it." C. "I will need to come to the clinic every 6 weeks to receive an intravenous infusion." D. "I will store the medication in a refrigerator and let it warm to room temperature before injecting it."

*D. "I will store the medication in a refrigerator and let it warm to room temperature before injecting it."

1) Which response would the nurse give to a client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted? A. "Yes, both are antipyretics and have the same effect." B. "Acetaminophen irritates the stomach more than ibuprofen does." C. "Acetaminophen is the preferred treatment for rheumatoid arthritis." D. "Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

*D. "Ibuprofen has anti-inflammatory properties, and acetaminophen does not."

A nurse is performing pain assessments on several clients. Which client would benefit the most from the administration of intravenous PRN pain medication? A. A client eating breakfast verbalizing a headache B. A client with a fractured arm pending discharge C. A client post-abdominal surgery sitting in a chair D. A client pending bedside debridement of a wound

*D. A client pending bedside debridement of a wound

Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic? A. An older client with Type 2 diabetes mellitus. B. A client with chronic rheumatoid arthritis. C. A client with a open compound fracture. D. A young adult with inflammatory bowel disease.

*D. A young adult with inflammatory bowel disease.

3) Which medication is safest to take for pain in the week before a surgical procedure? A) Naproxen B. Aspirin C. Ketorolac D. Acetaminophen

*D. Acetaminophen

Which treatment would the nurse be referring to when explaining to a client with trigeminal neuralgia that treatment is effective on a temporary (6- to 18-month) basis? A. Weekly intravenous injections of cobra venom B. A lidocaine injection at the ventral root of the 11th spinal nerve C. Microvascular decompression of the blood vessels at the nerve root D. An alcohol injection at the peripheral branch of the fifth cranial nerve

*D. An alcohol injection at the peripheral branch of the fifth cranial nerve

The nurse is caring for an 81-year-old client with colorectal cancer. Previously, the client's pain was managed with acetaminophen with codeine. However, the client is now experiencing frequent, severe pain and intravenous morphine has been prescribed. What should the nurse recognize about this order? A. Inappropriate due to the potential of respiratory depression B. Inappropriate and demonstrates lack of knowledge related to pain control C. Appropriate despite the risk of diarrhea and abdominal upset D. Appropriate pain management and should be available around the clock

*D. Appropriate pain management and should be available around the clock

When, during the first 24 hours postoperatively, will analgesics be administered to a client who undergoes an abdominal cholecystectomy for gangrene of the gallbladder? A. If repositioning is ineffective B. When the pain becomes severe C. In gradually increasing dosages D. As prescribed by the health care provider

*D. As prescribed by the health care provider

Which response to morphine would need to be reported immediately to the health care provider? A. Nausea B. Headache C. Drowsiness D. Bradycardia

*D. Bradycardia

The nurse is teaching a client who is postoperative cesarean section about prescribing morphine via a patient-controlled device. Which statement should the nurse include in client teaching about the medication? A. It is normal for this medication to cause burning at the IV site B. You will probably experience some itching each time you administer a dose C. Tell your family members to press the administration button if you are feeling tired D. Let a staff member know if you experience any trouble breathing

*D. Let a staff member know if you experience any trouble breathing

A client has increased intracranial pressure and is unconscious with a heart rate of 60 beats/min, respirations 16 breaths/min, and blood pressure 142/64 mm Hg. The nurse reviews the treatment plan and questions which prescription? A. Mannitol B. Dexamethasone C. Chlorpromazine D. Morphine

*D. Morphine

A client, admitted to the cardiac care unit with a myocardial infarction, complains of chest pain. Which intervention will be most effective in relieving the client's pain? A. Nitroglycerin sublingually B. Oxygen per nasal cannula C. Lidocaine hydrochloride 50-mg intravenous (IV) bolus D. Morphine sulfate 2 mg IV

*D. Morphine sulfate 2 mg IV

After surgery the client has a prescription for morphine sulfate via intravenous (IV) route every 3 hours as needed for pain. The client's preoperative blood pressure was 128/76 mm Hg. Postoperative assessments reveal that the client's blood pressure ranges between 90/60 mm Hg and 100/70 mm Hg. Which action will the nurse take if the client requests medication for pain? A. Administer morphine as prescribed. B. Obtain a prescription for a vasoconstrictor. C. Give half the prescribed amount of morphine. D. Withhold morphine until the blood pressure stabilizes.

*D. Withhold morphine until the blood pressure stabilizes.

A hospice client who has severe pain asks for another dose of oxycodone. Which consideration is the nurse's primary concern when responding to the client's request? A. Prevent addiction. B. Determine why the medication is needed. C. Provide alternative comfort measures. D.Reduce the client's pain

*D.Reduce the client's pain

A client using fentanyl transdermal patches for pain management in late-stage cancer dies. Which action will the hospice nurse take regarding the patch in use at the time of death? A. Tell the family to remove and dispose of the patch. B. Leave the patch in place for the mortician to remove. C. Have the family return the patch to the pharmacy for disposal. D.Remove and dispose of the patch in an appropriate receptacle

*D.Remove and dispose of the patch in an appropriate receptacle

The nurse is caring for a post-surgical client who is using patient-controlled analgesia (PCA) with morphine for pain management. The client reports that the pain is severe and does not get better, even after "pushing the PCA button". Place each step in the correct order by entering the numbers in order. Only enter numbers, no spaces or commas. 1. Consult with the health care provider 2. Check the MAR for adjuvant medications prescribed 3. Verify that the client is using the PCA equipment correctly 4. Confirm that the pump is working and the tubing is patent 5.Offer non-pharmacological interventions

3. Verify that the client is using the PCA equipment correctly 4. Confirm that the pump is working and the tubing is patent 2. Check the MAR for adjuvant medications prescribed 5. Offer non-pharmacological interventions 1. Consult with the health care provider

After surgery, an adolescent has a patient-controlled analgesia (PCA) pump that is set to allow morphine delivery every 6 minutes. Which statement indicates to the nurse that the family understand instructions about the PCA pump? A. 'I'll make sure that she pushes the PCA button every 6 minutes.' B. 'She needs to push the PCA button whenever she needs pain medication.' C. 'I'll have to wake her up on a regular basis so she can push the PCA button.' D. 'I'll press the PCA button every 6 minutes so she gets enough pain medication while she's sleeping.'

B. 'She needs to push the PCA button whenever she needs pain medication.'

An adolescent client has orders for morphine sulfate for severe pain and acetaminophen-codeine compound for moderate pain after a spinal fusion. The pain assessment reveals the client is rigid and crying in pain. Which information would influence the nurse's choice of analgesic? A. One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive. B. Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury. C. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. D. The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest.

C. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic.

Which relationship reflects the relationship of naloxone to morphine sulfate? A. Aspirin to warfarin B. Amoxicillin to infection C. Enoxaparin to dalteparin D. Protamine sulfate to heparin

D. Protamine sulfate to heparin