Pharm Pain - Opioid Analgesics (ch 10)

opioid drug interactions (5)

-alcohol -antihistamines -barbiturates -benzodiazepines -phenothiazide

morphine adverse effects: GI (4)

-constipation -urinary retention -nausea -vomiting

meperidine adverse effects (unique, different from morphine) (5)

-dizziness -drowsiness -tachycardia -seizures -tremors

morphine adverse effects: integumentary (3)

-itching/pruritis -rash -flushing

opioid reversal drugs

-naloxone (Narcan) IV -naltrexone (ReVia) PO

morphine adverse effects: cardiovascular (2)

-orthostatic hypotension -bradycardia

morphine adverse effects: respiratory (2)

-respiratory depression -cough supression

morphine adverse effects: CNS (4)

-sedation -confusion -hallucinations -miosis (pinpoint pupils)

A postpartum client who received an epidural analgesic after giving birth by cesarean section is lethargic and has a respiratory rate of 8 breaths per minute. The nurse should obtain which medication from the emergency cart after notifying the health care provider? 1. Naloxone 2. Betamethasone 3. Morphine sulfate 4. Meperidine hydrochloride

1. Naloxone (naloxone = opioid antagonist) NCLEX

The nurse is caring for a client with severe back pain. Codeine sulfate has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication? 1. Monitor radial pulse. 2. Monitor bowel activity. 3. Monitor apical heart rate. 4. Monitor peripheral pulses.

2. Monitor bowel activity. (constipation) NCLEX

The nurse is caring for a postoperative client who is receiving demand-dose hydromorphone via a PCA pump for pain control. The nurse enters the client's room and records the following vital signs: temperature 97.2 F (36.2 C) orally, pulse 52 beats/min, blood pressure 101/58, respiratory rate 11 breaths/min, and SpO2 of 93% on 3 L of oxygen via nasal cannula. Which action should the nurse take next? 1. document the findings 2. attempt to arouse the client 3. contact the health care provider (HCP) immediately 4. check the medication administration history on the PCA pump

2. attempt to arouse the client -the nurse should first attempt to arouse the pt and then reassess vital signs - the vital signs may begin to normalize once the client is aroused because sleep can cause decreased HR, BP, respiratory rate, and SpO2 -the nurse should contact the HCP and document the findings after all data are collected, after the pt is stabilized, and if an abnormality still exists after arousing the pt NCLEX

Meperidine has been prescribed for a client to treat pain. Which side and adverse effects should the nurse monitor? (Select all that apply) 1. diarrhea 2. tremors 3. drowsiness 4. hypotension 5. urinary frequency 6. increased respiratory rate

2. tremors 3. drowsiness 4. hypotension NCLEX

The nurse in the hospital emergency department is caring for a client with suspected opioid overdose and is preparing to administer the reversal agent via the intravenous route. Which statement is correct about the administration of this medication? 1. Prepare only 1 dose of the reversal agent. 2. Administer the entire dose by slow intravenous push. 3. Administer the medication rapidly by the intravenous route. 4. After the initial dose, prepare to administer additional intravenous doses if needed.

4. After the initial dose, prepare to administer additional intravenous doses if needed. (naloxone should be titrated every 2 to 5 min according to pt response) NCLEX

You have been assigned to care for a postoperative patient who has been switched from patient-controlled analgesia with meperidine (Demerol) to morphine sulfate after experiencing restlessness and agitation. The caregiver asks why the change has been made. Which of the following replies is most appropriate? a. "Restlessness and agitation are symptoms of meperidine toxicity." b. "Meperidine is not controlling the surgical pain effectively." c. "Meperidine has caused the respiratory rate to drop too low." d. "Meperidine can only be used for 24 hours postoperatively."

a. "Restlessness and agitation are symptoms of meperidine toxicity." MS ch 8

Which medication is used to treat a patient with severe adverse effects of a narcotic analgesic? a. Naloxone (Narcan) b. Acetylcysteine (Mucomyst) c. Methylprednisolone (Solu-Medrol) d. Flumazenil (Romazicon)

a. Naloxone (Narcan) Pharm

You are caring for a postoperative patient receiving epidural fentanyl for pain relief. For which of the following common side effects will you monitor the patient (select all that apply)? a. Nausea b. Itching c. Urinary retention d. Ataxia

a. Nausea b. Itching c. Urinary retention MS ch 8

The nurse plans pharmacologic management for a patient with pain. The nurse should administer the pain medication based on what dosage schedule? a. Pain relief is best obtained by administering analgesics around the clock. b. Administer the analgesic when the pain level reaches a "6" on a scale of 1 to 10. c. Opioid analgesics should not be used for more than 24 hours to prevent drug addiction. d. Analgesics should be administered as needed (prn) to minimize adverse effects.

a. Pain relief is best obtained by administering analgesics around the clock. Pharm

A nurse is preparing to administer an opioid agonist to a client who has acute pain. Which of the following complications should the nurse monitor? a. urinary retention b. tachypnea c. hypertension d. irritating cough

a. urinary retention ATI

After administering acetaminophen and oxycodone (Percocet) for complaints of pain, which of the following interventions would be of highest priority for the nurse to complete before leaving the patient's room? a. Leave the overbed light on at low setting. b. Ensure that the upper two side rails are raised. c. Offer to turn on the television to provide distraction. d. Ensure that documentation of intake and output is accurate.

b. Ensure that the upper two side rails are raised. MS ch 8

In developing a plan of care for a patient receiving morphine sulfate (MS Contin), which nursing diagnosis has the highest priority? a. Acute pain related to metastatic tumor cancer b. Impaired gas exchange related to respiratory depression c. Constipation related to decreased GI motility d. Risk for injury related to CNS adverse effects

b. Impaired gas exchange related to respiratory depression Pharm

You are caring for a patient who is receiving morphine sulfate via PCA. Which of the following patient assessment data demonstrate the most therapeutic effect of this medication? a. Pain rating 1/10, drowsy but arousable, respirations 16 b. Pain rating 2/10, awake and alert, respirations 18 c. Pain rating 3/10, awake and alert, respirations 20 d. Pain rating 2/10, drowsy but arousable, respirations 18

b. Pain rating 2/10, awake and alert, respirations 18 (adequate pain control + normal respirations) MS ch 8

A nurse is reviewing the medication administration record for a client who is receiving transdermal fentanyl for severe pain. Which of the following medications should the nurse expect to cause an adverse effect when administered concurrently with fentanyl? a. ampicillin b. diazepam c. furosemide d. prednisone

b. diazepam (diazepam is a CNS depressant) ATI

During a marathon, a runner had to drop out after 16 miles because of severe muscle spasms. Which type of pain is the runner experiencing? a. chronic pain b. somatic pain c. visceral pain d. superficial pain

b. somatic pain (pain that originates from skeletal muscles, ligaments, or joints) workbook

The nurse is preparing to administer an opioid analgesic. Which factors should be assessed before the dose is given? (Select all that apply) a. blood clotting time b. the level of pain rated on a scale c. prior analgesic use (time, amount, and effectiveness) d. dietary history e. allergies

b. the level of pain rated on a scale c. prior analgesic use (time, amount, and effectiveness) e. allergies workbook

A patient prescribed massage therapy for musculoskeletal pain asks the nurse, "How is rubbing my muscles going to make the pain go away?" What is the nurse's best response? a. "Massaging muscles helps relax the contracted fibers and decrease painful stimuli." b. "Massaging muscles decreases the inflammatory response that initiates the painful stimuli." c. "Massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain." d. "Massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain."

c. "Massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain." Pharm

A patient asks you why a dose of morphine sulfate by IV push is given before starting the medication via PCA. Which of the following responses is most appropriate? a. "PCA takes at least 2 hours to begin working, so the IV push dose will provide pain relief in the interim." b. "The IV push dose will enhance the effects of the PCA for the next 8 hours." c. "The IV push dose will provide for immediate pain relief, which can be maintained by using the PCA." d. "PCA will never be effective unless a loading dose is given first."

c. "The IV push dose will provide for immediate pain relief, which can be maintained by using the PCA." MS ch 8

A nurse is caring for a client who has end-stage cancer and is receiving morphine. The client's daughter asks why the provider prescribed methylnaltrexone. Which of the following responses should the nurse make? a. "The medication will increase your mother's respirations." b. "The medication will prevent dependence on the morphine." c. "The medication will relieve your mother's constipation." d. "The medication works with the morphine to increase pain relief."

c. "The medication will relieve your mother's constipation." (methylnaltrexone is an opioid antagonist used for treating severe constipation in pts who are opioid-dependent) ATI

When assessing a patient receiving morphine sulfate 2 mg every 10 minutes via PCA pump, the nurse should take action as soon as the patient's respiratory rate would drop down to or below which of the following parameters? a. 16 Breaths/min b. 14 Breaths/min c. 12 Breaths/min d. 10 Breaths/min

c. 12 Breaths/min MS ch 8

When assessing a patient for adverse effects related to morphine sulfate (MS Contin), which clinical findings is the nurse MOST likely to find? (Select all that apply.) a. Diarrhea b. Weight gain c. Constipation d. Inability to void e. Excessive bruising

c. Constipation d. Inability to void Pharm

A patient with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine when I have no pain?" The nurse's response is based on knowledge that codeine also has what effect? a. Expectorant b. Bronchodilation c. Cough suppressant d. Increases sputum production

c. Cough suppressant Pharm

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval? a. Once a week b. Every 24 hours c. Every 72 hours d. When pain recurs

c. Every 72 hours Pharm

In monitoring a patient for adverse effects related to morphine sulfate (MS Contin), the nurse assesses for stimulation of which area in the central nervous system (CNS)? a. The cough reflex center b. Sympathetic baroreceptors c. The chemoreceptor trigger zone d. Autonomic control over circulation

c. The chemoreceptor trigger zone (Morphine sulfate can irritate the gastrointestinal (GI) tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting.) Pharm

The nurse is preparing to administer an intravenous injection of morphine to a patient. The nurse assesses a respiratory rate of 10 breaths/min. Which action should the nurse perform? a. Administer the next prescribed dose intramuscularly. b. Administer a smaller dose and document in the patient's record. c. Withhold the medication and notify the health care provider. d. Check the pulse oximeter reading and reevaluate respiratory rate in 1 hour.

c. Withhold the medication and notify the health care provider. Pharm

When evaluating the pt's drug history, the nurse notes that the pt is taking an opioid twice a day for pain. Which additional drug, taken concurrently, would concern the nurse the most? a. an antihistamine b. a calcium channel blocker c. a monoamine oxidase inhibitor d. a disease modifying anti-rheumatic drug

c. a monoamine oxidase inhibitor workbook

A nurse is monitoring a client who is receiving opioid analgesia for adverse effects of the medication. Which of the following effects should the nurse anticipate? (Select all that apply) a. urinary incontinence b. diarrhea c. bradypnea d. orthostatic hypotension e. nausea

c. bradypnea d. orthostatic hypotension e. nausea ATI

An anticonvulsant drug has been ordered as part of a pt's pain management program. The nurse explains to the pt that the purpose of the anticonvulsant is to: a. produce sleep b. prevent seizures c. relieve neuropathic pain d. reduce anxiety

c. relieve neuropathic pain workbook

A nurse is planning to administer morphine IV to a client who is postoperative. Which of the following actions should the nurse take? a. monitor for seizures and confusion with repeated doses b. protect the client's skin from the severe diarrhea that occurs with morphine c. withhold this medication if respiratory rate is less than 12/min d. give morphine intermittent via IV bolus over 30 sec or less

c. withhold this medication if respiratory rate is less than 12/min ATI

The patient is receiving fentanyl (Duragesic) for control of chronic cancer pain. Which of the following should you observe for as a potential adverse effect of this medication? a. Pupillary dilation b. Hypertension c. Urinary incontinence d. Decreased respiratory rate

d. Decreased respiratory rate MS ch 8

The nurse is caring for a patient with opioid addiction. The nurse anticipates that the patient will be prescribed which medication? a. Naloxone (Narcan) b. Meperidine (Demerol) c. Morphine (MS Contin) d. Methadone (Dolophine)

d. Methadone (Dolophine) Pharm

When assessing for the MOST serious adverse effect to an opioid analgesic, what does the nurse monitor for in this patient? a. Heart rate b. Mental status c. Blood pressure d. Respiratory rate

d. Respiratory rate Pharm

A nurse is preparing to administer butorphanol to a pt who has a hx of substance use disorder. The nurse should identify which of the following information as true regarding butorphanol? a. butorphanol has a greater risk for abuse than morphine b. butorphanol causes a higher incidence of respiratory depression than morphine c. butorphanol cannot be reversed with an opioid antagonist d. butorphanol can cause abstinence syndrome in opioid-dependent pts

d. butorphanol can cause abstinence syndrome in opioid-dependent pts ATI

Moderate to severe pain is best treated with which of these medications? a. acetaminophen (Tylenol) b. naloxone (Narcan) c. alprazolam (Xanax) d. fentanyl (Duragesic)

d. fentanyl (Duragesic) workbook

A patient receiving narcotic analgesics for chronic pain can minimize the GI side effects by: a. taking Lomotil with each dose. b. eating foods high in lactobacilli. c. taking the medication on an empty stomach. d. increasing fluid and fiber in the diet.

d. increasing fluid and fiber in the diet. (opioids cause constipation) Pharm