PHARM - Pain practice questions

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?

"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." The gate theory identifies large sensory nerve fibers that, when stimulated, send signals to the spinal cord to close the gate, blocking pain stimuli from reaching the brain. Therefore, the patient is not having the sensation of pain even if the stimulus is still present.

A nurse is teaching a client who has a new prescription for prednisone. Which of the following instructions should the nurse include? (select all that apply)

- Discontinue the drug gradually - Report illness or infection - Increase intake of calcium and vitamin D - Monitor for signs of gastric bleeding

A nurse is caring for a client who is about to begin taking aspirin. The nurse should instruct the client to report which of the following manifestations of salicylism? (select all that apply)

- Fever - Tinnitus - Diaphoresis - Dizziness

A nurse is teaching a client who has a new prescription for tramadol. Which of the following instructions should the nurse include?

- Increase fiber and fluid intake - Take the drug with food - Avoid driving after taking the drug - Change positions gradually

A nurse is caring for a client who is taking naloxone to treat acute morphine toxicity. The nurse should monitor the client for which of the following adverse drug reactions? (select all that apply)

- Increased respiratory rate - Increased pain - Ventricular arrhythmias - Hypertension

A nurse is caring for a client who asks about taking acetaminophen. The nurse should identify that acetaminophen is indicated for which of the following conditions?

- To reduce fever - To relieve mild pain

A nurse is caring for a client who is receiving morphine to relieve severe pain. The nurse should monitor the client for which of the following adverse drug reactions?

- Urinary retention - Respiratory depression - Sedation - Orthostatic hypotension

A nurse is caring for a client who is opioid dependent and has a new prescription for butorphanol. The nurse should monitor the client for which of the following manifestations of abstinence syndrome? (select all that apply)

- Vomiting - Abdominal cramps - Hypertension

A nurse is caring for a client who is taking acetaminophen at regular intervals for mild discomfort. The nurse should tell the client to report which of the following early indications of acetaminophen toxicity?

- diaphoresis - nausea - diarrhea

When assessing a patient for adverse effects related to morphine sulfate (MS Contin), which clinical finding(s) are the nurse MOST likely to find? (Select all that apply)

- inability to void - constipation

A nurse is caring for a client who has a new prescription for butorphanol. The nurse should monitor the client for which of the following adverse drug reactions?

- nausea - dizziness - headache

A nurse is teaching a client who has a new prescription for allopurinol. The nurse should instruct the client to report which of the following adverse drug reactions?

- sore throat - vertigo - bruising - vision changes

A nurse is caring for a group of postoperative clients. The nurse should identify that morphine is contraindicated for which of the following clients?

A client who had a cholecystectomy Morphine can cause biliary colic. It should not be administered to a client who has just had biliary tract surgery, such as a cholecystectomy.

While admitting a patient for treatment of an acetaminophen (Tylenol) overdose, the nurse prepares to administer which medication to prevent toxicity?

Acetylcysteine (Mucomyst)

A nurse is reviewing the medical record of a client who reports taking acetaminophen at home. The nurse should identify that which of the following client conditions is a contraindication for acetaminophen?

Alcohol use disorder

A nurse is caring for a child who has a viral infection. The nurse should identify that which of the following drugs can increase the risk of Reye syndrome in children who have viral infections?

Aspirin

A nurse is teaching a client who has a new prescription for allopurinol. Which of the following instructions should the nurse include?

Avoid driving or activities that require mental alertness. Allopurinol can cause drowsiness.

A nurse is caring for a client who has a new prescription for prednisone for long-term treatment of rheumatoid arthritis. The nurse should monitor the client for which of the following adverse drug reactions?

Bone loss Clients who are taking the drug should increase weight-bearing activity and report back pain. The nurse should monitor the client's bone density.

A nurse is caring for a client who has a new prescription for celecoxib. The nurse should tell the client to report which of the following adverse drug reactions?

Chest pain Celecoxib, a COX-2 inhibitor, can cause cardiovascular or cerebrovascular events. Clients should report chest pain, shortness of breath, headache, numbness, weakness, or confusion. Providers should prescribe the lowest effective dosage of the drug for the shortest time period possible.

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?

Cough suppressant

A nurse is teaching a client who is taking allopurinol about minimizing adverse effects. Which of the following instructions should the nurse include?

Eat a small meal before taking the drug Taking allopurinol after eating a meal or drinking a glass of milk can prevent stomach upset.

The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?

Every 72 hours

A nurse is caring for a client who is taking allopurinol to treat gout. The nurse should monitor the client for which of the following manifestations of hypersensitivity syndrome?

Fever Allopurinol, an antigout drug, can cause hypersensitivity syndrome. The nurse should monitor the client for rash, itching, or fever, as manifestations of hypersensitivity syndrome, which can lead to renal or liver dysfunction. Clients who develop this type of reaction should stop taking the drug.

A nurse is caring for a client who currently takes furosemide and has a new prescription for prednisone. The nurse should monitor the client for which of the following manifestations during concurrent use of the two drugs?

Hypokalemia Prednisone, a glucocorticoid, can cause hypokalemia. The risk for this electrolyte imbalance increases when the client is taking potassium-depleting diuretics, such as furosemide. The nurse should clarify the prescription with the provider and monitor the client's potassium levels.

A nurse is caring for a client who takes low-dose aspirin to prevent cardiovascular events. The client asks the nurse about taking ibuprofen to treat rheumatoid arthritis. Which of the following responses should the nurse make?

Ibuprofen will reduce the cardioprotective effects of low-dose aspirin

In developing a plan of care for a patient receiving morphine sulfate (MS Contin), which nursing diagnosis has the highest priority?

Impaired gas exchange related to respiratory depression

A patient is prescribed an opioid analgesic for chronic pain. Which information should the nurse discuss with the patient to minimize the GI adverse effects?

Increase fluid intake and fiber in the diet

A patient receiving narcotic analgesics for chronic pain can minimize the GI side effects by:

Increasing fluid and fiber in the diet

The nurse is caring for a patient with opioid addiction. The nurse anticipates that the patient will be prescribed which medication?

Methadone (Dolophine)

A nurse is teaching a client who has a new prescription for prednisone. Which of the following instructions should the nurse include?

Monitor the client's blood glucose Prednisone can cause hyperglycemia.

A patient needs to switch analgesic drugs secondary to an adverse reaction to the current treatment regimen. The patient is concerned that the new prescription will not provide optimal pain control. The nurse's response is based on knowledge that doses of analgesics are determined using an equianalgesic table with which drug prototype?

Morphine An equianalgesic table is a conversion chart for commonly used opioids. It identifies oral and parenteral dosages that provide comparable analgesia. It identifies dosages of various narcotics that are equal to 10 mg of morphine. It is important when changing to a new opioid or route. Morphine is the drug prototype for all opioid drugs.

Which medication is used to treat a patient with severe adverse effects of a narcotic analgesic?

Naloxone (Narcan)

The nurse plans pharmacologic management for a patient with pain. The nurse should administer the pain medication based on what dosage schedule?

Pain relief is best obtained by administering analgesics around the clock

When assessing for the MOST serious adverse effect to an opioid analgesic, what does the nurse monitor for in this patient?

Respiratory rate

A nurse is reviewing the medical record of a client who has a new prescription for tramadol. The nurse should identify that which of the following conditions is a contraindication for tramadol?

Seizure disorder Tramadol, a nonopioid analgesic, can cause seizure activity. Clients who have seizure disorders, head injuries, or increased intracranial pressure should not take tramadol.

A nurse is reviewing the medical record of a client who has a new prescription for celecoxib. The nurse should identify that which of the following conditions is a contraindication to celecoxib?

Sulfonamide allergy Clients who are allergic to sulfonamides can have severe allergic reactions to celecoxib, a COX-2 inhibitor. Clients who are allergic to salicylates can also react adversely to celecoxib.

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)?

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

A nurse is reviewing the drug list for a client who has a new prescription for allopurinol. The nurse should identify that which of the following drug interacts with allopurinol?

Warfarin

A nurse is caring for a client who has a prescription for aspirin to treat an ankle sprain. The nurse should instruct the client to report which of the following adverse drug reactions?

Weight gain Aspirin use can cause renal impairment, which can result in the retention of salt and water. Clients should report reduced urine output, weight gain, edema, or bloating. The nurse should monitor BUN and creatinine levels and stop aspirin therapy for clients who develop signs of renal dysfunction.

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?

Withhold the medication and notify the health care provider