UWorld Analgesics Answers and Rationale

6. ANSWER B: "I regularly take ibuprofen for chronic low back pain."

NSAIDs may cause heart attack, stroke, high blood pressure, and possible heart failure after long-term use. NSAIDs decrease the effectiveness of diuretic and blood pressure medications. Long-term use is also associated with chronic kidney disease and peptic ulcers.

10. ANSWER A: Client falls asleep while talking to the nurse

Sedation should be monitored closely following administration of opioids because oversedation can quickly escalate to fatal resp depression. Falling asleep in conversation indicates that the client is oversedated.

3. ANSWER C: Ketorolac 15 mg IV every 6 hours, as needed for pain

The client has chronic kidney disease with an elevated serum creatinine level. Ketorolac (Toradol) is a highly potent NSAID often used for pain and available in IV form. However, NSAIDs are nephrotoxic and should be avoided in clients with kidney disease. Also, the client should not be given 2 types of NSAIDs simultaneously (eg, naproxen plus ibuprofen) as they can be toxic to the stomach and kidenys.

4. ANSWER B: Falls asleep while speaking with the nurse

The most serious adverse effect to morphine administration is resp depression. Sedation precedes respiratory depression; therefore, the nurse should monitor the client's level of consciousness and notify the HCP if the client becomes sedated.

6. During a routine office visit, the nurse documents the list of current medications of a client with a history of HTN. Which statements by the client would cause the most concern?

A. "I periodically take docusate sodium for constipation." B. "I regularly take ibuprofen for chronic low back pain." C. I take hydrochlorothiazide to prevent swelling around the ankles." D. "I take omeprazole daily to prevent heartburn."

5. A client is taking morphine sulfate for acute pain. Which statement will best assist the client worried about N/V while taking this medication?

A. "N/V rarely occur with this medication." B. "N/V rarely occur when you are up and walking." C. "Take the medication on an empty stomach." D. "Tolerance develops quickly and persistent nausea is rare."

9. The nurse is reviewing the plan of care for multiple clients receiving opioids for pain management. Which client has the GREATEST risk for resp depression?

A. 20-year-old client with chronic bronchitis who is receiving inhaled bronchodilator therapy every 4 hours. B. 30-year-old with opioid use disorder who had rotator cuff repair surgery this morning C. 50-year-old client with sleep apnea and left foot cellulitis who is scheduled for a bone scan

3. A client with chronic kidney disease is admitted with pneumonia and pleurisy. The client's lab results are shown in the exhibit. Which prescription with the nurse question? Hemoglobin 9 Platelets 267,000 WBC 14,500 Creatinine 2.8

A. Acetaminophen 500 mg PO every 6 hours, as needed for fever B. Epoetin alfa 15,000 units subcutaneous injection, once weekly C. Ketorolac 15 mg IV every 6 hours, as needed for pain D. Levofloxacin 500 mg IV, once daily

2. A postoperative client is prescribed patient-controlled analgesic (PCA). The client tells the nurse, "I am pushing the button, but I'm still having a lot of pain." What is the PRIORITY nursing action?

A. Administer a bolus dose of pain medication B. Notify the HCP to request a higher dose C. Perform a thorough pain assessment D. Reinforce the proper use of a PCA pump

1. The home health hospice nurse visits a client who is newly prescribed extended-release oxycodone 40 mg orally, scheduled every 12 hours to treat severe chronic caner pain. Which information is MOST important to reinforce to the client's caregiver?

A. Administer the med around the clock even if the client denies having pain B. Avoid administering with immediate-release opioids to prevent respiratory depression C. Change the dosage and frequency to 20 mg every 6 hours if breakthrough pain occurs D. Request a tapered dose from the HCP if pain decrease to prevent tolerance

11. The home health nurse visits a client with hand osteoarthritis whose health care provider has recommended topical capsaicin for pain relief. Which instruction about capsaicin should the nurse provide the client?

A. Apply a heating pad or warm compress for 20 minutes after applying cream B. Apply cream to hands and wait at least 30 minutes before washing them C. Discontinue immediately if burning or stinging sensation occurs D. Use only if oral pain medications have not been effective

12. A client is taking morphine sulfate for acute pain. The client stands, is immediately "lightheaded," and calls for the nurse. What is the nurse's PRIORITY action?

A. Assess the client's orthostatic blood pressure B. Assist the client to a sitting position C. Hold and walk with the client D. Keep the client on bed rest

7. The HCP prescribes naproxen for a client who has degenerative joint disease. What instructions regarding this drug does the nurse include in the client's discharge plan? SATA

A. Avoid driving while taking this medication B. Change positions slowly C. Discontinue immediately if suicidal thoughts occur D. Notify the HCP of tarry stools E. Take the medicine with food

10. The nurse administers the prescribed dose of hydromorphone 2 mg to a client who had knee replacement surgery 2 days ago. Which assessment finding is MOST concerning to the nurse?

A. Client falls asleep while talking to the nurse B. Client has had no bowel movement for 2 days C. Client has one episode of nonbilious emesis D. Client reports experiencing pruritus

4. The nurse is assessing a client who had surgery 12 hours ago and is receiving IV morphine for incisional pain. It would require IMMEDIATE follow-up if the client?

A. Has a blood pressure of 108/68 mm Hg B. Falls asleep while speaking with the nurse C. Reports burning at the IV site during administration of the medication D. Reports dizziness when getting out of bed to use the bathroom

8. A client with cancer pain is prescribed oxycodone. Which teaching is most ESSENTIAL to help prevent long term complications?

A. Teach the client how to assess blood pressure daily B. Teach the client how to prevent constipation C. Teach the client how to prevent itching D. Teach the client how to prevent nausea

7. ANSWER D and E. Notify the HCP of tarry stools. Take the medicine with food.

All NSAIDs are associated with gastrointestinal toxicity, kidney injury, exacerbation of fluid overload/hypertension, and bleeding risk. They should be used at the lowest dose and for the shortest period possible.

12. ANSWER B: Assist the client to a sitting position.

Client safety is the priority action in any situation. The nurse should assist the client to a safe position prior to proceeding with other interventions.

8. ANSWER B: Teach the client how to prevent constipation

Constipation is an expected long-term side effect of opioid use; clients will not develop tolerance to this side effect. It is important to teach aggressive preventative measures and simultaneous use of a stool softener and a stimulant.

1. ANSWER A: Administer the medication around the clock even if the client denies having pain

Extended-release oxycodone is a long-acting opioid agonist prescribed to manage severe chronic pain when nonopioids and immediate-release opioids are inadequate. The nurse should teach the client's caregiver to administer extended-release oxycodone as scheduled, even if the client does not report pain. Administration twice daily is necessary to maintain a therapeutic level and provide continuous relief as the duration of the analgesic effect is 12 hours.

9. ANSWER D: 70 yo client with COPD who had knee replacement this morning

Factors that increase risk for opioid-related resp depression include advanced age, underlying pulmonary disease, recent surgery, concurrent use of other sedating medications, history of smoking, obesity, opiate-naive status, and snoring/sleep apnea.

5. ANSWER D: "Tolerance develops quickly and persistent nausea is rare."

N/V are expected side effects when opioid pain medications are initiated. However, tolerance develops and persistent nausea is rare. N/V are decreased when the client lies still in a flat position. Anti-emetics may be needed initially.

11. ANSWER B: Apply cream to hands and wait at least 30 minutes before washing them.

The topical analgesic capsaicin relieves minor peripheral pain with regular use. Local irritation is quite common. The client should wait at least 30 minutes before washing the affected area to ensure adequate absorption.

2. ANSWER C: Perform a thorough pain assessment

When providing care for a client prescribed PCA, the nurse should assess pain on a regular and as-needed basis. The client's self-report is the most reliable indicator of pain: therefore, the priority is to perform a thorough pain assessment the cause of worsening/continuous pain despite the medication. This includes the location, quality, radiation, severity, and associated factors (eg, nause, diaphoresis) of pain. The assessment date will guide the nurse's subsequent interventions.