Analgesics Pharmacology Homework

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? "This combination medication will better help to manage your pain." "The combination medication will reduce the chance of addiction." "This medication will minimize any side effects from the codeine." "This medication combination will allow healing to occur faster."

"This combination medication will better help to manage your pain." Rationale: A post-operative client experiencing pain may receive opioid or non-opioid pain medication, in addition to non-pharmacologic comfort measures. The use of acetaminophen with codeine potentiates the effect of the codeine, thus providing greater/better pain relief. The presence of codeine doesn't alter the chance of addiction or reduce the chances of side effects. The medication will not affect healing.

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? Flank. Abdomen. Chest. Head.

Abdomen. Rationale: Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen, which might indicate liver damage, along with nausea and vomiting.

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

"Ibuprofen has anti-inflammatory properties, and acetaminophen does not." Rationale: Ibuprofen has an anti-inflammatory action that relieves the inflammation and pain associated with arthritis. Ibuprofen is not an antipyretic. Acetaminophen does not cause gastritis; this is an effect of aspirin. Acetaminophen is not a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are preferred for the treatment of rheumatoid arthritis.

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? "You cannot breastfeed your baby while using a patient controlled analgesia pump." "You may get drowsy if you press the administration button too many times." "The administration button should not be pressed by anyone other than you." "A patient controlled analgesia pump reduces the risk of post-partum hemorrhage."

"The administration button should not be pressed by anyone other than you." Rationale: A patient-controlled analgesia (PCA) pump is a device that the client can use to self-administer medication. The client is the only person who should press the administration button. These devices have a "lockout" that prevents the client from administering too many doses. The PCA pump does not affect the likelihood of hemorrhage, and clients may breastfeed while using the device.

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? 'Ibuprofen is a good choice for fever or pain.' 'Give your child acetaminophen. Ibuprofen may cause bleeding.' 'No. I'll explain why your child isn't allowed pain medications.' 'You seem concerned about giving medications to your child.'

'Give your child acetaminophen. Ibuprofen may cause bleeding.' Rationale: The parent is asking a specific question that should be answered by the nurse. Ibuprofen is contraindicated because it interferes with platelet function and may cause more bleeding; therefore an analgesic such as acetaminophen should be administered because it does not interfere with coagulation. Analgesics are permitted, provided they do not have anticoagulant effects.

Which medication is safest to take for pain in the week before a surgical procedure? Naproxen Aspirin Ketorolac Acetaminophen

Acetaminophen Rationale: Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not affect platelet function. Naproxen, aspirin, and ketorolac are nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) that are contraindicated for clients undergoing surgery; nonselective NSAIDs have an inhibitory effect on thromboxane, a strong aggregating agent, and can result in bleeding.

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? Administer both medications according to the prescription. Hold the ketorolac to prevent an antagonistic effect. Hold the morphine to prevent an additive drug interaction. Contact the healthcare provider to clarify the prescription.

Administer both medications according to the prescription. Rationale: Morphine and ketorolac (Toradol) can be administered concurrently, and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription. Toradol is an antiinflammatory analgesic, and does not have an antagonistic effect with morphine.

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? Weekly intravenous injections of cobra venom A lidocaine injection at the ventral root of the 11th spinal nerve Microvascular decompression of the blood vessels at the nerve root An alcohol injection at the peripheral branch of the fifth cranial nerve

An alcohol injection at the peripheral branch of the fifth cranial nerve Rationale: A nerve block of the trigeminal (fifth cranial) nerve with alcohol is a conservative approach that lasts 6 to 18 months. Weekly intravenous injections of cobra venom have been tried but provide little, if any, relief. Lidocaine is not used; cranial nerve XI is the spinal accessory nerve that innervates the sternocleidomastoid and trapezius muscles. Microvascular decompression of the blood vessels at the nerve root is not a conservative approach; this is the most commonly used surgical procedure for trigeminal neuralgia. Neuralgia may recur in 30% of clients within 6 years.

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? Administer a PRN dose of the PO lithium. Administer naloxone IV push. Decrease the IV infusion rate of the meperidine. Increase the IV infusion rate of the meperidine.

Decrease the IV infusion rate of the meperidine. Rationale: The client is exhibiting symptoms of meperidine toxicity, which is consistent with the large doses of meperidine received over four days. Decreasing the infusion rate of the meperidine as per protocol is the most effective action to immediately decrease the amount of serum meperidine. The next nursing action is for the nurse to notify the healthcare provider.

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

Epistaxis Rationale: A large dose of aspirin inhibits prothrombin formation and lowers platelet levels. With an overdose, clotting time is prolonged. Spontaneous bleeding often occurs from the nose or mucous membranes in the mouth. The other choices are not symptomatic of prolonged clotting time.

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

Gastrointestinal (GI) bleeding Rationale: Ibuprofen irritates the GI mucosa and can cause mucosal erosion while decreasing platelet activity, which can result in GI hemorrhage. Cardiac dysrhythmias and anaphylaxis are not typically associated with high-dose or long-term administration of ibuprofen. Disulfiram reactions are associated with alcohol intake, not ibuprofen.

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

Has an effect of longer duration Rationale: Methadone's duration of effect is 12 to 24 hours, compared with other opioids, which have a 3- to 6-hour duration of effect. It is just as addictive but controls the addiction and keeps the client out of the illicit drug market. Methadone does produce a cumulative effect. Physical and psychological dependence is possible, just as with other opioids.

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

Meperidine Rationale: Meperidine should be avoided because accumulation of its metabolites can cause central nervous system irritability and even tonic-clonic seizures (grand mal seizures). Ranitidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Cimetidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Promethazine is useful as an antiemetic for clients with pancreatitis.

The nurse teaches the client about effects of carbamazepine that would be reported to the primary health care provider. Which effects would the nurse include? Select all that apply. One, some, or all responses may be correct. Nausea Dizziness Unusual bleeding or bruising Sensitivity to bright light or sun Breast enlargement

Nausea Unusual bleeding or bruising Rationale: Nausea may be a side effect or it may signal toxicity. The client should be evaluated by the primary health care provider. Carbamazepine can cause severe bone marrow depression; the cclient should have weekly complete blood counts for the first 4 weeks of therapy and every 3 to 6 months thereafter. Dizziness is a common side effect of carbamazepine that does not require primary health care provider notification. The client should be cautioned not to engage in hazardous activities such as driving a car. Sensitivity to bright light or sun is not a side effect of carbamazepine. Breast enlargement is not associated with carbamazepine.

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? Begin cardiopulmonary resuscitation. Prepare to administer naloxone. Administer supplemental oxygen. Prepare for endotracheal intubation.

Prepare to administer naloxone. Rationale: Hydromorphone is an opioid analgesic. The client seems to be experiencing central nervous system and respiratory depression related to the medication. The antidote for opioids is naloxone. The nurse should first administer naloxone to reverse the effects of the hydromorphone. The other actions are not appropriate for the client at this time.

A client is admitted to the emergency department with multiple fractures and potential internal injuries. The client's history reveals abuse of multiple medications for the past 8 months.Which medication when withdrawn will cause the most serious life-threatening responses? Heroin Methadone Barbiturates Amphetamines

Rationale: Withdrawal from central nervous system depressants, such as barbiturates, is associated with more severe morbidity and mortality. Symptoms begin with anxiety, shakiness, and insomnia; within 24 hours convulsions, delirium, tachycardia, and death may occur. Withdrawal from heroin or methadone is rarely life threatening, but it does cause severe discomfort, including abdominal cramping and diarrhea. Withdrawal from amphetamines is rarely life threatening, but it causes severe exhaustion and depression.

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? Chronic pain Respiratory depression Constipation Tolerance

Respiratory depression Rationale: Opioids (e.g., morphine) are indicated for the treatment of moderate to severe pain. An opioid is a medication that relieves pain by binding to receptors in the nervous system. Respiratory depression is a life-threatening risk in an opioid overdose. The priority problem is ineffective respirations/respiratory depression due to central nervous system depression.

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? Tolerance Habituation Physical addiction Psychological dependence

Tolerance Rationale: Tolerance is a phenomenon that occurs in addicted individuals. It means that increasing amounts of the drug of addiction are required to satisfy need. The client should receive adequate analgesia after surgery. Drug habituation is a mild form of psychological dependence; the individual develops a habit of taking the substance. A physical addiction is related to biochemical changes in body tissues, especially the nervous system. The tissues come to require the substance for usual function. Psychological dependence is emotional reliance on the substance to maintain a sense of well-being.

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. "If you don't take aspirin every day, you might die." "Can you tell me what concerns you have about the aspirin?" "Do you experience any nausea when you take the aspirin?" "Do you take your other medications as prescribed by your provider?" "Would you like to take the aspirin at another time of day?"

"Can you tell me what concerns you have about the aspirin?" "Do you experience any nausea when you take the aspirin?" "Do you take your other medications as prescribed by your provider?" "Would you like to take the aspirin at another time of day?" Rationale: Although clients have the right to refuse medications, the nurse should still try to determine the underlying reasons for the client's refusal. Aspirin is a platelet aggregate inhibitor that is often prescribed for clients with cardiovascular disease (CVD) and stroke to prevent another thrombotic event and future stroke. Aspirin can cause gastrointestinal (GI) irritation and should be taken with food. The nurse can increase the client's adherence to their prescribed medication regimen by investigating their reasons for refusal, exploring any misconceptions about the drug and reinforcing the importance of the medication in preventing another stroke. In addition, involving the client in making decisions about when to take the medication can help the client accept the regimen. Stating that the client might die if they do not take the medication is nontherapeutic, inappropriate and violates the client's right to autonomy.

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

Benzodiazepines. Rationale: Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines. Antacids and antidiabetic agents do not interact with opiates to produce adverse effects. Antihypertensives may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider.

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? Oral Rectal Intravenous Intramuscular

Intravenous Rationale: The intravenous route provides for the quickest onset of action of the opioid; pain relief occurs almost immediately. Nausea, vomiting, and paralytic ileus may occur postburn, making oral medications impractical. The rectal route does not provide uniform absorption; also, relief of pain will be delayed. With the intramuscular route, medication may be sequestered in the tissues, and with fluid shifts it takes time for the medication to take effect.

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? Morphine Hydromorphone Codeine Meperidine

Meperidine Rationale: Meperidine, an older opioid analgesic, is not recommended in clients with sickle cell disease. Normeperidine, a metabolite in meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus and generalized seizures when it accumulates in the client's system. Clients with sickle cell disease are at high risk for normeperidine-induced seizures.

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? 15 minutes before the dressing change 60 minutes before the dressing change Along with a stool softener each time it is administered Only if the client rates pain between 8 and 10 on the pain scale

60 minutes before the dressing change Rationale: Oral morphine takes 30 to 90 minutes to reach peak effect and can be administered at least 60 minutes before the dressing change. Although pain medications can cause constipation, the nurse would not administer a stool softener each time the morphine is administered. If the client is experiencing pain and rates it anywhere on the pain scale, the client can receive pain medication if it is within the time frame. It is important to premedicate a client before a painful procedure.

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

Alcohol Rationale: Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage. Caffeine stimulates the cardiovascular system, not the liver. In addition, caffeine does not interact with acetaminophen. Diphenhydramine may be taken with acetaminophen. Ibuprofen may be taken with acetaminophen.

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? Add a placebo to the morphine to appease the spouse. Discuss with the spouse the risk for morphine addiction. Assess the client's pain before increasing the dose of morphine. Check the client's heart rate before increasing the morphine to the next level.

Assess the client's pain before increasing the dose of morphine. Rationale: Over time clients receiving morphine develop tolerance and require increasing doses to relieve pain, thus requiring continuing reassessments to ensure that the client does not have signs of toxicity such as respiratory depression. Adding a placebo to the morphine to appease the spouse will not meet the client's need for relief from pain. The client is terminally ill, so the risk for addiction is of no concern. The respiratory, not heart, rate is the significant vital sign to be monitored.

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? Diarrhea Hypothermia Blood in the urine Increased irritability

Blood in the urine Rationale: Hematuria may result from the use of NSAIDs because they may cause nephrotoxicity. Diarrhea can occur but is not a sign of toxicity. Hypothermia does not occur with NSAIDs. Drowsiness, not hyperactivity, may occur.

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

"I am able to rotate my wrists without pain." Rationale: Indomethacin is a non-steroidal anti-inflammatory medication used in the treatment of rheumatoid arthritis and other inflammatory disorders. The expected outcome is increased mobility of the joints without pain. Full range of motion without pain is an expected response. Improved appetite, decreased nocturia, and increased endurance are responses unrelated to the effects of indomethacin.

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? 'It could prolong bleeding time.' 'It's contraindicated for young children.' 'It can suppress the healing of the incision.' 'It becomes ineffective when given for long periods.'

'It could prolong bleeding time.' Rationale: Acetaminophen is not associated with bleeding complications like ibuprofen is, but if used long term, it can result in liver toxicity. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) prolongs bleeding time; in the postoperative period, medications that interfere with clotting and prolong bleeding are contraindicated. Ibuprofen is safe for young children when administered in appropriate doses. Ibuprofen exerts an anti-inflammatory action; it does not interfere with the healing process. Tolerance for ibuprofen does not develop.

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 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 ly 4. Confirm that the pump is working and the tubing is patent 5. Offer non-pharmacological interventions

34251 Rationale: The nurse should implement the interventions/actions in the following order: Verify that the client understands how to use the PCA equipment ly, assess if the PCA pump is functioning properly and medication is being delivered, determine if the client is able to receive additional or adjuvant medication for pain management, offer non-pharmacological interventions such as repositioning, diversional activities and rest. Lastly, the nurse should notify the health care provider if the client's pain level does not improve.

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

A young adult with inflammatory bowel disease. Rationale: The principal indication for opioid use is acute pain, and a client with inflammatory bowel disease is at risk for toxic megacolon or paralytic ileus related to slowed peristalsis, a side effect of morphine. Adverse effects of morphine do not pose as great a risk for clients with diabetes or a fracture as for the client with bowel disease.

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? Constipation and lack of interest in surroundings Agitation and attempts to escape from the hospital Skin dryness and scratching under the incision dressing Lethargy and refusal to participate in therapeutic exercises

Agitation and attempts to escape from the hospital Rationale: When the methadone dosage is reduced, a craving for opioids may occur, anxiety will increase, and the client will become agitated and may try to leave the hospital to secure drugs. Constipation and lack of interest in surroundings and skin dryness and itching under the incision dressing are not related to methadone dosage reduction. Lethargy and refusal to participate in therapeutic exercises may occur with methadone overdose.

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? Inappropriate due to the potential of respiratory depression Inappropriate and demonstrates lack of knowledge related to pain control Appropriate despite the risk of diarrhea and abdominal upset Appropriate pain management and should be available around the clock

Appropriate pain management and should be available around the clock Rationale: Older adults with cancer pain are frequently undermedicated. Pain management with IV morphine, while risky, is appropriate with proper assessment and monitoring of the client. The client should be started on the lowest, effective dose and the pain should be re-evaluated after administration. The nurse should assess the client for respiratory depression, constipation and altered mental status.

Which medication would the nurse anticipate the health care provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis? Aspirin Hydromorphone Meperidine Alprazolam

Aspirin Rationale: Because of its anti-inflammatory effect, acetylsalicylic acid is useful in treating arthritis symptoms. Opioids such as hydromorphone and meperidine should be avoided because they promote medication dependency and do not affect the inflammatory process. Alprazolam is an antianxiety, not an anti-inflammatory, agent.

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 Rationale: Blood in the stool indicates gastrointestinal irritation and may have resulted from the anticoagulant effect of aspirin. Salicylates, such as aspirin, can cause ototoxicity (affects eighth cranial nerve), which may manifest as ringing in the ears (tinnitus) or muffled hearing and it should be reported. Joint pain is not a symptom of salicylate toxicity; however, it is related to the disease process and should be minimized by the administration of aspirin. Bradycardia and increased urine output (polyuria) do not indicate salicylate toxicity.

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. Client is able to self-administer pain-relieving medications as necessary Amount of medication received is determined entirely by the client Decreases client dependency Relieves the nurse of monitoring the client Increases client sense of autonomy

Client is able to self-administer pain-relieving medications as necessary Decreases client dependency Increases client sense of autonomy Rationale: The purpose of patient-controlled analgesia is to give the client the ability to self-administer pain-relieving medications as necessary; usually smaller amounts of analgesics are used with self-administration. The amount and dosage of the medication are programmed to prevent accidents or abuse. Medication levels are kept in a maintenance range, and pain relief is achieved without extreme fluctuations. The client isn't dependent on the nurse availability to administer medication. This increases the client's sense of autonomy. The nurse is not absolved of responsibility when PCA is used; monitoring the client for effectiveness, refilling the apparatus with the prescribed narcotic, and charting the amount administered and the client's response are required.

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? Fentanyl Acetaminophen Ibuprofen Ketorolac

Fentanyl Rationale: The nurse is most likely to administer fentanyl to a client with liver disease. Fentanyl is an opioid analgesic with a short duration. The medication should be used cautiously in hepatic disease but is not contraindicated. Acetaminophen is highly metabolized by the liver and is contraindicated in clients with active liver disease. Ibuprofen and ketorolac are non-steroidal anti-inflammatory medications that may cause gastrointestinal bleeding. A client with liver disease is at risk for bleeding.

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

Occult bleeding Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) taken for long periods of time may cause serious side effects, including bleeding in the gastrointestinal tract. Clients should be instructed to take the medication with meals if stomach upset occurs. To avoid esophageal irritation, the client should take the drug with a full glass of water and to avoid lying down for 30 to 60 minutes after taking a dose.

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

Respiratory depression Rationale: Because morphine is a central nervous system depressant, it affects the medulla, the respiratory center in the brain. Respiratory depression may progress to respiratory arrest and death. Naloxone will reverse the effects of an opioid. Although blurred vision, urinary retention, and mental confusion are adverse effects of morphine, they do not require opioid reversal.

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. Polyuria Unconsciousness Bradycardia Dilated pupils Bradypnea

Unconsciousness Bradycardia Bradypnea Rationale: The central nervous system (CNS) depressant effect of morphine, if severe, can cause unconsciousness. The CNS depressant effect of morphine causes bradycardia and bradypnea. Morphine does not increase urine output. Morphine causes constriction of pupils.

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

"I have to be careful about which over-the-counter cold preparations I take." Rationale: Many over-the-counter cold preparations contain acetaminophen; the amount of acetaminophen in cold preparations must be taken into consideration when the total amount of acetaminophen taken daily is calculated. Alcohol of any type increases the risk of liver injury when taken with acetaminophen. A typical single dose is 650 mg for adults. Acetaminophen should not exceed 3 to 4 g a day. An emetic is contraindicated because it may reduce the client's ability to tolerate oral acetylcysteine, the antidote for acetaminophen toxicity.

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? "I will receive a continuous dose of medication." "I should call the nurse before I take additional doses." "The machine will prevent an overdose of the medication." "I will call for assistance if my pain is not relieved."

"I should call the nurse before I take additional doses." Rationale: Patient controlled analgesia offers the client more control in the prevention and relief of severe pain. The client should be instructed to initiate additional doses as needed when the pain is increased. The client needs to know to call for assistance when insufficient control of the pain is present. The other statements illustrate knowledge.

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

"I will store the medication in a refrigerator and let it warm to room temperature before injecting it." Rationale: Etanercept is in a class of medications called disease-modifying antirheumatic drugs (DMRDs) and is used alone or with other medications to relieve the symptoms of rheumatoid arthritis. It usually comes in a prefilled syringe and an automatic injection device. The medication is injected subcutaneously once a week. Besides knowing how and where to inject the medication, the client should be instructed never to shake the vial and, if the medication has been refrigerated, the nurse should reinforce to let the medication warm to room temperature for about 30 minutes prior to injecting. The other statements do not pertain to etanercept.

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

"I will take the medication as soon as I notice migraine symptoms." Rationale: Almotriptan and other triptans are serotonin receptor agonists that work by causing vasoconstriction of intracranial arteries. The drug is most effective when taken as soon as migraine symptoms start but before the onset of acute pain. It will not prevent headaches or reduce the number of attacks. One of the most common side effects of this medication is dry mouth. After taking a dose, if the headache goes away and comes back, it is acceptable to take a second dose. The client should not take more than two doses of any triptan in 24 hours.

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. "I can soak in a hot tub to help decrease my pain." "I should cut up the patch before I throw it away so no one else can use it." "It may take up to a half day or longer for the patch to start working, the first time I use it." "If my pain is too great while I am on the patch, I can take a supplemental pain medication." "I will take the old patch off before I apply the new patch on."

"If my pain is too great while I am on the patch, I can take a supplemental pain medication." Rationale: Fentanyl patches are slowly absorbed via the subcutaneous tissue at a predetermined rate for up to 72 hours. Due to the slow absorption rate, the first patch may take 12 to 24 hours before effective analgesia is felt; a short-acting opioid may be given for breakthrough pain. The client can shower or bathe with the patch, but it should not be exposed to heat (hot tubs, heating pads) because it speeds up the absorption of the medication. Old patches are removed and the new patch is applied to a different skin area. Old patches are disposed by folding the old patch in half, not by cutting them up and throwing them in the trash (which may be dangerous for people and pets).

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? "It is normal for this medication to cause burning at the IV site." "You will probably experience some itching each time you administer a dose." "Tell your family members to press the administration button if you are feeling tired." "Let a staff member know if you experience any trouble breathing."

"Let a staff member know if you experience any trouble breathing." Rationale: Opioids, such as morphine, are used to treat postoperative pain. A patient-controlled device allows the client to administer the medication at prescheduled intervals. Opioids can cause respiratory depression. When teaching about the patient-controlled device, the nurse should instruct the client to report any changes in respiratory status, including shortness of breath. Only the client should push the administration button for the device. Burning at the IV site and reports of itching are not normal findings and should be reported.

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? "Taking a higher dose will affect your hearing." "The higher dose will cause you to have heartburn." "Taking 325 mg of aspirin daily will increase your risk of bleeding." "The higher doses may interfere with your normal sleep patterns."

"Taking 325 mg of aspirin daily will increase your risk of bleeding." Rationale: Aspirin is a nonsteroidal anti-inflammatory drug and is prescribed to help keep blood clots from forming after a heart attack. Lower-dose aspirin therapy is just as effective in reducing the risk of secondary heart attacks as higher doses of aspirin, but with less risk of bleeding (including gastrointestinal bleeding.) This is especially important for the client to understand since he will may also be prescribed an anticoagulant after his heart attack. Common side effects of aspirin therapy include rash, upset stomach, heartburn, drowsiness, and headache. Many drugs, including aspirin, can affect hearing; usually much larger daily doses would be needed to affect hearing.

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? "This medication could cause gastrointestinal discomfort." "You may experience decreased vaginal discharge with this medication." "Taking this medication could decrease your breast milk production." "You could experience dizziness while taking this medication."

"This medication could cause gastrointestinal discomfort." Rationale: Ibuprofen, which is an NSAID, can cause gastrointestinal upset, especially if taken frequently without food. Ibuprofen can increase the risk for bleeding, so the client should monitor vaginal discharge. Ibuprofen does not affect breast milk production. Medications that cause vasodilation, such as beta-blockers, could cause dizziness.

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? 'Chew it and then swallow every 4 hours.' 'Suck on it for half an hour every 6 hours.' 'Hold it in your cheek only until the pain is relieved.' 'Place it in your mouth and suck on it until it dissolves.'

'Hold it in your cheek only until the pain is relieved.' Rationale: The fentanyl lozenge is absorbed through the buccal mucosa; once the pain is relieved the lozenge should be removed and kept until it is needed again. The lozenge should be sucked, not chewed. There is no specific length of time to suck on the lozenge. The lozenge should not remain in the mouth once the pain is relieved.

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. 'I need to report any dark tarry stools.' 'I will need to stop taking this medication before any scheduled surgery.' 'I should change positions slowly.' 'I will take the medication on an empty stomach.' 'I need to stop taking low-dose aspirin while I take this medication.'

'I need to report any dark tarry stools.' 'I will need to stop taking this medication before any scheduled surgery.' Rationale: Ibuprofen increases the risk for bleeding, so clients need to report any signs or symptoms of bleeding such as dark tarry stools. They also will need to stop taking this medication before scheduled surgery to prevent excessive bleeding. Ibuprofen does not cause postural hypotension, so there is no need to change positions slowly. Ibuprofen may cause epigastric distress; it should be taken with meals or milk to reduce this adverse effect. Clients should continue to take low-dose aspirin to reduce myocardial infarction or stroke risk; however, they will need to take this 2 hours before taking ibuprofen because ibuprofen can reduce the antiplatelet effects of aspirin by blocking access of aspirin to COX-1 in platelets.

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. 'Report persistent abdominal pain.' 'Do not chew enteric-coated tablets.' 'Take the aspirin with meals or a snack.' 'See a dentist if bleeding gums develop.' 'Switch to acetaminophen if tinnitus occurs.'

'Report persistent abdominal pain.' 'Do not chew enteric-coated tablets.' 'Take the aspirin with meals or a snack.' Rationale: Aspirin therapy may lead to gastrointestinal bleeding, which may be manifested by abdominal pain; if present, the prescriber must be notified immediately. Enteric-coated tablets must not be crushed or chewed. Aspirin is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Bleeding gums should be reported to the practitioner, not the dentist. Acetaminophen does not contain the anti-inflammatory properties present in aspirin; tinnitus should be reported to the practitioner.

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? 'I'll make sure that she pushes the PCA button every 6 minutes.' 'She needs to push the PCA button whenever she needs pain medication.' 'I'll have to wake her up on a regular basis so she can push the PCA button.' 'I'll press the PCA button every 6 minutes so she gets enough pain medication while she's sleeping.'

'She needs to push the PCA button whenever she needs pain medication.' Rationale: Morphine, an opioid analgesic, relieves pain; when control of pain is given to the adolescent, anxiety and pain are usually diminished, resulting in a decreased need for the analgesic; only the adolescent should press the PCA button. Having the adolescent press the PCA button every 6 minutes is unnecessary. Although pain medication can be delivered as often as every 6 minutes, it should be used only if necessary. If the adolescent is sleeping, the pain is under control; waking the adolescent will interfere with rest. If the adolescent is sleeping, the pain is under control; also, this will result in an unnecessary and excessive dosage of the opioid.

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? Refer the client to an audiologist for evaluation of her hearing. Advise the client that this is a common side effect. Notify the healthcare provider of the finding immediately. Face the client directly and speak in a low, monotone voice.

Notify the healthcare provider of the finding immediately. Rationale: Tinnitus (ringing in the ears) is an early sign of salicylate toxicity. The healthcare provider should be notified immediately, and the medication discontinued.

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 25-year-old client with a history of Down syndrome. A 16-year-old client who reads at a fourth-grade level. A 71-year-old client with numerous arthritic nodules on their hands. A 4-year-old client with intermittent episodes of alertness.

A 4-year-old client with intermittent episodes of alertness. Rationale: The 4-year-old client (preschool-aged) is most likely to have difficulty with the use or understanding of a patient-controlled analgesia (PCA) pump. The preschooler also has a decreased level of consciousness and would not be able to fully benefit from the use of a PCA pump. School age children, ages 6 and up, are better candidates for PCA electronic pumps.

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

A client pending bedside debridement of a wound Rationale: Intravenous pain medication has a rapid onset. A bedside wound debridement is a complex, painful procedure. This client would benefit the most from IV pain medication. A client with a headache who is able to tolerate meals and a postoperative client who is able to reposition may benefit from pain medication via a different route (oral). A client pending discharge should no longer require intravenous pain medication. Discharge criteria include pain management with less invasive options.

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? Normoactive bowel sounds Absence of pain Decreased cough reflex Normal respiratory rate

Absence of pain Rationale: Codeine is an opioid analgesic used primarily in the treatment of mild to moderate pain. The expected outcome of codeine taken after oral surgery is the absence of pain. Codeine may cause constipation and respiratory depression. Normoactive bowel sounds and a normal respiratory rate indicate the absence of side effects of codeine but do not suggest an expected outcome. A decreased cough reflex is expected when codeine is used in smaller doses (10-20 mg) as an antitussive.

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? Alternate the two medications every 4 hours PRN for pain. Alternate the two medications every 2 hours PRN for pain. Administer only the Dilaudid every 4 hours PRN for pain. Administer only the Stadol every 4 hours PRN for pain.

Administer only the Dilaudid every 4 hours PRN for pain. Rationale: Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided.

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

Analgesic Rationale: Acetylsalicylic acid (aspirin) acts as an analgesic by inhibiting production of inflammatory mediators. Acetylsalicylic acid does not act as a sedative to calm individuals. Acetylsalicylic acid does not act as a hypnotic to induce sleep. Acetylsalicylic acid does not destroy or control microorganisms.

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? The frequency of the dosing is necessary to increase the effectiveness. Therapeutic blood levels of this drug are reached in 4 to 6 weeks. Another type of nonsteroidal antiinflammatory drug may be indicated. Systemic corticosteroids are the next drugs of choice for pain relief.

Another type of nonsteroidal antiinflammatory drug may be indicated. Rationale: Individual responses to nonsteroidal antiinflammatory drugs are vary from person to person, so another nonsteroidal antiinflammatory drug (NSAID) may be indicated for this particular client.

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 Rationale: The anti-inflammatory action of aspirin reduces joint inflammation. Aspirin reduces fever, but this is not the rationale for prescribing it for clients with rheumatoid arthritis. It can relieve pain and prevent abnormal clotting; however, although these effects can be beneficial, these are not the primary reasons that it is prescribed for rheumatoid arthritis.

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

As prescribed by the health care provider Rationale: Relief from pain helps the client cooperate with coughing, deep breathing, turning, and ambulating. These activities help prevent pneumonia, a frequent complication, because the proximity of the incision to the diaphragm limits lung expansion. Repositioning will not relieve pain associated with deep breathing and coughing, although it may relieve mild incisional pain. Analgesics should be given as prescribed to enable the client to successfully take part in postsurgical activity. Analgesics are less effective if given when pain has intensified; they should be given before pain is unbearable for best results. Pain is most intense during the first 24 hours, and analgesics should be administered as prescribed. Pain and analgesic dosages decrease gradually as the postoperative period progresses.

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? Aspirin Atropine Gabapentin Epinephrine

Aspirin Rationale: Early administration of aspirin in the setting of acute myocardial infarction (MI) has been demonstrated to significantly reduce mortality. Aspirin inhibits the action of platelets, preventing their ability to clump together and form clots. The mechanism of acute coronary syndrome usually is ruptured plaque in one of the coronary arteries with clot formation obstructing blood flow. Prompt administration of an antiplatelet agent, such as aspirin, significantly reduces damage and can be lifesaving, the earlier the better; hence the reason why it is part of emergency management treatment. Gabapentin is an anticonvulsant and does not have a role in reducing development of an MI. Atropine and epinephrine are emergency medications that increase cardiac activity and thus oxygen demand; this can increase the risk for MI.

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

Aspirin Ibuprofen Methylprednisolone Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid and ibuprofen, and corticosteroids such as methylprednisolone are known causes of medication-induced gastrointestinal (GI) bleeding by causing irritation and erosion of the gastric mucosal barrier. Ciprofloxacin, an antibiotic, has not been associated with GI bleeding. Acetaminophen is a safe alternative to NSAIDs to reduce the risk of GI bleeding.

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

Aspirin 325 mg, two tablets every 4 hours Rationale: Aspirin is a salicylate. Extensive use of salicylates can cause salicylism. Tinnitus is a common manifestation of this condition. Tinnitus is not an adverse effect of digoxin, captopril, or diphenhydramine.

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? Assessment of the expiration date on the morphine syringe in the pump. Assessment of the rate and depth of the client's respirations. Assessment of the type of anesthesia used during the surgical procedure. Assessment of the client's subjective and objective signs of pain.

Assessment of the rate and depth of the client's respirations. Rationale: A life-threatening side effect of intravenous administration of morphine sulfate is respiratory depression. Prior to the initiation of the patient-controlled analgesia (PCA) pump, the nurse should assess the client's respirations to obtain a baseline of the client's respiratory rate and depth. Once the PCA pump is initiated, and if the client's respiratory rate falls below 12 breaths per minute, the PCA pump should be stopped and the healthcare provider notified immediately.

Which ophthalmic solution is contraindicated for clients with glaucoma? Timolol Atropine Pilocarpine Epinephrine

Atropine Rationale: Atropine, a mydriatic ophthalmic solution, is contraindicated for clients with glaucoma because it dilates the pupil, increasing intraocular pressure. Timolol, a beta blocker, decreases aqueous humor production; beta blockers are the preferred initial medications given to reduce intraocular pressure. Pilocarpine, a cholinergic, constricts the pupil, thereby increasing aqueous humor outflow. Epinephrine, an adrenergic agent, enhances aqueous humor outflow, thereby reducing intraocular pressure.

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? Blood pressure Abdominal girth Body temperature Serum glucose level

Body temperature Rationale: Hyperpyrexia (increased temperature) is a manifestation of acute aspirin poisoning; this leads to increased oxygen consumption and heat loss. Blood pressure is not directly affected by aspirin ingestion. Ascites does not occur as a result of aspirin ingestion; it may occur if liver failure develops. Aspirin ingestion does not affect the serum glucose level.

Which response to morphine would need to be reported immediately to the health care provider? Nausea Headache Drowsiness Bradycardia

Bradycardia Rationale: Because morphine is a central nervous system depressant, it may cause bradycardia, shock, and cardiac arrest. Although headache, drowsiness, and nausea may be a response to morphine, they do not have to be reported.

A client is diagnosed with trigeminal neuralgia. Which nonanalgesic can decrease the client's pain? Echinacea Leucovorin Allopurinol Carbamazepine

Carbamazepine Rationale: Carbamazepine is an anticonvulsant that can be used to control neurological pain such as trigeminal neuralgia. Echinacea is an herbal medication used by some to treat respiratory infections, but not neuralgic pain. Leucovorin is used as rescue medication with methotrexate to prevent cellular damage; it does not relieve neurological pain. Allopurinol is used in the treatment of gout but does not relieve pain.

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? Clarify the prescription for ibuprofen Administer the ibuprofen 30 minutes before the ranitidine Hold the ranitidine for 1 hour after meals Question the prescription for ranitidine

Clarify the prescription for ibuprofen Rationale: Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal (GI) bleeding. The client has a history of peptic ulcer disease. The nurse should clarify the prescription for ibuprofen. Administering the ibuprofen before the ranitidine does not address the issue of possible GI bleeding. Ranitidine can be administered without regard to meals. The prescription for ranitidine is appropriate for the client's condition and does not need to be questioned.

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

Client observed with steady gait upon ambulation Rationale: The observation of a steady gait while ambulating indicates the relief of pain associated with osteoarthritis. Osteoarthritis causes limping due to knee and/or hip pain. Erythema of the joints is associated with rheumatoid arthritis and does not indicate pain relief. A muscle strength of 3/5 indicates muscle atrophy and is not an expected outcome of the medication. Brisk reflexes are not associated with osteoarthritis or the intended effect of the medication.

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

Competition with opioids for occupancy of opioid receptors Rationale: Naloxone is used to treat opioid-induced apnea. It competes with the opioid for central nervous system receptor sites and thus acts as an opioid antagonist. Preventing excessive withdrawal symptoms as heroin wears off is not the specific action of this medication. Naloxone does not accelerate the metabolism of heroin. Stimulating cortical sites that control consciousness and cardiovascular function also is not the action of naloxone. One adverse reaction of naloxone is cardiovascular irritability.

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? Constipation Wheezing Diffuse rash Hyperglycemia

Constipation Rationale: Codeine is an opioid analgesic and antitussive (cough suppressant). For analgesic use, codeine is formulated alone and in combination with non-opioid analgesics (either aspirin or acetaminophen). Because codeine and non-opioid analgesics relieve pain by different mechanisms, the combination can produce greater pain relief than either agent alone. Opioids such as codeine slow down the function of the central nervous system. This can affect involuntary movements in the body, such as peristalsis. As the movement of food through the intestinal tract is slowed down, the walls of the intestine absorb more fluid. With less fluid in the intestines, stool becomes hard and constipation develops. The other side effects are not usually seen with codeine.

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? Sedation. Constipation. Urinary retention. Respiratory depression.

Constipation. Rationale: The client should be prepared to implement measures for constipation, which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation and respiratory depression as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention but may subside. The most likely persistent side effect is constipation.

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? Stop giving the analgesic Give an extra dose of the analgesic Decrease the analgesic dosage by half Continue the analgesic at the current dose

Continue the analgesic at the current dose Rationale: Clients who are actively dying and have been experiencing chronic pain, will probably continue to experience pain even though they cannot communicate this. Pain medication should be continued at the same dose as long as it is effective at that dose; some adjustment may be needed based on the client's physical manifestations of pain, such as grimacing or moaning.

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? Enhanced pain relief Faster onset of action Prevents tolerance Minimized side effects

Enhanced pain relief Rationale: Codeine is an opioid analgesic. It is considered a moderate opioid, similar to morphine in most respects. It is used for relief of mild to moderate pain. Codeine is formulated alone and in combination with non-opioid analgesics such as aspirin or acetaminophen. Because codeine and non-opioid analgesics relieve pain by different mechanisms, the combinations can produce greater (enhanced) pain relief than either agent alone. The onset of action, risk of tolerance and side effects are the same as with other oral, opioid medications.

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? Review the client's hemoglobin results. Notify the healthcare provider. Inquire about the reaction to sulfa. Record the client's vital signs.

Notify the healthcare provider. Rationale: Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are sensitive to sulfonamides, so the healthcare provider should be notified of the client's allergies.

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? The half-life of the medication has decreased. An idiosyncratic reaction has occurred. Higher doses are needed to achieve pain relief. An emotional dependence on the medication has developed.

Higher doses are needed to achieve pain relief. Rationale: As the body adapts to the medication (tolerance), an increased dose is needed to produce the desired effect. The half-life of a medication does not change and is related to the time required for it to be absorbed, distributed, metabolized, and excreted from the body. Idiosyncratic reactions are unpredictable; these sporadic reactions are unrelated to dosage. The data are insufficient for the nurse to conclude that emotional or physiological dependence has developed.

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

Dosages of the medication will be given automatically at regular intervals around the clock. Rationale: The medication will be given routinely to maintain a continuous therapeutic blood level to keep the terminally ill client comfortable. Addiction is not a major concern for the terminally ill client. The client should not have to request this medication; it should be given regularly. Morphine is not administered intermittently; usually, it is prescribed in liquid form and is taken orally when administered in the home.

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

Count the client's respirations. Document the intensity of the client's pain. Verify the number of doses in the locked cabinet before administering the prescribed dose. Rationale: Opioid analgesics can cause respiratory depression; the nurse must monitor respirations. The intensity of pain must be documented before and after administering an analgesic to evaluate its effectiveness. Because of the potential for abuse, the nurse is legally required to verify an accurate count of doses before taking a dose from the locked source and at the change of the shift. Pruritus is a common side effect of opioids that can be managed with antihistamines. It is not an allergic response, so it does not preclude administration. The nurse would not discard an opioid in a client's room. Any waste of an opioid must be witnessed by another nurse.

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. Count the client's respiratory rate. Examine the client for petechiae. Observe the client for movement disorders. Ask the client to rate the level of pain. Assess the client's level of consciousness.

Count the client's respiratory rate. Ask the client to rate the level of pain. Assess the client's level of consciousness. Rationale: Oxycodone is an opioid that depresses the central nervous system, resulting in a decreased level of consciousness and depressed respirations. The medication should be administered, delayed, or held, depending on the client's status. It is important to have the client rate the pain level as a basis for comparison when checking to see if the medication relieved the pain. Petechiae (or other signs of bleeding) and movement disorders are not associated with opioid use.

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? Increased respiratory rate Decreased workload of the heart Dilation of coronary arteries Diminished metabolites within the ischemic heart muscle

Decreased workload of the heart Rationale: Morphine reduces pain and anxiety. This limits the response of the sympathetic nervous system, ultimately decreasing cardiac preload and the workload of the heart. Reduced respiratory rate is a side effect of morphine; it is not the intended therapeutic effect for a client being treated for myocardial infarction. Morphine causes peripheral vasodilation but not coronary artery dilation. Decreasing metabolites within the ischemic heart muscle is not the action of morphine.

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? Monitor the client's pain level for another hour. Determine the integrity of the intravenous delivery system. Reprogram the pump to deliver a bolus dose every 8 minutes. Arrange for the client to be evaluated by the health care provider.

Determine the integrity of the intravenous delivery system. Rationale: Initially, the integrity of the intravenous system should be verified to ensure that the client is receiving medication. The intravenous tubing may be kinked or compressed, or the catheter may be dislodged. Continued monitoring will result in the client experiencing unnecessary pain. The nurse may not reprogram the pump to deliver larger or more frequent doses of medication without a health care provider's prescription. The health care provider should be notified if the system is intact and the client is not obtaining relief from pain. The prescription may have to be revised, the basal dose may be increased, the length of the delay may be reduced, or another medication or mode of delivery may be prescribed.

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? Discard the medication in the presence of another nurse Dispose of the syringe in the sharps container Flush the unused medication in the sink Document the client refusal of the medication in the electronic record

Discard the medication in the presence of another nurse Rationale: Hydromorphone is a controlled substance that is regulated by federal law. Any unused medication should be discarded in the presence of another licensed provider. The medication in the syringe should be discarded before disposing of the supplies. The medication should be flushed according to policy; however, it should be performed in the presence of another licensed provider. Documenting refusal of medications is an important nursing action; however, this should be done after the medication is discarded according to policy.

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? Feelings of drowsiness Disturbances in hearing Intermittent constipation Metallic taste in the mouth

Disturbances in hearing Rationale: Ringing in the ears occurs because of aspirin's effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity. Feelings of drowsiness are not side effects of aspirin; aspirin promotes comfort, which may permit rest. Aspirin may cause diarrhea, nausea, and vomiting, not intermittent constipation. A metallic taste in the mouth is not a side effect of salicylates such as aspirin.

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

Every 12 hours. Rationale: A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours provides the best around-the-clock pain management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or as needed schedule. Using a schedule of every 4 to 6 hours may jeopardize client safety due to cumulative effects of the medication.

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? Explain the reason for the medication and encourage the client to take it. Withhold the medication at this time and return to check with the client again in 30 minutes. Withhold the medication and tell the client to ask for it if the legs become uncomfortable. Request that the client take the medication and explain that it prevents the client from being uncomfortable in the next few hours.

Explain the reason for the medication and encourage the client to take it. Rationale: Aspirin is given to the client to prevent platelet aggregation and possible deep vein thrombosis. The client needs information to make an educated decision. Aspirin is not prescribed to relieve pain. The client should receive information and support before making the decision to refuse the medication. Clients should never be pressured to take medication, especially when they do not have an understanding of the risks and benefits of the medication.

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

Fentanyl Rationale: Fentanyl is recommended for short procedures on pediatric clients. For long procedures in which pain is anticipated even after the procedure, morphine should be administered. Meperidine and hydromorphone are used to achieve mild to moderate sedation in pediatric clients.

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. Glucocorticoids Biological-response modifiers Antimicrobial agents Diuretics Anti-inflammatory drugs

Glucocorticoids Biological-response modifiers Anti-inflammatory drugs Rationale: Rheumatoid arthritis is a chronic, systemic autoimmune disorder that results in symmetric joint destruction. Research shows that multiple drug therapy is most effective in protecting against further destruction and promoting function. Analgesics and anti-inflammatory drugs are used. Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate help slow or stop progression of RA. Biological response modifiers are used to help stop inflammation. Glucocorticoids can also be used for severe RA or when RA symptoms flare to ease the pain and stiffness of affected joints. Because RA is not an infectious disease, antimicrobials are ineffective. Although there is swelling in the joints, it is not fluid, so diuretics are not part of the treatment plan.

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

Is contraindicated in people with coronary artery disease. Rationale: In addition to promoting therapeutic cerebral vasoconstriction, sumatriptan promotes undesirable coronary artery vasoconstriction. Coronary vasoconstriction may cause harm to the client with coronary artery disease. For maximum effectiveness, sumatriptan should be administered at the onset of migraine headache. Sumatriptan may be given orally, subcutaneously, or as a nasal spray. The maximum adult dose of sumatriptan is two 6-mg doses in a 24-hour period for a total of 12 milligrams. The two doses must be separated by at least an hour. The second dose should not be administered unless some response was observed with the first dose.

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. Adolescents are afraid of injections. It decreases the risk of tissue irritation. Severe pain is reduced more effectively. Impaired peripheral circulation is bypassed. It provides for more prolonged relief of pain.

It decreases the risk of tissue irritation. Severe pain is reduced more effectively. Impaired peripheral circulation is bypassed. Rationale: Decreasing the risk for tissue irritation can reduce the risk of infection, which is also one of the top care priorities after a burn injury. The medication begins to work in minutes; doses can be controlled. Intramuscular medications are avoided when possible to prevent inadequate absorption of the medication because of damaged tissue. Stating that adolescents are afraid of injections is a generalization that is not necessarily true. The duration of effectiveness of an analgesic is based on its therapeutic level in the body, regardless of what route is used.

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? Ketorolac Trifluridine Natamycin Ciprofloxacin

Ketorolac Rationale: Ketorolac is a nonsteroidal anti-inflammatory medication that may disrupt platelet aggregation and can lead to bleeding in the eyes. Trifluridine is the topical antiviral agent that may cause sensitive reactions such as itching. Natamycin is an antifungal agent that may cause itching lids and burning eyes due to sensitivity. Ciprofloxacin is an anti-infective agent that may cause blindness if not taken in prescribed amounts.

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

Licensed practical nurse (LPN) Rationale: The wasting of controlled substances should be witnessed by two licensed personnel according to federal regulations; this can be done by a registered nurse (RN) or LPN. Although the nursing supervisor is licensed and may perform this function, it is not an efficient use of this individual's expertise. Federal regulations do not require the participation by the client's health care provider in this situation. A nursing assistant is not a licensed person who can take responsibility for the wasting of controlled substances.

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? Titrate the dose until pain is tolerable. Manage pain with an analgesic by a different route. Assess the client for anticholinergic side effects. Instruct the client to take the medication with food.

Manage pain with an analgesic by a different route. Rationale: It takes 24 hours to reach the peak effect of transdermal fentanyl. An alternate-route pain medication may be necessary to support client comfort until the fentanyl reaches its peak effect. The nurse needs to administer the dose of transdermal fentanyl exactly as prescribed by the health care provider. Anticholinergic side effects are associated with tricyclic antidepressants, not transdermal fentanyl. A transdermal medication is administered through the skin via a patch applied to the skin, not via the gastrointestinal tract.

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? Monitor serum albumin Measure daily protein intake Assess serum potassium level Teach the client that tinnitus is an expected side effect

Monitor serum albumin Rationale: Aspirin and salicylic acid are bound to serum albumin. A low serum albumin level may result in altered salicylate binding, thereby increasing the availability of unbound (active) drug for toxic effects. The effect is more evident in the elderly, especially someone with heart disease taking other medications that may be albumin-bound. Although aspirin can cause tinnitus and hearing loss, educating the client that this is an expected side effect is in and would not prevent toxicity.

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? Monitoring of respiratory rate hourly Assessing the client for tachycardia Administering naloxone every 3 to 4 hours Observing the client for signs of central nervous system (CNS) excitement

Monitoring of respiratory rate hourly Rationale: Intrathecal morphine can depress respiratory function depending on the level it reaches within the spinal column; hourly assessments during the first 12 to 24 hours will allow for early intervention with an antidote if respiratory depression needs to be ed. Bradycardia, not tachycardia, and hypotension occur. Administering naloxone every 3 to 4 hours is too infrequent if the client's respirations are depressed. The recommended adult dosage usually is 0.4 to 2 mg every 2 to 3 minutes, if indicated. CNS depression occurs secondary to hypoxia.

A school-age child with a seizure disorder has been on long-term carbamazepine therapy. Which intervention would the nurse incorporate into the plan of care? Assessing the mouth for gingivitis Checking the pupillary reaction to light Keeping an accurate intake and output record Monitoring the child's complete blood cell counts

Monitoring the child's complete blood cell counts Rationale: The side effects of carbamazepine include blood dyscrasias (e.g., thrombocytopenia, aplastic anemia, leukopenia, agranulocytosis). A side effect of long-term phenytoin, not carbamazepine, therapy is hyperplasia of the gingiva. Carbamazepine does not influence pupillary response directly. Keeping an accurate intake and output is unnecessary.

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

Morphine Rationale: Morphine binds with the same receptors as natural opioids. However, it has a rapid onset, lowers the blood pressure, decreases pulmonary reflexes, and produces sedation. Phenobarbital has a slower onset than morphine and does not affect respirations and blood pressure to the same extent as morphine. Hydroxyzine generally is used to control anxiety associated with less acute situations. Chloral hydrate is a hypnotic that is not appropriate for the acute situation described.

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? Mannitol Dexamethasone Chlorpromazine Morphine

Morphine Rationale: Morphine injection is contraindicated for an unconscious, neurologically impaired client because it depresses respirations. Mannitol, an osmotic diuretic, is used to reduce increased intracranial pressure. Dexamethasone, a corticosteroid anti-inflammatory agent, is used to help reduce increased intracranial pressure. Chlorpromazine, an antipsychotic/neuroleptic/antiemetic, can be given safely to a neurologically impaired client for restlessness.

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? Morphine Diazepam Midazolam Oxycodone

Morphine Rationale: Morphine is the medication of choice for a myocardial infarction because it relieves pain quickly and reduces anxiety. It also decreases cardiac workload. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the severe pain associated with a myocardial infarction. Midazolam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the severe pain associated with a myocardial infarction. Oxycodone is an orally administered analgesic; an analgesic that is administered via the intravenous, not the oral, route provides more immediate pain relief.

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

Morphine sulfate Rationale: For myocardial infarction, morphine sulfate is the medication of choice because it relieves pain quickly and reduces anxiety while decreasing cardiac workload. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the pain of a myocardial infarction. Although ketorolac and meperidine relieve pain, they do not offer all the additional benefits of morphine. In addition, meperidine has additional adverse effects. Flurazepam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the pain of a myocardial infarction.

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? Nitroglycerin sublingually Oxygen per nasal cannula Lidocaine hydrochloride 50-mg intravenous (IV) bolus Morphine sulfate 2 mg IV

Morphine sulfate 2 mg IV Rationale: Morphine is an opioid analgesic that acts on the central nervous system by a sympathetic mechanism. Morphine decreases systemic vascular resistance, which decreases left ventricular afterload, thus decreasing myocardial oxygen consumption. Nitroglycerin sublingually relieves anginal pain, not myocardial infarction pain. Oxygen administration elevates arterial oxygen tension, potentially improving tissue oxygenation; however, oxygen administration will not relieve the pain. Lidocaine is an antidysrhythmic, not an analgesic.

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

Muscle tension when repositioning in bed Rationale: Pain is an expected response for a postoperative client. The nurse should assess behaviors that prevent activities of daily living (ADLs) due to pain. Sustained muscle tension can prevent the client from performing ADLs. A slow gait is a protective response to movement after a surgical procedure. Palpation around the surgical area will produce an expected pain response. A refusal to eat is not specific to pain. It may be due to other factors, such as nausea.

Which medication is indicated for management of clinical manifestations associated with an opioid overdose? Naloxone Methadone Epinephrine Amphetamine

Naloxone Rationale: Naloxone is a narcotic antagonist that displaces opioids from receptors in the brain, thereby reversing respiratory depression. Methadone is a synthetic opioid that causes central nervous system depression; it will add to the problem of overdose. Epinephrine and amphetamine will have no effect on respiratory depression related to opioid overdose.

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

Naloxone administration Rationale: Naloxone is an opioid antagonist and will reverse respiratory depression caused by opioids. Nasotracheal suction, mechanical ventilation, and cardiopulmonary resuscitation are not needed; naloxone will the respiratory depression.

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. Nausea Oliguria Sedation Dry mouth Flushed skin Orthostatic hypotension

Nausea Sedation Dry mouth Orthostatic hypotension Rationale: Dry mouth, sedation, nausea, and hypotension are the most common side effects of nalbuphine hydrochloride. The client may lose bladder control, but oliguria is not seen. Cold and clammy skin, not flushed skin, may occur.

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? Decreased skin turgor No bowel movement for four days Hypertension Increased respiratory effort

No bowel movement for four days Rationale: A side effect is a mild, predictable response to a medication. Opioids slow down processes in the body, including gastrointestinal motility, so a possible side effect of this medication would be constipation. Skin turgor is not directly affected by opioids. A client who is having side effects of opioids will have hypotension and decreased respiratory effort.

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. Ongoing nausea Constipation Easy bruising Decreased pulse Ringing in the ears

Ongoing nausea Easy bruising Ringing in the ears Rationale: Aspirin is a gastrointestinal irritant that can cause nausea, vomiting, and gastrointestinal bleeding. Salicylates decrease platelet aggregation, resulting in easy bruising and gastrointestinal bleeding. Tinnitus and hearing loss can occur as a result of the effects of the medication on the eighth cranial nerve. Salicylates may cause diarrhea, not constipation, because of gastrointestinal irritation. Salicylates may increase, not decrease, the heart rate.

Which effect would the nurse monitor to evaluate the effectiveness of carbamazepine in the management of a client's trigeminal neuralgia? Pain intensity Gait Range of motion Seizure activity

Pain intensity Rationale: Carbamazepine is administered to control pain by reducing transmission of nerve impulses in clients with trigeminal neuralgia. This neurological condition isn't manifested by problems associated with gait or range of motion. Carbamazepine is not administered to clients with trigeminal neuralgia (tic douloureux) for its anticonvulsant properties because seizures are not present with this disorder.

Which therapeutic outcomes are expected after administering ibuprofen? Select all that apply. One, some, or all responses may be correct. Diuresis Pain relief Temperature reduction Bronchodilation Anticoagulation Reduced inflammation

Pain relief Temperature reduction Reduced inflammation Rationale: Prostaglandins accumulate at the site of an injury, causing pain; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing the temperature to decline. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.

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? Determine if this is an allergic reaction. Elevate the client's head and keep the extremities warm. Place the client in the supine position and take the vital signs. Tell the client that this is not a typical sensation after receiving morphine sulfate.

Place the client in the supine position and take the vital signs. Rationale: Dizziness is a symptom of hypotension, a side effect of morphine sulfate. The supine position increases venous return, cardiac output, and blood flow to the brain. Dizziness is a symptom of hypotension that is a side effect, not an allergic response, to morphine sulfate. Raising the client's head may aggravate dizziness. Dizziness is a typical side effect of morphine sulfate.

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

Prolonged bleeding time Rationale: Aspirin interferes with platelet aggregation, thereby lengthening bleeding time. Urate excretion is enhanced by high doses of aspirin. Aspirin does not cause atrophy of the liver; it is readily broken down in the gastrointestinal tract and liver. Aspirin does not destroy erythrocytes.

Which relationship reflects the relationship of naloxone to morphine sulfate? Aspirin to warfarin Amoxicillin to infection Enoxaparin to dalteparin Protamine sulfate to heparin

Protamine sulfate to heparin Rationale: Protamine sulfate is the antidote for heparin overdose, and naloxone will reverse the effects of opioids such as morphine. Aspirin and warfarin both interfere with coagulation. Although amoxicillin is used to treat some infections, an infection is not a medication, so amoxicillin cannot be considered an antidote. Both enoxaparin and dalteparin are low-molecular-weight heparins.

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? Prevent addiction. Determine why the medication is needed. Provide alternative comfort measures. Reduce the client's pain.

Reduce the client's pain. Rationale: Hospice clients with severe pain need increasing levels of analgesics and should be maintained at a pain-free level, even if addiction occurs. Pain management, not the prevention of addiction, is the priority. The client has severe pain, and the priority is to relieve the pain. Comfort measures should augment, not be substitutes for, pharmacological interventions when clients are experiencing severe pain.

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? Relief of pain Client teaching Cardiac monitoring Maintenance of bed rest

Relief of pain Rationale: Unrelieved chest pain increases anxiety, fatigue, and myocardial oxygen consumption, with the possibility of extending the infarction. The client will not be ready for teaching until the chest pain is relieved. The morphine will decrease cardiac workload and, thereby, decrease oxygen demand. Cardiac monitoring is important, but it does not take priority over relieving the chest pain. Bed rest is necessary to decrease the workload of the heart but decreasing the cardiac workload will be difficult to achieve unless the chest pain is relieved.

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

Relieves abdominal pain Rationale: Analgesics alleviate pain by binding with opioid receptors in the brain, thus altering the perception of and response to pain; patient-controlled analgesia (PCA) via an epidural catheter gives the client control over medication administration and usually results in the client using less medication. Opioids do not facilitate oxygen use; they decrease the respiratory rate, and less oxygen is used; the client should be monitored. Although decreasing anxiety and restlessness may be responses to an opioid, they are not the primary reason why opioids are used after abdominal surgery. Opioids are not given to dilate blood vessels; antianginal medications and vasodilators are used for this purpose.

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? Tell the family to remove and dispose of the patch. Leave the patch in place for the mortician to remove. Have the family return the patch to the pharmacy for disposal. Remove and dispose of the patch in an appropriate receptacle.

Remove and dispose of the patch in an appropriate receptacle. Rationale: The nurse would remove and dispose of the patch in a manner that protects self and others from exposure to the fentanyl. This involves folding the patch so that adhesive edges are together. The nurse would flush the patch down the toilet or place it in a proper disposal receptacle following the local governmental policy. Having the family remove and dispose of the patch or having the mortician remove the patch is not safe. It is not the responsibility of nonprofessionals because they do not know how to protect themselves and others from exposure to the fentanyl. It is unnecessary to return a used fentanyl patch to the pharmacy.

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? Request another nurse to witness wasting of the unused medication Dispose of the unused medication in the sink Store the unused of the medication in the medication cart Return the unused medication to the dispensing system

Request another nurse to witness wasting of the unused medication Rationale: Unused controlled substances such as fentanyl should be wasted. The waste of narcotics requires a witness. The nurse should request another licensed nurse to witness the waste of the additional 1 ml of medication. Disposal of controlled substances should be witnessed. Unused controlled substances should be wasted, not stored or returned to the dispensing system.

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

Respiratory depression Rationale: Morphine sulfate is a central nervous system depressant that commonly decreases the respiratory rate, which can lead to respiratory arrest. Morphine, an opioid, will cause constipation, not diarrhea. Addiction is not a concern for a terminally ill client. Urinary retention, not diuresis, is a common side effect of morphine.

The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? A client's statement that the chest pain is better. Respiratory rate is 16 breaths/minute. Seizure activity has stopped temporarily. Pupils are constricted bilaterally.

Respiratory rate is 16 breaths/minute. Rationale: Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed.

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

Respiratory rate of 11 breaths/min Rationale: The nurse should withhold the medication if the respiratory rate is 11 breaths/min. Opioid medications, such as morphine, can cause respiratory depression. A respiratory rate of 11 breaths/min increases the risk of respiratory depression and arrest. The normal respiratory rate is 12-20 breaths/min. A heart rate of 117 beats/min (tachycardia) is not contraindicated with the use of morphine. Morphine can cause the opposite effect, bradycardia. Morphine can cause urinary retention; however, a urine output of 35 ml/hr is a normal finding. Oxygen saturation of 92% is a low-normal finding. The nurse should administer the medication and monitor the client's respiratory status.

The nurse is assessing a client with suspected aspirin overdose. Which assessment findings would support this diagnosis? Select all that apply. One, some, or all may be correct. Respiratory rate of 28 Tinnitus Hypoglycemia Jaundice Serum pH 7.31 Headache

Respiratory rate of 28 Tinnitus Serum pH 7.31 Headache Rationale: Aspirin belongs to a chemical family known as salicylates. All members of this group are derivatives of salicylic acid. Aspirin is produced by substituting an acetyl group onto salicylic acid and is commonly known as acetylsalicylic acid, or simply ASA. Low therapeutic doses of aspirin produce plasma salicylate levels less than 100 mcg/ mL. Anti-inflammatory doses produce salicylate levels of about 150- 300 mcg/ mL. Signs of salicylism (toxicity) begin when plasma salicylate levels exceed 200 mcg/ mL. Severe toxicity occurs at levels above 400 mcg/ mL. Salicylism is a syndrome that begins to develop when aspirin levels climb just slightly above therapeutic. Overt signs include tinnitus (ringing in the ears), sweating, headache, and dizziness. Acid-base disturbance (metabolic acidosis) may also occur. The respiratory rate will increase in an effort to 'blow off' CO2 to compensate for the acidosis. Hypoglycemia and jaundice are not typically seen with salicylate overdose.

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? Salicylate toxicity Allergic reaction Withdrawal symptoms Aspirin tolerance

Salicylate toxicity Rationale: Aspirin is a salicylate; excessive aspirin ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness. The client is experiencing symptoms of toxicity, not an allergic response. Withdrawal symptoms occur when a medication is no longer being administered. Tolerance describes a condition in which additional medication is needed to achieve an effect; it is not associated with the development of new symptoms.

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? Give pain medication regularly as soon as possible. Obtain a prescription to increase the client's pain medication. Schedule coughing and deep-breathing exercises after analgesic has taken effect. Substitute incentive spirometry for coughing and deep breathing.

Schedule coughing and deep-breathing exercises after analgesic has taken effect. Rationale: Analgesics limit pain, facilitating effective coughing and deep breathing. Although giving pain medication regularly may be necessary, it must be coordinated with the deep breathing and coughing exercises. Opioids depress the central nervous system (CNS), particularly respirations, and increasing the dose should be an option only after other interventions have been unsuccessful. Incentive spirometry will cause pain because it increases intraabdominal pressure, and the client may not cooperate if pain is not relieved.

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? One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive. Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest.

Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. Rationale: Spinal fusion causes considerable pain for several days and requires a strong analgesic. The first postoperative day is too early to begin weaning the client from opiates. Adolescents are no more prone to exaggerating their discomfort than clients in any other age group. A more potent analgesic, such as morphine, is needed, and the prescribed dosage should not cause respiratory problems.

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? Continue performing the check while the charge nurse assists the client Leave the medication room to find another nurse to assist with the check Stop the check and sign out of the medication dispensing system Pause the check until the charge nurse returns to the medication room

Stop the check and sign out of the medication dispensing system Rationale: Performing inventory on controlled substances with another nurse should be finalized in one session. If one of the nurses is unable to complete the count, the session should be terminated, and the dispensing system should be secured. Performing an independently controlled substance check is not safe nursing practice. An open medication dispensing system should never be left unattended, especially with controlled substances. The charge nurse should not leave the medication room after entering credentials into the dispensing system. Both nurses should sign out of the system if unable to complete the check.

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

Subcutaneous Rationale: The subcutaneous route is used for the administration of etanercept because slow absorption is desired. Injection sites should be rotated among the upper arms, abdomen, and thighs. Sublingual administration, intravenous administration, and intramuscular administration are not recommended routes.

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

Switches the user from illicit opioid use to use of a legal drug Rationale: Methadone may be dispensed legally; the strength of this medication is controlled and remains constant from dose to dose, unlike illicit drugs. Methadone is used in the medically supervised withdrawal period to treat physical dependence on opiates; methadone therapy substitutes a legal drug for an illegal one. Methadone may be administered over the long term to replace illegal opioid use. If methadone treatment is abruptly stopped, there will be withdrawal symptoms. It is a synthetic opioid and can cause dependence; it is used in the treatment of heroin addiction but also may be prescribed for people who have chronic pain syndromes. It is not used for acute postoperative pain. Methadone is not known to counteract the depressive effects of long-term opioid use on thoracic muscles.

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? Naloxone and heroin can cause cardiac depression when combined. The medication may cause peripheral neuropathy. Symptoms of the heroin overdose may return after the naloxone is metabolized. Hyperexcitability and amnesia may cause the client to thrash about and become injured.

Symptoms of the heroin overdose may return after the naloxone is metabolized. Rationale: The duration of action of naloxone is shorter than that of heroin. After naloxone is metabolized and its effects are diminished, the respiratory distress caused by the heroin overdose will return, necessitating readministration of naloxone. A combination of these medications does not cause cardiac depression. There are no reports of peripheral neuropathy or hyperexcitability and amnesia with naloxone.

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? Eat a diet high in fiber Limit foods high in Vitamin K Take the medication with food Take the drug with an antacid

Take the medication with food Rationale: A common side effect of NSAIDs is gastrointestinal distress including heartburn, nausea, and stomach pain. Taking the medication with food will decrease this side effect. The other actions are not appropriate or indicated when taking NSAIDs.

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

Take the medicine with meals. Rationale: Acetylsalicylic acid is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Bleeding gums should be reported to the health care provider, not the dentist. Acetaminophen does not contain the anti-inflammatory properties present in aspirin; tinnitus should be reported to the health care provider. Avoiding spicy foods is unnecessary as long as aspirin is taken with food.

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? Assess the client's pain level once a shift Monitor the client's temperature every two hours Test the client's stool for occult blood Apply a hot pack to a warm, acutely inflamed joint

Test the client's stool for occult blood Rationale: Rheumatoid arthritis is a chronic, progressive immunologic disorder. This type of arthritis is associated with progressive inflammation of joints and pain. The client's pain level should be assessed more often than once a shift. However, the client's temperature does not need to be measured every two hours. The client is at risk for gastrointestinal bleeding with the use of these two medications. The nurse should anticipate checking the stool for occult blood and monitor the client for signs and symptoms of anemia. When joints are acutely inflamed and warm on palpitation, the nurse should apply an ice pack, not heat.

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? The dose administered based on the client weight The client pain level after administration of the medication The time the dose was administered to the client The client vital signs before the medication was administered

The dose administered based on the client weight Rationale: The most important action to document in the client's medical record is the dose administered. The dose of acetaminophen administered to infants is based on weight. Infants should not exceed more than 5 doses of 10-15 mg/kg/dose in a 24-hour period. Documenting the pain level after administration of analgesics, the time the dose was administered, and the latest vital signs should be performed on every client regardless of their developmental stage.

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? The client has a low pain tolerance. The medication is not adequately effective. The medication has sufficiently decreased the pain level. The client needs more education about the use of the pain scale.

The medication is not adequately effective. Rationale: The expected effect should be more than a 1-point decrease in the pain level. Whether a client has a low pain tolerance cannot be determined with the data available. The medication has not achieved an adequate response; pain generally is considered to be tolerable if it is 4 or below on a pain scale of 1 to 10. There is not sufficient data to determine whether the client needs more education about the use of the pain scale.

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? Administer the prescribed dose as ordered. Verify that the dose is appropriate for this child. Give half of the dose first, wait 30 minutes, then give the other half. Check with the pharmacist to clarify the dose.

Verify that the dose is appropriate for this child. Rationale: The nurse's responsibilities for safe medication administration include knowledge of appropriate doses for pediatric clients and how to perform weight-based dosage calculations. According to the Epocrates RX Online Reference (found under the Resources tab in the course), for morphine prescribed parenterally (SQ/IM/IV), the recommended pediatric dose is 0.1 to 0.2 mg/kg (1 to 2 mg in this case) every 2 to 4 hours. Therefore, the prescribed dose falls outside of those guidelines (too high) and the nurse should clarify the prescription with the health care provider.

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? Assess the client pain level Document the frequency of doses on the medication administration record Take the client vital signs Verify the infusion record with another registered nurse

Verify the infusion record with another registered nurse Rationale: The nurse should verify the infusion record with another licensed healthcare provider before discontinuation. Fentanyl is a controlled substance that requires recordkeeping of its usage. Assessing the client's pain level and checking vital signs are important assessments; however, these actions are not specific to patient-controlled analgesia with a controlled substance. Documenting the frequency of doses is important but must be verified with another licensed provider.

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? Pantoprazole Warfarin Simvastatin Alprazolam

Warfarin Rationale: Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) used in the treatment of mild to moderate pain. NSAIDS increase the risk of gastrointestinal bleeding. Warfarin is an anticoagulant medication that can increase the risk of bleeding. The nurse should monitor the client for adverse effects more frequently. Pantoprazole is a proton pump inhibitor used in the treatment of gastric ulcers. Simvastatin is an antilipemic medication used in the treatment of high cholesterol. Alprazolam is a benzodiazepine used in the treatment of anxiety. Pantoprazole, simvastatin, and alprazolam have no known drug interaction with indomethacin.

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? Just as a last resort Before going to sleep As the pain becomes intense When the discomfort begins

When the discomfort begins Rationale: Pain is most effectively relieved when an analgesic is administered at the onset of pain, before it becomes intense; this prevents a pain cycle from occurring. Analgesics are less effective if administered when pain is at its peak. Before going to sleep, it may or may not be necessary; the medication should be taken when the client begins to feel uncomfortable within the parameters specified by the health care provider's prescription. Analgesics are less effective if administered when pain is at its peak.

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

With food and a full glass of water Rationale: A full glass of water helps decrease gastric irritation by diluting the acidic substances in the stomach. If aspirin is taken on an empty stomach, gastric irritation is increased. Although taking the medicine with sodium bicarbonate will limit gastric irritation, it will also decrease the effect of aspirin by increasing its renal excretion. Aspirin has a gastric-irritating and ulcerogenic effect, which may be potentiated by other medications.

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? Administer morphine as prescribed. Obtain a prescription for a vasoconstrictor. Give half the prescribed amount of morphine. Withhold morphine until the blood pressure stabilizes.

Withhold morphine until the blood pressure stabilizes. Rationale: Morphine is an opioid analgesic that may decrease the blood pressure further. It should be withheld and not administered at this time. It is not unusual for blood pressure to be lowered after surgery, plus a vasoconstrictor may not be the best option to increase blood pressure; if obtaining a prescription, a better option would be to have an alternative for pain. Administration of a medication dosage other than that prescribed is not an independent nursing function.