Chapter 10: Analgesic Drugs

The nurse in the postanesthesia care unit (PACU) notes that a patient has a respiratory rate of 6 breaths/min 30 minutes after surgery. Which action should the nurse implement next? A. Check the timing of the last opioid B. Initiate resuscitative measures C. Give flumazenil (Romazicon) D. Prepare naloxone (Narcan) IV

A. Check the timing of the last opioid To complete the patient assessment for the planning of suitable nursing care, the PACU nurse checks the anesthesia record to determine the time and dosage of opioid analgesics and other anesthetics used in the operating room (OR). This is because many of the anesthetic agents used in the OR can induce respiratory depression. The patient's respiratory depression may be due to the residual effects of a muscle relaxant, an opioid (for which naloxone is the antidote), a benzodiazepine (for which flumazenil is the antidote), a barbiturate, or an anesthetic gas. The nurse needs to know which agent or agents are most likely causing the respiratory depression to complete the assessment.

When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply)

A. Decreased peristalsis C. Delayed gastric emptying D. Urinary retention

The patient has been taking morphine for postoperative pain. Before discharge, what patient teaching should be provided to prevent constipation? (Select all that apply.) A. Increase fluid intake throughout the day B. Increase rest periods C. Take a stool softener D. Decrease the medication dosage with constipation E. Eat more animal protein and dairy

A. Increase fluid intake throughout the day C. Take a stool softener Constipation may be managed with increased intake of fluids, use of stool softeners such as docusate sodium, or use of stimulants such as bisacodyl or senna. Agents such as lactulose, sorbitol, and polyethylene glycol (Miralax) have been proven effective. Less commonly used are bulk-forming laxatives such as psyllium, for which increased fluid intake is especially important to avoid fecal impactions or bowel obstructions.

When assessing for the most serious adverse reaction to a narcotic analgesic, what does the nurse monitor for in the patient? A. Respiratory rate B. Heart rate C. Blood pressure D. Mental status

A. Respiratory rate

Which medication is used to treat a patient suffering from severe advers effects of a narcotic analgesic? A. naloxone (Narcan) B. acetylcysteine (Mucomyst) C. methylprednisolone (Solu-Medrol) D. flumazenil (Romazicon)

A. naloxone (Narcan)

A patient is to receive codeine, 40 mg subcutaneously, every 6 hours as needed for pain. The solution is available in a concentration of 30 mg/mL. How many milliliters of codeine will be drawn up for this dose? Round to the nearest tenth.

ANS: 1.3 mL 30 mg : 1 mL :: 40 mg : x mL Solve for x to equal 1.3 mL.

A patient is receiving an anticonvulsant but has no history of seizures. The nurse suspects that the patient is receiving this drug for which condition? A. Pain associated with peripheral neuropathy B. Inflammation pain C. Depression associated with chronic pain D. Prevention of possible seizures

ANS: A Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct.

The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? A. Muscle aches B. Migraine headaches C. Leg cramps D. Incision pain after surgery

ANS: B Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.

A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse should expect this type of pain to be managed by A. administering NSAIDs. B. administering an immediate-release opioid. C. changing the opioid route to the rectal route. D. not changing the current therapy.

ANS: B If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions.

The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? a. Muscle aches b. Migraine headaches c. Leg cramps d. Incision pain after surgery

ANS: B Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.

A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing opioid a. addiction. b. tolerance. c. toxicity. d. abstinence syndrome.

ANS: B Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal)

A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? a. Inflammation pain b. Pain associated with peripheral neuropathy c. Depression associated with chronic pain d. Prevention of seizures

ANS: B Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct

A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing? a. Acute pain b. Chronic pain c. Somatic pain d. Neuropathic pain

ANS: B Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient's symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain.

A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by a.administering NSAIDs. b. administering an immediate-release opioid. c. changing the opioid route to the rectal route. d. not changing the current therapy.

ANS: B If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions

A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. His pulse rate b. His respiratory rate c. The appearance of the incision d. The date of his last bowel movemen

ANS: B One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are incorrect

Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? Select all that apply. A. Diarrhea B. Constipation C. Lightheadedness D. Nervousness E. Urinary retention F. Itching

ANS: B, C, E, F Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin.

Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Lightheadedness d. Nervousness e. Urinary retention f. Itching

ANS: B, C, E, F Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin

A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication? A. Giving the medication undiluted for full effect B. Avoiding use of a straw when giving this medication C. Disguising the flavor with soda or flavored water D. Preparing to give this medication via a nebulizer

ANS: C Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose.

A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse should include which information in the teaching plan? A. Management of diarrhea B. Drug addiction programs C. Prevention of constipation D. Dehydration due to polyuria

ANS: C Gastrointestinal adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea and polyuria are not effects of opioid analgesics.

A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is A. tachycardia. B. depression of the central nervous system. C. hepatic necrosis. D. nephropathy.

ANS: C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are not correct.

A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 9 per minute. The nurse prepares for which action at this time? A. Close observation of signs of opioid tolerance B. Immediate intubation and artificial ventilation C. Administration of naloxone (Narcan), an opioid reversal agent D. Administration of an agonist opioid such as fentanyl

ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at nine breaths per minute. It would be inappropriate to administer an opioid agonist.

A patient has been treated for lung cancer for 3 years. Over the past few months, she has noticed that the opioid analgesic she has been taking is not helping as much as it had previously and says she needs to take more medication for the same pain relief. The nurse is aware that this patient is experiencing opioid A. toxicity. B. addiction. C. tolerance. D. abstinence syndrome.

ANS: C Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal).

The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/minute d. Heart rate of 55 beats/minute

ANS: C The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats per minute are not indications of an opioid overdose.

A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication? a. Giving the medication undiluted for full effect b. Avoiding the use of a straw when giving this medication c. Disguising the flavor with soda or flavored water d. Preparing to give this medication via a nebulizer

ANS: C Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose

A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient's medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain? a. Antidepressant b. Anticonvulsant c. Corticosteroid d. Local anesthesia

ANS: C Corticosteroids have an antiinflammatory effect, which may help to reduce pain. The other medications do not have antiinflammatory properties

A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan? a. How to prevent dehydration due to diarrhea b. Importance of taking the drug only when the pain becomes severe c. How to prevent constipation d. Importance of taking the drug on an empty stomach

ANS: C Gastrointestinal adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset

A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy

ANS: C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect.

The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? a. A patient with a fever of 101 F (38.3 C) b. A patient who is complaining of a mild headache c. A patient with a history of liver disease d. A patient with a history of peptic ulcer disease

ANS: C Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication

A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time? a. Assessment of the patient's pain level b. Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance

ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths per minute. It would be inappropriate to assess the patient's level of pain.

A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate? a. "It would be best for you not to take anything if you are planning to drive your truck." b. "We will discuss with your doctor about taking an opioid because that would work best for your pain." c. "You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day." d. "You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day.

ANS: D Acetaminophen is indicated for mild to moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg per day. The 1000-mg amount per day is too low. Telling the patient not to take any pain medications is incorrect

The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists? a. They have antiinflammatory effects. b. They are given to reverse the effects of opiates. c. They have a higher potency than agonists. d. They have a lower dependency potential than agonists

ANS: D Partial agonists such as nalbuphine are similar to the opioid agonists in terms of their therapeutic indications; however, they have a lower risk of misuse and addiction. They do not have antiinflammatory effects, nor are they given to reverse the effects of opiates. They do not have a higher potency than agonists

An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic? a. Synthetic opioid, such as meperidine (Demerol) b. Opium alkaloid, such as morphine sulfate c. Opioid antagonist, such as naloxone HCL (Narcan) d. Nonopioid analgesic, such as indomethacin (Indocin)

ANS: D Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal antiinflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain

A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing? A. Acute Pain B. Chronic Pain C. Somatic Pain D. Neuropathic Pain

B. Chronic Pain Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient's symptoms are not characteristics of acute pain, somatic pain, or superficial pain.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse's response is based on the knowledge that codeine also has what effect?

B. Cough suppressant

Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how "rubbing my muscles" will help the pain go away. The nurse responds based on the knowledge that: A. Massaging muscles decreases the inflammatory response that initiates the painful stimuli. B. Massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain. C. Massaging muscles activates small sensory nerve fibers that send signals to the spinal cord and allow endorphins to reach the muscles and relieve the pain. D. Massaging muscles helps to relax the contracted fibers and decrease painful stimuli.

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

The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? A. Administer a smaller dose and record the findings B. Notify the physician and delay drug administration C. Administer the prescribed dose and notify the physician D. Hold the drug, record the assessment, and recheck in 1 hour

B. Notify the physician and delay drug administration

A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? A. Pulse Rate B. Respiratory Rate C. The appearance of his incision D. The date of his last bowel movement

B. Respiratory Rate One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient's respiratory rate before administering an opioid. The other options are not correct.

A patient's admission vital signs are temperature 37.6° C, heart rate 96 beats/min, respirations 22 breaths/min, and blood pressure 140/90 mm Hg. Later, the patient requests pain medication, and the nurse records vital signs before administering codeine 15 mg with acetaminophen 300 mg (Tylenol 2) two tablets by mouth. Before administering the medication, which patient assessment is the nurse's priority? A. Heart rate 110 B. Respiratory rate 10 C. Temperature 38.0°Celsius D. Blood pressure 160/86 mm Hg

B. Respiratory rate 10 The priority patient assessment is the respiratory rate because it has decreased by more than 50%. Opioids can cause respiratory depression, and breathing is more important than circulation issues. To prevent respiratory failure, the nurse withholds the analgesic and plans follow-up nursing interventions.

While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which medication to prevent toxicity? A. naloxone (Narcan) B. acetylcysteine (Mucomyst) C. methylprednisolone (Solu-Medrol) D. vitamin K

B. acetylcysteine (Mucomyst)

A patient is admitted to the psychiatric unit for treatment of narcotic addiction. The nurse would anticipate administration of which medication? A. morphine B. methadone C. meperidine D. naloxone

B. methadone

A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose? A. Renal failure B. Kidney stones C. Acute hepatic necrosis D. Metabolic alkalosis

C. Acute hepatic necrosis

The nurse teaches a patient prescribed the fentanyl (Duragesic), transdermal delivery system to change the patch at what interval? A. When pain recurs B. Every 24 hours C. Every 72 hours D. Once a week

C. Every 72 hours

In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority? A. Acute pain B. Risk for injury related to central nervous system side effects C. Impaired gas exchange related to respiratory depression D. Constipation related to gastrointestinal side effects

C. Impaired gas exhange related to respiratory depression

The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that: A. Narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction B. Analgesics should be administered as needed (pm) to minimize side effects C. Pain relief is best obtained by administering analgesics around the clock D. Patients should request analgesics when the pain level reaches a "6" on a scale of 1 to 10

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

In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of: A. Autonomic control over circulation B. The cough reflex center C. The chemoreceptor trigger zone D. Respiratory rate

C. The chemoreceptor trigger zone

A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by: A. Taking Lomotil with each dose B. Eating foods high in lactobacilli C. Taking the medication on an empty stomach D. Increasing fluid and fiber in diet

D. Increasing fluid and fiber in diet

An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic? A. Synthetic opioid, such as meperidine (Demerol) B. Opium alkaloid, such as morphine sulfate C. Opioid antagonist, such as naloxone HCL (Narcan) D. Nonopioid analgesic, such as indomethacin (Indocin)

D. Nonopioid analgesic, such as indomethacin (Indocin) Somatic pain, originating from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics, such as nonsteroidal antiinflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain.

For which type of pain is a fentanyl (Duragesic) transdermal patch best suited? A. Pain after abdominal surgery B. Acute treatment of a migraine headache C. Lower back pain related to lumbar strain D. Severe pain resulting from cancer metastasis

D. Severe pain resulting from cancer metastasis Transdermal fentanyl (Duragesic) is indicated only for persistent severe pain in patients who are already opioid tolerant because fentanyl can cause fatal respiratory depression in patients who are opioid naive. For this reason, the patch is not indicated for acute pain such as postoperative pain, intermittent pain, or pain that responds to a less powerful analgesic.

A patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective doese of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses of these drugs with what prototype? A. meperidine B. fentanyl C. codeine D. morphine

D. morphine