NUR 3420 Pharmacology PrepU Chapter 49

A postsurgical client has been provided with a morphine patient-controlled analgesic (PCA) but has expressed reluctance to use it for fear of becoming addicted. How can the nurse best respond to this client's concerns?

"It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction." Explanation: Addiction to opioids is a rare occurrence among hospital clients who do not have a history of drug abuse. It would be inappropriate to downplay the client's concerns, however. A more appropriate response would be to explain the phenomenon of dependence and to differentiate it from addiction.

A female client is crying and states that everyone thinks she is a "drug addict," and that no one will listen to her. She states she has abdominal pain and must have something for the pain. What is the best response of the nurse?

"Tell me more about your pain." Explanation: Nurses must lessen the barriers to good pain management by showing sensitivity to the client and conducting a through assessment. The nurse needs to encourage the client to share information regarding pain so that an appropriate treatment plan can be designed. To do this open ended statements need to be made. Questions with yes/no responses are not as therapeutic. Nurses must demonstrate nonjudgmental attitudes with clients.

A 72-year-old female client is admitted to the hospital for surgery. After the woman returns to the floor, her daughter tells the nurse she is concerned that her mother will overdose on morphine because she keeps pressing the button on her PCA pump. What would be the nurse's best response?

"The device is preset, so your mother cannot get more than a specific amount." Explanation: A patient controlled analgesia (PCA) system using morphine provides a baseline, constant infusion of morphine and gives the client control of the system to add bolus doses of morphine if the client feels that pain is not being controlled. The system prevents overdose by locking out extra doses until a specific period of time has elapsed. It is correct for the client to control their analgesia, not for a family member to control it. Negating the daughter's question is also incorrect.

To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.)

- Assist client from their bed to the toilet. - Assist client with rising from a lying position. - Assist client with hall-walking activities.

The nurse is caring for a client who has been admitted to the emergency department after a fall. An x-ray indicates that the client has fractured his ankle. Because of a previous stroke, the client does not speak. What other method will the nurse use to assess this client's pain? (Select all that apply.)

- Facial expressions - Movement of arms and hands - Guarding of the leg

The nurse is caring for a client who has been admitted to the emergency department after a fall. An x-ray indicates that the client has fractured his ankle. Because of a previous stroke, the client does not speak. What other method will the nurse use to assess this client's pain? (Select all that apply.)

- Facial expressions - Movement of arms and hands - Guarding of the leg

When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs? (Select all that apply.)

- Therapeutic response is achieved and discomfort is reduced. - An adequate breathing pattern is maintained. - Client maintains adequate nutritional status.

Opioids have adverse effects on what body systems that are potentially life threatening? Select all that apply.

- central nervous (CNS) - respiratory Explanation: Sedation from CNS depression and respiratory depression are major adverse effects and are potentially life threatening. Opioids are not generally responsible for life-threatening effects on the other body systems.

Naloxone will reverse the effects of which drugs? Select all that apply.

- fentanyl - codeine

A 62-year-old client admitted to the hospital is reporting pain. The provider has prescribed 3 mg hydromorphone SC. The medication is available in single-use vials of 10 mg/1mL. How many mL of hydromorphone should the nurse draw up to administer?

0.3 mL

A client has been prescribed morphine 4 - 6 mg IV q4h PRN. The client reports pain rated at 8/10 and the nurse verifies on the MAR that the client has most often required 6-mg doses. The nurse chooses to administer 6 mg. The drug is available in ampules containing 10mg/mL. How many mL should the nurse withdraw and administer?

0.6 mL

The nurse administers morphine 15 mg oral solution to a client with cancer pain at 0930. When should the nurse reassess the client for peak effect?

1030 Explanation: With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours.

Naloxone (Narcan) 2 mg IM has been ordered for a post surgical client. The pharmacy has sent to the floor naloxone 1 mg/mL. How much naloxone will the client receive?

2

The nurse is caring for four clients. For which client would the nurse question the health care provider's order of IV morphine?

A 78-year-old with osteoarthritis Explanation: Older clients are more likely to experience the adverse effects associated with these drugs, including central nervous system, gastrointestinal, and cardiovascular effects.

A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone (Narcan). Which explanation by the nurse is correct?

Abrupt reversal of opioid-induced respiratory depression may cause vomiting. Explanation: It is important to keep suction equipment readily available because abrupt reversal of opioid-induced respiratory depression may cause vomiting. None of the other rationales provided is a valid reason for adding suction equipment to the room of a client who requires a dose of naloxone.

The nurse is caring for a postoperative client taking an opioid medication for pain. The nurse assesses the client to have bradypnoea and an oxygen saturation value of 90%. Which actions should the nurse perform before administering the ordered opioid antagonist?

Assess the client's other vital signs. Explanation: Blood pressure, pulse, and respirations are important assessments to make prior to administering an opioid antagonist. It is unnecessary to call for a respiratory therapy consult because the cause of the respiratory depression is known. While assessing and managing pain are important postoperative interventions, the respiratory depression-management interventions are the most important ones to be addressed.

The nurse has administered a dose of naloxone (Narcan) and the client's respiratory depression improved within five minutes. When the nurse reassessed the client two hours later, the client demonstrates symptoms of respiratory depression. Which action should the nurse perform next?

Call the provider as another dose of opioid antagonist may be necessary. Explanation: he effects of some opioids may last longer than the effects of naloxone (Narcan). A repeat dose of naloxone may be ordered if results obtained from the initial dose are unsatisfactory. Therefore, calling for an order would be an appropriate response. Taking no action in light of respiratory depression, or merely continuing to monitor the client, could lead to deterioration in the client's condition. No medication should be administered without a provider order.

A client with a viral respiratory infection has an intense headache and cough. What drug will best address both of this client's symptoms?

Codeine Explanation: Codeine is a narcotic drug used for its analgesic and antitussive effects. Hydromorphone, ibuprofen, and acetaminophen do not have antitussive effects.

A patient is receiving drugs through a PCA infusion pump. Which of the following information should a nurse offer to the patient for proper administration of the drug through the infusion pump?

Control button activates administration of the drug. Explanation: The nurse should inform the patient that the control button activates administration of the drug. Pain relief occurs shortly after, and not an hour after, pushing the button. The nurse should educate the patient on the difference between the control button and the button to call the nurse, especially when they are similar in appearance and feel. The machine does not deliver the drug every time the control button is used; the machine regulates the dose of the drug as well as the time interval between doses. If the control button is used too soon after the last dose, the machine will not deliver the drug until the correct time.

The client has difficulty swallowing and requests the nurse to crush all the medications. The nurse notes a client prescribed an extended-release opioid requests that all medications be crushed to facilitate the administration. What information about this form of opioid presents a problem respecting the client's request?

Crushing the medication may precipitate an overdose Explanation: Health care providers and clients must be cautioned to avoid crushing or chewing the tablets or opening capsules because immediate release of the drug constitutes an overdose. None of the other answers apply.

A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent?

Fentanyl

Naloxone (Narcan) will reverse the effects of which drug?

Fentanyl (Duragesic) Explanation: Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic).

A 12-year-old cancer client is receiving morphine 5-10 mg PO q6 hours. The 12-year-old reports being in pain. The nurse checks the medication record and finds that it has been 5 1/2 hours since the client last received pain medicine. What would the nurse do?

Give the client 5 mg of morphine PO. Explanation: With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours. PO dosage with immediate-release morphine, 5-30 mg q4h PRN.

Although naloxone (Narcan) is given to counter opioid medication side effects such as respiratory depression, what additional issues (if any) may result from administration of an opioid antagonist?

Increase in the client's pain rating Explanation: An opioid antagonist will counter not only the negative effects of an opioid medication but the beneficial effects of the opioid (such as pain relief) as well, resulting in an increase in the client's pain rating. It would not result in a decrease or lack of change in the pain rating.

An 80-year-old male client presents to the emergency department with a fractured ankle and multiple abrasions and contusions. He is admitted to the hospital with an order for oxycodone for pain. Oxycodone may be prescribed for a geriatric client because the drug has which characteristic?

It has a short half-life and is less likely to accumulate, causing toxicity or overdosage.

A client is experiencing significant respiratory depression and sedation related to morphine administration. The nurse would anticipate administering:

Naloxone Explanation: Naloxone is a narcotic antagonist that is used to reverse the effects of narcotics such as morphine. Butorphanol and buprenorphine are narcotic agonists-antagonists that are used for moderate to severe pain relief. Ergotamine would be used to prevent and treat migraine attacks.

The client returns from the post-anesthesia recovery unit. The nurse notes a respiratory rate of 6. Which drug would the nurse anticipate being given immediately?

Narcan Explanation: Narcan has long been the drug of choice to treat respiratory depression caused by an opioid. Therapeutic effects occur within minutes after IV, IM, or sub-q injection and last 1 to 2 hours.

A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments?

Pain intensity, respiratory rate, and level of consciousness Explanation: The nurse must assess the patient's pain intensity before and after administering an opioid analgesic. The respiratory rate and level of consciousness need to be assessed because respiratory depression and sedation are two adverse effects of opioid analgesics. Seizure activity, electrolytes, liver function, blood glucose level, and mental status may need to be assessed during opioid analgesic therapy related to adverse effects, but they would not be the priority assessments.

A geriatric client received a narcotic analgesic before leaving the post-anesthesia care unit to return to the regular unit. What is the priority nursing intervention for the nurse receiving the client on the regular unit?

Put side rails up and place bed in low position. Explanation: Older clients are more susceptible to the central nervous system effects of narcotics; it is important to ensure their safety by using side rails and placing the bed in the low position in case the client tries to get up unaided. Postoperative clients are allowed nothing by mouth until bowel function returns so an oral medication or encouraging fluids would not be appropriate. This client will require careful observation for respiratory depression, so a dark room would be unsafe. There is no need to keep the head of the client's bed raised

Which adverse reactions may occur as a result of administering an opioid antagonist?

Sweating, tachycardia, and increased blood pressure Explanation: Side effects of opioid antagonists include nausea and vomiting, sweating, increased blood pressure, and tremors. All other side effects listed are not side effects of opioid antagonists.

The nurse is caring for a postoperative client with a history of opioid abuse who has been ordered to receive a dose of an opioid antagonist medication. Which issues should the nurse be prepared to address?

The client may begin to demonstrate symptoms of withdrawal. Explanation: The client may begin to demonstrate symptoms of withdrawal when he or she has a history of opioid abuse and is administered an opioid antagonist. The other answers are incorrect. In fact, clients will likely have increased pain due to antagonistic effects of the drug. The standard dosage and a single dose will be administered even with a history of opioid abuse.

A-delta fibers are small myelinated fibers that respond quickly to acute pain.

True Explanation: Two small-diameter sensory nerves, called the A-delta and C fibers, respectively, respond to stimulation by generating nerve impulses that produce pain sensations. The A-delta fibers are small, myelinated fibers that respond quickly to acute pain. The C fibers are unmyelinated and are slow conducting.

A group of students is reviewing various methods for assessing pain. The students demonstrate understanding of the material when they identify what as the most reliable method?

Using a pain rating scale Explanation: A pain rating scale is the most reliable method because it provides measurable evidence of pain severity. A client's description of pain is useful, but does not provide objective or quantifiable data over time. Although percussing or palpating provides information, it would increase the client's pain and be inappropriate. Vital sign changes occur for numerous reasons and are not the best indicator of pain in clients who can speak.

The nurse has just administered an opioid antagonist to a client who had been experiencing respiratory depression. How soon can the nurse expect to see improvement in the client's respiratory function?

Within one to five minutes, an effect may be seen. Explanation: Onset of action is generally rapid and may be seen within one to five minutes. Additional doses may be required to achieve optimal effects. The other answers are incorrect because they are referring to a time later than onset of action, or refer to a conditional onset of action that is untrue.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide:

a return to normal respiratory rate, rhythm, and depth.

When administering an opioid antagonist drug to a client, the primary goal of the therapy is to provide:

a return to normal respiratory rate, rhythm, and depth. Explanation: The primary reason for administering an opioid antagonist is because the client is experiencing respiratory depression. Therefore, the goal is to improve the client's respiratory rate, rhythm, and depth. None of the other options is part of the drug therapy.

A trauma client has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the client's what?

bowel patterns Explanation: Morphine, like most opioid analgesics, creates a risk for constipation. The drug is unlikely to influence the client's temperature, skin integrity, or urine specific gravity.

A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be most important for the nurse to do?

coach the client to breath Explanation: Sometimes the somnolence and pain relief produced by the opioid drug will slow the client's breathing pattern. The nurse should make efforts to arouse the client and coach him or her to breathe. The nurse need not monitor the blood pH level of the client, continue administering the prescribed drug, or increase the drug dosage level to be administered when caring for a client with a lowered breathing pattern because these interventions will not help increase the client's breathing rate.

A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain:

codeine Explanation: Typically, codeine or hydrocodone are used to relieve coughing.

While studying pharmacology, the nursing student learns that a naturally occurring narcotic drug with analgesic and antitussive effects is:

codeine Explanation: Codeine is a narcotic drug used for its analgesic and antitussive effects. Aspirin, ibuprofen, and acetaminophen do not have antitussive effects.

The nurse is administering morphine to a trauma client for acute pain. What is a common side effect of morphine?

drowsinesss Explanation: Dizziness, drowsiness, and visual changes are common side effects. If any of these occur, avoid driving, operating complex machinery, or performing delicate tasks. If these effects occur in the hospital, the side rails on the bed may be raised for your own protection. Morphine does not generally cause paresthesia in the lower extremities, an occipital headache, or increased intracranial pressure.

A nurse should not administer an opioid antagonist to a client with which finding?

hypersensitivity to naloxone Explanation: The use of opioid antagonists is contraindicated in those with a hypersensitivity to the opioid antagonists; therefore, a client with a hypersensitivity to naloxone should not be given the drug. Naloxone can be given to uncontrolled type 2 diabetics. Having a history of opioid or alcohol abuse does not have any effect on the use of naloxone.

The nurse is explaining to a client about the analgesic and its possible adverse effects. The client is receiving an opioid analgesic. What would be important to teach this client is a possible adverse effect of this drug?

hypotension Explanation: Orthostatic hypotension is commonly seen with some narcotics. Ataxia, blurred vision, and dysrhythmias are not generally adverse effects of an opioid analgesic.

Which client would the nurse identify as being opioid naive?

one who does not routinely take opioids Explanation: Opioid-naive clients are defined as those who do not use opioids or infrequently use them. Those who routinely take and are physically or psychologically dependent on opioids are not considered opioid naive.

A client who was recently diagnosed with cancer is now receiving morphine for pain. Since this client has been receiving morphine for only a short time, he is best described by which term?

opiate naive Explanation: An opiate tolerant client is one who, because of previous opioid use, has developed a drug tolerance. An opioid tolerant client typically requires a larger-than-usual dose for pain relief. Conversely, an opiate naive client has not received sufficient opioids for development of tolerance. The client described in the scenario is opiate naive.

Opioid antagonists may produce withdrawal symptoms in clients physically dependent on which substance?

opioids

Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management?

opioids Explanation: Health care professionals use the term "opioid" to describe drugs used in pain management. The term "narcotic" describes drugs that are addictive, abused, and/or obtained illegally, and that produce numbness and/or a stupor-like state. The term "anesthetic" describes drugs that cause a reversible loss of sensation. The term "antibiotic" describes drugs that are used to treat bacterial infection.

After obtaining the history of a client who is prescribed opioid therapy, the nurse determines that the client is opioid naive. The nurse would be especially alert for which effect after the client receives the prescribed opioid?

respiratory depression Explanation: Opioid-naive clients are mostly at risk for respiratory depression after opioid administration. First time opioid users do not experience diarrhea, hypertension, or physical dependence.

An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the client that:

there is risk of an extremely high dose available all at once if the tablet is crushed. Explanation: The nurse should caution the client against crushing the tablet before ingesting it. Crushing allows an extremely high dose of the drug to be available all at once, instead of being released slowly over time. Severe adverse effects are possible when it is used in this manner.