Pharmacology Chapter 10 Analgesic Drugs

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I'm not in pain." Which effect of codeine should the nurse discuss with the patient? 1 Antitussive 2 Expectorant 3 Immunostimulant 4 Immunosuppressant

1 Codeine provides both analgesic and antitussive therapeutic effects. Hence it is administered to patients with pneumonia. Expectorants are used for treating cough. Echinacea is an herb with immunostimulant properties. Immunosuppressants are used for preventing organ rejection.

Which factor should the nurse consider while planning pharmacologic therapy for a patient with pain? 1 Narcotic analgesics should not be used for more than 24 hours. 2 Pain relief is best obtained by administering analgesics around the clock. 3 Analgesics should be administered as needed to minimize adverse effects. 4 Patients should request analgesics when the pain level reaches a 3 on a scale of 1 to 10.

2 Studies have demonstrated that analgesics administered around the clock rather than on an as-needed basis provide the optimal pain relief. Narcotic analgesics have a potential for addiction, but pain management is more important, so they may be used for more than 24 hours. A rating of 3 on the pain scale may indicate effective pain relief.

Thirty minutes after surgery the nurse in the postanesthesia care unit (PACU) notes that a patient has a respiratory rate of 6 breaths/min. What is the nurse's priority action? 1 Administer flumazenil. 2 Prepare intravenous naloxone. 3 Initiate resuscitative measures. 4 Assess the patients' responsiveness.

4 To complete the patient assessment for the planning of suitable nursing care, the PACU nurse should check the patient's responsiveness, then assesses medication administration. The patient's respiratory depression may be from the residual effects of medications used during surgery. Flumazenil is the antidote for benzodiazepine, and naloxone is the antidote for opioids; however, these cannot be used based on anticipation; evidence of application is required. Initiating resuscitative measures before completing the assessment is not the correct nursing practice.

A patient with respiratory depression secondary to opioid toxicity is being treated in the emergency department. What is the nurse's priority action? 1 Administer naloxone. 2 Prepare for intubation. 3 Assess arterial blood gases. 4 Call the respiratory team stat.

1 Severe opioid toxicity causes respiratory depression. Naloxone is the best choice of treatment for the management of respiratory depression. Naloxone is an opioid antagonist, and it inhibits the action of opioids and improves the patient's respiratory status. Assessing blood gases and preparing for intubation would be interventions to implement if the naloxone does not reverse the respiratory depression. Calling the respiratory team would likewise be performed if the patient did not respond to the treatment.

A patient's medication administration record has the following entry: morphine sulfate 1 mg IV push q2h PRN severe pain. Upon assessment, the patient continues to complain of pain that is 8 on a scale of 0 to 10. The patient received 1 mg of morphine an hour ago. What is the nurse's best action? 1 Administer 1 mg of morphine and notify the primary health care provider. 2 Hold the drug, record the assessment, and reassess the patient in 1 hour. 3 Consult the primary health care provider and obtain another drug prescription. 4 Administer another 1 mg of morphine and reevaluate the pain scale in 15 minutes.

3 The nurse needs to consult with the primary health care provider for a medication for breakthrough pain. The patient is in severe pain. Hence the patient needs to be administered an analgesic. The nurse should not wait to treat the patient's pain.

Which drugs are opioid agonists-antagonists? Select all that apply. 1 Fentanyl 2 Tapentadol 3 Nalbuphine 4 Butorphanol 5 Buprenorphine

3, 4, 5 Opioid agonists-antagonists are drugs that have some properties of an agonist and some properties of an antagonist. These drugs have a ceiling effect. Nalbuphine, butorphanol, and buprenorphine are opioid agonists-antagonists. Fentanyl and tapentadol are full opioid agonists. These drugs do not possess any opioid antagonist properties.

Which assessment is essential for the nurse to monitor in a patient who is receiving an opioid analgesic? 1 Heart rate 2 Mental status 3 Blood pressure 4 Respiratory rate

4 The most serious side effect of opioid analgesics is respiratory depression. When death occurs from opioid overdose, it is almost always from respiratory depression. Opioids can also cause hypotension, bradycardia, and disorientation, but respiratory depression is the most important adverse effect for which the nurse should assess.

The nurse is caring for a patient who is receiving 20 mg of hydrocodone orally every 4 hours. The drug is to be changed to intravenous (IV) fentanyl. What is the equivalent dose of IV fentanyl for a period of 24 hours? Record your answer using one decimal point. Use a leading zero if necessary. ____________ mg

0.4 The amount of hydrocodone the patient is receiving for a period of 24 hours = 20 mg x 6 doses per 24 hours = 120 mg per 24 hours. The equianalgesic doses of fentanyl and hydrocodone: 30 mg of oral hydrocodone = 10 mg IV morphine = 0.1 mg of IV fentanyl. So 30 mg of oral hydrocodone = 0.1 mg of fentanyl. 24-hour amount of current drug (120 mg) Equianalgesic dose of current drug (30 mg) ------------------------------------------------------- = ---------------------------------------------------------- Amount of desired opioid for 24 hours (x) Equianalgesic dose of desired drug (0.1 mg) 120 mg × 0.1 = 30x mg 12 mg/30 mg = x x = 0.4 mg Amount of fentanyl to be given IV for a period of 24 hours (x) = 0.4 mg. See page 151 Box 10 - 3

A postoperative patient is receiving an epidural infusion of morphine sulfate. The patient's respiratory rate decreases to 8 breaths/min. Which medication should the nurse administer after attempting to have the patient respond to verbal and tactile stimuli? 1 Naloxone 2 Acetylcysteine 3 Protamine sulfate 4 Methylprednisolone

1 A respiratory rate of 8 breaths/min indicates respiratory depression. Naloxone is a narcotic antagonist that will reverse this effect of morphine sulfate. Acetylcysteine is used for acetaminophen toxicity. Protamine sulfate is used to reverse the drug effects of heparin. Methylprednisolone is administered to alleviate cytokine release syndrome caused by basiliximab and daclizumab, which are used to prevent rejection of transplanted kidneys.

The nurse cares for a patient on the second day following major abdominal surgery. The patient is receiving morphine via patient-controlled analgesia (PCA) and currently reports pain as a 2 on a scale of 0 to 10. The patient tearfully says to the nurse, "I'm so worried that I won't be able to go back to work. How am I going to manage my bills?" What is the best response by the nurse? 1 "Tell me more about your fears." 2 "Your pain is well controlled now. Why are you so worried?" 3 "Everything will be fine. You will be back to work in about 6 weeks." 4 "The disability benefit of your insurance plan will help pay your bills.

1 Anxiety exacerbates the pain experience. By demonstrating caring and concern and using therapeutic communication skills such as active listening and open-ended questions, the patient's anxiety can be explored. Telling the patient that the insurance plan will help to pay bills will not completely alleviate the patient's anxiety. Telling the patient that the pain is in control and not to worry shows a lack of concern for the patient's feelings. Telling the patient that it will take only 6 weeks to get well may be a false reassurance, because it may take longer for the patient to recover.

What intervention will assist a patient who is experiencing constipation as a side effect of opioid therapy? 1 Administering lactulose 2 Administering naloxone 3 Administering promethazine 4 Administering diphenhydramine

1 Constipation is a common side effect of opioid therapy. Agents such as lactulose have been proven to be effective in the treatment of constipation. Naloxone is an opioid antagonist used to improve respiratory status. Promethazine is an antiemetic used if the patient is experiencing nausea and vomiting. Diphenhydramine is used in the treatment of pruritus, which is an adverse effect of opioid therapy.

Which medication is used to treat a patient experiencing severe adverse effects of an opioid analgesic? 1 Naloxone 2 Flumazenil 3 Acetylcysteine 4 Methylprednisolone

1 Naloxone is the opioid antagonist that will reverse the effects, both adverse and therapeutic, of opioid analgesics. Flumazenil, a benzodiazepine antidote, can be used to acutely reverse the sedative effects of benzodiazepines. Acetylcysteine is the antidote for acetaminophen overdose. Methylprednisolone is a glucocorticoid that is used as an antiinflammatory.

The nurse is assessing patients who are in severe pain. Which patient can safely receive morphine for pain relief? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

1 Patient A has spinal cancer with metastasis and is in severe pain. Morphine is used to treat moderate to severe pain. The patient has stable vital signs and can receive morphine for pain relief. Patient B has renal impairment, as evidenced by a high serum creatinine value (normal is 0.7 - 1.4), which might lead to the accumulation of the drug metabolite. The metabolite of morphine is toxic; if it is not excreted and instead accumulates, it might lead to toxicity or other complications. Patient C has bradypnea. Morphine, when given in high doses, causes respiratory depression, so Patient C should not receive morphine. Patient D is under the influence of alcohol, and coadministration of morphine with alcohol can result in respiratory depression.

A patient diagnosed with cholecystitis reports pain in the back and scapular areas. What does the nurse infer about the type of pain from the assessment? 1 The patient has referred pain. 2 The patient has vascular pain. 3 The patient has phantom pain. 4 The patient has neuropathic pain.

1 Patients with cholecystitis may report back pain and scapular pain. The signal for pain that is sent from the gallbladder to the spinal cord can get mixed up with signals from the back and scapular areas. Therefore, the brain receives a signal about back pain and scapular pain because of misinterpretation of signals by the nervous system. This type of pain is called referred pain. Referred pain occurs when visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body. Vascular pain originates from the vascular or perivascular tissues. Phantom pain is associated with the area of a body part that has been removed surgically or traumatically. Neuropathic pain results from damage to peripheral or central nervous system nerve fibers by disease or injury.

After the placement of a new transdermal opioid patch, the patient complains of an increase in level of pain. What is a possible reason? 1 The new patch was placed on a hairy area. 2 The new patch was placed on an area after cleaning it. 3 The new patch was placed on the same place as the old patch. 4 The new patch was placed on a new area, with the old patch still in place.

1 Transdermal patches are an effective and easy method of pain relief. However, the presence of hair on the application area may interfere with absorption of the medication, resulting in ineffective pain relief. Therefore, the patch should be applied in a nonhairy area. For maximum therapeutic effect, the new patch should be applied after cleaning the area. The new patch may cause skin irritation if placed on the same place as the old patch, but it should not affect the drug's effectiveness. If the old and new patches both remain on the patient's body, it may lead to overdose.

A patient is prescribed oxycodone extended release (ER) for pain management. What information is essential to include in the teaching plan? Select all that apply. 1 "Do not crush the medication." 2 "Swallow the medication whole." 3 "Take the medication frequently." 4 "Do not dissolve the medication in water." 5 "Increase the dose if you experience no pain relief."

1, 2, 4 Oxycodone ER is an extended-release dosage form. The nurse should instruct the patient not to chew or crush the medicine to prevent excessive sedation, urinary retention, and respiratory depression. The medication should be swallowed whole. Chewing or crushing or dissolving the medication in water would result in increased serum concentration of the drug, which may cause adverse effects. Rapid absorption of the drug results in severe opioid toxicity. The medication is not taken frequently, because it is an extended-release form. This means it works for longer periods of time. The patient should not increase the dose if there is no pain relief, but rather should call the primary health care provider.

A patient has taken an excessive dose of acetaminophen for pain management. Which adverse effects associated with acetaminophen are likely to be found in the patient? Select all that apply. 1 Nausea 2 Vomiting 3 Blurred vision 4 Decreased hearing 5 Elevated liver enzymes

1, 2, 5 Acetaminophen is a nonsteroidal antiinflammatory drug. Nausea, vomiting, and elevated liver enzymes are the effects of an excess dose of acetaminophen. Acetaminophen does not affect vision or hearing function.

What are the adverse effects of Chrysanthemum parthenium? Select all that apply. 1 Nausea 2 Joint pain 3 Skin rashes 4 Blurred vision 5 Muscle stiffness

1, 2, 5 Chrysanthemum parthenium is also known as feverfew. It is commonly used for the treatment of migraine headaches, menstrual cramps, inflammation, and fever. Nausea, joint pain, and muscle stiffness are the adverse effects of Chrysanthemum parthenium. Chrysanthemum parthenium does not produce any effect on skin integrity or vision.

The nurse is caring for a patient who is receiving morphine sulfate for pain management. Which assessment findings are cause for immediate nursing action? Select all that apply. 1 Hallucinations 2 Excess urination 3 Slow pupil reaction 4 Altered consciousness 5 Change in sputum color

1, 3, 4 Morphine sulfate is an opioid drug. The nurse should immediately notify the primary health care provider after finding symptoms such as hallucination, sluggish pupil reaction, or changes in consciousness level. These symptoms indicate adverse effects of morphine sulfate. After observing these symptoms, the nurse should not administer further doses of morphine sulfate to the patient. Excessive urination is a sign of polyuria, but it is not an adverse effect of morphine sulfate. Change in color of sputum may indicate infection but it is not an adverse effect of morphine sulfate.

During assessment, the nurse finds that a patient has bowel obstruction as a result of administration of oral oxycodone 80 mg every 12 hours. The primary health care provider prescribes intravenous morphine to the patient. If a 15 mg dose of oxycodone is equivalent to a 10 mg dose of parenteral morphine, calculate the equivalent intravenous dose of morphine. Record your answer using a whole number. _____ mg

107 The intravenous dose of morphine can be calculated by using a basic conversion equation: 24-hr amount of the current drug divided by x = EA dose of the current drug divided by the EA dose of the desired drug. In this equation, x = amount of desired opioid in 24 hours and EA = equianalgesic dose. Therefore, as per the formula, the amount of current drug taken by the patient in 24 hours is 80 mg × 2 doses per 24 hours = 160 mg. A 15 mg dose of oxycodone is equivalent to a 10 mg dose of parenteral morphine. Therefore, according to the formula, 160 mg divided by x = 15 mg divided by 10 mg. The equivalent intravenous morphine dose is 107 mg.

A patient who regularly takes acetaminophen returns to the clinic for a follow-up visit. Which assessment indicates the need for a change in the patient's therapy? 1 Hemoglobin 11.2 g/dL 2 Serum bilirubin 3.2 mg/dL 3 Serum creatinine 0.8 mg/dL 4 Random blood glucose 160 mg/dL

2 Acetaminophen used for pain relief can be hepatotoxic if taken in large doses. Elevated serum bilirubin indicates chemical damage to the liver. A serum bilirubin level of 3.2 mg/dL is much higher than normal; it indicates hepatotoxicity and the need for a change in therapy. A hemoglobin level of 11.2 g/dL, serum creatinine level of 0.8 mg/dL, and random blood glucose level of 160 mg/dL are under the normal range.

A patient is seen daily in a community clinic for treatment of a narcotic addiction. Which medication will assist the patient's recovery? 1 Naloxone 2 Methadone 3 Vitamin K1 4 Protamine sulfate

2 Methadone is a synthetic opioid analgesic. Controlled distribution of this medication helps the patient to prevent symptoms of withdrawal and craving. Naloxone is used to reverse central nervous system depression that is sometimes caused by opioids. In patients who are treated with warfarin, vitamin K1 is used to reduce warfarin's ability to prevent clots. Protamine sulfate is used to reverse the effects of heparin.

Which assessment finding indicates that the patient may have received an overdose of morphine sulfate? 1 Blood in urine 2 Pinpoint pupils 3 Heart rate 110 beats/min 4 Respiratory rate 28 breaths/min

2 Morphine sulfate is an opioid drug used for pain management. After administration of morphine sulfate, the nurse should assess the patient's pupillary reaction to light. Pinpoint pupils indicate an overdose of morphine sulfate. Overdose of morphine sulfate does not cause blood in the urine, increased heart rate or increased respiratory rate.

Which condition listed in the patients' medical history could be a contraindication to administration of morphine sulfate? 1 Cancer 2 Asthma 3 Diarrhea 4 Anorexia

2 Morphine sulfate should be used with caution in patients with asthma, because naturally occurring opioids cause the release of histamine; a release of histamine in a patient with asthma can trigger bronchoconstriction. Because 20% to 35% of morphine sulfate binds to protein, cancer and anorexia are causes for concern, because both conditions can result in hypoproteinemia and a lack of protein-binding sites for morphine, which can alter the pharmacokinetics of the medication. The administration of morphine sulfate can help diminish diarrhea.

The nurse will advise a patient receiving opioid analgesics for chronic pain to perform which action to minimize the gastrointestinal (GI) side effects? 1 Eat foods high in lactobacilli. 2 Increase fluid and fiber in the diet. 3 Take the medication on an empty stomach. 4 Take diphenoxylate/atropine with each dose.

2 Opioid analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent constipation. The nurse should advise the patient to take the opioid with meals, not on an empty stomach, to decrease GI side effects. Diphenoxylate/ atropine is an antidiarrheal preparation that will further decrease GI motility.

The nurse prepares to administer 5 mg of intravenous (IV) morphine sulfate to a patient who underwent surgery 30 minutes earlier. What is the most important reason for the nurse to record baseline vital signs before administering this drug? 1 Morphine sulfate dilates vascular smooth muscle. 2 Morphine sulfate depresses the respiratory center. 3 Morphine sulfate causes the release of histamines. 4 Morphine sulfate reduces the level of consciousness

2 Respiratory depression is the most important reason that the nurse records baseline vital signs before administering the IV morphine. Opioid analgesics can cause respiratory depression and death when administered in standard dosages and in an overdose, respectively. Because this patient is in the immediate postoperative period and is likely to experience residual effects of anesthesia, including an inability to maintain an airway and respiratory depression, the risk for respiratory depression is high. The patient is also at risk because the IV route of administration is used. IV administration of an opioid means that the onset of action occurs quickly, the peak drug level occurs more quickly, and the risk of respiratory depression increases as a result of a generally high plasma drug concentrations. The nurse records baseline data for comparison to vital signs taken 15 minutes after IV administration of morphine to determine whether the patient is experiencing adverse effects of therapy. Morphine dilates vascular smooth muscle, releases histamines, and causes sedation; however, airway and breathing issues are more important. Death following overdose is almost always a result of respiratory arrest.

A patient is prescribed sufentanil for the treatment of acute pain. The nurse instructs the patient to increase fluid intake up to 3000 mL per day. What is the reason for this? 1 To prevent crystalluria 2 To prevent constipation 3 To prevent mucosal irritation 4 To prevent electrolyte imbalance

2 Sufentanil is an opioid drug. Administration of opioid drugs reduces peristalsis because of central nervous system depression and may result in constipation. Therefore, the nurse instructs the patient to increase fluid intake up to 3000 mL per day to prevent constipation. Sufentanil does not cause crystalluria, mucosal irritation, or electrolyte imbalance.

A patient is being discharged after undergoing surgery with a prescription for fentanyl and a phenothiazine. What information is essential to include in the discharge teaching plan? 1 "The phenothiazine will treat constipation." 2 "The phenothiazine is taken to decrease nausea." 3 "The phenothiazine will increase the effects of fentanyl." 4 "The phenothiazine decreases the risk of respiratory depression from fentanyl."

2 The patient is prescribed fentanyl for surgical pain management. Fentanyl is an opioid analgesic. Opioids decrease gastrointestinal tract peristalsis and also stimulate the vomiting center in the central nervous system, resulting in nausea. A phenothiazine helps to manage nausea. Phenothiazines do not affect the respiratory system or the digestive system. Therefore, it is not helpful for the management of respiratory depression or constipation. Phenothiazines have no synergistic effect with fentanyl. Therefore, phenothiazines do not improve the efficacy of fentanyl.

A patient is prescribed high-dose acetaminophen for long-term treatment of pain. Which medicine may be part of the patient's treatment plan to prevent complications associated with acetaminophen toxicity? 1 Naloxone 2 Nalbuphine 3 Acetylcysteine 4 Naltrexone hydrochloride

3 Acetaminophen is a nonopioid drug. Higher doses of acetaminophen may increase the risk for acute hepatotoxicity and liver damage. Liver damage from acetaminophen may be minimized by timely dosage of acetylcysteine. Therefore, acetylcysteine should be involved in the patient's treatment plan to prevent complications associated with acetaminophen. Naloxone is an opioid antagonist used for the treatment of opioid toxicity. Nalbuphine is an opioid agonist-antagonist. Naltrexone hydrochloride is an opioid antagonist used in the treatment of opioid toxicity.

While admitting a patient for treatment of an acetaminophen overdose, the nurse should prepare to administer which medication to prevent toxicity? 1 Naloxone 2 Vitamin K 3 Acetylcysteine 4 Methylprednisolone

3 Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 more doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours). Naloxone is used to reverse an opioid overdose or opioid-induced respiratory depression. Vitamin K is indicated in cases of warfarin overdose and toxicity. Methylprednisolone is a glucocorticoid that is used as an antiinflammatory.

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. What is the nurse's best response? 1 "This medication helps to open up your airways." 2 "This medication will help your immune system." 3 "This medication is used as a cough suppressant." 4 "This medication will help you get rid of mucous.

3 Codeine provides both analgesic and antitussive (cough suppressant) therapeutic effects. Codeine does not help the immune system. It would be inaccurate to say that codeine gets rid of mucous or opens up the airways.

A patient needs to switch analgesic drugs after an adverse reaction to the present regimen. The patient is concerned about not receiving an effective dose of the 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? 1 Codeine 2 Fentanyl 3 Morphine 4 Meperidine

3 Equianalgesia refers to the ability to provide equivalent pain relief by calculating dosages of different drugs and/or routes of administration that provide comparable analgesia. If the opioid used is not morphine, the nurse will convert its dose to the equianalgesic dose of morphine.

Which finding alerts the nurse to the possibility that the patient is experiencing adverse effects of morphine sulfate? 1 Diarrhea 2 Insomnia 3 Drowsiness 4 Hyperactive bowel sounds

3 Morphine sulfate depresses the central nervous system, resulting in drowsiness. It also causes a decrease in gastrointestinal motility, leading to constipation. This effect is helpful in treating diarrhea. Morphine sulfate does not cause insomnia. Morphine does not cause hyperactive bowel sounds.

Which action of naloxone causes reversal of respiratory depression? 1 Binds to the opioid receptor instead of the agonist and causes analgesia 2 Binds to the opioid receptor and causes less pain response than an agonist 3 Binds to the opioid receptor in place of the agonist and causes no response 4 Binds to the opioid receptor and causes a response opposite to that of an agonist

3 Naloxone is a competitive antagonist because it competes with the opioid agonist to bind with the receptor, but produces no response. It reduces the response of the agonist by displacing the agonist from the receptor site. In this way, it reverses the respiratory depression caused by the opioid agonist. If a drug binds to the receptor sites and produces a response, it means that the drug is an agonist that has more affinity to the receptor site than the original drug and causes analgesia. If a drug causes less response than that produced by an agonist even at full dose, it is called agonist-antagonist or a partial agonist. If a drug binds to the receptors and causes a response opposite to that of an agonist, then it is called an inverse agonist.

Massage therapy is prescribed as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how "rubbing my muscles" will help the pain go away. What principle should the nurse use to explain this to the patient? 1 Massaging muscles helps relax the contracted fibers and decrease painful stimuli. 2 Massaging muscles decreases the inflammatory response that initiates the painful stimuli. 3 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. 4 Massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain.

3 The gate theory of pain control identifies large sensory nerves that, when stimulated, send signals to the spinal cord to close the gate, blocking pain stimuli from reaching the brain. Therefore, the patient does not have the sensation of pain even if the stimulus is still present.

The nurse cares for a postoperative patient receiving epidural analgesia. The patient is resistant to the nurse's encouragement to turn, cough, and breathe deeply. The patient says, "I'm afraid the needle will stick in my spinal cord and paralyze me." What is the best response by the nurse? 1 "I can understand your fears, but there is no risk of paralysis from epidural analgesia." 2 "Tell me more about your understanding of how epidural analgesia relieves your pain." 3 "There's no needle. It's a thin plastic tube in the protective covering of your spinal cord." 4 "If you don't turn, cough, and breathe deeply, you may get pneumonia or other complications."

3 The patient is communicating fear and has a misunderstanding of the epidural line. By educating the patient regarding the lack of an indwelling needle in epidural analgesia, the feelings of fear and worry will decrease and the patient will be more willing to participate in the plan of care. Telling the patient that there is no risk of paralysis will not help to alleviate the patient's fears, because it may not convince the patient. The nurse needs to quickly inform the patient about the equipment instead of discussing the inaccurate information that the patient has. Telling the patient about potential complications will increase the patient's anxiety.

The nurse assesses a respiratory rate of 6 breaths/min in a patient receiving fentanyl. What is the nurse's best action? 1 Assess the patient for pain. 2 Administer an amphetamine. 3 Administer naltrexone hydrochloride. 4 Assess the patient's electrocardiogram (ECG).

3 The patient may have respiratory depression from the fentanyl, an opioid drug that may depress the respiratory center. Therefore, naltrexone hydrochloride should be administered to the patient to reverse the action of fentanyl and to improve the patient's respiratory status. When in pain, a patient's respiratory rate typically increases, rather than decreases. The priority is to reverse the effects of fentanyl. Administering an amphetamine will not reverse the effects of the fentanyl. There is no immediate need to assess the electrocardiogram.

What is the primary indication for the administration of morphine? 1 To treat ischemic pain 2 To diminish feelings of anxiety 3 To relieve acute and chronic pain 4 To induce a state of unconsciousness

3 The principal indication for morphine is the relief of moderate to severe acute and chronic pain, including postoperative pain and cancer pain. In addition, morphine is used during acute myocardial infarction to relieve pain, anxiety, and dyspnea and to promote relaxation of vascular smooth muscle. Morphine may also be administered before surgery for sedation. Nitroglycerin is used to treat ischemic pain.

A patient is diagnosed with gallstones and has gallbladder pain. What is this type of pain called? 1 Deep pain 2 Somatic pain 3 Visceral pain 4 Superficial pain

3 Visceral pain originates from organs and smooth muscles. The gallbladder is an organ, so the pain that the patient is experiencing is known as visceral pain. Deep pain occurs in tissues below skin level. Somatic pain originates from the skeletal muscles, ligaments, and joints. Superficial pain originates from the skin and mucous membranes.

Which condition would contraindicate the administration of naltrexone hydrochloride? 1 Anemia 2 Asthma 3 Diabetes 4 Hepatitis

4 Administration of naltrexone hydrochloride is contraindicated in a patient who has hepatitis or liver dysfunction. Administering naltrexone hydrochloride to these patients may produce severe complications, because the drug is metabolized in the liver. Naltrexone hydrochloride does not alter hemoglobin levels, respiratory function, or blood sugar levels. Thus the administration of naltrexone hydrochloride is safe in a patient who has anemia, asthma, or diabetes.

A patient with cancer who has had adequate pain control with a long-acting opioid reports pain. The nurse understands that the patient is experiencing breakthrough pain, and the time of the next scheduled opioid dose is in 2 hours. What is the nurse's best action? 1 Administer the scheduled opioid dose early. 2 Ask the patient to bear the pain until the next scheduled opioid dose. 3 Distract the patient for 2 hours by using alternative methods, such as music therapy. 4 Administer a short-acting opioid and follow the regular opioid schedule for the next dose.

4 Breakthrough pain occurs between two doses of opioids, usually as the effect of the opioid starts wearing off. A short-acting opioid can be administered for pain relief, maintaining the same schedule for the regular opioid. The nurse should not administer the regular long-acting opioid for breakthrough pain, because it can cause an overdose. Music therapy may not be an effective method of pain relief. The nurse's best action is not to ask the patient to bear the pain until the next scheduled opioid dose.

The nurse administered oral codeine sulfate to a patient as needed (PRN) for cough suppression. When should the nurse assess to determine whether the medication has been effective? 1 In 8 hours 2 In 4 hours 3 Within 2 hours 4 Within a half hour

4 Codeine sulfate is derived from codeine, which is a natural opiate alkaloid obtained from opium. The duration of action of codeine sulfate is 4 to 6 hours. If the medication is ordered PRN, there will be a time frame on the medication as to when the next dose can be administered that corresponds to the duration of action of the drug (4 to 6 hours). The nurse should assess in 4 hours to determine whether the patient needs another dose. The nurse should assess within a half hour to determine whether the medication has worked, because the onset of action is 15 to 30 minutes.

The nurse assesses a patient who is receiving methadone hydrochloride and notes a respiratory rate of 10 breaths/min. What action by the nurse is a priority? 1 Assess blood gasses. 2 Reassess the patient in an hour. 3 Administer a narcotic antagonist. 4 Assess the patient's neurologic status

4 Methadone hydrochloride is an opioid analgesic used for pain management. Respiratory depression is an adverse effect of opioid drugs. If the patient's respiration is less than the normal rate, then the nurse should further assess the patient first. If the patient is unresponsive, the nurse would proceed with administering an antagonist. The nurse should not wait and reassess in an hour if an assessment finding was abnormal.

The nurse assesses a patient who is receiving methadone hydrochloride and notes a respiratory rate of 10 breaths/min. What action by the nurse is a priority? 1 Assess blood gasses. 2 Reassess the patient in an hour. 3 Administer a narcotic antagonist. 4 Assess the patient's neurologic status.

4 Methadone hydrochloride is an opioid analgesic used for pain management. Respiratory depression is an adverse effect of opioid drugs. If the patient's respiration is less than the normal rate, then the nurse should further assess the patient first. If the patient is unresponsive, the nurse would proceed with administering an antagonist. The nurse should not wait and reassess in an hour if an assessment finding was abnormal.

When monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for which response? 1 Stimulation of circulation 2 Stimulation of respiratory rate 3 Stimulation of the cough reflex 4 Stimulation of the chemoreceptor trigger zone

4 Morphine sulfate can irritate the gastrointestinal tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting. Opioids cause a decrease in respiratory rate, not stimulation.

A patient is admitted to the unit who is prescribed oral naltrexone hydrochloride daily. What should the nurse include in the admission assessment? 1 Assessment of culture reports 2 Assessment of chronic diseases causing pain 3 Questions regarding the date of the last flu vaccine 4 Questions regarding past history of drug and alcohol use

4 Naltrexone hydrochloride is used as an adjunct to psychosocial treatments for alcoholism. Naltrexone hydrochloride is an opioid antagonist. It is also used as an adjunct for the maintenance of an opioid-free state in former opioid addicts. The nurse should include questions regarding the patient's past history of drug and alcohol use and determine how long the patient has been on the medication. The medication is not prescribed as a treatment for infection or chronic pain. There is no need to ask the date of the last flu vaccine; it is not relevant.

The nurse is caring for a patient who has oral ulcers. What type of pain, originating from the skin and mucous membranes, does the patient have? 1 Deep pain 2 Visceral pain 3 Somatic pain 4 Superficial pain

4 Pain is an unpleasant sensory and emotional experience that is associated with either actual or potential tissue damage. Superficial pain originates from the skin and mucous membranes. Deep pain originates in tissues below the skin level. Visceral pain originates from organs and smooth muscles. Somatic pain originates from skeletal muscles, ligaments, and joints.

A patient has started on a fentanyl patch. After 3 hours, the patient continues to complain of pain of "8 on a scale of 0 to 10." What is the nurse's best action? 1 Change the patch. 2 Administer naloxone. 3 Add a second patch. 4 Call the primary health care provider.

4 The fentanyl patch takes 6 to 12 hours to reach steady-state pain control after the first patch is applied. The nurse should call the primary health care provider for a medication to control pain immediately until the full effect of the patch is realized. The nurse should not change the patch, because it would then take longer for the patient to achieve pain control. The nurse should not administer naloxone, because this is not symptomatic of an overdose. The addition of a second patch would constitute an overdose.

Which patient will benefit the most from a fentanyl transdermal patch? 1 A patient with pain after abdominal surgery 2 A patient being treated for an acute migraine 3 A patient with lower back pain related to lumbar strain 4 A patient with severe pain resulting from cancer metastasis

4 Transdermal fentanyl is indicated only for persistent severe pain in patients who already tolerate opioids, because it 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.