Pharmacology Chapter 25

Pinpoint pupils

The nurse is assessing a patient for a possible overdose of opioids. Which of the following is an indication of opioid overdose?

Acetylcysteine

A nurse is admitting a toddler to the hospital after an acetaminophen overdose. Which of the following medications should the nurse anticipate administering to this client?

Dizziness Tinnitus Headache

A nurse is assessing a client who has salcylism. Which of the folliwng findings should the nurse expect? select all that apply

PRACTICE

QUESTIONS #4

Noceceptors

Sensory receptors for pain

Analgesics

Class of drugs that relieve pain

Vascular pain

Contributes to headaches or migraines

Visceral pain

Originates from smooth muscle and organs

Pain threshold

Level of stimuls needed to create a painful sensation

Neuropathic pain

Pain due to disease or injury of the PNS or CNS

Monitor any changes in repirations. Administer intravenous nalbuphine undiluted Instruct the patient to avoid alcohol when taking nalbuphine to avoid respiratory depression.

For the patient who is taking balbuphine, what should the nurse do? a.Monitor any changes in repirations. b. Instruct the patient to report bradycardia c. Administer intravenous nalbuphine undiluted d. Explain to the patient to expect an excessive amount of urine output e. Instruct the patient to avoid alcohol when taking nalbuphine to avoid respiratory depression.

Naloxone

The patient is brought to the emergency department with a reported overdose of morphine. Which drug does the nurse anticipate will be prescribed?

side effect health care provider

The patient taking meperidine reports blurred vision. The nurse knows this is a (n) ________________ and would report this finding to the __________________.

Increase fluid and fiber in the diet. Opioid analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent this. Eating foods high in lactobacilli and taking the medication on an empty stomach will not minimize GI side effects and may intensify them. Lomotil is used to treat diarrhea rather than the constipation that would result from use of narcotic analgesics.

What will the nurse teach the patient to minimize gastrointestinal (GI) side effects of opioid analgesics for chronic pain? Take diphenoxylate hydrochloride and atropine sulfate with each dose. Eat foods high in lactobacilli. Take the medication on an empty stomach. Increase fluid and fiber in the diet.

Seizures

A nurse is caring for a client who receives a local anesthetic of lidocaine during the repair of a skin laceration. For which of the following adverse reactions should the nurse monitor the client?

Calcium carbonate

A nurse is caring for a young adult client whose serum calcium is 8.8 mg/dL. Which of the following medications should the nurse anticipate administering to this client?

Keep the client NPO until pharyngeal response retunrs.

A nurse is planning care for a client who is to receive tetracaine prior to a bronchoscopy. Which of the following actions should the nurse include in the plan of care?

Dexamethasone

A nurse is planning care for client who has brain cancer and is experiencing headaches. Which of the following adjuvant medications are indicated for this client?

Urinary retention

A nurse is preparing to administer an opioid agonist to a client who has acute pain. Which of the following complications should the nurse monitor?

Positive home pregnancy test Numbness and tingling in fingers Muscle pain

A nurse is providing teaching to a client who has migraine headaches and a new prescription for ergotamine. For which of the following adverse effects should the nurse instruct the client to stop taking the medication and notify the provider? select all that apply

Identify and avoid trigger factors Lie down in a dark quiet room at the onset of a migraine Avoid foods that contain tyramine

A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide? select all that apply

Hot flashes Swelling or redness in calf Shortness of breath

A nurse is providing teaching to a client who is taking raloxifene to prevent postmenopausal osteoporosis. The nurse should advise the client that which of the following are adverse effects of this medication? select all that apply

Administer naloxone. Morphine overdose can be indicated by unresponsive, pinpoint pupils and respiratory depression. Rescue breathing, calling anesthesia, or calling a code will not correct the underlying problem.

A patient who has been taking morphine for pain is assessed by the nurse. The patient's respiratory rate is 7 per minute, and pupils are 1 mm and unreactive. What is the nurse's immediate action? Start rescue breathing. Call anesthesia. Call a code. Administer naloxone.

Celecoxib

A patient requires a nonopioid medication. The nurse knows that which medication will cause the least gastrointestinal distress? a. Aspirin b. Ketorolac c. Celecoxib d. Ibuprofen

Endorphins

Neurohormones that naturally suppress pain conduction

pheriperal prostaglandins

Nonsteroidal antiinflammatory drugs (NSAIDs) control pain at the ___________ level by blocking pain sensitizing chemicals and interfering with the production of _______________.

Cancer pain

Occurs from pressure on nerves and organs

Acute pain

Occurs suddenly and is usually less than 3 months in duration

CNS PNS

Opioids act primarily on the _______ and nonopioid analgesics act on the ________ at the pain receptor sites.

head injury / shock respiratory depression / hypertension

Opioids are contraindicated for use in patients with _________________ and _________________.

respirations coughing

In addition to suppressing pain impulses, opioids also suppress _________ and __________.

IV

Pentazocine, an opioid agonist-antagonist, is classified as Schedule _________________drug.

Administer the dose and contact the health care provider about his pain control

The patient is taking morphine after a procedure. The patient has made his third request for pain medication in the past 4 hours. The patient's vital signs are temperature 97.5 F, heart rate 88 beats/min, blood pressure 104/60 mm Hg, and oxygen saturation 98% on room air. He rates his pain as an 8 on a scale of 1 to 10. Assuming that a dose of the drug is due, what is the nurse's best action?

Having a few beers on the weeend will help me relax and ease the pain

The patient is taking a combination drug of hydrocodone and ibuprofen after reconstructive knee surgery. Which statement by the patient indicates the need for more teaching?

Mantoux test to rule out exposure to tuberculosis

A nurse is caring for a client who has a new prescription for cacitonin-salmon for ostoporosis. Which of the following tests should the nurse tell the client to expect before beginning this medication?

Monitor serum glucose Monitor serum potassium level Monitor for gastric bleeding

A nurse is planning care for client who has cancer and is taking a glucocrticoid as an adjuvant medication for pain control. Which of the following interventions should the nurse include in th plan of care? select all that apply

Withhold the medication if respiratory rate is less than 12/min

A nurse is planning to administer morphine IV to a client who is postoperative. Which of the following actions should the nurse take?

Butorphanol can cause abstinence syndrome in opioid-dependent clients.

A nurse is preparing to administer butorphanol to a client who has a history of substance use disorder. The nurse should identify which of the following information as true regarding butorphanol

Assess the IV site for thrombophlebitis frequently during administration

A nurse is preparing to administer pamidronate to a client who has bone pain related to cancer. Which of the following precautions should the nurse take when administering pamidronate?

Alternate nostrils each time calcitonin-salmon is inhaled

A nurse is providing instruction to a client who has a new prescription for calcitonin-salmon for postmenopausal osteoporosis. Which of the following instructions should the nurse include in the teaching?

Diazepam

A nurse is reviewing the medication administration record for a client who is receiving transdermal fentanyl for severe pain. Which of the following medications should the nurse expect to cause an adverse effect when administered concurrently with fentanyl?

Warfarin

A nurse is taking a history for a client who reports that he is taking aspirin about four times daily for sprained wrist. Which of the following prescribed medications taken by the client is contraindicated with aspirin?

Increases the risk for a myocardial infarction

A nurse is teaching a client about the new prescription for celecoxib. Which of the following information should the nurse include in the teaching?

Take medication in the morning before eating Drink an 8 oz glass of water with each tablet Avoid lying down after taking this medication

A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of he following instructions should the nurse provide?

a. Patient verbalizes pain relief

A patent received morphine sulfate for severe pain. The nurse assesses the patient 20 minutes later. What is the best indication that the medication has been effective? a. Patient verbalizes pain relief b. Patient has an increase in heart rate c. Patient is resting d. Patient has an increase in blood pressure

Orthostatic hypotension

A nurse is administering amitriptline to a client who is experiencing cancer pain. For which of the following adverse effects should the nurse monitor?

Pain tolerance

Amount of pain a person can endure without interfering with normal functioning

increase

As a result of unrelieved pain, a patient may develop glucose intolerance and ________ respiratory rate, heart rate, blood pressure. and stress response.

Naloxone

Assessing a patient follwing intravenous morphine administration, the nurse notes cold, clammy skin; a pulse of 40 beats/min; and constricted pupils. Which medication will the patient likely need next? a. Naloxone b. Meloxicam c. Pentazocine d. Propoxyphene

Monitor routine liver enzyme tests. Encourage the patient to check package labels of over-the-counter drugs to avoid overdosing. Report side effects immediately, as toxicity can cause severe hepatic damage

For the patient who is taking acetaminphen, what should the nurse do? select all that apply a. Monitor routine liver enzyme tests. b. Encourage the patient to check package labels of over-the-counter drugs to avoid overdosing. c. Report side effects immediately, as toxicity can cause severe hepatic damage d. Teach the female patient that oral contraceptives can increase the effect of acetminophen.

antitussive antidiarrheal

In additon to pain relief, many opioids have ________ and _________ effects.

Impaired gas exchange related to respiratory depression Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority.

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

Opioid abuse

Mixed opioid agonis-antagonists were developed in hopes of decreasing what problem?

endorphins

Opioids such as morphine activate the same receptors as __________ to reduce pain.

Somatic pain

Originates in skeletal muscle, ligaments and joints

Superficial pain

Originates on surace areas such as skin and mucous membranes

Chronic pain

Persists for more than 3 months and is difficult to treat

gate nociceptors

The __________ theory proposes tissue injury activates __________ and causes the release of chemical mediators.

Hydrophone is more potent than morphine

The next day, the patient's pain medication is changed from morphine sulfate to hydromorphone. Which statement regarding hydromorphone does the nurse identify as being true? a. Hyfromorphone must be administered intravenously b. Hypertension is a common side effect c. Physical dependence does not occur with hydromorphone therapy d. Hydromorphone is more potent than morphine.

Naloxone

The nurse assesses a patient receiving morphine via a PCA pump. The patient has a respiratory rate of 6 breaths/min. The nurse anticipates administration of which of the following drugs?a. a. Naloxone b. Sumatriptan c. Nalbuphine d. Hydroprphone

Instructions not to exceed recommended dosage Instructions not to use alcohol or central nervous system depressants while taking hydrocodone Instructions on how to prevent constipation Side effects to report

What information should the nurse include in a teaching plan for a patient who is being discharged home after knee surgery with a prescription for an opioid?

Use of drugs with long suration of action

Which factor is most relevant to the relief of chronic pain?

Respiratory depression

A nurse in an emergency department is performing an admission assessment for a client who has severe aspirin toxicity. Which of the following findings should the nurse expect?

Need for reduced dosage of the opioid Reduced adverse effects of the opioid Increased analgesic effects

A nurse is caring for a client who has cancer and is taking morphine and carbamaxepine for pain. Which of the following effects should the nurse monitor for when giving the medications together? select all that apply

The medication will relieve your mothers constipation

A nurse is caring for a client who has end-stage cancer and is receiving morphine. The client's daughter asks why the provide prescribed mehylnaltrexone. Which of the following responses should the nurse make?

This medication will help decrease your coughing." Codeine provides both analgesic and antitussive therapeutic effects. It does not strengthen the immune system, increase lung volume, or help the patient expectorate sputum.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she is free of pain. What is the nurse's best response? a. "This medication will help decrease your coughing." b. "This medication will help you bring up sputum." c. "This medication will help increase lung volume." d. "This medication will strengthen your immune system."

Urinary retention

The nurse identifies which of the following as a common side effect/adverse effect of morphine therapy? a. Diarrhea b. Hypertension c. Urinary retention d. Tachypnea

Pinpoint pupils Pinpoint pupils might be a sign of morphine overdose or toxicity. The nurse needs to act on this finding immediately. Decreased bowel sounds and constipation are expected. Nausea and delayed gastric emptying are expected side effects of morphine sulfate and do not require immediate action.

The nurse is assessing a patient taking morphine sulfate. Which assessment requires immediate action? Decreased bowel sounds Nausea Delayed gastric emptying Pinpoint pupils

Change the patch every 72 hours. The fentanyl transdermal delivery system is designed to slowly release analgesic over a 72-hour period. It should not be changed every time that pain recurs, every 24 hours, or once a week.

What will the nurse teach the patient who is prescribed a fentanyl transdermal delivery system? Change the patch when pain recurs. Change the patch every 24 hours. Change the patch every 72 hours. Change the patch once a week.

Respiratory rate The most serious side effect of narcotic analgesics is respiratory depression.

Which assessment is most important for the nurse to monitor in a patient receiving an opioid analgesic? Blood pressure Heart rate Mental status Respiratory rate

Fluid intake

Which nursing assessment would be least important when monitoring a patient who is reciving hydromophone?

Constipation Dysuria Respiratory depression

The nurse is concerned that the patient is experiencing side effects of opioid agonist-agonists. What would be priorities for the nurse to assess if this patient is experiencing side/adverse effects?

Decreeased respirations

For the patient receiving periodic morphine via intravenous push, which of the following findings would be of utmost concern to the nurse? a. Increased temperature b. Decreased bowel sounds c. Decreased respirations d. Increased red blood cell count

Assess for nausea and vomiting. Morphine sulfate can cause nausea and vomiting by stimulating the vomiting center in the brain.

In monitoring a patient for adverse effects related to morphine sulfate, which is a priority assessment? Assess circulation. Assess cough reflex. Assess for nausea and vomiting. Assess lung sounds.

Acute hepatic necrosis Acetaminophen in large doses is extremely hepatotoxic. Patients with normal hepatic function should receive no more than 4000 mg/day. An overdosage of acetaminophen should not result in decreased urinary output, kidney stones, or metabolic alkalosis.

A patient has been admitted after overdosing on acetaminophen. The nurse plans to monitor this patient for development of which complication related to the overdose? Decreased urinary output Kidney stones Acute hepatic necrosis Metabolic alkalosis

Administer methadone. Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment. The patient's blood pressure needs to be monitored more frequently than every 8 hours for a patient in withdrawal. The patient's temperature is not a concern. Narcan is not administered to the patient in withdrawal from narcotic addiction.

A patient is admitted for treatment of opioid addiction. Which intervention is a priority? Assess blood pressure every 8 hours. Administer methadone. Monitor temperature hourly. Administer naloxone.

Noloxone

A patient is admitted to the emergency department with signs of respiratory depression following self-injection with hydromorphone. The admitting nurse knows that which drug will reverse respiratory depression cause by opioid overdose? a. Fentanyl b. Naloxone c. Butorphanol d. Sufenta

Triptans

A patient is having a migraine attack. The nurse should know that which drugs are used to treat migraine attacks? a. Triptans b. Anticonvulsants c. Tricyclic antidepressants. d. Beta-adrenergic blockers

3 g/day

A patient states during a medical history that he takes several acetaminophen tablets throughout the dayfor acute pain. The nurse teaches the patient that the dosage should not exceed which amount? a. 1 g/day b. 3 g/day c. 4 g /day d. 6 g /day

Cholestyramine

The nurse is completing the medication reconciliation for the patient who will be discharged home with a prescription for oxycodone and acetaminophen. Which drug that the patient is currently taking raises a concern for the nurse?

Notify the health care provider and delay drug administration. Respiratory depression is a side effect of opioid analgesia. Therefore, since the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the health care provider. The drug should not be given while the respiratory rate is this much low, and the health care provider should be notified of the change in the patient's condition.

The nurse is preparing to administer an injection of morphine to a patient and notes a respiratory rate of 10 breaths/min. What is the nurse's best action? Administer a smaller dose and record the findings. Notify the health care provider and delay drug administration. Administer the prescribed dose and notify the health care provider. Hold the drug, record the assessment, and recheck in 1 hours

The dose may be too high for this patient

The older adult patient has a fentanyl patch 50 mg for chronic pain from an injury. What does the nurse know regarding this drug for this patient?

An ECG indicates a first-degree heart block

A nurse is reviewing the health history of a client who has migraine headaches and is to begin prophylaxis therapy with propranolol. Which of the following findings in the client history should the nurse report to the provider?

Take no more than 2 grams of acetaminophen per day. The patient with decreased hepatic function should decrease the dose of acetaminophen.

The nurse is teaching a patient with decreased hepatic function about taking pain relievers. What is the most important information to teach this patient? Take COX-2 inhibitors every 8 hours. Do not take aspirin. Take no more than 2 grams of acetaminophen per day. Do not take narcotic pain relievers.

8-12 hours

The patent has breast cancer and is in hospice care. She has been taking morphine for pain control. What is the duration pf pain relief for controlled release morphine?

24-48 hours

The patient has been taking an opioid for 8 weeks for a back injury he sustained at work. He has stopped taking drug. How many hours after he last takes his medication does the nurse anticipate his withdrawal symptoms will begin?

Acetaminophen Aspirin Ibuprofen

The patient has fallen off his mountain bike and sustained multiple abrasions to both of his knees. Which would be appropriated drug(s) for pain management for this patient? select all that apply

5 days

The patient has had major surgery and has been prescribed oral ketorolac. What is the maximum length of time this drug can be taken?

Decreased blood pressure

The patient has returned to the floor from surgery after a hip arthroplasty. For the first 48 hours post-operatively, meperidine is ordered for pain control/ Which of the following is a major side effect of meperidine?

Discuss the child's typical respinses with the carefivers Use a pain scale appropriate for children such as the Ouch Scale Utilize developmentally appropriate communication techniques

What will the nurse do to be more successful in treating pain in a 8-year-old patient who fell from a tree and broke his arm? select of that apply

Acetylcysteine When acetaminophen toxicity occurs, acetylcysteine is the antidote, which reduces liver injury by converting toxic metabolites to a nontoxic form.

The patient is admitted with an acetaminophen overdose. In addition to monitoring liver function results, the nursing would anticipate administering which of the following? Naloxone Activated charcoal Acetylcysteine An antacid