16 Opioid Antagonists

Which of the following would a nurse most likely be ordered to give to a client experiencing opioid-induced respiratory depression? Select all that apply. A) Naloxone B) Nalbuphine C) Naltrexone D) Naproxen E) Nitroglycerin

Ans: A Feedback: Naloxone is an opioid antagonist specifically developed to reverse respiratory depression associated with opioids. Naltrexone may also be used, but its primary use is in the treatment of alcohol dependence. Nalbuphine is an agonist-antagonist used for severe chronic pain. Naproxen is an NSAID. Nitroglycerin is used for angina.

After administering naloxone to a client with respiratory depression, the nurse would expect to see the effects of the drug within which time frame? A) 1 to 2 minutes B) 3 to 4 minutes C) 5 to 6 minutes D) 7 to 8 minutes

Ans: A Feedback: Naloxone is capable of restoring respiratory function within 1 to 2 minutes after administration.

A client who has been receiving naloxone suddenly starts grimacing and moaning, moving his arms back and forth across his body, and drawing his legs up to his abdomen. Prior to administration the client was sleepy and calm. Assessment reveals that his respiratory rate is 18 breaths per minute. Which nursing diagnosis would most likely apply? A) Acute Pain B) Impaired Spontaneous Ventilation C) Deficient Knowledge D) Ineffective Coping

Ans: A Feedback: The client is exhibiting nonverbal indicators of acute pain, which can result after naloxone reverses the opioid's effects. The client's respiratory rate is 18 breaths per minute, so impaired spontaneous ventilation is not appropriate. There is nothing to indicate at the present time that the client has a knowledge deficit or that he is not coping well.

A client with respiratory depression is administered an opioid antagonist by the nurse. What ongoing assessment should the nurse perform when administering the opioid antagonist to the client? A) Monitor vital signs every 5 to 15 minutes. B) Review allergy history and other treatment modalities. C) Teach different breathing patterns to the client. D) Monitor the blood pH level of the client.

Ans: A Feedback: The ongoing assessment performed by the nurse when administering an opioid antagonist to the client involves monitoring the vital signs of the client every 5 to 15 minutes. Monitoring the blood pH level of the client is not part of the ongoing assessment. Reviewing the allergy history and other treatment modalities and teaching different breathing patterns to the client are preadministration assessments that are performed before the administration of the drug; they are not ongoing assessments.

A nurse is caring for a client who is receiving naloxone intravenously. The client develops acute pain while the drug is being administered. Which of the following would most likely explain the client's pain level? A) The drug was administered as too rapid a dose. B) The client's pain wasn't controlled before the administration of naloxone. C) The change in respiratory status has caused the increase in pain. D) The dosage of the naloxone was too small.

Ans: A Feedback: When naloxone is given IV and the bolus is given too rapidly, withdrawal symptoms and the return of intense pain occur as the level of opioid is reduced. There is no indication that the client's pain hadn't been controlled previously. A change in the respiratory status does not lead to increased pain. If the dose was too small, the client would still be experiencing some of the effects of the opioid that is being reversed.

Which of the following can occur if the nurse administers naloxone (Narcan) as a rapid IV bolus? Select all that apply. A) Withdrawal B) Intense pain C) Vomiting D) Hypotension E) Respiratory depression

Ans: A, B, C Feedback: Withdrawal, return of intense pain, and vomiting may occur if the nurse administers naloxone (Narcan) as a rapid IV bolus.

When administering an opioid antagonist, the nurse would expect reversal of which of the following opioid effects? Select all that apply. A) Respiratory depression B) Constipation C) Analgesia D) Hypotension E) Bradycardia

Ans: A, B, C, D, E Feedback: Opioid antagonists are not selective for reversal of specific adverse reactions occurring with the use of an opioid but will reverse all adverse reactions caused by opioids.

Which of the following are evaluations the nurse should make when caring for a client receiving naloxone? Select all that apply. A) Pain relief is resumed. B) Adverse reactions are identified and managed. C) Therapeutic response is achieved. D) Client demonstrates an understanding of the drug regimen. E) Client's respiratory rate is normal.

Ans: A, B, C, D, E Feedback: Pain relief is resumed, adverse reactions are identified and managed, therapeutic response is achieved, client demonstrates an understanding of the drug regimen, and client's respiratory rate is normal are evaluations of successful therapy with an opioid antagonist.

A nurse would expect to administer naloxone cautiously to which client? Select all that apply. A) A client who is pregnant B) A client with cardiovascular disease C) A client with an alcohol dependency D) A client with an opioid dependency E) A client with chronic obstructive pulmonary disease

Ans: A, B, D Feedback: Opioid antagonists like naloxone (Narcan) should be used cautiously in those who are pregnant or lactating, in infants of opioid-dependent mothers, and in clients with an opioid dependency or cardiovascular disease.

If time allows, the nurse should review which of the following with the client prior to administering an opioid antagonist? Select all that apply. A) Initial health history B) Allergy history C) Bowel history D) Family medical history E) Current treatment modalities

Ans: A, B, E Feedback: If time allows, the nurse should review the client's initial health history, allergy history, and current treatment modalities prior to administering an opioid antagonist.

A nursing student is assigned to lead a class discussion on opioid antagonists. Which of the following would the student include as the mechanism by which opioid antagonists reverse the effects of opioid agonists? Select all that apply. A) Competitive inhibition of the opioid receptor B) Direct binding to the opioid agonist C) Displacement of the opioid agonist from the opioid receptor D) Irreversible inhibition of the opioid receptor E) Mutation of the opioid receptor

Ans: A, C Feedback: Opioid agonists reverse the opioid effects by competing for the opiate receptor site and displacing the opioid drug.

A nurse monitoring a client receiving naloxone (Narcan) should be cognizant for the development of which of the following adverse reactions? Select all that apply. A) Nausea B) Constipation C) Tachycardia D) Hypotension E) Tremors

Ans: A, C, E Feedback: Generalized reactions that can occur with the use of opioid antagonists such as naloxone include nausea, vomiting, sweating, tachycardia, increased blood pressure, and tremors.

Abrupt reversal of opioid-induced respiratory depression may cause vomiting. Which action by the nurse would be most appropriate if this occurs during reversal of opioid-induced respiratory depression? Select all that apply. A) Maintaining a patent airway B) Stopping the opioid antagonist C) Suctioning the client as needed D) Administering more of the opioid E) Turning the client to the side as needed

Ans: A, C, E Feedback: If vomiting occurs during the reversal of opioid-induced respiratory depression, the nurse must maintain a patent airway and should turn and suction the client as needed.

A nurse determines that an opioid antagonist would most likely be needed in which situation? Select all that apply. A) Postoperative acute respiratory depression B) Reversal of phenytoin toxicity C) Reversal of opioid-induced hypotension D) Suspected acute benzodiazepine overdosage E) Suspected acute opioid overdosage

Ans: A, C, E Feedback: Opioid antagonists are used for the treatment of the following: postoperative acute respiratory depression, reversal of opioid adverse effects (hypotension, bradycardia, etc.), and suspected acute opioid overdosage.

A nurse must be careful when administering opioid antagonists to clients taking which of the following? Select all that apply. A) Codeine for cough B) Zolpidem for sleep C) Oxycodone for analgesia D) Naproxen for analgesia E) Diphenoxylate for diarrhea

Ans: A, C, E Feedback: Opioid antagonists may prevent the action or intended use of opioids like codeine for cough, oxycodone for analgesia, or diphenoxylate for diarrhea, so administration of opioid antagonists in clients taking these medications must be monitored carefully.

Prior to the administration of an opioid antagonist, which of the following would be most important for the nurse to obtain? Select all that apply. A) Blood pressure B) Blood glucose C) Pulse D) Pain assessment E) Respiratory rate

Ans: A, C, E Feedback: Prior to the administration of an opioid antagonist, the nurse must obtain the client's blood pressure, pulse, and respiratory rate.

1. After teaching a group of nursing students about opioid antagonists, the instructor determines that the teaching was successful when the students identify which of the following as true about these drugs? Select all that apply. A) An opioid antagonist has greater affinity for opioid receptors than do opioid agonists. B) An opioid antagonist has lesser affinity for opioid receptors than do opioid agonists. C) An opioid antagonist prevents a response to the opioid by binding to opioid agonists in the bloodstream. D) An opioid antagonist prevents a response to the opioid by binding to opioid receptors. E) An opioid antagonist potentiates the effect of an opioid.

Ans: A, D Feedback: An opioid antagonist has a greater affinity for a cell receptor than an opioid agonist, and by binding to the cell receptor, it prevents a response to the opioid agonist.

A client with chronic back pain is admitted to a local health care facility for respiratory depression secondary to an inadvertent overdose of his opioid analgesic. The client is to receive naloxone. Which of the following would the nurse include before administering naloxone? A) Monitor the client's blood pressure every 5 minutes. B) Review the client's allergy history and treatment modalities. C) Monitor vital signs every 5 to 15 minutes if the client is responsive. D) Monitor respiratory rate and rhythm of the client.

Ans: B Feedback: Before administering the antagonist, the nurse should review the client's initial health history, allergy history, and treatment modalities. The nurse should also obtain the client's blood pressure, pulse, and respiratory rate and review the record for the drug suspected of causing the symptoms of respiratory depression. All these interventions are part of the preadministration assessment, which is conducted before the administration of the drug. Monitoring the client's blood pressure every 5 minutes until the client responds, monitoring vital signs every 5 to 15 minutes if the client is responsive, and monitoring the client's respiratory rate and rhythm are all interventions involved in the ongoing assessment of the client that the nurse performs while the client is undergoing the drug therapy.

A client is prescribed naloxone for the treatment of postoperative acute respiratory depression after a kidney transplant. The nurse explains the drug to the family, describing its action as which of the following? A) Naloxone stops internal bleeding. B) Naloxone restores respiratory function. C) Naloxone restores reflexes of limbs. D) Naloxone helps the client overcome pain.

Ans: B Feedback: The nurse should explain that naloxone restores respiratory function within 1 to 2 minutes after administration. Naloxone neither stops internal bleeding nor restores limb reflexes. Naloxone also does not overcome pain.

A client is given a postoperative opioid drug for pain relief. The nurse observes that the drug has slowed the client's breathing pattern. Which of the following reasons would the nurse most likely identify as the cause of the lowered breathing pattern? A) Anxiety B) Somnolence C) Nausea D) Anorexia

Ans: B Feedback: The nurse should identify somnolence as a cause of slowing of the client's breathing pattern. Sometimes the somnolence and pain relief produced by the opioid drug can slow the client's breathing pattern. Anxiety, nausea, and anorexia are not known to be responsible for slowing down a client's breathing pattern when the client is administered an opioid drug.

A client is receiving an opioid antagonist. The nurse would closely monitor the client for which of the following? A) Cramps B) Sweating C) Low blood pressure D) Skin inflammation

Ans: B Feedback: The nurse should monitor for sweating when caring for the client since it is one of the adverse reactions of opioid antagonists. Other adverse reactions include nausea, vomiting, tachycardia, increased blood pressure, and tremors. The nurse need not monitor for cramps, low blood pressure, or skin inflammation since these conditions are not known to be caused by opioid antagonists.

After administering an opioid antagonist, which of the following would be most appropriate for the nurse to do when the client's pain recurs? Select all that apply. A) Change opioid antagonists. B) Review the circumstances that led to the use of the opioid antagonist. C) Assess the client's pain level. D) Begin to treat the pain again. E) Decrease the rate of opioid antagonist administration.

Ans: B, C, D Feedback: The nurse should assess the client's pain level, review the circumstances that required the use of the antagonist, and begin to treat the pain again. Changing antagonists and decreasing the rate of antagonist administration are inappropriate.

When administering an opioid antagonist to reverse opioid-induced respiratory depression, which of the following would be most important for the nurse to keep in mind? Select all that apply. A) Monitoring is less frequent if respiratory depression occurs in the immediate postoperative setting. B) The nurse should notify the primary health care provider if any adverse drug reactions occur. C) After the client has shown a response to the drug, the nurse monitors vital signs every 30 to 60 minutes. D) Monitoring of the client's respiratory status includes rate, rhythm, and depth. E) The nurse monitors the client's blood pressure, pulse, and respiratory rate at frequent intervals, usually every 3 minutes, until the client responds.

Ans: B, D Feedback: As part of the ongoing assessment during the administration of the antagonist, continue to monitor the blood pressure, pulse, and respiratory rate at frequent intervals, usually every 5 minutes, until the client responds. This monitoring should be more frequent if respiratory depression occurs in the immediate postoperative setting. After the client has shown a response to the drug, monitor vital signs every 5 to 15 minutes. Notify the anesthesiologist or primary health care provider if any adverse drug reactions occur because additional medical treatment may be needed. Continue to monitor the respiratory rate, rhythm, and depth; pulse; blood pressure; and level of consciousness until the effects of the opioid wear off.

A client is prescribed naloxone. The nurse would expect to administer the drug by which route? Select all that apply. A) IM injection B) IV push C) Intrathecal injection D) IV piggyback E) Subcutaneous injection

Ans: B, D Feedback: Naloxone (Narcan) is administered by IV infusion requiring the use of a secondary line, an IV piggyback, or an IV push.

A nurse suspects that a client receiving naloxone is experiencing an adverse reaction when the assessment reveals which of the following? A) Bradycardia B) Dry, flushed skin C) Tremors D) Diarrhea

Ans: C Feedback: Generalized reactions to naloxone include nausea and vomiting, sweating, tachycardia, increased blood pressure, and tremors.

After teaching a group of nursing students about opioid antagonists, the instructor determines that the teaching was successful when the students identify which of the following as an example? A) Naproxen B) Nalbuphine C) Naloxone D) Nevirapine

Ans: C Feedback: Naloxone is an opioid antagonist. Naproxen is an NSAID. Nalbuphine is an opioid agonist-antagonist. Nevirapine is an antiretroviral agent.

The nurse is evaluating a client who has received naloxone for respiratory depression. Assessment of which of the following would indicate effectiveness of the drug therapy? A) Client is now receiving mechanical ventilation. B) Client's level of pain has decreased. C) Respiratory rate and depth are within acceptable parameters. D) Fluid intake and output are balanced.

Ans: C Feedback: The client receives naloxone to reverse respiratory depression. Therefore, a respiratory rate and depth within acceptable parameters indicate that the drug was effective. The need for mechanical ventilation indicates that the client is still experiencing respiratory difficulty. Naloxone is not given for pain relief; however, pain relief must be addressed since the drug will negate any opioid pain relief. Naloxone does not affect fluid balance.

A primary health care provider orders opioid antagonist treatment for a client with respiratory depression. The nurse should be aware of which of the following conditions that can occur during an abrupt reversal of opioid respiratory treatment? A) Dizziness B) Headache C) Vomiting D) Lightheadedness

Ans: C Feedback: The nurse should know that an abrupt reversal of opioid respiratory depression with an opioid antagonist results in vomiting. The nurse must maintain a patent airway and should turn and suction the client as needed in such cases. Headache, dizziness, and lightheadedness are not known to occur during an abrupt reversal of opioid respiratory treatment.

An opioid-naÔve client experiences acute pain after surgery and is prescribed opioid therapy. The nurse would be especially alert for the development of which of the following? A) Pruritus B) Severe headache C) Respiratory depression D) Urticaria

Ans: C Feedback: The nurse should monitor for symptoms of respiratory depression developing in the client as one of the severe adverse reactions of opioid treatment. Pruritus, urticaria, and headache are caused by opioids, but these conditions are not the most severe and common adverse reactions observed in opioid-naÔve clients. Therefore, the nurse need not monitor for pruritus, severe headache, or severe urticaria in an opioid-naÔve client undergoing opioid therapy.

A client is admitted to a local health care facility for alcohol dependence. The nurse knows that the physician is most likely to prescribe which of the following drugs for the client? A) Cisapride B) Naproxen C) Lincosamide D) Naltrexone

Ans: D Feedback: The nurse should administer naltrexone to the client who has alcohol dependence. It is also used to block the effects of suspected opioids if they are being used by the person undergoing treatment for alcohol dependence. Cisapride, naproxen, and lincosamide are not used to treat alcohol dependence.