ATI BOOK-PHARMACOLOGY: Unit 9: Ch 30-33: Medications for Pain and Inflammation

A nurse is caring for a client who has cancer and is taking morphine and carbamazepine for pain. Which of the following effects should the nurse monitor for when giving the medications together? (select all that apply) A. Need for reduced dosage of the opioid B. Reduced adverse effects of the opioid C. Increased analgesic effects D. Enhanced CNS stimulation E. Increased opioid tolerance

1. Need for reduced dosage of the opioid 2. Reduced adverse effects of the opioid 3. Increased analgesic effects *Dosage of the opioid can be reduced when adjuvant medications are added for pain. Adverse effects of the opioid can be reduced when adjuvant medications are added for pain. Analgesic effects are increased when adjuvant medications are added for pain. CNS stimulation is not enhanced when morphine and carbamazepine are used together for pain relief. Opioid tolerance can be decreased when an adjuvant medication is added for pain

A nurse is caring for a client who has end-stage cancer and is receiving morphine. The client's family member asks why the provider prescribed methylnaltrexone. Which of the following responses should the nurse make? A. "The medication will increase respirations." B. "The medication will prevent dependence on the morphine." C. "The medication will relieve constipation." D. "The medication works with the morphine to increase pain relief."

"The medication will relieve constipation." *Methylnaltrexone does not decrease analgesia or increase a depressed respiratory rate. Methylnaltrexone does not prevent dependence on opioids, such as morphine. Methylnaltrexone is an opioid antagonist used for treating severe constipation that is unrelieved by laxatives in clients who have opioid dependence. The medication blocks the mu opioid receptors in the GI tract. Methylnaltrexone is not an adjunct to opioids for pain relief

A nurse is collecting data on a client who has salicylism. Which of the following findings should the nurse expect? (select all that apply) A. Dizziness B. Diarrhea C. Jaundice D. Tinnitus E. Headache

1. Dizziness 2. Tinnitus 3. Headache *The client who has salicylism can have dizziness, tinnitus, and headaches, which are expected findings. The client who take aspirin is not expected to develop diarrhea. However, monitor the color of the client's stools to determine if the client has a gastric bleed from taking aspirin. The client who takes aspirin will metabolize the medication through the liver. Jaundice is not an expected finding in salicylism

A nurse is reinforcing teaching with a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide? (select all that apply) A. Take ergotamine as a prophylaxis to prevent a migraine headache B. Identify and avoid trigger factors C. Lie down in a dark quiet room at the onset of a migraine D. Avoid foods that contain tyramine E. Avoid exercise that can increase heart rate

1. Identify and avoid trigger factors 2. Lie down in a dark quiet room at the onset of a migraine 3. Avoid foods that contain tyramine *Ergotamine is used at the onset of a migraine to abort headache manifestations. It should not be used regularly because it can cause physical dependence and toxicity. Identifying and avoiding trigger factors in an important action that can help to prevent some migraines. Lying down in a dark, quiet room at the onset of a migraine can prevent the onset of more severe manifestations. Foods that contain tyramine can be a trigger for some migraines and should be avoided. Exercise should be encourage between migraines because it can relieve stress, which can trigger headaches.

A nurse is contributing to the plan of care for a client who has cancer and is taking glucocorticoid as an adjuvant medication for pain control. Which of the following interventions should the nurse recommend for inclusion in the plan of care? (select all that apply) A. Monitor for urinary retention B. Monitor for blood glucose C. Monitor blood potassium level D. Monitor for gastric bleeding E. Monitor for respiratory depression

1. Monitor for blood glucose 2. Monitor blood potassium level 3. Monitor for gastric bleeding *Monitoring for urinary retention is not necessary because glucocorticoids do not cause this effect. Monitoring blood glucose is important because glucocorticoids raise the glucose level, especially in clients who have diabetes mellitus. Monitoring blood potassium level is important because glucocorticoids can cause hypokalemia. Monitoring for gastric bleeding is important because glucocorticoids do not depress respirations.

A nurse is reinforcing teaching with a client who has migraine headaches and a new prescription for ergotamine. For which of the following manifestations indicating a possible adverse reaction should the nurse instruct the client to stop taking the medication and notify the provider? (select all that apply) A. Nausea B. Visual disturbances C. Positive home pregnancy test D. Numbness and tingling in the fingers E. Muscle pain

1. Positive home pregnancy test 2. Numbness and tingling in the fingers 3. Muscle pain *Nausea that occurs with a migraine is a common associated finding and does not warrant stopping the medication and notifying the provider. Nausea and vomiting also are common adverse effects of ergotamine, and the provider can prescribe an antiemetic. Visual disturbances (flashing lights) are common findings associated with migraine and do not warrant stopping the medication and notifying the provider. A client who has a positive home pregnancy test should stop taking ergotamine and notify the provider. Numbness and tingling of the fingers or toes can be a finding in ergotamine toxicity. The medication should be stopped and the provider notified. Unexplained muscle pain can be a finding in ergotamine toxicity. The medication should be stopped and the provider notified.

A nurse is assisting with the admission of a client to the hospital following acetaminophen toxicity. Which of the following medications should the nurse expect to administer to this client? A. Acetylcysteine B. Pegfilgrastim C. Misoprostol D. Naltrexone

Acetylcysteine *Administer acetylcysteine, which is the antidote for acetaminophen toxicity. To increase the body's production of neutrophils, administer pegfilgrastim. To prevent the formation of gastric ulcers, administer misoprostol, which is a prostaglandin hormone. To prevent alcohol craving, administer naltrexone, which is an opioid antagonist.

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? A. The client had a prior myocardial infarction B. The client takes warfarin for atrial fibrillation C. The client takes an SSRI for depression D. An ECG indicates a first-degree heart block

An ECG indicates a first-degree heart block *Propranolol is contraindicated in clients who have a first-degree heart block. Report this finding to the provider

A nurse is preparing to administer butorphanol to a client who has a substance use disorder. The nurse should identify which of the following information as true regarding butorphanol? A. Butorphanol has a greater risk for abuse than morphine. B. Butorphanol causes a higher incidence of respiratory depression than morphine C. Butorphanol cannot be reversed with an opioid antagonist D. Butorphanol can cause abstinence syndrome in clients who have opioid dependence

Butorphanol can cause abstinence syndrome in clients who have opioid dependence *Butorphanol has less risk for misuse than morphine. It is less likely to cause respiratory depression than morphine. Manifestations of butorphanol toxicity can be reversed with an opioid antagonist if necessary. Opioid agonist/antagonist syndrome in clients who have opioid dependence. Manifestations include abdominal pain, fever, and anxiety.

A nurse is contributing to the plan of care for a client who has brain cancer and is experiencing headaches. Which of the following adjuvant medications are indicated for this client? A. Dexamethasone B. Methlyphenidate C. Hydroxyzine D. Amitriptyline

Dexamethasone *Dexamethasone, a glucocorticoid, decreased inflammation and swelling. It is used to reduce cerebral edema and relieve pressure from the tumor. The use of methyphenidate as an adjuvant is to elevate mood and increase pain relief. The use of hydroxyzine as an adjuvant is to decreased anxiety and help the client sleep. The use of amitriptyline as an adjuvant is to relieve neuropathic pain and elevate mood.

A nurse is reviewing the medication administration record for a client who is receiving transdermal fentanyl for severe pain. The nurse should identify that which of the following medications can cause an adverse effect when administered concurrently with fentanyl? A. Ampicillin B. Diazepam C. Furosemide D. Prednisone

Diazepam *Ampicillin, an antibiotic, does not interact with fentanyl and should not cause adverse toxicity. Diazepam, a benzodiazepine, is a CNS depressant, which can interact by causing the client to become severely sedated when administered concurrently with an opioid antagonist or agonist/antagonist. Furosemide, a loop diuretic, does not interact with fentanyl and should not cause an adverse effect. Prednisone, a glucocorticoid, does not interact with fentanyl and should not cause an adverse effect.

A nurse is reinforcing teaching with a client about a new prescription for celecoxib. Which of the following information should the nurse include? A. Increases the risk for a myocardial infarction B. Decreases the risk of stroke C. Inhibits COX-1 D. Increases platelet aggregation

Increases the risk for a myocardial infarction *The client who takes celecoxib has an increased risk for a myocardial infarction secondary to suppressing vasodilation. The client who takes celecoxib has an increased risk for stroke secondary to suppressing vasodilation. Celecoxib inhibits COX-2, which suppresses inflammation, relieves pain, decreases fever, and protects against colorectal cancer. Celecoxib does not have an effect on platelet aggregation. However, the medication suppresses vasodilation.

A nurse is contributing to the plan of care for a client who is to receive tetracaine prior to a bronchoscopy. Which of the following actions should the nurse recommend for inclusion in the plan of care? A. Keep the client NPO until pharyngeal response returns B. Monitor the insertion site for a hematoma C. Palpate the bladder to detect urinary retention D. Maintain the client on bed rest for 12 hr following the procedure

Keep the client NPO until pharyngeal response returns *Keep the client NPO following the procedure until normal pharyngeal sensation returns (approximately 1 hr), and then monitor the client's first oral intake to ensure aspiration does not occur. Monitor the insertion site for a hematoma, palpate the bladder to detect urinary retention, and maintain the client on bed rest for 12 hr following the procedure for the client who receives a spinal anesthesia.

A nurse is administering amitriptyline to a client who is experiencing cancer pain. For which of the following adverse effects should the nurse monitor? A. Decreased appetite B. Explosive diarrhea C. Decreased pulse rate D. Orthostatic hypotension

Orthostatic hypotension *Amitriptyline can cause increased appetite and weight gain, constipation, increased pulse rate, and orthostatic hypotension. Monitor for this effect and instruct the client to move slowly from lying down or sitting after taking this medication.

A nurse is collecting data from a client who has severe aspirin toxicity. Which of the following findings should the nurse expect? A. Body temperature 35°C (95°F) B. Lung crackles C. Cool, dry skin D. Respiratory depression

Respiratory depression *Expect hyperthermia as a manifestation of severe aspirin toxicity. Expect dehydration as a manifestation of severe aspirin toxicity. Lung crackles are not an expected finding. Expect diaphoresis as a manifestation of severe aspirin toxicity. Cool, dry skin is not an expected finding. Respiratory depression due to increasing respiratory acidosis is an expected manifestation of severe aspirin toxicity.

A nurse is caring for a client who is receiving a local anesthetic of lidocaine during the repair of a skin laceration. For which of the following manifestations should the nurse monitor for as an adverse reaction to the anesthetic? A. Seizures B. Tachycardia C. Hypertension D. Fever

Seizures *Seizure activity is an adverse effect that can occur as a result of local anesthetic injection. Bradycardia can occur as a result of local anesthetic injection. Hypotension can occur as a result of local anesthetic injection. Fever is not an adverse effect of local anesthetic injection.

A nurse is reinforcing teaching with a client who has a new prescription for etidronate to help relieve bone pain. Which of the following instruction should the nurse include? A. Wait 30 min after taking the medication before eating any food B. Take the medication with 30 mL (1 oz) of water C. Sit upright or stand for 30 min after taking the medication D. Increase fluid fiber intake to prevent the constipation the medication causes

Sit upright or stand for 30 min after taking the medication *For maximum absorption, clients should wait 2 hr before ingesting food, antacids, or vitamins. The nurse should instruct the client to take this medication with 240 mL (8 oz) water to minimize the risk of esophagitis. The nurse should instruct the client to sit or stand upright for 30 to 60 min after taking the medication to minimize the risk of esophagitis. Adverse effects of etidronate include abdominal cramps, nausea, and diarrhea, not constipation.

A nurse is preparing to administer an opioid agonist to a client who has acute pain. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? A. Urinary retention B. Tachypnea C. Hypertension D. Irritating cough

Urinary retention *Monitor for urinary retention because morphine can suppress awareness that the bladder is full.. Monitor for respiratory depression because the activation of mu receptors has an effect on respirations. Monitor for hypotension because opioid medications can lower blood pressure by dilating peripheral arterioles and veins. Administer an opioid medication to suppress a cough because opioid receptors affect the medulla

A nurse is collecting data from a client who reports taking aspirin about four times daily for a sprained wrist. Which of the following prescribed medications taken by the client is contraindicated with aspirin? A. Digoxin B. Metformin C. Warfarin D. Nitroglycerin

Warfarin *The effect of warfarin and other anticoagulants is increased by aspirin, which inhibits platelet aggregation. This client would have an increased risk for bleeding. Use of aspirin generally is contraindicated for clients who take warfarin.

A nurse is caring for a client who is postoperative and receiving morphine. Which of the following actions should the nurse take? A. Monitor for seizures and confusion with repeated doses B. Protect the client's skin from the severe diarrhea that occurs with morphine C. Withhold this medication if respiratory rate is less than 12/min D. Give morphine intermittent via IV bolus over 30 seconds or less

Withhold this medication if respiratory rate is less than 12/min *When administering repeated doses of meperidine, a toxic metabolite can build up and cause severe CNS effects (agitation, confusion, and seizures). Plan to monitor for constipation because morphine affects the mu opioid receptors in the GI tract. Withhold all opioids if the respiratory rate is 12/min or less, and notify the charge nurse and provider. Administer morphine IV bolus slowly over 3 to 5 min to determine the client's response, and monitor the respiratory rate and blood pressure